Chapter 27: Female Genitourinary System
Jarvis: Physical Examination and Health Assessment, 8th Edition
MULTIPLE CHOICE
1. During a health history, a 22-year-old woman asks, “Can I get that vaccine for human
papilloma virus (HPV)? I have genital warts and I’d like them to go away!” What is the
nurse’s best response?
a.
“The HPV vaccine is for girls and women ages 9 to 26 years, so we can start that
today.”
b.
“This vaccine is only for girls who have not yet started to become sexually active.”
c.
“Let’s check with the physician to see if you are a candidate for this vaccine.”
d.
“The vaccine cannot protect you if you already have an HPV infection.”
2. The nurse is examining a female patient’s vestibule. What does the nurse expect to visualize?
a.
Urethral meatus and vaginal orifice
b.
Vaginal orifice and vestibular (Bartholin) glands
c.
Urethral meatus and paraurethral (Skene) glands
d.
Paraurethral (Skene) and vestibular (Bartholin) glands
3. During a speculum inspection of the vagina, what would the nurse expect to see at the end of
the vaginal canal?
a.
Cervix
b.
Uterus
c.
Ovaries
d.
Fallopian tubes
4. The uterus is usually positioned tilting forward and superior to the bladder. What is this
position called?
a.
Anteverted and anteflexed
b.
Retroverted and anteflexed
c.
Retroverted and retroflexed
d.
Superiorverted and anteflexed
5. An 11-year-old girl is in the clinic for a sports physical examination. The nurse notices that
she has begun to develop breasts, and during the conversation the girl reveals that she is
worried about her development. The nurse should use which of these techniques to best assist
the young girl in understanding the expected sequence for development?
a.
Use the Tanner scale on the five stages of sexual development.
b.
Describe her development and compare it with that of other girls her age.
c.
Use the Jacobsen table on expected development on the basis of height and weight
data.
d.
Reassure her that her development is within normal limits and tell her not to worry
about the next step.
6. A woman who is 8 weeks pregnant is in the clinic for a checkup. The nurse reads on her chart
that her cervix is softened and looks cyanotic. Based on these findings, what two signs is the
patient exhibiting?
a.
Tanner and Hegar
b.
Hegar and Goodell
c.
Chadwick and Hegar
d.
Goodell and Chadwick
7. What usually occurs to the cells in the reproductive tract to cause the changes normally
associated with menopause?
a.
Aging
b.
Becoming fibrous
c.
Estrogen dependent
d.
Able to respond to progesterone
8. The nurse is reviewing the changes that occur with menopause. Which changes are expected?
a.
Uterine and ovarian atrophy, along with thinning of vaginal epithelium
b.
Ovarian atrophy, increased vaginal secretions, and increasing clitoral size
c.
Cervical hypertrophy, ovarian atrophy, and increased acidity of vaginal secretions
d.
Vaginal mucosa fragility, increased acidity of vaginal secretions, and uterine
hypertrophy
9. A 54-year-old woman who has just completed menopause is in the clinic today for a yearly
physical examination. Which of these statements should the nurse include in patient
education?
a.
“You can continue with hormone replacement therapy as it actually decreases your
risk for breast cancer.”
b.
“You should be aware that you’re at increased risk for dyspareunia because of
decreased vaginal secretions.”
c.
“You have only stopped menstruating and there are not really any other changes
that you need to be concerned about.”
d.
“You likely may have difficulty with sexual pleasure as a result of drastic changes
in the female sexual response cycle.”
10. A woman is in the clinic for an annual gynecologic examination. How should the nurse begin
the interview?
a.
Menstrual history, because it is generally nonthreatening.
b.
Sexual history, because discussing it first will build rapport.
c.
Obstetric history, because it includes the most important information.
d.
Urinary system history, because problems may develop in this area as well.
11. A patient has had three pregnancies and two live births. How should the nurse record this
information?
a.
G2; P2; AB1
b.
G3; P2; AB0
c.
G3; P2; AB1
d.
G3; P3; AB1
12. During the interview with a female patient, the nurse gathers data that indicates the patient is
perimenopausal. Which of these statements made by this patient leads to this conclusion?
a.
“I have noticed that my muscles ache at night when I go to bed.”
b.
“I will be very happy when I can stop worrying about having a period.”
c.
“I have been noticing that I sweat a lot more than I used to, especially at night.”
d.
“I have only been pregnant twice, but both times I had breast tenderness as my first
symptom.”
13. A 50-year-old woman calls the clinic because she has noticed some changes in her body and
breasts and wonders if these changes could be attributable to the hormone replacement
therapy (HRT) she started 3 months earlier. How should the nurse respond?
a.
“HRT is at such a low dose that side effects are very unusual.”
b.
“HRT has several side effects, including fluid retention, breast tenderness, and
vaginal bleeding.”
c.
“Vaginal bleeding with HRT is very unusual; I suggest you come into the clinic
immediately to have this evaluated.”
d.
“It sounds as if your dose of estrogen is too high; I think you may need to decrease
the amount you are taking and then call back in a week.”
14. A 52-year-old patient states that when she sneezes or coughs she “wets herself a little.” She is
very concerned that something may be wrong with her. What does this finding suggest?
a.
Dysuria
b.
Hematuria
c.
Urge incontinence
d.
Stress incontinence
15. During the interview, a patient reveals that she has some vaginal discharge. She is worried
that it may be a sexually transmitted infection. What would be the most appropriate response
by the nurse?
a.
“Oh, don’t worry. Some cyclic vaginal discharge is normal.”
b.
“Have you been engaging in unprotected sexual intercourse?”
c.
“I’d like more information about the discharge. What color is it?”
d.
“Have you had any urinary incontinence associated with the discharge?”
16. A woman states that 2 weeks ago she had a urinary tract infection that was treated with an
antibiotic. What should the nurse ask the woman?
a.
“Have you had excessive vaginal bleeding?”
b.
“Have you experienced changes in your urination patterns?”
c.
“Do you have any unusual vaginal discharge or itching?”
d.
“Have you noticed any changes in your desire for intercourse?”
17. Which statement would be most appropriate when the nurse is introducing the topic of sexual
relationships during a health interview?
a.
“Now, it is time to talk about your sexual history. When did you first have
intercourse?”
b.
“Most women your age have had more than one sexual partner. How many would
you say you have had?”
c.
“Women often feel dissatisfied with their sexual relationships. Would it be okay to
discuss this now?”
d.
“Women often have questions about their sexual relationship and how it affects
their health. Do you have any questions?”
18. A 22-year-old woman has been considering using oral contraceptives. As a part of her health
history, what should the nurse ask?
a.
“Do you have a history of heart murmurs?”
b.
“Will you be in a monogamous relationship?”
c.
“Have you carefully thought this choice through?”
d.
“If you smoke, how many cigarettes do you smoke per day?”
19. A married couple has come to the clinic seeking advice on pregnancy. They have been trying
to conceive for 4 months and have not been successful. What should the nurse do first?
a.
Ascertain whether either of them has been using broad-spectrum antibiotics.
b.
Explain that couples are considered infertile after 1 year of unprotected
intercourse.
c.
Immediately refer the woman to an expert in pelvic inflammatory disease—the
most common cause of infertility.
d.
Explain that couples are considered infertile after 3 months of engaging in
unprotected intercourse and that they will need a referral to a fertility expert.
20. A nurse is assessing a patient’s risk for contracting a sexually transmitted infection (STI).
What is an appropriate question to ask this patient?
a.
“Do you have a sexually transmitted infection?”
b.
“You are aware of the dangers of unprotected sex, aren’t you?”
c.
“You know that it’s important to use condoms for protection, right?”
d.
“Do you use a condom with each episode of sexual intercourse?”
21. When the nurse is interviewing a preadolescent girl, which opening question would be least
threatening?
a.
“Do you have any questions about growing up?”
b.
“What has your mother told you about growing up?”
c.
“When did you notice that your body was changing?”
d.
“I remember being very scared when I got my period. How do you think you’ll
feel?”
22. When the nurse is discussing sexuality and sexual issues with an adolescent, a permission
statement helps convey that it is normal to think or feel a certain way. Which statement is the
best example of a permission statement?
a.
“It is okay that you have become sexually active.”
b.
“Girls your age often have questions about sexual activity. Do you have any
questions?”
c.
“If it is okay with you, I’d like to ask you some questions about your sexual
history.”
d.
“Girls your age often engage in sexual activities. It is okay to tell me if you have
had intercourse.”
23. The nurse is preparing to interview a postmenopausal woman. Which of these statements is
true as it applies to obtaining the health history of a postmenopausal woman?
a.
The nurse should screen for monthly breast tenderness.
b.
The nurse should ask a postmenopausal woman if she has ever had vaginal
bleeding.
c.
Once a woman reaches menopause, the nurse does not need to ask any history
questions.
d.
Postmenopausal women are not at risk for contracting STIs; therefore, these
questions can be omitted.
24. During the examination portion of a patient’s visit, she will be in lithotomy position. Which
statement reflects some things that the nurse can do to make this position more comfortable
for her?
a.
Ask her to place her hands and arms over her head.
b.
Elevate her head and shoulders to maintain eye contact.
c.
Allow her to choose to have her feet in the stirrups or have them resting side by
side on the edge of the table.
d.
Allow her to keep her buttocks approximately 6 inches from the edge of the table
to prevent her from feeling as if she will fall off.
25. An 18-year-old patient is having her first pelvic examination. Which action by the nurse is
appropriate?
a.
Inviting her mother to be present during the examination.
b.
Avoiding the lithotomy position for this first time because it can be uncomfortable
and embarrassing.
c.
Raising the head of the examination table and giving her a mirror so that she can
view the examination.
d.
Fully draping her, leaving the drape between her legs elevated to avoid
embarrassing her with eye contact.
26. The nurse has just completed an inspection of a nulliparous woman’s external genitalia.
Which of these would be a description of a finding within normal limits?
a.
Redness of the labia majora
b.
Multiple nontender sebaceous cysts
c.
Gaping and slightly shriveled labia majora
d.
Discharge that is foul smelling and irritating
27. The nurse is preparing for an internal genitalia examination of a woman. Which order of the
examination is correct?
a.
Bimanual, speculum, and rectovaginal
b.
Speculum, rectovaginal, and bimanual
c.
Speculum, bimanual, and rectovaginal
d.
Rectovaginal, bimanual, and speculum
28. During an internal examination of a woman’s genitalia, the nurse will use which technique for
proper insertion of the speculum?
a.
The woman is instructed to bear down, the speculum blades are opened and
applied in a swift, upward movement.
b.
The woman is instructed to bear down, the width of the blades is horizontally
turned, and the speculum is inserted downward at a 45-degree angle toward the
small of the woman’s back.
c.
The blades of the speculum are inserted on a horizontal plane, turning them to a
30-degree angle while continuing to insert them. The woman is asked to bear down
after the speculum is inserted.
d.
The blades are locked open by turning the thumbscrew. Once the blades are open,
pressure is applied to the introitus and the blades are inserted downward at a
45-degree angle to bring the cervix into view.
29. The nurse is examining a 35-year-old female patient. During the health history, the nurse
notices that she has had two term pregnancies, and both babies were delivered vaginally.
During the internal examination, the nurse observes that the cervical os is a horizontal slit
with some healed lacerations and that the cervix has some nabothian cysts that are small,
smooth, and yellow. In addition, the nurse notices that the cervical surface is granular and red,
especially around the os. Finally, the nurse notices the presence of stringy, opaque, odorless
secretions. Which of these findings are abnormal?
a.
Nabothian cysts are present.
b.
The cervical os is a horizontal slit.
c.
The cervical surface is granular and red.
d.
Stringy and opaque secretions are present.
30. A patient calls the clinic for instructions before having a Papanicolaou (Pap) smear. What is
an appropriate response by the nurse?
a.
“If you are menstruating, please use pads to avoid placing anything into the
vagina.”
b.
“Avoid intercourse, inserting anything into the vagina, or douching within 24
hours of your appointment.”
c.
“We would like you to use a mild saline douche before your examination. You
may pick this up in our office.”
d.
“If you suspect that you have a vaginal infection, please gather a sample of the
discharge to bring with you.”
31. During an examination, which tests will the nurse collect to screen for cervical cancer?
a.
Endocervical specimen, cervical scrape, and vaginal pool
b.
Endocervical specimen, vaginal pool, and acetic acid wash
c.
Cervical scrape, acetic acid wash, saline mount (wet prep)
d.
Endocervical specimen, potassium hydroxide (KOH) preparation, and acetic acid
wash
32. When performing the bimanual examination, the nurse notices that the cervix feels smooth
and firm, is round, and is fixed in place (does not move). When cervical palpation is
performed, the patient complains of some pain. How should the nurse interpret these findings?
a.
These findings are all within normal limits.
b.
Pain may occur during palpation of the cervix.
c.
Cervical consistency should be soft and velvety—not firm.
d.
The cervix should move when palpated; an immobile cervix may indicate
malignancy.
33. The nurse is palpating a female patient’s adnexa. The findings include a firm, smooth uterine
wall; the ovaries are palpable and feel smooth and firm. The fallopian tube is firm and
pulsating. How should the nurse proceed?
a.
Tell the patient that her examination is normal.
b.
Give her an immediate referral to a gynecologist.
c.
Suggest that she return in a month for a recheck to verify the findings.
d.
Tell the patient that she may have an ovarian cyst that should be evaluated further.
34. A 65-year-old woman is in the office for routine gynecologic care. She had a complete
hysterectomy 3 months ago after cervical cancer was detected. Which statement does the
nurse know to be true regarding this visit?
a.
Her cervical mucosa will be red and dry looking.
b.
She will not need to have a Pap smear performed.
c.
The nurse can expect to find that her uterus will be somewhat enlarged and her
ovaries small and hard.
d.
The nurse should plan to lubricate the instruments and the examining hand
adequately to avoid a painful examination.
35. The nurse is preparing to examine the external genitalia of a school-age girl. Which position
would be most appropriate in this situation?
a.
In the parent’s lap
b.
In a frog-leg position on the examining table
c.
In the lithotomy position with the feet in stirrups
d.
Lying flat on the examining table with legs extended
36. When assessing a newborn infant’s genitalia, the nurse notices that the genitalia are somewhat
engorged. The labia majora are swollen, the clitoris looks large, and the hymen is thick. The
vaginal opening is difficult to visualize. The infant’s mother states that she is worried about
the labia being swollen. How should the nurse reply?
a.
“This is a normal finding in newborns and should resolve within a few weeks.”
b.
“This finding could indicate an abnormality and may need to be evaluated by a
physician.”
c.
“We will need to have estrogen levels evaluated to ensure that they are within
normal limits.”
d.
“We will need to keep close watch over the next few days to see if the genitalia
decrease in size.”
37. During a vaginal examination of a 38-year-old woman, the nurse notices that the vulva and
vagina are erythematous and edematous with thick, white, curdlike discharge adhering to the
vaginal walls. The woman reports intense pruritus and thick white discharge from her vagina.
The nurse knows that these history and physical examination findings are most consistent with
which condition?
a.
Candidiasis
b.
Trichomoniasis
c.
Atrophic vaginitis
d.
Bacterial vaginosis
38. A 22-year-old woman is being seen at the clinic for problems with vulvar pain, dysuria, and
fever. On physical examination, the nurse notices clusters of small, shallow vesicles with
surrounding erythema on the labia. Inguinal lymphadenopathy is also present. What do these
findings indicate?
a.
HPV
b.
Pediculosis pubis
c.
Contact dermatitis
d.
Herpes simplex virus type 2
39. When performing an external genitalia examination of a 10-year-old girl, the nurse notices
that no pubic hair has grown in and the mons and the labia are covered with fine vellus hair.
According to the Sexual Maturity Rating scale, what stage of sexual maturity do these
findings indicate?
a.
1
b.
2
c.
3
d.
4
40. A 46-year-old woman is in the clinic for her annual gynecologic examination. She voices
concern about ovarian cancer because her mother and sister died of it. Which statement does
the nurse know to be correct regarding ovarian cancer?
a.
Ovarian cancer rarely has any symptoms.
b.
The Pap smear detects the presence of ovarian cancer.
c.
Women over age 40 years should have a thorough pelvic examination every 3
years.
d.
Women at high risk for ovarian cancer should have annual transvaginal
ultrasonography for screening.
41. During a bimanual examination, the nurse detects a solid tumor on the ovary that is heavy and
fixed, with a poorly defined mass. What does this finding suggest?
a.
Ovarian cyst
b.
Endometriosis
c.
Ovarian cancer
d.
Ectopic pregnancy
42. A 25-year-old woman comes to the emergency department with a sudden fever of 38.3 C and
abdominal pain. Upon examination, the nurse notices that she has rigid, boardlike lower
abdominal musculature. When the nurse tries to perform a vaginal examination, the patient
has severe pain when the uterus and cervix are moved. What do these findings suggest?
a.
Endometriosis
b.
Uterine fibroids
c.
Ectopic pregnancy
d.
Pelvic inflammatory disease
43. During an external genitalia examination of a woman, the nurse notices several lesions around
the vulva. The lesions are pink, moist, soft, and pointed papules. The patient states that she is
not aware of any problems in that area. What do these findings likely indicate?
a.
Syphilitic chancre
b.
HPV or genital warts
c.
Pediculosis pubis (crab lice)
d.
Herpes simplex virus type 2 (herpes genitalis)
44. During an examination, how would the nurse expect the cervical os of a woman who has
never had children to appear?
a.
Everted
b.
Stellate
c.
Small and round
d.
As a horizontal irregular slit
45. A woman has just been diagnosed with HPV or genital warts. The nurse should counsel her to
receive regular examinations because this virus makes her at a higher risk for what type of
cancer?
a.
Uterine
b.
Cervical
c.
Ovarian
d.
Endometrial
46. During an internal examination, the nurse notices that the cervix bulges outside the introitus
when the patient is asked to strain. How should the nurse document this finding?
a.
A normal finding
b.
Uterine prolapse, graded first degree
c.
Uterine prolapse, graded third degree
d.
Uterine prolapse, graded second degree
47. A 35-year-old woman is at the clinic for a gynecologic examination. During the examination,
she asks the nurse, “How often do I need to have this Pap test done?” Which reply by the
nurse is correct?
a.
“It depends. Do you smoke?”
b.
“A Pap test needs to be performed annually until you are 65 years of age.”
c.
“If you have two consecutive normal Pap tests, then you can wait 5 years between
tests.”
d.
“After age 30 years, if you have three consecutive normal Pap tests, then you may
be screened every 2 to 3 years.”
1. The nurse is palpating an ovarian mass during an internal examination of a 63-year-old
woman. Which findings of the mass’s characteristics would suggest the presence of an
ovarian cyst? (Select all that apply.)
a.
Fixed
b.
Poorly defined
c.
Heavy and solid
d.
Mobile and solid
e.
Smooth and round
f.
Mobile and fluctuant