Maternal Child Nursing Care in Canada 1st By Perry Hockenberry Wilson - Test Bank

Maternal Child Nursing Care in Canada 1st By Perry Hockenberry Wilson – Test Bank

 

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Sample Questions Are Posted Below

 

Chapter 05: Health Assessment

Test Bank

 

MULTIPLE CHOICE

 

1. What are the two primary functions of the ovary?

a.	Normal female development and sex hormone release
b.	Ovulation and internal pelvic support
c.	Sexual response and ovulation
d.	Ovulation and hormone production

 

 

ANS:  D

The two functions of the ovaries are ovulation and hormone production. The presence of ovaries does not guarantee normal female development. The ovaries produce estrogen, progesterone, and androgen. Ovulation is the release of a mature ovum from the ovary; the ovaries are not responsible for interval pelvic support. Sexual response is a feedback mechanism involving the hypothalamus, anterior pituitary gland, and the ovaries. Ovulation does occur in the ovaries.

 

DIF:    Cognitive Level: Knowledge            REF:   page 65          OBJ:   1

TOP:   Nursing Process: Assessment           MSC:  CRNE: CH-8

 

2. The uterus is a muscular, pear-shaped organ that is responsible for which of the following?

a.	Cyclic menstruation
b.	Sex hormone production
c.	Fertilization
d.	Sexual arousal

 

 

ANS:  A

The uterus is an organ for reception, implantation, retention, and nutrition of the fertilized ovum; it also is responsible for cyclic menstruation. Hormone production and fertilization occur in the ovaries. Sexual arousal is a feedback mechanism involving the hypothalamus, the pituitary gland, and the ovaries.

 

DIF:    Cognitive Level: Knowledge            REF:   page 64          OBJ:   1

TOP:   Nursing Process: Assessment           MSC:  CRNE: CH-8

 

3. Unique longitudinal muscle fibres make the uterine myometrium ideally suited for which event?

a.	Menstruation
b.	Birth process
c.	Ovulation
d.	Fertilization

 

 

ANS:  B

The myometrium is made up of layers of smooth muscle that extend in three directions. These muscles assist in the birth process by expelling the fetus, ligating blood vessels after birth, and controlling the opening of the cervical os. The myometrium has little connection to menstruation. The muscles in the myometrium are not related to ovulation or fertilization.

 

DIF:    Cognitive Level: Application           REF:   page 64          OBJ:   1

TOP:   Nursing Process: Assessment           MSC:  CRNE: CH-8

 

4. Which hormone is responsible for maturation of mammary gland tissue?

a.	Estrogen
b.	Testosterone
c.	Prolactin
d.	Progesterone

 

 

ANS:  D

Progesterone causes maturation of the mammary gland tissue, specifically acinar structures of the lobules. Estrogen increases the vascularity of the breast tissue. Testosterone has no bearing on breast development. Prolactin is produced after birth and released from the pituitary gland. It is produced in response to infant suckling and emptying of the breasts.

 

DIF:    Cognitive Level: Knowledge            REF:   page 67          OBJ:   1

TOP:   Nursing Process: Assessment           MSC:  CRNE: CH-8

 

5. What is the best time for breast self-examination (BSE)?

a.	5 to 7 days after menses ceases
b.	Day 1 of the endometrial cycle
c.	7 days before the onset of menses
d.	Any time during a shower or bath

 

 

ANS:  A

The physiological alterations in breast size and activity reach their minimal level about 5 to 7 days after menstruation stops. Therefore, all women should perform BSE during this phase of the menstrual cycle.

 

DIF:    Cognitive Level: Knowledge            REF:   page 67          OBJ:   7

TOP:   Nursing Process: Planning               MSC:  CRNE: HW-2

 

6. Which myometrial muscle fibres prevent menstrual blood from flowing back into the uterine tubes during menstruation?

a.	Oblique
b.	Circular
c.	Transverse
d.	Longitudinal

 

 

ANS:  B

Circular fibres of the inner myometrium prevent menstrual blood from flowing back into the uterine tubes during menstruation. Oblique fibres do not prevent menstrual blood from flowing back into the uterine tubes during menstruation. Transverse fibres do not prevent menstrual blood from flowing back into the uterine tubes during menstruation. Longitudinal fibres do not prevent menstrual blood from flowing back into the uterine tubes during menstruation.

 

DIF:    Cognitive Level: Knowledge            REF:   page 64          OBJ:   1

TOP:   Nursing Process: Assessment           MSC:  CRNE: CH-8

 

7. Mrs. Jones is unable to lie in the lithotomy position for a Pap smear test. Which is an alternative position for a gynecological examination?

a.	Sims
b.	Prone
c.	Lateral
d.	High-Fowler’s

 

 

ANS:  C

Alternative positions to the lithotomy position that may be used for a pelvic examination include a lateral (side-lying) position, a V-shaped position, a diamond-shaped position, and an M-shaped position.

 

DIF:    Cognitive Level: Application           REF:   page 71          OBJ:   3

TOP:   Nursing Process: Implementation     MSC:  CRNE: CH-13

 

8. In which of the following situations is it more likely that intimate partner violence will increase?

a.	Marriage
b.	Pregnancy
c.	Birth of a baby
d.	Children becoming school-age

 

 

ANS:  B

Intimate partner violence is known to increase in pregnancy and during separation and divorce. Marriage, birth of a baby, and children becoming school-age have not been reported to be associated with an increase in intimate partner violence.

 

DIF:    Cognitive Level: Knowledge            REF:   page 71          OBJ:   4

TOP:   Nursing Process: Assessment           MSC:  CRNE: HW-7

 

9. Which of the following best reflects who should be screened for risk of abuse during pregnancy?

a.	Adolescents
b.	Single mothers
c.	Women of low socioeconomic status
d.	All pregnant women when they enter prenatal care

 

 

ANS:  D

All women who enter the health care system should be screened for their risk of abuse. Age, marital status, or socioeconomic status are not to be singled out for abuse screening.

 

DIF:    Cognitive Level: Knowledge            REF:   page 71          OBJ:   4

TOP:   Nursing Process: Assessment           MSC:  CRNE: HW-7

 

10. When performing a gynecological exam, the nurse would expect to find Bartholin glands in which position on the labia majora?

a.	10 and 2 o’clock
b.	12 and 6 o’clock
c.	8 and 4 o’clock
d.	9 and 3 o’clock

 

 

ANS:  C

The correct position to locate Bartholin glands is at the 8 and 4 o’clock positions on the labia majora.

 

DIF:    Cognitive Level: Application           REF:   page 76          OBJ:   6

TOP:   Nursing Process: Implementation     MSC:  CRNE: CH-4

 

11. 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 states, “I have special undergarments that I do not remove, for religious reasons.” What is the most appropriate response from the nurse?

a.	“You can’t have an examination without removing all your clothes, as they may get soiled.”
b.	“I’ll ask the doctor if he is able to modify the examination.”
c.	“Tell me about your undergarments. Then we can discuss how you can have your examination done comfortably.”
d.	“What? I’ve never heard of such a thing! That sounds different.”

 

 

ANS:  C

This statement reflects cultural competence by the nurse and shows respect for the woman’s religious practices. The nurse must respect the rich and unique qualities that cultural diversity brings to individuals. In recognizing the value of these differences, the nurse can modify the plan of care to meet the needs of each woman.

 

DIF:    Cognitive Level: Application           REF:   page 70          OBJ:   2

TOP:   Nursing Process: Planning               MSC:  CRNE: NCP-13

 

12. A 62-year-old woman has not been to the clinic for an annual examination for 5 years. The recent death of her husband reminded her that she should come for a visit. Her family doctor has retired, and she is going to see the women’s health nurse practitioner for her visit. What should the nurse do to facilitate a positive health care experience?

a.	Remind the woman that she is long overdue for her examination and that she should come in annually.
b.	Listen carefully and allow extra time for this woman’s health history interview.
c.	Reassure the woman that a nurse practitioner is just as good as her old doctor.
d.	Encourage the woman to talk about the death of her husband and her fears about her own death.

 

 

ANS:  B

The nurse has an opportunity to use reflection and empathy while listening and to ensure open and caring communication. Scheduling a longer appointment time may be necessary because older women may have longer histories or may need to talk. A respectful and reassuring approach to caring for women over age 50 can help ensure that they continue to seek health care. Reminding the woman about her overdue examination, reassuring the woman that she has a good practitioner, and encouraging conversation about the death of her husband and her own death are not the best approaches at the initial visit.

 

DIF:    Cognitive Level: Application           REF:   page 73          OBJ:   5

TOP:   Nursing Process: Planning               MSC:  CRNE: CH-1

 

13. During a health history interview, a woman states that she thinks that she has “bumps” on her labia. She also states that she is not sure how to check herself. Which is the correct response?

a.	Reassure the woman that the examination will not reveal any problems.
b.	Teach her what normal and abnormal findings are during the examination.
c.	Inform the woman that “bumps” can be treated.
d.	Tell her that most women have “bumps” on their labia.

 

 

ANS:  B

During the assessment and evaluation the responsibility for self-care, health promotion, and enhancement of wellness is emphasized. The pelvic examination provides a good opportunity for the practitioner to emphasize the need for regular vulvar self-examination. Providing reassurance to the woman concerning the “bumps” would not be an accurate response.

 

DIF:    Cognitive Level: Application           REF:   pages 73-74    OBJ:   5

TOP:   Nursing Process: Assessment           MSC:  CRNE: CH-1

 

14. 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. What should be the nurse’s initial response?

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 history and physical examination is the patient’s description of any symptoms she may be experiencing. Although vaginal creams may interfere with the Pap test, the best response is for the nurse to inquire about the symptoms the patient is experiencing. Women should not douche, use vaginal medications, or have sexual intercourse for 24 to 48 hours before obtaining a Pap test. Although the woman may need to reschedule a visit for her Pap test, her current symptoms should still be addressed.

 

DIF:    Cognitive Level: Application           REF:   pages 73-74    OBJ:   5

TOP:   Nursing Process: Assessment           MSC:  CRNE: CH-3

 

15. Upon vaginal examination, the nurse sees a bulge from the anterior vaginal wall. What should the nurse suspect?

a.	Rectocele
b.	Cystocele
c.	Uterine lesion
d.	Scar tissue from previous episiotomy

 

 

ANS:  B

Upon vaginal examination, if an anterior vaginal bulge is palpated or visualized, the most probable cause is a cystocele or urethrocele. A rectocele would be indicated if the bulge was on the posterior vaginal wall. A uterine lesion would not be seen or palpated through the vaginal wall. Scar tissue from a previous episiotomy would be seen or palpated on the perineum.

 

DIF:    Cognitive Level: Knowledge            REF:   page 76          OBJ:   5

TOP:   Nursing Process: Assessment           MSC:  CRNE: CH-6

 

16. Which statement would indicate that the patient requires additional instruction about breast self-examination?

a.	“Yellow discharge from my nipple is normal if I’m having my period.”
b.	“I should check my breasts at the same time each month, right after my period.”
c.	“I should also feel in my armpit area while performing my breast examination.”
d.	“I should check each breast in a set way, such as in a circular motion.”

 

 

ANS:  A

Discharge from the nipples requires further examination from a health care provider. “I should check my breasts at the same time each month, like after my period,” “I should also feel in my armpit area while performing my breast examination,” and “I should check each breast in a set way, such as in a circular motion” all indicate successful learning.

 

DIF:    Cognitive Level: Analysis                REF:   page 67 | page 75

OBJ:   7                    TOP:   Nursing Process: Assessment           MSC:  CRNE: HW-2

 

17. What is the nurse’s best response to a 20-year-old patient who calls the clinic to report that she has found a lump in her breast?

a.	“Don’t worry about it. I’m sure it’s nothing.”
b.	“Wear a tight bra, and it should shrink; if not, make an appointment with your doctor.”
c.	“Many women have benign lumps and bumps in their breasts, but you should come in for an examination.”
d.	“Check it again in 1 month and call the clinic back if it’s still there.”

 

 

ANS:  C

Try to ease the patient’s fear, but provide a time for a thorough evaluation of the lump, because it may indicate abnormal changes in the breast. Discrediting the patient’s findings may discourage her from continuing with breast self-examination. Wearing a tight bra may irritate the skin and will not cause the lump to shrink. Delaying treatment may allow proliferation of abnormal cells.

 

DIF:    Cognitive Level: Analysis                REF:   page 69 | page 74

OBJ:   7                    TOP:   Nursing Process: Assessment           MSC:  CRNE: NCP-4

 

18. Diethylstilbestrol (DES) was used between 1938 and 1971 for pregnant women in order to increase their chances of having a successful pregnancy. Which of the following groups has an increased risk of noncancerous epididymal cysts?

a.	DES sons
b.	DES daughters
c.	DES granddaughters
d.	Women who took DES while pregnant

 

 

ANS:  A

DES sons have an increased risk of noncancerous epididymal cysts. DES daughters have an increased risk of pregnancy complications, infertility, and structural differences of the reproductive tract. There are no known effects for DES granddaughters. DES women are at an increased risk of breast cancer.

 

DIF:    Cognitive Level: Knowledge            REF:   page 76          OBJ:   5

TOP:   Nursing Process: Assessment           MSC:  CRNE: CH-7

 

19. Which of the following both protects the pelvic structures and accommodates the growing fetus during pregnancy?

a.	Perineum
b.	Bony pelvis
c.	Vaginal vestibule
d.	Fourchette

 

 

ANS:  B

The bony pelvis protects and accommodates the growing fetus. The perineum covers the pelvic structures. The vaginal vestibule contains openings to the urethra and vagina. The fourchette is formed by the labia minor.

 

DIF:    Cognitive Level: Knowledge            REF:   page 66          OBJ:   1

TOP:   Nursing Process: Assessment           MSC:  CRNE: CH-8

 

20. At which age may a woman discontinue Pap screening?

a.	Never
b.	After childbearing years
c.	After menopause
d.	After the age of 70

 

 

ANS:  D

Women can discontinue Pap screening after the age of 70 years provided that their last 3 to 4 Pap tests have been normal.

 

DIF:    Cognitive Level: Comprehension     REF:   page 77          OBJ:   6

TOP:   Nursing Process: Assessment           MSC:  CRNE: HW-2

 

21. Before Pap screening it is recommended that the woman abstain from sexual intercourse for at least what period of time before the test?

a.	12 hours
b.	24 hours
c.	48 hours
d.	7 days

 

 

ANS:  B

It is recommended that women not have sexual intercourse for at least 24 hours before the procedure.

 

DIF:    Cognitive Level: Knowledge            REF:   page 78, Box 5-3

OBJ:   6                    TOP:   Nursing Process: Implementation     MSC:  CRNE: CH-5

 

22. Which of the following should the nurse do as part of his or her participation in the gynecological portion of the physical examination?

a.	Take a firm approach that encourages the patient to facilitate the examination by following the physician’s instructions exactly.
b.	Explain the procedure as it unfolds and continue to question the patient to get information in a timely manner.
c.	Take the opportunity to explain that the trendy vulvar self-examination is only for women at risk for cancer.
d.	Help the woman relax through proper placement of her hands and proper breathing during the examination.

 

 

ANS:  D

Breathing techniques are important relaxation techniques that can help the patient during the examination. The nurse should encourage the patient to participate in an active partnership with the care provider. Explanations during the procedure are fine, but many women are uncomfortable answering questions in the exposed and awkward position of the examination. Vulvar self-examination on a regular basis should be encouraged and taught during the examination.

 

DIF:    Cognitive Level: Application           REF:   page 75, Box 5-1

OBJ:   6                    TOP:   Nursing Process: Implementation     MSC:  CRNE: CH-4

 

23. Which assessment is completed when microscopic examination of scrapings from the cervix, endocervix, or other mucous membranes to detect premalignant or malignant cells occurs?

a.	Bimanual palpation
b.	Rectovaginal palpation
c.	A Papanicolaou (Pap) test
d.	A five A’s procedure

 

 

ANS:  C

The Pap test is a microscopic examination for cancer that should be performed regularly, depending on the patient’s age. Bimanual palpation is a physical examination of the vagina. Rectovaginal palpation is a physical examination performed through the rectum. The five A’s is an intervention procedure to help a patient stop smoking.

 

DIF:    Cognitive Level: Knowledge            REF:   pages 77-78, Box 5-3

OBJ:   6                    TOP:   Nursing Process: Implementation     MSC:  CRNE: CH-4

 

24. As a girl progresses through development, she may be at risk for a number of age-related conditions. While preparing a 21-year-old patient for her first adult physical examination and Papanicolaou (Pap) test, the nurse is aware of excessive shyness. The young woman states that she will not remove her bra because “there is something wrong with my breasts; one is way bigger.” What is the best response by the nurse in this situation?

a.	“Please reschedule your appointment until you are more prepared.”
b.	“It is okay; the provider will not do a breast examination.”
c.	“I will explain normal growth and breast development to you.”
d.	“That is unfortunate; this must be very stressful for you.”

 

 

ANS:  C

During adolescence one breast may grow faster than the other; breasts are rarely the same size. Discussion regarding this aspect of growth and development with the patient will reassure her that there may be nothing wrong with her breasts. Female teenagers usually enter the health system for screening (Pap tests begin at age 18 or younger if sexually active). Situations such as these can produce great stress for the teenager, and the nurse and health care provider should treat her carefully. Asking her to reschedule will likely result in the patient’s not returning for her appointment at all. A breast examination at her age is part of the complete physical examination. Young women should be taught about normal breast development and begin doing breast self-examinations. The last response is inappropriate. Although it shows empathy on the part of the nurse and acknowledges the patient’s stress, it will not correct the patient’s deficient knowledge related to normal growth and development.

 

DIF:    Cognitive Level: Application           REF:   page 67          OBJ:   7

TOP:   Nursing Process: Diagnosis              MSC:  CRNE: HW-22