Guidelines for Nurse Practitioners in Gynecologic Settings, 11th Ed. Test Bank

/Studyguide
Chapter 1. Well-Woman Initial/Annual Gynecologic Exam
1. Due to the effects of cyclic ovarian changes in the breast, when is the best time for breast selfexamination (BSE)?
a. Between 5 and 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 approximately 5
to 7 days after menstruation ceases. 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, which 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.
2. Individual irregularities in the ovarian (menstrual) cycle are most often caused by what?
a. Variations in the follicular (preovulatory) phase
b. Intact hypothalamic-pituitary feedback mechanism
c. Functioning corpus luteum
d. 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.
3. How would the physiologic process of the sexual response best be characterized?
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.
4. Which action would be inappropriate for the nurse to perform before beginning the health
history interview?
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. Beginning any
client interaction with a smile is important and assists in putting the client at ease. If the nurse
speaks in a relaxed manner, then the client will likely be more relaxed during the interview. The
clients comfort should always be ensured before beginning the interview.
5. 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 replies, I have special
undergarments that I do not remove for religious reasons. Which is the most appropriate
response from the nurse?
a. You cant have an examination without removing all your clothes.
b. Ill ask the physician to modify the examination.
c.
Tell me about your undergarments. Ill explain the examination procedure, and then we
can discuss how you can comfortably have your examination.
d. I have no idea how we can accommodate your beliefs.
ANS: C
Explaining the examination procedure reflects cultural competence by the nurse and shows
respect for the womans 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.
6. 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. How should the nurse initially respond?
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 that she has a vaginal
infection.
d. Ask the woman to reschedule the appointment for the examination.
ANS: C
An important element of the health history and physical examination is the clients description of
any symptoms she may be experiencing. The best response is for the nurse to inquire about the
symptoms the woman is experiencing. Women should not douche, use vaginal medications,