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Chapter 03: Nursing and Genomics
Lowdermilk: Maternity & Women’s Health Care, 11th Edition
MULTIPLE CHOICE
1. A
father and mother are carriers of phenylketonuria (PKU). Their 2-year-old
daughter has the condition. The couple tells the nurse that they are having a
second baby. Because their daughter has PKU, they are certain that this baby
will not be affected. Which response by the nurse is the most accurate?
|
a. |
“Good planning. You need to
take advantage of the odds that are in your favor.” |
|
b. |
“I think you’d better first
check with your physician.” |
|
c. |
“You are both carriers;
therefore, each baby has a 25% chance of being affected.” |
|
d. |
“The ultrasound indicates a
boy, and boys are not affected by PKU.” |
ANS: C
Each child conceived by this couple has a one-in-four chance of
being affected with the PKU disorder. This couple still has an increased
likelihood of having a child with PKU; having one child already with PKU does
not guarantee that they will not have another. These parents need to discuss
their options with their physician. However, an opportune time has presented
itself for the couple to receive correct teaching about inherited genetic
risks. No correlation exists between gender and inheritance of the disorder,
because PKU is an autosomal recessive disorder.
DIF: Cognitive Level:
Apply
REF: p.
51
TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
2. A
client is 5 months pregnant. On a routine ultrasound scan, the physician
discovers that the fetus has a diaphragmatic hernia. The woman becomes
distraught and asks the nurse what she should do. Which response would be most
suitable?
|
a. |
Talk to the client, and
refer her to a genetic counselor. |
|
b. |
Suggest that the client
travel to a fetal treatment center for intrauterine surgery. |
|
c. |
Tell her that everything is
going to be fine. |
|
d. |
Sit with the client, and
calmly suggest that she consider terminating this pregnancy. |
ANS: A
Before the client makes any decisions, she should discuss this
newly discovered information with a genetic counselor. Genetic counselors can
help with the diagnosis and management of families affected by genetic
conditions. The discussion of potential surgery should be pursuant to genetic
counseling. Telling the woman that everything is going to be fine may give her
false hope and is not accurate. All options should be discussed with the
genetic counselor. Furthermore, the guiding principle for genetic counseling is
nondirection, which respects the right of the individual or family who are
being counseled to make autonomous decisions.
DIF: Cognitive Level:
Apply
REF: p.
54
TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
3. A
client who is gravida 2 and 16 weeks of gestation comes in for her prenatal
appointment. Her 2-year-old daughter is with her and is wearing a sleeveless
top. While interacting with her daughter, you note axillary freckling and
several café-au-lait spots (>2 cm). In reviewing her chart, the nurse should
assess for documentation of which genetic disease?
|
a. |
Tay-Sachs disease |
|
b. |
Galactosemia |
|
c. |
Neurofibromatosis (NF) |
|
d. |
PKU |
ANS: C
Clinical manifestations of NF may include axillary freckling and
café-au-lait spots. Tay-Sachs disease is an incurable lipid-storage disorder
and is not associated with café-au-lait spots. Galactosemia is an inborn error
of metabolism and is also not associated with café-au-lait spots. PKU is not
associated with café-au-lait spots. A child with PKU would have difficulty
manufacturing the liver enzyme phenylalanine.
DIF: Cognitive Level:
Remember
REF: p. 51
TOP: Nursing Process:
Assessment MSC:
Client Needs: Health Promotion and Maintenance
4. A new
father has just been told that his infant has trisomy 18. Which identifying
physical feature is unique to an infant with this genetic disorder?
|
a. |
Microcephaly and capillary
hemangiomas |
|
b. |
Epicanthal folds and a
simian crease |
|
c. |
Oblique palpebral fissures
and Cri du chat syndrome |
|
d. |
Rocker-bottom feet and
clenched hands with overlapping fingers |
ANS: D
Rocker-bottom feet and clenched hands with overlapping fingers
are associated with trisomy 18. Microcephaly and capillary hemangiomas are
associated with trisomy 13. Epicanthal folds and a simian crease are associated
with trisomy 21 (Down syndrome). Deletion of the short arm of chromosome number
5 is manifested by Cri du chat syndrome.
DIF: Cognitive Level:
Understand
REF: p. 49
TOP: Nursing Process:
Assessment MSC:
Client Needs: Health Promotion and Maintenance
5. A
nurse is assessing the knowledge of new parents of a child born with
Klinefelter syndrome. Which statement accurately describes this genetic
disorder?
|
a. |
Klinefelter syndrome is a
sex chromosome abnormality. |
|
b. |
It affects only female
children. |
|
c. |
The disorder is expressed
as trisomy XYY. |
|
d. |
The child with this
disorder will grow to be infertile. |
ANS: A
Klinefelter syndrome, also known as trisomy XXY, is a sex
chromosomal deviation that is expressed in males. Turner syndrome (monosomy X)
is displayed in females. Most males with Klinefelter syndrome are tall, may be
infertile, and are slow to learn; however, those who have mosaic Klinefelter
syndrome may be fertile as adults.
DIF: Cognitive Level: Understand
REF: p. 50
TOP: Nursing Process:
Assessment MSC:
Client Needs: Health Promotion and Maintenance
6. Which
factor is least likely to influence the decision to undergo genetic testing?
|
a. |
Anxiety and altered family
relationships |
|
b. |
Cost of testing or denial
of insurance benefits |
|
c. |
Imperfection of test
results |
|
d. |
Ethnic and socioeconomic
disparity associated with genetic testing |
ANS: B
Testing is not 100% accurate and has a high percentage of
false-negative results. An individual may not take these results seriously and
subsequently fail to have testing completed or to seek necessary follow-up
consultation. Anxiety and altered family relationships are often the result of
genetic testing. The results of genetic testing may be difficult to keep
confidential, and family members may feel pressured to have testing performed.
Decisions about genetic testing are shaped by socioeconomic status and the
ability to pay for the testing. Some types of genetic testing are expensive and
are not covered by insurance benefits. Caucasian middle-class families have
greater access to genetic screening; therefore, this population is less at
likely to decide against genetic testing.
DIF: Cognitive Level:
Understand
REF: p. 54
TOP: Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance
7. A
32-year-old woman is pregnant for the third time. One child was born with cystic
fibrosis, and the other child is healthy. The client and her husband wonder
what chance this child has of having cystic fibrosis. This type of testing is
most commonly known as what?
|
a. |
Occurrence risk |
|
b. |
Recurrence risk |
|
c. |
Predictive testing |
|
d. |
Predisposition testing |
ANS: B
The couple already has a child with a genetic disease;
therefore, this couple will be given a recurrence risk test. If a couple has
not yet had a child but is known to be at risk for having a child with a genetic
disease, then an occurrence risk test is administered. Predictive testing
clarifies the genetic status of an asymptomatic family member. Predisposition
testing differs from presymptomatic testing in that a positive result does not
indicate 100% risk of a condition developing.
DIF: Cognitive Level:
Understand
REF: p.
54
TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
8. Cancer
is now recognized as a genetic disorder that begins with one or more genetic
mutations. Which type of cancer is specifically being investigated in this
regard?
|
a. |
Lung cancer |
|
b. |
Liver cancer |
|
c. |
Colorectal cancer |
|
d. |
Oral cancer |
ANS: C
Colorectal cancer usually results from one or more predisposing
genes and is the third leading cause of cancer deaths in women. Although
tobacco smoke is a known causative factor for lung cancer, an acquired mutation
of an oncogene may also be present. Liver cancer is not being investigated in
this regard. Oral cancer may be caused by an inherited mutation of one or more
oncogenes.
DIF: Cognitive Level:
Remember
REF: p. 53
TOP: Nursing Process:
Assessment MSC:
Client Needs: Health Promotion and Maintenance
9. Which
statement describes a key finding of the Human Genome Project?
|
a. |
Humans produce one protein
per gene. |
|
b. |
All human beings are 99.9%
identical at the deoxyribonucleic acid (DNA) level. |
|
c. |
The Human Genome Project
has not yet been able to translate the accumulating raw research into
anything medically practical. |
|
d. |
Humans have more genes than
other species. |
ANS: B
The majority of the 0.1% genetic variations are found within and
not among populations. Most human genes produce at least three proteins. The
project’s research has been very valuable in the identification of genes
involved in disease and in the development of genetic testing. There are 20,500
genes in the human genome; scientists originally estimated more than 50,000
genes. Human genes are more efficient than the genes in other species, thereby
increasing the human genetic complexity.
DIF: Cognitive Level:
Remember
REF: p. 42
TOP: Nursing Process:
Assessment MSC:
Client Needs: Health Promotion and Maintenance
10. Which
condition or treatment reduces the risk of morbidity in women with the
inherited factor V Leiden disorder?
|
a. |
Anticoagulant therapy |
|
b. |
Pregnancy |
|
c. |
Oral contraceptives |
|
d. |
Hormone replacement therapy |
ANS: A
Factor V Leiden is the most common inherited risk factor for
primary or recurrent venous thromboembolism. It is an autosomal recessive
disorder that increases an individual’s risk for blood clots in the legs and
pulmonary emboli. This risk significantly increases if the woman is pregnant or
is taking oral contraceptives or hormone replacement therapy. Prophylactic
anticoagulation therapy decreases the risk of comorbidities.
DIF: Cognitive Level:
Understand
REF: p.
51
TOP: Nursing Process: Planning
MSC: Client Needs: Physiologic Integrity
11. Nurses
who elect to practice in the field of obstetrics must have a basic working
knowledge of genetics. What is the correct term used to describe an
individual’s genetic makeup?
|
a. |
Genotype |
|
b. |
Phenotype |
|
c. |
Karyotype |
|
d. |
Chromotype |
ANS: A
The genotype comprises all the genes the individual can pass on
to a future generation. The phenotype is the observable expression of an
individual’s genotype. The karyotype is a pictorial analysis of the number,
form, and size of an individual’s chromosomes. Genotype refers to an
individual’s genetic makeup.
DIF: Cognitive Level:
Remember
REF: p. 44
TOP: Nursing Process:
Assessment MSC:
Client Needs: Health Promotion and Maintenance
12. The
U.S. Department of Health and Human Services has designated Thanksgiving Day as
National Family History Day. The U.S. Surgeon General encourages family members
to discuss important family health information while sharing in holiday
gatherings. Why is this initiative significant to nurses?
|
a. |
Few genetic tests are
available that identify this information. |
|
b. |
Only physicians should
obtain this detailed information. |
|
c. |
Clients cannot accurately
complete these histories on their own. |
|
d. |
Family history is the
single most cost-effective source for genetic information. |
ANS: D
Although more than 1000 genetic tests are available, the single
most cost-effective piece of genetic information is the family history. Nurses
are ideally suited to take the lead in ongoing efforts to recognize the
significance of the family history as an important source of genetic
information. A computerized tool called My
Family Health Portrait is available free of charge
(https://familyhistory.hhs.gov/fhh-web/home.action). Other tools designed to
help the lay community in completing their family histories are available to
the public.
DIF: Cognitive Level:
Understand
REF: pp. 42-43
TOP: Nursing Process:
Assessment MSC: Client
Needs: Health Promotion and Maintenance
13. A
maternal-newborn nurse is caring for a mother who just delivered a baby born
with Down syndrome. Which nursing diagnosis would be the most essential in
caring for the mother of this infant?
|
a. |
Disturbed body image |
|
b. |
Interrupted family
processes |
|
c. |
Anxiety |
|
d. |
Risk for injury |
ANS: B
This mother will likely experience a disruption in the family
process related to the birth of a baby with an inherited disorder. Therefore,
the probable nursing diagnosis for this family is “Interrupted family
processes.” Women commonly experience “body image disturbances in the
postpartum period”; however, this nursing diagnosis is unrelated to giving
birth to a child with Down syndrome. The mother will likely have a mix of
emotions that may include anxiety, guilt, and denial, but this nursing
diagnosis is not the most essential for this family. “Risk for injury” is not
an applicable nursing diagnosis.
DIF: Cognitive Level: Apply
REF: p.
48
TOP: Nursing Process: Diagnosis
MSC: Client Needs: Psychosocial Integrity
14. A
couple has been counseled for genetic anomalies. They ask you, “What is
karyotyping?” Which description is most accurate?
|
a. |
“Karyotyping will reveal if
the baby’s lungs are mature.” |
|
b. |
“Karyotyping will reveal if
the baby will develop normally.” |
|
c. |
“Karyotyping will provide
information about the gender of the baby and the number and structure of the
chromosomes.” |
|
d. |
“Karyotyping will detect
any physical deformities the baby has.” |
ANS: C
Karyotyping provides genetic information such as gender and
chromosomal structure. The lecithin/sphingomyelin (L/S) ratio, not karyotyping,
reveals lung maturity. Although karyotyping can detect genetic anomalies, the
range of normal is nondescriptive, and not all such anomalies display obvious
physical deformities. The term deformities is
a nondescriptive word, and physical anomalies may be present that are not
detected by genetic studies (e.g., cardiac malformations).
DIF: Cognitive Level:
Analyze
REF: p. 46
TOP: Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance
15. Which
statement regarding genetic health care is most important to the nurse
practicing in this specialty?
|
a. |
Genetic disorders equally
affect people of all socioeconomic backgrounds, races, and ethnic groups. |
|
b. |
Genetic health care is more
concerned with populations than individuals. |
|
c. |
Providing emotional support
to the family during counseling is the most important of all nursing
functions. |
|
d. |
Taking genetic histories is
the province of large universities and medical centers. |
ANS: C
Perhaps the most important of all nursing functions is the
ability to provide emotional support. Nurses should be prepared to help with
various stress reactions from a couple facing the possibility of a genetic
disorder. Although anyone may have a genetic disorder, certain disorders appear
more often in certain ethnic and racial groups. Genetic health care is highly
individualized because treatments are based on the phenotypic responses of the
individual. Individual nurses at any facility can take a genetic history,
although larger facilities may have better support services.
DIF: Cognitive Level:
Understand
REF: p.
55
TOP: Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity
16. Which
statement most accurately describes dominant genetic disorders?
|
a. |
With a dominant disorder,
the likelihood of the second child also having the condition is 100%. |
|
b. |
An autosomal recessive
disease carries a one-in-eight risk of the second child also having the
disorder. |
|
c. |
Disorders involving
maternal ingestion of drugs carry a one-in-four chance of being repeated in
the second child. |
|
d. |
The risk factor remains the
same no matter how many affected children are already in the family. |
ANS: D
Each pregnancy is an independent event. The risk factor (e.g., one-in-two,
one-in-four) remains the same for each child, no matter how many children are
born to the family. In a dominant disorder, the likelihood of recurrence in
subsequent children is 50% (i.e., one-in-two). An autosomal recessive disease
carries a one-in-four chance of recurrence. In disorders involving maternal
ingestion of drugs, subsequent children would be at risk only if the mother
continued to take the drugs; the rate of risk would be difficult to calculate.
DIF: Cognitive Level: Understand
REF: p.
55
TOP: Nursing Process: Diagnosis
MSC: Client Needs: Health Promotion and Maintenance
17. Which
statement regarding chromosomal abnormalities is most accurate?
|
a. |
Chromosomal abnormalities
occur in approximately 10% of newborns. |
|
b. |
Abnormalities of number are
the leading cause of pregnancy loss. |
|
c. |
Down syndrome is a result
of an abnormal chromosomal structure. |
|
d. |
Unbalanced translocation
results in a mild abnormality that the child will outgrow. |
ANS: B
Aneuploidy is an abnormality of number that is
also the leading genetic cause of mental retardation. Chromosomal abnormalities
occur in fewer than 1% of newborns. Down syndrome is the most common form of a
trisomal abnormality, an abnormality of chromosome number (47 chromosomes).
Unbalanced translocation is an abnormality of chromosomal structure that often
has serious clinical effects.
DIF: Cognitive Level:
Understand
REF: p.
46
TOP: Nursing Process: Diagnosis
MSC: Client Needs: Psychosocial Integrity
18. Which
type of genetic tests in clinical practice are most often offered to clients
with a family history of disease?
|
a. |
Single-gene disorders |
|
b. |
Carrier screening |
|
c. |
Predictive value testing |
|
d. |
Predispositional testing |
ANS: A
Most tests now offered are tests for single-gene disorders in
clients with clinical symptoms or clients who have a family history of a
genetic disease. Carrier screening is used to identify individuals who have a
gene mutation for a genetic condition but do not display symptoms. Predictive
value testing is used only to clarify the genetic status of asymptomatic family
members. Predispositional testing differs from the other types of genetic
screening in that a positive result does not indicate a 100% chance of
developing the condition.
DIF: Cognitive Level:
Understand
REF: p.
43
TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
MULTIPLE RESPONSE
1. Which
congenital malformations result from multifactorial inheritance? (Select all that apply.)
|
a. |
Cleft lip |
|
b. |
Congenital heart disease |
|
c. |
Cri du chat syndrome |
|
d. |
Anencephaly |
|
e. |
Pyloric stenosis |
ANS: A, B, D, E
Cleft lip, congenital heart disease, anencephaly, and pyloric
stenosis are associated with multifactorial inheritance. Cri du chat syndrome
is related to a chromosomal deletion.
DIF: Cognitive Level:
Analyze
REF: p.
50
TOP: Nursing Process: Diagnosis
MSC: Client Needs: Psychosocial Integrity
2. Which
activities are included in the role of a nurse practicing in the field of
genetics? (Select all that
apply.)
|
a. |
Assessing the responses of
family members to a genetic disorder |
|
b. |
Performing genetic testing,
such as amniocentesis |
|
c. |
Constructing a family
pedigree of three or more generations |
|
d. |
Advising a pregnant mother
whose fetus has a genetic disorder to have an abortion |
|
e. |
Offering parents
information about genetics |
ANS: A, C, E
Assessing the responses of family members, constructing a family
pedigree, and offering parents information about genetics are activities that a
genetics nurse would carry out in caring for a family undergoing genetic
counseling. Physicians perform amniocentesis, but the nurse may assist in this
procedure. Being aware of their own values and beliefs and refraining from
attempting to influence the family are important responsibilities for nurses.
The nurse must respect the right of the individual or family to make autonomous
decisions.
DIF: Cognitive Level:
Understand
REF: p.
42
TOP: Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity
3. One
of the most promising clinical applications of the Human Genome Project has
been pharmacogenomic testing (the use of genetic information to guide a
client’s drug therapy). Which conditions are potential candidates for
pharmacogenomic application? (Select
all that apply.)
|
a. |
Fragile X syndrome |
|
b. |
Deep vein thrombosis (DVT) |
|
c. |
Breast cancer |
|
d. |
Myocardial infarction |
|
e. |
Hemophilia |
ANS: B, C, D
Associations between genetic variation and drug effect have been
observed for a number of commonly used drugs. The conditions for which these
are applicable include: DVT, breast cancer, and myocardial infarction. Gene
therapy has been unsuccessfully used in hemophilia treatment. Fragile X
syndrome is the leading cause of intellectual disability and lacks effective
treatment of any kind.
DIF: Cognitive Level: Apply
REF: p.
44
TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
Chapter 04: Assessment and Health Promotion
Lowdermilk: Maternity & Women’s Health Care, 11th Edition
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.
DIF: Cognitive Level:
Understand
REF: p.
63
TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
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.
DIF: Cognitive Level:
Understand
REF: pp. 66-67
TOP: Nursing Process:
Assessment MSC:
Client Needs: Health Promotion and Maintenance
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.
DIF: Cognitive Level:
Knowledge
REF: p. 68
TOP: Nursing Process:
Assessment MSC:
Client Needs: Health Promotion and Maintenance
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 client’s comfort should always be ensured before beginning the
interview.
DIF: Cognitive Level: Understand
REF: pp. 78-79
TOP: Nursing Process:
Assessment MSC:
Client Needs: Health Promotion and Maintenance
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 can’t have an
examination without removing all your clothes.” |
|
b. |
“I’ll ask the physician to
modify the examination.” |
|
c. |
“Tell me about your
undergarments. I’ll 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 woman’s 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.
DIF: Cognitive Level:
Apply
REF: pp. 79-80 TOP:
Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity
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 client’s 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.
DIF: Cognitive Level:
Apply
REF: p. 79
TOP: Nursing Process:
Assessment MSC:
Client Needs: Physiologic Integrity
7. Preconception
and prenatal care have become important components of women’s 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.
DIF: Cognitive Level:
Understand
REF: p.
69
TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
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.
DIF: Cognitive Level:
Remember
REF: p. 67
TOP: Nursing Process:
Assessment MSC:
Client Needs: Physiologic Integrity
9. Which
statement indicates that a client requires additional instruction regarding
BSE?
|
a. |
“Yellow discharge from my
nipple is normal if I’m 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.
DIF: Cognitive Level:
Analyze
REF: p. 63
TOP: Nursing Process:
Assessment MSC:
Client Needs: Health Promotion and Maintenance
10. A
blind woman has arrived for an examination. Her guide dog assists her to the
examination room. She appears nervous and says, “I’ve never had a pelvic
examination.” What response from the nurse would be most appropriate?
|
a. |
“Don’t worry. It will be
over before you know it.” |
|
b. |
“Try to relax. I’ll be very
gentle, and I won’t hurt you.” |
|
c. |
“Your anxiety is common. I
was anxious when I first had a pelvic examination.” |
|
d. |
“I’ll let you touch each
instrument that I’ll 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 client’s 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 client’s concerns.
DIF: Cognitive Level:
Apply
REF: p.
80
TOP: Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity
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.
DIF: Cognitive Level:
Remember
REF: p. 60
TOP: Nursing Process:
Assessment MSC:
Client Needs: Health Promotion and Maintenance
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.
DIF: Cognitive Level:
Knowledge
REF: p. 62
TOP: Nursing Process:
Assessment MSC:
Client Needs: Health Promotion and Maintenance
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.
DIF: Cognitive Level:
Understand
REF: p. 67
TOP: Nursing Process:
Assessment MSC:
Client Needs: Health Promotion and Maintenance
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.
DIF: Cognitive Level: Remember
REF: pp. 65-66
TOP: Nursing Process:
Assessment MSC:
Client Needs: Health Promotion and Maintenance
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.
DIF: Cognitive Level:
Remember
REF: p. 67
TOP: Nursing Process:
Assessment MSC:
Client Needs: Health Promotion and Maintenance
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.
DIF: Cognitive Level:
Understand
REF: p. 74
TOP: Nursing Process:
Assessment MSC:
Client Needs: Psychosocial Integrity
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 physician’s
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.
DIF: Cognitive Level:
Apply
REF: p. 83
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
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.
DIF: Cognitive Level:
Remember
REF: p.
92
TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
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 client’s 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.
DIF: Cognitive Level:
Remember
REF: p. 86
TOP: Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity
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.
DIF: Cognitive Level:
Apply
REF: p.
75
TOP: Nursing Process: Diagnosis
MSC: Client Needs: Health Promotion and Maintenance
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.
DIF: Cognitive Level:
Apply
REF: pp. 60-61
TOP: Nursing Process:
Assessment MSC:
Client Needs: Health Promotion and Maintenance
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.
DIF: Cognitive Level:
Remember
REF: p. 62
TOP: Nursing Process:
Assessment MSC:
Client Needs: Health Promotion and Maintenance
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 individual’s body image.
DIF: Cognitive Level:
Apply
REF: p. 75
TOP: Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
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