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Which layer of the uterus is responsible for labor and delivery?
a.
Myometrium
b.
Endometrium
c.
Perimetrium
d.
Epimetrium
ANS: A
The outermost layer of the uterine wall is the perimetrium, a fold of the visceral peritoneum. The myometrium is the middle, smooth muscle layer. During pregnancy, these cells increase in size to accommodate the growing fetus, and during labor and delivery, oxytocin causes coordinated contractions of this middle layer to expel the fetus. The lining of the uterus is called the endometrium and is a highly vascular mucous membrane, part of which is lost and regenerated with each menstrual cycle. During pregnancy, the endometrium helps in forming the maternal side of the placenta.
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The smooth muscle of the prostate gland contributes to what function?
a.
Erection
b.
Ejaculation
c.
Secretion of prostaglandins and clotting proteins
d.
Production of alkaline secretions that neutralize urine
ANS: B
The smooth muscle of the prostate contracts during ejaculation, causing the expulsion of semen from the urethra. Erection occurs when blood fills the sinuses in the penis. The seminal vesicles secrete prostaglandins and clotting proteins. The bulbourethral glands produce an alkaline secretion that coats the interior of the urethra just before ejaculation and neutralizes any acidic urine that might be present.
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What hormone stimulates the release of milk from the breast of a nursing mother?
a.
Prolactin
b.
Follicle-stimulating hormone (FSH)
c.
Luteinizing hormone (LH)
d.
Oxytocin
ANS: D
The sucking of the infant on the nipple stimulates the release of oxytocin from the posterior pituitary gland, which in turn stimulates the release of milk as well as contraction of the uterine muscle. Prolactin promotes milk production, not release. FSH initiates development of ovarian follicles and stimulates estrogen secretion. LH causes ovulation, converts a ruptured ovarian follicle into the corpus luteum, and stimulates secretion of progesterone by the corpus luteum.
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Women secrete less estrogen as they age. What is one effect of this decrease?
a.
Breast enlargement
b.
Lowered serum cholesterol
c.
Osteoporosis
d.
Vaginal discharge
ANS: C
Lowered estrogen levels contribute to bone loss and osteoporosis risk. Breasts atrophy, cholesterol levels increase, and vaginal epithelium atrophies.
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What change in the reproductive system do men experience as a normal part of aging?
a.
Prostatic hypertrophy
b.
Cancer of the prostate
c.
Cessation of sperm production
d.
Muscle hypertrophy
ANS: A
As a result of decreased testosterone secretion, men experience prostate hypertrophy, decreased (but not cessation of) spermatogenesis, and gradual decrease in muscle size and strength. Cancer is not normal.
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A woman has had two pregnancies. The first pregnancy produced a healthy baby girl. The second pregnancy produced a set of twins, a boy and a girl. How would the nurse document this history?
a.
GII, PI, PII
b.
GII, PII
c.
GII, PIII
d.
GIII, PIII
ANS: B
Obstetrical history is documented using abbreviations of Latin words: G is the number of pregnancies (from the Latin word gravida); P is births, whether alive or stillborn (regardless of number of fetuses) after 20 weeks gestation (from the Latin word para); A stands for abortions, whether spontaneous or therapeutic (from the Latin word abortus; a spontaneous abortion is sometimes called a miscarriage). Roman numerals follow the letter to specify the number of each. For example, three pregnancies—twins, one single birth, and one spontaneous abortion—are recorded as GIII, PII, AI. This may also be written as G3P2A1.
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What does the term abortus mean in an obstetrical history?
a.
Delivery of a live but impaired infant
b.
A medically induced abortion
c.
An ectopic pregnancy
d.
Loss of a fetus before it was mature enough to live outside of the mother
ANS: D
Abortus refers to abortions, whether spontaneous or therapeutic (from the Latin word abortus); a spontaneous abortion is sometimes called a miscarriage. A medically induced abortion would be included in this definition, but abortus is more than just medically induced abortions. A and C are not correct.
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The nurse is assisting with teaching a woman about early detection of cancer. According to the American Cancer Society, how should a 52-year-old woman be instructed to monitor for breast cancer?
a.
Monthly breast self-examination (BSE) and a mammogram every 5 years
b.
Monthly BSE and a mammogram every 3 years
c.
Yearly BSE, mammogram, and clinical examination
d.
Monthly BSE and a mammogram and clinical examination yearly
ANS: D
The American Cancer Society recommends from age 20 throughout life that women do monthly BSE, from ages 20 to 39 that they add a breast examination by a health professional every 3 years, and from age 40 that they have a yearly mammogram and breast examination by a health professional. Those who experience breast symptoms or have a strong family history of breast cancer may be advised to have more frequent examinations.
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A woman is advised by her physician to have a mammogram. What instructions should the nurse provide to assist the patient to prepare for the examination?
a.
There is no preparation required.
b.
Fast for 12 hours before the test.
c.
Avoid caffeinated foods and beverages for 24 hours before the test.
d.
Avoid applying deodorant or powder before the test.
ANS: D
Patients preparing for mammography should be advised to bathe and not to apply deodorant, powder, or any other substance to the upper body, because these may cause false shadows on the test. Fasting and dietary restrictions are not necessary.
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Which palpation pattern should women be taught to use when practicing breast self-examination?
a.
Spiral pattern
b.
Parallel lines
c.
Wheel-spoke pattern
d.
Any pattern that is consistent and covers all breast tissue
ANS: D
Whether the breasts are examined in parallel lines, a spiral formation, or a wedge pattern is probably insignificant. It is important, however, to encourage that the examination be methodical and cover all areas of the breast, the tail of Spence, and the axilla.
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The nurse is preparing a woman for a pelvic examination. Which action should the nurse take prior to the examination?
a.
Cleanse the perineum with an iodine preparation.
b.
Have the patient void.
c.
Assist the patient into a knee–chest position.
d.
Administer a suppository.
ANS: B
Instruct the patient to empty her bladder before the examination, change into a gown, and remove her underclothing. Instruct the patient to lie either on her back with her arms resting down at her sides (to aid relaxation of abdominal muscles) or in a side-lying position, according to the health-care provider’s preference. Iodine preparation and a suppository are not necessary.
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The nurse is helping a young woman prepare for her first pelvic examination. Which of the following actions by the nurse is best?
a.
Administer a mild sedative before the examination.
b.
Teach the patient a relaxation exercise.
c.
Distract the patient by explaining the reproductive disorders she is being tested for.
d.
Have the patient close her eyes and bear down.
ANS: B
Some women may be fearful, embarrassed, or tense and may find the procedure uncomfortable. Active relaxation strategies may decrease discomfort. Sedatives, distraction, and having the patient turn her head all interfere with teaching. Talking about disorders she is being tested for may increase anxiety.
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The nurse is assisting with a Papanicolaou (Pap) smear. Following specimen placement on the slide, what should the nurse do first with the slide?
a.
Spray it with a fixative.
b.
Label and wrap it.
c.
Wash it with antiseptic.
d.
Place it in a sterile container.
ANS: A
During a Pap smear, one or more small samples of cells are gently scraped away from the surface of the cervical canal using a small wooden spatula, tiny cylindrical brush, and/or a long cotton-tipped applicator. The samples are then smeared or rolled onto microscopic slides and sprayed with a fixative to preserve them for viewing, or placed into a fixative solution for later preparation and viewing in a laboratory. Labeling is done after spraying it. Washing it would remove the cells.
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The nurse notes that insufflation was used on a patient who has had an endoscopic examination. What care should the nurse provide for the patient during the recovery period after the procedure?
a.
Have the patient ambulate as soon as she is able.
b.
Encourage 1 to 2 L of fluids.
c.
Have the patient lie flat for several hours.
d.
Keep the patient NPO for 6 hours.
ANS: C
The CO2 remaining after completion of the examination travels to the highest level of the body before being absorbed, so lying flat for a few hours after the examination may decrease discomfort. Fluids, ambulation, and remaining NPO will not help reduce discomfort.
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A nurse is teaching a 30-year-old male patient about testicular self-examinations (TSE). Which of the following instructions would be included in the teaching?
a.
“You should do this on a weekly basis.”
b.
“Monthly TSE is an important part of cancer screening.”
c.
“If you do this every other month, you will locate tumors before they metastasize.”
d.
“This should be done each year just prior to your routine physical examination by a physician.”
ANS: B
All men after puberty should do a monthly TSE to detect any tumors or other changes in the scrotum.
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The nurse assists with patient education related to testicular self-examination (TSE). The nurse determines that teaching was effective when the patient makes which of the following statements?
a.
“I should perform TSE after intercourse.”
b.
“It is best to do TSE at the end of the day.”
c.
“The TSE examination is easiest after a warm bath or shower.”
d.
“TSE should be done after vigorous exercise.”
ANS: C
The examination is easiest during or right after a warm shower or bath, when the scrotum is relaxed and the testicles are hanging low. Teach the patient to choose one day a month to always do the examination.
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What should a nurse teach a 50-year-old man about monitoring for prostate problems?
a.
Perform regular testicular self-examination (TSE).
b.
Have a monthly ultrasound examination.
c.
Have a semiannual x-ray examination.
d.
Have a yearly digital rectal examination (DRE).
ANS: D
Remind all men older than age 40 that unless they have had a complete removal of the prostate gland, they still need a DRE performed every year. TSE does not screen for prostate problems. Ultrasounds and x-rays are not prostate screening procedures.
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The nurse provides care for an elderly man with noted breast enlargement. He denies discomfort. Which of the following statements, recorded in the chart, is most appropriate?
a.
“Gynecomastia noted bilaterally, no complaints of tenderness.”
b.
“Patient with symptoms of mastalgia, no drainage seen.”
c.
“Mastitis noted in both breasts, patient denies itching.”
d.
“Abnormal swelling in both breasts; patient denies recent trauma.”
ANS: A
The presence of excess breast tissue may indicate gynecomastia related to an excess of female hormones. Mastalgia is breast pain. Mastitis is inflammation of the breasts. Gynecomastia is not caused by swollen tissue or injury.
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While performing a physical examination on a male patient, the nurse notes that the urethral opening is located on the underside of the penis. Which of the following terms best describes this condition?
a.
Phimosis
b.
Paraphimosis
c.
Hypospadias
d.
Epispadias
ANS: C
A urethral opening on the underside of the shaft is called hypospadias, and on the dorsum of the shaft is called epispadias. Phimosis and paraphimosis refer to the foreskin, not the urethra.
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The nurse is helping a patient who is scheduled to have a cystourethroscopy. Which of the following questions is most important for the nurse to ask?
a.
“Do you have any allergies?”
b.
“When was your last bowel movement?”
c.
“Do you tend to be claustrophobic?”
d.
“Are you sexually active?”
ANS: A
Possible allergic reaction to dyes is assessed and communicated to the physician as necessary. The patient is instructed to void before the procedure, not have a bowel movement. Claustrophobia is a problem with computed tomography (CT) scans and magnetic resonance imaging (MRI); patients do not have to be enclosed in endoscopic exams. Sexual activity is not a concern.
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The nurse is caring for a patient who recently underwent cystourethroscopy. Which of the following instructions should the nurse provide before the patient is discharged?
a.
“You will not urinate for about 8 hours.”
b.
“You can expect your urine to be red for about 3 days.”
c.
“You might experience some white drainage for the next couple of days.”
d.
“You should report any changes in your usual urination pattern.”
ANS: D
After the procedure, intake and output are measured for 24 hours, and alteration from the patient’s normal pattern or absence of urination are reported to the physician. Fluids are encouraged to promote excretion of the dye. Normal urination is expected and should not be delayed for 8 hours and should not be red, and the patient should not experience white discharge.
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A patient learns he has an elevated prostate-specific antigen (PSA) and asks the nurse what this means. What is the best response?
a.
“The higher the PSA, the better. It is protective against prostate cancer.”
b.
“An elevated PSA can indicate prostatic hypertrophy or cancer. You should follow up as your physician advises.”
c.
“Prostate cancer causes the PSA to increase. You should talk to your physician about treatment.”
d.
“An elevated PSA is usually harmless. Your physician will watch it carefully over the next couple of months.”
ANS: B
The normal value of PSA is less than 4 ng/L. PSA is a glycoprotein produced by prostate cells. An elevated level indicates prostatic hypertrophy or cancer.
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According to the American Cancer Society, how often should a breast self-examination (BSE) be performed?
a.
Yearly
b.
Monthly
c.
Weekly
d.
Semiannually
ANS: B
A BSE should be performed monthly, following menses if premenopausal.
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The vulva includes which of the following structures? (Select all that apply.)
a.
Mons pubis
b.
Bartholin’s glands
c.
Cervix
d.
Clitoris
e.
Vagina
f.
Urethra
ANS: A, B, D
Also called the vulva, the female external genital structures are the clitoris, mons pubis, labia majora and minora, and Bartholin’s glands.
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Which glands produce secretions that become part of semen? (Select all that apply.)
a.
Bulbourethral glands
b.
Testes
c.
Ductus deferens
d.
Prostate gland
e.
Anterior pituitary gland
f.
Seminal vesicles
ANS: A, D, F
The reproductive glands are the seminal vesicles, prostate gland, and bulbourethral glands, all of which produce secretions that become part of semen.
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What assessment findings on breast palpation should the nurse report to the physician for follow-up? (Select all that apply.)
a.
Puckering or dimpling of skin
b.
Slight difference in size between breasts
c.
Asymmetrical movement of the breasts
d.
Areas of different consistency
e.
Different pointing position of nipples
f.
Stretch marks
ANS: A, C, D, E
Although most women’s breasts are not exactly the same size, marked differences between the breasts or a change in the size of one breast should be checked with a health-care provider. Puckering or dimpling of skin, changes in consistency, asymmetrical movement, and different pointing position of the nipples can indicate changes in tissue and should also be reported to a health-care provider.
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The LPN is providing instructions on testicular self-examination. Which of the following statements would be included in the teaching? (Select all that apply.)
a.
“If you notice any lumps or unusual changes, you should call your doctor.”
b.
“The left side of the scrotum usually hangs a little lower than the right.”
c.
“Hold the scrotum in one hand and massage gently to note any tenderness.”
d.
“The testicles should be round, smooth, and egg-shaped.”
e.
“The spermatic cord generally cannot be felt without deep palpation.”
ANS: A, B, D
Testicular self-examination should be done monthly, and lumps or unusual changes should be communicated to the physician. The left side of the scrotum usually hangs a little lower than the right. Both hands are used to hold the scrotum and gently roll each testicle between the thumb and first three fingers, feeling for any lumps or hard spots. The testicles are round, smooth, and egg shaped. The spermatic cord usually feels firm, smooth, and movable and can be readily identified.
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An LPN is caring for a woman whose obstetrical history is noted as GIV, PIII, AI. The nurse knows which of the following is true about the patient’s history? (Select all that apply.)
a.
The woman has been pregnant six times.
b.
The woman had a spontaneous miscarriage.
c.
The woman gave birth three times.
d.
The woman has a set of triplets.
e.
One pregnancy failed to result in a live birth.
f.
All of the live infants were carried to full term.
ANS: C, E
Obstetrical history is documented using abbreviations of Latin words: G is the number of pregnancies (from the Latin word gravida); P is births, whether live or stillborn (regardless of number of fetuses) after 20 weeks’ gestation (from the Latin word para); A stands for abortions, whether spontaneous or therapeutic (from the Latin word abortus; a spontaneous abortion is sometimes called a miscarriage). No information regarding length of term is included in this notation. This woman had four pregnancies—three births and one abortion. (It is not known if this was a miscarriage or a therapeutic abortion.)
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