. 1. The nurse must choose an appropriate location for, and a method of taking a sexual health history.

Which of the following would be the best choice? A. Mailing a preprinted history form to the patient's residence B. An interview in the examination room with the door closed C. Giving the patient a preprinted history form and asking her partner to assist D. An interview in the waiting room of the clinic 2. Which of the following statements made by a preteen girl indicates successful adaptation to menarche? A. "My cycle should occur every 28 days and last about 5 days." B. "Super-absorbent tampons are the best for teenagers. C. "My cycle should occur every 20 days and last about 3 days." D. "I won't need to wear protection on the last few days of my period." 3. A 20-year-old woman reports to the nurse about her menstrual flow. Which of the following statements made by the client would be cause for further investigation? A. "I've saturated one tampon today." B. "I had to change my maxi pad at least 14 times today." C. "A panty liner is sufficient to contain my flow." D. "I always wear tampons, because they are easier to use." 4. An adolescent boy asks, "Does the scrotum have a function?" The nurse's best response is: A. "The scrotum helps to protect the testes, and provides an ideal environment to create sperm." B. "The scrotum is an insensitive structure that houses the testicles." C. "The scrotum maintains a higher temperature than the core body temperature." D. "The scrotum is the source of ejaculation." 5. During a pelvic exam, the nurse practitioner teaches the client about the function of the cervix. The nurse practitioner knows that teaching has been successful when the client states: A. "Cervical mucus helps lubricate the vagina." - Rationale: Cervical mucus has three functions: to lubricate the vaginal canal, act as a bacteriostatic agent, and provide an alkaline environment to shelter deposited sperm from the acidic vagina. B. "The cervix acts as a natural barrier against pregnancy." C. "My uterus protects the cervix from being punctured during sex." D. "My cervix would be pale pink in color." 6. Which of the following lists the correct order of the four phases of the menstrual cycle? A. Menstrual, follicular, secretory, ischemic B. Luteal, follicular, secretory, menstrual C. Luteal, secretory, ischemic, follicular D. Menstrual, proliferative, secretory, ischemic

7. A nurse is teaching a couple about the process of fertilization. Which statement by the couple would indicate understanding of fertilization? A. "Fertilization takes place in the fimbria, or outer third, of the fallopian tube." B. "Fertilization takes place in the ampulla, or outer third, of the fallopian tube." C. "Fertilization takes place in the isthmus, or inner third, of the fallopian tube." D. "Fertilization takes place in the uterine cavity." 8. A nurse in the fertility clinic is teaching clients about the process of fertilization. Which statement by the client would not require further teaching by the nurse? A. "Testosterone in the semen helps to transport the sperm by increasing uterine smooth muscle contractions." B. "Progesterone increases peristalsis in the fallopian tubes during ovulation, moving the ovum toward the uterus." C. "If the sperm plasma membrane is not removed (capacitation), the sperm will not be able to fertilize the ovum." - Rationale: Capacitation is the removal of the plasma membrane. Capacitation occurs in the female reproductive tract (aided by uterine enzymes) and is thought to take about 7 hours. If the sperm plasma membrane is not removed, the sperm will not be able to fertilize the ovum. D. "Transportation of the sperm to the fallopian tube takes an average of 12-24 hours after ejaculation." 9. A pregnant client is concerned about a blow to the abdomen if she continues to play basketball during her pregnancy. The nurse's response is based upon her knowledge of which of the following facts concerning amniotic fluid? A. Amniotic fluid functions as a cushion to protect against mechanical injury. B. The total amount of amniotic fluid during pregnancy is 300 mL. C. The fetus does not contribute to the production of amniotic fluid. D. Amniotic fluid is slightly acidic.

10. A client in the prenatal clinic tells the nurse that her sister has twins. The client is concerned that
she also might have twins. The nurse's response is based upon her knowledge of which of the following facts? A. The chance of dizygotic twins decreases with maternal age up to about 35 years. B. The survival rate of monozygotic twins is about 10% higher than that of dizygotic twins. C. Twinning occurs more often in Asian women. D. Genetic factors in the mother can lead to elevated serum gonadotropin levels, causing double ovulation. - Rationale: A genetic factor that results in elevated serum gonadotropin levels can cause double ovulation. The chance of dizygotic twins increases with maternal age up to about 35 years and then decreases abruptly.

11. The nurse is explaining to a female client about the advantages and disadvantages of using an intrauterine device. Which of the following is a disadvantage of intrauterine devices? A. Continuous contraceptive protection B. Increased bleeding during menses - Rationale: Advantages include high rate of effectiveness, continuous contraceptive protection, non-coitus-related activity, and relative inexpensiveness over time. Possible adverse reactions to IUDs include discomfort to the wearer, increased bleeding during menses, increased risk of pelvic infection for about 3 weeks following insertion, perforation of the uterus during insertion, dysmenorrhea, and expulsion of the device. C. Non-coitus-related activity D. Expensiveness of the device 12. The nurse is counseling a group of sexually active college-age women about the use of birth control pills. The pill would be contraindicated for a woman with: A. Epilepsy but with no recent seizures. B. Migraine headaches without visual disturbances C. Oligomenorrhea D. Gallbladder disease.
Rationale: Absolute contraindications to the use of oral contraceptives include pregnancy, previous history of thrombophlebitis or thromboembolic disease, acute or chronic liver disease of cholestatic type with abnormal function, presence of estrogen-dependent carcinomas, undiagnosed uterine bleeding, heavy smoking, gallbladder disease, hypertension, diabetes, migraine with visual disturbances, hypercoagulable disorders, and hyperlipidemia. Women with the following relative contraindications may initiate COC use; however, they require close and frequent monitoring. These include women with migraine headaches without visual disturbances, epilepsy, depression, oligomenorrhea, and amenorrhea.

13. A female client and her husband are exploring operative types of sterilization. The couple is now discussing the benefits of, and risks associated with, having a vasectomy. Which misconception about vasectomies needs to be clarified with the couple before their decision is made? A. A couple is advised to use another form of birth control for about 4 to 6 weeks after the procedure. B. The man needs to be rechecked at 6 and 12 months to ensure that fertility has not been restored by recanalization. C. Once the vasectomy procedure is complete, sterilization is immediately achieved. Rationale: It takes about 4 to 6 weeks and 6 to 36 ejaculations to clear the remaining sperm from the vas deferens. D. A vasectomy is a surgical procedure that severs the vas deferens in both sides of the scrotum.

14. A woman and her husband are speaking with the nurse about female sterilization. The client is scheduled to have a laparoscopy. Which of the following signs should the nurse alert this client to watch for after the procedure is completed? A. Pain, dizziness, and fatigue B. Pain, bowel perforation, and hemorrhage - Rationale: Complications of female sterilization procedures include coagulation burns on the bowel, bowel perforation, pain, infection, hemorrhage, and adverse anesthesia effects C. Syncope, hemorrhage, and orthostatic hypotension D. Urinary retention, infection, and hemorrhage 15. A client reports breasts that "feel lumpy" when she performs breast self-exam, and she has an expressible nipple discharge. She asks the nurse if that means she has cancer. The best response by the nurse would be: A. "You will need to avoid caffeine to prevent these symptoms." B. "These findings are consistent with fibrocystic changes, but all nipple discharge should be evaluated." - Rationale: Some women with fibrocystic changes can have expressible nipple discharge. Although unilateral discharge and serosanguineous discharge are the most worrisome findings, all breast discharge should be investigated further. C. "It is not a problem unless the discharge is bloody." D. "Did you perform breast self-exam during the middle of the menstrual cycle?" 16. A 20-year-old female client has arrived at the clinic reporting painful urination and a fever. The nurse anticipates that a urine culture will be ordered. The rationale for this test is to: A. Rule out pregnancy as a cause of symptoms. B. Confirm reports of dysuria. C. Detect red and white cells in urine. D. Confirm cystitis so that treatment can prevent ascending infection.
Rationale: Because UTIs are ascending, it is important to recognize and diagnose a lower UTI early to avoid the sequelae associated with an upper UTI. When cystitis develops, the initial symptom is often dysuria, specifically at the end of urination. Urgency and frequency also occur. Cystitis is usually accompanied by a low-grade fever (38.3C/101F or lower), and hematuria is occasionally seen. Urine specimens usually contain an abnormal number of leukocytes and bacteria. Diagnosis is made with a urine culture. Urine culture is not required to detect leukocytes or red blood cells. Pregnancy can increase the risk of UTIs, but a urine culture is not a pregnancy test.