NCLEX Review Questions 1 The Preconception Client

1. NCLEX Review Questions 1The Preconception Client Ana H. Corona, MSN, FNP-C Nursing Instructor February 2008 Lippincott�s Review 8/E, Skyscape

2. Question 1. After the nurse instructs a 20-year-old nulligravid client on how to perform a breast self-examination, which of the following client statements indicates that the teaching has been successful? Choices . "I should perform breast self-examination on the day my menstrual flow begins." . "It's important that I perform breast self-examination on the same day each month." . "If I notice that one of my breasts is much smaller than the other, I shouldn't worry." . "If there is some discharge from my nipples, I should avoid squeezing them."

3. Answer is 4 The nurse determines that the client has understood the instructions when the client says that she should not squeeze her nipples if there is a discharge present. If the client notices a discharge or bleeding, she should notify her physician or health care provider, because this may be symptomatic of underlying disease. Ideally, breast self-examination should be performed about 1 week after the onset of menses because hormonal influences on breast tissue are at a low ebb at this time. The client should perform breast self-examination on the same day each month only if she has stopped menstruating (eg, menopause). The client's breasts should mirror each other. If one breast is significantly larger than the other, or if there is "pitting" disease, a tumor may be present.

4. Question 2. Assessment of a 16-year-old nulligravid client who visits the clinic and asks for information on contraceptives reveals a menstrual cycle of 28 days. The nurse formulates a nursing diagnosis of Deficient Knowledge related to ovulation and fertility management. Which of the following would be important to include in the teaching plan for the client? Choices . The ovum survives for 96 hours after ovulation, making conception possible during this time. . The basal body temperature falls at least 0.2�F after ovulation has occurred. . Ovulation usually occurs on day 14, plus or minus 2 days, before the onset of the next menstrual cycle. . Most women can tell they have ovulated because of severe pain and thick, scant cervical mucus.

5. Answer is 3 For a client with a menstrual cycle of 28 days, ovulation usually occurs on day 14, plus or minus 2 days, before the onset of the next menstrual cycle. Stated another way, the menstrual period begins about 2 weeks after ovulation has occurred. Ovulation does not usually occur during the menses component of the cycle when the uterine lining is being shed. In most women, the ovum survives for about 12 to 24 hours after ovulation, during which time conception is possible. The basal body temperature rises 0.5� to 1.0�F when ovulation occurs. Although some women experience some pelvic discomfort during ovulation (mittelschmerz), severe or unusual pain is rare. After ovulation, the cervical mucus is thin and copious.

6. Question 3. Which of the following instructions about activities during menstruation would the nurse include when counseling an adolescent who has just begun to menstruate? Choices . Take a mild analgesic if needed for menstrual pain. . Avoid cold foods if menstrual pain persists. . Stop exercise while menstruating. . Avoid sexual intercourse during menstruation.

7. Answer is 1 The nurse should instruct the client to take a mild analgesic, such as ibuprofen, if menstrual pain or "cramps" are present. The client should also eat foods rich in iron and should continue moderate exercise during menstruation, which increases abdominal tone. Avoiding cold foods will not decrease dysmenorrhea. Sexual intercourse is not prohibited during menstruation, but the male partner should wear a condom to prevent exposure to blood

8. Question 4. After conducting a class for female adolescents about human reproduction, which of the following statements indicates that the school nurse's teaching has been effective? Choices . "Under ideal conditions, sperm can reach the ovum in 15 to 30 minutes, resulting in pregnancy." . "I won't become pregnant if I abstain from intercourse during the last 14 days of my menstrual cycle." . "Sperm from a healthy male usually remain viable in the female reproductive tract for 96 hours." . "After an ovum is fertilized by a sperm, the ovum then contains 21 pairs of chromosomes."

9. Answer is 1 Under ideal conditions, sperm can reach the ovum in 15 to 30 minutes. This is an important point to make with adolescents who may be sexually active. Many people believe that the time interval is much longer and that they can wait to take steps to prevent conception until after intercourse. Without protection, pregnancy and sexually transmitted diseases can occur. When using the abstinence or calendar method, the couple should abstain from intercourse on the days of the menstrual cycle when the woman is most likely to conceive. Using a 28-day cycle as an example, a couple should abstain from coitus 3 to 4 days before ovulation (days 10 through 14) and 3 to 4 days after ovulation (days 15 through 18). Sperm from a healthy male can remain viable for 24 to 72 hours in the female reproductive tract. If the female client ovulates after coitus, there is a possibility that fertilization can occur. Before fertilization, the ovum and sperm each contain 23 chromosomes. After fertilization, the conceptus contains 46 chromosomes unless there is a chromosomal abnormality

10. Question 5. A 20-year-old nulligravid client expresses a desire to learn more about the symptothermal method of family planning. Which of the following would the nurse include in the teaching plan? Choices . This method has a 50% failure rate during the first year of use. . Couples must abstain from coitus for 5 days after the menses. . Cervical mucus is carefully monitored for changes. . The male partner uses condoms for significant effectiveness.

11. Answer is 3 The symptothermal method is a natural method of fertility management that depends on knowing when ovulation has occurred. Because regular menstrual cycles can vary by 1 to 2 days in either direction, the symptothermal method requires daily basal body temperature assessments plus close monitoring of cervical mucus changes. The method relies on abstinence during the period of ovulation, which occurs approximately 14 days before the beginning of the next cycle. Abstinence from coitus for 5 days after menses is unnecessary because it is unlikely that ovulation will occur during this time period (days 1 through 10). Typically, the failure rate for this method is between 10% and 20%. Although a condom may increase the effectiveness of this method, most clients who choose natural methods are not interested in chemical or barrier types of family planning.

12. Question 6. Before advising a 24-year-old client desiring oral contraceptives for family planning, the nurse would assess the client for signs and symptoms of which of the following? Choices . Anemia. . Hypertension. . Dysmenorrhea. . Acne vulgaris.

13. Answer is 2 Before advising a client about oral contraceptives, the nurse needs to assess the client for signs and symptoms of hypertension. Clients who have hypertension, thrombophlebitis, obesity, or a family history of cerebral or cardiovascular accident are poor candidates for oral contraceptives. In addition, women who smoke, are older than 40 years of age, or have a history of pulmonary disease should be advised to use a different method. Iron-deficiency anemia, dysmenorrhea, and acne are not contraindications for the use of oral contraceptives. Iron-deficiency anemia is a common disorder in young women. Oral contraceptives decrease the amount of menstrual flow and thus decrease the amount of iron lost through menses, thereby providing a beneficial effect when used by clients with anemia. Low-dose oral contraceptives to prevent ovulation may be effective in decreasing the severity of dysmenorrhea (painful menstruation). Dysmenorrhea is thought to be caused by the release of prostaglandins in response to tissue destruction during the ischemic phase of the menstrual cycle. Use of oral contraceptives often improves facial acne

14. Question 7. After instructing a 20-year-old nulligravid client about side effects of oral contraceptives, the nurse determines that further instruction is needed when the client states which of the following as a side effect? Choices . Weight gain. . Nausea. . Headache. . Ovarian cancer.

15. Answer is 4 The nurse determines that the client needs further instruction when the client says that one of the side effects of oral contraceptive use is ovarian cancer. Some studies suggest that ovarian and endometrial cancer are reduced in women using oral contraceptives. Other side effects of oral contraceptives include weight gain, nausea, headache, breakthrough bleeding, and monilial infections. The most serious side effect is thrombophlebitis.

16. Question 8. While discussing reproductive health with a group of female adolescents, one of the adolescents asks the nurse, "Where is the ovum fertilized?" The nurse responds by stating that fertilization normally occurs at which of the following sites? Choices . Uterus. . Vagina. . Fallopian tube. . Cervix.

17. Answer is 3 Fertilization normally occurs in the outer third of the fallopian tube. Although there have been reports of fertilization outside the fallopian tube, this is not a normal occurrence.

18. Question 9. A 22-year-old nulligravid client tells the nurse that she and her husband have been considering using condoms for family planning. Which of the following instructions would the nurse include about the use of condoms as a method for family planning? Choices . Using a spermicide with the condom offers added protection against pregnancy. . Natural skin condoms protect against sexually transmitted diseases. . The typical failure rate for couples using condoms is about 25%. . Condom users frequently report penile gland sensitivity

19. Answer 1 The typical failure rate of a condom is approximately 12% to 14%. Adding a spermicide can decrease this potential failure rate because it offers additional protection against pregnancy. Natural skin condoms do not offer the same protection against sexually transmitted diseases caused by viruses as latex condoms do. Unlike latex condoms, natural skin (membrane) condoms do not prevent the passage of viruses. Most condom users report decreased penile gland sensitivity. However, some users do report an increased sensitivity or allergic reaction (such as a rash) to latex, necessitating the use of another method of family planning or a switch to a natural skin condom.

20. Question 10. Which of the following would the nurse include in the teaching plan for a 32-year-old female client requesting information about using a diaphragm for family planning? Choices . Douching with an acidic solution after intercourse is recommended. . Diaphragms should not be used if the client develops acute cervicitis. . The diaphragm should be washed in a weak solution of bleach and water. . The diaphragm should be left in place for 2 hours after intercourse.

21. Answer 2 The teaching plan should include a caution that diaphragms should not be used if the client develops acute cervicitis, possibly aggravated by contact with the rubber of the diaphragm. Some studies have also associated diaphragm use with increased incidence of urinary tract infections. Douching after use of a diaphragm and intercourse is not recommended because pregnancy could occur. The diaphragm should be inspected and washed with mild soap and water after each use. A diaphragm should be left in place for at least 6 hours but no longer than 24 hours after intercourse. More spermicidal jelly or cream should be used if intercourse is repeated during this period.

22. Question 11. After being examined and fitted for a diaphragm, a 24-year-old client receives instructions about its use. Which of the following client statements indicates a need for further teaching? Choices . "I can continue to use the diaphragm for about 2 to 3 years if I keep it protected in the case." . "If I get pregnant, I will have to be refitted for another diaphragm after the delivery." . "Before inserting the diaphragm I should coat the rim with contraceptive jelly." . "If I gain or lose 20 pounds, I can still use the same diaphragm."

23. 4 The Preconception Client . A client would need additional instructions when she says that she can still use the same diaphragm if she gains or loses 20 pounds. Gaining or losing more than 15 pounds can change the pelvic and vaginal contours to such a degree that the diaphragm will no longer protect the client against pregnancy. The diaphragm can be used for 2 to 3 years if it is cared for and well protected in its case. The client should be refitted for another diaphragm after pregnancy and delivery of a newborn because weight changes and physiologic changes of pregnancy can alter the pelvic and vaginal contours, thus affecting the effectiveness of the diaphragm. The client should use a spermicidal jelly or cream before inserting the diaphragm. (E, 7)

24. Question 12. A 22-year-old client tells the nurse that she and her husband are trying to conceive a baby. When teaching the client about reducing the incidence of neural tube defects in newborns, the nurse would emphasize the need for intake of which of the following nutrients? Choices . Iron. . Folic acid. . Calcium. . Magnesium.

25. 2 . Folic acid (folate) can reduce the incidence of neural tube defects in newborns. Adequate intake of folic acid is especially important just before conception and during the first 6 weeks after conception. Folic acid supplements may be prescribed, especially after conception occurs. Foods that are rich in folic acid include fruits and green leafy vegetables. Iron, calcium, and magnesium are not associated with reducing the risk for neural tube defects. Iron is necessary to maintain iron stores during pregnancy and postpartum. Calcium is important for bone density of the mother and bone formation in the developing fetus. Magnesium aids in the synthesis of proteins and fats in the mother. It also is important in promoting cell growth in the fetus. Magnesium can be found in dark green leafy vegetables. (I, 7)

26. Question 13. When describing a vasectomy to a couple inquiring about this procedure, the nurse would explain that which of the following is clamped or excised? Choices . Ejaculatory duct. . Seminiferous tubules. . Seminal vesicles. . Vas deferens.

27. 4 In vasectomy, a common procedure for male sterilization, the vas deferens (ductus deferens) is cut and tied. Coagulation may also be used to create an obstruction in the vas deferens and block the passage of sperm.

28. Question 14. A 39-year-old multigravid client asks the nurse for information about female sterilization with a tubal ligation. Which of the following client statements indicates effective teaching? Choices . "My fallopian tubes will be tied off through a small abdominal incision." . "Reversal of a tubal ligation is easily done, with a pregnancy success rate of 80%." . "After this procedure, I must abstain from intercourse for at least 3 weeks." . "Both of my ovaries will be removed during the tubal ligation procedure."

29. 1 Tubal ligation, a female sterilization procedure, involves ligation (tying off) or cauterization of the fallopian tubes through a small abdominal incision (laparotomy). Reversal of a tubal ligation is not easily done, and the pregnancy success rate after reversal is about 30%. After a tubal ligation, the client may engage in intercourse 2 to 3 days after the procedure. The ovaries are not generally removed during a tubal ligation. An oophorectomy involves removal of one or both ovaries.

30. Question 15. When discussing sexual arousal and orgasm with a 25-year-old nulliparous client, which of the following would the nurse include as the primary anatomic female structure involved? Choices . Vaginal wall. . Clitoris. . Mons pubis. . Vulvovaginal glands

31. 2 Although the vaginal wall and cervix may be sensitive structures, the primary anatomic female structure involved in sexual arousal is the clitoris. Composed of erectile tissue with a plentiful arterial blood supply, the clitoris is especially sensitive to foreplay, temperature, and movements of the shaft of the penis against its surface. The mons pubis�the round, fleshy prominence over the symphysis pubis�forms the anterior border of the external reproductive organs. Covered with varying amounts of pubic hair, the mons pubis is not associated with sexual arousal. The vulvovaginal glands include the Skene and Bartholin glands with ducts that lie within the vestibule. These glands provide lubrication for the urethra and vaginal introitus. They are not the primary anatomic organ associated with sexual arousal because they do not contain the highly sensitive erectile tissues of the clitoris.

32. Question 16. A 20-year-old woman desiring to use a cervical cap for family planning is instructed on its use. Which of the following client statements would indicate to the nurse that the client needs further instruction? Choices . "Cervical caps can be left in place longer than a diaphragm." . "Using a cervical cap may increase the risk of irritation." . "Cervical caps usually fit better than a diaphragm." . "Many women are unable to use cervical caps."

33. 3 The client needs further instruction when she says that cervical caps fit better than the diaphragm. Many women are unable to use cervical caps because their cervix is too short for the cap to fit the cervix properly. A cervical cap may remain in place for up to 48 hours after intercourse, whereas it is recommended that a diaphragm be left in place for only 24 hours. The cervical cap is associated with cervical irritation.

34. Question 17. A 23-year-old nulliparous client visiting the clinic for a routine examination tells the nurse that she desires to use the basal body temperature method for family planning. The nurse should instruct the client to do which of the following? Choices . Check the cervical mucus to see if it is thick and sparse. . Take her temperature at the same time every morning. . Document ovulation when the temperature decreases at least 1�F. . Avoid coitus for 10 days after a slight rise in temperature.

35. 2 The basal body temperature method requires that the client take her temperature each morning before arising, preferably at the same time each day before eating or any other activity. Just before the day of ovulation, the temperature falls by 0.5�F. At the time of ovulation, the temperature rises 0.4� to 0.8�F because of increased progesterone secretion in response to the luteinizing hormone. The temperature remains higher for the rest of the menstrual cycle. The client should keep a diary of about 6 months of menstrual cycles to calculate "safe" days. There is no mucus for the first 3 or 4 days after menses, and then thick, sticky mucus begins to appear. As estrogen increases, the mucus changes to clear, slippery, and stretchy. This condition, termed spinnbarkeit, is present during ovulation. After ovulation, the mucus decreases in amount and becomes thick and sticky again until menses. Because the ovum typically survives about 24 hours and sperm can survive up to 72 hours, couples must avoid coitus when the cervical mucus is copious and for about 3 to 4 days before and after ovulation to avoid a pregnancy.

36. Question 18. A couple visiting the infertility clinic for the first time asks the nurse, "What causes infertility in a woman?" Which of the following would the nurse include in the response as one of the most common factors? Choices . Absence of an ovary. . Overproduction of prolactin. . Anovulation. . Immunologic factors.

37. 3 The most common factor in female infertility is ovarian dysfunction, particularly anovulation. Other common factors include blocked fallopian tubes and cervical factors such as infection and inflammation. The causes of infertility can be determined in about 80% to 90% of couples investigated, but in about 10% to 20% of the cases no cause can be found. Less frequent causes include endometriosis, vaginitis, polycystic ovaries, overproduction of prolactin, immunologic factors, inadequate secretion of progesterone, and stenosis of the cervical os (possibly preventing sperm transport). Immunologic factors do play a role in female infertility; however, they are less common than anovulation. Overproduction of prolactin is also a less frequent cause of infertility in women. Absence of an ovary is an extremely rare cause of infertility.

38. Question 19. A couple visiting the infertility clinic for the first time state that they have been trying to conceive for the past 2 years without success. After a history and physical examination of both partners, the nurse determines that an appropriate outcome for the couple would be to accomplish which of the following by the end of this visit? Choices . Choose an appropriate infertility treatment method. . Acknowledge that only 50% of infertile couples achieve a pregnancy. . Discuss alternative methods of having a family, such as adoption. . Describe each of the potential causes and possible treatment modalities.

39. 4 By the end of the first visit, the couple should be able to identify potential causes and treatment modalities for infertility. If their evaluation shows that a treatment or procedure may help them to conceive, the couple must then decide how to proceed, considering all of the various treatments before selecting one. Treatments can be difficult, painful, or risky. The first visit is not the appropriate time to decide on a treatment plan because the couple needs time to adjust to the diagnosis of infertility, a crisis for most couples. Although the couple may be in a hurry for definitive therapy, a thorough assessment of both partners is necessary before a treatment plan can be initiated. The success rate for achieving a pregnancy depends on both the cause and the effectiveness of the treatment, and in some cases it may be only as high as 30%. The couple may desire information about alternatives to treatment, but insufficient data are available to suggest that a specific treatment modality may not be successful. Suggesting that the couple consider adoption at this time may inappropriately imply that the couple has no other choice. If a specific therapy may result in a pregnancy, the couple should have time to consider these options. After a thorough evaluation, adoption may be considered by the couple as an alternative to the costly, time-consuming, and sometimes painful treatments for infertility.

40. Question 20. A client is scheduled to have in vitro fertilization (IVF) as an infertility treatment. Which of the following client statements about IVF indicates that the client understands this procedure? Choices . "IVF requires supplemental estrogen to enhance the implantation process." . "The pregnancy rate with IVF is higher than that with gamete intrafallopian transfer (GIFT)." . "IVF involves bypassing the blocked or absent fallopian tubes." . "Both ova and sperm are instilled into the open end of a fallopian tube."

41. 3 The client's understanding of the procedure is demonstrated by the statement describing IVF as a technique that involves bypassing the blocked or absent fallopian tubes. The physician removes the ova by laparoscope- or ultrasound-guided transvaginal retrieval and mixes them with prepared sperm from the woman's partner or a donor. Two days later, up to four embryos are returned to the uterus to increase the likelihood of a successful pregnancy. Supplemental progesterone, not estrogen, is given to enhance the implantation process. Both GIFT and tubal embryo transfer have a higher pregnancy rate than IVF. However, these procedures cannot be used for clients who have blocked or absent fallopian tubes because the fertilized ova are placed into the fallopian tubes, subsequently entering the uterus naturally for implantation. In IVF, fertilization of the ova by the sperm occurs outside the client's body. In GIFT, both ova and sperm are implanted into the fallopian tubes and allowed to fertilize within the woman's body

42. Question 21. A 20-year-old nulligravid client tells the nurse that her mother had a friend who died from hemorrhage about 10 years ago during a vaginal delivery. Which of the following responses would be most helpful? Choices . "Today's modern technology has resulted in a low maternal mortality rate." . "Don't concern yourself with things that happened in the past." . "In the United States, mothers seldom die in childbirth." . "What is it that concerns you about pregnancy, labor, and delivery?"

43. 4 The client is verbalizing concerns about death during childbirth, thus providing the nurse with an opportunity to gather additional data. Asking the client about these concerns would be most helpful to determine the client's knowledge base and to provide the nurse with the opportunity to answer any questions and clarify any misconceptions. Although the maternal mortality rate is low in the United States, maternal deaths do occur, even with modern technology. Leading causes of maternal mortality in the United States include embolism, pregnancy-induced hypertension, hemorrhage, ectopic pregnancy, and infection. Telling the client not to concern herself about what has happened in the past is not useful. It only serves to discount the client's concerns and block further therapeutic communication. Also, postponing or ignoring the client's need for a discussion about complications of pregnancy may further increase the client's anxiety.

44. Question 22. A 19-year-old nulligravid client visiting the clinic for a routine examination asks the nurse about cervical mucus changes that occur during the menstrual cycle. Which of the following statements would the nurse expect to include in the client's teaching plan? Choices . About midway through the menstrual cycle, cervical mucus is thick and sticky. . During ovulation, the cervix remains dry without any mucus production. . As ovulation approaches, cervical mucus is abundant and clear. . Cervical mucus disappears immediately after ovulation, resuming with menses.

45. 3 As ovulation approaches, cervical mucus is abundant and clear, resembling raw egg white. Ovulation generally occurs 14 days (plus or minus 2 days) before the beginning of menses. During the luteal phase of the cycle, which occurs after ovulation, the cervical mucus is thick and sticky, making it difficult for sperm to pass. Changes in the cervical mucus are related to the influences of estrogen and progesterone. Cervical mucus is always present.

46. Question 23. When instructing a client about the proper use of condoms for pregnancy prevention, which of the following instructions would be included to ensure maximum effectiveness? Choices . Place the condom over the erect penis before coitus. . Withdraw the condom after coitus when the penis is flaccid. . Ensure that the condom is pulled tightly over the penis before coitus. . Obtain a prescription for a condom with nonoxynol 9.

47. 1 To ensure maximum effectiveness, the condom should always be placed over the erect penis before coitus. Some couples find condom use objectional because foreplay may have to be interrupted to apply the condom. The penis, covered by the condom, should be withdrawn before the penis becomes flaccid. Otherwise sperm may escape from the condom, providing an opportunity for possible fertilization. Rather than having the condom pulled tightly over the penis before coitus, space should be left at the tip of the penis to allow the condom to hold the sperm. The client does not need a prescription for a condom with nonoxynol 9 because these are sold over-the-counter.

48. Question 24. A multigravid client will be using medroxyprogesterone acetate (Depo-Provera) as a family planning method. After the nurse instructs the client about this method, which of the following client statements indicates effective teaching? Choices . "This method of family planning requires monthly injections." . "I should have my first injection during my menstrual cycle." . "One possible side effect is absence of a menstrual period." . "This drug will be given by subcutaneous injections."

49. 3 With medroxyprogesterone acetate, irregular menstrual cycles and amenorrhea are common side effects. Other side effects include weight gain, breakthrough bleeding, headaches, and depression. This method requires deep intramuscular injections every 3 months. The first injection should occur within 5 days after menses.

50. Question 25. Which of the following would the nurse expect to include in the teaching plan for a 30-year-old multiparous client who will be using an intrauterine device (IUD) for family planning? Choices . Amenorrhea is a common side effect of IUDs. . The client needs to use additional protection for conception. . IUDs are more costly than other forms of contraception. . Severe cramping may occur when the IUD is inserted.

51. 4 Severe cramping and pain may occur as the device is passed through the internal cervical os. The insertion of the device is generally done when the client is having her menses, because it is unlikely that she is pregnant at that time. Common side effects of IUDs are heavy menstrual bleeding and subsequent anemia, not amenorrhea. Uterine infection or ectopic pregnancy may occur. The IUD has an effectiveness rate of 98%. Therefore, additional protection is not necessary to prevent pregnancy. IUDs generally are less costly than other forms of contraception because they do not require additional expense. Only one insertion is necessary, in comparison to daily doses of oral contraceptives or the need for spermicides in conjunction with diaphragm use.

52. Question 26. After counseling a 35-year-old client about breast self-examination and mammography, the nurse determines that the client has understood the instructions when the client states which of the following? Choices "I should have a mammogram every year once I'm 40." "I should schedule a mammography examination during my menstrual period." "Mammography screening is inexpensive." "Mammography is an extremely painful procedure."

53. 1 The American Cancer Society recommends an annual mammography screening examination for all women after the age of 40. Some high-risk women may begin annual screening at an earlier age. Some women have never had a mammogram because of fear or misconceptions. Mammography should be scheduled after the client's menses to reduce complaints of breast tenderness. Mammography screening is considered expensive, especially by low-income women. Although some discomfort is common because the breast is placed between two plates during the screening process, the procedure should not be considered extremely painful

54. Question 27. After instructing a 40-year-old woman about osteoporosis after menopause, the nurse determines that the client needs further instruction when the client states which of the following? Choices . "One cup of yogurt is the equivalent of one glass of milk." . "Women who do not eat dairy products should consider calcium supplements." . "African American women are at the greatest risk for osteoporosis." . "Estrogen therapy at menopause can reduce the risk of osteoporosis."

55. 3 Small-boned, fair-skinned women of northern European descent are at the greatest risk for osteoporosis, not African American women. One cup of yogurt or 1.5 ounces of hard cheese is the equivalent of one glass of milk. Women who do not eat dairy products, such as women who are lactose intolerant, should consider using calcium supplements. Inadequate lifetime intake of calcium is a major risk factor for osteoporosis. Estrogen therapy, or some of the newer medications that are non�estrogen based, can greatly reduce the incidence of osteoporosis.

56. Question 28. When developing a teaching plan about sexually transmitted diseases for an 18-year-old female client, which of the following treatments would the nurse need to keep in mind? Choices . Acyclovir (Zovirax) can be used to cure herpes genitalis. . Chlamydia trachomatis infections are usually treated with penicillin. . Ceftriaxone sodium (Rocephin) may be used to treat Neisseria gonorrhoeae infections. . Metronidazole (Flagyl) is used to treat condylomata acuminata.

57. 3 Ceftriaxone sodium (Rocephin) may be used to treat Neisseria gonorrhoeae infections and is often combined with doxycycline. Both the client and her partner should be treated if gonorrhea is present. Acyclovir (Zovirax) can be used to treat herpes genitalis; however, the drug does not cure the disease. Chlamydia trachomatis infections are usually treated with antibiotics such as doxycycline hyclate (Vibramycin) or azithromycin (Zithromax). Metronidazole (Flagyl) is used to treat trichomoniasis vaginalis, not condylomata acuminata (genital warts)

58. Question 29. The physician prescribes raloxifene hydrochloride (Evista) for a 60-year-old woman. The nurse should instruct the client that this drug is useful in preventing which of the following? Choices . Hot flashes. . Osteoporosis. . Hyperglycemia. . Migraine headaches.

59. 2 Raloxifene hydrochloride (Evista), an estrogen receptor modulator, increases bone mineral density without stimulating the endometrium. The drug is useful in preventing osteoporosis in postmenopausal women. This drug is contraindicated for women who smoke cigarettes or who have a history of venous thrombosis. Raloxifene does not prevent hot flashes, hyperglycemia, or migraine headaches. One of its side effects is increased headaches.

60. Question 30. A couple is visiting the clinic because they have been unable to conceive a baby after 3 years of frequent coitus. After discussing the various causes of male infertility, the nurse determines that the male partner needs further instruction when he states which of the following as a cause? Choices . Seminal fluid with an alkaline pH. . Frequent exposure to heat sources. . Abnormal hormonal stimulation. . Immunologic factors.

61. 1 The client needs further instruction when he says that one cause of male infertility is decreased sperm count due to seminal fluid that has an alkaline pH. A slightly alkaline pH is necessary to protect the sperm from the acidic secretions of the vagina and is a normal finding. An alkaline pH is not associated with decreased sperm count. However, seminal fluid that is abnormal in amount, consistency, or chemical composition suggests obstruction, inflammation, or infection, which can decrease sperm production. The typical number of sperm produced during ejaculation is 400 million. Frequent exposure to heat sources, such as saunas and hot tubs, can decrease sperm production, as can abnormal hormonal stimulation. Immunologic factors produced by the man against his own sperm (autoantibodies) or by the woman can cause the sperm to clump or be unable to penetrate the ovum, thus contributing to infertility.