smear and pelvic examination. Which statement by the nurse is most accurate?

Assessment of the Reproductive System NCLEX

When performing an assessment of the external genitalia of an older man, the nurse observes the scrotum to have smooth skin and to be very pendulous. Which action by the nurse is most appropriate?

• Suggest to the client that he should wear an athletic supporter while awake.
• Ask the client if he has been treated for a sexually transmitted disease.
• Document the observation and continue the assessment.
• Notify the health care provider and facilitate a scrotal ultrasound.

Rationale: As the male client ages, the scrotum loses rugae and becomes increasingly pendulous. This is a normal assessment finding. No further action is needed.

The nurse is counseling a mother who wants her teenage daughter to have a Pap smear and pelvic examination. Which statement by the nurse is most accurate?

• "If your daughter is over 18, she needs a pelvic examination and Pap smear."
• "A teenager does not need this examination unless she is sexually active."
• "Teach her to have her first examination by the age of 21 at the latest."
• "It is not needed unless you are worried about sexually transmitted diseases."

Rationale: A woman needs to have her first pelvic examination with Pap smear by the age of 21, or within 3 years of becoming sexually active. The other statements are not accurate.

A young woman is not pregnant but has not had a menstrual period for 5 months. Which factors does the nurse explore as a possible cause of the amenorrhea?

• The client's mother having type 2 diabetes mellitus
• Running 10 to 15 miles/day
• Taking aspirin daily
• Having a diet high in protein

Rationale: Excessive exercise, with corresponding loss of body fat, is associated with insufficient estrogen levels for the maintenance of normal ovulatory and menstrual cycles. The other factors are noncontributory.

When scheduling an annual pelvic examination and Pap test, the client asks if she should abstain from intercourse before the test. Which is the nurse's best response?

• "Yes. Avoid having intercourse for 24 hours before the test."
• "Yes. Avoid having intercourse for 2 hours before the test."

• "No. Intercourse does not interfere with this test."
• "No. Intercourse can actually enhance the test results."

Rationale: The woman should not douche, use vaginal medications or deodorants, or have sexual intercourse for at least 24 hours before the test. Such activities may prevent the accurate evaluation of smears, cultures, and cytologic data.

During examination of the male client's external genitalia, the nurse observes a discharge from the urethra when compressing the glans. Which is the nurse's next action?

• Document the observation.
• Ask the client to turn his head and cough.
• Obtain a specimen for culture.
• Test the cremasteric reflex.

Rationale: Urethral discharge is not considered normal in a continent client and should be cultured. The other options would not help provide information about the nature of the discharge.

A client is in the clinic for an annual examination and questions the need for a pelvic examination and Pap smear because she had a hysterectomy many years ago. Which response by the nurse is most appropriate?

• "Do you still have your cervix?"
• "Are you sexually active?"
• "We can skip it if you like."
• "Let's see what the doctor says."

Rationale: Women who still have their cervix after hysterectomy still need a Pap smear according to the guidelines established for other women. Sexual activity is not relevant.Simply stating that it can be skipped does not help the woman protect her health.Asking the provider does not help the nurse further assess the client.

A client is scheduled for an ultrasound to evaluate for possible uterine fibroids. Which instruction by the nurse is most appropriate?

• "Do not eat or drink anything after midnight."
• "Take these laxatives the morning of the test."
• "Do not urinate an hour before the test; a full bladder will give best results."
• "Have a designated driver because you will be sleepy from the anesthesia."

The scan is noninvasive and painless. The abdominal and pelvic organs are better visualized with the bladder full during the scan. The other statements are inaccurate An African-American client has a prostate-specific antigen (PSA) of 12 ng/mL. Which action by the nurse is best?

• Remind the client to repeat the test in 1 year.
• Prepare the client for further diagnostic testing.
• Ask if the client ejaculated within 48 hours of the test.
• Assess the client for alcohol and tobacco use.

Rationale: A normal PSA level is less than 4 ng/mL. Elevated PSA levels, particularly those over 10 ng/mL, are associated with cancer. African Americans tend to have higher PSA levels as they age, but this level is so high that the nurse must suspect cancer and prepare the client for further diagnostic testing. The client should not wait a year to repeat the test. The client should not ejaculate for 24 hours before having blood drawn. Alcohol and tobacco use does not cause an elevation in PSA.

The nurse is teaching high school girls about the female reproductive tract. Which statements by the nurse are accurate? (Select all that apply.)

• The vagina has an acidic environment.
• The cervix is where the Pap smear is taken from.
• The ovum is fertilized in the uterus.
• Ovaries produce sex steroid hormones.
• The breasts contain fat tissue.

ANS: A, B, D, E

Rationale: The acidic environment of the vagina helps protect against infection. The cervix is the site for Pap testing. The ovaries produce sex steroid hormones. The breasts contain fat, glandular, fibrous, and ductal tissue. Ova are fertilized in the fallopian tubes.

A young adult client is in the clinic for evaluation of amenorrhea lasting 3 months. She takes birth control pills but is on no other medications. Which actions by the nurse are most appropriate? (Select all that apply.)

• Instruct the client on collecting a urinalysis for a pregnancy test.
• Assess the client's urinary and bowel habits.
• Perform a physical assessment on the client's abdomen.
• Weigh the client and calculate the body mass index.
• Reassure the client that amenorrhea can occur with oral contraception.

ANS: A, D

Rationale: Amenorrhea can be caused by several things, but not by urinary or bowel problems. Pregnancy should always be considered, even if the woman is on birth control of any type. Too little body fat can lead to menstrual irregularities. Simply reassuring the client is not as helpful as conducting further assessment.

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

• "You can try a variety of briefs and undergarments."
• "It will be important to keep that area clean and dry."
• "I can refer you to a good incontinence clinic."
• "Unfortunately, incontinence is common in women your age."

Rationale: 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.

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

• "Men his age tend to have a rapid decline in sexual abilities."
• "His testosterone levels will decrease only slightly until he is quite old."
• "Changes in testosterone levels do not affect sexual performance."
• "You are lucky your husband is healthy enough for sexual activity."

Rationale: 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.

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?

• "The test should be carried out even if you are pregnant."
• "Do not use deodorant on breasts or underarms before the test."
• "You will not experience any discomfort because this is just an x-ray."
• "The entire test should not take longer than 1 hour."

Rationale: 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.

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

• Urinary incontinence
• Vaginal dryness