Care of Women and Pediatric Client

Which patient will the registered nurse (RN) assess first after receiving a change-of-shift report?

54-year-old with an anterior and posterior colporrhaphy who has an elevated heart rate and an oral temperature of 101.2°F (38.4°C) The patient with an anterior and posterior colporrhaphy is showing signs of postoperative infection and warrants frequent assessments that need to be communicated to the surgeon in charge of care. The patient with abdominal pain and light vaginal spotting after an endometrial biopsy, the patient receiving morphine through a PCA device with a pain level of 3, and the patient with a history of hypothyroidism who is scheduled for a hysterectomy and bladder suspension are not unusual cases and do not require rapid intervention by the nurse

Which response by the nurse is appropriate when teaching a patient diagnosed with vulvovaginitis after the onset of vulvar burning, redness, and pruritus on how to prevent future occurrences?

"During a bath or shower, clean your labia with water only." A common cause of vulvovaginitis is chemical irritants, such as bath soap. Using only water to clean the labia will avoid this irritation. Douching can disturb the balance of hormones, and flora in the vagina and vulva and should be avoided. Wearing undergarments made of quick-drying material, such as cotton, is preferred over nylon because it reduces moisture in the perineal area. A sitz bath is an appropriate intervention for vulvovaginitis, but it does not prevent an occurrence.

Which statement made by the patient after an educational session by the nurse regarding the prevention of toxic shock syndrome indicates understanding? Select all that apply. One, some, or all responses may be correct.

"I should insert tampons gently." "Sanitary napkins should be used at night." "I'll change my tampon every 3 to 6 hours." "Super absorbent tampons should be avoided." To reduce the risk for toxic shock syndrome, it is important to insert a tampon gently and use sanitary napkins at night. Tampons should be changed every 3 to 6 hours, and super absorbent tampons should be avoided. Avoiding tampons when a person has diarrhea is not indicated to avoid toxic shock syndrome.

Which response by the nurse is appropriate when caring for a postoperative patient complaining of pain in the chest and shoulders after laparoscopic removal of endometrial implants and adhesions?

"It is common to experience referred pain from carbon dioxide buildup." Endometriosis can be treated by laparoscopic removal of endometrial implants and adhesions; however, the carbon dioxide used during the procedure may cause pain in the chest and shoulders postoperatively. The nurse should reassure the patient that this is an expected and temporary consequence of the surgery. Pain in the chest and shoulders alone would not indicate heart disease, so the nurse should not indicate so to the patient. Improper positioning during surgery does not result in chest pain. Retained endometrial tissue does not cause pain in the chest and shoulders.

Which device or action would the nurse include in teaching regarding the diagnosis of vaginal prolapse? Select all that apply. One, some, or all responses may be correct.

A pessary Kegel exercises A pessary and Kegel exercises are treatments indicated for vaginal prolapse. Bladder training is not indicated unless there are bladder issues present. A high-fiber diet is not indicated for this diagnosis. Progestin treatment will not help vaginal prolapse.

Which action should the nurse take first when caring for a patient who has reported soaking two pads within an hour after hysteroscopic surgery.

Assess the patient's vital signs. It is important to assess the patient's vital signs first, and then contact the health care provider. Documenting the finding should be done after the health care provider has been contacted. Placing the patient in a supine position will not affect this patient's condition.

Which information would the nurse include in a patient teaching plan regarding preventing vulvovaginitis?

Avoid wearing pantyhose or tight jeans. The patient should be taught to avoid wearing pantyhose or tight jeans because they can cause chafing. The inner labial mucosa must be cleaned with water, not with soap. The patient must always wipe front to back after a bowel movement or urination. The patient must avoid sexual intercourse when the partner has an infection of the sexual organs to avoid transmission of infection.

Which clinical manifestation reported by the patient undergoing brachytherapy for treatment of gynecologic cancer is a priority for the patient to report to the health care provider? Select all that apply. One, some, or all responses may be correct.

Blood in the urine Fever of more than 100°F (37.8°C) Heavy vaginal bleeding A fever of more than 100°F (37.8°C), blood in the urine, and heavy vaginal bleeding are signs of potential complications and should be reported immediately. Headaches are not a side effect of brachytherapy and do not need to be reported. Urethral burning for 2 hours does not need to be reported; if it persists longer than 24 hours, it should be reported.

Which risk factor would the nurse include in a patient educational session regarding endometrial cancer? Select all that apply. One, some, or all responses may be correct.

DM, obesity, smoking

Which nursing action is appropriate when caring for a patient experiencing dyspareunia?

Discuss sexuality issues. This patient is experiencing pain during sexual intercourse. It is important to discuss sexuality issues. Measuring urine output, assessing bowel sounds, and administering pain medication are not indicated.

Which concern is the priority for a patient diagnosed with lichen planus?

Infection The highest priority concern is risk for infection. Social isolation is important, but it is not as important as infection. Impaired skin integrity is not applicable because the patient already has impaired skin integrity. This diagnosis does not mean that the patient has ineffective health management.

For which clinical manifestation would the nurse assess in a patient diagnosed with vulvovaginitis? Select all that apply. One, some, or all responses may be correct.

Itching Lesions Vaginal discharge Itching, lesions, and vaginal discharge are three symptoms of vulvovaginitis. Uterine prolapse and frequent urination are not symptoms of vulvovaginitis.

Which is the expected outcome for a patient with vulvovaginitis who has been receiving nursing interventions of wet compresses, sitz baths, and use of estrogens and lidocaine?

Less itching in a week Itching in the perineal area is the most prominent and annoying manifestation of vulvovaginitis, so the care plan should be aimed at decreasing the itching. Control over voiding in a week would be an appropriate outcome for a patient with urinary incontinence, not in cases of vulvovaginitis. Although vulvovaginitis may cause pain during intercourse, it is not likely to be relieved in a week given the described interventions. Vulvovaginitis does not cause abdominal pain, so a reduction in abdominal pain is not expected from the current interventions.

Which nursing action is most appropriate when a patient recently discharged after a total vaginal hysterectomy reports vaginal discharge?

Let the patient know that this is a normal finding for a few days after surgery. Vaginal discharge is expected for a few days after the patient goes home after having a total vaginal hysterectomy. The patient does not need to go to the emergency department. Vaginal discharge is not an indication that she needs to be checked for STIs, and it is not related to taking antibiotics postoperatively.

Which risk factor for cervical cancer will be included by the nurse in an educational session regarding reproductive health in women? Select all that apply. One, some, or all responses may be correct.

Smoking Human papilloma virus (HPV) infection Obesity Use of oral contraceptives Smoking, HPV infection, obesity, and the use of oral contraceptives are all risk factors for cervical cancer. Hypertension is not a risk factor for cervical cancer.

Which assessment data would the nurse expect to note in a patient diagnosed with toxic shock syndrome? Select all that apply. One, some, or all responses may be correct.

Myalgias Fever Hypotension A patient diagnosed with toxic shock syndrome will have myalgia, fever, and hypotension. Pruritus and vaginal discharge are not symptoms related to this diagnosis.

Which nursing action is appropriate for a patient reporting muscle aches 24 hours after uterine artery embolization for treatment of fibroids?

Notify the health care provider. It is important to notify the health care provider if the patient develops muscle aches and cramping. The patient may need to be readmitted if pain cannot be controlled. Increasing fluid intake and neurologic assessment are not indicated. Muscle aches are not a normal finding.

Which risk factor would the nurse consider when educating a patient regarding ovarian cancer? Select all that apply. One, some, or all responses may be correct.

Obesity Infertility Family history of breast cancer Risk factors for ovarian cancer include obesity, infertility, and family history of breast cancer. Being older than 40 years, not 20 years, is a risk factor. Early menarche, not late menarche, is another risk factor.

Which risk factor would the nurse include when presenting an educational session for preventing ovarian cancer? Select all that apply. One, some, or all responses may be correct.

Obesity Nulliparity Endometriosis Obesity, nulliparity, and endometriosis are all risk factors for ovarian cancer. A history of STIs and multiple sexual partners do not increase the risk for ovarian cancer.

Which assessment finding indicates additional treatment is needed in a patient with toxic shock syndrome (TSS) who has received IV antibiotics and prednisolone?

Platelet count of 50,000 per microliter (mcL) A platelet count of 50,000 per microliter (mcL) is below normal levels, which range from 150,000 to 400,000 per microliter. A low platelet level indicates thrombocytopenia and severe internal bleeding, which means there is a further need for treatment. The body temperature of 101°F (38.3°C) indicates a reduction in the high fever associated with TSS. Blood pressure of 110/80 mm Hg indicates effective treatment, as systolic pressure in TSS is below 90 mm Hg. The serum creatinine phosphatase level in TSS is twice the normal level, which ranges from 10 to 120 mcg/L; therefore a level of 120 mcg/L indicates effective treatment.

Which nursing action is appropriate when a patient reports feeling the urge to have a bowel movement after a posterior repair for a rectocele?

Provide pain medication before the bowel movement. Pain medication is important before bowel movements after a posterior repair. Saline enema, ambulation, and splinting the abdomen are not indicated.

Which task for a patient after posterior repair surgery can be delegated to the assistive personnel?

Providing a sitz bath Administering a sitz bath is care that assistive personnel can perform. Assessing the patient's pain is a nursing intervention. Inspecting the incision should be done by the nurse. Administering a saline enema is not indicated for patients with posterior repair surgery.

Which nursing action is appropriate when caring for a patient diagnosed with vulvovaginitis? Select all that apply. One, some, or all responses may be correct.

Providing reassurance to the patient Assessing for erythema and itching Providing reassurance and assessing erythema and itching are appropriate nursing interventions when caring for this patient. Obtaining vaginal smears, performing the pelvic examination, and performing the Pap test are interventions done by the health care provider.

Which would the nurse include in an educational plan regarding a possible cause for noninfectious vulvovaginitis?

Spermicide Feminine hygiene sprays Bacteria from stool entering the vagina Spermicides, feminine hygiene sprays, and bacteria from stool entering the vagina are all possible causes of noninfectious vulvitis. Herpes genitalis and candidiasis are both caused by an infection.

Which instruction by the nurse is appropriate when discharging a patient diagnosed with a rectocele?

Stool softeners Stool softeners are important in the treatment of rectoceles. Pessaries are not a treatment for this diagnosis. A low-fiber diet is contraindicated. Bladder training is not indicated.

Which clinical manifestation would the nurse document as a cardinal sign of toxic shock syndrome (TSS)?

Sunburn-like rash The rash associated with TSS often looks like a sunburn, and patients often develop broken capillaries in the eyes and skin. The patient experiences hypotension with systolic pressure less than 90 mm Hg. The patient has a fever with temperature greater than 102°F (38.9°C) as the infection develops. Decreased urine output and pyuria develop as multiorgan failure sets in.

Which treatment would the nurse include in a teaching plan for a patient with a vaginal infection secondary to pediculosis?

Topical lotion Application of a topical pediculicide is the treatment for pediculosis. Tepid sitz baths are not priority. Topical estrogen does not treat this infection. Cool compresses are not indicated.

Which common treatment for endometrial cancer would the nurse include in the patient teaching plan? Select all that apply. One, some, or all responses may be correct.

Total hysterectomy Bilateral salpingo-oophorectomy Total hysterectomy and bilateral salpingo-oophorectomyare the most common treatments for an endometrial cancer diagnosis. Radiation, chemotherapy, and radical hysterectomies are usually not indicated.

Which clinical manifestation will support the nurse documenting a cystocele in a patient?

Urine loss when laughing Cystocele is a condition in which the urinary bladder protrudes through the wall of the vagina because of weakness of the muscles and tendons supporting it. It results in stress urinary incontinence, which is characterized by urine loss caused by increased intra-abdominal pressure; therefore the loss of urine while laughing indicates the presence of a cystocele. The protrusion of the rectum through the vaginal wall is called rectocele. Constipation and hemorrhoids are signs of a rectocele, not a cystocele. ARDS could be an indication of toxic shock syndrome.

Which nursing assessment question is a priority for a woman reporting abdominal distention and indigestion over the past several months?

"Have you had any unexplained weight loss?" It is important to ask about unexplained weight loss because the symptoms expressed by the patient are consistent with ovarian cancer. Tubal ligation decreases the risk for ovarian cancer. It is important to find out about family history of breast cancer; however, asking about weight loss is more important because weight loss is a sign directly related to the patient's current condition and assists in the potential diagnosis of ovarian cancer. Family history could indicate risk, but it is not diagnostic. Excessive vaginal bleeding is not associated with ovarian cancer.

Which statement made by a patient regarding anterior colporrhaphy surgery for a prolapsed uterine indicates understanding of the procedure? Select all that apply. One, some, or all responses may be correct.

"I may also have a vaginal hysterectomy along with this procedure." "Sutures of the anterior colporrhaphy will not need to be removed." "It is important to avoid lifting anything heaving than 5 lb after the surgery." Sometimes a vaginal hysterectomy may be performed during the uterine prolapse repair surgery including an anterior colporrhaphy. The patient should avoid lifting anything heavier than 5 lb after the surgery and to limit strenuous activities. These restrictions are placed to avoid putting strain on the incision line. Sutures do not need to be removed; some get absorbed and others fall out during the healing process. Anterior colporrhaphy is an open surgical technique and is not considered minimally invasive surgery. The patient will be able to drive 2 weeks after the surgery. The patient should avoid sexual intercourse for 6 weeks after the surgery or as directed by the health care provider to avoid trauma to the incision inside the vagina.

Which statement made by the patient supports documentation of toxic shock syndrome by the nurse?

"I started my period about 4 days ago." Toxic shock syndrome usually starts within 5 days of the onset of menstruation. Sex while menstruating is not a cause of toxic shock syndrome. Discharge is not associated with toxic shock syndrome. A mother having toxic shock syndrome does not necessarily mean that the child will have it too.

Which statement made by the patient indicates an understanding of teaching regarding a laparoscopic myomectomy?

"I'll need to give birth by cesarean section if pregnancy occurs." If the patient becomes pregnant, she will need to have a cesarean section to give birth. Patients can get pregnant after laparoscopic myomectomy. There is not a link to spontaneous uterine rupture from this procedure. The procedure is scheduled early in the menstrual cycle to avoid chances of interrupting an unsuspected pregnancy.

Which statement made by the patient with a diagnosis of fibroids will make the nurse suspect twisting of the fibroid at the stalk?

"I've saturated two pads with vaginal bleeding in 2 hours." Heavy vaginal bleeding is a sign that a fibroid has twisted at the stalk. Anuria, difficulty breathing, and flulike symptoms are not symptoms of twisting of the fibroid.

Which statement made by the patient indicates understanding of an appropriate nonsurgical method of treatment for pelvic organ prolapse? Select all that apply. One, some, or all responses may be correct.

"Kegel exercises should be performed to improve pelvic support." "I could use pessaries, or spheres, in my vagina." "Bladder training would be beneficial." The patient should be encouraged to practice pelvic floor muscle (Kegel) exercises to improve pelvic support. The patient can use pessaries, or spheres, in the vagina to elevate the uterine prolapse. Women with bladder symptoms benefit from bladder training and complete bladder emptying. Management of a rectocele includes intake of a high-fiber diet, stool softeners, and laxatives. Intravaginal estrogen therapy may be prescribed for postmenopausal women to prevent weakening of the vaginal walls.

Which would the nurse include in discharge instructions for a patient after an anterior colporrhaphy?

"Make sure to splint your abdomen when you perform coughing exercises." The patient should splint the abdomen to protect the incision. Sutures do not need to be removed because they may be absorbable or they may fall out (slough off) as healing occurs. The patient must avoid lifting anything heavier than 5 lb and avoid sexual intercourse for 6 weeks.

Which statement is an appropriate response by the nurse when a patient with a family history of a cystocele inquires about ways to prevent personal occurrence?

"Performing Kegel exercises will help prevent a cystocele." A cystocele can be prevented by strengthening the pelvic muscle with Kegel exercises. Muscle relaxants and progesterone do not prevent a cystocele, but topical estrogen cream used after menopause can treat vaginal atrophy, which can lead to a cystocele.

Which statement made by an adolescent regarding the human papillomavirus (HPV) vaccination indicates a need for further education?

"The vaccine is for girls; a different one is available for boys." The same vaccine is advised to be given to both girls and women, and to boys and men. It protects men from genital warts and from some strains of HPV. The vaccine will help prevent girls and women from developing cancer of the cervix. The HPV vaccine is composed of three injections administered over a 6-month period. It is advised that young women have the vaccination before they start having sexual relations. It is typically given between ages 9 and 10 and 25 and 26.

Which rationale for a low-residue diet would the nurse provide when instructing a patient after an anterior and posterior colporrhaphy for repair of a cystocele and rectocele?

"This type of diet will decrease the number of bowel movements you have." A low-residue or low-fiber diet is prescribed to decrease bowel movements. It does not cause stool to bulk, and it does not reduce the chance of infection. Low-fiber diets do not decrease the chance of dehydration.

Which statement by the nurse is appropriate when providing education regarding a laparoscopic removal of endometrial adhesions to a 32-year-old patient?

"You may have referred pain in your chest and shoulders caused by the carbon dioxide (CO2) used in the procedure." Patients often have their abdomen insufflated during these procedures for better visualization. As the CO2 leaves the body, it causes muscular discomfort that is referred and presents as chest and shoulder pain. If this procedure was done because the couple is having fertility problems, the nurse can never guarantee any sort of outcome, especially pregnancy. This procedure should not interrupt the patient's menstrual cycle for longer than a month, if at all. Fever and vaginal discharge would be abnormal findings after the procedure.

Which action would the nurse implement when caring for an obese patient reporting pain and bleeding upon defecation and a feeling of rectal fullness?

Administer stool softeners. Pain and bleeding upon defecation and rectal fullness are indicative of a rectocele or rectal prolapse; therefore the patient is administered stool softeners to ease the passage of stools without further pressure on the weakened suspensor muscles and ligaments. Lindane lotion is administered for the treatment of pediculosis and scabies. Bladder training is recommended as part of the care plan for cystocele. Biofeedback is recommended to reduce muscle tissue hypoxia and ischemia in the treatment of endometriosis.

Which action can be delegated to an assistive personnel (AP) by the registered nurse (RN) on the medical-surgical unit?

Assisting with a sitz bath for a patient with ulcerative vulvitis Assisting with a sitz bath is within the scope of practice of the AP, so this task can safely be delegated. Some specially trained APs do catheterize patients, but a patient with a uterine prolapse poses additional problems and should be managed by a licensed nurse. Giving a report to a receiving nurse about a patient who is being transferred is an interaction that should be nurse-to-nurse. Providing discharge teaching for a patient who will be having brachytherapy (intracavitary radiation) is a complex nursing action that should be done by an RN.

Which information would the nurse include in the teaching plan for a patient regarding postoperative care after an anterior colporrhaphy? Select all that apply. One, some, or all responses may be correct.

Avoid straining with bowel movements. Expect to have a urinary catheter after surgery. Teach the patient about splinting of the abdomen. The patient should avoid straining with bowel movements. A urinary catheter is usually left in place for approximately 24 hours after surgery. The patient should splint the abdomen to protect sutures. The patient must avoid lifting any weight heavier than 5 lb to avoid strain on the muscles. A low-residue diet is usually prescribed.

Which instruction would the nurse include when teaching a patient newly diagnosed with vulvovaginitis about preventing future occurrences? Select all that apply. One, some, or all responses may be correct.

Avoid wearing tight clothing Do not use feminine hygiene sprays Avoid using soap near the inner labial mucosa. Patients should avoid wearing tight clothing and using feminine sprays. They should also not use soap near the inner labia mucosa. Douching is contraindicated.

Which condition would the nurse include as a possible cause for vulvovaginitis from a secondary infection when developing a teaching plan for a patient newly diagnosed? Select all that apply. One, some, or all responses may be correct.

Candidiasis Pediculosis pubis Candidiasis and pediculosis pubis are both secondary infections that cause vulvovaginitis. Lichen planus is not an infection. Herpes genitalis and condylomata acuminata are primary infections.

Which information would the nurse include in a teaching plan for the patient diagnosed with vulvovaginitis?

Change detergents. A common cause of vulvovaginitis is chemical irritants or allergens such as vaginal sprays, fabric dyes, and detergents. Therefore the patient should change the detergent she uses. Neither cold compresses nor dry heat help alleviate symptoms. The patient must use wet compresses and have sitz baths for 30 minutes several times a day for relief from pain.

Which condition would the nurse suspect when the patient reports a urinary tract infection, urgency, and stress urinary incontinence?

Cystocele Urgency, urinary tract infection, and stress urinary incontinence are symptoms consistent with a cystocele. Rectocele, vulvovaginitis, and vaginal prolapse do not present all of these symptoms.

Which complication would the nurse assess for in a patient after hysteroscopic surgery? Select all that apply. One, some, or all responses may be correct.

Embolism Fluid overload Perforation of the uterus Complications of hysteroscopic surgery are embolism, fluid overload, and perforation of the uterus. Renal failure and SIADH are not complications of the surgery.

Which female reproductive malignancy would the nurse emphasize as being the most common?

Endometrial cancer Endometrial cancer is the most common female reproductive malignancy. Vulvovaginitis is a common condition, not a malignancy. Ovarian cancer is not as common as endometrial cancer, though it is still relatively common. HPV is a type of sexually transmitted infection, and it can increase the risk for developing cancer but is not a malignancy.

Which hormone would the nurse associate with fibroid growth during pregnancy? Select all that apply. One, some, or all responses may be correct.

Estrogen Progesterone Estrogen and progesterone can lead to the growth of fibroids. Oxytocin, lactogen, and human chorionic gonadotropin do not cause increased fibroid growth.

Which patient complaint would the nurse include in a teaching session as the main symptom of endometrial cancer?

Heavy vaginal bleeding The main symptom of endometrial cancer is heavy vaginal bleeding. Pelvic pain, low back pain, and watery vaginal discharge are found in this diagnosis but are not the most common findings.

Which parasitic infection would the nurse address in an education session regarding sexually transmitted infections? Select all that apply. One, some, or all responses may be correct.

Scabies Pediculosis pubis Scabies, also known as itch mite , and pediculosis pubis, also known as crabs, are common parasitic infestations of the skin of the vulva that can be sexually transmitted from one partner to another. Lichen planus are thickened, leathery skin and possible lesions that are not sexually transmitted.

Which assessment finding will further support the nurse documenting toxic shock syndrome in a febrile patient who regularly uses tampons? Select all that apply. One, some, or all responses may be correct.

Severe body aches Blood pressure of 88/52 mm Hg Reddening of the conjunctiva of the eyes Severe body aches, hypotension, and hyperemia (reddening) of the mucosa of the throat and the conjunctiva are features of TSS. Body aches occur as a result of the toxins released from the infection. Redness occurs because of the strep or staph infection that causes the toxic shock syndrome. There is vomiting and diarrhea with TSS rather than constipation. Urine output is decreased because of the vomiting and diarrhea. This causes a decrease in fluid volume, leading to dehydration. Not all women have these symptoms.

Which action would the nurse include in a patient self-management plan after a local cervical ablation therapy?

Take showers instead of baths. The patient who has undergone cervical ablation therapy should perform self-care after the procedure, including showering instead of taking a bath. The patient should avoid douches and tampons after the procedure. It is not advisable for patients to lift heavy weights after cervical ablation therapy.

Which would the nurse include when teaching a patient with the diagnosis of toxic shock syndrome about potential causes? Select all that apply. One, some, or all responses may be correct.

Tampon use Internal contraceptives Tampon use and internal contraceptives are both causes of toxic shock syndrome. Sexual intercourse, urinary incontinence, and hormonal dysfunction do not cause toxic shock syndrome.

Which medication would the nurse provide teaching about for a patient reporting itching and a thick, white vaginal discharge who also has pediculosis pubis and scabies?

Topical pediculicide Thick, white vaginal discharge and itching are signs of vulvovaginitis. Pediculosis pubis and scabies are common parasitic infestations of the skin of the vulva; therefore the patient is prescribed a pediculicide lotion that kills lice and mites. Leuprolide is prescribed to patients with dysfunctional uterine bleeding (DUB). Leuprolide causes amenorrhea by reducing luteinizing and follicle-stimulating hormones. Patients over the age of 35 years with dysfunctional uterine bleeding and who are at a risk for thrombophlebitis are prescribed medroxyprogesterone acetate. Patients exhibiting acute and heavy bleeding are prescribed estrogen, progestin combination pills.

Which diagnostic test would the nurse provide education regarding for the patient reporting lower abdominal pain before the onset of menstruation, nausea, diarrhea, and pain during defecation with limited movement of the uterus and tenderness on the pelvic examination?

Transvaginal ultrasound The patient's symptoms of lower abdominal pain before menstruation, nausea, diarrhea, and painful defecation are indicators of endometriosis. Pelvic tenderness and limited mobility of the uterus are also findings associated with endometriosis; therefore a transvaginal ultrasound should be performed to rule out the possibility of pelvic masses and confirm endometriosis. Sonohysterography is a procedure that makes use of a vaginal ultrasound to visualize the outline of the inner uterine cavity, which is done by injecting sterile saline through the cervix. Endometrial ablation is a surgical procedure that removes the buildup of the uterine lining and helps treat dysfunctional uterine bleeding. Serum cancer antigen CA-125 helps detect ovarian cancer and can be positive for patients with endometriosis.

Which preventive measure for toxic shock syndrome (TSS) would the nurse include in an educational session for adolescents? Select all that apply. One, some, or all responses may be correct.

Use sanitary napkins at night. Report sudden vomiting or diarrhea. Wash hands before inserting tampons. To prevent TSS, patients should wash their hands before inserting tampons to eliminate bacteria. Patients should also use sanitary napkins at night because tampons must be changed every 3 to 6 hours. It is important to report any sudden vomiting or diarrhea because it could indicate the onset of TSS. Although it is important to insert tampons gently, superabsorbent tampons should be avoided because they absorb more menstrual blood, which can harbor bacteria. Changing tampons two to three times daily is not often enough.

Which action would the nurse instruct a group of women to avoid to prevent vulvovaginitis? Select all that apply. One, some, or all responses may be correct.

Using lemon-based perineal spray Douching twice a week during menses Washing the inner labial mucosa with soap and water Using feminine hygiene products may cause skin irritation, which increases the risk for vulvovaginitis. Douching causes an imbalance in the vaginal flora, which increases the risk for vulvovaginitis. Washing the inner labial mucosa with soap and water may irritate the labial mucosa, thereby increasing the risk for vulvovaginitis. Wearing loose cotton underwear allows for air circulation, which keeps the perineal area dry. Wiping from front to back after a bowel movement prevents the spread of microorganisms from the rectal area to the vaginal area.

For which complication of childbirth would the nurse assess when a patient reports backache, pressure in the pelvis, and a feeling like something is protruding out of her vagina 2 weeks postpartum?

Uterine prolapse Uterine prolapse can happen after childbirth. Vulvovaginitis, urinary tract infection, and toxic shock syndrome do not have the symptoms the patient reported.

Which information would the nurse include during a community presentation on preventing toxic shock syndrome (TSS)?

Wash hands before inserting a tampon. The patient should be taught to use proper health habits and good personal hygiene when using tampons, always wash hands before inserting a tampon and always use a clean tampon. Menstrual blood provides a growth medium for Staphylococcus aureus. Exotoxins produced from the bacteria cross the vaginal mucosa to the bloodstream via microabrasions from tampon insertion or prolonged use. Superabsorbent tampons must be avoided. Tampons must be changed every 3 to 6 hours. It is preferable to use sanitary napkins instead of tampons at night.

Which meal is appropriate for the nurse to include in the dietary plan for a patient after a posterior colporrhaphy?

White bread, eggs, a glass of milk A patient should follow a low-residue or a low-fiber diet after a posterior colporrhaphy to minimize the pain and discomfort associated with bowel movements. A low-fiber diet does not contain fruits and vegetables; therefore the patient should choose white bread, eggs, and milk in the diet. Oatmeal, peaches, and peanut butter are high in fiber and need to be avoided. Brown rice, apple, green salad, and beans are also rich in fiber and should not be eaten. Whole grain pasta, steamed vegetables, and dried fruits are also high in fiber content and should not be consumed.

Which instruction would the nurse include when teaching a patient regarding a transabdominal synthetic mesh repair of a pelvic organ prolapse? Select all that apply. One, some, or all responses may be correct.

You should take stool softeners daily. Avoid lifting anything over 5 lb. Smoking should be avoided to allow proper healing. It is important to take stool softeners every day and avoid smoking if possible. The patient should avoid lifting anything over 5 lb. Sexual intercourse should be avoided for 6 weeks. Using heat on the abdomen is encouraged.