New Book
Brunner & Saddarth 14th ed
A premenopausal patient is complaining of vaginal spotting and sharp,
colicky lower abdominal pain.
She informs the nurse that her
period is 2 weeks late. The nurse should recognize a need for this
patient
to be investigated for what health problem?
A)
Trichomonas vaginalis
B) Ectopic pregnancy
C) Cervical
cancer
D) Fibromyalgia
Ans: B
Feedback:
Clinical symptoms of an ectopic pregnancy
include delay in menstruation of 1 to 2 weeks, vaginal
spotting,
and sharp, colicky pain. Trichomonas vaginalis causes a vaginal
infection. Cervical cancer and
fibromyalgia do not affect menstruation.
The school nurse is presenting a class on female reproductive health.
The nurse should describe what
aspect of Pap smears?
Test
Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing
14e (Hinkle 2017) 1059
A) The test may be performed at any time
during the patients menstrual cycle.
B) The smear should be done
every 2 years.
C) The test can detect early evidence of cervical
cancer.
D) Falsepositive Pap smear results occur mostly from not
douching before the examination
Ans: C
Feedback:
The test should be performed when the
patient is not menstruating. Douching washes away
cellular
material. The test detects cervical cancer, and
falsenegative Pap smear results occur mostly from
sampling errors
or improper technique. For most women, a Pap smear should be done annually.
When teaching patients about the risk factors of cervical cancer,
what would the nurse identify as the
most important risk
factor?
Test Bank - Brunner & Suddarth's Textbook of
Medical-Surgical Nursing 14e (Hinkle 2017) 1075
A) Late
childbearing
B) Human papillomavirus (HPV)
C) Postmenopausal
bleeding
D) Tobacco use
Ans: B
Feedback:
HPV is the most salient risk factor for
cervical cancer, exceeding the risks posed by smoking,
late
childbearing, and postmenopausal bleeding.
A female patient with HIV has just been diagnosed with condylomata
acuminata (genital warts). What
information is most appropriate
for the nurse to tell this patient?
A) This condition puts her at
a higher risk for cervical cancer; therefore, she should have
a
Papanicolaou (Pap) test annually.
B) The most common
treatment is metronidazole (Flagyl), which should eradicate the
problem within
7 to 10 days.
C) The potential for
transmission to her sexual partner will be eliminated if condoms are
used every
time they have sexual intercourse.
Test Bank -
Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e
(Hinkle 2017) 1077
D) The human papillomavirus (HPV), which
causes condylomata acuminata, cannot be transmitted
during oral sex.
Ans: A
Feedback:
HIV-positive women have a higher rate of
HPV. Infections with HPV and HIV together increase the risk
of
malignant transformation and cervical cancer. Thus, women with HIV
infection should have frequent
Pap smears. Because condylomata
acuminata is a virus, there is no permanent cure.
Because
condylomata acuminata can occur on the vulva, a condom
will not protect sexual partners. HPV can be
transmitted to other
parts of the body, such as the mouth, oropharynx, and larynx.
A public health nurse is participating in a campaign aimed at
preventing cervical cancer. What strategies
should the nurse
include is this campaign? Select all that apply.
A) Promotion of
HPV immunization
B) Encouraging young women to delay first
intercourse
C) Smoking cessation
D) Vitamin D and calcium
supplementation
E) Using safer sex practices
Ans: A, B, C, E
Feedback:
Preventive measures relevant to
cervical cancer include regular pelvic examinations and Pap tests for
all
women, especially older women past childbearing age.
Preventive counseling should encourage delaying
first
intercourse, avoiding HPV infection, participating in safer sex only,
smoking cessation, and
receiving HPV immunization. Calcium and
vitamin D supplementation are not relevant.
A 27-year-old female patient is diagnosed with invasive cervical
cancer and is told she needs to have a
hysterectomy. One of the
nursing diagnoses for this patient is disturbed body image related to
perception
of femininity. What intervention would be most
appropriate for this patient?
A) Reassure the patient that she
will still be able to have children.
B) Reassure the patient that
she does not have to have sex to be feminine.
C) Reassure the
patient that you know how she is feeling and that you feel her anxiety
and pain.
D) Reassure the patient that she will still be able to
have intercourse with sexual satisfaction and
orgasm.
Ans: D
Feedback:
The patient needs reassurance that she
will still have a vagina and that she can experience
sexual
intercourse after temporary postoperative abstinence while
tissues heal. Information that sexual
satisfaction and orgasm
arise from clitoral stimulation rather than from the uterus reassures
many
women. Most women note some change in sexual feelings after
hysterectomy, but they vary in intensity.
In some cases, the
vagina is shortened by surgery, and this may affect sensitivity or
comfort. It would be
inappropriate to reassure the patient that
she will still be able to have children; there is no reason
to
reassure the patient about not being able to have sex. There
is no way you can know how the patient is
feeling and it would be
inappropriate to say so.
A patient diagnosed with cervical cancer will soon begin a round of
radiation therapy. When planning
the patients subsequent care,
the nurse should prioritize actions with what goal?
A) Preventing
hemorrhage
B) Ensuring the patient knows the treatment is
palliative, not curative
C) Protecting the safety of the patient,
family, and staff
D) Ensuring that the patient adheres to dietary
restrictions during treatment
Ans: C
Feedback:
Care must be taken to protect the safety
of patients, family members, and staff during radiation
therapy.
Hemorrhage is not a common complication of radiation
therapy and the treatment can be curative.
Dietary restrictions
are not normally necessary during treatment.
A 45-year-old woman has just undergone a radical hysterectomy for
invasive cervical cancer. Prior to
the surgery the physician
explained to the patient that after the surgery a source of radiation
would be
placed near the tumor site to aid in reducing
recurrence. What is the placement of the source of
radiation
called?
A) Internal beam radiation
Test Bank
- Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e
(Hinkle 2017) 1090
B) Trachelectomy
C) Brachytherapy
D)
External radiation
Ans: C
Feedback:
Radiation, which is often part of the
treatment to reduce recurrent disease, may be delivered by
an
external beam or by brachytherapy (method by which the
radiation source is placed near the tumor) or
both.
A 25-year-old patient diagnosed with invasive cervical cancer
expresses a desire to have children. What
procedure might the
physician offer as treatment?
A) Radical hysterectomy
B)
Radical culposcopy
C) Radical trabeculectomy
D) Radical trachelectomy
Ans: D
Feedback:
A procedure called a radical trachelectomy
is an alternative to hysterectomy in women with invasive
cervical
cancer who are young and want to have children. In this procedure, the
cervix is gripped with
retractors and pulled down into the vagina
until it is visible. The affected tissue is excised while the
rest
of the cervix and uterus remain intact. A drawstring suture
is used to close the cervix. For a woman who
wants to have
children, a radical hysterectomy would not provide the option of
children. A radical
culposcopy and a radical trabeculectomy are
simple distracters for this question.
A patient with ovarian cancer is admitted to the hospital for surgery
and the nurse is completing the
patients health history. What
clinical manifestation would the nurse expect to assess?
A)
Fish-like vaginal odor
B) Increased abdominal girth
C) Fever
and chills
D) Lower abdominal pelvic pain
Ans: B
Feedback:
Clinical manifestations of ovarian cancer
include enlargement of the abdomen from an accumulation of
fluid.
Flatulence and feeling full after a light meal are significant
symptoms. In bacterial vaginosis, a
fish-like odor, which is
noticeable after sexual intercourse or during menstruation, occurs as
a result of a
rise in the vaginal pH. Fever, chills, and
abdominal pelvic pain are atypical.
A 30-year-old patient has come to the clinic for her yearly
examination. The patient asks the nurse about
ovarian cancer.
What should the nurse state when describing risk factors for ovarian
cancer?
A) Use of oral contraceptives increases the risk of
ovarian cancer.
B) Most cases of ovarian cancer are attributed to
tobacco use.
C) Most cases of ovarian cancer are considered to be
random, with no obvious causation.
D) The majority of women who
get ovarian cancer have a family history of the disease.
Ans: C
Feedback:
Most cases of ovarian cancer are random,
with only 5% to 10% of ovarian cancers having a
familial
connection. Contraceptives and tobacco have not been
identified as major risk factors.
The nurse is caring for a patient who has just been told that her
ovarian cancer is terminal and that no
curative options remain.
What would be the priority nursing care for this patient at this
time?
A) Provide emotional support to the patient and her
family.
B) Implement distraction and relaxation
techniques.
C) Offer to inform the patients family of this
diagnosis.
D) Teach the patient about the importance of
maintaining a positive attitude.
Ans: A
Feedback:
Emotional support is an integral part of
nursing care at this point in the disease progression. It is
not
normally appropriate for the nurse to inform the family of
the patients diagnosis. It may be inappropriate
and simplistic to
focus on distraction, relaxation, and positive thinking.
The nurse is caring for a 63-year-old patient with ovarian cancer.
The patient is to receive chemotherapy
consisting of Taxol and
Paraplatin. For what adverse effect of this treatment should the nurse
monitor
Test Bank - Brunner & Suddarth's Textbook of
Medical-Surgical Nursing 14e (Hinkle 2017) 1089
the patient?
A) Leukopenia
B) Metabolic acidosis
C)
Hyperphosphatemia
D) Respiratory alkalosis
Ans:
A
Feedback:
Chemotherapy is usually administered IV on an
outpatient basis using a combination of platinum and
taxane
agents. Paclitaxel (Taxol) plus carboplatin (Paraplatin) are most
often used because of their
excellent clinical benefits and
manageable toxicity. Leukopenia, neurotoxicity, and fever may
occur.
Acidbase imbalances and elevated phosphate levels are not anticipated.
You are caring for a patient, a 42-year-old mother of two children,
with a diagnosis of ovarian cancer.
She has just been told that
her ovarian cancer is terminal. When you admitted this patient, you
did a
spiritual assessment. What question would it have been most
important for you to evaluate during this
assessment?
A) Is
she able to tell her family of negative test results?
B) Does she
have a sense of peace of mind and a purpose to her life?
C) Can
she let go of her husband so he can make a new life?
Test Bank -
Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e
(Hinkle 2017) 327
D) Does she need time and space to bargain with
God for a cure?
Ans: B
Feedback:
In addition to assessment of the role of
religious faith and practices, important religious rituals,
and
connection to a religious community, you should further
explore the presence or absence of a sense of
peace of mind and
purpose in life; other sources of meaning, hope, and comfort; and
spiritual or
religious beliefs about illness, medical treatment,
and care of the sick. Telling her family and letting her
husband
go are not parts of a spiritual assessment. Bargaining is a stage of
death and dying, not part of a
spiritual assessment.
new book
giddens 2nd ed- none
New book
ignatavicious 9th ed
A nurse is participating in primary prevention efforts directed
against cancer. In which activities is this nurse
most likely to
engage? (Select all that apply.)
a. Demonstrating breast
self-examination methods to women
b. Instructing people on the
use of chemoprevention
c. Providing vaccinations against certain
cancers
d. Screening teenage girls for cervical cancer
e.
Teaching teens the dangers of tanning booths
ANS: B, C, E
Primary prevention aims to prevent the occurrence
of a disease or disorder, in this case cancer.
Secondary
prevention includes screening and early diagnosis.
Primary prevention activities include teaching people
about
chemoprevention, providing approved vaccinations to prevent
cancer, and teaching teens the dangers of
tanning beds. Breast
examinations and screening for cervical cancer are secondary
prevention methods.
DIF: Applying/Application REF: 381
KEY:
Cancer| primary prevention| secondary prevention| patient
education
MSC: Integrated Process: Teaching/Learning
NOT:
Client Needs Category: Health Promotion and Maintenance
The nurse is assessing the reproductive history of a 68-year-old
postmenopausal woman. Which finding is
cause for immediate action
by the nurse?
a. Vaginal dryness
b. Need for a Papanicolaou
test if none for 3 years
c. Bleeding from the vagina
d.
Leakage of urine
ANS: C
Vaginal bleeding is not normal for the postmenopausal
woman. Vaginal dryness and leakage of urine are
common findings
in adults of this age range. Pap tests may not be needed for women
over 65 who have had
regular cervical cancer testing with normal
results.
DIF: Applying/Application REF: 1432
KEY: Adult life
stages| older adult| nursing assessment
MSC: Integrated Process:
Nursing Process: Evaluation
NOT: Client Needs Category:
Physiological Integrity: Physiological Adaptation
A 20-year-old client is interested in protection from the human
papilloma virus (HPV) since she may
become sexually active. Which
response from the nurse is the most accurate?
a. You are too old
to receive an HPV vaccine.
b. Either Gardasil or Cervarix can
provide protection.
c. You will need to have three injections
over a span of 1 year.
d. The most common side effect of the
vaccine is itching at the injection site.
ANS: B
Current HPV vaccines are Gardasil and Cervarix, which
should be given before the first sexual contact to
protect
against the highest risk HPV types associated with cervical cancer.
The client is not too old since it is
recommended that young
women up to 26 years should receive an HPV vaccine. The entire series
consists of
three injections over 6 months, not 1 year. Local
pain and redness surrounding the injection site are very
common,
but this does not include itching.
DIF: Analyzing/Analysis REF:
1471
KEY: Patient education| infection control| reproductive
problems
MSC: Integrated Process: Teaching/Learning
The nurse is taking the history of a 24-year-old client diagnosed
with cervical cancer. What possible risk
factors would the nurse
assess? (Select all that apply.)
a. Smoking
b. Multiple
sexual partners
c. Poor diet
d. Nulliparity
e. Younger
than 18 at first intercourse
ANS: A, B, C, E
Smoking, multiple sexual partners, poor diet,
and age less than 18 for first intercourse are all risk factors
for
cervical cancer. Nulliparity is a risk factor for endometrial
cancer.
DIF: Remembering/Knowledge REF: 1469
KEY: Cancer|
nursing assessment
MSC: Integrated Process: Nursing Process:
Assessment
NOT: Client Needs Category: Physiological Integrity:
Physiological Adaptation
A 19-year-old female is asking the nurse about the vaccine for human
papilloma virus (HPV). Which
statement by the nurse is
accurate?
a. Gardasil protects against all HPV strains.
b.
You are too young to receive the vaccine.
c. Only females can
receive the vaccine.
d. This will lower your risk for cervical cancer.
ANS: D
Gardasil is used to provide immunity for HPV types 6, 11,
16, and 18 that are high risk for cervical cancer and
warts. The
vaccine is recommended for people ages 10 to 26 years.
DIF:
Remembering/Knowledge REF: 1512
KEY: Reproductive problems|
antiviral medications| infection| cancer
MSC: Integrated Process:
Teaching/Learning
NOT: Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
New Book
Lewis 9th ed
A nursing diagnosis that is likely to be appropriate for a
67-year-old woman who has
just been diagnosed with stage III
ovarian cancer is
a. sexual dysfunction related to loss of
vaginal sensation.
b. risk for infection related to impaired
immune function.
c. anxiety related to cancer diagnosis and need
for treatment decisions.
d. situational low self-esteem related
to guilt about delaying medical care.
ANS: C
The patient with stage III ovarian cancer is likely to be
anxious about the poor prognosis and about the
need to make
decisions about the multiple treatments that may be used. Decreased
vaginal sensation does
not occur with ovarian cancer. The patient
may develop immune dysfunction when she receives
chemotherapy,
but she is not currently at risk. It is unlikely that the patient has
delayed seeking medical
care because the symptoms of ovarian
cancer are vague and occur late in the course of the cancer.
DIF:
Cognitive Level: Apply (application) REF: 1298
TOP: Nursing
Process: Analysis MSC: NCLEX: Physiological Integrity
Which nursing actions can the nurse working in a women’s health
clinic delegate to
unlicensed assistive personnel (UAP) (select
all that apply)?
a. Call a patient with the results of an
endometrial biopsy.
b. Assist the health care provider with
performing a Pap test.
c. Draw blood for CA-125 levels for a
patient with ovarian cancer.
d. Screen a patient for use of
medications that may cause amenorrhea.
e. Teach the parent of a
10-year-old about the human papilloma virus (HPV) vaccine
ANS: B, C
Assisting with a Pap test and drawing blood (if
trained) are skills that require minimal critical thinking
and
judgment and can be safely delegated to UAP. Patient teaching, calling
a patient who may have
questions about results of diagnostic
testing, and risk-factor screening all require more education
and
critical thinking and should be done by the registered nurse
(RN).
DIF: Cognitive Level: Apply (application) REF:
15-16
OBJ: Special Questions: Delegation TOP: Nursing Process:
Planning
MSC: NCLEX: Safe and Effective Care Environment
A 31-year-old patient who has been diagnosed with human
papillomavirus (HPV)
infection gives a health history that
includes smoking tobacco, taking oral contraceptives, and
having
been treated twice for vaginal candidiasis. Which topic will the nurse
include in patient
teaching?
a. Use of water-soluble
lubricants
b. Risk factors for cervical cancer
c. Antifungal
cream administration
d. Possible difficulties with conception
ANS: B
Because HPV infection and smoking are both associated
with increased cervical cancer risk, the nurse
should emphasize
the importance of avoiding smoking. An HPV infection does not decrease
vaginal
lubrication, decrease ability to conceive, or require the
use of antifungal creams.
DIF: Cognitive Level: Apply
(application) REF: 1292
TOP: Nursing Process: Implementation MSC:
NCLEX: Physiological Integrity
The nurse will plan to teach the female patient with genital warts
about the
a. importance of regular Pap tests.
b. increased
risk for endometrial cancer.
c. appropriate use of oral
contraceptives.
d. symptoms of pelvic inflammatory disease (PID).
ANS: A
Genital warts are caused by the human papillomavirus
(HPV) and increase the risk for cervical cancer.
There is no
indication that the patient needs teaching about PID, oral
contraceptives, or endometrial
cancer.
DIF: Cognitive Level:
Apply (application) REF: 1286 | 1292
TOP: Nursing Process:
Planning MSC: NCLEX: Health Promotion and Maintenance
Which action should the nurse take when a 35-year-old patient has a
result of minor
cellular changes on her Pap test?
a. Teach
the patient about colposcopy.
b. Teach the patient about punch
biopsy.
c. Schedule another Pap test in 4 months.
d.
Administer the human papillomavirus (HPV) vaccine.
ANS: C
Patients with minor changes on the Pap test can be
followed with Pap tests every 4 to 6 months because
these changes
may revert to normal. Punch biopsy or colposcopy may be used if the
Pap test shows more
prominent changes. The HPV vaccine may reduce
the risk for cervical cancer, but it is recommended only
for ages
9 through 26.
DIF: Cognitive Level: Apply (application) REF:
1293
TOP: Nursing Process: Implementation MSC: NCLEX: Health
Promotion and
Maintenance
A healthy 28-year-old who has been vaccinated against human
papillomavirus (HPV)
has a normal Pap test. Which information
will the nurse include in patient teaching when calling
the
patient with the results of the Pap test?
a. You can wait until
age 30 before having another Pap test.
b. Pap testing is
recommended every 3 years for women your age.
c. No further Pap
testing is needed until you decide to become pregnant.
d. Yearly
Pap testing is suggested for women with multiple sexual partners.
ANS: B
The current national guidelines suggest Pap testing every
3 years for patients between ages 21 to 65.
Although HPV
immunization does protect against cervical cancer, the recommendations
are unchanged
for individuals who have received the HPV
vaccination.
DIF: Cognitive Level: Understand (comprehension)
REF: 1293
TOP: Nursing Process: Planning MSC: NCLEX: Health
Promotion and Maintenance