3102 EAQ: Chapter 26- Female GU System
A patient reports to the nurse about having intense vaginal itching along with a white and clumpy vaginal discharge even when using oral contraceptives. The laboratory results show branched hyphae on microscopic examination. Which condition should the nurse suspect that the patient has? The patient has moniliasis. The patient has trichomoniasis. The patient has atrophic vaginitis. The patient has Haemophilus vaginalis infection.
1 Moniliasis, also called candidiasis, is a fungal infection of the genitalia. It may be caused by various factors such as the use of oral contraceptives, douching, wearing tight or nylon underwear, and diabetes mellitus. Oral contraceptives increase the glycogen content of the vaginal epithelium, providing a fertile medium for some organisms, resulting in vulvovaginal infections such as moniliasis. Intense itching and thick, white, and clumpy discharge from the vagina indicate moniliasis. The microscopic examination shows branched hyphae, which confirms the diagnosis of moniliasis. Red, granular papules with frothy and foul-smelling discharge from the vagina indicate trichomoniasis. Microscopic examination shows characteristic flagellated cells. Vaginal itching, a burning sensation, dryness, and mucoid discharge from the vagina indicate atrophic vaginitis. Thin, creamy, gray-white malodorous discharge from the vagina indicates Haemophilus vaginosis. Microscopic examination shows typical clue cells.
The nurse is assessing an elderly female patient who has diabetes mellitus. The patient reports to the nurse that she has night sweats, vaginal dryness, itching, and numbness. What should the nurse infer from these findings? The patient is at increased risk of vaginitis. The patient is at increased risk of cervical cancer. The patient is at increased risk of vascular problems. The patient is at an increased risk of endometrial cancer.
1 Night sweats, itching, vaginal dryness, and numbness are symptoms of menopause that occur in patients older than 45 years of age. Elderly patients with diabetes mellitus are at an increased risk of vaginitis, because diabetes mellitus increases the glycogen content, which favors the growth of pathogens, resulting in vaginitis. Menopausal patients have an alkaline vaginal pH and decreased glycogen content because of their decreased estrogen levels. Because these factors create a suitable medium for the growth of pathogens, a menopausal patient with diabetes mellitus is at an increased risk for vaginitis. Infection of the cervix with human papillomavirus (HPV) is the most common cause of cervical cancer. Multiple sex partners, cigarette smoking, and undetected HPV are risk factors for cervical cancer. Oral contraceptives and cigarette smoking increase the risk of vascular problems. Obesity, early menarche, late menopause, history of infertility, failure to ovulate, and unopposed estrogen therapy increase the risk of endometrial cancer.
Which finding does the nurse consider abnormal when inspecting the patient's cervix and its opening? Lateral position of the cervix Diameter of cervix as 2.5 cm Pink-colored cervical mucosa Small, round cervical opening
1 Normally, the position of the uterine cervix should be anterior or posterior, but a lateral position of the cervix may indicate that the patient has a cervical adhesion or tumor. The normal diameter of the cervix is 2.5 cm. The diameter of the cervix increases with a tumor or inflammation. Normally, the cervical mucosa is pink in color. Redness of the cervical mucosa indicates inflammation. The cervical opening is small and round in a normal patient. p. 750
A patient reports to the nurse about having pain during urination with increased frequency and postcoital bleeding. The nurse also notices yellow mucopurulent discharge and a friable cervix during the pelvic assessment. Which infection does the nurse suspect in the patient? Chlamydia Gonorrhea Candidiasis Trichomoniasis
1 Painful urination, increased urinary frequency, and postcoital bleeding are characteristics of a chlamydial infection. Patients with a chlamydia infection have a friable cervix, with yellow or green mucopurulent cervical discharge. Therefore, the nurse concludes that the patient has chlamydia. Dysuria, vaginal bleeding, and abnormal uterine bleeding indicate gonorrhea. Thick, white, curdlike discharge from erythematous vagina indicates candidiasis. Red, granular papules and frothy, foul-smelling discharge from the vagina indicate trichomoniasis.
Which instructions should the nurse provide to a patient regarding a pelvic examination? "Do not douche or have intercourse 24 hours before the examination." "You can hold your breath during the examination if you feel uncomfortable." "It is best if you do not view the procedure because you may find it disturbing." "You will have to remove all clothing including shoes and socks before the examination."
1 The nurse instructs the patient to avoid douching 24 hours before the pelvic examination, because douching can wash away surface cells. Vaginal intercourse can cause inflammation of the tissue, which can interfere with a Pap test. The nurse does not ask the patient to hold her breath if she feels uncomfortable, but stops the examination. The patient can wear her shoes and socks during the examination if she prefers to do so. The procedure should not be characterized as disturbing, and the nurse can use a mirror during the pelvic examination so that the patient gets a full view of her genitalia.
While examining the external genitalia of a patient, the nurse observes urethral inflammation and purulent discharge from the urethral meatus. The nurse also finds erythema and tenderness of the anterior vaginal wall. The patient reports to the nurse about having a burning sensation during urination. What do the patient's findings suggest? Urethritis Herpes genitalis Syphilitic chancre Urethral caruncle
1 Urethritis is referred to as the inflammation of the urethra, which causes a burning sensation during urination. Erythema, tenderness of the anterior vaginal wall, and purulent discharge from the urethral meatus are characteristics of urethritis. Clusters of small, shallow vesicles with erythema emerging around genital areas and the inner thigh indicate herpes genitalis. Small, round, solitary, silvery papules, which transform into superficial ulcers with yellowish discharge, indicate syphilitic chancres. A small, deep red, benign mass protruding from the meatus resulting in painful urination indicates urethral caruncle.
To what does "version" refer in the female genitourinary system? The position of the uterus in a female body The classification system of cervical neoplasia The placement of the ovaries in relation to the uterus When the long axis of the uterus is not straight but is bent on itself
1 Version refers to the position of the uterus. The relationship of the long axis of the uterus to the long axis of the body helps in understanding the version of the uterus. Version does not refer to the position of the ovaries. Cervical neoplasia is classified into three grades: CIN 1, CIN 2, and CIN 3. The midposition and retroverted position occur when the long axis of the uterus is not straight but bent on itself.
After performing a genital assessment of a patient, the nurse concludes that the patient has atrophic vaginitis. Which assessment findings led the nurse to this conclusion? Vaginal itching, dryness with a mucoid vaginal discharge Shortened, narrowed vaginal opening and decreased rugae Thick, white, curdlike discharge from erythematous vagina Thin, creamy, gray-white malodorous discharge from vagina Red, granular papules and frothy, foul-smelling vaginal discharge
1, 2 Vaginal itching, a burning sensation with dryness, and mucoid discharge from the vagina are characteristics of atrophic vaginitis. This condition is caused by the loss of estrogen. Estrogen keeps the vaginal tissues thick, moist, and rugated. Therefore, the loss of estrogen causes decreased rugae along with a shortened, narrowed vagina. A thick, white, curdlike discharge from an erythematous vagina indicates candidiasis. Thin, creamy, gray-white malodorous discharge from the vagina indicates bacterial vaginosis. Red, granular papules and frothy, foul-smelling discharge from the vagina indicate trichomoniasis.
Which changes would the nurse observe in an elderly female patient during a genital examination? Shrinkage of the uterus Thinning of the pubic hair Increase in the vaginal pH Increased size of the clitoris Enlargement of the mons pubis
1, 2, 3 Because female hormone levels decrease rapidly with age, the nurse can observe dramatic changes in the reproductive system of an elderly patient. The uterus shrinks in size due to a decreased myometrium, which decreases the production of hormones like progesterone and estrogen. Pubic hair becomes thin and sparse due to a lack of ovarian hormones. The vaginal pH becomes more alkaline as the pH increases. This is the result of decreased estrogen levels. The size of the clitoris gradually decreases with age, and the mons pubis becomes smaller because of atrophy of the fat pad.
Which conditions are examples of vulvovaginal inflammation? Candidiasis Trichomoniasis Acute salpingitis Atrophic vaginitis Human papillomavirus infection
1, 2, 4 Candidiasis, trichomoniasis, and atrophic vaginitis are vulvovaginal inflammations. Candidiasis is characterized by thick, whitish, clumpy discharge with intense pruritus in the vulvovaginal area. Trichomoniasis is characterized by pruritus, watery vaginal discharge, urinary frequency, terminal dysuria, and itching. Atrophic vaginitis is characterized by dryness, a burning sensation, dyspareunia, and mucoid discharge. Acute salpingitis is the enlargement of adnexa; it is characterized by sudden fever, suprapubic pain, and tenderness. Human papillomavirus infection is usually confined to the cervix. It is characterized by warty growth on the cervical epithelium.
What places a patient at risk for developing candidiasis? Diabetes mellitus Vaginal douching Cigarette smoking Prolonged use of antibiotics Unopposed estrogen therapy
1, 2, 4 Diabetes mellitus, vaginal douching, and prolonged use of antibiotics are risk factors for developing candidiasis. Increased glycogen content due to diabetes mellitus favors the growth of pathogens that may result in candidiasis. Vaginal douching alters the vaginal pH, which favors the growth of pathogens and therefore causes infection. Use of antibiotics and frequent vaginal douching disrupt the normal flora and favor the growth of pathogens, resulting in candidiasis. Cigarette smoking increases the risk for vascular problems and cervical cancer. Unopposed estrogen therapy (estrogen only without progesterone) increases the risk for endometrial cancer.
While assessing a female patient with a genital infection, the nurse determines that the patient has diethylstilbestrol (DES) syndrome. Which assessment findings made the nurse reach this conclusion? Bulging of the anterior cervical lip with round grooves Chronic ulcerations and indurations noted on the cervix Reddened cervical lip with a reddened granular surface Red, granular patches of columnar epithelium on cervix Red, soft, pedunculated growth on the cervical opening
1, 2, 4 Females who have been exposed to DES prenatally may develop DES syndrome during adolescence. DES syndrome is characterized by cervical and vaginal abnormalities. Bulging of the anterior lip, circular grooves, and transverse ridges are the cervical abnormalities caused by DES. Red-colored, granular patches of columnar epithelium extending beyond the squamocolumnar junction of the cervix and into the fornices also indicate DES syndrome. Inflamed cervical lips with a reddened granular surface indicate erosion of the cervix. Red, soft, pedunculated growth emerging from cervical opening with mucoid discharge indicates a polyp.
Which measures should the nurse include while examining the external genitalia of a female adolescent patient? Do the examination of the patient without the mother in the room. Determine the patient's growth rate as well as the menstrual history. Lubricate the hands and instruments adequately before examination. Use the sexual maturity charts to teach about developmental changes. Instruct the patient to report whether the vaginal secretions are increased.
1, 2, 4 The nurse should perform genital examinations of an adolescent patient alone, without the parents, to ensure patient privacy. The nurse should assess the growth rate and menstrual history of the patient to determine the presence of any sexual health problems. Sexual maturity charts help teach the patient effectively about the developmental changes like breast and pubic hair development. Increased secretions of vaginal fluid during examination indicate physiologic leucorrhea, which is a normal finding in the adolescent patient due to the estrogen effect. Lubricating the hands and instruments before genital examination is not necessary because of the high estrogenic activity that keeps the adolescent genitalia well lubricated.
The nurse is examining the genitourinary system of a female patient. Which procedures should the nurse include when doing a vaginal examination? Situate the patient in the lithotomy position. Have the patient raise her arms over her head. Put an examination glove on each of the stirrups. Elevate the end of the exam table near the head. Teach the patient to keep quiet during the exam.
1, 3, 4 The lithotomy position requires the patient to lie on her back with hips and knees flexed, feet placed in the stirrups, thighs apart, and the perineum at the end of the examination table. This position is most commonly used for vaginal examinations. The nurse should place an examination glove over each stirrup to warm up the stirrups and prevent the patient's feet from slipping. Elevating the head end of the examination table helps the nurse maintain eye contact with the patient during the examination. The nurse should not instruct the patient to place her hands over her head because this position tightens the abdominal muscles during the examination. The nurse should communicate and explain every part of the examination and encourage the patient to ask any questions during the examination.
What are the risk factors for endometrial cancer? Obesity Body sprays Oral contraceptives Decreased vaginal pH Long-term estrogen therapy
1, 5 Obesity and long-term estrogen therapy are risk factors for endometrial cancer. Obesity increases the production of endogenous estrogen, and estrogen therapy continually stimulates the endometrium, causing hyperplasia, which increases the risk of cancer. Using body sprays increases the risk for contact dermatitis. Decreased vaginal pH and use of oral contraceptives increase the glycogen content of the vaginal epithelium, thus providing a fertile medium for pathogens and increasing the risk of vaginitis.
A female patient reports to the nurse about having pelvic and abdominal pain. On reviewing the diagnostic reports, the nurse finds that the patient has a heavy, solid, fixed, and poorly defined mass on the ovary. What does the nurse infer from these findings? The patient has ovarian cysts. The patient has ovarian cancer. The patient has acute salpingitis. The patient has an ectopic pregnancy.
2 A heavy, solid, fixed, poorly defined mass indicates a cancerous growth. Abnormal swelling in the abdominal area indicates bloating. Symptoms such as abdominal and pelvic pain are associated with ovarian cancer. Smooth, round, fluctuant, mobile, and nontender masses on the ovaries are characteristic of ovarian cysts. Fever, suprapubic pain, tenderness, and purulent discharge from the cervix indicate acute salpingitis. Abdominal or pelvic pain with vaginal spotting and softening of the uterus and fundus are characteristics of ectopic pregnancy.
Which assessment finding indicates a normal cervix? Velvety and soft 2 to 3 cm in diameter Projecting into the vagina 4 cm Covered with "strawberry spots"
2 A normal cervix is 2.5 cm in diameter. A normal cervix projects 3 cm into the vagina. Strawberry spots on the cervix indicate infection and needs prompt treatment. A velvety and soft cervix is seen only in a pregnant patient.
A patient with anemia reports having backaches, a feeling of heaviness in the abdomen, and excessive uterine bleeding. On palpation of the uterus, the nurse finds that the uterus is enlarged and painless nodules are present in the uterine wall. Which condition does the nurse expect the patient to have? The patient has polyps. The patient has myomas. The patient has endometriosis. The patient has acute salpingitis.
2 An enlarged uterus along with bloating, and hard, painless nodules on the uterine wall, indicate uterine fibroids. The presence of fibroids in the uterine wall causes heaviness, bloating, backache, and excessive uterine bleeding, the latter of which in turn leads to anemia. A bright red, soft, pedunculated growth emerging from the cervical opening is referred to as a polyp. An enlarged uterus, which is fixed, tender on movement, and has small, firm nodular masses on the posterior part of the fundus indicates endometriosis. A fever greater than 100.4° F (38° C) along with suprapubic pain, tenderness, and purulent discharge from the cervix indicates acute salpingitis.
What is the shape of the uterus of a patient who is 24 weeks pregnant? Pear Oval Round Globular
2 During pregnancy, drastic changes occur in the uterus to accommodate the growing fetus. During 20 to 24 weeks of pregnancy, the uterus appears oval in shape and rises almost up to the liver. A nonpregnant uterus has a flattened pear shape. The uterus appears round at midgestation and changes to an elongated oval shape at the end of gestation due to the growing fetus. The uterus is globular in shape at 10 to 12 weeks of gestation.
Which position would the nurse consider best to examine the genitalia of a toddler? Standing position Frog-leg position Side-lying position Lithotomy position
2 During the genital examination of a toddler, the toddler is placed in the frog-leg position on the parent's lap. In this position, the toddler's knees are flexed apart with soles of the feet together. This position facilitates better viewing and inspection of the external genitalia of the toddler. All other positions such as standing, side-lying, and lithotomy are not effective for examining the toddler. The standing position is not effective, because it does not provide proper access to examine the genitalia. The toddler is placed in the side-lying position to relax after the examination. The lithotomy position is used for the genital examination of adolescent patients who are cooperative.
While examining a patient who has stress incontinence, the nurse observes that the patient's bladder is prolapsed into the vagina. Which condition does this finding suggest? Rectocele Cystocele Atrophic vaginitis Uterine prolapse
2 Part of the bladder being covered by the vaginal mucosa and being prolapsed into the vagina describe a cystocele. This causes a feeling of pressure in the vagina and leads to stress incontinence. A rectocele is a condition in which a part of rectum is covered by the vaginal mucosa and is prolapsed into the vagina. Vaginal itching, a burning sensation, dryness, and mucoid discharge from the vagina indicate atrophic vaginitis. Protrusion of the uterus into the vagina indicates uterine prolapse.
Which statement best describes the clitoris? It has a visible length of 5 cm. It is composed of erectile tissue. It is a thin circular fold covering the vaginal opening. It is composed of glandular tissue that secretes vaginal moisture.
2 The clitoris is composed of the erectile tissue that is similar to the corpus cavernosum of the penis. The clitoris has a length of 1.5 to 2 cm. The hymen is a thin circular or crescent-shaped fold that may cover part of the vaginal opening. The cervix secretes vaginal fluid, depending on the day of the menstrual cycle.
When would the nurse first observe the softening of the uterus in a pregnant patient who has missed her first menstrual period? 4 to 6 weeks 6 to 8 weeks 8 to 12 weeks 10 to 12 weeks
2 The female genitalia show signs of the growing fetus after missing the first menstrual period. Softening of the isthmus of the uterus is referred to as Hegar sign. This can be observed at 6 to 8 weeks of gestation due to increased vascularity. Softening of the cervix is indicative of Goodell sign, which is observed at 4 to 6 weeks of gestation. A bluish discoloration of the vaginal mucosa, cervix, and labia is referred to as the Chadwick sign, which can be observed at 8 to 12 weeks of gestation. At 10 to 12 weeks of gestation, the uterus appears globular in shape because of the growing fetus and hormonal changes.
What does the nurse instruct the patient to do during the speculum examination? "Place your hips midway down the examining table." "Bear down so that the perineal muscles can relax." "Squeeze your perineal muscles so that I can assess the pelvic floor strength." "Tell me if there is any discomfort, so that the speculum will be removed."
2 The nurse instructs the patient to bear down so that the perineal muscles can relax. This helps open the introitus and eases the speculum insertion. The hips are placed to the edge of the table for ease of insertion. Squeezing the perineal muscles will not open the introitus and will hinder examination. The nurse can elevate the bed to decrease the patient's discomfort. The nurse does not remove the speculum before obtaining the smears.
What does the nurse use to lubricate the speculum to obtain a Pap smear? Mineral oil Warm water Liquid paraffin Petroleum gel
2 The nurse should use warm water to lubricate the speculum and facilitate easy insertion. Mineral oil and petroleum gel may not be safe and may further increase an infection. Liquid paraffin is a highly refined mineral oil that may not be safe for the patient.
The nurse teaches a student nurse about obtaining a female patient's reproductive health history. Which statement, if made by the student nurse, indicates effective learning? "It should be obtained during the pelvic examination." "It should include the pattern of menstruation and sexual satisfaction." "It should focus on physical complaints such as discharge, pain, or rash." "It should be obtained every 3 to 5 years in a patient without complaints."
2 The reproductive health history for females should include the pattern of menstruation, because menstruation disorders result in reproductive dysfunction. Questions about sexual satisfaction help probe the patient's sexual relationship and how it affects her health. The nurse obtains the reproductive health history during the interview to better focus on specific problems during the physical assessment. The reproductive health history should focus on all aspects of the patient's sexual health such as menstruation, self-care, sexual activity, and use of contraception and not be limited to physical complaints. The nurse obtains the patient's reproductive health history annually to screen for infections.
Which conditions can be prevented with the recombinant human papillomavirus quadrivalent vaccine? Gonorrhea Anal cancer Genital warts Cervical cancer Human immunodeficiency virus (HIV)
2, 3, 4 The recombinant human papillomavirus quadrivalent vaccine protects against diseases caused by the human papillomavirus (HPV). These conditions include anal cancer, genital warts, and cervical cancer. Gonorrhea and HIV infection are not caused by HPV and cannot be prevented by the recombinant human papillomavirus quadrivalent vaccine.
Which assessment findings does the nurse consider as abnormal when reviewing a patient's medical results? Vaginal pH of 4.0 Dark and cloudy urine Clots in menstrual flow Cloudy vaginal discharge Yellow-green vaginal discharge
2, 3, 5 Dark and cloudy urine indicates the presence of a urinary tract infection. Clots in the menstrual flow may be indicative of menorrhagia, or vaginal pooling of blood. Normally urine is clear and pale yellow in color. Normally, females have a small amount of clear or cloudy white vaginal discharge. A yellow-green vaginal discharge indicates a vaginal infection. Normal levels of vaginal pH range from 3.8 to 4.5. Therefore, a vaginal pH of 4.0 is a normal condition. Cloudy vaginal discharge is a normal condition.
Which are examples of external genital abnormalities? Cystocele Urethritis Uterine prolapse Urethral caruncle Syphilitic chancre
2, 4, 5 Urethritis, urethral caruncles, and syphilitic chancres are examples of abnormalities of the external genitalia. Urethritis is caused by inflammation of the urethra. It is characterized by a burning sensation and purulent discharge from the urethra. A urethral caruncle is characterized by a small, deep red, benign mass protruding from the urethral meatus, which results in painful urination. Cystocele and uterine prolapse are caused by weakness of the pelvic musculature.
Which findings obtained during the assessment of a newborn female require further evaluation? Thick hymen Large clitoris Engorged labia Fusion of the labia Palpable mass in the fused labia
2, 4, 5 Routine screening of the newborn genitalia is limited to visual inspection of the external genitalia. The clitoris is a small, pea-shaped erectile body. An enlarged clitoris makes it appear like a penis, which is a characteristic of ambiguous genitalia. Fusion of the labia minora and labia majora resembles the scrotum of a male newborn and requires further evaluation. A palpable mass in the fused labia resembles the testes. This finding indicates the need for further evaluation. The hymen is a thin, circular crescent shaped organ that partly or completely covers the vaginal orifice. A thick hymen due to the engorgement of genitalia during birth is a normal finding, and it doesn't require further evaluation. Engorged labia are caused by transient enlargement of the genitalia and are a normal finding after the birth of a newborn.
While assessing a patient, the nurse finds that the patient has a body temperature of 102.2° F (39° C), suprapubic pain, and purulent discharge from the cervix. The nurse finds it difficult to palpate the bilateral adnexal masses, because the patient complains of having severe pain during the palpation. What should the nurse infer from these findings? The patient may have an ovarian cyst. The patient may have ovarian cancer. The patient may have acute salpingitis. The patient may have an ectopic pregnancy.
3 A body temperature of 102.2° F (39° C) indicates a fever. A fever greater than 100.4° F (38° C), suprapubic pain, tenderness, and purulent discharge from the cervix are signs that indicate acute salpingitis. The patient with this condition has rigid abdominal musculature, which causes intense pain when manually palpating the uterus and examining the cervix. Thus, it is difficult to palpate the bilateral adnexal masses due to intense pain and muscle spasms. A smooth, round, mobile, and nontender mass on an ovary is referred to as an ovarian cyst. Ovarian cancer is characterized by a heavy, solid, fixed, poorly defined mass in the ovary. The symptoms associated with ovarian cancer include abdominal pain, pelvic pain, and increased abdominal size. Abdominal or pelvic pain with vaginal spotting and softening of the uterus and fundus are characteristics of ectopic pregnancy.
Which assessment finding in a patient would indicate a third-degree uterine prolapse? The bladder prolapses into the vagina. A bulge emerges from the posterior fornix. The whole uterus is outside the introitus. The cervix is visible at the introitus when the client strains.
3 A third-degree uterine prolapse occurs when the whole uterus bulges outside introitus even without straining. Cystocele refers to an abnormality of the pelvic musculature in which the bladder prolapses into the vagina. Rectocele results in a bulge emerging from the posterior fornix. The cervix is visible at the introitus with straining in first-degree uterine prolapse.
While assessing a female adolescent patient, the nurse finds that the patient's hymen is bluish in color and bulging. The patient reports to the nurse that she has not started her menses. For which condition should the nurse screen in this patient? Dyspareunia Delayed puberty Imperforate hymen Physiologic leucorrhea
3 Absence of menses indicates amenorrhea. Normally, the hymen is perforate and should allow menstrual blood to flow through. Presence of amenorrhea along with a bluish and bulging hymen indicate that the patient has an imperforate hymen. Painful sexual intercourse is termed as dyspareunia. Absence of pubic hair even at the age of 13 years indicates delayed puberty. Increased secretions of vaginal fluid indicate physiologic leucorrhea.
A female patient reports to the nurse of having pain during her menstrual period and a feeling of being bloated. On further assessment, the nurse also finds that the patient has breast tenderness. What should the nurse conclude from these findings? The patient has menorrhagia. The patient has amenorrhea. The patient has dysmenorrhea. The patient has vaginal pooling.
3 Any pain or abdominal cramping during the menstrual period indicates dysmenorrhea. Symptoms associated with dysmenorrhea include pain, bloating, breast tenderness, and moodiness. A high amount of menstrual flow is referred to as menorrhagia. An absence of menses indicates amenorrhea. Clotting of menstrual flow causes vaginal pooling.
The nurse assesses that a patient has an enlarged uterus and small, firm, nodular masses on the posterior part of the fundus. The patient reports chronic pelvic pain and irregular uterine bleeding to the nurse. Which complication should the nurse expect to find in the patient? Polyp Myomas Endometriosis Pelvic inflammatory disease
3 Endometriosis is a condition characterized by an enlargement of the uterus, which is tender on movement and has the presence of small, firm, nodular masses on the posterior part of the uterine fundus. It causes cyclic or chronic pelvic pain with irregular uterine bleeding. A bright red, soft, pedunculated growth emerging from the cervical opening with mucoid discharge is referred to as a polyp. Painless, hard nodules on the uterine wall that cause enlargement of the uterus are referred to as myomas. A sudden fever greater than 100.4° F (38° C) along with suprapubic pain, tenderness, and purulent discharge from the cervix may indicate pelvic inflammatory disease.
When does the nurse perform a Pap smear? If a patient complains of abdominal pain or vaginal bleeding When there are symptoms of Chlamydia infection in the patient When a patient reaches 21 years of age When a patient is between 35 to 55 years of age, when most cervical cancers occur
3 Female patients above the age of 21 need to undergo a Pap smear, because they are at risk for cervical cancer due to cell changes. Abnormal vaginal discharge, not abdominal pain or vaginal bleeding, indicates the possibility of cervical cancer. Pap smear is not used to detect vaginal infections. Cervical cancer can occur in any female above the age of 21 or in a sexually active female. p. 760
Which condition presented here can be sexually transmitted? Urethral caruncle Abscess of the Bartholin gland Human papillomavirus (HPV) genital warts Cystocele
3 Human papillomavirus (HPV) genital warts are the most common sexually transmitted infection, especially in adolescents. An early age of menarche and multiple sexual partners increase the risk for genital warts. A urethral caruncle is a deep red mass protruding from the meatus. It is not sexually transmitted. An abscess of the Bartholin gland also cannot be sexually transmitted. A cystocele occurs when the urinary bladder prolapses. This condition is not transmitted sexually.
When doing a genital assessment of a patient who has a genital infection, the nurse finds small, round, solitary, and silvery papules with yellowish serous discharge. Upon palpation, the nurse notes nontender, button-like structures, and enlarged lymph nodes. Which condition should the nurse expect in the patient? Urethritis Herpes genitalis Syphilitic chancre Urethral caruncle
3 Small, round, solitary, silvery papules with yellowish discharge are a characteristic lesion of syphilis. These papules further form superficial ulcers with serous discharge called chancres. Upon palpation, these papules can be lifted with the help of the thumb and forefinger and are nontender. Enlargement of lymph nodes indicates lymphadenopathy, which is also a symptom of syphilis. Clusters of small, shallow vesicles with erythema emerging around genital areas and the inner thigh indicate herpes genitalis. Inflammation of the urethra and a burning sensation and purulent discharge indicate urethritis. A small, deep red, benign mass protruding from the meatus resulting in painful urination indicates a urethral caruncle.
Which disease is best detected using a Pap smear? Polyp Ovarian cancer Cervical cancer Endometrial cancer
3 The Pap smear is used to detect cervical cancer in female patients. The test involves insertion of a speculum into the cervix to collect cells, which are then examined under a microscope. A polyp can be identified during pelvic examination as a red, pediculate growth from the os. The Pap smear is not effective in determining endometrial cancer. Instead, hysteroscopy and pelvic examination are more useful. Screening with serum CA 125 test and transvaginal ultrasonography are used to detect ovarian cancer.
What is a characteristic of the adnexal structures of the uterus? Palpable in a healthy patient Include the bladder and rectum Include the fallopian tubes and ovaries Include an arterial pulse in a normal pregnancy
3 The adnexal structures of the uterus include fallopian tubes and ovaries that are structurally and functionally related to the uterus. If the fallopian tubes are palpable, it indicates ectopic pregnancy in the patient. The adnexal structures do not include the arterial pulse, the bladder, or the rectum, because these structures are not structurally or functionally related to the uterus.
Which structure is highly sensitive to tactile stimulation? Hymen Vagina Clitoris Vestibule
3 The clitoris is a small, pea-shaped erectile body, homologous to the male penis; it is highly sensitive to tactile stimulation. The hymen, vagina, and vestibule are not as rich in sensory nerve endings and thus are less stimulated by touch than the clitoris. The hymen is a thin, circular, or crescent-shaped fold that surrounds and narrows the vaginal opening. The vagina is a soft, flattened, elastic, and tubular muscular canal that provides lubrication. The vestibule is an area between the labia minora.
In which position does the nurse ask the female patient to lie for a pelvic examination? Sims Supine Lithotomy Trendelenburg
3 The nurse asks the patient to lie in a lithotomy position for the pelvic examination, because it helps in effectively locating internal structures. In this position, the body is supine and the feet are placed in the stirrups and knees apart. The supine position is not effective for pelvic examination, because the nurse would not be able to locate the internal structures. The Sims position is more useful for rectal examination. The Trendelenburg position is most effective for examining the back or spine.
A patient complains of vaginal pruritus and burning. The nurse notes a fishy smell and watery gray drainage. What does this finding indicate? Candidiasis Trichomoniasis Bacterial vaginosis Atrophic vaginitis
3 Vaginal pruritus, a burning, fishy smell, and watery gray drainage from the vagina indicate bacterial vaginosis. Watery and often malodorous vaginal discharge, urinary frequency, and terminal dysuria indicate trichomoniasis. Thick curdy discharge indicates candidiasis. Atrophic vaginitis is postmenopausal vaginal itching and dryness with mucoid discharge.
A female patient complains of watery, bubbly, malodorous, yellowish green discharge. Which condition does the nurse suspect in the patient? Pubic lice Candidiasis Trichomoniasis Gardnerella vaginalis
3 Watery, bubbly, malodorous, yellowish-green discharge indicates trichomoniasis. The patient's vagina is erythematous and has red, raised papules and petechiae. Severe perineal itching occurs due to pubic lice. Thick curdy discharge indicates candidiasis. Vaginal pruritus, burning, fishy smell, and watery gray drainage from the vagina indicate Gardnerella vaginalis.
Which developmental change should the nurse expect to find in a 9-year-old female child? Flat labia majora Thin labia minora Thickened mons pubis Tissue paper-thin hymen
3 he nurse would observe a thickened mons pubis, thickened labia majora, and slightly rounded labia minora in a 9-year-old female child. Signs such as a flat labia majora, thin labia minora, and a tissue paper-thin hymen are observed in female children between the ages of 2 months and 7 years.
Which conditions can be prevented by using the human papillomavirus (HPV) vaccine? Chlamydia Gonorrhea Anal cancer Genital warts Cervical cancer
3, 4, 5 Anal cancer, genital warts, and cervical cancer can be prevented by treatment with the HPV vaccine. The vaccine is effective in the prevention of infection caused by different strains of human papilloma virus (HPV), including HPV-6, 11, 16, and 18. These strains of HPV cause anal cancer, genital warts, and cervical cancer. Genital warts caused by HPV can be treated by using the HPV vaccine, which protects against cervical and anal cancers. There is no specific vaccine available for the prevention of chlamydia or gonorrhea infections, because these are caused by bacteria, not viruses. These infections can be prevented by practicing safe sex measures.
What is the purpose of elevating the head of the examination table during a pelvic examination? To prevent pressure on the bladder To prevent pain during the examination To relax the patient's abdominal muscles To maintain the patient's eye contact with the examiner To allow the patient to breathe more easily
3, 4, 5 The nurse elevates the head of the examination table to help the patient relax the abdominal muscles. Elevating the bed also helps in maintaining eye contact with the patient and facilitating communication. This will decrease the patient's discomfort or anxiety. Elevating the bed also helps the patient breathe more easily. Pelvic examination may be painful for the patient, and elevating the bed will not decrease it. There is no pressure on the bladder during pelvic examination.
After examining a patient who has missed a menstrual period, the nurse documents that the patient has a positive Chadwick sign. Which assessment findings led the nurse to reach such a conclusion? Softened cervix Soft uterine isthmus Bluish vaginal mucosa Globular shaped uterus Cyanotic appearance of the cervix
3, 5 The female genitalia show signs of the growing fetus after missing the first menstrual period. Chadwick sign is the bluish discoloration of the vaginal mucosa, cervix, and labia that is caused by increased blood flow. This sign can be observed at 8 to 12 weeks of gestation. Softening of the cervix is indicative of Goodell sign, which appears at 4 to 6 weeks of gestation. Hegar sign is a nonsensitive softening of the cervix and isthmus of the uterus due to increased vascularity. This occurs at 6 to 8 weeks and lasts until the 12th week of pregnancy. At 10 to 12 weeks of gestation, the uterus appears globular in shape. because of the growing fetus and hormonal changes.
A patient tells the nurse, "I am experiencing severe pain in the lower abdomen for the past 3 months during menses." Which test should the nurse advise the patient to undergo? Serum CA 125 test Papanicolaou (Pap) test Nucleic acid amplification tests Transvaginal ultrasound imaging
4 A pain in the lower abdomen or pelvis during menstrual periods indicates acute pelvic pain. If acute pain lasts for more than 3 months, the patient may have a serious condition such as pelvic inflammatory disease (PID), appendicitis, ruptured ovarian cysts, or ovarian torsion. Transvaginal ultrasound imaging is required for detecting these conditions specifically. A serum CA 125 test is also used to detect ovarian cancer. The Papanicolaou (Pap) smear test is used to detect cervical cancer. Nucleic acid amplification testing is used to detect both pregnancy and chlamydia.
While examining a female child, the nurse finds an enlarged clitoris and a fused labia. Which condition should the nurse document in the child's examination report based on these findings? <p>While examining a female child, the nurse finds an enlarged clitoris and a fused labia. Which condition should the nurse document in the child’s examination report based on these findings?</p> Cystocele Rectocele Endometriosis Ambiguous genitalia
4 Ambiguous genitalia are characterized by an enlarged clitoris and fused labia. This condition is caused by hyperplasia of the adrenal glands in utero, which causes excess production of androgens, resulting in masculinization of the external genitalia. A fixed uterus with small, firm, nodular masses on the posterior part of the fundus is referred to as endometriosis. A prolapsed or drooping of the bladder into the vagina is referred to as cystocele. A rectocele is a condition in which part of the rectum, covered by vaginal mucosa, prolapses into the vagina.
Which technique is used to detect ovarian cancer at an early stage? Serum CA 125 test Papanicolaou (Pap) smear test Nucleic acid amplification test (NAT) Annual transvaginal ultrasonography
4 Annual transvaginal ultrasonography is used to detect ovarian cancer in its early stages in women who are at higher risk for this cancer. A serum CA 125 test is also used to detect ovarian cancer, but it is a nonspecific test, because it can detect other diseases besides cancer. The Pap smear test and NAT are not used to detect ovarian cancer. A Pap smear test is used to screen for cervical cancers. The NAT is used to detect the presence of chlamydia infection.
On reviewing a patient's laboratory results, the nurse finds that the patient has chlamydia. What potential complication should the nurse explain to the patient to ensure treatment compliance? Trauma Infection Dyspareunia Pelvic inflammatory disease
4 Chlamydia infection causes vulvovaginal inflammation, which is characterized by yellow- or green-colored mucopurulent discharge. If this condition is left untreated or treated with the wrong medications, it may lead to pelvic inflammatory disease, which in turn results in infertility. Other complications like trauma, infection, and dyspareunia are not caused by chlamydial infection. Lack of estrogen results in atrophic vaginitis and increases the risk for trauma and infection. Decreased vaginal secretions cause dryness of the vagina and increase the risk of irritation and dyspareunia.
The nurse is doing a vaginal examination in a patient with menorrhagia. In which position should the patient be placed to best assess the vagina? Sitting position Standing position Side-lying position Lithotomy position
4 During the vaginal examination, a patient should be placed in the lithotomy position. In this position, the patient's feet are at the level of the hips, and the perineum is at the edge of the table. This position provides good visual and physical access to the perineum. The perineum is not adequately exposed in the sitting, standing, or side-lying positions. The patient should be in the sitting position while the nurse is explaining the examination and how the procedure will proceed. Thus, the nurse cannot do a vaginal examination in these positions. The nurse, not the patient, should be in a standing position while assessing the vagina, because it provides good visual and physical access to the patient's perineum, which eases the examination procedure. The patient should be placed in a right or left side-lying position after the procedure. These positions help the patient relax.
A female postmenopausal patient is obese and has had no children. She has hypertension and is undergoing estrogen replacement. What is the highest risk in this patient? Cervical cancer Ovarian cancer Uterine prolapse Endometrial cancer
4 Obesity increases endogenous estrogen in a postmenopausal patient and may cause endometrial cancer. At the same time, a history of infertility increases the risk for endometrial cancer in the patient. Unopposed estrogen therapy may also cause hyperplasia and increase the risk for endometrial cancer. Multiple sex partners and human papillomavirus (HPV) infection are risk factors for cervical cancer. Abdominal pain and pelvic pain are symptoms of ovarian cancer. The patient may have uterine prolapse if the uterus protrudes into the vagina.
