Ladewig, Contemporary Maternal-Newborn Nursing, 8/E

Chapter 05
Question 1
Type: MCSA

The clinic nurse is returning phone calls. Which call should the nurse return first?

1. 22-year-old reporting that she has menstrual cramps and vomiting every month

2. 17-year-old asking if there is a problem with using one tampon for a whole day

3. 46-year-old mother of a teen wondering if her daughter should be on birth control

4. 34-year-old requesting information on douching after intercourse

Correct Answer: 2

Rationale 1: Because vomiting can lead to dehydration, this patient will require further assessment. Because her
symptoms are not life-threatening, this patient’s assessment is not the first priority.

Rationale 2: Using a single tampon for an entire day can lead to toxic shock syndrome, a potentially life-
threatening condition. This patient needs education on the danger of using one tampon more than 3–6 hours.

Rationale 3: A sexually active teen could be at risk for unintended pregnancy, as well as sexually transmitted
infections. However, it is unclear whether the daughter is sexually active. This call is a low priority.

Rationale 4: Douching is not recommended, because the practice causes a change in the pH of the vagina and
impacts the normal flora, predisposing patients to candidiasis and bacterial vaginosis. This patient requires
education but is not the first priority.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: LO01 - Identify appropriate nursing care based on the results of the patient’s sexual history.

Question 2
Type: MCSA

When taking a sexual history from a patient, the nurse should:

1. Ask questions that the patient can answer with a “yes” or “no.”

2. Ask mostly open-ended questions.

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3. Have the patient fill out a comprehensive questionnaire and review it after the patient leaves.

4. Try not to make much direct eye contact.

Correct Answer: 2

Rationale 1: “Yes-or-no” answers indicate closed-ended questions that will not encourage the patient to share the
necessary information.

Rationale 2: Open-ended questions are often useful in eliciting information because they encourage more than a
one-word answer.

Rationale 3: Filling out a questionnaire and reviewing it after the patient leaves is not appropriate. It should be
reviewed in the presence of the patient, encouraging conversation regarding the results.

Rationale 4: It is helpful to use direct eye contact as much as possible, unless culturally unacceptable. Eye contact
encourages a connection between the involved parties and shows care and concern.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: LO01 - Identify appropriate nursing care based on the results of the patient’s sexual history.

Question 3
Type: MCSA

Which patient would the nurse document as exhibiting signs and symptoms of primary dysmenorrhea?

1. 17-year-old, has never had a menstrual cycle

2. 16-year-old, had regular menses for 4 years, but has had no menses in four months

3. 19-year-old, regular menses for 5 years that have suddenly become painful

4. 14-year-old, irregular menses for one year, experiences cramping every cycle

Correct Answer: 4

Rationale 1: This is primary amenorrhea, or the lack of menses.

Rationale 2: Secondary amenorrhea is the term used when a patient has had regular cycles that cease.

Rationale 3: Secondary dysmenorrheal is the sudden onset of pain and discomfort with menses.

Rationale 4: Primary dysmenorrhea is when menstruation has been painful from the first menstrual cycle and
consistently continues to be painful each month.
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Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Diagnosis
Learning Outcome: LO02 - Describe accurate information to be provided to girls and women so that they can
implement effective self-care measures for dealing with menstruation.

Question 4
Type: MCSA

A patient asks her nurse, "Is it okay for me to use a vaginal douche each day when I'm on my period?" The nurse's
correct response is:

1. "Douching should be avoided when you're on your period."

2. "Using a douche each day will help prevent vaginal infections from occurring."

3. "During your period, douching will help promote the flow of menstrual secretions."

4. "Regular douching is necessary in order to promote good hygiene."

Correct Answer: 1

Rationale 1: Women should avoid douching during menstruation because the cervix is dilated to permit the
downward flow of menstrual fluids from the uterine lining.

Rationale 2: Douching washes away the natural mucus and upsets the vaginal flora, which can make the vagina
more susceptible to infection.

Rationale 3: During menstruation, douching may interfere with downward flow of menstrual fluids from the
uterine lining.

Rationale 4: Douching as a hygiene practice is unnecessary because the vagina cleanses itself.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: LO02 - Describe accurate information to be provided to girls and women so that they can
implement effective self-care measures for dealing with menstruation.

Question 5
Type: MCSA

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What should the gynecology clinic nurse recommend for the patient experiencing premenstrual syndrome?

1. “Eat more chocolate and drink more caffeine beginning a week prior to when your menstrual cycle bleeding
should begin.”

2. “Engage in aerobic activity often throughout the month, and continue exercising when your symptoms begin.”

3. “Decrease your dietary intake of dairy and soy slightly during the month, and especially during your days of
bleeding.”

4. “Increase your consumption of red meat when you feel symptoms, and eat three large meals per day.”

Correct Answer: 2

Rationale 1: Chocolate and caffeine contain methylxanthines; therefore, intake of chocolate, coffee, and colas
should be limited throughout the month.

Rationale 2: Regular aerobic activity helps to decrease PMS symptoms.

Rationale 3: 1,200 mg of calcium per day can help decrease PMS symptoms. The calcium can either come from
supplements or be obtained through dietary intake of dairy and soy products.

Rationale 4: Decreased red meat consumption can be beneficial to reduce PMS symptoms, as will eating several
small meals per day rather than three large meals.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: LO03 - Discriminate between the signs, symptoms, and nursing management of women with
dysmenorrhea and premenstrual syndrome.

Question 6
Type: MCSA

A patient comes to the clinic complaining of severe menstrual cramps. She has never been pregnant, has been
diagnosed with ovarian cysts, and has had an intrauterine device (IUD) for two years. The most likely cause for
the patient’s complaint is:

1. Primary dysmenorrhea.

2. Secondary dysmenorrhea.

3. Menorrhagia.

4. Hypermenorrhea.

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Correct Answer: 2

Rationale 1: Primary dysmenorrhea is defined as cramps without underlying disease.

Rationale 2: Secondary dysmenorrhea is associated with pathology of the reproductive tract and usually appears
after menstruation has been established. Conditions that most frequently cause secondary dysmenorrhea include
ovarian cysts and the presence of an intrauterine device.

Rationale 3: Menorrhagia is excessive, profuse flow.

Rationale 4: Hypermenorrhea is an abnormally long menstrual flow.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: LO03 - Discriminate between the signs, symptoms, and nursing management of women with
dysmenorrhea and premenstrual syndrome.

Question 7
Type: MCMA

Which issues should the nurse consider when counseling a patient on contraceptive methods?

Standard Text: Select all that apply.

1. Cultural perspectives on menstruation and pregnancy

2. Efficacy of the method

3. Future childbearing plans

4. Whether the patient is a vegetarian

5. Age at menarche

Correct Answer: 1,2,3

Rationale 1: Cultural and religious beliefs, practices, and sanctions must be considered when discussing
contraception with patients in order to avoid insulting a patient for whom a particular type of contraceptive
method is prohibited by her background.

Rationale 2: Efficacy of contraceptive methods varies and must be considered when discussing contraception
with patients. When pregnancy is medically contraindicated, high-efficacy methods (such as an IUD, hormonal
methods, or sterilization) should be discussed with the patient. When the patient would like to avoid pregnancy at
this time, but pregnancy is not medically contraindicated, lower-efficacy methods (such as diaphragm, cervical
cap, or Today sponge) could be discussed.
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Rationale 3: If a patient desires children in the future, sterilization methods would be inappropriate to discuss.

Rationale 4: Vegetarianism has no impact on contraceptive method use.

Rationale 5: Age at menarche has no impact on contraceptive method use.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: LO04 - Compare the advantages, disadvantages, and effectiveness of the various methods of
contraception available today.

Question 8
Type: MCSA

A patient has decided to use the NuvaRing vaginal contraceptive ring as her method of contraception. Which
statement suggests the patient needs further instruction?

1. "I do not need to be examined in order to determine the contraceptive ring size that is correct for me."

2. "Every three months, I will need to remove the contraceptive ring and replace it with a new one."

3. "When I store my replacement rings, I should keep them in my refrigerator."

4. "The contraceptive ring provides a sustained release of low-dose contraceptive."

Correct Answer: 2

Rationale 1: One size of the NuvaRing fits virtually all women.

Rationale 2: The ring is left in place for 3 weeks and then removed for 1 week to allow for withdrawal bleeding.

Rationale 3: Replacement rings should be kept in the refrigerator to maintain integrity.

Rationale 4: The contraceptive ring provides a low-dose, sustained-release hormonal contraceptive.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: LO04 - Compare the advantages, disadvantages, and effectiveness of the various methods of
contraception available today.

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Question 9
Type: MCSA

Which patient is not a good candidate for Depo-Provera (DMPA)?

1. One who wishes to get pregnant within three months

2. One who wishes to breastfeed

3. One with a vaginal prolapse

4. One who weighs 200 pounds

Correct Answer: 1

Rationale 1: Return of fertility after the use of Depo-Provera takes an average of nine months.

Rationale 2: Studies have proven there is no harm to a breastfed baby when a woman uses Depo-Provera.

Rationale 3: There is no correlation between a vaginal prolapse and use of Depo-Provera.

Rationale 4: There is no correlation between one’s weight and use of Depo-Provera.

Global Rationale:

Cognitive Level: Understanding

Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: LO04 - Compare the advantages, disadvantages, and effectiveness of the various methods of
contraception available today.

Question 10
Type: MCSA

The Public Health Nurse receives a phone call from a 16-year-old girl who asks, "Do I need to have a Pap smear
just because I'm sexually active?" What is the nurse's correct response?

1. "Yes, all sexually active females should be screened for both cervical cancer and HPV.”

2. "No, you do not need to be screened for cervical cancer until you are 21 years old."

3. "Yes, all women under the age of 29 should be screened for both cervical cancer and HPV."

4. "No, but you will need to begin your screenings for both cervical cancer and HPV when you are 18 years old."

Correct Answer: 2

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Rationale 1: Engaging in sexual activity is not an indication for routine cervical cancer or for HPV screening.

Rationale 2: 2012 guidelines issued by the U.S. Preventive Services Task Force (USPSTF) recommend initiating
cervical cancer screening at age 21.

Rationale 3: 2012 guidelines issued by the U.S. Preventive Services Task Force (USPSTF) recommend cervical
cancer screening without HPV co-testing in women ages 21 to 29.

Rationale 4: 2012 guidelines issued by the U.S. Preventive Services Task Force (USPSTF) recommend initiating
cervical cancer screening at age 21.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: LO05 - Delineate basic gynecologic screening procedures indicated for well women.

Question 11
Type: MCMA

A nurse is providing a patient with instructions regarding breast self-examination (BSE). Which of the following
statements by the patient would indicate the likelihood that she understands how to detect changes such as lumps
in her breast?

Standard Text: Select all that apply.

1. “I should perform BSE one week prior to the start of my period.”

2. “When I reach menopause, I will perform BSE every two months.”

3. “Knowing the texture and feel of my breasts is important.”

4. “I should inspect my breasts in a circular manner.”

5. “I should inspect my breasts while in a supine position, with my arms at my sides.”

Correct Answer: 3,4

Rationale 1: BSE should be performed one week after the start of each menstrual period because hormonal levels
are lowest and allow closer exam of softer breast tissue.

Rationale 2: BSE should be performed monthly, on the same day each month, during menopause.

Rationale 3: A woman who knows the texture and feel of her own breasts is far more likely to detect changes that
develop.

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Rationale 4: Checking breasts in a circular manner, feeling all parts of the breast, provides adequate palpation
and possible detection of lumps.

Rationale 5: The breasts should be inspected while standing with arms at sides.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: LO05 - Delineate basic gynecologic screening procedures indicated for well women.

Question 12
Type: MCSA

What is the best indicator that the patient is experiencing menopause?

1. No menses for 8 consecutive months

2. Hot flashes and night sweats

3. High serum FSH with low serum estrogen

4. Diagnosed with osteoporosis 4 months ago

Correct Answer: 3

Rationale 1: Menopause is defined as 12 months of amenorrhea.

Rationale 2: Although hot flashes and night sweats are common in menopause, lab values or twelve months of
amenorrhea are better indicators.

Rationale 3: Examining serum levels of the hormones FSH and estrogen is a very accurate indication of
menopause.

Rationale 4: Menopause is not the only cause of osteoporosis; therefore, the diagnosis of osteoporosis 4 months
ago is not an indicator of menopause.

Global Rationale:

Cognitive Level: Understanding

Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: LO06 - Explain the physical and psychologic aspects and clinical treatment options of
menopause when caring for menopausal women.

Question 13
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Type: MCSA

A 63-year-old female patient requests information about complementary and alternative therapies that promote
wellness during menopause. Which therapies should the nurse recommend?

1. Non-weight-bearing exercise, such as swimming.

2. Increased consumption of phytoestrogens (i.e., plant products with estrogen properties) for women with a
history of endometeriosis or fibroids.

3. Calcium intake of 600 mg per day to help prevent osteoporosis.

4. Soy for reducing insomnia symptoms.

Correct Answer: 4

Rationale 1: Weight-bearing exercises such as walking, jogging, tennis, and low-impact aerobics are encouraged
in order to increase bone mass and decrease the risk of osteoporosis.

Rationale 2: Women who have endometriosis or fibroids should be cautioned on the use of phytoestrogens

Rationale 3: Peri- and postmenopausal women are advised to have a calcium intake of at least 1200 mg per day.
Most women require supplements to achieve this level.

Rationale 4: Research suggests that isoflavones, which are found in soy, are effective in reducing symptoms of
insomnia in postmenopausal women.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: LO06 - Explain the physical and psychologic aspects and clinical treatment options of
menopause when caring for menopausal women.

Question 14
Type: MCSA

The nurse is presenting a session on intimate partner violence. Which statement indicates a need for further
education?

1. “My daughter is not to blame for the violence in her marriage.”

2. “Everyone experiences anger and hitting in a relationship.”

3. “Abusers can be either husbands or boyfriends or girlfriends.”

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4. “The ‘honeymoon period’ follows an episode of violence.”

Correct Answer: 2

Rationale 1: The victims of violence are not the cause of the violence. Abusers are responsible for their violent
behavior. Avoiding blaming and shaming of victims of domestic violence is important to establish a therapeutic
relationship.

Rationale 2: Violence is not a normal part of intimate relationships. This statement indicates that the patient has
likely been a victim of domestic violence.

Rationale 3: Abusers can be spouses or boyfriends or girlfriends. Intimate partner violence can be experienced in
any intimate relationship, regardless of whether the couple is straight, gay, or lesbian, and both within marriage
and outside of marriage.

Rationale 4: An acute episode of battering is followed by the tranquil phase, or honeymoon period, when the
abuser is often repentant and promising never to abuse the victim again. In some cases, the honeymoon period is
the only time there is a lack of building tension.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: LO07 - Examine the nurse’s role in screening and caring for women who have experienced
domestic violence or rape.

Question 15
Type: MCSA

When a woman who has been raped is admitted to the emergency department, which nursing intervention has
priority?

1. Explain exactly what will need to be done to preserve legal evidence.

2. Assure the woman that everything will be all right.

3. Create a safe, secure atmosphere for the woman.

4. Contact family members.

Correct Answer: 3

Rationale 1: Explaining exactly what will need to be done to preserve legal evidence is not the top priority.

Rationale 2: Assuring the woman that everything will be all right is not the top priority and is giving false
promise.

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

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Rationale 3: The first priority in caring for a survivor of a sexual assault is to create a safe, secure atmosphere
that will allow the woman to process what has happened.

Rationale 4: Contacting family members is not the top priority and can wait until a safe environment is
established.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: LO07 - Examine the nurse’s role in screening and caring for women who have experienced
domestic violence or rape.

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

Copyright 2014 by Pearson Education, Inc.