Maternity & Women’s Health Care 10th Edition by Kathryn Rhodes – Deitra Leonard Lowdermilk – Test Bank
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Lowdermilk: Maternity & Women’s Health Care, 10th Edition
Chapter 03: Clinical Genetics
Test Bank
MULTIPLE CHOICE
1. A
father and mother are carriers of phenylketonuria (PKU). Their 2-year-old
daughter has PKU. The couple tells the nurse that they are planning to have a
second baby. Because their daughter has PKU, they are sure that their next baby
won’t be affected. What response by the nurse is most accurate?
|
a. |
“Good planning; you need to
take advantage of the odds in your favor.” |
|
b. |
“I think you’d better check
with your doctor first.” |
|
c. |
“You are both carriers, so
each baby has a 25% chance of being affected.” |
|
d. |
“The ultrasound indicates a
boy, and boys are not affected by PKU.” |
ANS: C
The chance is one in four that each child produced by this
couple will be affected by 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:
Application REF: 53
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning
2. A
woman 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. What action by the nurse is
most appropriate?
|
a. |
Talk to the woman and refer
her to a genetic counselor. |
|
b. |
Suggest that the woman
travel to a fetal treatment center for intrauterine surgery. |
|
c. |
Tell her that everything is
going to be fine. |
|
d. |
Sit with her and calmly
suggest that she consider terminating this pregnancy. |
ANS: A
Before the woman 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 nondirectiveness.
This respects the right of the individual or family being counseled to make
autonomous decisions.
DIF: Cognitive Level:
Application REF: 56
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning
3. A
woman who is gravida 2 and 16 GW 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, you would assess for documentation of which
genetic disease?
|
a. |
Tay-Sachs disease |
|
b. |
Galactosemia |
|
c. |
Neurofibromatosis (NF) |
|
d. |
Phenylketonuria |
ANS: C
Clinical manifestations of NF may include axillary freckling and
café-au-lait spots.
Tay-Sachs disease is not associated with café-au-lait spots.
Tay-Sachs is an incurable lipid-storage disorder.
Galactosemia is not associated with café-au-lait spots; rather
it is an inborn error of metabolism.
Phenylketonuria is not associated with café-au-lait spots. This
child would have difficulty manufacturing the liver enzyme phenylalanine.
DIF: Cognitive Level:
Knowledge REF: 52
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment
4. A new
father has just been told that his child has trisomy 18. He asks the nurse what
made her suspect a problem after the birth. The nurse explains that during the infant’s
newborn assessment, she noted:
|
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:
Comprehension
REF: “50, 51”
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment
5. A
nurse is assessing the knowledge of new parents with a child born with maple
syrup urine disease (MSUD). This is an autosomal recessive inherited disorder,
which means that:
|
a. |
Both genes of a pair must
be abnormal for the disorder to be expressed |
|
b. |
Only one copy of the
abnormal gene is required for the disorder to be expressed |
|
c. |
The disorder occurs in
males and heterozygous females |
|
d. |
The disorder is carried on
the X chromosome |
ANS: A
MSUD is a type of autosomal recessive inheritance disorder in
which both genes of a pair must be abnormal for the disorder to be expressed.
MSUD is an autosomal recessive inheritance disorder that cannot
be expressed when only one copy of the abnormal gene is present.
MSUD is not an autosomal dominant inheritance disorder. The
disorder would not be present with this genetic presentation.
MSUD is not an X- linked disorder; it is an autosomal recessive
inheritance disorder in which both genes of a pair must be abnormal for the
disorder to be present.
DIF: Cognitive Level:
Comprehension
REF: 53
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment
6. In
presenting to obstetric nurses interested in genetics, the genetic nurse
identifies the primary risk(s) associated with genetic testing as:
|
a. |
Anxiety and altered family
relationships |
|
b. |
Denial of insurance
benefits |
|
c. |
High false positives
associated with genetic testing |
|
d. |
Ethnic and socioeconomic
disparity associated with genetic testing |
ANS: B
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.
Anxiety and altered family relationships are often the result of
genetic testing; however, they are not the primary risk.
False-negative results are more likely to affect an individual
or family because they will fail to seek necessary follow-up.
Caucasian middle-class families have greater access to genetic
screening, so this is less of a risk for this population.
DIF: Cognitive Level:
Comprehension
REF: 47
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Implementation
7. A
man’s wife is pregnant for the third time. One child was born with cystic
fibrosis, and the other child is healthy. The man wonders what the chance is
that this child will have cystic fibrosis. This type of testing is known as:
|
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, they will be given a recurrence risk test.
If a couple has not yet had children but are known to be at risk
for having children with a genetic disease, they are given an occurrence risk
test. This couple already has a child with a genetic disorder.
Predictive testing is used to clarify 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:
Comprehension
REF: 56
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning
8. Cancer
is genetic and begins with one or more genetic mutations. A cancer specifically
being investigated in this regard is:
|
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.
Tobacco smoke is a known causative factor for lung cancer. There
may also be an acquired mutation of an oncogene 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:
Knowledge REF: 55
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment
9. In
practical terms regarding genetic health care, nurses should be aware that:
|
a. |
Genetic disorders affect
equally people of all socioeconomic backgrounds, races, and ethnic groups |
|
b. |
Genetic health care is more
concerned with populations than individuals |
|
c. |
The most important of all
nursing functions is providing emotional support to the family during
counseling |
|
d. |
Taking genetic histories is
the province of large universities and medical centers |
ANS: C
Nurses should be prepared to help with a variety of 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:
Comprehension
REF: 57
OBJ: Client Needs: Psychosocial Integrity
TOP: Nursing Process: Planning
10. The
Human Genome Project, which began in 1990:
|
a. |
Expected to complete a map
of the entire human genome by 2010 |
|
b. |
Found that all human beings
are 99.9% identical at the DNA level |
|
c. |
Has not yet been able to
translate the accumulating raw research into anything medically practical |
|
d. |
Put its research relevant
to nursing in a document published by the International Society of Nurses in
Genetics (ISONG) |
ANS: B
The majority of the 0.1% genetic variations are found within and
not among populations.
The project completed its map ahead of schedule, in 2000.
The project’s research has been very valuable in the
identification of genes involved in disease and in the development of genetic
tests.
The ISONG document, the “Statement of the Scope and Standards of
Genetics Clinical Nursing Practice,” is very useful but not directly related to
the Human Genome Project.
DIF: Cognitive Level:
Knowledge REF: 44
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment
11. With
regard to prenatal genetic testing, nurses should be aware that:
|
a. |
Maternal serum screening
can determine whether a pregnant woman is at risk of carrying a fetus with
Down syndrome |
|
b. |
Carrier screening tests
look for gene mutations of people already showing symptoms of a disease |
|
c. |
Predisposition testing
predicts with near certainty that symptoms will appear |
|
d. |
Presymptomatic testing is
used to predict the likelihood of breast cancer |
ANS: A
Maternal serum screening identifies the risk for the neural tube
defect and the specific chromosome abnormality involved in Down syndrome.
Carriers of some diseases, such as sickle cell disease, do not
display symptoms.
Predisposition testing determines susceptibility, such as for
breast cancer.
Presymptomatic testing indicates that if the gene is present,
symptoms are certain to appear.
DIF: Cognitive Level:
Knowledge REF: 45
OBJ: Client Needs: Physiologic Integrity
TOP: Nursing Process: Planning
12. A
nurse must be cognizant that an individual’s genetic makeup is known as
his/her:
|
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: Knowledge
REF: 47
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment
13. The
U.S. Department of Health and Human Services has designated Thanksgiving Day as
National Family History Day. The Surgeon General encourages family members to
discuss important family health information while sharing in holiday
gatherings. This initiative is significant to nurses because:
|
a. |
There are few genetic tests
available to identify this information |
|
b. |
Only physicians should
obtain this detailed information |
|
c. |
Clients cannot accurately
complete these histories on their own |
|
d. |
This is the single most
cost effective source of genetic information |
ANS: D
Although there are more than 1000 genetic tests available, the
single most cost-effective piece of genetic information is the family history.
Although there are more than 1000 genetic tests 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 (www.hhs.gov/familyhistory/download.html). Other tools to aid
the lay community in completing their family histories are available to the
public.
DIF: Cognitive Level:
Comprehension
REF: 45
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment
MULTIPLE RESPONSE
1. Which
congenital malformations result from multifactorial inheritance? Choose 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:
Knowledge REF: 52
OBJ: Client Needs: Psychosocial Integrity
TOP: Nursing Process: Diagnosis
2. Which
activities are included in the role of a nurse practicing in the field of
genetics? Choose 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; the nurse may assist in this
procedure. It is important for nurses to be aware of their own values and
beliefs and to refrain from attempting to influence the family. The nurse must
respect the right of the individual or family to make autonomous decisions.
DIF: Cognitive Level:
Comprehension
REF: 44
OBJ: Client Needs: Psychosocial Integrity
TOP: Nursing Process: Planning
COMPLETION
1. The
karyotype designated as female is ___________________.
ANS: 46 XX
DIF: Cognitive Level:
Comprehension
REF: 48
OBJ: Client Needs: Psychosocial Integrity
TOP: Nursing Process: Diagnosis
TRUE/FALSE
1. BRCA1
and BRCA2 mutations account for approximately 50% of hereditary breast and
ovarian cancer. Is this statement true or false?
ANS: F
These mutations account for about 70% to 85% of hereditary
breast and ovarian cancers. The mutation is inherited as an autosomal dominant
pattern; thus each offspring of an individual found to carry a BRCA mutation
has a 50% chance of inheriting the same mutation. According to estimations of
lifetime risk, 12% of women in the general population will develop breast
cancer compared with about 60% of women who have inherited a deleterious
mutation in their BRCA genes.
DIF: Cognitive Level: Knowledge
REF: 55
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning
Lowdermilk: Maternity & Women’s Health Care, 10th Edition
Chapter 04: Assessment and Health Promotion
Test Bank
MULTIPLE CHOICE
1. The two
primary functions of the ovary are:
|
a. |
Normal female development
and sex hormone release |
|
b. |
Ovulation and internal
pelvic support |
|
c. |
Sexual response and
ovulation |
|
d. |
Ovulation and hormone
production |
ANS: D
The two functions of the ovaries are ovulation and hormone
production.
The presence of ovaries does not guarantee normal female
development. The ovaries produce estrogen, progesterone, and androgen.
Ovulation is the release of a mature ovum from the ovary; the
ovaries are not responsible for interval pelvic support.
Sexual response is a feedback mechanism involving the
hypothalamus, anterior pituitary gland, and the ovaries. Ovulation does occur
in the ovaries.
DIF: Cognitive Level:
Knowledge REF: 63
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment
2. Because
of the effect of cyclic ovarian changes on the breast, the best time for breast
self-examination (BSE) is:
|
a. |
Five to 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 about 5 to 7 days after menstruation stops. 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. This 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:
Knowledge REF: 65
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning
3. Menstruation
is periodic uterine bleeding:
|
a. |
That occurs every 28 days |
|
b. |
In which the entire uterine
lining is shed |
|
c. |
That is regulated by
ovarian hormones |
|
d. |
That leads to fertilization |
ANS: C
Menstruation is periodic uterine bleeding that is controlled by
a feedback system involving three cycles: the endometrial cycle, the
hypothalamic-pituitary cycle, and the ovarian cycle.
The average length of a menstrual cycle is 28 days, but
variations are normal.
During the endometrial cycle, the functional two thirds of the
endometrium is shed.
Lack of fertilization leads to menstruation.
DIF: Cognitive Level:
Knowledge REF: 67
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment
4. Individual
irregularities in the ovarian (menstrual) cycle are most often caused by:
|
a. |
Variations in the
follicular (preovulatory) phase |
|
b. |
An intact
hypothalamic-pituitary feedback mechanism |
|
c. |
A functioning corpus luteum |
|
d. |
A 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:
Comprehension
REF: 67
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment
5. Prostaglandins
are produced in most organs of the body, including the uterus. Other source(s)
of prostaglandins is/are:
|
a. |
Ovaries |
|
b. |
Breast milk |
|
c. |
Menstrual blood |
|
d. |
The vagina |
ANS: C
Menstrual blood is a potent source of prostaglandins.
Prostaglandins are not produced in the ovaries.
Breast milk is not a source of prostaglandins.
The vagina neither produces nor is a source of prostaglandins.
DIF: Cognitive Level:
Knowledge REF: 69
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment
6. Physiologically,
sexual response can be characterized by:
|
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: 69
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment
7. Before
beginning the health history interview, the nurse should perform all
actions except:
|
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.
It is important to begin any client interaction with a smile.
This assists in putting the client at ease.
If the nurse speaks in a relaxed manner, the client will likely
be more relaxed during the interview.
Always ensure the client’s comfort prior to beginning the
interview.
DIF: Cognitive Level: Comprehension
REF: 78
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment
8. 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 states, “I have
special undergarments that I do not remove for religious reasons.” The most
appropriate response from the nurse would be:
|
a. |
“You can’t have an
examination without removing all your clothes.” |
|
b. |
“I’ll ask the doctor to
modify the examination.” |
|
c. |
“Tell me about your
undergarments. I’ll explain the examination procedure, and then we can
discuss how you can have your examination comfortably.” |
|
d. |
“What? I’ve never heard of
such a thing! That sounds different and strange.” |
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:
Application REF: 72
OBJ: Client Needs: Psychosocial Integrity
TOP: Nursing Process: Planning
9. 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. The nurse’s initial
response should be to:
|
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 she has a vaginal infection |
|
d. |
Ask the woman to reschedule
the appointment for the examination |
ANS: C
An important element of the history and physical examination is
the client’s description of any symptoms she may be experiencing.
Although this statement is true, 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:
Application REF: 78
OBJ: Client Needs: Physiologic Integrity
TOP: Nursing Process: Assessment
10. One
purpose of preconception care is to:
|
a. |
Ensure that pregnancy
complications do not occur |
|
b. |
Identify women 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 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.
In many instances, counseling can allow behavior modification
before 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, she likely is aware of
prenatal care.
DIF: Cognitive Level:
Comprehension
REF: 70
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning
11. The
transition phase during which ovarian function and hormone production decline
is called:
|
a. |
The climacteric |
|
b. |
Menarche |
|
c. |
Menopause |
|
d. |
Puberty |
ANS: A
The climacteric is a transitional phase 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 stage between childhood and sexual maturity.
DIF: Cognitive Level:
Knowledge REF: 69
OBJ: Client Needs: Physiologic Integrity
TOP: Nursing Process: Assessment
12. Which
statement indicates that a client requires additional instruction about breast
self-examination?
|
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 exam.” |
|
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 in which to ascertain any
changes in the breast tissue.
DIF: Cognitive Level:
Analysis
REF: 65
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment
13. 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.” The nurse’s most appropriate response would be:
|
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
item 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 communicate openly and
directly 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 won’t 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:
Application REF: 79
OBJ: Client Needs: Psychosocial Integrity
TOP: Nursing Process: Planning
14. A
20-year-old client calls the clinic to report that she has found a lump in her
breast. The nurse’s best response is:
|
a. |
“Don’t worry about it. I’m
sure it’s nothing.” |
|
b. |
“Wear a tight bra, and it
should shrink.” |
|
c. |
“Many women have benign
lumps and bumps in their breasts. However, to make sure it’s benign you
should come in for an examination by your physician.” |
|
d. |
“Check it again in 1 month
and call me back if it’s still there.” |
ANS: C
Try to ease the client’s fear but provide a time for a thorough
evaluation of the lump, because it may indicate abnormal changes in the breast.
Discrediting the client’s findings may discourage her from
continuing with breast self-examination (BSE).
Wearing a tight bra may irritate the skin and will not cause the
lump to shrink.
Delaying treatment may allow proliferation of abnormal cells.
DIF: Cognitive Level:
Analysis
REF: 65
OBJ: Client Needs: Physiologic Integrity
TOP: Nursing Process: Assessment
15. The
female reproductive organ(s) responsible for cyclic menstruation is/are the:
|
a. |
Uterus |
|
b. |
Ovaries |
|
c. |
Vaginal vestibule |
|
d. |
Urethra |
ANS: A
The uterus is responsible for cyclic menstruation. It also
houses and nourishes the fertilized ovum and the fetus.
The ovaries are responsible for ovulation and production of
estrogen; the uterus is responsible for cyclic menstruation.
The vaginal vestibule is an external organ that has openings to
the urethra and vagina; the uterus is responsible for cyclic menstruation.
The urethra is not a reproductive organ, although it is found in
the area; the uterus is responsible for cyclic menstruation.
DIF: Cognitive Level:
Knowledge REF: 62
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment
16. The
body part that both protects the pelvic structures and accommodates the growing
fetus during pregnancy is the:
|
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 bony pelvis
protects and accommodates the growing fetus.
The vaginal vestibule contains openings to the urethra and
vagina; the bony pelvis protects and accommodates the growing fetus.
The fourchette is formed by the labia minor; the bony pelvis
protects and accommodates the growing fetus.
DIF: Cognitive Level:
Knowledge REF: 63
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment
17. A
fully matured endometrium that has reached the thickness of heavy, soft velvet
describes the _____ phase of the endometrial cycle.
|
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 phase the
endometrium becomes fully mature.
During the menstrual phase the endometrium is being shed; the
endometrium is fully mature again during the secretory phase.
The proliferative phase is a period of rapid growth, but the
endometrium becomes fully mature again during the secretory phase.
During the ischemic phase the blood supply is blocked and
necrosis develops. The endometrium is fully mature during the secretory phase.
DIF: Cognitive Level:
Comprehension
REF: 67
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment
18. The
stimulated release of gonadotropin-releasing hormone (GnRH) and
follicle-stimulating hormone (FSH) is part of the:
|
a. |
Menstrual cycle |
|
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 occur
simultaneously 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:
Knowledge REF: 67
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment
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