Nursing Assessment: Reproductive System
MULTIPLE CHOICE
1. Which question should the nurse ask when assessing a patient who has a
history of benign prostatic hyperplasia (BPH)?
a. Have you noticed any unusual discharge from your penis?
b. Has there been any change in your sex life in the last year?
c. Has there been a decrease in the force of your urinary stream?
d. Have you been experiencing any difficulty in achieving an erection?
ANS: C
Enlargement of the prostate blocks the urethra, leading to urinary changes such
as a decrease in the force of the urinary stream. The other questions address
possible problems with infection or sexual difficulties, but would not be helpful in
determining whether there were functional changes caused by BPH.
DIF: Cognitive Level: Application REF: 1296
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
2. After a patient has been treated for pelvic inflammatory disease, the nurse
will plan to implement teaching about
a. irregularities in the menstrual cycle.
b. changes in secondary sex characteristics.
c. possible difficulty with becoming pregnant.
d. use of hormone replacement therapy (HRT).
ANS: C
Pelvic inflammatory disease may cause scarring of the fallopian tubes and result
in difficulty in fertilization or implantation of the fertilized egg. Because ovarian
function is not affected, the patient will not require HRT, have irregular
menstrual cycles, or experience changes in secondary sex characteristics.
DIF: Cognitive Level: Application REF: 1297-1298 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
3. While the nurse is assessing a 62-year-old man, the patient says that he does
not respond to sexual stimulation the way he did when he was younger. The
nurses best response to the patients comment is,
a. Many men need more sexual stimulation with aging.
b. Interest in sex frequently decreases as men get older.
c. Erectile dysfunction is a common problem with older men.
d. Tell me more about how your sexual response has changed.
ANS: D
The initial response by the nurse should be further assessment of the problem.
The other statements by the nurse are accurate but might not respond to the
patients concerns.
DIF: Cognitive Level: Application REF: 1294-1295 | 1298
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
4. When scheduling a pelvic examination and Pap test for a patient, the nurse
instructs the patient that she should
a. shower, but not take a tub bath, before the examination.
b. not have sexual intercourse the day before the Pap test.
c. plan to have the Pap test just after her menstrual period.
d. avoid douching for at least 24 hours before the examination.
ANS: D
The results of a Pap test may be affected by douching, and so the patient should
not douche before the examination. The exam may be scheduled without regard
to the menstrual period. The patient may shower or bathe before the
examination. Sexual intercourse does not affect the results of the examination
or Pap test.
DIF: Cognitive Level: Application REF: 1301-1304
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
5. A 19-year-old patient who is being assessed for amenorrhea at the clinic
makes all of the following statements to the nurse. Which one indicates a need
for patient teaching?
a. I run at least 8 miles every day to keep in shape.
b. I drink at least 3 glasses of non-fat milk every day.
c. I am not sexually active but currently I have an IUD [intrauterine device].
d. I was recently treated for a sexually transmitted disease.
ANS: A
Excessive exercise can cause amenorrhea. The other statements by the patient
do not suggest any urgent teaching needs.
DIF: Cognitive Level: Application REF: 1296
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and
Maintenance
6. When the nurse is assessing the sexual-reproductive functional health pattern
for a 34-year-old man, which question is most useful in determining the patients
sexual orientation and risk factors?
a. Do you have sex with men, women, or both?
b. Which gender do you prefer to have sex with?
c. What types of sexual activities do you prefer?
d. Are you heterosexual, homosexual, or bisexual?
ANS: A
This question is the most simply stated and will increase the likelihood of
obtaining the relevant information about sexual orientation and possible risk
factors associated with sexual activity. A patient who prefers intercourse with
women also may have intercourse at times with men. The types of sexual
activities engaged in may not indicate sexual orientation. Many patients who
have intercourse with both men and women do not identify themselves as
homosexual or bisexual.
DIF: Cognitive Level: Application REF: 1296-1298 | 1301-1304
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and
Maintenance
7. When preparing a patient for colposcopy with a cervical biopsy, the nurse
explains to the patient that the procedure
a. involves dilation of the cervix and biopsy of the tissue lining the uterus.
b.
will take place in a same-day surgery center so that local anesthesia can be
used.
c.
requires that the patient have nothing to eat or drink for 6 hours before the
procedure.
d.
is similar to a speculum examination of the cervix and should result in little
or no pain.
ANS: D
Colposcopy involves visualization of the cervix with a binocular microscope and
is similar to a speculum examination. A cervical biopsy may cause a minimal
amount of pain.
DIF: Cognitive Level: Application REF: 1301-1304
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
8. A couple who has not been able to conceive is scheduled for a Huhner test for
infertility. In preparation for the test, the nurse will instruct the couple about
a. possible shoulder pain after the procedure.
b. sedative medications used during the procedure.
c. ways to determine the estimated time of ovulation.
d. how long to refrain from intercourse before the test.
ANS: C
For the Huhner test, the couple should have intercourse at the estimated time of
conception and then arrive for the test 2 to 8 hours after intercourse. The other
instructions would be used for other types of fertility testing.
DIF: Cognitive Level: Application REF: 1301-1304
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
9. A patient in the sexually transmitted disease clinic has a positive Venereal
Disease Research Laboratory (VDRL) test, but no chancre is noted. The nurse
will plan to send specimens for
a. gram stain.
b. cytologic studies.
c. rapid plasma reagin (RPR) agglutination.
d. fluorescent treponemal antibody absorption (FTA-ABS).
ANS: D
Since false positives are common with VDRL and RPR testing, FTA-ABS testing is
recommended to confirm a diagnosis of syphilis. Gram staining is used for other
sexually transmitted diseases (STDs) such as gonorrhea and chlamydia and
cytologic studies are used to detect abnormal cells (such as neoplastic cells).
DIF: Cognitive Level: Application REF: 1300-1301 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
10. Which information about a 22-year-old who wants to start using oral
contraceptives is most important to report to the health care provider?
a. The patient quit smoking 6 months previously.
b. The patients blood pressure is 164/90 mm Hg.
c. The patient has not been vaccinated for rubella.
d. The patient has chronic iron-deficiency anemia.
ANS: B
Since hypertension increases the risk for morbidity and mortality in women
taking oral contraceptives, the patients blood pressure should be controlled
before oral contraceptives are prescribed. The other information also will be
reported but will not affect the choice of contraceptive.
DIF: Cognitive Level: Application REF: 1295
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and
Maintenance
11. A 42-year-old man who is taking the following medications tells the nurse
that he has had difficulty in achieving an erection. Which of the following
medications may cause erectile dysfunction (ED)?
a. atorvastatin (Lipitor) for hyperlipidemia
b. metformin (Glucophage) for type 2 diabetes
c. propranolol (Inderal) for high blood pressure
d. ranitidine (Zantac) for gastroesophageal reflux
ANS: C
Some antihypertensives may cause erectile dysfunction, and the nurse should
anticipate a change in antihypertensive therapy. The other medications will not
affect erectile function.
DIF: Cognitive Level: Application REF: 1295 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
12. A patient calls the clinic and tells the nurse, My menstrual period is very
heavy. I have to change my tampon every 4 hours. Which action should the
nurse take next?
a. Tell the patient that her flow is not unusually heavy.
b. Schedule the patient for an appointment later that day.
c. Ask the patient how heavy her usual menstrual flow is.
d. Have the patient call again if the heavy flow continues.
ANS: C
Because a heavy menstrual flow is usually indicated by saturating a pad or
tampon in 1 to 2 hours, the nurse should first assess how heavy the patients
usual flow is. There is no need to schedule the patient for an appointment that
day. The patient may need to call again, but this is not the first action that the
nurse should take. Telling the patient that she does not have a heavy flow
implies that the patients concern is not important.
DIF: Cognitive Level: Application REF: 1293
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and
Maintenance
13. A patient with a possible ovarian cyst is scheduled for ultrasound. The nurse
will teach the patient that she should
a. discontinue taking aspirin before the procedure.
b. receive IV contrast solution during the procedure.
c. expect mild abdominal cramps after the procedure.
d. drink several glasses of fluids before the procedure.
ANS: D
A full bladder is needed for many ultrasound procedures, so the nurse will have
the patient drink fluids before arriving for the ultrasound. The other instructions
are not accurate for this procedure.
DIF: Cognitive Level: Application REF: 1301-1304
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
14. A 52-year-old man is scheduled for an annual physical exam. The nurse will
plan to teach the patient about
a. increased risk for testicular cancer.
b. possible changes in erectile function.
c. normal decreases in testosterone level.
d. annual prostate specific antigen (PSA) testing.
ANS: D
PSA testing should be done annually for all men, starting at age 50. There is no
indication that the other patient teaching topics are appropriate for this patient.
DIF: Cognitive Level: Application REF: 1295-1296 TOP: Nursing Process: Planning
MSC: NCLEX: Health Promotion and Maintenance
15. A 22-year-old female patient who has been admitted to the emergency
department after an automobile accident is scheduled for abdominal x-rays.
Which information is most important to report to the health care provider before
the x-rays are obtained?
a. Abdominal pain
b. Positive hCG testing
c. Temperature 102.1 F (38.9 C)
d. Blood pressure 172/88 mm Hg
ANS: B
Positive hCG testing indicates that the patient is pregnant and that unnecessary
abdominal x-rays should be avoided. The other information also is important to
report, but it will not affect whether the x-rays should be done.
DIF: Cognitive Level: Application REF: 1299-1300
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
16. The following patients call the outpatient clinic. Which phone call should the
nurse return first?
a. A patient who has severe breast tenderness following a breast biopsy
b. A patient who has bloody discharge after a hysteroscopy earlier today
c.
A patient who is complaining of dyspnea after a pelvic computed
tomography (CT) with contrast
d. A patient who is experiencing shoulder pain after a laparoscopy yesterday
ANS: C
The patients dyspnea suggests a delayed reaction to the iodine dye used for the
CT scan. The other patients symptoms are not unusual after the procedures they
had done.
DIF: Cognitive Level: Analysis REF: 1301-1304
OBJ: Special Questions: Multiple Patients
TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care
Environment
17. A woman calls the clinic because she is having an unusually heavy
menstrual flow. She tells the nurse that she has saturated two tampons in the
past 2 hours. The nurse estimates that the amount of blood loss is
a. 10 to 20 mL.
b. 20 to 30 mL.
c. 30 to 40 mL.
d. 40 to 60 mL.
ANS: D
The average tampon absorbs 20 to 30 mL.
DIF: Cognitive Level: Comprehension REF: 1293
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
18. When performing a physical assessment on a male patient, the nurse
obtains this information. Which finding is most important to report to the health
care provider?
a. One testis hangs lower than the other.
b. Inguinal lymph nodes are nonpalpable.
c. Genital hair distribution is diamond shaped.
d. Clear penile discharge is present at the meatus.
ANS: D
Clear penile discharge may be indicative of a sexually transmitted disease
(STD). The other findings are normal and do not need to be reported.
Chapter 52: Nursing Management: Breast Disorders
MULTIPLE CHOICE
1. When teaching a 28-year-old patient about breast self-examination (BSE), the nurse will
instruct the patient that
a. BSE will reduce the risk of dying from breast cancer.
b. BSE should be done daily while taking a bath or shower.
c. annual mammograms should be scheduled in addition to BSE.
d. performing BSE right after the menstrual period will improve comfort.
ANS: D
Performing BSE at the end of the menstrual period will reduce the breast tenderness associated
with the procedure. The evidence is not clear that BSE reduces breast cancer mortality. BSE
should be done monthly. Annual mammograms are not routinely scheduled for women under age
40.
DIF: Cognitive Level: Application REF: 1306-1308
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
2. To determine the risk for breast cancer in a 52-year-old patient who has found a small lump in
her breast, which question is most pertinent for the nurse to ask?
a. Do you currently smoke cigarettes?
b. Have you ever had any breast injuries?
c. At what age did you start having menstrual periods?
d. Is there any family history of fibrocystic breast changes?
ANS: C
Early menarche and late menopause are risk factors for breast cancer because of the prolonged
exposure to estrogen that occurs. Cigarette smoking, breast trauma, and fibrocystic breast
changes are not associated with increased breast cancer risk.
DIF: Cognitive Level: Application REF: 1311
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
3. A patient with a small immobile breast lump is advised to have a fine needle aspiration (FNA)
biopsy. The nurse explains that an advantage to this procedure is that
a. FNA is done in the outpatient clinic, and results are available in 1 to 2 days.
b. only a small incision is needed, resulting in minimal breast pain and scarring.
c. if the biopsy results are negative, no further diagnostic testing will be needed.
d. FNA is guided by a mammogram, ensuring that cells are taken from the lesion.
ANS: A
FNA is done in outpatient settings and results are available in 24 to 48 hours. No incision is
needed. FNA may be guided by ultrasound, but not by mammogram. Since the immobility of the
breast lump suggests cancer, further testing will be done if the FNA is negative.
DIF: Cognitive Level: Application REF: 1308
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
4. When the nurse is assessing the breasts of a 31-year-old, which finding is most indicative of a
need for further evaluation?
a. Bilateral nodules that are tender with palpation
b. A nodule that is 1 cm in size, painless, and fixed
c. A lump that increases in size before the menstrual period
d. A lump that is small, mobile, and has a rubbery consistency
ANS: B
Painless and fixed lumps suggest breast cancer. The other findings are more suggestive of benign
processes such as fibrocystic breasts and fibroadenoma.
DIF: Cognitive Level: Application REF: 1309-1310
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
5. A 51-year-old woman at menopause is considering the use of hormone replacement therapy
(HRT) but is concerned about the risk of breast cancer. Which information will the nurse include
when discussing HRT with the patient?
a. HRT does not appear to increase the risk for breast cancer unless there are other risk factors.
b. HRT is a safe therapy for menopausal symptoms if there is no family history of BRCAgenes.
c.
She and her health care provider must weigh the benefits of HRT against the possible risks of
breast cancer.
d.
Alternative therapies with herbs and natural drugs are as effective as estrogen in relieving
menopausal symptoms.
ANS: C
Because HRT has been linked to increased risk for breast cancer, the patient and provider must
determine whether or not to use HRT. Breast cancer incidence is increased in women using HRT,
independent of other risk factors. HRT increases the risk for both nonBRCA-associated cancer
and BRCA-related cancers. Alternative therapies can be used but are not consistent in relieving
menopausal symptoms.
DIF: Cognitive Level: Application REF: 1311
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
6. A patient with stage II breast cancer tells the nurse, I need to decide about what type of surgery
to have, but I feel so overwhelmed that I cannot make any decisions yet! What do you think I
should do? Which response by the nurse is best?
a. I would have a lumpectomy, but you need to decide what is best for you.
b. Tell me what you understand about the surgical options that are available.
c. It would not be appropriate for me to make the decision about your health.
d. There is no need to make a decision rapidly; you have time to think about this.
ANS: B
This response indicates the nurses willingness to assist the patient with the decision-making
process without imposing the nurses values or opinions. Response B indicates that the nurse is
not willing to help the patient with the decision about treatment. Because treatment decisions for
breast cancer do need to be made relatively quickly, response C is not accurate. Since the nurses
values and situation are not the same as the patients, imposing the nurses opinions during this
emotionally vulnerable time is not appropriate.
DIF: Cognitive Level: Application REF: 1320
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
7. A patient at the clinic who has metastatic breast cancer has a new prescription for trastuzumab
(Herceptin). The nurse will plan to
a. have the patient schedule frequent eye examinations.
b. instruct the patient to call if she notices ankle swelling.
c. remind the patient that hot flashes may occur with the medication.
d. teach the patient about the need to monitor serum electrolyte levels.
ANS: B
Herceptin can lead to ventricular dysfunction, so the patient is taught to self-monitor for
symptoms of heart failure. There is no need to monitor serum electrolyte levels. Hot flashes or
changes in visual acuity may occur with tamoxifen, but not with trastuzumab.
DIF: Cognitive Level: Application REF: 1319-1320 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
8. The pathology report for a 42-year-old who has had a modified radical mastectomy identifies
the tumor as an estrogen-receptor positive adenocarcinoma. The nurse will plan on teaching the
patient about
a. estradiol (Estrace).
b. raloxifene (Evista).
c. tamoxifen (Nolvadex).
d. trastuzumab (Herceptin).
ANS: C
Tamoxifen is used for estrogen-dependent breast tumors in premenopausal women. Raloxifene is
used to prevent breast cancer, but it is not used postmastectomy to treat breast cancer. Estradiol
will increase the growth of estrogen-dependent tumors. Trastuzumab is used to treat tumors that
have the HER-2 receptor.
DIF: Cognitive Level: Application REF: 1318-1319 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
9. A patient returns to the surgical unit following a right modified radical mastectomy with
dissection of axillary lymph nodes. Which nursing action should be included in the plan of care?
a. Insist that the patient examine the surgical incision when the dressings are removed.
b. Teach the patient to use the ordered patient-controlled analgesia (PCA) every 10 minutes.
c. Post a sign at the bedside warning against blood pressures or venipunctures in the right arm.
d.
Obtain a permanent breast prosthesis for the patient before she is discharged from the
hospital.
ANS: C
The patient is at risk for lymphedema and infection if blood pressures or venipuncture are done
on the right arm. The patient is taught to use the PCA as needed for pain control rather than at a
set time. The nurse allows the patient to examine the incision and participate in care when the
patient feels ready. Permanent breast prostheses are usually obtained about 6 weeks after surgery.
DIF: Cognitive Level: Application REF: 1320-1323 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
10. After the nurse completes discharge teaching for a patient who has had a left modified radical
mastectomy and lymph node dissection, which statement by the patient indicates that teaching
has been successful?
a. I will need to use my right arm and to rest the left one.
b. I will avoid reaching over the stove with my left hand.
c. I will keep my left arm in a sling until the incision is healed.
d. I will stop the left arm exercises if moving the arm is painful.
ANS: B
The patient should avoid any activity that might injure the left arm, such as reaching over a
burner. If the left arm exercises are painful, analgesics should be used and the exercises
continued in order to restore strength and range of motion. The left arm should be elevated at or
above heart level and should be used to improve range of motion and function.
DIF: Cognitive Level: Application REF: 1320-1323 TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity
11. A patient has a saline breast implant inserted in the outpatient surgery area. Which instruction
will the nurse include in the discharge teaching?
a. Take aspirin every 4 hours to reduce inflammation.
b. Check wound drains for excessive blood or any foul odor.
c. Wear a loose-fitting bra to decrease irritation of the sutures.
d. Resume normal activities 2 to 3 days after the mammoplasty.
ANS: B
The patient should be taught drain care because the drains will be in place for 2 or 3 days after
surgery. Normal activities can be resumed after 2 to 3 weeks. A bra that provides good support is
typically ordered. Aspirin will decrease coagulation and is typically not given after surgery.
DIF: Cognitive Level: Application REF: 1326-1327
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
12. Which information will the nurse include when teaching a patient about the transverse rectus
abdominis musculocutaneous (TRAM) procedure?
a. Saline-filled implants are placed under the pectoral muscles.
b. Recovery from the TRAM surgery takes at least 6 to 8 weeks.
c. Muscle tissue is removed from the back and used to form a breast.
d. TRAM flap procedures may be done in outpatient surgery centers.
ANS: B
Patients take at least 6 to 8 weeks to recover from the TRAM surgery. Tissue from the abdomen
is used to reconstruct the breast. The TRAM procedure can take up to 8 hours and requires
postoperative hospitalization. Saline implants are used in mammoplasty.
DIF: Cognitive Level: Application REF: 1326
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
13. Which statement by a 52-year-old patient newly diagnosed with stage I breast cancer
indicates to the nurse that patient teaching may be needed?
a. There are several options available for treating the cancer.
b. I will probably need radiation to the breast after having the surgery.
c. I can probably have reconstructive surgery at the same time as a mastectomy.
d. Mastectomy will be the best choice to decrease the chance of cancer recurrence.
ANS: D
The survival rates with lumpectomy and radiation or modified radical mastectomy are
comparable. The other patient statements indicate a good understanding of stage I breast cancer
treatment.
DIF: Cognitive Level: Application REF: 1314-1316
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
14. When a patient is scheduled for stereotactic core biopsy of the breast, which information will
the nurse include in patient education?
a. A local anesthetic will be given before the biopsy specimen is obtained.
b. You will need to lie flat on your back and lie very still during the biopsy.
c. A thin needle will be inserted into the lump and aspirated to remove tissue.
d. You should not have anything to eat or drink for 6 hours before the procedure.
ANS: A
A local anesthetic is given before stereotactic biopsy. NPO status is not needed because no
sedative drugs are given. The patient is placed in the prone position. A biopsy gun is used to
obtain the specimens.
DIF: Cognitive Level: Application REF: 1308
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
15. A student nurse prepares a list of teaching topics for a patient with a new diagnosis of breast
cancer. Which topic indicates that the student needs more education about breast cancer
diagnostic testing?
a. CA 15-3 level testing
b. HER-2 receptor testing
c. Estrogen receptor testing
d. Oncotype DX assay testing
ANS: A
Tumor markers such as CA 15-3 are used to monitor response to treatment for breast cancer, not
to detect or diagnose breast cancer. The other tests are likely to be used for additional diagnostic
testing in a patient with breast cancer.
DIF: Cognitive Level: Application REF: 1312-1314 TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
16. After a patient is diagnosed with lobular carcinoma in situ (LCIS), the nurse will anticipate
that patient teaching may be needed about
a. lumpectomy.
b. lymphatic mapping.
c. MammaPrint testing.
d. tamoxifen (Nolvadex).
ANS: D
Tamoxifen is used as a chemopreventive therapy in some patients with LCIS. The other
diagnostic tests and therapies are not needed because LCIS does not usually require treatment.
DIF: Cognitive Level: Application REF: 1312-1313 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
17. Following a lumpectomy, a patient is scheduled for external beam radiation to the right
breast. Which information should the nurse include in patient teaching?
a. The radiation therapy will take a week to complete.
b. Careful skin care in the radiated area will be necessary.
c. Visitors are restricted until the radiation therapy is completed.
d. Wigs may be used until the hair regrows after radiation therapy.
ANS: B
Skin care will be needed because of the damage caused to the skin by the radiation. External
beam radiation is done over a 5- to 6-week period. Hair loss does not occur with radiation
therapy. Since the patient does not have radioactive implants, no visitor restrictions are
necessary.
DIF: Cognitive Level: Application REF: 1314
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
18. After the nurse has completed teaching a patient who has breast cancer about the newly
prescribed tamoxifen (Nolvadex), which patient statement indicates that the teaching has been
effective?
a. I will expect to have leg cramps with this drug.
b. I will call the clinic if I develop any hot flashes.
c. I will be taking the medication for at least a year.
d. I will call immediately if I have any eye problems.
ANS: D
Retinopathy, cataracts, and decreased visual acuity should be immediately reported because it is
likely that the tamoxifen will be discontinued or decreased. Tamoxifen treatment generally lasts
5 years. Hot flashes are an expected side effect of tamoxifen. Leg cramps may be a sign of deep
vein thrombosis, and the patient should immediately notify the health care provider if pain
occurs.
DIF: Cognitive Level: Application REF: 1316-1317 TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity
19. Which action should the nurse take first when caring for a patient who has been admitted for
lumpectomy and axillary lymph node dissection?
a. Teach the patient how to deep breathe and cough.
b. Discuss options for postoperative pain management.
c. Explain the postdischarge care of the axillary drains.
d. Ask the patient to describe what she knows about the surgery.
ANS: D
Before teaching, the nurse should assess the patients current knowledge level. The other teaching
also may be appropriate, depending on the assessment findings.
DIF: Cognitive Level: Application REF: 1320-1323
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
20. When the nurse is working in the womens health care clinic, which of these actions is
appropriate to take?
a. Educate a healthy 36-year-old about the need for an annual mammogram.
b. Discuss the need for a clinical breast examination every year with a 22-year-old.
c. Talk about magnetic resonance imaging (MRI) with a 26-year-old with a BRCA-1mutation.
d. Teach an active 70-year-old that mammography frequency can be reduced to every 3 years.
ANS: C
MRI (in addition to mammography) is recommended for women who are at high risk for breast
cancer. A 22-year-old patient should have a clinical breast exam every 3 years. Annual
mammograms are recommended for women starting at age 40. Annual mammography is
recommended for healthy older women.
DIF: Cognitive Level: Application REF: 1305-1308 TOP: Nursing Process: Planning
MSC: NCLEX: Health Promotion and Maintenance
21. When the nurse is caring for a patient with left arm lymphedema, which action will be
included in the plan of care?
a. Check BP on both right and left arms.
b. Avoid isometric exercise on the left arm.
c. Assist with application of compression dressings.
d. Keep the left arm at or below the level of the heart.
ANS: C
Compression of the arm assists in improving lymphatic flow toward the heart. Isometric
exercises may be prescribed for lymphedema. BPs should only be done on the patients right arm.
The arm should not be placed in a dependent position.
DIF: Cognitive Level: Application REF: 1323 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
22. A 33-year-old who has a diagnosis of fibrocystic breast changes calls the nurse in the clinic
with these symptoms. Which is most important to report to the health care provider?
a. There is yellow-green discharge from one of the patients nipples.
b. There is an area on the breast that is hot, pink, and tender to touch.
c. The lumps are firm feeling and most are in the upper outer breast quadrants.
d. The lumps are larger and more painful before the patients menstrual period.
ANS: B
An area that is hot or pink suggests an infectious process such as mastitis, which would require
further assessment and treatment. The other information also will be reported, but these findings
are typical in fibrocystic breasts.
DIF: Cognitive Level: Application REF: 1309
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
23. During examination of a 67-year-old man, the nurse notes bilateral enlargement of the
breasts. Which action should the nurse take first?
a. Question the patient about any medications being currently used.
b. Teach the patient about how to palpate the breast tissue for lumps.
c. Refer the patient for mammography and biopsy of the breast tissue.
d. Explain that this is a temporary condition due to hormonal changes.
ANS: A
The first action should be further assessment. Since gynecomastia is a possible side effect of
drug therapy, asking about the current drug regimen is appropriate. The other actions may be
needed, depending on the data that are obtained with further assessment.
DIF: Cognitive Level: Application REF: 1310-1311
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
24. Which of the following nursing interventions for the patient who has had right-sided breast-
conservation surgery and an axillary lymph node dissection is appropriate to delegate to an
LPN/LVN?
a. Teaching the patient how to avoid injury to the right arm
b. Assessing the patients range of motion for the right arm
c. Administering an analgesic 30 minutes before the scheduled arm exercises
d. Evaluating the patients understanding of discharge instructions about drain care
ANS: C
LPN/LVN education and scope of practice include administration and evaluation of the effects of
analgesics. Assessment, teaching, and evaluation of a patients understanding of instructions are
more complex tasks that are more appropriate to RN level education and scope of practice.
DIF: Cognitive Level: Application REF: 1320-1324
OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
25. When the nurse is caring for a patient with breast cancer who is receiving chemotherapy with
doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan), which assessment finding is most
important to communicate to the health care provider?
a. The patients apical pulse is irregular.
b. The patient has complaints of fatigue.
c. The patient eats only 15% of food on meal tray.
d. The patients white blood cell (WBC) count is 5000/mm3.
ANS: A
Doxorubicin can cause cardiac toxicity; the dysrhythmia should be reported because it may
indicate a need for a change in therapy. Anorexia, fatigue, and a low-normal WBC count are
expected effects of chemotherapy.
Chapter 54: Nursing Management: Female Reproductive Problems
MULTIPLE CHOICE
1. A 33-year-old woman who uses oral contraceptives tells the nurse, I want to have children in a
few years. Which response by the nurse is appropriate?
a. You may have more difficulty becoming pregnant after about age 35.
b. You have many years of fertility left, so there is no rush to have children.
c.
You should plan to stop taking oral contraceptives several years before you want to become
pregnant.
d.
If you do not have children within the next few years, it will be very difficult for you to
become pregnant.
ANS: A
The probability of successfully becoming pregnant decreases after age 35, although some
patients may have no difficulty in becoming pregnant. Oral contraceptives do not need to be
withdrawn for several years for a woman to become pregnant. Although the patient may be
fertile for many years, it would be inaccurate to indicate that there is no concern about infertility
as she becomes older. Although the risk for infertility increases after age 35, not all patients have
difficulty in conceiving.
DIF: Cognitive Level: Application REF: 1345-1346
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
2. A couple is considering the possibility of in vitro fertilization (IVF). The woman tells the
nurse that they cannot afford IVF on her husbands salary, and the husband replies that if the wife
would get a job, they would have enough money. Which nursing diagnosis is appropriate?
a. Decisional conflict related to inadequate financial resources
b. Ineffective sexuality patterns related to psychological stress
c. Defensive coping related to anxiety about lack of conception
d. Ineffective denial related to frustration about continued infertility
ANS: C
The statements made by the couple are consistent with the diagnosis of defensive coping. No
data indicate that ineffective sexuality and ineffective denial are problems. Although the couple
is quarrelling about finances, the data do not provide information indicating that the finances are
inadequate.
DIF: Cognitive Level: Application REF: 1347 TOP: Nursing Process: Diagnosis
MSC: NCLEX: Psychosocial Integrity
3. A patient who is trying to become pregnant asks the nurse about ways to determine when she
is most likely to conceive. The nurse explains that
a. ovulation prediction kits provide accurate information about ovulation.
b. ovulation is difficult to predict unless she has regular menstrual periods.
c. she will need to bring a specimen of cervical mucus to the clinic for testing.
d. she should take her body temperature daily and have intercourse when it drops.
ANS: A
Ovulation prediction kits indicate when luteinizing hormone (LH) levels first rise. Ovulation
occurs about 28 to 36 hours after the first rise of LH. This information can be used to determine
the best time for intercourse. Body temperature rises at ovulation. Postcoital cervical smears are
used in infertility testing, but they do not predict the best time for conceiving and are not
obtained by the patient. Determination of the time of ovulation can be predicted by basal body
temperature charts or ovulation prediction kits and is not dependent on regular menstrual periods.
DIF: Cognitive Level: Application REF: 1346
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
4. A woman has an induced abortion with suction curettage at an ambulatory surgical center.
Which instructions will the nurse include when discharging the patient?
a. Heavy vaginal bleeding is expected for about 2 weeks.
b. You should abstain from sexual intercourse for 2 weeks.
c. Irregular menstrual periods are expected for the next few months.
d. Use of contraceptives should be avoided until your reexamination.
ANS: B
Because infection is a possible complication of this procedure, the patient is advised to avoid
intercourse until the reexamination in 2 weeks. Patients may be started on contraceptives on the
day of the procedure. The patient should call the doctor if heavy vaginal bleeding occurs. No
change in the regularity of the menstrual periods is expected.
DIF: Cognitive Level: Application REF: 1348-1349
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
5. A woman is scheduled for an induced abortion using instillation of hypertonic saline solution.
Before the procedure, which information will the nurse discuss with the patient?
a. The expulsion of the fetus may take up to a day or longer.
b. There is a possibility that the patient may deliver a live fetus.
c. The patient will require a general anesthetic for the procedure.
d. The procedure may be unsuccessful in terminating the pregnancy.
ANS: A
Uterine contractions take 12 to 36 hours to begin after the hypertonic saline is instilled. Because
the saline is feticidal, the nurse does not need to discuss any possibility of a live delivery or that
the pregnancy termination will not be successful. General anesthesia is not needed for this
procedure.
DIF: Cognitive Level: Application REF: 1348
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
6. A 31-year-old woman tells the nurse that she has noticed increasing headaches with dizziness,
abdominal bloating, and unexplained anxiety occurring before her menstrual periods. Which
action is best for the nurse to take at this time?
a. Ask the patient to write down her symptoms in a diary for 3 months.
b. Suggest that the patient try aerobic exercise to decrease her symptoms.
c.
Teach the patient about appropriate lifestyle changes to reduce premenstrual syndrome
(PMS) symptoms.
d.
Advise the patient to use nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
(Advil) to control symptoms.
ANS: A
The patients symptoms indicates possible PMS, but they also may be associated with other
diagnoses. Having the patient keep a symptom diary for 2 or 3 months will help in confirming a
diagnosis of PMS. The nurse should not implement interventions for PMS until a diagnosis is
made.
DIF: Cognitive Level: Application REF: 1349
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
7. When teaching a patient about ways to prevent primary dysmenorrhea, the nurse will suggest
that the patient
a. avoid aerobic exercise during her menstrual period.
b. use cold packs on the abdomen and back for pain relief.
c. talk with her health care provider about antidepressant therapy.
d.
start taking nonsteroidal antiinflammatory drugs (NSAIDs) regularly when her menstrual
period starts.
ANS: D
NSAIDs should be started as soon as the menstrual period begins and taken at regular intervals
during the usual time frame in which pain occurs. Aerobic exercise may help reduce symptoms.
Heat therapy, such as warm packs, is recommended for relief of pain. Antidepressant therapy is
not a typical treatment for dysmenorrhea.
DIF: Cognitive Level: Application REF: 1350
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
8. A 26-year-old who was admitted to the hospital with increasing abdominal pain is diagnosed
with an ectopic pregnancy. The patient begins to cry and asks the nurse to leave her alone to
grieve. Which action should the nurse take next?
a. Stay with the patient and encourage her to discuss her feelings.
b. Explain the reason for taking vital signs every 15 to 30 minutes.
c. Close the door to the patients room and minimize disturbances.
d. Provide teaching about options for termination of the pregnancy.
ANS: B
Because the patient is at risk for rupture of the fallopian tube and hemorrhage, frequent
monitoring of vital signs is needed. The patient has asked to be left alone, so staying with her and
encouraging her to discuss her feelings are inappropriate actions. Minimizing contact with her
and closing the door of the room is unsafe because of the risk for hemorrhage. Since the patient
has requested time to grieve, it would be inappropriate to provide teaching about options for
pregnancy termination.
DIF: Cognitive Level: Application REF: 1353-1354
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
9. When caring for a 60-year-old patient with persistent menorrhagia, the nurse will plan to
monitor the
a. estrogen level.
b. complete blood count (CBC).
c. gonadotropin-releasing hormone (GNRH) level.
d. serial b-human chorionic gonadotropin (hCG) results.
ANS: B
Because anemia is a likely complication of menorrhagia, the nurse will need to check the CBC.
Estrogen and GNRH levels are checked for patients with other problems, such as infertility.
Serialb-hCG levels are monitored in patients who may be pregnant, which is not likely for this
patient.
DIF: Cognitive Level: Application REF: 1349-1353 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
10. A 46-year-old woman tells the nurse that she has not had a menstrual period for 3 months and
asks whether she is going into menopause. The best response by the nurse is,
a. Have you thought about using hormone replacement therapy?
b. Most women feel a little depressed about entering menopause.
c. What was your menstrual pattern before your periods stopped?
d. Since you are in your mid-40s, it is likely that you are menopausal.
ANS: C
The initial response by the nurse should be to assess the patients baseline menstrual pattern.
Although many women do enter menopause in the mid-40s, more information about this patient
is needed before telling her that it is likely she is menopausal. Although hormone replacement
therapy (HRT) may be prescribed, further assessment of the patient is needed before discussing
therapies for menopause. Because the response to menopause is very individual, the nurse should
not assume that the patient is experiencing any adverse emotional reactions.
DIF: Cognitive Level: Application REF: 1354-1357
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
11. Which information will the nurse include when teaching a 51-year-old woman who is
considering the use of combined estrogen-progesterone hormone replacement therapy (HRT)
during menopause?
a. Use of estrogen-containing vaginal creams provides most of the same benefits as oral HRT.
b.
Use of HRT for up to 10 years to prevent symptoms such as hot flashes is generally
considered safe.
c.
HRT decreases osteoporosis risk and increases the risk for cardiovascular disease and breast
cancer.
d.
Increased incidence of colon cancer in women taking HRT requires frequent stool assessment
for occult blood.
ANS: C
Data from the Womens Health Initiative indicate an increased risk for cardiovascular disease and
breast cancer in women taking combination HRT but a decrease in hip fractures. Vaginal creams
decrease symptoms related to vaginal atrophy and dryness, but they do not offer the other
benefits of HRT, such as decreased hot flashes. Most women who use HRT are placed on short-
term treatment and are not treated for up to 10 years. The incidence of colon cancer decreases in
women taking HRT.
DIF: Cognitive Level: Application REF: 1354-1355
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
12. Six months after being sexually assaulted, a woman tells the nurse that she has nightmares
about the incident and develops acute anxiety if she finds herself alone in situations where
several men are present. The most appropriate nursing diagnosis for the patient is
a. anxiety related to effects of being raped.
b. sleep deprivation related to frightening dreams.
c. rape-trauma syndrome related to rape experience.
d. ineffective coping related to inability to resolve incident.
ANS: C
The patients symptoms are most consistent with the nursing diagnosis of rape-trauma syndrome.
The nursing diagnoses of sleep deprivation, ineffective coping, and anxiety address some aspects
of the patients symptoms but do not address the problem as completely as the rape-trauma
syndrome diagnosis.
DIF: Cognitive Level: Application REF: 1373 TOP: Nursing Process: Diagnosis
MSC: NCLEX: Psychosocial Integrity
13. A patient is diagnosed with vaginal candidiasis and an antifungal vaginal cream is prescribed.
Which statement by the patient indicates that the nurses teaching about the treatment plan has
been effective?
a. I will tell my husband that we cannot have sex for the next month.
b. I should clean carefully after each urination and bowel movement.
c. I can douche daily with warm water if the itching continues to bother me.
d. I will insert the cream using the applicator before I get up in the morning.
ANS: B
Cleaning of the perineal area will decrease itching caused by contact of the irritated tissues with
urine and reduce the chance of further infection of irritated tissues by bacteria in the stool.
Sexual intercourse should be avoided for 1 week. Douching will disrupt normal protective
mechanisms in the vagina. The cream should be used at night so that it will remain in the vagina
for longer.
DIF: Cognitive Level: Application REF: 1357 TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity
14. A 22-year-old woman who is scheduled for a Pap test tells the nurse that she has had
intercourse during the last year with several men. The nurse will plan to teach about the reason
for
a. contraceptive use.
b. antibiotic therapy.
c. chlamydia testing.
d. pregnancy testing.
ANS: C
Chlamydia testing is recommended annually for women with multiple sex partners. There is no
indication that the patient needs teaching about contraceptives, pregnancy testing, or antibiotic
therapy.
DIF: Cognitive Level: Application REF: 1358 TOP: Nursing Process: Planning
MSC: NCLEX: Health Promotion and Maintenance
15. When the nurse is caring for a patient with pelvic inflammatory disease (PID) requiring
hospitalization, which nursing intervention will be included in the plan of care?
a. Monitor liver function tests.
b. Use cold packs PRN for pelvic pain.
c. Teach the patient how to perform Kegel exercises.
d. Elevate the head of the bed to at least 30 degrees.
ANS: D
The head of the bed should be elevated to at least 30 degrees to promote drainage of the pelvic
cavity and prevent abscess formation higher in the abdomen. Although a possible complication
of PID is acute perihepatitis, liver function tests will remain normal. There is no indication for
increased fluid intake. Application of heat is used to reduce pain. Kegel exercises are not helpful
in PID.
DIF: Cognitive Level: Application REF: 1358-1359 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
16. A patient with pelvic inflammatory disease (PID) is treated on an outpatient basis with oral
antibiotics. Which instruction will be included in patient teaching?
a. Return for a follow-up appointment in 2 days.
b. Abdominal pain may persist for several weeks.
c. Sexual intercourse should be avoided for 1 week.
d. Nonsteroidal antiinflammatory drug (NSAID) use may prevent scarring of pelvic organs.
ANS: A
The patient is instructed to return for follow-up in 48 to 72 hours. The patient should abstain
from intercourse for 3 weeks. Abdominal pain should subside with effective antibiotic therapy.
Corticosteroids may help prevent inflammation and scarring, but NSAIDs will not decrease
scarring.
DIF: Cognitive Level: Application REF: 1358-1359
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
17. When a patient has oral contraceptives prescribed for endometriosis, the nurse will teach the
patient to
a. expect to experience side effects such as facial hair.
b. take the medication every day for the next 9 months.
c. use a second method of contraception to ensure that she will not become pregnant.
d. take calcium supplements to prevent osteoporosis from developing during therapy.
ANS: B
When oral contraceptives are prescribed to treat endometriosis, the patient should take the
medications continuously for 9 months. Facial hair is a side effect of synthetic androgens. The
patient does not need to use additional contraceptive methods. The hormones in oral
contraceptives will protect against osteoporosis.
DIF: Cognitive Level: Application REF: 1360
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
18. A patient with endometriosis is treated with medroxyprogesterone (Depo-Provera). The nurse
explains that this therapy
a. suppresses the menstrual cycle by mimicking pregnancy.
b. may cause symptoms such as vaginal atrophy and hot flashes.
c. is associated with loss of bone density and increased fracture risk.
d. will lead to permanent suppression of abnormal endometrial tissues.
ANS: A
Depo-Provera induces a pseudopregnancy, which suppresses ovulation and causes shrinkage of
endometrial tissue. Vaginal atrophy and hot flashes are caused by synthetic androgens such as
danazol or gonadotropin-releasing hormone agonists (GNRH) such as leuprolide. Although
hormonal therapies will control endometriosis while the therapy is used, endometriosis will recur
once the menstrual cycle is reestablished. Depo-Provera use is not associated with bone loss.
DIF: Cognitive Level: Comprehension REF: 1360
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
19. When caring for a patient recently diagnosed with polycystic ovary syndrome, it is most
important for the nurse to teach the patient
a. reasons for a total hysterectomy.
b. how to decrease facial hair growth.
c. ways to reduce the occurrence of acne.
d. methods to maintain appropriate weight.
ANS: D
Obesity exacerbates the problems associated with polycystic ovary syndrome, such as insulin
resistance and type 2 diabetes. The nurse also will address the problems of acne and hirsutism,
but these symptoms are lower priority because they do not have long-term health consequences.
Although some patients do require total hysterectomy, this is usually performed only after other
therapies have been unsuccessful.
DIF: Cognitive Level: Application REF: 1362-1363
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
20. A 58-year-old woman calls the health clinic when she has a moderate amount of vaginal
bleeding after 6 years of menopause. The nurse will anticipate teaching the patient about
a. endometrial biopsy.
b. uterine balloon therapy.
c. laser endometrial ablation.
d. dilation and curettage (D&C).
ANS: A
A postmenopausal woman with vaginal bleeding should be evaluated for endometrial cancer, and
endometrial biopsy is the primary test for endometrial cancer. D&C will be needed only if the
biopsy does not provide sufficient information to make a diagnosis. Endometrial ablation and
balloon therapy are used to treat menorrhagia, which is unlikely in this patient.
DIF: Cognitive Level: Application REF: 1364 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
21. Stage III ovarian cancer is diagnosed in a 63-year-old woman. A nursing diagnosis that is
likely to be appropriate is
a. sexual dysfunction related to loss of vaginal sensation.
b. risk for infection related to impaired immune function.
c. situational low self-esteem related to guilt about delaying medical care.
d. anxiety related to cancer diagnosis and need to make treatment decisions.
ANS: D
The patient with stage III ovarian cancer is likely to be anxious about the poor prognosis and
about the need to make decisions about the multiple treatments that may be used. Decreased
vaginal sensation does not occur with ovarian cancer. The patient may develop immune
dysfunction when she receives chemotherapy, but she is not currently at risk. It is unlikely that
the patient has delayed seeking medical care because the symptoms of ovarian cancer are vague
and occur late in the course of the cancer.
DIF: Cognitive Level: Application REF: 1365-1366 TOP: Nursing Process: Diagnosis
MSC: NCLEX: Physiological Integrity
22. When caring for a patient who has a radium implant for treatment of cancer of the cervix, the
nurse will
a. maintain the patient on complete bed rest.
b. use gloves when changing the patients bed.
c. allow extra time for patient discussion of concerns.
d. flush the toilet several times after the patient voids.
ANS: A
To prevent displacement of the implant, absolute bed rest is required. Wearing of gloves when
changing linens and flushing the toilet several times are not necessary because the isotope is
confined to the implant. The nurse should spend minimal time in the patients room to avoid
exposure to radiation.
DIF: Cognitive Level: Application REF: 1363-1364
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
23. Which information about a 48-year-old patient indicates that the nurse will need to teach the
patient about endometrial biopsy?
a. The patient has had 6 full-term pregnancies.
b. The patient has 3 to 4 alcoholic drinks daily.
c. The patient has used various oral contraceptives since she was 20 years old.
d. The patient has a family history of hereditary nonpolyposis colorectal cancer.
ANS: D
Patients with a personal or familial history of hereditary nonpolyposis colorectal cancer are at
increased risk for endometrial cancer. Alcohol addiction does not increase this risk. Multiple
pregnancies and oral contraceptive use offer protection from endometrial cancer.
DIF: Cognitive Level: Application REF: 1363-1364
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
24. A 45-year-old patient is diagnosed with stage 0 cervical cancer using a punch biopsy. The
nurse will plan to teach the patient about
a. radiation.
b. conization.
c. chemotherapy.
d. radial hysterectomy.
ANS: B
Because the carcinoma is in situ, conization can be used for treatment. Radical hysterectomy,
chemotherapy, or radiation will not be needed.
DIF: Cognitive Level: Application REF: 1363-1364 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
25. Which topic will the nurse include in patient teaching for a 29-year-old patient who has been
diagnosed with human papilloma virus (HPV) infection and who smokes cigarettes, uses oral
contraceptives, and has a history of candidiasis?
a. Use of water soluble lubricants
b. Antifungal cream administration
c. Importance of smoking cessation
d. Possible difficulties with conception
ANS: C
Because smoking and HPV infection are both associated with increased cervical cancer risk, the
nurse should emphasize the importance of avoiding smoking. An HPV infection does not
decrease vaginal lubrication, decrease ability to conceive, or require the use of antifungal creams.
DIF: Cognitive Level: Application REF: 1362-1363 | 1368
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
26. A patient with multiple uterine leiomyomas is admitted for an abdominal hysterectomy.
Which topic will the nurse include in patient teaching?
a. Leg exercises and the purpose of frequent ambulation
b. Temporary decrease in vaginal sensation after surgery
c. Adverse effects of systemic chemotherapy or radiation
d. Symptoms caused by the sudden drop in estrogen level
ANS: A
Venous thromboembolism (VTE) is a potential complication after the surgery, and the nurse will
instruct the patient about ways to prevent it. Vaginal sensation is decreased after a vaginal
hysterectomy but not after abdominal hysterectomy. Leiomyomas are benign tumors, so
chemotherapy and radiation will not be prescribed. Because the patient will still have her ovaries,
the estrogen level will not decrease.
DIF: Cognitive Level: Application REF: 1368-1369
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
27. Which assessment finding for a patient who is on the surgical unit after a radical abdominal
hysterectomy is most important to report to the health care provider?
a. Decreased bowel sounds in all four abdominal quadrants
b. Urine output of 100 mL in the first 8 hours after surgery
c. One inch area of bloody drainage on the abdominal dressing
d. Complaints of abdominal pain at the incision site with coughing
ANS: B
The decreased urine output indicates possible low blood volume and further assessment is
needed to assess for possible internal bleeding. The other findings are not unusual after this
surgery.
DIF: Cognitive Level: Application REF: 1368-1369
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
28. A 56-year-old woman undergoes an anterior and posterior (A&P) colporrhaphy for repair of a
cystocele and rectocele. Which nursing action will be included in the postoperative care plan?
a. Teach the patient correct pessary use.
b. Perform indwelling catheter care daily.
c. Repack the vaginal wound daily with gauze.
d. Provide patient teaching about a high fiber diet.
ANS: B
The patient will have a retention catheter for several days after surgery to keep the bladder empty
and decrease strain on the suture. A pessary will not be needed after the surgery. Vaginal wound
packing is not usually used after an A&P repair. A low-residue diet will be ordered after posterior
colporrhaphy.
DIF: Cognitive Level: Application REF: 1371-1372 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
29. A 54-year-old woman tells the nurse that she is postmenopausal but has occasional spotting.
Which initial response by the nurse is most appropriate?
a. A frequent cause of spotting is endometrial cancer.
b. How long has it been since your last menstrual period?
c. Breakthrough bleeding is not unusual in women your age.
d. Are you using prescription hormone replacement therapy?
ANS: D
In postmenopausal women, a common cause of spotting is hormone replacement therapy (HRT).
Because breakthrough bleeding may be a sign of problems such as cancer or infection, the nurse
would not imply that this is normal. The length of time since the last menstrual period is not
relevant to the patients symptoms. Although endometrial cancer may cause spotting, this
information is not appropriate as an initial response.
DIF: Cognitive Level: Application REF: 1351-1352
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
30. An 18-year-old visits the health clinic for a routine check-up. To determine whether a Pap
test is needed, which question should the nurse ask?
a. Do you use any illegal substances?
b. Have you ever had sexual intercourse?
c. How old were you when your menstrual periods started?
d. Do you have any cramping with your menstrual periods?
ANS: B
The current American Cancer Society recommendation is that a Pap test be done every 3 years,
starting 3 years after the first sexual intercourse and no later than age 21. The information about
menstrual periods and substance abuse will not help to determine whether the patient requires a
Pap test.
DIF: Cognitive Level: Application REF: 1363
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
31. Which information will the nurse include when developing a patient teaching plan for a 48-
year-old patient with uterine bleeding caused by a leiomyoma?
a.
Aspirin or nonsteroidal antiinflammatory drugs (NSAIDs) may be used to control mild to
moderate pain.
b. The tumor size is likely to increase throughout the patients lifetime.
c. The symptoms may decrease after the patient undergoes menopause.
d. The patient will need frequent monitoring to detect any malignant changes.
ANS: C
Leiomyomas appear to depend on ovarian hormones and will atrophy after menopause, leading
to a decrease in symptoms. Aspirin use is discouraged because the antiplatelet effects may lead to
heavier uterine bleeding. The size of the tumor will shrink after menopause. Leiomyomas are
benign tumors that do not undergo malignant changes.
DIF: Cognitive Level: Application REF: 1361 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
32. A female patient who is seen in the health clinic is diagnosed with genital warts. The nurse
will plan to teach the patient about
a. the need for regular Pap tests.
b. increased risk for endometrial cancer.
c. appropriate use of oral contraceptives.
d. symptoms of pelvic inflammatory disease.
ANS: A
Genital warts are caused by the human papilloma virus (HPV) and increase the risk for cervical
cancer. There is no indication that the patient needs teaching about PID, oral contraceptives, or
endometrial cancer.
DIF: Cognitive Level: Application REF: 1362-1363 TOP: Nursing Process: Planning
MSC: NCLEX: Health Promotion and Maintenance
33. Which statement by a patient who has just been instructed in the treatment for a Chlamydia
trachomatis vaginal infection indicates that the nurses teaching has been effective?
a. I can purchase an over-the-counter medication to treat this infection.
b. The symptoms are due to the overgrowth of normal vaginal bacteria.
c. The medication will need to be inserted once daily with an applicator.
d. Both my partner and I will need to take the medication for a full week.
ANS: D
Chlamydia is a sexually transmitted bacterial infection that requires treatment of both partners
with antibiotics for 7 days. The other statements are true for the treatment of Candida
albicans infection.
DIF: Cognitive Level: Application REF: 1357 TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity
34. Which action by the nurse will be most important in maintaining the medicolegal chain of
evidence for a patient who has been sexually assaulted?
a. Label all specimens and materials obtained from the patient.
b. Educate the patient about the reason for baseline sexually transmitted disease (STD) testing.
c. Assist the patient in filling out the application for financial compensation.
d. Discuss the availability of the morning-after pill for pregnancy prevention.
ANS: A
All of the interventions are appropriate, but only the careful labeling of specimens and materials
will assist in maintaining the chain of evidence.
DIF: Cognitive Level: Application REF: 1373-1374
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
35. A 32-year-old patient has minor changes on her Pap test. Which action should the nurse take?
a. Teach the patient about colposcopy.
b. Teach the patient about punch biopsy.
c. Schedule another Pap test in 4 months.
d. Administer the human papilloma virus (HPV) vaccine.
ANS: C
Patients with minor changes on the Pap test can be followed with Pap tests every 4 to 6 months
because these changes may revert to normal. Punch biopsy or colposcopy may be used if the Pap
test shows more prominent changes. The HPV vaccine may reduce the risk for cervical cancer,
but it is recommended only for ages 9 through 26.
DIF: Cognitive Level: Application REF: 1363-1364
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
36. A 19-year-old requests a prescription for birth control pills to decrease abdominal cramping
and headaches during her menstrual periods. Which of these actions should the nurse take first?
a. Determine whether the patient is sexually active.
b.
Suggest that the patient use nonsteroidal antiinflammatory drugs (NSAIDs) for symptom
relief.
c. Take a personal and family health history from the patient.
d. Teach the patient about the side effects of oral contraceptives.
ANS: C
Oral contraceptives may be appropriate to control this patients symptoms, but the patients health
history may indicate contraindications to oral contraceptive use. Because the patient is requesting
contraceptives for management of dysmenorrhea, whether she is sexually active is irrelevant.
Since the patient is asking for birth control pills, responding that she should try NSAIDs is
nontherapeutic. The patient does not need teaching about oral contraceptive side effects at this
time.
DIF: Cognitive Level: Application REF: 1350
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Health Promotion and Maintenance
37. Which assessment finding in a woman who recently started taking hormone replacement
therapy (HRT) is most important for the nurse to report to the health care provider?
a. Breast tenderness
b. Weight gain of 3 lb
c. Intermittent spotting
d. Unilateral calf swelling
ANS: D
Unilateral calf swelling may indicate deep vein thrombosis caused by the changes in coagulation
associated with HRT and would indicate that the HRT should be discontinued. Breast tenderness,
weight gain, and intermittent spotting are common side effects of HRT and do not indicate a need
for a change in therapy.
DIF: Cognitive Level: Application REF: 1354-1355
OBJ: Special Questions: Prioritization TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity
38. After being sexually assaulted, a woman is brought to the emergency department by a friend.
The patient is confused and has a large laceration above the left eye. Which action should the
nurse take first?
a. Assess the patients neurologic status.
b. Assist the patient in removing her clothing.
c. Contact the sexual assault nurse examiner (SANE).
d. Ask the patient to describe what occurred during the assault.
ANS: A
The first priority is to treat urgent medical problems associated with the sexual assault. The
patients head injury may be associated with a head trauma such as a skull fracture or subdural
hematoma. Therefore her neurologic status should be assessed first. The other nursing actions
also are appropriate, but they are not as high in priority as assessment and treatment for acute
physiologic injury.
DIF: Cognitive Level: Application REF: 1372
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
39. A patient who has undergone a radical vulvectomy for vulvar carcinoma returns to the
medical-surgical unit after the surgery. The priority nursing diagnosis for the patient at this time
is
a. self-care deficit: bathing/hygiene related to pain and difficulty in moving.
b. risk for infection related to contamination of the wound with urine and stool.
c. imbalanced nutrition: less than body requirements related to low-residue diet.
d. risk for ineffective sexual pattern related to disfiguration caused by the surgery.
ANS: B
Complex and meticulous wound care is needed to prevent infection and delayed wound healing.
The other nursing diagnoses also may be appropriate for the patient but are not the highest
priority immediately after surgery.
DIF: Cognitive Level: Application REF: 1369-1370
OBJ: Special Questions: Prioritization TOP: Nursing Process: Diagnosis
MSC: NCLEX: Physiological Integrity
40. A patient who has a large cystocele has not voided since admission 8 hours previously.
Which action should the nurse take first?
a. Insert a straight catheter per the PRN order.
b. Encourage the patient to increase oral fluids.
c. Notify the health care provider of the inability to void.
d. Use an ultrasound scanner to check for urinary retention.
ANS: D
Since urinary retention is common with a large cystocele, the nurses first action should be to use
an ultrasound bladder scanner to check for the presence of urine in the bladder. The other actions
may be appropriate, depending on the findings with the bladder scanner.
DIF: Cognitive Level: Application REF: 1370-1371
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
41. A patient tells the nurse that she would like a prescription for oral contraceptives to control
her premenstrual dysphoric disorder (PMD-D) symptoms. Which patient information is most
important to communicate to the health care provider?
a. Chronic breast tenderness
b. Frequent abdominal bloating
c. History of migraine headaches
d. Previous spontaneous abortion
ANS: C
Oral contraceptives are contraindicated in patients with a history of migraine headaches. The
other patient information would not prevent the patient from receiving oral contraceptives.
DIF: Cognitive Level: Application REF: 1350
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
42. The nurse has just received change-of-shift report about the following four patients. Which
patient should be assessed first?
a. A patient with a possible ectopic pregnancy who is complaining of severe shoulder pain
b.
A patient in the fifteenth week of gestation who is experiencing uterine cramping and
spotting
c. A patient who has a radium implant in place to treat cervical cancer and is crying in her room
d.
A patient with ovarian cancer who is complaining of 5/10 pain after an abdominal
hysterectomy
ANS: A
The patient with the ectopic pregnancy has symptoms consistent with rupture and needs
immediate assessment for signs of hemorrhage and possible transfer to surgery. The other
patients also should be assessed as quickly as possible but do not have symptoms of life-
threatening complications.
DIF: Cognitive Level: Analysis REF: 1353
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Safe and Effective Care Environment
MULTIPLE RESPONSE
1. When counseling a healthy perimenopausal woman who prefers not to use hormone
replacement therapy (HRT), which nonhormonal therapies will the nurse suggest (select all that
apply)?
a. Reduce coffee intake.
b. Exercise several times a week.
c. Take black cohosh supplements.
d. Have a glass of wine in the evening.
e. Increase intake of dietary soy products.
ANS: A, B, C, E
Reduction in caffeine intake, use of black cohosh, increasing dietary soy intake, and exercising
three to four times weekly are recommended to reduce symptoms associated with menopause.
Alcohol intake in the evening may increase the sleep problems associated with menopause.
Chapter 55: Nursing Management: Male Reproductive Problems
MULTIPLE CHOICE
1. To determine the severity of the symptoms for a patient with benign prostatic hyperplasia
(BPH) the nurse will ask the patient about
a. blood in the urine.
b. lower back or hip pain.
c. erectile dysfunction (ED).
d. strength of the urinary stream.
ANS: D
The American Urological Association (AUA) Symptom Index for a patient with BPH asks
questions about the force and frequency of urination, nocturia, etc. Blood in the urine, ED, and
back or hip pain are not typical symptoms of BPH.
DIF: Cognitive Level: Application REF: 1377-1379
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
2. A patient who has been recently diagnosed with benign prostatic hyperplasia (BPH) tells the
nurse that he does not want to have a transurethral resection of the prostate (TURP) because he is
afraid it might affect his ability to have intercourse. Which action should the nurse take?
a. Offer reassurance that sperm production is not affected by TURP.
b. Discuss alternative methods of sexual expression besides intercourse.
c.
Provide education about the use of medications for erectile dysfunction (ED) occurring after
TURP.
d. Teach that ED is not a common complication following a TURP.
ANS: D
ED is not a concern with TURP, although retrograde ejaculation is likely and the nurse should
discuss this with the patient. Erectile function is not usually affected by a TURP, so the patient
will not need information about penile implants or reassurance that other forms of sexual
expression may be used. Because the patient has not asked about fertility, reassurance about
sperm production does not address his concerns.
DIF: Cognitive Level: Application REF: 1383-1384
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
3. The health care provider prescribes finasteride (Proscar) for a 56-year-old patient who has
benign prostatic hyperplasia (BPH). When teaching the patient about the drug, the nurse informs
him that
a. he should change position from lying to standing slowly to avoid dizziness.
b. his interest in sexual activity may decrease while he is taking the medication.
c. improvement in the obstructive symptoms should occur within about 2 weeks.
d. he will need to monitor his blood pressure frequently to assess for hypertension.
ANS: B
A decrease in libido is a side effect of finasteride because of the androgen suppression that
occurs with the drug. Although orthostatic hypotension may occur if the patient also is taking a
medication for erectile dysfunction (ED), it should not occur with finasteride alone.
Improvement in symptoms of obstruction takes about 6 months. The medication does not cause
hypertension.
DIF: Cognitive Level: Application REF: 1380
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
4. A patient has an enlarged prostate detected by digital rectal examination (DRE) and an
elevated prostate specific antigen (PSA) level. The nurse will anticipate that the patient will need
teaching about
a. cystourethroscopy.
b. uroflowmetry studies.
c. magnetic resonance imaging (MRI).
d. transrectal ultrasonography (TRUS).
ANS: D
In a patient with an abnormal DRE and elevated PSA, transrectal ultrasound is used to visualize
the prostate for biopsy. Uroflowmetry studies help determine the extent of urine blockage and
treatment, but there is no indication that this is a problem for this patient. Cystoscopy may be
used before prostatectomy but will not be done until after the TRUS and biopsy. MRI is used to
determine whether prostatic cancer has metastasized but would not be ordered at this stage of the
diagnostic process.
DIF: Cognitive Level: Application REF: 1380 | 1387-1388
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
5. When teaching a patient who is scheduled for a transurethral resection of the prostate (TURP)
about continuous bladder irrigation, which information will the nurse include?
a. Bladder irrigation decreases the risk of postoperative bleeding.
b. Hydration and urine output are maintained by bladder irrigation.
c. Bladder irrigation prevents obstruction of the catheter after surgery.
d. Antibiotics are infused on a continuous basis with bladder irrigation.
ANS: C
The purpose of bladder irrigation is to remove clots from the bladder and to prevent obstruction
of the catheter by clots. The irrigation does not decrease bleeding or improve hydration.
Antibiotics are given by the IV route, not through the bladder irrigation.
DIF: Cognitive Level: Comprehension REF: 1383-1385
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
6. A patient with symptomatic benign prostatic hyperplasia (BPH) is scheduled for
photovaporization of the prostate (PVP) at an outpatient surgical center. The nurse will plan to
teach the patient
a. how to care for an indwelling urinary catheter.
b. that the urine will appear bloody for several days.
c. about complications associated with urethral stenting.
d. that symptom improvement will occur in 2 to 3 weeks.
ANS: A
The patient will have an indwelling catheter for 24 to 48 hours and will need teaching about
catheter care. There is minimal bleeding with this procedure. Symptom improvement is almost
immediate after PVP. Stent placement is not included in the procedure.
DIF: Cognitive Level: Application REF: 1381-1382 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
7. A 51-year-old man is scheduled for an annual physical exam at the outpatient clinic. The nurse
will plan to teach the patient about the purpose of
a. urinalysis collection.
b. uroflowmetry studies.
c. prostate specific antigen (PSA) testing.
d. transrectal ultrasound scanning (TRUS).
ANS: C
An annual digital rectal exam (DRE) and PSA are recommended starting at age 50 for men who
have an average risk for prostate cancer. Urinalysis and uroflowmetry studies are done if patients
have symptoms of urinary tract infection or changes in the urinary stream. TRUS may be ordered
if the DRE or PSA are abnormal.
DIF: Cognitive Level: Application REF: 1380 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
8. A 64-year-old has a perineal radical prostatectomy for prostatic cancer. In the immediate
postoperative period, the nurse establishes the nursing diagnosis of risk for infection related to
a. urinary stasis.
b. urinary incontinence.
c. possible fecal contamination of the surgical wound.
d. placement of a suprapubic catheter into the bladder.
ANS: C
The perineal approach increases the risk for infection because the incision is located close to the
anus and contamination with feces is possible. Urinary stasis and incontinence do not occur
because the patient has a retention catheter in place for 1 to 2 weeks. A urethral catheter is used
after the surgery.
DIF: Cognitive Level: Application REF: 1388-1389 TOP: Nursing Process: Diagnosis
MSC: NCLEX: Physiological Integrity
9. Following a radical retropubic prostatectomy for prostate cancer, the patient is incontinent of
urine. The nurse will plan to teach the patient
a. to restrict oral fluid intake.
b. pelvic floor muscle exercises.
c. the use of belladonna and opium suppositories.
d. how to perform intermittent self-catheterization.
ANS: B
Pelvic floor muscle training (Kegel) exercises are recommended to strengthen the pelvic floor
muscles and improve urinary control. Belladonna and opium suppositories are used to reduce
bladder spasms after surgery. Intermittent self-catheterization may be taught before surgery if the
patient has urinary retention, but it will not be useful in reducing incontinence after surgery. The
patient should have a daily oral intake of 2 to 3 L.
DIF: Cognitive Level: Application REF: 1388-1389 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
10. Following discharge teaching for a patient who has had a transurethral resection of the
prostate (TURP) for benign prostatic hyperplasia (BPH), the nurse determines that additional
instruction is needed when the patient says,
a. I will avoid driving until I get approval from my doctor.
b. I should call the doctor if I have any incontinence at home.
c. I will increase fiber and fluids in my diet to prevent constipation.
d. I should continue to schedule yearly appointments for prostate exams.
ANS: B
Since incontinence is common for several weeks after a TURP, the patient does not need to call
the health care provider if this occurs. The other patient statements indicate that the patient has a
good understanding of post-TURP instructions.
DIF: Cognitive Level: Application REF: 1388-1389 TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity
11. Leuprolide (Lupron) is prescribed for a patient with cancer of the prostate. In teaching the
patient about this drug, the nurse informs the patient that side effects may include
a. dizziness.
b. hot flashes.
c. urinary incontinence.
d. increased infection risk.
ANS: B
Hot flashes may occur with decreased testosterone production. Dizziness may occur with the a-
blockers used for benign prostatic hyperplasia (BPH). Urinary incontinence may occur after
prostate surgery, but it is not an expected medication side effect. Risk for infection is increased in
patients receiving chemotherapy.
DIF: Cognitive Level: Comprehension REF: 1390
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
12. Which information will the nurse include when teaching a patient who has a diagnosis of
chronic prostatitis?
a. Ibuprofen (Motrin) should provide good pain control.
b. Prescribed antibiotics should be taken for 7 to 10 days.
c. Sexual intercourse and masturbation will help relieve symptoms.
d. Cold packs should be used every 4 hours to reduce inflammation.
ANS: C
Ejaculation helps drain the prostate and relieve pain. Warm baths are recommended to reduce
pain. Nonsteroidal antiinflammatory drugs (NSAIDs) are frequently prescribed but usually do
not offer adequate pain relief. Antibiotics for chronic prostatitis are taken for 4 to 12 weeks.
DIF: Cognitive Level: Application REF: 1393
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
13. A couple is seen at the infertility clinic because they have not been able to conceive. When
performing a focused examination to determine any possible causes for infertility, the nurse will
check the man for the presence of
a. hydrocele.
b. varicocele.
c. epididymitis.
d. paraphimosis.
ANS: B
Persistent varicoceles are commonly associated with infertility. Hydrocele, epididymitis, and
paraphimosis are not risk factors for infertility.
DIF: Cognitive Level: Comprehension REF: 1396
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
14. Which information will the nurse plan to include when teaching a 19-year-old to perform
testicular self-examination?
a. Testicular self-examination should be done in a warm area.
b. The only structure normally felt in the scrotal sac is the testis.
c. Testicular self-examination should be done at least every week.
d. Call the health care provider if one testis is larger than the other.
ANS: A
The testes will hang lower in the scrotum when the temperature is warm (e.g., during a shower),
and it will be easier to palpate. The epididymis is also normally palpable in the scrotum. One
testis is normally larger. The patient should perform testicular self-examination monthly.
DIF: Cognitive Level: Comprehension REF: 1397 TOP: Nursing Process: Planning
MSC: NCLEX: Health Promotion and Maintenance
15. A 32-year-old man who is being admitted for a unilateral orchiectomy for testicular cancer
does not talk to his wife and speaks to the nurse only to answer the admission questions. Which
action is best for the nurse to take?
a. Ask the patient if he has any questions or concerns about the diagnosis and treatment.
b. Document the patients lack of communication on the chart and continue preoperative care.
c. Assure the patients wife that concerns about sexual function are common with this diagnosis.
d.
Teach the patient and the wife that impotence is rarely a problem after unilateral
orchiectomy.
ANS: A
The initial action by the nurse should be assessment for any anxiety or questions about the
surgery or postoperative care. The nurse should address the patient, not the spouse, when
discussing the diagnosis and any possible concerns. Without further assessment of patient
concerns, the nurse should not offer education about complications after orchiectomy.
Documentation of the patients lack of interaction is not an adequate nursing action in this
situation.
DIF: Cognitive Level: Application REF: 1397
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
16. When performing discharge teaching for a patient who has undergone a vasectomy in the
health care providers office, the nurse instructs the patient that
a. he may have temporary erectile dysfunction (ED) because of postoperative swelling.
b. he should continue to use other methods of birth control for 6 weeks.
c. he should not have sexual intercourse until his 6-week follow-up visit.
d. he will notice a decrease in the appearance and volume of his ejaculate.
ANS: B
Because it takes about 6 weeks to evacuate sperm that are distal to the vasectomy site, the patient
should use contraception for 6 weeks. ED that occurs after vasectomy is psychologic in origin
and not related to postoperative swelling. The patient does not need to abstain from intercourse.
The appearance and volume of the ejaculate are not changed because sperm are a minor
component of the ejaculate.
DIF: Cognitive Level: Comprehension REF: 1398
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
17. A 46-year-old man who has erectile dysfunction (ED) tells the nurse that he decided to seek
treatment because his wife is losing patience with the situation. The most appropriate nursing
diagnosis for the patient is
a. ineffective role performance related to effects of ED.
b. anxiety related to inability to have sexual intercourse.
c. situational low self-esteem related to decrease in sexual activity.
d. ineffective sexuality patterns related to frequency of intercourse.
ANS: A
The patients statement indicates that the relationship with his wife is his primary concern.
Although anxiety, low self-esteem, and ineffective sexuality patterns also may be concerns, the
patient information suggests that addressing the role performance problem will lead to the best
outcome for this patient.
DIF: Cognitive Level: Application REF: 1399-1400 TOP: Nursing Process: Diagnosis
MSC: NCLEX: Psychosocial Integrity
18. A patient with benign prostatic hyperplasia (BPH) with mild obstruction tells the nurse, My
symptoms have gotten a lot worse this week. Which response by the nurse is most appropriate?
a. I will talk to the doctor about ordering a prostate specific antigen (PSA) test.
b. Have you been taking any over-the-counter (OTC) medications recently?
c.
Have you talked to the doctor about surgical procedures such as transurethral resection of the
prostate (TURP)?
d.
The prostate gland changes slightly in size from day to day, and this may be making your
symptoms worse.
ANS: B
Because the patients increase in symptoms has occurred abruptly, the nurse should ask about
OTC medications that might cause contraction of the smooth muscle in the prostate and worsen
obstruction. The prostate gland does not vary in size from day to day. A TURP may be needed,
but more assessment about possible reasons for the sudden symptom change is a more
appropriate first response by the nurse. PSA testing is done to differentiate BPH from prostatic
cancer.
DIF: Cognitive Level: Application REF: 1383
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
19. When obtaining a focused health history for a patient with possible testicular cancer, the
nurse will ask the patient about any history of
a. sexually transmitted disease (STD) infection.
b. testicular trauma.
c. testicular torsion.
d. undescended testicles.
ANS: D
Cryptorchidism is a risk factor for testicular cancer if it is not corrected before puberty. STD
infection, testicular torsion, and testicular trauma are risk factors for other testicular conditions
but not for testicular cancer.
DIF: Cognitive Level: Comprehension REF: 1395
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
20. When caring for a patient who has been diagnosed with orchitis, the nurse will plan to
provide teaching about
a. pain management.
b. emergency surgical repair.
c. aspiration of fluid from the scrotal sac.
d. application of warm packs to the scrotum.
ANS: A
Orchitis is very painful and effective pain management will be needed. The other therapies will
not be used to treat orchitis.
DIF: Cognitive Level: Application REF: 1395 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
21. A patient with benign prostatic hyperplasia (BPH) is admitted to the hospital with urinary
retention and new onset elevations in the blood urea nitrogen (BUN) and creatinine. Which of
these prescribed therapies should the nurse implement first?
a. Schedule an abdominal computed tomography (CT) scan.
b. Insert a urinary retention catheter.
c. Draw blood for a complete blood count.
d. Infuse normal saline at 50 mL/hr.
ANS: B
The patient data indicate that the patient may have acute renal failure caused by the BPH. The
initial therapy will be to insert a catheter. The other actions also are appropriate, but they can be
implemented after the acute urinary retention is resolved.
DIF: Cognitive Level: Application REF: 1378-1379
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
22. When reviewing patient laboratory results, the nurse in the clinic notes elevated prostate
specific antigen (PSA) levels in the following four patients. Which patients PSA result is most
important to report to the health care provider?
a. A 75-year-old who uses saw palmetto to treat benign prostatic hyperplasia (BPH)
b. A 38-year-old who is being treated for acute prostatitis
c. A 48-year-old whose father died of metastatic prostate cancer
d. A 52-year-old who goes on long bicycle rides every weekend
ANS: C
The family history and elevation of PSA in the 48-year-old indicate that further evaluation of the
patient for prostate cancer is needed. The elevations in PSA for the other patients are not unusual.
DIF: Cognitive Level: Application REF: 1387
OBJ: Special Questions: Multiple Patients
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
23. After a transurethral resection of the prostate (TURP), a patient with continuous bladder
irrigation complains of painful bladder spasms. The nurse observes a decrease in urine output
and clots in the urine. Which action should the nurse take first?
a. Increase the flow rate of the bladder irrigation.
b. Administer the prescribed IV morphine sulfate.
c. Give the patient the prescribed belladonna and opium suppository.
d. Manually instill and then withdraw 50 mL of saline into the catheter.
ANS: D
The assessment suggests that obstruction by a clot is causing the bladder spasms, and the nurses
first action should be to irrigate the catheter manually and to try to remove the clots. IV
morphine will not decrease the spasm, although pain may be reduced. Increasing the flow rate of
the irrigation will further distend the bladder and may increase spasms. The belladonna and
opium suppository will decrease bladder spasms but will not remove the obstructing blood clot.
DIF: Cognitive Level: Application REF: 1383-1384
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
24. A 22-year-old man tells the nurse at the health clinic that he has recently had some problems
with erectile dysfunction. When assessing for possible etiologic factors, which question should
the nurse ask first?
a. Are you using any recreational drugs or drinking a lot of alcohol?
b. Have you been experiencing an unusual amount of anxiety or stress?
c. Do you have any history of an erection that lasted for 6 hours or more?
d. Do you have any chronic cardiovascular or peripheral vascular disease?
ANS: A
A common etiologic factor for erectile dysfunction (ED) in younger men is use of recreational
drugs or alcohol. Stress, priapism, and cardiovascular illness also contribute to ED, but they are
not common etiologic factors in younger men.
DIF: Cognitive Level: Application REF: 1398
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
25. A 53-year-old man tells the nurse he has been having increasing problems with erectile
dysfunction (ED) for several years but is now interested in using Viagra (sildenafil). Which
action should the nurse take first?
a. Ask the patient about any prescription drugs he is taking.
b. Tell the patient that Viagra does not always work for ED.
c. Discuss the common adverse effects of erectogenic drugs.
d. Assure the patient that ED is commonly associated with aging.
ANS: A
Because some medications can cause ED and patients using nitrates should not take Viagra, the
nurse should first assess for prescription drug use. The nurse may want to teach the patient about
realistic expectations and adverse effects of Viagra therapy, but this should not be the first action.
Although ED does increase with aging, it may be secondary to medication use or cardiovascular
disease in a 53-year-old.
DIF: Cognitive Level: Application REF: 1399
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
26. The nurse working in a health clinic receives calls from all these patients. Which patient
should be seen by the health care provider first?
a. A 44-year-old man who has perineal pain and a temperature of 100.4 F
b. A 66-year-old man who has a painful erection that has lasted over 7 hours
c.
A 62-year-old man who has light pink urine after having a transurethral resection of the
prostate (TURP) 3 days ago
d. A 23-year-old man who states he had difficulty maintaining an erection last night
ANS: B
Priapism can cause complications such as necrosis or hydronephrosis, and this patient should be
treated immediately. The other patients do not require immediate action to prevent serious
complications.
DIF: Cognitive Level: Analysis REF: 1394
OBJ: Special Questions: Multiple Patients
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
27. Which assessment information about a 62-year-old man is most important for the nurse to
report to the health care provider when the patient is asking for a prescription for testosterone
replacement therapy?
a. The patients symptoms have increased steadily over the last few years.
b. The patient has been using sildenafil (Viagra) several times every week.
c. The patient has had a gradual decrease in the force of his urinary stream.
d. The patient states that he has noticed a decrease in energy level for a few years.
ANS: C
The decrease in urinary stream may indicate benign prostatic hyperplasia (BPH) or prostate
cancer, which are contraindications to the use of testosterone replacement therapy (TRT). The
other patient data indicate that TRT may be a helpful therapy for the patient.
