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Chapter 07: Reproductive Health
Perry: Maternal Child Care Nursing in Canada, 2nd Canadian Edition

MULTIPLE CHOICE

1. When assessing the patient for amenorrhea, the nurse should be aware that which may cause
amenorrhea?
a. Alcohol use
b. Type 1 diabetes mellitus
c. Lack of exercise
d. Cessation of oral contraception use
ANS: B
Type 1 diabetes may cause amenorrhea. Lack of exercise does not cause amenorrhea. It is the
use of oral contraception that may cause amenorrhea. Alcohol use does not cause amenorrhea.

DIF: Cognitive Level: Knowledge REF: p. 107

OBJ: Nursing Process: Assessment

2. When a nurse is counselling a woman for primary dysmenorrhea, which nonpharmacological

intervention might be recommended?
a. Increase the intake of red meat and simple carbohydrates.
b. Reduce the intake of diuretic foods, such as peaches and asparagus.
c. Temporarily substitute physical activity for a sedentary lifestyle.
d. Use a heating pad on the abdomen to relieve cramping.
ANS: D
Heat minimizes cramping by increasing vasodilation and muscle relaxation and minimizing
uterine ischemia. Dietary changes such as eating less red meat may be recommended for
women experiencing dysmenorrhea. Increasing the intake of diuretics, including natural
diuretics such as asparagus, cranberry juice, peaches, parsley, and watermelon, may help ease
the symptoms associated with dysmenorrhea. Exercise has been found to help relieve
menstrual discomfort through increased vasodilation and subsequent decreased ischemia.

DIF: Cognitive Level: Analysis REF: p. 110 OBJ: Nursing Process: Planning

3. What symptom described by a woman is characteristic of premenstrual syndrome (PMS)?

a. Irritable and moody prior to menses.
b. Lower abdominal pain that begins halfway through menstruation.
c. Nausea and headache after menses begins lasting 2 to 3 days.
d. Abdominal bloating and breast pain halfway through menstruation.
ANS: A
PMS is a cluster of physical, psychological, and behavioural symptoms that begin in the luteal
phase of the menstrual cycle and coincide with menses. Complaints of lower abdominal pain,
nausea and headaches, and abdominal bloating are all associated with PMS; however, the
timing reflected is inaccurate.

DIF: Cognitive Level: Application REF: p. 111

OBJ: Nursing Process: Assessment
4. A woman complains of severe abdominal and pelvic pain around the time of menstruation that
has gotten worse over the last 5 years. She also complains of pain during intercourse and has
tried unsuccessfully to get pregnant for the past 18 months. What are these symptoms most
likely related to?
a. Endometriosis
b. PMS
c. Primary dysmenorrhea
d. Secondary dysmenorrhea
ANS: A
Symptoms of endometriosis can change over time and may not reflect the extent of the
disease. Major symptoms include dysmenorrhea and deep pelvic dyspareunia (painful
intercourse). Impaired fertility may result from adhesions caused by endometriosis. Although
endometriosis may be associated with secondary dysmenorrhea, it is not a cause of primary
dysmenorrhea or PMS. In addition, this woman is complaining of dyspareunia and infertility,
which are associated with endometriosis, not with PMS or primary or secondary
dysmenorrhea.

DIF: Cognitive Level: Comprehension REF: p. 113

OBJ: Nursing Process: Assessment

5. Nafarelin (Synarel) 200 mg BID per nasal spray currently is used as a treatment for
mild-to-severe endometriosis. What patient teaching should the nurse tell the woman who is
taking this medication?
a. It stimulates the secretion of gonadotropin-releasing hormone (GnRH), thereby
stimulating ovarian activity.
b. It should be sprayed into one nostril every other day.
c. It should be injected into subcutaneous tissue BID.
d. It can cause her to experience some hot flashes and vaginal dryness.
ANS: D
Nafarelin is a GnRH agonist, and its adverse effects are similar to those of menopause. The
hypoestrogenism effect results in hot flashes and vaginal dryness. Nafarelin is a GnRH
agonist that suppresses the secretion of GnRH and is administered twice daily by nasal spray.

DIF: Cognitive Level: Application REF: p. 113

OBJ: Nursing Process: Implementation

6. While interviewing a 31-year-old woman before her routine gynecological examination, the
nurse collects data about the patient’s recent menstrual cycles. The nurse should collect
additional information when the woman makes which statement?
a. The woman says her menstrual flow lasts 5 to 6 days.
b. She describes her flow as very heavy.
c. She reports that she has had a small amount of spotting midway between her
periods for the past 2 months.
d. She says the length of her menstrual cycle varies from 26 to 29 days.
ANS: B
 Menorrhagia is defined as excessive menstrual bleeding, in either duration or amount. Heavy
bleeding can have many causes. The amount of bleeding and its effect on daily activities
should be evaluated. A menstrual flow lasting 5 to 6 days is a normal finding. Mittelschmerz,
a small amount of bleeding or spotting that occurs at the time of ovulation (14 days before
onset of the next menses), is considered normal. During her reproductive years, a woman may
have physiological variations in her menstrual cycle. Variations in the length of a menstrual
cycle are considered normal.

DIF: Cognitive Level: Comprehension REF: p. 107 | p. 114

OBJ: Nursing Process: Assessment

7. When evaluating a patient whose primary complaint is secondary amenorrhea, the nurse must
be aware that lack of menstruation is most often the result of which event?
a. Stress
b. Excessive exercise
c. Pregnancy
d. Eating disorders
ANS: C
Secondary amenorrhea, or the absence of menstrual flow, is most often a result of pregnancy.
Although stress, excessive exercise, and eating disorders all may be contributing factors, none
is the most common factor associated with amenorrhea.

DIF: Cognitive Level: Knowledge REF: p. 107

OBJ: Nursing Process: Assessment | Nursing Process: Diagnosis

8. When planning care for a woman who has been diagnosed as having uterine fibroids, what is
important for the nurse to know?
a. Fibroids are malignant tumours of the uterus that require radiation or
chemotherapy.
b. Fibroids will increase in size during the perimenopausal period.
c. Menorrhagia is a common finding in women with uterine fibroids.
d. The woman is unlikely to become pregnant as long as the fibroids are in her uterus.
ANS: C
Uterine fibroids are a common cause of menorrhagia. Fibroids are benign tumours of the
smooth muscle of the uterus, and their etiology is unknown. Fibroids are estrogen sensitive
and shrink as levels of estrogen decline. Fibroids occur in 25% of women of reproductive age
and are seen in 2% of pregnant women.

DIF: Cognitive Level: Comprehension REF: p. 115 OBJ: Nursing Process: Planning

9. During her annual gynecological checkup, a woman states that recently she has been
experiencing cramping and pain during her menstrual periods. The nurse would use which
term to document this complaint?
a. Amenorrhea
b. Dysmenorrhea
c. Dyspareunia
d. Premenstrual syndrome (PMS)
ANS: B
 Dysmenorrhea is pain during or shortly before menstruation. Amenorrhea is the absence of
menstrual flow. Dyspareunia is pain during intercourse. PMS is a cluster of physical,
psychological, and behavioural symptoms that begin in the luteal phase of the menstrual cycle
and resolve within a couple of days of the onset of menses.

DIF: Cognitive Level: Knowledge REF: p. 108 OBJ: Nursing Process: Diagnosis

10. Nurses should be aware that which is true with regard to dysmenorrhea?
a. It is more common in older women.
b. It is more common in leaner women who exercise strenuously.
c. Symptoms can begin at any point in the ovulatory cycle.
d. Pain usually occurs in the suprapubic area or lower abdomen.
ANS: D
Pain is described as sharp and cramping or sometimes as a dull ache. It may radiate to the
lower back or upper thighs. Dysmenorrhea is more common in younger women ages 17 to 24
and in women who smoke and who are obese. Symptoms begin with menstruation or
sometimes a few hours before the onset of flow.

DIF: Cognitive Level: Knowledge REF: p. 108 OBJ: Nursing Process: Diagnosis

11. Which statement is accurate?

a. Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual
syndrome (PMS) and more common in younger women.
b. Secondary dysmenorrhea is more intense and medically significant than primary
dysmenorrhea.
c. Premenstrual syndrome is a complex but clearly understood condition that may
include many symptoms.
d. The causes of PMS have been well established.
ANS: A
PMDD is a more severe variant of PMS. PMS may manifest itself with one or more of many
physical, mood, and behavioural symptoms and is poorly understood. Secondary
dysmenorrhea is characterized by more muted pain than that seen in primary dysmenorrhea;
the medical treatment is much the same. The cause of PMS is unknown. It may be a collection
of different problems.

DIF: Cognitive Level: Comprehension REF: p. 111 OBJ: Nursing Process: Diagnosis

12. Nurses should be aware of which in relation to endometriosis?

a. It is characterized by the presence and growth of endometrial tissue inside the
uterus.
b. It is found more often in Black women than in White or Asian women.
c. It may worsen with repeated cycles or remain asymptomatic and disappear after
menopause.
d. It is unlikely to affect sexual intercourse or fertility.
ANS: C
Symptoms vary among women, ranging from nonexistent to incapacitating. With
endometriosis the endometrial tissue is outside the uterus. Endometriosis is found equally in
women from all cultures. Women can experience painful intercourse and impaired fertility.
 DIF: Cognitive Level: Knowledge REF: p. 113
OBJ: Nursing Process: Assessment

13. Which refers to an alteration in cyclic bleeding that occurs between periods of menstruation?
a. Oligomenorrhea
b. Menorrhagia
c. Leiomyoma
d. Metrorrhagia
ANS: D
Metrorrhagia is bleeding between periods. It can be caused by progestin injections and
implants. Oligomenorrhea is infrequent or scanty menstruation. Menorrhagia is excessive
menstruation. Leiomyoma is a common cause of excessive bleeding.

DIF: Cognitive Level: Knowledge REF: p. 114 OBJ: Nursing Process: Diagnosis

14. What should the nurse be aware of with regard to abnormal uterine bleeding (AUB)?
a. Inherited blood disorders may be a cause of AUB.
b. It most often occurs in middle age.
c. Acute bleeding episodes require a dilation and curettage.
d. The most effective medical treatment involves steroids.
ANS: A
Inherited bleeding disorders may be an underlying cause of abnormal uterine bleeding, with
von Willebrand’s disease present in the majority of cases, and should be considered when
other causes cannot be determined. AUB can occur at any age. Acute bleeding episodes do not
automatically require a dilation and curettage. The most effective medical treatment is oral or
intravenous estrogen, not steroids.

DIF: Cognitive Level: Knowledge REF: p. 114 OBJ: Nursing Process: Diagnosis

15. Management of primary dysmenorrhea often requires a multifaceted approach. What is the
optimal pharmacological therapy for pain relief for dysmenorrhea?
a. Acetaminophen
b. Oral contraceptives (OCPs)
c. Nonsteroidal anti-inflammatory drugs (NSAIDs)
d. Aspirin
ANS: C
This pharmacological agent has the strongest research results for pain relief. Often if one
NSAID is not effective, another one will provide relief. Approximately 80% of women find
relief from these prostaglandin inhibitors. Preparations containing acetaminophen are less
effective for dysmenorrhea because they lack the antiprostaglandin properties of NSAIDs.
OCPs are a reasonable choice for women who also want birth control. The benefit of OCPs is
the reduction of menstrual flow and irregularities. OCPs may be contraindicated for some
women and have a number of potential adverse effects. NSAIDs are the drug of choice. If a
woman is taking an NSAID, she should avoid taking aspirin.

DIF: Cognitive Level: Application REF: pp. 109-110 OBJ: Nursing Process: Planning

16. What are the two primary areas of risk for sexually transmitted infections (STIs)?
 a. Sexual orientation and socioeconomic status
b. Age and educational level
c. Large number of sexual partners and race
d. Risky sexual behaviours and inadequate preventive health behaviours
ANS: D
Risky sexual behaviours and inadequate preventive health behaviours put a person at risk for
acquiring or transmitting an STI. Low socioeconomic status may be a factor in being less able
to purchase barrier protection, and sexual orientation does not put one at higher risk. Younger
individuals with less education may not be aware of proper prevention techniques: however,
these are not the primary areas of risk for STIs. Having a large number of sexual partners is
certainly a risk-taking behaviour. Being of a certain race does not increase the risk for STIs.

DIF: Cognitive Level: Knowledge REF: p. 117

OBJ: Nursing Process: Assessment

17. When evaluating a patient for sexually transmitted infections (STIs), the nurse should be
aware that which STI is on the rise in Canada?
a. Chancroid
b. Candidiasis
c. Chlamydia
d. Herpes simplex virus (HSV) type 2
ANS: C
Chlamydia is the one of the three STIs on the rise in Canada; the other two are gonorrhea and
syphilis. Candidiasis is caused by a fungus, not by bacteria. Chancroid is not on the rise in
Canada. HSV type 2 is common in women; however, it is not cited as one of the three STIs
that are on the increase in Canada.

DIF: Cognitive Level: Knowledge REF: p. 118

OBJ: Nursing Process: Assessment

18. What is the viral sexually transmitted infection (STI) that affects most people in Canada
today?
a. Herpes simplex virus type 2 (HSV-2)
b. Human papillomavirus (HPV)
c. Human immunodeficiency virus (HIV)
d. Cytomegalovirus (CMV)
ANS: B
HPV infection, an STI, is the most prevalent viral STI seen in ambulatory health care settings.
HSV-2, HIV, and CMV are all viral STIs, but are not the most prevalent viral STI.

DIF: Cognitive Level: Knowledge REF: p. 124

OBJ: Nursing Process: Assessment

19. Which medication does the Public Health Agency of Canada recommend for the treatment of
patients with human papillomavirus (HPV)?
a. Miconazole ointment
b. Topical podofilox 0.5% solution or gel
c. Penicillin given intramuscularly (IM) for two doses
d. Metronidazole by mouth
 ANS: B
Available treatments are imiquimod, podophyllin, and podofilox. Miconazole ointment is used
to treat athlete’s foot. Penicillin IM is used to treat syphilis. Metronidazole is used to treat
bacterial vaginosis.

DIF: Cognitive Level: Knowledge REF: p. 125

OBJ: Nursing Process: Implementation

20. A woman has a thick, white, lumpy, cottage cheese-like discharge, with patches on her labia
and in her vagina. She complains of intense pruritus. The nurse would anticipate which
preparation for treatment?
a. Fluconazole
b. Tetracycline
c. Clindamycin
d. Acyclovir
ANS: A
Fluconazole, metronidazole, and clotrimazole are the drugs of choice to treat candidiasis.
Tetracycline is used to treat syphilis. Clindamycin is used to treat bacterial vaginosis.
Acyclovir is used to treat genital herpes.

DIF: Cognitive Level: Synthesis REF: p. 131

OBJ: Nursing Process: Implementation

21. What do most laboratory tests focus on to detect the human immunodeficiency virus (HIV)?
a. HIV virus
b. HIV antibodies
c. CD4 counts
d. CD8 counts
ANS: B
The screening tool used to detect HIV is the enzyme immunoassay, which tests for the
presence of antibodies to the HIV virus. CD4 counts are associated with the incidence of
acquired immunodeficiency syndrome (AIDS) in HIV-infected individuals.

DIF: Cognitive Level: Knowledge REF: p. 129 OBJ: Nursing Process: Planning

22. What would most likely be included for the care management of a woman diagnosed with
acute pelvic inflammatory disease (PID)?
a. Oral antiviral therapy
b. Bedrest in a semi-Fowler position
c. Antibiotic regimen continued until symptoms subside
d. Frequent pelvic examination to monitor the progress of healing
ANS: B
The woman with acute PID should be on bedrest in a semi-Fowler position. Broad-spectrum
antibiotics are used. Antibiotics must be taken as prescribed, even if symptoms subside. Few
pelvic examinations should be conducted during the acute phase of the disease.

DIF: Cognitive Level: Application REF: p. 124

OBJ: Nursing Process: Implementation
23. On vaginal examination of a 30-year-old woman, the nurse documents the following findings:
profuse, thin, greyish white vaginal discharge with a “fishy” odour; complaint of pruritus.
These findings lead the nurse to which diagnosis?
a. Bacterial vaginosis (BV)
b. Candidiasis
c. Trichomoniasis
d. Gonorrhea
ANS: A
Most women with BV complain of a characteristic “fishy” odour. The discharge usually is
profuse and thin and has a white, grey, or milky colour. Some women also may have mild
irritation or pruritus. The discharge associated with candidiasis is thick, white, and lumpy and
resembles cottage cheese. Trichomoniasis may be asymptomatic, but women commonly have
a characteristic yellowish to greenish, frothy, mucopurulent, copious, and malodorous
discharge. Women with gonorrhea are often asymptomatic. They may have a purulent
endocervical discharge, but discharge usually is minimal or absent.

DIF: Cognitive Level: Comprehension REF: p. 130

OBJ: Nursing Process: Assessment

24. What is a recommended treatment for human papillomavirus (HPV)?

a. Acyclovir
b. Ofloxacin
c. Podophyllin
d. Penicillin
ANS: C
Podophyllin is a solution used in the treatment of HPV. Acyclovir is an antiviral treatment for
herpes simplex virus. Ofloxacin is an antibacterial treatment for gonorrhea. Penicillin is used
in the treatment of syphilis.

DIF: Cognitive Level: Knowledge REF: p. 120 | Table 7-3

OBJ: Nursing Process: Planning | Nursing Process: Implementation

25. Which viral sexually transmitted infection is characterized by a primary infection followed by
recurrent episodes?
a. Herpes simplex virus (HSV)-2
b. Human papillomavirus (HPV)
c. Human immunodeficiency virus (HIV)
d. Cytomegalovirus (CMV)
ANS: A
 The initial HSV genital infection is characterized by multiple painful lesions, fever, chills,
malaise, and severe dysuria; it may last 2 to 3 weeks. Recurrent episodes of HSV infection
commonly have only local symptoms that usually are less severe than those of the initial
infection. With HPV infection, lesions are a chronic problem. HIV is a retrovirus.
Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has
entered the body. Severe depression of the cellular immune system associated with HIV
infection characterizes acquired immunodeficiency syndrome (AIDS). AIDS has no cure. In
most adults the onset of CMV infection is uncertain and asymptomatic. However, the disease
may become a chronic, persistent infection.

DIF: Cognitive Level: Comprehension REF: pp. 125-126

OBJ: Nursing Process: Assessment

26. The nurse should know that once human immunodeficiency virus (HIV) enters the body,
seroconversion to HIV positivity occurs in 70% of individuals by what week?
a. 1 week
b. 4 weeks
c. 8 weeks
d. 12 weeks
ANS: D
Seroconversion to HIV positivity usually occurs within 3 to 6 weeks after the virus has
entered the body; 70% of individuals will have seroconverted by 12 weeks.

DIF: Cognitive Level: Knowledge REF: p. 126

OBJ: Nursing Process: Assessment

27. A 25-year-old single female comes to the gynecologist’s office for a follow-up visit related to
her abnormal Papanicolaou (Pap) smear. The test revealed that the patient has human
papillomavirus (HPV). The patient asks, “What is that? Can you get rid of it?” What is the
basis for the nurses’ response?
a. Provide reassurance that it can be frozen and it will fall off.
b. Explain that HPV stands for “human papillomavirus” and is a sexually transmitted
infection (STI).
c. Explain that HPV is a type of early human immunodeficiency virus (HIV) and is
usually fatal.
d. Explain transmission from the current partner, who needs to be tested as well.
ANS: B
It is important to inform the patient about STIs and the risks involved with HPV. The health
care team has a duty to provide proper information to the patient, including information
related to STIs. HPV and HIV are both viruses that can be transmitted sexually, but they are
not the same virus. The onset of HPV can be insidious and it is not fatal. Often STIs go
unnoticed. Abnormal bleeding frequently is the initial symptom. The patient may have had
HPV before her current boyfriend. The nurse cannot make any deductions from this limited
information.

DIF: Cognitive Level: Analysis REF: p. 124 OBJ: Nursing Process: Planning

28. Which statement about the various forms of hepatitis is accurate?

a. A vaccine exists for hepatitis C, but not for hepatitis B.
 b. Hepatitis A is acquired by eating contaminated food or drinking polluted water.
c. Hepatitis B is less contagious than human immunodeficiency virus (HIV).
d. The incidence of hepatitis C is decreasing.
ANS: B
Contaminated milk and shellfish are common sources of infection with hepatitis A. A vaccine
exists for hepatitis B but not for hepatitis C. Hepatitis B is more contagious than HIV. The
incidence of hepatitis C is increasing.

DIF: Cognitive Level: Knowledge REF: p. 127

OBJ: Nursing Process: Assessment

29. Which is the most important aspect of a discussion related to health promotion and condom
use that the nurse should be aware of?
a. Strategies to enhance condom use
b. Choice of colours and special features
c. Leaving the decision up to the male partner
d. Places to safely carry condoms
ANS: A
When the nurse opens discussion on safer sex practices, it gives the woman permission to
clear up any concerns or misapprehensions that she may have regarding condom use. The
nurse can also suggest ways that the woman can enhance her condom negotiation and
communications skills. These include role-playing, rehearsal, cultural barriers, and situations
that put the patient at risk. Although women can be taught the differences among condoms,
such as size ranges, where to purchase them, and price, this is not as important as negotiating
the use of safer sex practices. Women must address the issue of condom use with every sexual
contact. Some men need time to think about this. If they appear reluctant, the woman may
want to reconsider the relationship. Although not ideal, women may safely choose to carry
condoms in shoes, wallets, or inside their bra. They should be taught to keep the condom
away from heat. This information is important; however, it is not germane if the woman
cannot even discuss strategies on how to enhance condom use.

DIF: Cognitive Level: Analysis REF: p. 119 OBJ: Nursing Process: Planning

30. Which should the nurse explain when providing education regarding breast care and
fibrocystic changes in breasts?
a. Fibrocystic changes are a disease of the milk ducts and glands in the breasts.
b. Fibrocystic changes are a premalignant disorder characterized by lumps found in
the breast tissue.
c. Fibrocystic changes describe lumpiness with pain and tenderness in the breast
tissue of healthy women during menstrual cycles.
d. Fibrocystic changes include lumpiness accompanied by the appearance of
tenderness after menses.
ANS: C
Fibrocystic changes are palpable thickenings in the breast that are usually associated with pain
and tenderness. The pain and tenderness fluctuate with the menstrual cycle. Symptoms usually
subside within 1 week of menses, not appear then.

DIF: Cognitive Level: Knowledge REF: pp. 132-133

 OBJ: Nursing Process: Assessment

31. When teaching a group of women about breast cancer, which fact would the nurse point out to
them?
a. Risk factors identify more than 50% of women who will develop breast cancer.
b. Nearly 90% of lumps found by women are malignant.
c. One in 10 women in Canada will develop breast cancer in her lifetime.
d. The exact cause of breast cancer is unknown.
ANS: D
The exact cause of breast cancer in unknown. Risk factors help to identify fewer than 30% of
women in whom breast cancer eventually will develop. Women detect about 90% of all breast
lumps. Of this 90%, only 20% to 25% are malignant. One in nine women in Canada will
develop breast cancer in her lifetime.

DIF: Cognitive Level: Application REF: p. 135

OBJ: Nursing Process: Implementation

32. Which diagnostic test is used to confirm a suspected diagnosis of breast cancer?
a. Mammogram
b. Ultrasound
c. Fine-needle aspiration (FNA)
d. CA 15-3
ANS: C
When a suspicious mammogram is noted or a lump is detected, diagnosis is confirmed by
FNA, core needle biopsy, or needle localization biopsy. Mammography is a clinical screening
tool that may aid early detection of breast cancers. Transillumination, thermography, and
ultrasound breast imaging are being explored as methods of detecting early breast carcinoma.
CA-15 is a serum tumour marker that is used to test for residual disease.

DIF: Cognitive Level: Knowledge REF: p. 136 OBJ: Nursing Process: Diagnosis

33. What common adverse effects would the nurse teach a patient who has been prescribed
adjuvant tamoxifen therapy?
a. Nausea, hot flashes, and vaginal bleeding
b. Vomiting, weight loss, and hair loss
c. Nausea, vomiting, and diarrhea
d. Hot flashes, weight gain, and headaches
ANS: A
Common adverse effects of tamoxifen therapy include hot flashes, night sweats, nausea,
vaginal bleeding or discharge, and mood swings. Weight loss and hair loss, diarrhea, and
weight gain and headaches are not common adverse effects of tamoxifen.

DIF: Cognitive Level: Knowledge REF: p. 139 |Medication Guide

OBJ: Nursing Process: Diagnosis

34. Which should a woman be taught to do after a mastectomy?

a. Empty surgical drains twice a day and as needed.
b. Avoid lifting more than 5 kg or reaching above her head until given permission by
her surgeon.
 c. Wear clothing with snug sleeves to support the tissue of the arm on the operative
side.
d. Expect mild signs of inflammation at the incision site or in the affected arm.
ANS: B
The woman should not be advised to wear snug clothing. Rather, she should be advised to
avoid tight clothing, tight jewelry, and other causes of decreased circulation in the affected
arm. As part of the teaching plan the woman should be instructed to empty surgical drains,
avoid lifting more than 5 kg or reaching above her head, and report the development of
incision site inflammation.

DIF: Cognitive Level: Application REF: p. 140 | Home Care

OBJ: Nursing Process: Planning

35. Which is true of fibroadenoma?

a. Fibroadenoma is an inflammation of the milk ducts and glands behind the nipples.
b. Fibroadenoma is a thick, sticky discharge from the nipple of the affected breast.
c. Fibroadenoma is lumpiness in both breasts that develops 1 week before
menstruation.
d. Fibroadenoma is a 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 averaging 2.5 cm in
diameter. Fibroadenomas increase in size during pregnancy and shrink as the woman ages.
Inflammation of the milk ducts is associated with mammary duct ectasia, not fibroadenoma. A
thick, sticky discharge is associated with galactorrhea, not fibroadenoma. Lumpiness before
menstruation is associated with fibrocystic changes of the breast.

DIF: Cognitive Level: Knowledge REF: p. 133

OBJ: Nursing Process: Assessment

36. 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 woman’s 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.

DIF: Cognitive Level: Application REF: p. 140

OBJ: Nursing Process: Implementation

37. What does a woman most likely have when she experiences a breast mass that is not well
delineated and is nonpalpable, immobile, and nontender?
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.

DIF: Cognitive Level: Application REF: p. 134 | Table 7-6

OBJ: Nursing Process: Diagnosis

38. Which is a modality that may provide relief for women with fibrocystic breast changes?
a. Diuretic administration
b. Including caffeine daily 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 is recommended. Although
not supported by research, some advocate eliminating dimethylxanthines (caffeine) from the
diet. Smoking should also be avoided and alcohol consumption reduced. Vitamin E
supplements are recommended; however, the patient should avoid megadoses because this is a
fat-soluble vitamin. Pain relief measures include applying heat to the breast, wearing a
supportive bra, and taking nonsteroidal anti-inflammatory drugs.

DIF: Cognitive Level: Application REF: p. 133 OBJ: Nursing Process: Planning

39. The Jarisch-Herxheimer reaction is an acute febrile reaction associated with treatment for
which sexually transmitted infection?
a. Syphilis
b. Gonorrhea
c. Herpes simplex virus type 2
d. Human immunodeficiency virus
ANS: A
The Jarisch-Herxheimer reaction is an acute febrile reaction associated with syphilis
treatment. Other symptoms may include headache, myalgias, and arthralgias that develop
within the first 24 hours of treatment.

DIF: Cognitive Level: Knowledge REF: p. 123 |Nursing Alert

OBJ: Nursing Process: Implementation

MULTIPLE RESPONSE

1. Which communicable diseases must be reported in all provinces and territories? Select all that
apply. Express answer with small letters, followed by a comma and a space—e.g., a, b, c.
a. Gonorrhea
b. Human papillomavirus
c. Human immunodeficiency virus (HIV)
d. Herpes simplex virus 2 (HSV-2)
e. Chlamydia
f. HSV-1
g. Infectious syphilis
 ANS: A, C, E, G
Gonorrhea, chlamydia, infectious syphilis, and HIV are reportable communicable diseases in
all provinces and territories.

DIF: Cognitive Level: Comprehension REF: p. 122 OBJ: Nursing Process: Planning

2. Which are viral sexually transmitted infections (STIs)? Select all that apply. Express answer
with small letters, followed by a comma and a space—e.g., a, b, c.
a. Herpes simplex virus (HSV)
b. Chancroid
c. Mycoplasmas
d. Human papillomavirus (HPV)
e. Trichmoniasis
f. Syphilis
g. Cytomegalovirus
ANS: A, D, G
Viral STIs include HIV, HSV, cytomegalovirus, viral hepatitis A and B, and HPV. Chancroid,
mycoplasms, and syphilis are bacterial STIs. Trichmoniasis is a protozoa STI.

DIF: Cognitive Level: Comprehension REF: p. 116 | Box 7-2

OBJ: Nursing Process: Planning

3. Which are symptoms of endometriosis? Select all that apply. Express answer with small
letters, followed by a comma and a space—e.g., a, b, c.
a. Dysmenorrhea
b. Dysuria
c. Apnea
d. Dyschezia
e. Dyscrasias
f. Hypertension
ANS: A, B, D
Symptoms of endometriosis include dysmenorrhea, dyspareunia, dysuria, dyschezia, lower
back or abdominal discomfort, and chronic pelvic pain.

DIF: Cognitive Level: Comprehension REF: p. 113

OBJ: Nursing Process: Assessment
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