Test Bank – Guidelines for Nurse Practitioner in Gynecologic Setting (4) – 2017

1. Early postpartum hemorrhage is defined as a blood loss greater than:

a. 500 mL within 24 hours after a vaginal birth.
b. 750 mL within 24 hours after a vaginal birth.
c. 1000 mL within 48 hours after a cesarean birth.
d. 1500 mL within 48 hours after a cesarean birth.
ANS: B
The average amount of bleeding after a vaginal birth is 500 mL. Early postpartum hemorrhage occurs in the first 24 hours, not 48 hours. Blood loss after a cesarean averages 1000 mL. Late postpartum hemorrhage is 48 hours and later.

2. The nurse expecting a uterine infection in a postpartum client should assess the:
a. episiotomy site.
b. odor of the lochia.
c. abdomen for distention.
d. pulse and blood pressure.
ANS: B
An abnormal odor of the lochia indicates infection in the uterus. The infection may move to the episiotomy site if proper hygiene is not followed. The abdomen becomes distended usually because of a decrease of peristalsis, such as after cesarean section. The pulse may be altered with an infection, but the odor of the lochia will be an earlier sign and will be more specific.

3. A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests:
a. uterine atony.
b. perineal hematoma.
c. infection of the uterus.
d. lacerations of the genital tract.
ANS: D
Undetected lacerations will bleed slowly and continuously. Bleeding from lacerations is uncontrolled by uterine contraction. The fundus would not be firm with uterine atony. A hematoma would be internal. Swelling and discoloration would be noticed, but bright bleeding would not be. With an infection of the uterus, there would be an odor to the lochia and systemic symptoms such as fever and malaise.

4. A multiparous client is admitted to the postpartum unit after a rapid labor and birth of a 4000- g infant. Her fundus is boggy, lochia is heavy, and vital signs are unchanged. The nurse has the client void and massages her fundus, but the fundus remains difficult to find and the rubra lochia remains heavy. Which action should the nurse take next?
a. Recheck vital signs.
b. Insert a Foley catheter.
c. Notify the health care provider.
d. Continue to massage the fundus.

ANS: C
Treatment of excessive bleeding requires the collaboration of the health care provider and the nurses. Do not leave the client alone. The nurse should call the clinician while a second nurse rechecks the vital signs. The client has voided successfully, so a Foley catheter is not needed at this time. The uterine muscle can be overstimulated by massage, leading to uterine atony and rebound hemorrhage.

5. The priority nursing intervention when admitting a pregnant client who has experienced a bleeding episode in late pregnancy is to:
a. monitor uterine contractions.
b. assess fetal heart rate and maternal vital signs.
c. place clean disposable pads to collect any drainage.
d. perform a venipuncture for hemoglobin and hematocrit levels.
ANS: B
Assessment of the fetal heart rate (FHR) and maternal vital signs will assist the nurse in determining the degree of the blood loss and its effect on the client and fetus. Monitoring uterine contractions is important, but not the top priority. It is important to assess future bleeding, but the top priority is client and fetal well-being. The most important assessment is to check client and fetal well-being. The blood levels can be obtained later.
6. A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on which of the following?
a. Hemorrhage is the major concern.
b. She will be unable to conceive in the future.
c. Bed rest and analgesics are the recommended treatment.
d. A D&C will be performed to remove the products of conception.
ANS: A

Severe bleeding occurs if the fallopian tube ruptures. If the tube must be removed, her fertility will decrease but she will not be infertile. The recommended treatment is to remove the pregnancy before hemorrhaging. A D&C is done on the inside of the uterine cavity. The ectopic is located within the tubes.

1.When preparing a woman with suspected vulvar cancer for a biopsy, the nurse expects that the lesion would most likely be located at which area?

A) Labia majora Correct.

B) Labia minora

C)Clitoris

D)Prepuce

2. When describing the various types of reproductive tract cancers to a local womens group, which of the following would the nurse identify as the least common type?

A)Vulvar B)Vaginal Correct. C)Endometrial
D)Ovarian
3..When assessing a female client for the possibility of vulvar cancer, which of the following would the nurse most likely expect the client to report? (Select all that apply.)
A)Abnormal vaginal bleeding B)Persistent vulvar itching Correct. C)History of herpes simplex Correct.
D) Lesion on the cervix

E) Abnormal Pap smear

4.A nurse is reviewing the medical record of a woman diagnosed with vulvar cancer. Which of the following would the nurse identify as a risk factor for this cancer? (Select all that apply.)

A) Age under 40 years

B) HPV 16 exposure Correct. C)Monogamous sexual partner D)Hypertension Correct.
E)Diabetes Correct.
4) A nurse is assisting with the collection of a Pap smear. When collecting the specimen, which of the following is done first?

A) Insertion of the speculum B)Swabbing of the endocervix C)Spreading of the labia Correct.
D)Insertion of the cytobrush
5).An instructor is describing the development of cervical cancer to a group of students. The instructor determines that the teaching was successful when the students identify which area as most commonly involved?

A) Internal cervical os

B) Junction of the cervix and fundus C)Squamous-columnar junction Correct. D)External cervical os
6).A client is scheduled for cryosurgery to remove some abnormal tissue on the cervix. The nurse teaches the client about this treatment, explaining that the tissue will be removed by which method?

A) Freezing Correct.

B) Cutting C)Burning D)Irradiating

7. Which of the following is not a risk factor for developing uterine cancer?

Response:

being over age 50 being overweight
having high blood pressure having multiple sexual partners Feedback:

Having multiple sexual partners is not considered a risk factor for developing uterine cancer. Major risk factors for endometrial cancer include being overweight, being over 50, having high blood pressure, having diabetes, having a history of irregular periods and late onset of menopause.

8. Abnormal uterine bleeding may be caused by: Response:
benign fibroids

polyps, scar tissue, infection precancerous conditions
all of the above

Feedback:
Structural causes of abnormal uterine bleeding (AUB) include fibroids, polyps, scar tissue, infection and precancerous conditions. Irregular menstrual bleeding may also be caused by hormone-related conditions, including menopause and thyroid and adrenal gland conditions.

9. During a dilation and curettage (D&C), the opening of the cervix is dilated to allow an instrument to be passed through the cervix and into the uterine cavity to:

Response:
test any growths,decrease abnormal bleeding,check for signs of cancer,check for signs of cancer Feedback:
A D&C is a therapeutic procedure to remove any growths, alleviate abnormal uterine bleeding and check for signs of cancer. However, D&Cs stop abnormal bleeding only temporarily, usually for about three months, and then a woman typically resumes heavy periods.

10. Total abdominal hysterectomy involves:
A. removal of the fallopian tubes and the ovaries through the vagina
B. removal of the cervix and ovaries through an incision in the abdomen
C. removal of the uterus and part of the vagina through the vagina
D. removal of the uterus and cervix through an incision in the abdomen ANS D. Response:

Feedback:
A total hysterectomy involves the removal of the uterus and cervix. For the treatment of endometrial cancer, in addition to removal of the uterus and cervix, the fallopian tubes and ovaries are also usually taken out during a procedure called a bilateral salpingo-oophorectomy (BSO). The BSO is often done at the same time as a hysterectomy.

11.A radical hysterectomy differs from a total abdominal hysterectomy in that: Response:
the lymph nodes are left intact
the parametrial (structures next to the uterus) and paravaginal supporting structures are removed

Feedback:
A total hysterectomy involves removal of the whole uterus and cervix. A radical hysterectomy removes additional tissue surrounding the uterus the ovaries are left intact part of the urethra is rerouted

12, Which of these is the most crucial warning sign of uterine (endometrial) cancer?
A. Fever
B. Fatigue
C. Frequent nausea
D. Abnormal bleeding from the vagina
The correct answer is D. Abnormal bleeding from the vagina.
It’s present in most cases of endometrial cancer. Although endometrial cancer is more likely to develop after menopause, it can also develop around the time menopause begins, when a woman is still menstruating. A woman should not assume that any abnormal bleeding at this time is normal; she should check with her doctor. Other symptoms of endometrial cancer include difficult or painful urination, pain during intercourse, and pain in the pelvic area. These symptoms can be caused by cancer or other less serious conditions. Most often they are not cancer, but only a doctor can tell for sure.

13. Which of these puts a woman at risk for uterine cancer?
A. Older age
B. Multiple sex partners
C. Smoking
D. Lack of exercise
The correct answer is A. Older age.
Cancer of the uterus occurs mostly in women older than 50. Other risk factors for uterine cancer are:
14. What are some of the risks for developing Endometrial hyperplasia?
A. Hormone therepy
B. Obesity
C. Immunosuppresant drugs
D. Race

E. History of colorectal cancer
F. All of the above ANS. All of the above
Feedback: Hormone therapy. Women who use estrogen and progesterone have an increased risk for this cancer. Women using estrogen alone having the highest risk.
Obesity and related conditions. The body makes estrogen in fatty tissue, so obese women have higher estrogen levels, putting them at increased risk for cancer.
Tamoxifen. The risk appears to be linked to the estrogen-like effect of this medicine, which is used to prevent or treat breast cancer.
Race. White American women are at higher risk than African-American women. Colorectal cancer. Women who have an inherited form of this cancer have a higher risk of developing uterine cancer.

15) Which finding obtained during a client history would the nurse identify as increasing a clients risk for ovarian cancer?

A) Multiple sexual partners B)Consumption of a high-fat diet C)Underweight
D)Grand multiparity (more than five children)

16) The daughter of a woman who has been diagnosed with ovarian cancer asks the nurse about screening for this cancer. Which response by the nurse would be most appropriate?

A) Currently there is no reliable screening test for ovarian cancer.

B) A Pap smear is almost always helpful in identifying this type of cancer.

C) Theres a blood test for a marker, CA-125, that if elevated indicates cancer.

D) A genetic test for two genes, if positive, will identify the ovarian cancer.

17).Which of the following would the nurse be least likely to suggest when teaching a group of young women how to reduce their risk for ovarian cancer?

A) Pregnancy

B) Oral contraceptives

C) Feminine hygiene sprays

D) Breast-feeding

18. When describing the various types of reproductive tract cancers to a local womens group, which of the following would the nurse identify as the least common type?

A)Vulvar B)Vaginal C)Endometrial
D)Ovarian
19. The result of a twin pregnancy with normal development of one fetus and placenta & molar degeneration of the other ovum is called a:
a. Mole with co=existent fetus
b. Zygote
c. Mole with non-existent fetus
d. None of the above
Correct answer:
C. mole with co-existent fetus

1. Risk factor of trophoblastic disease:
A. Over 40
B. Low economic status
C. Previous molar pregnancy
D. Women living in far eastern countries
E. Diets deficient in protein and folic acid
F. 30 or younger ANS. A-E
20. Trophoblast are cells of the embryo that become , are cells that become , and are cells biopsied during CVS.
Correct answer:
• placenta, hCG
21. Select all that apply to the clinical findings of Trophoblastic Disease AKA Molar Pregnancies:
A. Hyperemesis gravidarum
B. enlargement of uterus
C. Grossly elevated hCG levels
D. Uterine bleeding in 1st trimester
E. Theca lutein cysts
F. Early onset of pre-eclampsia
G. Expulsion of vesicles

ANS. All of the above

1. If menopause occurs in a woman younger than _ years, it is considered to be premature. A 40
B 45

C 50
D 30
Explanation: ANS A

In the U.S., the average age of onset for “natural” menopause is 51. However, because of genetics, illness, or medical procedures, some women go through menopause before the age of
40. Menopause that occurs before this time – whether natural or induced – is known as “premature” menopause.

2. Which is NOT a usual symptom of menopause? A Hormone therapies (HT)
B Birth control pills
C Benzodiazepines
D A or B

B Back pain
The correct answer is:
Back pain Explanation:
Back pain is not a usual symptom of menopause. Typically menopause has three main types of symptoms: physical, emotional and sexual. Problems and symptoms can include hot flashes, night sweats, profuse sweating, difficulty sleeping, headaches, decreased bone density, moodiness, anxiety, forgetfulness and problems with concentration, and vaginal dryness.

3. The average age of menopause is:
A. 55
B. 60
C. 65
D. 75 Explanation:ANS 55

Although the average age for the onset of menopause is 51, there is no way to determine when a particular woman will have menopause. Most women will reach menopause between 45 and 55 years of age, although it may be earlier or even later in some women. Women tend to undergo menopause at an age similar to that of their mothers. The age at which a woman began menstruating is not related to the age at which she will reach menopause.

4. most characteristic symptom of menopause is: A Hot flashes
B It varies from woman to woman C Mood swings
D Vaginal dryness and painful intercourse

The correct answer is:It varies from woman to woman Explanation:

Symptoms of menopause vary among women. Some of the most common symptoms are hot flashes, vaginal dryness, and mood swings, but the extent to which women suffer from all of these is variable. Some women experience only minimal symptoms, while others may have severe and troublesome symptoms associated with menopause.

5. Menopause increases health risks such as… A Heart disease
B Sexually transmitted diseases C Osteoporosis
D A and C
The correct answer is:A and C Explanation:

Health risks associated with menopause include an increased risk for heart disease (the #1 cause of death for U.S. women) and bone density loss (osteoporosis). Estrogen offers some protection against both of these conditions, so when estrogen levels fall at menopause, the risk increases.

6. Women who are going through menopause should take:
A Hormone therapy
B Estrogen therapy
C Bioidentical hormone therapy
D It depends on the woman’s symptoms and medical history.
The correct answer is:It depends on the woman’s symptoms and medical history. Explanation:

Menopause is a part of life and is not a disease. Some women may wish to have treatment for bothersome symptoms, but not all women need treatment. A woman should discuss treatment options with her doctor if she desires to be treated for symptoms of menopause. Hormonal therapies are only one of the options available to treat the symptoms of menopause.

7. Which of the following are proven alternative therapies for menopause symptoms: A Black cohosh
B Plant estrogens
C Herbals
D None of the above
The correct answer is:None of the above Explanation:

There are no proven alternative remedies for menopause symptoms, although some small studies have suggested a benefit for certain preparations. These studies in general are not considered to be extensive or thorough enough to prove a benefit for any alternative therapies. Black cohosh (remifemin) is an herbal supplement that is believed to help reduce hot flashes. Black cohosh is not regulated by the U.S. Food and Drug Administration, so it is important to be careful about

the safety and purity of this and other herbal preparations. Plant estrogens (phytoestrogens) such as soy protein are another popular remedy for hot flashes even though data to show their effectiveness are limited. Inconclusive and conflicting studies indicate that other herbal preparations and supplements including, such as dong quai, red clover (Promensil), chasteberry (Vitex), yam cream, Chinese medicinal herbs, and evening primrose oil, should be avoided or if tried at all, taken with care under the supervision of a health care professional.

8. Which factors can affect the timing of menopause? A Surgical removal of the ovaries
B Chemotherapy and radiation C Medication
D Answers A & B

The correct answer is:Answers A & B Explanation:

Any time the ovaries are surgically removed (oophorectomy) in an ovulating woman, menopause will result immediately. Further, chemotherapy and radiation therapy for cancer can result in menopause if given to an ovulating woman. Whether or not this occurs depends upon the type and location of the cancer and the specific treatments given.

9. Hot flashes can last from a few minutes to a few hours. A True
B False

The correct answer is:False Explanation:

Hot flashes are usually very brief and last from 30 seconds to a few minutes. Flushing (reddened skin) can accompany the hot flashes. Sweating can also occur with hot flashes.

9. About 15%-28% of postmenopausal women can still bear children. A True
B False

The correct answer is:False Explanation:

When menopause occurs, the function of the ovaries ceases. The ovaries release the mature eggs that are available for fertilization during the normal menstrual cycle. When ovarian function stops, a woman does not have menstrual cycles and can no longer become pregnant.

10. Menopause increases a woman’s risk for depression. A True

B False
The correct answer is:True Explanation:

Changing hormone levels during menopause and midlife can increase the risk for depression in women. Emotional symptoms related to menopause can include anxiety, fears, and mood swings. Depression during perimenopause and menopause is treated similarly to depression that occurs at other times in life.

1.A nurse is reviewing the medical record of a client. Which of the following would lead the nurse to suspect that the client is experiencing polycystic ovarian syndrome? (Select all that apply..

A)Decreased androgen levels B)Elevated blood insulin levels C)Anovulation
D)Waist circumference of 32 inches E)Triglyceride level of 175 mg/dL
F) High-density lipoprotein level of 40 mg/dL ANS. B,C,E
2.A woman with polycystic ovary syndrome tells the nurse, I hate this disease. Just look at me! I have no hair on the front of my head but Ive got hair on my chin and upper lip. I dont feel like a woman anymore. Further assessment reveals breast atrophy and increased muscle mass. Which nursing diagnosis would most likely be a priority?

A) Situational low self-esteem related to masculinization effects of the disease
B) Social isolation related to feelings about appearance
C) Risk for suicide related to effects of condition and fluctuating hormone levels D)Ineffective peripheral tissue perfusion related to effects of disease on vasculature

ANS C.
3. Which data found on a clients health history would place her at risk for an ectopic pregnancy?
a. Ovarian cyst 2 years ago
b. Recurrent pelvic infections
c. Use of oral contraceptives for 5 years
d. Heavy menstrual flow of 4 days duration
ANS: B
Infection and subsequent scarring of the fallopian tubes prevent normal movement of the fertilized ovum into the uterus for implantation. Ovarian cysts do not cause scarring of the fallopian tubes. Oral contraceptives do not increase the risk for ectopic pregnancies. Heavy menstrual flow of 4 days duration will not cause scarring of the fallopian tubes, which is the main risk factor for ectopic pregnancies.

4.A nurse is reviewing the medical record of a client. Which of the following would lead the nurse to suspect that the client is experiencing polycystic ovarian syndrome? (Select all that apply..

A)Decreased androgen levels B)Elevated blood insulin levels C)Anovulation
D)Waist circumference of 32 inches E)Triglyceride level of 175 mg/dL
F)High-density lipoprotein level of 40 mg/dL ANS. BCE

5. A primary topic for health promotion for a 25-year-old woman with a history of polycystic ovary syndrome is (select the most important topic):
a. The adverse effects of cigarette smoking
b. The adverse effects of excessive alcohol consumption
c. Nutrition
d. Self-esteem issues
ANS: c
Women with PCOS are at higher risk for being obese. Obesity increases the womans risk for type 2 diabetes. Obesity and type 2 diabetes increase the womans risk for cardiovascular disease, hypertension, dyslipidemia, and metabolic syndrome. It is also important to talk about self- esteem issues related to hirsutism and the effects of smoking and drinking, but the long-term effects of obesity are a greater risk to a woman with PCOS.

7. Secondary amenorrhea results from (select all that apply):
a. Polycystic ovary syndrome
b. Diabetes
c. Metritis
d. Pregnancy
ANS: a, b, d

Nutritional disturbances such as anoxia and emotional distress can cause secondary amenorrhea.

MULTIPLE CHOICE
1. Syphilis is a complex disease that can lead to serious systemic illness and even death if left untreated. Which manifestation differentiates primary syphilis from secondary syphilis?
a. Fever, headache, and malaise
b. Widespread rash
c. Identified by serologic testing
d. Appearance of a chancre 2 months after infection
ANS: D
Primary syphilis is characterized by a primary lesion (the chancre), which appears 5 to 90 days after infection. The chancre begins as a painless papule at the site of inoculation and erodes to form a nontender, shallow, and clean ulcer several millimeters to centimeters in
size. Secondary syphilis occurs 6 weeks to 6 months after the appearance of the chancre and is characterized by a widespread maculopapular rash. The individual may also experience fever, headache, and malaise. Latentsyphilis are those infections that lack clinical manifestations; however, they are detected by serologic testing.
2. The human papillomavirus (HPV), also known as genital warts, affects 79 million Americans, with an estimated number of 14 million new infections each year. The highest rate of infection occurs in young women, ages 20 to 24 years. Prophylactic vaccination to prevent the HPV is now available. Which statement regarding this vaccine is inaccurate?
a. Only one vaccine for the HPV is available.
b. The vaccine is given in three doses over a 6-month period.
c. The vaccine is recommended for both boys and girls.
d. Ideally, the vaccine is administered before the first sexual contact.
ANS: A
Two vaccines for HPV are availableCervarix and Gardasiland other vaccines continue to be investigated. These vaccines protect against HPV types 6, 11, 16, and 18. They are most effective if administered before the first sexual contact. Recommendations are that vaccines be administered to 11- and 12-year-old girls and boys. The vaccine can be given to girls as young as 9 years of age and young women ages 13 to 26 years in three doses over a 6-month period.
3. Which sexually transmitted infection (STI) is the most commonly reported in American women?
a. Gonorrhea
b. Syphilis
c. Chlamydia
d. Candidiasis
ANS: C

Chlamydia is the most common and fastest spreading STI among American women, with an estimated 3 million new cases each year. Infection rates are two and a half times that of men. Gonorrhea is probably the oldest communicable disease in the United States and second toChlamydia in reported conditions. Syphilis is the earliest described STI. Candidiasis is a relatively common fungal infection.
4. The Centers for Disease Control and Prevention (CDC) recommends which therapy for the treatment of the HPV?
a. Miconazole ointment
b. Topical podofilox 0.5% solution or gel
c. Two doses of penicillin administered intramuscularly (IM)
d. Metronidazole by mouth
ANS: B
Available treatments are imiquimod, podophyllin, and podofilox. Miconazole ointment is used to treat athletes foot. Penicillin IM is used to treat syphilis. Metronidazole is used to treat bacterial vaginosis.
5. A client exhibits a thick, white, lumpy, cottage cheeselike discharge, along with white patches on her labia and in her vagina. She complains of intense pruritus. Which medication should the nurse practitioner order to treat this condition?
a. Fluconazole
b. Tetracycline
c. Clindamycin
d. Acyclovir
ANS: A
The client is experiencing a candidiasis infection. Fluconazole, metronidazole, and clotrimazole are the drugs of choice to treat this condition. Tetracycline is used to treat syphilis. Clindamycin is used to treat bacterial vaginosis. Acyclovir is used to treat genital herpes.

6. Which laboratory testing is used to detect the human immunodeficiency virus (HIV)?
a. HIV screening
b. HIV antibody testing
c. Cluster of differentiation 4 (CD4) counts
d. Cluster of differentiation 8 (CD8) counts
ANS: B
The screening tool used to detect HIV is the enzyme immunoassay, which tests for the presence of antibodies to the HIV. HIV-1 and HIV-2 antibody tests are used to confirm the diagnosis. To determine whether the HIV is present, the test performed must be able to detect antibodies to the virus, not the virus itself. CD4 counts are associated with the incidence of acquired immunodeficiency syndrome (AIDS) in HIV-infected individuals. CD8 counts are not performed to detect HIV.
7. Which condition is the most life-threatening virus to the fetus and neonate?
a. Hepatitis A virus (HAV)

b. Herpes simplex virus (HSV)
c. Hepatitis B virus (HBV)
d. Cytomegalovirus (CMV)
ANS: C
HBV is the most life-threatening viral condition to the fetus and neonate. HAV is not the most threatening to the fetus nor is HSV the most threatening to the neonate. Although serious, CMV isnot the most life-threatening viral condition to the fetus.
8. Which treatment regime would be most appropriate for a client who has been recently diagnosed with acute pelvic inflammatory disease (PID)?
a. Oral antiviral therapy
b. Bed rest in a semi-Fowler position
c. Antibiotic regimen continued until symptoms subside
d. Frequent pelvic examination to monitor the healing progress
ANS: B
The woman with acute PID should be on bed rest in a semi-Fowler position. Broad-spectrum antibiotics are used; antiviral therapy is ineffective. Antibiotics must be taken as prescribed, even if symptoms subside. Few pelvic examinations should be conducted during the acute phase of the disease.
9. On vaginal examination of a 30-year-old woman, the nurse documents the following findings: profuse, thin, grayish-white vaginal discharge with a fishy odor and complaints of pruritus. Based upon these findings, which condition would the nurse suspect?
a. Bacterial vaginosis
b. Candidiasis
c. Trichomoniasis
d. Gonorrhea
ANS: A
Most women with bacterial vaginosis complain of a characteristic fishy odor. The discharge is usually profuse, thin, and has a white, gray, or milky color. Some women may also experience mild irritation or pruritus. The discharge associated with candidiasis is thick, white, and lumpy and resembles cottage cheese. Trichomoniasis may be asymptomatic, but women commonly have a characteristic yellow-to-green, frothy, mucopurulent, copious, and malodorous discharge. Women with gonorrhea are often asymptomatic. Although they may have a purulent endocervical discharge, the discharge is usually minimal or absent.
10. Which viral sexually transmitted infection is characterized by a primary infection followed by recurrent episodes?
a. Herpes simplex virus 2 (HSV-2)
b. HPV
c. HIV
d. CMV
ANS: A

The initial HSV genital infection is characterized by multiple painful lesions, fever, chills, malaise, and severe dysuria; it may last 2 to 3 weeks. Recurrent episodes of the HSV infection commonly have only local symptoms that usually are less severe than those of the initial infection. With HPV infection, lesions are a chronic problem. The HIV is a retrovirus.
Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has entered the body. Severe depression of the cellular immune system associated with the HIV infection characterizes AIDS, which has no cure. In most adults, the onset of CMV infection is uncertain and asymptomatic. However, the disease may become a chronic, persistent infection.
11. The nurse should understand the process by which the HIV infection occurs. Once the virus has entered the body, what is the time frame for seroconversion to HIV positivity?
a. 6 to 10 days
b. 2 to 4 weeks
c. 6 to 12 weeks
d. 6 months
ANS: C
Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has entered the body. Both 6 to 10 days and 2 to 4 weeks are too short for seroconversion to HIV positivity to occur, and 6 months is too long.
12. A 25-year-old single woman comes to the gynecologists office for a follow-up visit related to her abnormal Papanicolaou (Pap) smear. The test revealed that the client has the HPV. The woman asks, What is that? Can you get rid of it? Which is the best response for the nurse to provide?
a. Its just a little lump on your cervix. We can just freeze it off.

b. HPV stands for human papillomavirus. It is a sexually transmitted infection that may lead to cervical cancer.
c. HPV is a type of early human immunodeficiency virus. You will die from this.
d. You probably caught this from your current boyfriend. He should get tested for this.
ANS: B
Informing the client about STIs and the risks involved with the HPV is important. The health care team has a duty to provide proper information to the client, including information related to STIs and the fact that although the HPV and HIV are both viruses that can be sexually transmitted, they are not the same virus. The onset of the HPV can be insidious. Often STIs go unnoticed. Abnormal bleeding is frequently the initial symptom. The client may have had the HPV before her current boyfriend. The nurse should make no deductions from this limited information.
13. Which STI does not respond well to antibiotic therapy?

a. Chlamydia
b. Gonorrhea
c. Genital herpes
d. Syphilis
ANS: C

Genital herpes is a chronic and recurring disease for which no known cure is available; therefore, it does not respond to antibiotics. Chlamydia is a bacterial infection that is treated with doxycycline or azithromycin. Gonorrhea is a bacterial infection that is treated with any of several antibiotics. Syphilis is a bacterial infection that is treated with penicillin.
14. Five different viruses (A, B, C, D, and E) account for almost all cases of hepatitis infections. Which statement regarding the various forms of hepatitis is most accurate?
a. Vaccine exists for hepatitis C virus (HCV) but not for HBV.
b. HAV is acquired by eating contaminated food or drinking polluted water.
c. HBV is less contagious than HIV.
d. Incidence of HCV is decreasing.
ANS: B
Contaminated milk and shellfish are common sources of infection for HAV. A vaccine exists for HBV but not for HCV. HBV is more contagious than HIV. The incidence of HCV is on the rise.
15. A 21-year-old client exhibits a greenish, copious, and malodorous discharge with vulvar irritation. A speculum examination and wet smear are performed. Which condition is this client most likely experiencing?
a. Bacterial vaginosis
b. Candidiasis
c. Yeast infection
d. Trichomoniasis
ANS: D
Although uncomfortable, a speculum examination is always performed and a wet smear obtained if the client exhibits symptoms of trichomoniasis. The presence of many white blood cell protozoa is a positive finding for trichomoniasis. A normal saline test is used to test for bacterial vaginosis. A potassium hydroxide preparation is used to test for candidiasis. Yeast infection is the common name for candidiasis, for which the test is a potassium hydroxide preparation.
16. An essential component of counseling women regarding safe sex practices includes a discussion regarding avoiding the exchange of body fluids. The most effective physical barrier promoted for the prevention of STIs and HIV is the condom. To educate the client about the use of condoms, which information related to condom use is the most important?
a. Strategies to enhance condom use
b. Choice of colors and special features
c. Leaving the decision up to the male partner
d. Places to carry condoms safely
ANS: A
When the nurse opens the discussion on safe-sex practices, it gives the woman permission to clear up any concerns or misapprehensions that she may have regarding condom use. The nurse can also suggest ways that the woman can enhance her condom negotiation and communications skills with a sexual partner. These include role-playing, rehearsal, cultural barriers, and situations that place the client at risk. Although women can be taught the differences among condoms, such as size ranges, where to purchase, and price, these features are not as important as negotiating the use of safe sex practices. Although not ideal, women may safely choose to carry condoms in

shoes, wallets, or inside their bra. They should be taught to keep the condom away from heat. Although this information is important, it is not relevant if the woman cannot even discuss strategies on how to enhance condom use.

17. Group B Streptococcus (GBS) is part of the normal vaginal flora in 20% to 30% of healthy pregnant women. GBS has been associated with poor pregnancy outcomes and is an important factor in neonatal morbidity and mortality. Which finding is not a risk factor for neonatal GBS infection?
a. Positive prenatal culture
b. Preterm birth at 37 weeks or less of gestation
c. Maternal temperature of 38 C or higher
d. Premature rupture of membranes (PROM) 24 hours or longer before the birth
ANS: D
PROM 18 hours or longer before the birth increases the risk for neonatal GBS infection. Positive prenatal culture is a risk factor for neonatal GBS infection. Preterm birth at 37 weeks or less of gestation remains a risk factor for neonatal GBS infection. Maternal temperature of 38 C or higher is also a risk factor for neonatal GBS infection.
18. Clients treated for syphilis with penicillin may experience a Jarisch-Herxheimer reaction. Which clinical presentation would be unlikely if a client is experiencing this reaction?
a. Vomiting and diarrhea
b. Headache, myalgias, and arthralgia
c. Preterm labor
d. Jarisch-Herxheimer in the first 24 hours after treatment
ANS: A
The Jarisch-Herxheimer reaction is an acute febrile reaction that occurs within the first 24 hours of treatment and is accompanied by headache, myalgias, and arthralgia. Vomiting and diarrhea are not anticipated. If the client is pregnant, then she is at risk for preterm labor and birth.
19. The health history and physical examination cannot reliably identify all persons infected with HIV or other blood-borne pathogens. Which infection control practice should the nurse use when providing eye prophylaxis to a term newborn?
a. Wear gloves.
b. Wear mouth, nose, and eye protection.
c. Wear a mask.
d. Wash the hands after medication administration.
ANS: A
Standard Precautions should be consistently used in the care of all persons. Personal protective equipment in the form of gloves should be worn during infant eye prophylaxis, care of the umbilical cord, circumcision site care, diaper changes, handling of colostrum, and parenteral procedures. Masks are worn during respiratory isolation or if the health care practitioner has a cough. Mouth, eye, and nose protection are used to protect the mucous membranes if client-care activities are likely to generate splashes or sprays of body fluids. The hands should be washed both before having contact with the client and after administering medications.

20. The nurse providing care in a womens health care setting must be knowledgeable about STIs. Which STIs can be successfully treated?
a. HSV
b. AIDS
c. Venereal warts
d. Chlamydia
ANS: D
The usual treatment for Chlamydia bacterial infection is doxycycline or azithromycin. Concurrent treatment of all sexual partners is needed to prevent recurrence. No known cure is available for HSV; therefore, the treatment focuses on pain relief and preventing secondary infections. Because no cure is known for AIDS, prevention and early detection are the primary focus of care management. HPV causes condylomata acuminata (venereal warts); no available treatment eradicates the virus.
21. What is the drug of choice for the treatment of gonorrhea?
a. Penicillin G
b. Tetracycline
c. Ceftriaxone
d. Acyclovir
ANS: C
Ceftriaxone is effective for the treatment of all gonococcal infections. Penicillin is used to treat syphilis. Tetracycline is prescribed for chlamydial infections. Acyclovir is used to treat herpes genitalis.
MULTIPLE RESPONSE
1. Which sexual behaviors are associated with exposure to an STI? (Select all that apply.)
a. Fellatio
b. Unprotected anal intercourse
c. Multiple sex partners
d. Dry kissing
e. Abstinence
ANS: A, B, C
Engaging in fellatio, unprotected anal intercourse, or having multiple sex partners increases the exposure risk and the possibility of acquiring an STI. Dry kissing and abstinence are considered safe sexual practices.
2. Which statements regarding the HPV are accurate? (Select all that apply.)
HPV infections:
a. are thought to be less common in pregnant women than in women who are not pregnant.

b. are thought to be more common in pregnant women than in women who are not pregnant.
c. were previously called genital warts.

d. were previously called herpes.
e. may cause cancer.
ANS: B, C, E
HPV infections are thought to be more common in pregnant women than in women who are not pregnant, with an increase in incidence from the first trimester to the third trimester. HPV, formerly called venereal or genital warts, is an STI with more than 30 known serotypes, several of which are associated with cervical cancer.

3. A 23-year-old primiparous client with inconsistent prenatal care is admitted to the hospitals maternity unit in labor. The client states that she has tested positive for the HIV. She has not undergone any treatment during her pregnancy. The nurse understands that the risk of perinatal transmission can be significantly decreased by a number of prophylactic interventions. Which interventions should be included in the plan of care?
a. Intrapartum treatment with antiviral medications
b. Cesarean birth
c. Postpartum treatment with antiviral medications
d. Avoidance of breastfeeding
e. Pneumococcal, HBV, and Haemophilus influenzae vaccine
ANS: A, B, D
The prophylactic measures of prenatal antiviral use, elective cesarean birth, and formula feeding reduce the transmission of the HIV to as low as 1% to 2%. The client who refuses a cesarean birth should be given intravenous antiviral therapy during labor. Ideally, medications should be given prenatally. Administration of antiviral drugs in the postpartum period will not reduce transmission to the infant. All women who are HIV positive should be encouraged to receive these immunizations. They will not reduce the risk of perinatal transmission.
4. A group of infections known collaboratively as TORCH infections are capable of crossing the placenta and causing serious prenatal effects on the fetus. Which infections are included in this group of organisms? (Select all that apply.)
a. Toxoplasmosis
b. Other infections
c. Roseola
d. Clostridium
e. Herpes simplex
ANS: A, B, E Toxoplasmosis, other infections, rubella virus, CMV, and HSV are collectively known as TORCH infections. Generally, all TORCH infections produce influenza-like symptoms in the mother; however, fetal effects are more serious.
5. The nurse should be familiar with the use of the five Ps as a tool for evaluating risk behaviors for STIs and the HIV. Which components would the nurse include in her use of the five Ps as an assessment tool? (Select all that apply.)
a. Number of partners
b. Level of physical activity

c. Prevention of pregnancy
d. Protection from STIs
e. Past history
ANS: A, C, D, E Level of physical activity is not a component of this assessment. The five Ps include partners,prevention of pregnancy, protection from STIs, understanding of
sexual practices, and past history.
6. Counseling and education are critical components of the nursing care of women with herpes infections. Clients should be taught to identify triggers that might result in a herpes attack. Which factors are possible triggers recurrence? (Select all that apply.)
a. Menstruation
b. Trauma
c. Febrile illness
d. Soap
e. Ultraviolet light

ANS: A, B, C, E Stress, menstruation, trauma, febrile illness, chronic illnesses, and ultraviolet light have all been found to trigger genital herpes. Women might elect to keep a diary of symptoms to help identify stressors. Lesions should be cleansed with saline or simple soap and water. Lesions can be kept dry by using a blow dryer, wearing cotton underwear, and wearing loose clothing. Tea bags or hydrogen peroxide might also be helpful.

1. Which action by the nurse prevents infection in the labor and birth area?

a. Using clean techniques for all procedures

b. Keeping underpads and linens as dry as possible
c. Cleaning secretions from the vaginal area by using a back to front motion
d. Performing vaginal examinations every hour while the client is in active labor

ANS: B
Bacterial growth prefers a moist, warm environment. Use an aseptic technique if membranes are not ruptured; use a sterile technique if membranes are ruptured. Vaginal drainage should be removed with a front to back motion to decrease fecal contamination. Vaginal examinations should be limited to decrease transmission of vaginal organisms into the uterine cavity.
2. A client with polyhydramnios was admitted to a labor-birth-recovery-postpartum (LDRP) suite. Her membranes rupture and the fluid is clear and odorless, but the fetal heart monitor indicates bradycardia and variable decelerations. Which action should be taken next?
a. Perform Leopold maneuvers.
b. Perform a vaginal examination.
c. Apply warm saline soaks to the vagina.
d. Place the client in a high Fowler position.

ANS: B
A prolapsed cord may not be visible but may be palpated on vaginal examination. The priority is to relieve pressure on the umbilical cord. Leopold maneuvers are not an appropriate action at this time. Moist towels retard cooling and drying of the prolapsed cord, but it is hoped the fetus will be delivered before this occurs. The high Fowler position will increase cord compression and decrease fetal oxygenation.
3. A client with polycystic ovarian syndrome (PCOS. is receiving oral contraceptives as part of her treatment plan. The nurse understands that the rationale for this therapy is to:

A) Restore menstrual regularity

B) Induce ovulation

C) Improve insulin uptake D)Alleviate hirsutism

ANS.A
4. After teaching a group of students about genital fistulas, the instructor determines that the teaching was successful when the students identify which of the following as a major cause?

A)Radiation therapy B)Congenital anomaly C)Female genital cutting
D)Bartholins gland abscess ANS. C