MULTIPLE CHOICE
1. The justification for the victimization of women very early in history was that:

a. Women were regarded as possessions
b. Women were the weaker sex
c. Control of women was necessary for protection
d. Women were created subordinate to men
ANS: A
Misogyny, patriarchy, devaluation of women, power imbalance, a view of women as property, gender-role stereotyping, and acceptance of aggressive male behaviors as appropriate contributed and continue to contribute to the subordinate status of women in many of the worlds societies.

Viewing women as the weaker sex is a cultural and modern stereotype that contributes to the victimization of women.
Control of women in order to protect them is another cultural and modern stereotype that contributes to the victimization of women.
Women having been created as subordinate to men is yet another example of a cultural stereotype that contributes to the victimization of women.

2. The primary theme of the feminist perspective on violence against women recognizes the:
a. Role of testosterone as the underlying cause of mens violent behavior
b. Basic human instinctual drive toward aggression
c. Dominance and coercive control over women by men
d. Cultural norm of violence in Western society
ANS: C
The contemporary social view of violence is derived from the feminist theory. With the primary theme of male dominance and coercive control, this view enhances our understanding of all forms of violence against women, including wife battering, stranger and acquaintance rape, incest, and sexual harassment in the workplace.
The role of testosterone as an underlying cause of mens violent behavior is not associated with the feminist perspective of violence against women.
The basic human instinctual drive toward aggression is not associated with the feminist perspective.
The cultural norm of violence in Western society is not associated with the feminist perspective regarding violence against women.
3. The nurse suspects that a client who comes to the maternity clinic for a pregnancy test is in an abusive relationship. The nurse includes the abuse assessment screen as part of the assessment. Although the woman was very emotional and hesitant in responding to the questions, verbally she denied abuse as being a problem. While waiting for the results of the pregnancy test, the nurse decides to teach the client about partner abuse anyway. The rationale for the nurses decision is that all women should be informed about:
a. The nurses ethical responsibility to protect clients
b. The cycle of violence, which continues and escalates over time once it begins
c. Womens legal right not to be controlled by men
d. The masochistic nature of women who stay in abusive relationships
ANS: B
Because of the cycle of violence and the loving respite phase, denial is a coping mechanism often used by battered women. During pregnancy the nurse should assess for abuse at each prenatal visit and on admission to labor.
Although the nurse may feel an ethical responsibility to protect the client, it is not the best rationale for the nurses behavior.
Although women have a right not to be controlled by men, it is not the reason the nurse should continue the teaching with this client.
The belief that women are masochistic is simply a myth.

4. The primary responsibility of the nurse who suspects or confirms any type of violence against a woman is:
a. Report the incident to legal authorities
b. Provide information to social services

c. Call a client advocate who can assist in the clients decision making about what action to take
d. Document the incident (or findings) accurately and concisely in the clients record
ANS: D
Documentation can be useful to women later in court if they choose to press charges.
Although many states have mandatory reporting laws, the primary responsibility of the nurse is to document the incident and findings.
Social services is called only if a child also is a victim of violence or had witnessed the violence. A client advocate usually is notified when legal action is to be taken or if the woman is seeking shelter. The nurse may assist in this endeavor, but it is not the first action to be taken.
5. Intimate partner violence (IPV) is seen in all races, ethnicities, religions, and socioeconomic backgrounds. Which statement is most accurate regarding the reporting of IPV in the United States?
a. Asian women report more IPV than do other minority groups.
b. Caucasian women report less IPV than do non-Caucasians.
c. Native-American women report IPV at a rate similar to other groups.
d. African-American women are less likely to report IPV than Caucasian women.
ANS: B
Caucasian women report less IPV than other ethnic groups.
Asian women report significantly less IPV than do other racial groups.
Native-American and Alaska Native women report significantly more IPV than do women of any other racial background.
African-American women tend to report violence at a slightly higher rate than Caucasian women.
6. Intervention for the sexual abuse survivor often is not attempted by maternity and womens health nurses because of the concern about increasing the distress of the woman and the lack of expertise in counseling. What initial intervention is appropriate and most important in facilitating the womans care?
a. Initiating a referral to an expert counselor
b. Setting limits on what the client discloses
c. Listening and encouraging therapeutic communication skills
d. Acknowledging the nurses discomfort to the client as an expression of empathy
ANS: C
The survivor needs support on many different levels, and a womens health nurse may be the first person to whom she relates her story. Therapeutic communication skills and listening are initial interventions.
Referring this client to a counselor is an appropriate measure but not the most important initial intervention.

A client should be allowed to disclose any information she feels the need to discuss. As a nurse you should provide a safe environment in which she can do so.
Either verbal or nonverbal shock and horror reactions from the nurse are particularly devastating. Professional demeanor and professional empathy are essential.
7. A young woman arrives at the emergency department and states that she thinks she has been raped. She is sobbing and expresses disbelief that this could happen because the man was her best friend. In an effort to calm the client in order to perform a thorough assessment and physical examination, the nurse acknowledges the clients fear and anxiety and tells her:

a. Rape is not limited to strangers and frequently occurs by someone who is known to the victim.
b. I would be very upset if my best friend did that to me; that is very unusual.
c. You must feel very betrayed. In what way do you think you might have led him on?

d. This does not sound like rape. Didnt you just change your mind about having sex after the fact?
ANS: A
Acquaintance rape involves individuals who know one another. Sexual assault occurs when the trust of a relationship is violated. Victims may be less prone to recognize what is happening to them because the dynamics are different from those of stranger rape.
It is not at all unusual for the victim to know and trust the perpetrator.
Stating that the woman might have led the man to attack her indicates that the sexual assault was somehow the victims fault. This type of mentality is not constructive. Nurses must first reflect on their own feelings and learn to be unbiased when dealing with victims. A statement of this type can be very psychologically damaging to the victim.
Nurses must display compassion by first believing what the victim states. The nurse is not responsible for deciphering the facts involving the victims claim.

8. The nurses best measure of evaluating care of a rape victim is that:
a. All legal evidence is preserved during the physical examination
b. The victim appreciates the legal information but decides not to pursue legal proceedings
c. The victim states that she is going to advocate against sexual violence
d. The victim leaves the health care facility without feeling revictimized
ANS: D
Nurses can assist clients through an examination that is as nontraumatic as possible with kindness, skill, and empathy. The initial care of the victim affects her recovery and decision to receive follow-up care.
Preservation of all legal evidence is very important; however, this may not be the best measure in terms of evaluating care of a rape victim.
Offering legal information is not the best measure of evaluating the care that this victim received. The victim may well decide not to pursue legal proceedings.
Advocating against sexual violence may be extremely therapeutic for the client after her initial recovery. This is not a measure of evaluating her care.

9. Proper documentation of the abuse as reported by the victim is a crucial role of the nurse. Evaluate the following data, which include information from the victim, and choose the best documentation by the nurse.
A 34-year-old Caucasian arrives at the emergency department with a black right eye; she also is bleeding from the left side of her head. She reports that her boyfriend has been abusing her physically. The nurse performs a history and physical examination and documents her findings.
a. Client alleges that her boyfriend beat her up.
b. Client reports that her boyfriend hit her in the eye and head.

c. Client is a 34-year-old Caucasian female. Presents with periorbital ecchymosis on right side. Laceration of left parietal area, 3 cm long with tissue bridging. Approximately 1 cm deep. Client states that her boyfriend threw a brick from 10 feet away, aiming at my head. The corner of the brick hit the left side of my head. She reports that he also hit me in the eye. Client indicates that the hit was with her boyfriends closed left fist.

d. Client presents with a black eye and a cut on the left side of her head. Reports being abused.
ANS: C
It is important to list the name of the abuser, if possible, because a defense strategy is to portray the victim as having more than one partner. Listing the name eliminates any confusion as to who the abuser was. In addition, using accurate medical terminology is crucial. If you are unsure of the proper descriptive terms to use in documentation, simply describe what you see without labeling the injury. Photographs should be taken.
Documenting only that the client states that her boyfriend beat her lacks specificity and important details related to the event. In addition, improper medical terminology is used. This type of documentation would be detrimental to the victims case if she were to pursue legal recourse against the abuser.
Documenting only that the client states that her boyfriend hit her in the eye and head lacks specificity and important details related to the event. In addition, improper medical terminology is used. This type of documentation would be detrimental to the victims case if she were to pursue legal recourse against the abuser.
Documenting only that the client reports being abused lacks specificity and important details related to the event. In addition, improper medical terminology is used. This type of documentation would be detrimental to the victims case if she were to pursue legal recourse against the abuser.
10. With regard to violence against women, intimate partner violence (IPV) nurses should be aware that:

a. Relationship violence usually consists of a single episode that the couple can put behind them
b. Violence often declines or ends with pregnancy
c. Economic coercion is considered part of IPV

d. Battered women generally are poorly educated and come from a deprived social background
ANS: C
Economic coercion accompanies physical assault and psychologic attacks.

IPV almost always follows an escalating pattern. It rarely ends with a single episode of violence. IPV often begins with and escalates during pregnancy. It may include both psychologic attacks and economic coercion.
Race, religion, social background, age, and education level are not significant factors in differentiating women at risk.
11. In 1979, Lenore Walker pioneered the cause of women as victims of violence when she published her book The Battered Woman. While Walker conducted her research she found a similar pattern of abuse among many of the women. This concept is now referred to as the Cycle of Violence. Which phase does not belong in this three-cycle pattern of violence?
a. Tension-building state
b. Frustration followed by violence
c. Acute battering incident
d. Kindness and contrite, loving behavior
ANS: B
Frustration followed by violence is not part of the Cycle of Violence.
Tension-building state is also known as phase I of the cycle. The batterer expresses dissatisfaction and hostility with violent outbursts. The woman senses anger and anxiously tries to placate him.
Acute battering incident is phase II of the cycle. It results in the mans uncontrollable discharge of tension toward the woman. Outbursts can last from several hours to several days and may involve kicking, punching, slapping, choking, burns, broken bones, and the use of weapons.
Sometimes referred to as the honeymoon, kindness and contrite, loving behavior is the third phase of the cycle. The batterer feels remorseful and apologizes profusely. He tries to help the woman and often showers her with gifts.
12. Nurses must remember that pregnancy is a time of risk for all women. Which condition is likely the biggest risk for the pregnant client?
a. Preeclampsia
b. Intimate partner violence (IPV)
c. Diabetes
d. Abnormal Pap test
ANS: B
The prevalence of IPV during pregnancy is estimated at 4% to 8% of all pregnant women. The risk for IPV and even IPV-related homicide is more common than all of the other pregnancy- related conditions.
Although preeclampsia poses a risk to the health of the pregnant client, it is less common than IPV.
Gestational diabetes continues to be a complication of pregnancy; however, it is less common than IPV during pregnancy.
Some women are at risk for an abnormal Pap screening during pregnancy. This finding is not as common as IPV.
MULTIPLE RESPONSE
1. The nurse who is evaluating the client for potential abuse should be aware that intimate partner violence includes (choose all that apply):

a. Physical abuse
b. Sexual abuse
c. Emotional abuse
d. Psychologic abuse
e. Economic abuse
ANS: A, B, C, D, E
Physical, sexual, emotional, psychologic, and economic abuse can be factors in intimate partner violence.
2. Common characteristics of a potential batterer include (choose all that apply):
a. High level of self-esteem
b. High frustration tolerance
c. Substance abuse problems
d. Excellent verbal skills
e. Personality disorders
ANS: C, E
Substance abuse and personality disorders are often seen in batterers.
Typically the batterer has low self-esteem. Batterers usually have a low frustration level (i.e., they lose their temper easily). Batterers characteristically have poor verbal skills and especially can have difficulty expressing their feelings.

3. Which nursing diagnosis would be most applicable for battered women? Choose all that apply.
a. Loss of trust
b. Ineffective family coping
c. Situational low self-esteem
d. Risk for self-directed violence
e. Enhanced communication
ANS: A, B, C, D
Loss of trust, ineffective family coping, situational low self-esteem, and risk for self-directed violence are potential nursing diagnoses associated with battered women.
A more appropriate nursing diagnosis for this client would be impaired communication.
4. A thorough abuse assessment screen should be done on all clients. This screen includes (choose all that apply):

a. Asking the client if she has ever been slapped, kicked, punched, or physically hurt by her partner
b. Asking the client if she is afraid of her partner
c. Asking the client if she has been forced to perform sexual acts
d. Diagramming the clients current injuries on a body map
e. Asking the client what she did wrong to elicit the abuse

ANS: A, B, C, D
Asking the client if she has been slapped, kicked, punched, or physically hurt by her partner, if she is afraid of her partner, or if she has been forced to perform sexual acts are questions that should be posed to all clients. If any physical injuries are present, they should be marked on a form that indicates their location on the body.
Implying that a client did something wrong can be very emotionally damaging. Many victims of violence are not aware that they are in an abusive relationship. They may not respond to questions about abuse. It is best to use general descriptive words, such as slap, kick, or punch to elicit information.

MULTIPLE CHOICE

1. Which contraceptive method provides protection against sexually transmitted diseases?

a. Oral contraceptives
b. Tubal ligation
c. Male or female condoms
d. Intrauterine device (IUD)
ANS: C
Because latex condoms provide the best protection available, they should be used during any potential exposure to a sexually transmitted disease. Only the barrier methods provide some protection from sexually transmitted diseases. A tubal ligation is considered a permanent

contraceptive method but does not offer any protection against sexually transmitted diseases. IUDs are inserted in the uterus but do not block or inhibit sexually transmitted diseases.

2. A nurse is leading a discussion regarding birth control measures. Which method is considered the most reliable method?
a. Coitus interruptus
b. Breastfeeding
c. Natural family planning
d. Intrauterine device
ANS: D
IUDs are 98% effective. Although coitus interruptus is considered 81% effective, it requires great control by the man and may be unsatisfying for both partners. Only women who breastfeed every 2 hours around the clock may avoid ovulation. Another method should be used when the frequency of breastfeeding decreases. Couples must be highly motivated to use natural family planning because they must abstain from sex for as much as half of their cycle. Errors in the forbidden time carry a very high risk of pregnancy.
3. Which client is a safe candidate for the use of oral contraceptives?
a. 39-year-old with a history of thrombophlebitis
b. 16-year-old with a benign liver tumor
c. 20-year-old who suspects she may be pregnant
d. 43-year-old who does not smoke cigarettes
ANS: D
Heavy cigarette smoking is a contraindication. Oral contraceptives are contraindicated with a history of thrombophlebitis. Liver tumors, benign or malignant, preclude the use of oral contraceptives. Pregnancy is a contraindication.
4. The role of the nurse in family planning is to:
a. refer the couple to a reliable physician.
b. decide on the best method for the couple.
c. advise couples on which contraceptive to use.
d. educate couples on the various methods of contraception.
ANS: D
The nurses role is to provide information to the couple so that they can make an informed decision about family planning. The nurse can help the couple; they do not need to be sent to a physician. The nurses role is to educate, not decide for the couple which is the best method or advise couples on which contraceptive to use.
5. Informed consent concerning contraceptive use is important because some of the methods:
a. may not be reliable.
b. require a surgical procedure to insert.
c. have potentially dangerous side effects.
d. are invasive procedures that require hospitalization.

ANS: C
It is important for couples to be aware of potential side effects so they can make an informed decision about the use of contraceptives. Some contraceptives are not reliable but the side effects are the reason for the informed consent. A written consent is required if it involves a surgical procedure. Some contraceptive procedures are invasive but do not require hospitalization.

6. Which contraceptive method should be contraindicated in a client with a history of toxic shock syndrome?
a. Condom
b. Spermicide
c. Cervical cap
d. Oral contraceptives
ANS: C
The cervical cap may increase the risk of toxic shock syndrome because it may be left in the vagina for a prolonged period. A condom is not contraindicated with a history of toxic shock syndrome. Spermicide is not contraindicated with a history of toxic shock syndrome. Oral contraceptives are not contraindicated with a history of toxic shock syndrome.

7. When instructing a client in the use of spermicidal foam or gel, it is important to include the information that:
a. effectiveness is about 85%.
b. douching should be avoided for at least 6 hours.
c. it should be inserted 1 to 2 hours before intercourse.
d. one application is effective for several hours.
ANS: B
Douching within 6 hours of intercourse would remove the spermicide and increase the risk of pregnancy. Effectiveness is only 29% when used alone. The spermicidal foam or gel should be inserted 15 minutes before intercourse. One application is effective for about 1 hour.
8. Which symptom in a client using oral contraceptives should be reported to the physician immediately?
a. 5-lb weight gain
b. Leg pain and edema
c. Decrease in menstrual flow
d. Increased pigmentation of the face
ANS: B
Oral contraceptives increase clotting factors, which place the woman at risk for thrombophlebitis. Leg pain and edema are symptoms of thrombophlebitis. A 5-lb weight gain can be expected. A decrease in menstrual flow is an expected finding. Increased pigmentation of the face is a common finding.
9. Which response by the nurse is most appropriate when a client asks, What contraceptive do you think I should use?

a. Ask your doctor. She will know what is best for you.
b. The male condom is probably the easiest for you to use.
c. Because you are younger than 40, you should use oral contraceptives.
d. I can discuss the various methods with you so you can decide what is best.
ANS: D
The nurse should provide the woman with all the necessary information to make an informed decision but should not make the decision for her. The nurse can educate the woman about contraception; she does not have to ask the doctor. The nurse should provide information about contraception, not tell her which one to choose. The nurse should educate the woman about different types of contraception, not make the choice for her.
10. When using the basal body temperature method of family planning, the woman should know that:
a. she will remain fertile for 5 days after ovulation.
b. she should take her temperature each night before going to bed.
c. her temperature will increase about 0.4 to 0.8 F after ovulation.
d. her temperature is normally lower during the second half of her cycle.
ANS: C
The basal body temperature will increase about 0.4 to 0.8 F when ovulation occurs. The woman is fertile for up to 18 days. She should take her temperature on rising in the morning. A womans temperature is usually higher in the second half of her cycle.

11. The major difference between the diaphragm and the cervical cap is that the diaphragm:
a. is more effective.
b. requires spermicide.
c. applies pressure on the urethra.
d. has no contribution to toxic shock syndrome.
ANS: C
The diaphragm is made to fit snugly in the vaginal area and contains a hard rim that may put pressure on the urethra. The cervical cap is smaller and fits around the cervix. The cervical cap is not more effective than a diaphragm. The diaphragm does not require spermicide. Both may contribute to toxic shock syndrome.
12. The client who has had an intrauterine device (IUD) inserted should be instructed to:
a. use a vinegar douche weekly for 4 weeks.
b. have the IUD replaced every 2 to 4 years.
c. check the placement of the string once a week for 4 weeks.
d. use another method of contraception for 2 weeks after insertion.
ANS: C
Checking the placement of the string is necessary to determine whether the IUD is still correctly positioned. If the string is shorter or longer than when checked previously, she should contact her physician. A vinegar douche weekly for 4 weeks is not required. An IUD can be left in place for

up to 10 years. A second method of contraception is not required after insertion of the IUD; it is effective immediately.
13. A male client asks, Why do I have to use another contraceptive? I had a vasectomy last week. The best response is:
a. A vasectomy is only 85% effective.
b. A vasectomy is not effective in all men.
c. Semen may contain sperm for 6 months following a vasectomy.
d. Complete sterilization doesnt occur until all sperm have left the system.
ANS: D
It may take a month or longer for all sperm to be removed from the system. During that time, an additional method of contraception must be used. A vasectomy is more than 85% effective.
Vasectomies have a high success rate but it may take 1 month for all the sperm to be removed from the system. After 1 month, all the sperm have usually been removed from the system.
14. A woman who has a successful career and a busy lifestyle will most likely look for which type of contraceptive?
a. Requires extensive education to use
b. Is the easiest and most convenient to use
c. Costs the least
d. Is permanent
ANS: B
A woman who has a busy life will probably have less time to devote to contraceptive use, so she needs something that is easy and convenient. Extra time for education would not be acceptable for this woman. Cost would probably not be a problem with this woman. There is no indication that a woman who has a successful career and a busy lifestyle wants it to be permanent, just easy.
15. The method of contraception that is considered the safest for women is a(n):
a. IUD.
b. diaphragm.
c. male condom.
d. oral contraceptive.
ANS: C
A male condom does not have any side effects or risk factors for the woman. Oral contraception, an IUD, and the diaphragm all have significant side effects or risk factors for the woman.

16. A client is 27 years old and delivered her first baby yesterday. She and her husband do not want to have another baby for at least 3 to 4 years. The best method of birth control to meet their needs is:
a. withdrawal.
b. fertility awareness method.
c. combination of condoms and foam.
d. vasectomy with a reversal in 3 years.

ANS: C
Of the methods listed, condoms and foam would be the best for this couple. Withdrawal is the least effective form of birth control. Fertility awareness is not that effective and an unwanted pregnancy could result. They want another child so a vasectomy with a reversal would not be an appropriate option.
17. The most appropriate statement for introducing the topic of family planning in the postpartum setting is:
a. What are your plans for future pregnancies?
b. Do you plan on being sexually active in the future?

c. Lets talk about birth control, because breastfeeding is not 100% effective for preventing pregnancy.

d. Here are some pamphlets on available methods of birth control. Ill come back later and discuss them with you.
ANS: A
Discussing future pregnancy plans opens the conversation to ways of preventing pregnancy from occurring before the woman is ready. Do you plan on being sexually active in the future? will only provide a yes or no answer and not allow for conversation. The family needs to be ready to talk about birth control; the effect of breastfeeding on birth control is applicable only to the woman. Pamphlets are not always the best form of teaching; the woman is usually too tired and overwhelmed to read.

18. In reviewing information related to the occurrence of pregnancies using a focus group discussion with women, concern was expressed that many of them had problems using their respective type of contraception and, as a result, became pregnant. Based on this information, the nurse would incorporate which of the following in a teaching plan for group members?
a. Provide information relative to product recalls of contraceptive devices.

b. Have the clients keep a contraceptive diary related to the consistency of using methods because it is apparent that they forgot to use their preferred method as directed.

c. Have the clients consider switching to a different form of contraception because the contraception did not prevent pregnancy for them.

d. Plan for assessing the clients knowledge related to the contraception methods and provide information to increase the knowledge base so that the effectiveness rate would improve.
ANS: D
A typical effectiveness rate refers to the occurrence of pregnancy while using contraception methods. If contraception is used correctly and consistently, pregnancy should not occur. A decreased effectiveness rate is associated with incorrect usage in terms of application or inconsistent use. Providing information relative to product recalls of contraceptive devices refers to an ideal effectiveness rate; the implication is that the contraception method, although used correctly, is at fault. There is no evidence to support this finding. Having the client keep a contraceptive diary does not address the primary concerns related to the typical effectiveness rate. Having the client switch methods may not be necessary because the primary focus is to determine the knowledge base and identify learning needs.

19. You are teaching a group of adolescents about myths and facts related to contraception. Which statement indicates that additional teaching is needed for this group with regard to contraception?

a. Adolescents are more likely to become pregnant even if they use available contraception methods correctly.
b. The withdrawal technique provides a higher likelihood that a teen will not get pregnant.
c. Pregnancy can occur in the presence or absence of orgasm.
d. Pregnancy can occur even if a teen is menstruating at the time of coitus.
ANS: B
The withdrawal technique does not decrease the likelihood of becoming pregnant for a teen because it is unreliable in application and, even without penetration, ejaculation can result in pregnancy. It is true that adolescents are more likely to become pregnant even if they correctly use available contraception methods, based on current clinical evidence, because they are more likely to have contraceptive failure in the context of decreased knowledge. It is also true that pregnancy can occur in the presence or absence of orgasm, and even if a teen is menstruating at the time of coitus.
20. A client presents to the Womens Health Clinic for continuation of her contraceptive method. She has been using Depo-Provera (medroxyprogesterone acetate) for 24 months. In preparation for instituting a plan of care, the nurse would consider which option as a priority?

a. Schedule the client for follow-up baseline diagnostic testing to confirm that the client is not pregnant.
b. Obtain information for an alternate contraception method.
c. Ask the client for additional information related to her menstrual cycle.
d. Inspect the skin for site selection of contraceptive method.
ANS: B
According to WHO (World Health Organization) guidelines, women should not be on Depo- Provera for more than 2 years because of bone density loss. Therefore, the nurse should include assessments for other types of contraception methods for the client. Although it may prove to be important to rule out possible pregnancy, based on the provided information, discontinuation of this method is the priority intervention. Depo-Provera can cause menstrual irregularities, but this is not the priority intervention. The nurse can follow up on this issue later. Because the current method of contraception should no longer be used, this option is not necessary.
21. Which of the statements is correct regarding use of contraception and the occurrence of sexually transmitted diseases (STDs)?

a. As long as the oral contraception method is used correctly, there is no transmission of STDs during sexual activity.
b. Oral contraceptives provide the greatest protection against getting STDs.

c. Barrier methods, if used correctly, are more likely to protect individuals from STDs as compared with other contraceptive methods.

d. It is less likely to see transmission of STDs if clients engage in oral sex as opposed to vaginal penetration.
ANS: C

The correct use of barrier methods helps protect against the transmission of STDs compared with other methods of contraception. The use of oral contraceptives has no effect on the transmission of STDs. The effectiveness of oral contraceptives is increased related to the prevention of pregnancy compared with other methods with the exception of abstinence. The method of sexual activity does not affect the transmission of STDs.
22. Which of the following is a potential disadvantage for a client who wishes to use an intrauterine device (IUD) as a method of birth control?
a. Insertion of the device prior to coitus resulting in decreased spontaneity
b. Ectopic pregnancy
c. Protection against STDs
d. Decrease in dysmenorrhea
ANS: B
The insertion of an IUD is done in a health care providers office. An ectopic pregnancy can occur as a possible complication of the IUD. An IUD does not offer protection against STDs. A decrease in dysmenorrhea would be an advantage of using an IUD.
23. A client is using Depo-Provera as her method of birth control. Which finding warrants immediate intervention?
a. Mid-cycle bleeding
b. Nausea
c. Temperature of 100 F
d. Irregular periods
ANS: A
When using Depo-Provera, the major side effect is irregular bleeding. The presence of mid-cycle bleeding warrants further investigation at this time so it is the priority assessment.
24. A client has had a prior history of endometriosis and comes to the clinic asking about which method of birth control might be helpful to alleviate her symptoms. Which birth control method should the client use?
a. Withdrawal method
b. Oral contraceptives
c. Depo-Provera
d. Intrauterine device (IUD)
ANS: B
A client who has a history of endometriosis may gain additional benefit from using an oral contraceptive as her birth control method because hormone levels will be more uniformly regulated with this type of treatment. The withdrawal method and Depo-Provera will not provide any additional benefit relative to a history of endometriosis. An IUD may cause further irritation to the endometrial lining so it would not be a prudent choice.
25. You are assessing a client in the clinic setting who has been taking oral contraceptives for several years, without side effects. Vital signs are stable and the client denies any pain or tenderness. On examination, you note a small erythematous area of approximately 2 cm on her right lower leg. She denies any traumatic injury and says this is a recent onset of a few days. Based on this information you would:

a. instruct the client to use warm compresses for several days and keep the leg elevated as much as possible.

b. have the client wear flats rather than heels to modify her gait and help alleviate this issue.
c. refer the client to the health care provider for additional diagnostic work up.

d. have the client take an over-the-counter (OTC) nonsteroidal antiinflammatory drug (NSAID) and return to the clinic if the problem persists.
ANS: C

Because the client has a history of taking oral contraceptives, the nurse must assess and evaluate findings relative to ACHES (warning signs of oral contraceptives). Thus, the client should be worked up for the possibility of a superficial or deep vein thrombosis (DVT). Warm compresses and elevation of the leg, wearing flats, and taking an OTC NSAID may lead to further problems if there is an underlying clot that is not addressed promptly.

MULTIPLE CHOICE
1. Due to the effects of cyclic ovarian changes in the breast, when is the best time for breast self- examination (BSE)?
a. Between 5 and 7 days after menses ceases
b. Day 1 of the endometrial cycle
c. Midmenstrual cycle
d. Any time during a shower or bath
ANS: A
The physiologic alterations in breast size and activity reach their minimal level approximately 5 to 7 days after menstruation ceases. Therefore, BSE is best performed during this phase of the menstrual cycle. Day 1 of the endometrial cycle is too early to perform an accurate BSE. After the midmenstrual cycle, breasts are likely to become tender and increase in size, which is not the ideal time to perform BSE. Lying down after a shower or bath with a small towel under the shoulder of the side being examined is appropriate teaching for BSE. A secondary BSE may be performed while in the shower.
2. Individual irregularities in the ovarian (menstrual) cycle are most often caused by what?
a. Variations in the follicular (preovulatory) phase

b. Intact hypothalamic-pituitary feedback mechanism
c. Functioning corpus luteum
d. Prolonged ischemic phase
ANS: A
Almost all variations in the length of the ovarian cycle are the result of variations in the length of the follicular phase. An intact hypothalamic-pituitary feedback mechanism would be regular, not irregular. The luteal phase begins after ovulation. The corpus luteum is dependent on the ovulatory phase and fertilization. During the ischemic phase, the blood supply to the functional endometrium is blocked, and necrosis develops. The functional layer separates from the basal layer, and menstrual bleeding begins.
3. How would the physiologic process of the sexual response best be characterized?
a. Coitus, masturbation, and fantasy
b. Myotonia and vasocongestion
c. Erection and orgasm
d. Excitement, plateau, and orgasm
ANS: B
Physiologically, according to Masters (1992), sexual response can be analyzed in terms of two processes: vasocongestion and myotonia. Coitus, masturbation, and fantasy are forms of stimulation for the physical manifestation of the sexual response. Erection and orgasm occur in two of the four phases of the sexual response cycle. Excitement, plateau, and orgasm are three of the four phases of the sexual response cycle.
4. Which action would be inappropriate for the nurse to perform before beginning the health history interview?
a. Smile and ask the client whether she has any special concerns.
b. Speak in a relaxed manner with an even, nonjudgmental tone.
c. Make the client comfortable.
d. Tell the client her questions are irrelevant.
ANS: D
The woman should be assured that all of her questions are relevant and important. Beginning any client interaction with a smile is important and assists in putting the client at ease. If the nurse speaks in a relaxed manner, then the client will likely be more relaxed during the interview. The clients comfort should always be ensured before beginning the interview.
5. The nurse guides a woman to the examination room and asks her to remove her clothes and put on an examination gown with the front open. The woman replies, I have special undergarments that I do not remove for religious reasons. Which is the most appropriate response from the nurse?
a. You cant have an examination without removing all your clothes.
b. Ill ask the physician to modify the examination.

c. Tell me about your undergarments. Ill explain the examination procedure, and then we can discuss how you can comfortably have your examination.

d. I have no idea how we can accommodate your beliefs.
ANS: C
Explaining the examination procedure reflects cultural competence by the nurse and shows respect for the womans religious practices. The nurse must respect the rich and unique qualities that cultural diversity brings to individuals. The examination can be modified to ensure that modesty is maintained. In recognizing the value of cultural differences, the nurse can modify the plan of care to meet the needs of each woman. Telling the client that her religious practices are different or strange is inappropriate and disrespectful to the client.
6. A woman arrives at the clinic for her annual examination. She tells the nurse that she thinks she has a vaginal infection, and she has been using an over-the-counter cream for the past 2 days to treat it. How should the nurse initially respond?

a. Inform the woman that vaginal creams may interfere with the Papanicolaou (Pap) test for which she is scheduled.
b. Reassure the woman that using vaginal cream is not a problem for the examination.

c. Ask the woman to describe the symptoms that indicate to her that she has a vaginal infection.
d. Ask the woman to reschedule the appointment for the examination.
ANS: C
An important element of the health history and physical examination is the clients description of any symptoms she may be experiencing. The best response is for the nurse to inquire about the symptoms the woman is experiencing. Women should not douche, use vaginal medications, or have sexual intercourse for 24 to 48 hours before obtaining a Pap test. Although the woman may need to reschedule a visit for her Pap test, her current symptoms should still be addressed.
7. Preconception and prenatal care have become important components of womens health. What is the guiding principal of preconception care?
a. Ensure that pregnancy complications do not occur.
b. Identify the woman who should not become pregnant.
c. Encourage healthy lifestyles for families desiring pregnancy.
d. Ensure that women know about prenatal care.
ANS: C
Preconception counseling guides couples in how to avoid unintended pregnancies, how to identify and manage risk factors in their lives and in their environment, and how to identify healthy behaviors that promote the well-being of the woman and her potential fetus.
Preconception care does not ensure that pregnancy complications will not occur. In many cases, problems can be identified and treated and may not recur in subsequent pregnancies. For many women, counseling can allow behavior modification before any damage is done, or a woman can make an informed decision about her willingness to accept potential hazards. If a woman is seeking preconception care, then she is likely aware of prenatal care.
8. Ovarian function and hormone production decline during which transitional phase?
a. Climacteric
b. Menarche
c. Menopause

d. Puberty
ANS: A
The climacteric phase is a transitional period during which ovarian function and hormone production decline. Menarche is the term that denotes the first menstruation. Menopause refers only to the last menstrual period.Puberty is a broad term that denotes the entire transitional period between childhood and sexual maturity.

9. Which statement indicates that a client requires additional instruction regarding BSE?
a. Yellow discharge from my nipple is normal if Im having my period.
b. I should check my breasts at the same time each month, after my period.
c. I should also feel in my armpit area while performing my breast examination.
d. I should check each breast in a set way, such as in a circular motion.
ANS: A
Discharge from the nipples requires further examination from a health care provider. The breasts should be checked at the same time each month. The armpit should also be examined. A circular motion is the best method during which to ascertain any changes in the breast tissue.
10. A blind woman has arrived for an examination. Her guide dog assists her to the examination room. She appears nervous and says, Ive never had a pelvic examination. What response from the nurse would be most appropriate?
a. Dont worry. It will be over before you know it.
b. Try to relax. Ill be very gentle, and I wont hurt you.
c. Your anxiety is common. I was anxious when I first had a pelvic examination.

d. Ill let you touch each instrument that Ill use during the examination as I tell you how it will be used.
ANS: D
The client who is visually impaired needs to be oriented to the examination room and needs a full explanation of what the examination entails before the nurse proceeds. Telling the client that the examination will be over quickly diminishes the clients concerns. The nurse should openly and directly communicate with sensitivity. Women who have physical disabilities should be respected and involved in the assessment and physical examination to the full extent of their abilities. Telling the client that she will not be hurt does not reflect respect or sensitivity.
Although anxiety may be common, the nurse should not discuss her own issues nor compare them to the clients concerns.

11. Which female reproductive organ(s) is(are) responsible for cyclic menstruation?
a. Uterus
b. Ovaries
c. Vaginal vestibule
d. Urethra
ANS: A

The uterus is responsible for cyclic menstruation and also houses and nourishes the fertilized ovum and the fetus. The ovaries are responsible for ovulation and the production of estrogen. The vaginal vestibule is an external organ that has openings to the urethra and vagina. The urethra is not a reproductive organ, although it is found in the area.
12. Which body part both protects the pelvic structures and accommodates the growing fetus during pregnancy?
a. Perineum
b. Bony pelvis
c. Vaginal vestibule
d. Fourchette
ANS: B
The bony pelvis protects and accommodates the growing fetus. The perineum covers the pelvic structures. The vaginal vestibule contains openings to the urethra and vagina. The fourchette is formed by the labia minor.
13. Which phase of the endometrial cycle best describes a heavy, velvety soft, fully matured endometrium?
a. Menstrual
b. Proliferative
c. Secretory
d. Ischemic
ANS: C
The secretory phase extends from the day of ovulation to approximately 3 days before the next menstrual cycle. During this secretory phase, the endometrium becomes fully mature again.
During the menstrual phase, the endometrium is shed. The proliferative phase is a period of rapid growth. During the ischemic phase, the blood supply is blocked and necrosis develops.
14. Which part of the menstrual cycle includes the stimulated release of gonadotropin-releasing hormone (GnRH) and follicle-stimulating hormone (FSH)?
a. Menstrual phase
b. Endometrial cycle
c. Ovarian cycle
d. Hypothalamic-pituitary cycle
ANS: D
The cyclic release of hormones is the function of the hypothalamus and pituitary glands. The menstrual cycle is a complex interplay of events that simultaneously occur in the endometrium, hypothalamus, pituitary glands, and ovaries. The endometrial cycle consists of four phases: menstrual phase, proliferative phase, secretory phase, and ischemic phase. The ovarian cycle remains under the influence of FSH and estrogen.
15. What fatty acids (classified as hormones) are found in many body tissues with complex roles in many reproductive functions?
a. GnRH
b. Prostaglandins (PGs)

c. FSH
d. Luteinizing hormone (LH)
ANS: B
PGs affect smooth muscle contraction and changes in the cervix. GnRH is part of the hypothalamic-pituitary cycle, which responds to the rise and fall of estrogen and progesterone. FSH is part of the hypothalamic-pituitary cycle, which responds to the rise and fall of estrogen and progesterone. LH is part of the hypothalamic-pituitary cycle, which responds to the rise and fall of estrogen and progesterone.

16. Which information regarding substance abuse is important for the nurse to understand?

a. Although cigarette smoking causes a number of health problems, it has little direct effect on maternity-related health.
b. Women, ages 21 to 34 years, have the highest rates of specific alcohol-related problems.

c. Coffee is a stimulant that can interrupt body functions and has been related to birth defects.

d. Prescription psychotherapeutic drugs taken by the mother do not affect the fetus; otherwise, they would not have been prescribed.
ANS: B
Although a very small percentage of childbearing women have alcohol-related problems, alcohol abuse during pregnancy has been associated with a number of negative outcomes. Cigarette smoking impairs fertility and is a cause of low-birth-weight infants. Caffeine consumption has not been related to birth defects. Psychotherapeutic drugs have some effect on the fetus, and that risk must be weighed against their benefit to the mother.
17. As part of their participation in the gynecologic portion of the physical examination, which approach should the nurse take?

a. Take a firm approach that encourages the client to facilitate the examination by following the physicians instructions exactly.

b. Explain the procedure as it unfolds, and continue to question the client to get information in a timely manner.

c. Take the opportunity to explain that the trendy vulvar self-examination is only for women at risk for developing cancer.

d. Help the woman relax through the proper placement of her hands and proper breathing during the examination.
ANS: D
Breathing techniques are important relaxation techniques that can help the client during the examination. The nurse should encourage the client to participate in an active partnership with the health care provider. Explanations during the procedure are fine, but many women are uncomfortable answering questions in the exposed and awkward position of the examination. Vulvar self-examination on a regular basis should be encouraged and taught during the examination.
18. Which statement best describes Kegel exercises?
a. Kegel exercises were developed to control or reduce incontinent urine loss.

b. Kegel exercises are the best exercises for a pregnant woman because they are so pleasurable.
c. Kegel exercises help manage stress.
d. Kegel exercises are ineffective without sufficient calcium in the diet.
ANS: A
Kegel exercises help control the urge to urinate. Although these exercises may be fun for some, the most important factor is the control they provide over incontinence. Kegel exercises help manage urination, not stress. Calcium in the diet is important but not related to Kegel exercises.

19. The microscopic examination of scrapings from the cervix, endocervix, or other mucous membranes to detect premalignant or malignant cells is called what?
a. Bimanual palpation
b. Rectovaginal palpation
c. Papanicolaou (Pap) test
d. Four As procedure
ANS: C
The Pap test is a microscopic examination for cancer that should be regularly performed, depending on the clients age. Bimanual palpation is a physical examination of the vagina. Rectovaginal palpation is a physical examination performed through the rectum. The four As procedure is an intervention to help a client stop smoking.
20. Which questionnaire would be best for the nurse to use when screening an adolescent client for an eating disorder?
a. Four Cs
b. Dietary Guidelines for Americans
c. SCOFF screening tool
d. Dual-energy x-ray absorptiometry (DEXA) scan
ANS: C
A screening tool specifically developed to identify eating disorders uses the acronym SCOFF. Each question scores 1 point. A score of 2 or more indicates that the client may have anorexia nervosa or bulimia. The letters represent the following questions:
Do you make yourself Sick because you feel too full?
Do you worry about loss of Control over the amount that you eat?
Have you recently lost more than One stone (14 pounds) in a 3-month period? Do you think that you are too Fat, even if others think you are thin?
Does Food dominate your life?
The 4 Cs are used to determine cultural competence. Dietary Guidelines for Americans provide nutritional guidance for all, not only for those with eating disorders. The DEXA scan is used to determine bone density.
21. The unique muscle fibers that constitute the uterine myometrium make it ideally suited for what?
a. Menstruation

b. Birth process
c. Ovulation
d. Fertilization
ANS: B
The myometrium is made up of layers of smooth muscle that extend in three directions. These muscles assist in the birth process by expelling the fetus, ligating blood vessels after birth, and controlling the opening of the cervical os.
22. Which hormone is responsible for the maturation of mammary gland tissue?
a. Estrogen
b. Testosterone
c. Prolactin
d. Progesterone
ANS: D
Progesterone causes maturation of the mammary gland tissue, specifically acinar structures of the lobules. Estrogen increases the vascularity of the breast tissue. Testosterone has no bearing on breast development. Prolactin is produced after birth and released from the pituitary gland; it is produced in response to infant suckling and an emptying of the breasts.
23. What is the goal of a long-term treatment plan for an adolescent with an eating disorder?
a. Managing the effects of malnutrition
b. Establishing sufficient caloric intake
c. Improving family dynamics
d. Restructuring client perception of body image
ANS: D
The treatment of eating disorders is initially focused on reestablishing physiologic homeostasis. Once body systems are stabilized, the next goal of treatment for eating disorders is maintaining adequate caloric intake. Although family therapy is indicated when dysfunctional family relationships exist, the primary focus of therapy for eating disorders is to help the adolescent cope with complex issues. The focus of treatment in individual therapy for an eating disorder involves restructuring cognitive perceptions about the individuals body image.
24. A 62-year-old woman has not been to the clinic for an annual examination for 5 years. The recent death of her husband reminded her that she should come for a visit. Her family physician has retired, and she is going to see the womens health nurse practitioner for her visit. What should the nurse do to facilitate a positive health care experience for this client?

a. Remind the woman that she is long overdue for her examination and that she should come in annually.
b. Carefully listen, and allow extra time for this womans health history interview.
c. Reassure the woman that a nurse practitioner is just as good as her old physician.

d. Encourage the woman to talk about the death of her husband and her fears about her own death.
ANS: B

The nurse has an opportunity to use reflection and empathy while listening, as well as ensure an open and caring communication. Scheduling a longer appointment time may be necessary because older women may have longer histories or may need to talk. A respectful and reassuring approach to caring for women older than age 50 years can help ensure that they continue to seek health care. Reminding the woman about her overdue examination, reassuring the woman that she has a good practitioner, and encouraging conversation about the death of her husband and her own death are not the best approaches.
25. During a health history interview, a woman states that she thinks that she has bumps on her labia. She also states that she is not sure how to check herself. The correct response by the nurse would be what?
a. Reassure the woman that the examination will reveal any problems.

b. Explain the process of vulvar self-examination, and reassure the woman that she should become familiar with normal and abnormal findings during the examination.
c. Reassure the woman that bumps can be treated.
d. Reassure her that most women have bumps on their labia.
ANS: B
During the assessment and evaluation, the responsibility for self-care, health promotion, and enhancement of wellness is emphasized. The pelvic examination provides a good opportunity for the practitioner to emphasize the need for regular vulvar self-examination. Providing reassurance to the woman concerning the bumps would not be an accurate response.
26. Which statement regarding female sexual response is inaccurate?

a. Women and men are more alike than different in their physiologic response to sexual arousal and orgasm.
b. Vasocongestion is the congestion of blood vessels.
c. Orgasmic phase is the final state of the sexual response cycle.
d. Facial grimaces and spasms of the hands and feet are often part of arousal.
ANS: C
The final state of the sexual response cycle is the resolution phase after orgasm. Men and women are surprisingly alike. Vasocongestion causes vaginal lubrication and engorgement of the genitals. Arousal is characterized by increased muscular tension (myotonia).
27. A client at 24 weeks of gestation says she has a glass of wine with dinner every evening. Why should the nurse counsel her to eliminate all alcohol intake?
a. Daily consumption of alcohol indicates a risk for alcoholism.
b. She is at risk for abusing other substances as well.
c. Alcohol places the fetus at risk for altered brain growth.
d. Alcohol places the fetus at risk for multiple organ anomalies.
ANS: C
No period during pregnancy is safe to consume alcohol. The documented effects of alcohol consumption during pregnancy include fetal mental retardation, learning disabilities, high activity level, and short attention span. The fetal brain grows most rapidly in the third trimester and is vulnerable to alcohol exposure during this time. Abuse of other substances has not been linked to alcohol use.

28. Which statement by the client indicates that she understands BSE?
a. I will examine both breasts in two different positions.
b. I will examine my breasts 1 week after my menstrual period starts.
c. I will examine only the outer upper area of the breast.
d. I will use the palm of the hand to perform the examination.
ANS: B
The woman should examine her breasts when hormonal influences are at their lowest level. The client should be instructed to use four positions: standing with arms at her sides, standing with arms raised above her head, standing with hands pressed against hips, and lying down. The entire breast needs to be examined, including the outer upper area. The client should use the sensitive pads of the middle three fingers.
29. What is the primary reason why a woman who is older than 35 years may have difficulty achieving pregnancy?
a. Personal risk behaviors influence fertility.
b. Mature women have often used contraceptives for an extended time.
c. Her ovaries may be affected by the aging process.
d. Prepregnancy medical attention is lacking.
ANS: C
Once the mature woman decides to conceive, a delay in becoming pregnant may occur because of the normal aging of the ovaries. Older adults participate in fewer risk behaviors than younger adults. The past use of contraceptives is not the problem. Prepregnancy medical care is both available and encouraged.
30. What is the most dangerous effect on the fetus of a mother who smokes cigarettes while pregnant?
a. Genetic changes and anomalies
b. Extensive central nervous system damage
c. Fetal addiction to the substance inhaled
d. Intrauterine growth restriction
ANS: D
The major consequences of smoking tobacco during pregnancy are low-birth-weight infants, prematurity, and increased perinatal loss. Cigarettes will not normally cause genetic changes or extensive central nervous system damage. Addiction to tobacco is not usually a concern related to the neonate.

MULTIPLE CHOICE
1. A nurse is providing breast care education to a client after mammography. Which information regarding fibrocystic changes in the breast is important for the nurse to share?
a. Fibrocystic breast disease is a disease of the milk ducts and glands in the breasts.
b. It is a premalignant disorder characterized by lumps found in the breast tissue.

c. Healthy women with fibrocystic breast disease find lumpiness with pain and tenderness in varying degrees in the breast tissue during menstrual cycles.
d. Lumpiness is accompanied by tenderness after menses.
ANS: C
Fibrocystic changes are palpable thickenings in the breast usually associated with pain and tenderness. The pain and tenderness fluctuate with the menstrual cycle. Fibrocystic changes are not premalignant changes; this information is inaccurate. Tenderness most often occurs before menses.
2. A nurse is providing education to a support group of women newly diagnosed with breast cancer. It is important for the nurse to discuss which factor related to breast cancer with the group?
a. Genetic mutations account for 50% of women who will develop breast cancer.
b. Breast cancer is the leading cause of cancer death in women.
c. In the United States, 1 in 10 women will develop breast cancer in her lifetime.
d. The exact cause of breast cancer remains unknown.
ANS: D

The exact cause of breast cancer is unknown. Between 15% and 20% of these cancers are related to genetic mutations. Breast cancer is the second leading cause of cancer death in woman ages 45 to 55 years. One in eight women in the United States will develop breast cancer in her lifetime.
3. Which diagnostic test is used to confirm a suspected diagnosis of breast cancer?
a. Mammogram
b. Ultrasound
c. Needle-localization biopsy
d. Magnetic resonance imaging (MRI)
ANS: C
When a suspicious mammogram is noted or a lump is detected, diagnosis is confirmed by either a core-needle biopsy or a needle-localization biopsy. Mammography is a clinical screening tool that may aid in the early detection of breast cancers. Transillumination, thermography, and ultrasound breast imaging are being explored as methods for detecting early breast carcinoma. An MRI is useful in women with masses that are difficult to find (occult breast cancer).

4. A healthy 60-year-old African-American woman regularly receives health care at her neighborhood clinic. She is due for a mammogram. At her first visit, her health care provider is concerned about the 3-week wait at the neighborhood clinic and made an appointment for her to have a mammogram at a teaching hospital across town. She did not keep her appointment and returned to the clinic today to have the nurse check her blood pressure. What is
the most appropriate statement for the nurse to make to this client?

a. Do you have transportation to the teaching hospital so that you can get your mammogram?
b. Im concerned that you missed your appointment; let me make another one for you.
c. Its very dangerous to skip your mammograms; your breasts need to be checked.
d. Would you like me to make an appointment for you to have your mammogram here?
ANS: D
Offering to make an appointment for the client at the neighborhood location is nonjudgmental and gives her options as to where she may have her mammogram. Furthermore, it is an innocuous way to investigate the reasons the client missed her previous appointment. Mortality rates from breast cancer remain high for African-American women. Rather than reminding this woman that she has missed her appointment, discussing the evidence behind the recommendations for a mammogram might be preferable for the nurse. The nurse can offer to reschedule should the client agree to return for the test. Telling the client that it is dangerous to skip mammograms can be perceived as judgmental and derogatory and may alienate and embarrass the client.
5. A clients oncologist has just finished explaining the diagnostic workup results to her, and she still has questions. The woman states, The physician says I have a slow-growing cancer. Very few cells are dividing. How does she know this? What is the name of the test that gave the health care provider this information?
a. Tumor ploidy
b. S-phase index
c. Nuclear grade
d. Estrogen-receptor assay
ANS: B
The S-phase index measures the number of cells in the synthesis phase of cell development. If the number of cells noted is high, then the cancer is growing at a fast rate. In this clients case, her S-phase index is assumed to be low. Tumor ploidy is the amount of deoxyribonucleic acid (DNA) in a tumor cell, compared with that in a normal cell. Nuclear grade describes the degree of abnormalities present in the cancer cell tubules, the nuclei morphologic features, and mitotic rates. Estrogen and progesterone receptors are proteins found in the cell cytoplasm and surface of some breast cancer cells.
6. Breast pain occurs in many women during their perimenopausal years. Which information is a priority for the nurse to share with the client?
a. Breast pain is an early indication of cancer.
b. Pain is almost always an indication of a solid mass.
c. Distinguishing between cyclical and noncyclical pain is important.
d. Breast pain is most often treated with narcotics.
ANS: C
Breast pain is unusual in breast cancer. Solid masses are generally benign and described as smooth, round, mobile, and painless. Distinguishing between cyclical and noncyclical pain is important to determine whether the cause is hormonal. Idiopathic pain is most often treated with nonsteroidal antiinflammatory medications.
7. After a mastectomy, which activity should the client be instructed to avoid?
a. Emptying surgical drains twice a day and as needed

b. Lifting more than 4.5 kg (10 lb) or reaching above her head until given permission by her surgeon
c. Wearing clothing with snug sleeves to support the tissue of the arm on the operative side

d. Immediately reporting inflammation that develops at the incision site or in the affected arm
ANS: C
The woman should not be advised to wear snug clothing. She should be advised to avoid tight clothing, tight jewelry, and other apparel that might cause decreased circulation in the affected arm. As part of the teaching plan, the woman should be instructed to empty the surgical drains twice a day, to avoid lifting more than 4.5 kg (10 lb) or reaching above her head until given permission by her surgeon, and to report immediately any inflammation that develops at the incision site or in the affected arm.
8. A health care provider performs a clinical breast examination on a woman diagnosed with fibroadenoma. How would the nurse explain the defining characteristics of a fibroadenoma?
a. Inflammation of the milk ducts and glands behind the nipples
b. Thick, sticky discharge from the nipple of the affected breast
c. Lumpiness in both breasts that develops 1 week before menstruation
d. Single lump in one breast that can be expected to shrink as the woman ages

ANS: D
Fibroadenomas are characterized by discrete, usually solitary lumps smaller than 3 cm in diameter. Fibroadenomas increase in size during pregnancy and shrink as the woman ages. Inflammation of the milk ducts and glands behind the nipples is associated with mammary duct ectasia, not fibroadenoma. Thick, sticky discharge from the nipple of the affected breast is associated with galactorrhea, not fibroadenoma. Lumpiness in both breasts that develops 1 week before menstruation is associated with fibrocystic changes of the breast, not fibroadenoma.
9. What important, immediate postoperative care practice should the nurse remember when caring for a woman who has had a mastectomy?
a. The blood pressure (BP) cuff should not be applied to the affected arm.
b. Venipuncture for blood work should be performed on the affected arm.
c. The affected arm should be used for intravenous (IV) therapy.
d. The affected arm should be held down close to the womans side.
ANS: A
The affected arm should not be used for BP readings, IV therapy, or venipuncture. The affected arm should be elevated with pillows above the level of the right atrium.
10. A woman has a breast mass that is not well delineated and is nonpalpable, immobile, and nontender. Which condition is this client experiencing?
a. Fibroadenoma
b. Lipoma
c. Intraductal papilloma
d. Mammary duct ectasia
ANS: C
Intraductal papilloma is the only benign breast mass that is nonpalpable. Fibroadenoma is well delineated, palpable, and movable. Lipoma is palpable and movable. Mammary duct ectasia is not well delineated and is immobile, but it is palpable and painful.
11. A client is concerned because she has been experiencing some milky, sticky breast discharge. Which nonmalignant condition is exhibited with this finding?
a. Relative inflammatory lesion
b. Galactorrhea
c. Mammary duct ectasia
d. Breast infection
ANS: B
Galactorrhea bilaterally exhibits a spontaneous, milky, and sticky discharge and is a normal finding during pregnancy; however, it may also occur as the result of elevated prolactin levels. Prolactin can become elevated as a result of a thyroid disorder, pituitary tumor, stress, coitus, trauma, or chest wall surgery.
12. A client has been prescribed adjuvant tamoxifen therapy. What common side effect might she experience?
a. Weight gain, hot flashes, and blood clots
b. Vomiting, weight loss, and hair loss

c. Nausea, vomiting, and diarrhea
d. Hot flashes, weight gain, and headaches
ANS: A
Common side effects of tamoxifen therapy include hot flashes, weight gain, and blood clots. Weight loss, hair loss, diarrhea, and headaches are not common side effects of tamoxifen.
13. Fibrocystic changes in the breast most often appear in women in their 20s and 30s. Although the cause is unknown, an imbalance of estrogen and progesterone may be the cause. The nurse who cares for this client should be aware that treatment modalities are conservative. Which proven modality may offer relief for this condition?
a. Diuretic administration
b. Daily inclusion of caffeine in the diet
c. Increased vitamin C supplementation
d. Application of cold packs to the breast as necessary
ANS: A
Diuretic administration plus a decrease in sodium and fluid intake are recommended. Although not supported by research, some advocate eliminating dimethylxanthines (caffeine) from the diet. Smoking should also be avoided, and alcohol consumption should be reduced. Vitamin E supplements are recommended; however, the client should avoid megadoses because vitamin E is a fat-soluble vitamin. Pain relief measures include applying heat to the breast, wearing a supportive bra, and taking nonsteroidal antiinflammatory drugs.
14. What is the correct name describing a benign breast condition that includes dilation and inflammation of the collecting ducts?
a. Mammary duct ectasia
b. Intraductal papilloma
c. Chronic cystic disease
d. Fibroadenoma
ANS: A
Generally occurring in women approaching menopause, mammary duct ectasia results in a firm irregular mass in the breast, enlarged axillary nodes, and nipple discharge. Intraductal papillomas develop in the epithelium of the ducts of the breasts; as the mass grows, it causes trauma or erosion within the ducts. Chronic cystic disease causes pain and tenderness. The cysts that form are multiple, smooth, and well delineated. Fibroadenoma is evidenced by fibrous and glandular tissues. They are felt as firm, rubbery, and freely mobile nodules.
15. Which client is most at risk for fibroadenoma of the breast?
a. 38-year-old woman
b. 50-year-old woman
c. 16-year-old girl
d. 27-year-old woman
ANS: C

Although it may occur at any age, fibroadenoma is most common in the teenage years. Ductal ectasia and intraductal papilloma become more common as a woman approaches menopause. Fibrocystic breast changes are more common during the reproductive years.
16. Which client should the nurse refer for further testing?
a. Left breast slightly smaller than right breast
b. Eversion (elevation) of both nipples
c. Faintly visible bilateral symmetry of venous network
d. Small dimple located in the upper outer quadrant of the right breast
ANS: D
A small dimple is an abnormal finding and should be further evaluated. Nipple retraction and a dimpling or pitting of the skin is suggestive of a locally advanced, aggressive form of breast cancer. In many women, one breast is smaller than the other, and eversion of both nipples is a normal finding. Faintly visible venous network is also a normal finding.

17. The most conservative approach for early breast cancer treatment involves lumpectomy followed by which procedure?
a. Radiation
b. Adjuvant systemic therapy
c. Hormonal therapy
d. Chemotherapy
ANS: A
Radiation therapy, in the form of either brachytherapy or accelerated breast radiation, is the standard therapy after lumpectomy for the treatment of early-stage breast cancer. Chemotherapy administered soon after surgical removal of the tumor is referred to as adjuvant chemotherapy. Not all women are candidates for hormonal therapy. After the entire tumor or portion is removed by excision, a receptor assay must be performed. Chemotherapy with multiple-drug combinations is used in the treatment of recurrent and advanced breast cancer with positive results.

18. Macromastia, or breast hyperplasia, is a condition in which women have very large and pendulous breasts. Breast hyperplasia can be corrected with a reduction mammoplasty. Which statement regarding this procedure is themost accurate?
a. Breast reduction surgery is covered by insurance.
b. Breastfeeding might be difficult.
c. No sequelae after the procedure is known.
d. Pain in the back and shoulders may not be relieved.
ANS: B
If breast reduction surgery is performed, then establishing breastfeeding at a later date may be difficult. Macromastia may not be covered by all insurance companies. A consequence of surgery may be decreased sensation and pain, secondary to scar tissue. Reduction mammoplasty will relieve chronic neck and back pain.

19. Having a genetic mutation may create an 85% chance of developing breast cancer in a womans lifetime. Which condition does not increase a clients risk for breast cancer?
a. BRCA1 or BRCA2 gene mutation
b. Li-Fraumeni syndrome
c. Paget disease
d. Cowden syndrome
ANS: C
Paget disease originates in the nipple and causes nipple carcinoma and exhibits bleeding, oozing, and crusting of the nipple. BRCA1 or BRCA2, Li-Fraumeni syndrome, and Cowden syndrome are all genetic mutations that have different family pedigrees and increase the risk of breast cancer.
20. A client is scheduled for surgery after a recent breast cancer diagnosis. The nurse is discussing the procedure with the client. To allay her fears, which explanation best describes a skin-sparing mastectomy?
a. Removal of the breast, nipple, and areola, leaving only the skin
b. Removal of the breast, nipple, areola, and axillary node dissection
c. Incision on the outside of the breast, leaving the nipple intact
d. Removal of both breasts in their entirety
ANS: A
A skin-sparing mastectomy is a special procedure that keeps the outer breast of the skin intact. The breast, nipple, and areola are removed. A tissue expander may be placed for later reconstruction. A modified radical mastectomy also removes the axillary lymph nodes. The nipple-sparing mastectomy is reserved for a small number of women during which the areola is removed leaving the nipple intact. Women who test positive for the BRCA1 or BRCA2 gene mutation may have both breasts removed to reduce the risk of cancer and is most commonly known as a prophylactic or preventative mastectomy.
MULTIPLE RESPONSE
1. Researchers have found a number of common risk factors that increase a womans chance of developing a breast malignancy. It is essential for the nurse who provides care to women of any age to be aware of which risk factors? (Select all that apply.)
a. Family history
b. Late menarche
c. Early menopause
d. Race
e. Nulliparity or first pregnancy after age 40 years
ANS: A, D, E
Family history, race, and nulliparity or the first pregnancy after age 40 years are known risk factors for the development of breast cancer. Others risk factors include age, personal history of cancer, high socioeconomic status, sedentary lifestyle, hormone replacement therapy, recent use of oral contraceptives, never having breastfed a child, and drinking more than one alcoholic beverage per day. Early menarche and late menopause are not risk factors for breast malignancy.

2. Cellulitis with or without abscess formation is a fairly common condition. The nurse is providing education for a client whose presentation to the emergency department includes an infection of the breast. Which information should the nurse share with this client? (Select all that apply.)
a. Nipple piercing may be the cause of a recent infection.
b. Treatment for cellulitis will include antibiotics.
c. Streptococcus aureus is the most common pathogen.
d. Obesity, smoking, and diabetes are risk factors.
e. Breast is pale in color and cool to the touch.
ANS: A, B, D
The at-risk population for breast infection shares characteristics such as large breasts, obesity, previous surgeries, sebaceous cysts, smoking, diabetes, and recent nipple piercing. The most common pathogen isStaphylococcus aureus. Presentation of cellulitis of the breast includes pain, reddening, and warmth to the touch; treatment includes antibiotics and/or aspiration.
3. Guidelines for breast cancer screening continue to evolve as new evidence is generated. Which examination or procedure and frequency would be recommended for a 31-year-old asymptomatic client? (Select all that apply.)
a. Annual mammography
b. Clinical breast examination every 3 years
c. Annual MRI
d. Breast self-examination
e. Mammography every 3 years
ANS: B, D
A 31-year-old client with no risk factors and who is asymptomatic should perform breast self- examination on a regular basis and have a clinical breast examination every 3 years. Women who are 40 years of age and older require both mammography and clinical breast examination annually. High-risk women 30 years and older should have an annual MRI and mammogram.
4. Chemotherapy with multiple drug agents is used in the treatment of recurrent and advanced breast cancer with positive results. Which side effects would the nurse anticipate for the client once treatment has begun? (Select all that apply.)
a. Hair loss
b. Severe constipation
c. Anemia
d. Leukopenia
e. Thrombocytopenia
ANS: A, C, D, E
Because chemotherapeutic agents rapidly kill reproducing cells, treatment also affects normal cells that frequently reproduce. The side effects that the nurse would anticipate and on which the nurse will provide education include partial or full hair loss, gastrointestinal effects (e.g., nausea, vomiting, anorexia, mucositis), leukopenia, neutropenia, thrombocytopenia, and anemia.

1. A group of students are preparing a class presentation about polyps. Which of the following would the students most likely include in the presentation?

A)Polyps are rarely the result of an infection. B)Endocervical polyps commonly appear after menarche.
C) Cervical polyps are more common than endocervical polyps.

D) Endocervical polyps are most common in women in their 50s. ANS.D
2. Which assessment by the nurse would differentiate a placenta previa from an abruptio placentae?
a. Saturated perineal pad in 1 hour
b. Pain level 0 on a scale of 0 to 10
c. Cervical dilation at 2 cm
d. Fetal heart rate at 160 bpm
ANS: B
The classic sign of placenta previa is the sudden onset of painless uterine bleeding, whereas abruptio placentae results in abdominal pain and uterine tenderness; heavy bleeding, cervical dilation, and fetal heart rate of 160 bpm could be associated with both conditions.

3. Which finding should be the nurses priority in a client suspected as having gestational trophoblastic disease?
a. Uterine contractions
b. Nausea and vomiting
c. Blood pressure of 130/80 mm Hg

d. Increase discharge of vaginal mucus
ANS: A
Uterine contractions can cause trophoblastic tissue to be pulled into large venous sinusoids in the uterus, resulting in embolization of the tissue and respiratory distress. Nausea and vomiting and blood pressure of 130/80 mm Hg represent no immediate danger to the client and can be addressed later. Increased discharge of vaginal mucus is a normal finding in pregnancy.

4. A client who was pregnant had a spontaneous abortion at approximately 4 weeks gestation. At the time of the miscarriage, it was thought that all products of conception were expelled. Two weeks later, the client presents at the clinic office complaining of crampy abdominal pain and a scant amount of serosanguineous vaginal drainage with a slight odor. The pregnancy test is negative. Vital signs reveal a temperature of 100 F, with blood pressure of 100/60 mm Hg, irregular pulse 88 beats/min (bpm), and respirations, 20 breaths/min. Based on these assessment data, what does the nurse anticipate as a clinical diagnosis?
a. Ectopic pregnancy
b. Uterine infection
c. Gestational trophoblastic disease
d. Endometriosis
ANS: B
5. The client is exhibiting signs of uterine infection, with elevated temperature, vaginal discharge with odor, abdominal pain, and blood pressure and pulse manifesting as shock-trended vitals.
Because the pregnancy test is negative, an undiagnosed ectopic pregnancy and gestational trophoblastic disease are ruled out. There is no supportive evidence to indicate a clinical diagnosis of endometriosis at this time; however, it is more likely that this is an infectious process that must be aggressively treated.

6. An abortion when the fetus dies but is retained in the uterus is called:
a. inevitable.
b. missed.
c. incomplete.
d. threatened.
ANS: B
A missed abortion refers to a dead fetus being retained in the uterus. An inevitable abortion means that the cervix is dilating with the contractions. An incomplete abortion means that not all the products of conception were expelled. With a threatened abortion, the client has cramping and bleeding but not cervical dilation.

7,The nurse would be least likely to find which of the following in a client with uterine fibroids? A)Regularly shaped, shrunken uterus
B) Acute pelvic pain

C) Menorrhagia

D) Complaints of bloating

ANS. B