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Maternity and Womens Health Care 11th Edition Lowdermilk Test Bank
Maternity and Womens Health Care 11th Edition Lowdermilk Test Bank
Maternity and Womens Health Care 11th Edition Lowdermilk Test Bank
MULTIPLE CHOICE
1. Syphilis is a complex disease that can lead to serious systemic illness and even death if left
untreated. Which manifestation differentiates primary syphilis from secondary syphilis?
a. Fever, headache, and malaise
b. Widespread rash
c. Identified by serologic testing
d. Appearance of a chancre 2 months after infection
ANS: D
Primary syphilis is characterized by a primary lesion (the chancre), which appears 5 to 90
days after infection. The chancre begins as a painless papule at the site of inoculation and
erodes to form a nontender, shallow, and clean ulcer several millimeters to centimeters in size.
Secondary syphilis occurs 6 weeks to 6 months after the appearance of the chancre and is
characterized by a widespread maculopapular rash. The individual may also experience fever,
headache, and malaise. Latent syphilis are those infections that lack clinical manifestations;
however, they are detected by serologic testing.
2. The human papillomavirus (HPV), also known as genital warts, affects 79 million Americans,
with an estimated number of 14 million new infections each year. The highest rate of infection
occurs in young women, ages 20 to 24 years. Prophylactic vaccination to prevent the HPV is
now available. Which statement regarding this vaccine is inaccurate?
a. Only one vaccine for the HPV is available.
b. The vaccine is given in three doses over a 6-month period.
c. The vaccine is recommended for both boys and girls.
d. Ideally, the vaccine is administered before the first sexual contact.
ANS: A
Two vaccines for HPV are available—Cervarix and Gardasil—and other vaccines continue to
be investigated. These vaccines protect against HPV types 6, 11, 16, and 18. They are most
effective if administered before the first sexual contact. Recommendations are that vaccines
be administered to 11- and 12-year-old girls and boys. The vaccine can be given to girls as
young as 9 years of age and young women ages 13 to 26 years in three doses over a 6-month
period.
3. Which sexually transmitted infection (STI) is the most commonly reported in American
women?
a. Gonorrhea
b. Syphilis
c. Chlamydia
d. Candidiasis
ANS: C
Chlamydia is the most common and fastest spreading STI among American women, with an
estimated 3 million new cases each year. Infection rates are two and a half times that of men.
Gonorrhea is probably the oldest communicable disease in the United States and second to
Chlamydia in reported conditions. Syphilis is the earliest described STI. Candidiasis is a
relatively common fungal infection.
4. The Centers for Disease Control and Prevention (CDC) recommends which therapy for the
treatment of the HPV?
a. Miconazole ointment
b. Topical podofilox 0.5% solution or gel
c. Two doses of penicillin administered intramuscularly (IM)
d. Metronidazole by mouth
ANS: B
Available treatments are imiquimod, podophyllin, and podofilox. Miconazole ointment is used
to treat athlete’s foot. Penicillin IM is used to treat syphilis. Metronidazole is used to treat
bacterial vaginosis.
5. A client exhibits a thick, white, lumpy, cottage cheese–like discharge, along with white
patches on her labia and in her vagina. She complains of intense pruritus. Which medication
should the nurse practitioner order to treat this condition?
a. Fluconazole
b. Tetracycline
c. Clindamycin
d. Acyclovir
ANS: A
The client is experiencing a candidiasis infection. Fluconazole, metronidazole, and
clotrimazole are the drugs of choice to treat this condition. Tetracycline is used to treat
syphilis. Clindamycin is used to treat bacterial vaginosis. Acyclovir is used to treat genital
herpes.
6. Which laboratory testing is used to detect the human immunodeficiency virus (HIV)?
a. HIV screening
b. HIV antibody testing
c. Cluster of differentiation 4 (CD4) counts
d. Cluster of differentiation 8 (CD8) counts
ANS: B
The screening tool used to detect HIV is the enzyme immunoassay, which tests for the
presence of antibodies to the HIV. HIV-1 and HIV-2 antibody tests are used to confirm the
diagnosis. To determine whether the HIV is present, the test performed must be able to detect
antibodies to the virus, not the virus itself. CD4 counts are associated with the incidence of
acquired immunodeficiency syndrome (AIDS) in HIV-infected individuals. CD8 counts are
not performed to detect HIV.
DIF: Cognitive Level: Understand REF: p. 160 TOP: Nursing Process: Planning
MSC: Client Needs: Physiologic Integrity
7. Which condition is the most life-threatening virus to the fetus and neonate?
a. Hepatitis A virus (HAV)
b. Herpes simplex virus (HSV)
c. Hepatitis B virus (HBV)
d. Cytomegalovirus (CMV)
ANS: C
HBV is the most life-threatening viral condition to the fetus and neonate. HAV is not the most
threatening to the fetus nor is HSV the most threatening to the neonate. Although serious,
CMV is not the most life-threatening viral condition to the fetus.
DIF: Cognitive Level: Remember REF: p. 158 TOP: Nursing Process: Diagnosis
MSC: Client Needs: Safe and Effective Care Environment
8. Which treatment regime would be most appropriate for a client who has been recently
diagnosed with acute pelvic inflammatory disease (PID)?
a. Oral antiviral therapy
b. Bed rest in a semi-Fowler position
c. Antibiotic regimen continued until symptoms subside
d. Frequent pelvic examination to monitor the healing progress
ANS: B
The woman with acute PID should be on bed rest in a semi-Fowler position. Broad-spectrum
antibiotics are used; antiviral therapy is ineffective. Antibiotics must be taken as prescribed,
even if symptoms subside. Few pelvic examinations should be conducted during the acute
phase of the disease.
DIF: Cognitive Level: Apply REF: p. 153 TOP: Nursing Process: Planning
MSC: Client Needs: Physiologic Integrity
9. On vaginal examination of a 30-year-old woman, the nurse documents the following findings:
profuse, thin, grayish-white vaginal discharge with a “fishy” odor and complaints of pruritus.
Based upon these findings, which condition would the nurse suspect?
a. Bacterial vaginosis
b. Candidiasis
c. Trichomoniasis
d. Gonorrhea
ANS: A
Most women with bacterial vaginosis complain of a characteristic “fishy” odor. The discharge
is usually profuse, thin, and has a white, gray, or milky color. Some women may also
experience mild irritation or pruritus. The discharge associated with candidiasis is thick,
white, and lumpy and resembles cottage cheese. Trichomoniasis may be asymptomatic, but
women commonly have a characteristic yellow-to-green, frothy, mucopurulent, copious, and
malodorous discharge. Women with gonorrhea are often asymptomatic. Although they may
have a purulent endocervical discharge, the discharge is usually minimal or absent.
10. Which viral sexually transmitted infection is characterized by a primary infection followed by
recurrent episodes?
a. Herpes simplex virus 2 (HSV-2)
b. HPV
c. HIV
d. CMV
ANS: A
The initial HSV genital infection is characterized by multiple painful lesions, fever, chills,
malaise, and severe dysuria; it may last 2 to 3 weeks. Recurrent episodes of the HSV infection
commonly have only local symptoms that usually are less severe than those of the initial
infection. With HPV infection, lesions are a chronic problem. The HIV is a retrovirus.
Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has
entered the body. Severe depression of the cellular immune system associated with the HIV
infection characterizes AIDS, which has no cure. In most adults, the onset of CMV infection
is uncertain and asymptomatic. However, the disease may become a chronic, persistent
infection.
11. The nurse should understand the process by which the HIV infection occurs. Once the virus
has entered the body, what is the time frame for seroconversion to HIV positivity?
a. 6 to 10 days
b. 2 to 4 weeks
c. 6 to 12 weeks
d. 6 months
ANS: C
Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has
entered the body. Both 6 to 10 days and 2 to 4 weeks are too short for seroconversion to HIV
positivity to occur, and 6 months is too long.
12. A 25-year-old single woman comes to the gynecologist’s office for a follow-up visit related to
her abnormal Papanicolaou (Pap) smear. The test revealed that the client has the HPV. The
woman asks, “What is that? Can you get rid of it?” Which is the best response for the nurse to
provide?
a. “It’s just a little lump on your cervix. We can just freeze it off.”
b. “HPV stands for ‘human papillomavirus.’ It is a sexually transmitted infection that
may lead to cervical cancer.”
c. “HPV is a type of early human immunodeficiency virus. You will die from this.”
d. “You probably caught this from your current boyfriend. He should get tested for
this.”
ANS: B
Informing the client about STIs and the risks involved with the HPV is important. The health
care team has a duty to provide proper information to the client, including information related
to STIs and the fact that although the HPV and HIV are both viruses that can be sexually
transmitted, they are not the same virus. The onset of the HPV can be insidious. Often STIs go
unnoticed. Abnormal bleeding is frequently the initial symptom. The client may have had the
HPV before her current boyfriend. The nurse should make no deductions from this limited
information.
DIF: Cognitive Level: Analyze REF: p. 154 TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
DIF: Cognitive Level: Understand REF: p. 156 TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
14. Five different viruses (A, B, C, D, and E) account for almost all cases of hepatitis infections.
Which statement regarding the various forms of hepatitis is most accurate?
a. Vaccine exists for hepatitis C virus (HCV) but not for HBV.
b. HAV is acquired by eating contaminated food or drinking polluted water.
c. HBV is less contagious than HIV.
d. Incidence of HCV is decreasing.
ANS: B
Contaminated milk and shellfish are common sources of infection for HAV. A vaccine exists
for HBV but not for HCV. HBV is more contagious than HIV. The incidence of HCV is on
the rise.
15. A 21-year-old client exhibits a greenish, copious, and malodorous discharge with vulvar
irritation. A speculum examination and wet smear are performed. Which condition is this
client most likely experiencing?
a. Bacterial vaginosis
b. Candidiasis
c. Yeast infection
d. Trichomoniasis
ANS: D
Although uncomfortable, a speculum examination is always performed and a wet smear
obtained if the client exhibits symptoms of trichomoniasis. The presence of many white blood
cell protozoa is a positive finding for trichomoniasis. A normal saline test is used to test for
bacterial vaginosis. A potassium hydroxide preparation is used to test for candidiasis. Yeast
infection is the common name for candidiasis, for which the test is a potassium hydroxide
preparation.
DIF: Cognitive Level: Understand REF: p. 164 TOP: Nursing Process: Diagnosis
MSC: Client Needs: Health Promotion and Maintenance
16. An essential component of counseling women regarding safe sex practices includes a
discussion regarding avoiding the exchange of body fluids. The most effective physical barrier
promoted for the prevention of STIs and HIV is the condom. To educate the client about the
use of condoms, which information related to condom use is the most important?
a. Strategies to enhance condom use
b. Choice of colors and special features
c. Leaving the decision up to the male partner
d. Places to carry condoms safely
ANS: A
When the nurse opens the discussion on safe-sex practices, it gives the woman permission to
clear up any concerns or misapprehensions that she may have regarding condom use. The
nurse can also suggest ways that the woman can enhance her condom negotiation and
communications skills with a sexual partner. These include role-playing, rehearsal, cultural
barriers, and situations that place the client at risk. Although women can be taught the
differences among condoms, such as size ranges, where to purchase, and price, these features
are not as important as negotiating the use of safe sex practices. Although not ideal, women
may safely choose to carry condoms in shoes, wallets, or inside their bra. They should be
taught to keep the condom away from heat. Although this information is important, it is not
relevant if the woman cannot even discuss strategies on how to enhance condom use.
DIF: Cognitive Level: Analyze REF: pp. 147-148 TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
17. Group B Streptococcus (GBS) is part of the normal vaginal flora in 20% to 30% of healthy
pregnant women. GBS has been associated with poor pregnancy outcomes and is an important
factor in neonatal morbidity and mortality. Which finding is not a risk factor for neonatal GBS
infection?
a. Positive prenatal culture
b. Preterm birth at 37 weeks or less of gestation
c. Maternal temperature of 38 C or higher
d. Premature rupture of membranes (PROM) 24 hours or longer before the birth
ANS: D
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CHAPTER XI.
A REVOLUTIONARY HOUSEWIFE.
The settlers builded great chimneys with ample open hearths, and
to those hearths the vast forests supplied plentiful fuel; but as the
forests disappeared in the vicinity of the towns, the fireplaces also
shrank in size, so that in Franklin’s day he could write of the big
chimneys as “the fireplaces of our fathers;” and his inventions for
economizing fuel had begun to be regarded as necessities.
The kitchen was the housewife’s domain, the chimney-seat her
throne; but the furniture of that throne and the sceptre were far
different from the kitchen furnishings of to-day.
We often see fireplaces with hanging cranes in pictures illustrating
earliest colonial times, but the crane was unknown in those days.
When the seventeenth-century chimney was built, ledges were left
on either side, and on them rested the ends of a long heavy pole of
green wood, called a lug-pole or back bar. The derivation of the word
lug-pole is often given as meaning from lug to lug, as the chimney-
side was often called the lug. Whittier wrote:—
And for him who sat by the chimney lug.
Others give it from the old English word lug, to carry; for it was
indeed the carrying-pole. It was placed high up in the yawning
chimney, with the thought and intent of its being out of reach of the
devouring flames, and from it hung a motley collection of hooks of
various lengths and weights, sometimes with long rods, sometimes
with chains, and rejoicing in various names. Pot-hooks, pot-hangers,
pot-hangles, pot-claws, pot-cleps, were one and the same; so also
were trammels and crooks. Gib and gibcroke were other titles. Hake
was of course the old English for hook:—
Niddy-noddy,
Two heads and one body.