Stuvia.com - The Marketplace to Buy and Sell your Study Material www.nursylab.com Test Bank - Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th) 249 Chapter 25: Alterations of the Female Reproductive System MULTIPLE CHOICE 1. In the majority of children experiencing delayed puberty, what is the problem caused by? a. Disruption in the hypothalamus b. Disruption of the pituitary c. Deficit in estrogen or testosterone d. Physiologic delays in maturation ANS: D In 95% of children with delayed puberty, the delay is physiologic; that is, hormonal levels are normal and the hypothalamic-pituitary-gonadal (HPG) axis is intact, but maturation is happening slowly. PTS: 1 DIF: Cognitive Level: Remembering 2. What is the first sign of puberty in girls? a. Breast enlargement b. Growth of pubic hair c. Menstruation d. Vaginal discharge ANS: A The first sign of puberty in girls is usually thelarche or breast development. Growth of pubic hair, menstruation, and vaginal discharge are not the usual first sign of puberty in girls. PTS: 1 DIF: Cognitive Level: Remembering 3. Which type of precocious puberty causes the child to develop some secondary sex characteristics of the opposite sex? a. Mixed b. Partial c. Isosexual d. Central ANS: A Mixed precocious puberty, which is virilization of a girl or feminization of a boy, causes the child to develop some secondary sex characteristics of the opposite sex. Partial precocious puberty is the partial early development of appropriate secondary sex characteristics alone or in combination. Central precocious puberty is GnRH dependent and occurs when the HPG axis is working normally but prematurely. Central precocious puberty results from failure of central inhibition of the GnRH pulse generator (the gonadostat), often because of CNS abnormality. “Isosexual” is not a description of a type of precocious puberty. PTS: 1 DIF: Cognitive Level: Remembering www.nursylab.com Downloaded by: jesslizarraga15 | jess.lizarraga15@gmail.com Distribution of this document is illegal Want to earn $103 per month? Stuvia.com - The Marketplace to Buy and Sell your Study Material www.nursylab.com Test Bank - Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th) 250 4. A person has been diagnosed with primary dysmenorrhea and wants to know why ibuprofen is a good choice for pain control. What response by the health care professional is best? a. “It inhibits the release of leukotrienes in your system.” b. “It reduces the production of prostaglandins in your body.” c. “It enhances the effects of bradykinin release.” d. “It contributes to a higher C reactive protein in your blood.” ANS: B Primary dysmenorrhea is painful menstruation associated with the release of prostaglandins in ovulatory cycles. Nonsteroidal antiinflammatory medications like ibuprofen reduce the activity of the COX enzyme, which in turn inhibits prostaglandin production. Leukotrienes are part of the inflammatory process. Bradykinin is a vasodilator and also has a role in pain, but is not related to dysmenorrhea. C reactive protein is part of the innate immune system. PTS: 1 DIF: Cognitive Level: Understanding 5. A woman has been diagnosed with compartment II primary amenorrhea. The healthcare professional helps prepare the woman for what type of diagnostic testing? a. Genetic testing b. CT scan of the anterior pituitary c. Blood work for hypothalamic function d. Vaginal speculum exam ANS: A Compartment II disorders involve the ovary and are often linked to genetic disorders. The professional would help prepare the woman for genetic testing. Compartment III disorders result from dysfunction of the anterior pituitary gland. Hypothalamic disorders often cause compartment IV primary amenorrhea. Compartment I disorders are anatomic defects of the outflow tract associated with primary amenorrhea and include congenital absence of the vagina. PTS: 1 DIF: Cognitive Level: Remembering 6. Which condition is considered a clinical cause of amenorrhea? a. Disorder in the endometrium b. Obstruction of the fallopian tubes c. Lack of physical exercise d. Failure to ovulate ANS: D Depressed ovarian hormone levels, which are associated with a variety of clinical disorders, also cause amenorrhea by preventing ovulation. Disorders of the endometrium, obstruction of fallopian tubes, and sedentary lifestyle do not cause amenorrhea. PTS: 1 DIF: Cognitive Level: Remembering 7. Clinical manifestations that include irregular or heavy bleeding, the passage of large clots, and the depletion of iron stores support which diagnosis? a. Premenstrual syndrome www.nursylab.com Downloaded by: jesslizarraga15 | jess.lizarraga15@gmail.com Distribution of this document is illegal Want to earn $103 per month? Stuvia.com - The Marketplace to Buy and Sell your Study Material www.nursylab.com Test Bank - Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th) 251 b. Abnormal uterine bleeding c. Polycystic ovary syndrome d. Primary dysmenorrhea ANS: B Unpredictable and variable bleeding, in terms of amount and duration, characterize abnormal uterine bleeding. Especially during perimenopause, dysfunctional bleeding also may involve flooding and the passage of large clots, which often indicate excessive blood loss. Excessive bleeding can lead to iron-deficiency anemia. Premenstrual syndrome involves distressing physical, emotional, or behavioral symptoms. Over 300 symptoms have been ascribed to this condition, but heavy bleeding, passing clots, and iron deficiency anemia are not characteristics of PMS. Polycystic ovary syndrome can include dysfunctional bleeding or amenorrhea. Primary dysmenorrhea is lack of the menstrual period, so heavy bleeding would not be a manifestation of this disorder. PTS: 1 DIF: Cognitive Level: Remembering 8. A woman has been diagnosed with polycystic ovary syndrome but is confused because her pelvic ultrasound (US) was read as “normal” and did not show cysts. What response by the health care professional is most appropriate? a. “We will schedule another US in 3 months to check again.” b. “The cysts may be too small to see right now.” c. “Maybe that diagnosis was incorrect; let’s schedule more testing.” d. “You do not need to have cysts on your ovaries to have this condition.” ANS: D The three criteria used to diagnose PCOS are androgen excess, chronic anovulation, and sonographic evidence of polycystic ovaries. Two of the three criteria must be present for the diagnosis, so the woman’s ovaries may or may not have cysts and she can still be diagnosed with this condition. If the woman meets the other 2 criteria, there is no need for a follow-up US or testing for other diagnoses. PTS: 1 DIF: Cognitive Level: Understanding 9. A woman reports bloating, anxiety, irritability, and feeling depressed before each of her monthly menstrual cycles. What medication classification does the healthcare professional educate this woman on? a. NSAIDs b. Estrogen c. SSRIs d. Progesterone ANS: C www.nursylab.com Downloaded by: jesslizarraga15 | jess.lizarraga15@gmail.com Distribution of this document is illegal Want to earn $103 per month? Stuvia.com - The Marketplace to Buy and Sell your Study Material www.nursylab.com Test Bank - Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th) 252 This woman is describing premenstrual syndrome (PMS). Selective serotonin reuptake inhibitors (SSRI) (an antidepressant) relieve symptoms in approximately 60% to 90% of women and may be continually administered or only prescribed during the premenstrual period. Oral contraceptive pills that contain a combination of estrogen and progesterone also can be continuously used for up to 3 months to decrease the frequency of menstrual periods, PMS, and premenstrual dysphoric disorder (PMDD). Nonsteroidal antiinflammatory drugs (NSAIDs) and pure estrogen or progesterone preparations would not be administered continually. PTS: 1 DIF: Cognitive Level: Applying 10. A student is learning about pelvic inflammatory disease (PID). What information does the student clarify with a study partner as being correct? a. An episode of mild PID can decrease the possibility of a successful pregnancy by 80%. b. Such an inflammation results in permanent changes to the ciliated epithelium of the fallopian tubes. c. PID has not been associated with an increased risk of an ectopic pregnancy. d. Contracting this infection increases the risk of cervical cancer. ANS: B PID infection results in permanent changes to the ciliated epithelium of the fallopian or uterine tubes. A recent study has found that one episode of mild, subclinical PID resulted in a 40% decrease in later pregnancy rates, and multiple episodes of PID further increase the risk of infertility. Scarring caused by PID greatly increases the risk of a later ectopic pregnancy by up to 10-fold. Scarring and adhesions also can result in chronic pelvic pain and, potentially, an increased risk of later uterine (not cervical) cancer. PTS: 1 DIF: Cognitive Level: Remembering 11. A healthcare professional reads in a woman’s chart that she has a grade 2 uterine prolapse. What assessment finding does the professional correlate with this condition? a. Uterus halfway to the hymen b. Uterus reaches the hymen c. Uterus protruding from the vagina d. Uterus and rectum protruding ANS: B A grade 2 prolapse reaches the hymen. PTS: 1 DIF: Cognitive Level: Remembering 12. Which term is used to identify the descent of the posterior bladder and trigone into the vaginal canal? a. Rectocele b. Vaginocele c. Cystocele d. Enterocele ANS: C www.nursylab.com Downloaded by: jesslizarraga15 | jess.lizarraga15@gmail.com Distribution of this document is illegal Want to earn $103 per month? Stuvia.com - The Marketplace to Buy and Sell your Study Material www.nursylab.com Test Bank - Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th) 253 Cystocele is the only term used to identify the descent of a portion of the posterior bladder wall and trigone into the vaginal canal. A rectocele is the bulging of the rectum and posterior vaginal wall into the vaginal canal. “Vaginocele” is not a term used to describe relaxation of pelvic structure support. An enterocele is the herniation of the peritoneal sac between the vagina and rectum. PTS: 1 DIF: Cognitive Level: Remembering 13. What type of cyst develops when an ovarian follicle is stimulated but no dominant follicle develops and completes the maturity process? a. Follicular b. Corpus luteum c. Corpus albicans d. Benign ovarian ANS: D Benign cysts of the ovary are produced when a follicle or a number of follicles are stimulated but no dominant follicle develops and completes the maturity process. Two types of benign ovarian cysts are corpus luteum cysts and follicular cysts. The corpus albicans is what is left of the corpus luteum after being broken down by macrophages. PTS: 1 DIF: Cognitive Level: Remembering 14. Which term is used to identify benign uterine tumors that develop from smooth muscle cells in the myometrium and are commonly called uterine fibroids? a. Endometrial polyps b. Myometrial polyps c. Leiomyomas d. Myometriomas ANS: C Leiomyomas, commonly called myomas or uterine fibroids, are benign smooth muscle tumors in the myometrium A polyp is a mass covered by endometrial tissue. PTS: 1 DIF: Cognitive Level: Remembering 15. What theory is used to describe the cause of endometriosis? a. Obstruction within the fallopian tubes prevents the endometrial tissue from adhering to the lining of the uterus. b. Endometrial tissue passes through the fallopian tubes and into the peritoneal cavity and remains responsive to hormones. c. Inflammation of the endometrial tissue develops after recurrent sexually transmitted diseases. d. Endometrial tissue lies dormant in the uterus until the ovaries produce sufficient hormone to stimulate its growth. ANS: B www.nursylab.com Downloaded by: jesslizarraga15 | jess.lizarraga15@gmail.com Distribution of this document is illegal Want to earn $103 per month? Stuvia.com - The Marketplace to Buy and Sell your Study Material www.nursylab.com Test Bank - Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th) 254 It has been proposed that endometriosis is caused by the implantation of endometrial cells during retrograde menstruation, during which menstrual fluids move through the fallopian tubes and empty into the pelvic cavity. Similar to normal endometrial tissue, the ectopic (out of place) endometrium responds to the hormonal fluctuations of the menstrual cycle. PTS: 1 DIF: Cognitive Level: Remembering 16. In order to help prevent a preadolescent girl from developing later cervical cancer, which virus does the healthcare professional recommend vaccination against to the parent? a. Human papillomavirus (HPV) b. Epstein-Barr virus (EBV) c. Herpes simplex II virus (HSV) d. Cytomegalovirus (CMV) ANS: A Infection with high-risk (oncogenic) types of HPV (predominantly 16 and 18) is a necessary precursor to the development of precancerous dysplasia of the cervix that leads to invasive cancer. EBV, HSV, and CMV are not precursors to CIN and cervical cancer. PTS: 1 DIF: Cognitive Level: Remembering 17. A woman has been diagnosed with cervical carcinoma in situ and asks the healthcare professional to explain it to her. What description by the professional is best? a. It involves the full epithelial thickness of the cervix. b. It involves abnormal cells growing on the cervix. c. It is when cancer has spread to the peritoneum. d. It is when only the top layer of the cervix is affected. ANS: A The progressive neoplastic changes of cervical cells are classified on a continuum from cervical intraepithelial neoplasia (dysplasia) to cervical carcinoma in situ (full epithelial thickness of the cervix is involved), which is generally a precursor of invasive carcinoma of the cervix to invasive carcinoma of the cervical tissue. Dysplasia is the condition of having abnormal cells that have replaced normal ones and could become cancerous. Invasive cancer is one that has spread. In CIN grade, only the top layer of the endothelium is affected. PTS: 1 DIF: Cognitive Level: Remembering 18. Which factor increases the risk for ovarian cancer after the age of 40 years? a. Never having children b. Oral contraceptive use c. Multiple pregnancies d. Prolonged lactation ANS: A Ovarian cancer in women older than 40 years of age is associated with prolonged ovulation over the lifetime due to circumstances such as early menarche, late menopause, and nulliparity. Use of fertility drugs, oral contraceptives, and prolonged lactation would not lead to prolonged exposure to ovulation over a lifetime. www.nursylab.com Downloaded by: jesslizarraga15 | jess.lizarraga15@gmail.com Distribution of this document is illegal Want to earn $103 per month? Stuvia.com - The Marketplace to Buy and Sell your Study Material www.nursylab.com Test Bank - Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th) PTS: 1 255 DIF: Cognitive Level: Remembering 19. Infertility is defined as the inability to conceive after how many months of unprotected intercourse with the same partner? a. 6 b. 12 c. 18 d. 24 ANS: B Infertility is defined as the inability to conceive after 1 year of unprotected intercourse with the same partner. Although some experts say that women over 35 years of age should be evaluated after not conceiving after 6 months; this is not the standard definition. PTS: 1 DIF: Cognitive Level: Remembering 20. A woman has been diagnosed with galactorrhea. Which condition would the healthcare provider be least likely to assess the woman for? a. Proliferation of the lactiferous ducts of the breast b. Hypothyroidism, resulting from a decrease in thyroid-releasing hormone c. Excess prolactin secretion from the pituitary d. Drugs such as phenothiazines ANS: A Galactorrhea is a consequence of physiologic changes in the body and is not a primary breast disorder. The most common cause of galactorrhea is nonpuerperal hyperprolactinemia, or excessive amounts of prolactin. A variety of exogenous agents (such as drugs) and disorders can trigger one of these three mechanisms, thereby causing hyperprolactinemia. Hypothyroidism causes increased secretion of hypothalamic thyroid-releasing hormone, which stimulates the release of prolactin from the pituitary. Other causes include some drugs such as phenothiazines and some physical causes. The proliferation of lactiferous breast ducts is not associated with galactorrhea. PTS: 1 DIF: Cognitive Level: Understanding 21. A woman’s chart reveals she has superficial breast cysts. What assessment finding does the healthcare professional correlate with this condition? a. Hard, painful lump b. Reddened skin surrounding the lump c. Squishy feeling and easily palpated d. Dimpling on the surface of the breast ANS: C Cysts (fluid-filled sacs) are a specific type of lump that commonly occurs in women in their 30s, 40s, and early 50s. Cysts feel squishy when they occur close to the surface of the breast; however, when deeply embedded, cysts can feel hard. A reddened area surrounding a lump might signify an infection. Dimpling on the surface of the breast may indicate cancer. www.nursylab.com Downloaded by: jesslizarraga15 | jess.lizarraga15@gmail.com Distribution of this document is illegal Want to earn $103 per month? Stuvia.com - The Marketplace to Buy and Sell your Study Material www.nursylab.com Test Bank - Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th) PTS: 1 256 DIF: Cognitive Level: Remembering 22. A woman has been diagnosed with a simple fibroadenoma. What treatment does the healthcare provider educate the woman about? a. A repeat biopsy in 6 months b. More frequent mammograms c. Nothing; no treatment is needed. d. Rapid surgical excision and chemotherapy ANS: C Simple fibroadenomas are benign, and if asymptomatic, do not require treatment. A complex fibroadenoma with surrounding proliferative changes needs further treatment. If the woman has a family history of breast cancer, she may wish to have it removed to decrease worry. PTS: 1 DIF: Cognitive Level: Understanding 23. What are the majority of the small percentage of ovarian cancers that are associated with a known pattern of inheritance associated with? a. Mutation of the BRCA1 gene b. Mutations of the BRCA2 gene c. Hereditary nonpolyposis colorectal cancer (HNPCC) syndrome d. Low progesterone levels ANS: A The majority (approximately 90%) of ovarian cancers are sporadic and not associated with a known pattern of inheritance. Of the 5% to 10% that have a familial component, the majority are associated with the breast cancer susceptibility gene 1 (BRCA1) and a smaller number with mutations of the BRCA2 or mismatched repair genes (HNPCC syndrome). Low progesterone levels are not associated with ovarian cancers. PTS: 1 DIF: Cognitive Level: Remembering MULTIPLE RESPONSE 1. A woman has a pelvic organ prolapse. What treatments does the healthcare professional teach the woman about? (Select all that apply.) Pessary Kegel exercises Estrogen therapy Surgical repair Bearing down exercises a. b. c. d. e. ANS: A, B, C, D www.nursylab.com Downloaded by: jesslizarraga15 | jess.lizarraga15@gmail.com Distribution of this document is illegal Want to earn $103 per month? Stuvia.com - The Marketplace to Buy and Sell your Study Material www.nursylab.com Test Bank - Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th) 257 A common first-line treatment is a pessary, which is a removable mechanical device that holds the uterus in position. The pelvic fascia may be strengthened through Kegel exercises (repetitive isometric tightening and relaxing of the pubococcygeal muscles) or by estrogen therapy in menopausal women. Maintaining a healthy body mass index, preventing constipation, and treating chronic cough may help as well. Surgical repair with or without a hysterectomy is the treatment of last resort. Bearing down would likely exacerbate the problem. PTS: 1 DIF: Cognitive Level: Remembering 2. The size of benign uterine tumors, such as leiomyomas, is thought to be caused by the influence of which hormones? (Select all that apply.) a. Progesterone b. Estrogen c. Luteinizing hormone d. Gonadotropin-stimulating hormone e. Growth factors ANS: A, B, E The cause of uterine leiomyomas is unknown, although their size appears to be related to estrogen, progesterone, growth factors, angiogenesis, and apoptosis. Luteinizing hormone and gonadotropin-stimulating hormone have no suspected role in leiomyomas. PTS: 1 DIF: Cognitive Level: Remembering 3. What are the common clinical manifestations of endometriosis? (Select all that apply.) a. Back and flank pain b. Infertility c. Dysuria d. Amenorrhea e. Dysmenorrhea ANS: B, E Common clinical manifestations primarily include infertility, dysmenorrhea, dyschezia (pain on defecation), and dyspareunia (pain on intercourse). PTS: 1 DIF: Cognitive Level: Remembering 4. A woman has been diagnosed with compartment IV primary amenorrhea. What assessments would the healthcare professional perform as priorities? (Select all that apply.) a. Weight and body mass index b. Signs of systemic infection c. Stress self-assessment questionnaire d. Genetic family history e. Presence of secondary sex characteristics ANS: A, B, C, E www.nursylab.com Downloaded by: jesslizarraga15 | jess.lizarraga15@gmail.com Distribution of this document is illegal Want to earn $103 per month? Stuvia.com - The Marketplace to Buy and Sell your Study Material www.nursylab.com Test Bank - Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th) 258 Compartment IV primary amenorrhea is due to CNS dysfunction, specifically of the hypothalamus. The hypothalamus is unable to synthesize GnRH, so the pituitary fails to secrete LH and FSH. Therefore, the ovary does not receive the hormonal signals required to stimulate estrogen production, and ovulation and menstruation do not occur. Because the ovarian hormones are absent, estrogen-dependent sex characteristics do not develop. Other possible causes of this condition include starvation or malnutrition, infections, and stress. The healthcare professional would assess for these contributing factors. Genetic testing/screening would be more appropriate for compartment II primary amenorrhea, which involves the ovaries and is often linked to genetic disorders. PTS: 1 DIF: Cognitive Level: Applying www.nursylab.com Downloaded by: jesslizarraga15 | jess.lizarraga15@gmail.com Distribution of this document is illegal Want to earn $103 per month?
