1. The nurse is counseling a postmenopausal woman about her new stress incontinence. Which statement by the nurse is most important?

a.            “You can try a variety of briefs and undergarments.”

b.            “It will be important to keep that area clean and dry.”

c.             “I can refer you to a good incontinence clinic.”

d.            “Unfortunately, incontinence is common in women your age.”

ANS: B

After menopause, the vagina becomes dry, thinner, and smoother. This atrophy places the vagina at risk for infection. The combination of this fact with the presence of urine places the woman at higher risk for infection. The nurse should teach the client good hygienic practices to reduce the likelihood of infection. Education about briefs/undergarments may be needed, and a referral to an incontinence clinic would be very helpful, but neither takes priority over preventing infection. Stating that incontinence is common is not a helpful strategy.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Teaching/Learning

2. An older woman is asking the nurse about her husband’s sexual functioning. Which statement by the nurse is most accurate?

a.            “Men his age tend to have a rapid decline in sexual abilities.”

b.            “His testosterone levels will decrease only slightly until he is quite old.”

c.             “Changes in testosterone levels do not affect sexual performance.”

d.            “You are lucky your husband is healthy enough for sexual activity.”

ANS: B

Men experience a gradual but slight decrease in testosterone until they are in their 80s. Low testosterone levels do affect sexual performance. Stating that the woman is lucky does not give accurate information about sexual functioning.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1577

TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC: Integrated Process: Teaching/Learning

3. The nurse is preparing a teaching plan for a client who is scheduled to undergo mammography for the first time. What instruction by the nurse is accurate?

a.            “The test should be carried out even if you are pregnant.”

b.            “Do not use deodorant on breasts or underarms before the test.”

c.             “You will not experience any discomfort because this is just an x-ray.”

d.            “The entire test should not take longer than 1 hour.”

ANS: B

The client should be reminded not to use creams, powders, or deodorant on breast or underarm areas before mammography because these products can show on the x-ray. The test should be rescheduled if any possibility exists that the client is pregnant. Women can experience discomfort as the breasts are compressed. The test is generally much less than an hour in duration.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1583

TOP: Client Needs Category: Health Promotion and Maintenance (Health Screening)

MSC: Integrated Process: Teaching/Learning

4. The nurse is conducting a reproductive assessment of a postmenopausal woman. Which assessment finding reported by the client requires immediate intervention by the nurse?

a.            Urinary incontinence

b.            Vaginal dryness

c.             Painful intercourse

d.            Returning periods

ANS: D

All client reports require some action by the nurse, but the priority would be to further investigate and report the “returning periods.” In a postmenopausal woman, this can signal cancer.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

5. The nurse is working with a client who is recovering after a cervical biopsy. Which statement by the client indicates a need for further instruction?

a.            “I can resume vaginal intercourse after 6 weeks.”

b.            “I should report heavy bleeding to the health care provider.”

c.             “I must not lift heavy objects for about 2 weeks.”

d.            “I will use the antiseptic rinse on a regular basis.”

ANS: A

The client should be instructed to keep the perineum clean and dry by using antiseptic solution rinses (as directed by her health care provider) and changing pads frequently. In addition, the client is instructed not to lift heavy objects for 2 weeks and to report excessive bleeding (more than like a normal period). She can resume intercourse in about 2 weeks, when the site has healed; she does not need to wait 6 weeks.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Teaching/Learning

6. The nurse is working with a client who is recovering after a laparoscopy. Which assessment finding is considered a priority by the nurse?

a.            Slight drainage from the incision site

b.            Grogginess after the anesthesia

c.             Discomfort from the catheter

d.            Reports of shoulder pain

ANS: D

Clients should expect mild drainage or blood from the incision site. Grogginess from the anesthesia and discomfort from a catheter are also expected minor occurrences post-laparoscopy. The nurse would not be concerned about these but should intervene and treat the client with shoulder pain. Shoulder pain is referred pain from phrenic nerve irritation and can be expected.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Therapeutic Procedures) MSC: Integrated Process: Nursing Process (Implementation)

7. A postmenopausal client says that she is experiencing difficulty with vaginal dryness during intercourse and wonders what might be causing this. Which is the nurse’s best response?

a.            “The less frequently you have intercourse, the drier the vaginal tissues become.”

b.            “Estrogen deficiency causes the vaginal tissues to become drier and thinner.”

c.             “Drinking at least 3 liters of water each day will make all your tissues less dry.”

d.            “Try using a water-soluble lubricant during intercourse.”

ANS: B

Estrogen deprivation, which occurs as a result of menopause, decreases the moisture-secreting capacity of vaginal cells, thereby making the area drier. The vaginal tissues also become thinner and the rugae become smoother. Reduced frequency of intercourse will not dry out the vaginal tissues. Drinking excess water will not make the tissues less dry. A water-soluble lubricant may make intercourse less difficult. However, the client is asking what causes the problem.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC: Integrated Process: Teaching/Learning