Ch 19: Alterations in Women's Health

16. The nurse is providing postoperative care to a patient who underwent a total abdominal hysterectomy 12 hours ago. Which of the following are appropriate nursing interventions? Select all that apply. 1. Assist the patient with ambulation. 2. Maintain the Foley catheter for 48 to 72 hours postoperatively. 3. Monitor intake and output and characteristics of urine. 4. Maintain bedrest while taking narcotic pain medications. 5. Initiate antiembolism therapy as ordered.

1 This is correct. Ambulation decreases the risk for deep vein thrombosis and facilitates return of peristalsis, which decreases the amount of gas buildup. 3 This is correct. Monitoring intake and output, as well as the characteristics of the urine, will facilitate monitoring for signs

19. The nurse is assessing a 25-year-old female patient when the patient becomes tearful. The patient states that she has thin milky discharge from her nipples and two small masses on her left breast. She has lost over 40 pounds in the past year due to intensive exercises and finds that she needs to wear a sports bra during her sessions. The patient states that she is afraid that she will become the first member of her family to have breast cancer. Besides a negative mammogram, what other symptoms would correlate with this being a benign finding? Select all that apply. 1. Milky discharge from nipples 2. Extensive weight loss 3. Painful masses 4. Mood swings 5. Multiple masses

1 This is correct. Discharge from nipples that are milky may be due to the elicited response from compression (resulting from the sports bra). 3 This is correct. Fewer than 10% of women with breast cancer will present with pain. 5 This is incorrect. The two masses are painful, and fewer than 10% of women with breast cancer will present with pain.

10. The nurse is caring for a 33-year-old female patient who has just undergone laparoscopic removal of endometrial lesions. Which statement by the patient illustrates her understanding of the disease process and prognosis? 1. "I realize that this is not a cure for the issue, but I want to have more children within the next year." 2. "I'm happy to know that the surgeon has been able to cure me of this disease without a hysterectomy." 3. "I realize that my type 2 diabetes will be cured now that I have those lesions removed." 4. "I understand that I will not have to have a colostomy now that the growths were removed from my bowels."

1 This is correct. Endometriosis may recur after surgical interventions, but the laparoscopic surgery is used for women with severe symptoms who are infertile and desire pregnancy.

GYN clinic. The patient states that she thinks she may be pregnant because she has missed three menstrual cycles. The patient says, "This couldn't be happening at a worse time. I have been training heavily for a triathlon in 4 months." Which response by the nurse is most appropriate? 1. "Secondary amenorrhea, or no menses for 3 months, is not always a sign of pregnancy; it may be due to your heavy athletic activity." 2. "Pregnancy during times of stress such as heavy athletic activity can occur when precautions are not followed." 3. "If the pregnancy test is negative, the physician will need to perform a diagnostic laparoscopy to rule out a neoplasm." 4. "Amenorrhea may occur at times of nutritional disturbances. Are you eating a well-balanced diet?"

1 This is correct. Heavy athletic activity may cease ovulation and menstrual cycles.

8. The nurse is preparing a teaching plan for a polycystic ovary syndrome (PCOS) support group. One of the teaching points will include diet and weight loss to decrease hirsutism and acne. What is the reasoning for this rationale? 1. Diet and exercise will promote weight loss, which will decrease hyperandrogenemia. 2. Diet and exercise will decrease the risk of type 2 diabetes and gestational diabetes. 3. Diet and exercise will decrease serum lipid levels and lower the risk for cardiovascular disease. 4. Diet and exercise will increase the frequency of ovulation and menstruation and increase fertility.

1 This is correct. Hyperandrogenemia can lower testosterone levels, which can reduce the degree of acne and hirsutism.

6. The nurse is assessing a 33-year-old female patient who comes to the family practice clinic with complaints of excessive menstrual bleeding with bleeding between periods for the past 6 months. The health care provider has performed an endometrial biopsy and has discontinued the patient's oral contraceptives. What is the rationale for this treatment? 1. This condition is often associated with use of oral contraceptives and may subside upon discontinuation. 2. This condition is often associated with type 2 diabetes and must be controlled with a different type of birth control. 3. This condition is often associated with hyperplasia of the endometrial tissue, which is exacerbated with oral contraceptives. 4. This condition is often associated with ovarian cysts, which are exacerbated with the use of oral contraceptives.

1 This is correct. Metrorrhagia is the most significant form of menstrual disorder. If not caused by endometrial cancer, it is typically associated with use of an IUD and use of oral contraceptives.

18. The nurse is assessing a 42-year-old patient who presents to the gynecology office with complaints of pelvic pressure, backaches, menorrhagia, and urinary frequency. The health care provider has diagnosed the patient with leiomyoma of the uterus. What are the treatment options for this condition? Select all that apply. 1. Routine pelvic examinations to assess rate of disease process 2. Oral contraceptives to control the bleeding and pain 3. Myomectomy for women who desire pregnancy 4. Hysterectomy for women who do not desire pregnancy 5. Antibiotic therapy with NSAIDS for symptom management

1 This is correct. Routine pelvic examinations may be performed to assess the rate of growth of the leiomyomas (fibroids). A pelvic ultrasound to confirm the diagnosis of tumors and rule out pregnancy is another option of diagnosis. 3 This is correct. A myomectomy may be a surgical intervention to remove the fibroids, while leaving the uterus intact for those that desire pregnancy. 4 This is correct. Hysterectomy is recommended for women who do not desire pregnancy and who are experiencing excessive bleeding. Leiomyomas are the main indicator for hysterectomy.

14. The nurse is assessing a 72-year-old female patient in the women's health clinic. The mildly obese patient's history includes 7 vaginal births, 2 of which necessitated forceps deliveries, type 2 diabetes, and hypertension. The patient states that she has become incontinent of urine, has a history of frequent urinary tract infections (UTIs), and has a sense of fullness "down there." What would be an appropriate nursing intervention to help the patient with her symptoms? 1. Instruct the patient to stop urinating midstream at least twice a day. 2. Instruct the patient to eat a high-fiber diet and increase fluid intake. 3. Instruct the patient to add probiotics to their diet while taking antibiotics. 4. Instruct the patient to bear down effectively while having a bowel movement.

1 This is correct. This is the Kegel exercise, which helps improve pelvic muscle strength for a mild cystocele. Key words in this question are frequent UTIs, urinary incontinence, multiple births, two of which were forceps deliveries, which further traumatizes the pelvic floor.

15. The nurse at a family practice clinic is providing care to a 47-year-old obese patient. The patient states that she realizes that she has put on extra weight but is reluctant to go to any exercise classes. She states that she often has to cross her legs when she sneezes and cannot do any exercises with her legs crossed. The health care provider has prescribed tolterodine (Detrol). What is the rationale for this medication? 1. Tolterodine is used to treat overactive bladders and to decrease urinary frequency, urgency, and urge incontinence. 2. Tolterodine is used to improve the tone and tissue in the urethral and vaginal areas. 3. Tolterodine is used to facilitate weight loss by acting as an appetite suppressant. 4. Tolterodine is used to improve blood flow to the pelvic muscles to decrease urinary tract infections.

1 This is correct. Tolterodine (Detrol) inhibits cholinergic bladder contractions, thereby decreasing urinary frequency, urgency, and urge incontinence.

20. The nurse is preparing to teach the community about risk factors for the second most common cancer of the female reproductive system. Which of the following groups of women are at higher risk for this cancer? Select all that apply. 1. Menopausal women with an intact uterus who receive hormonal therapy 2. Women who have undergone treatment for breast cancer 3. Women who have many pregnancies and nursed their infants 4. Women who smoke and have many sexual partners 5. Women with a long-standing history of polycystic ovarian syndrome

1 This is correct. Unopposed estrogen therapy in women with a uterus can cause endometrial hyperplasia in the lining of the uterus. The second most common cancer of the female reproductive system is endometrial cancer. 2 This is correct. Tamoxifen is indicated for reducing risk for breast cancer in women or as a treatment of breast cancer. The medication competes with estrogen for binding sites in the breast but increases the risk for endometrial cancer. 5 This is correct. Polycystic ovarian syndrome increases the risk for endometrial cancer.

3. The telephone triage nurse receives a call from a patient who is 5 days postoperative total abdominal hysterectomy. The patient states that her pain is not relieved with the medications and that she has noticed blood in her urine. The nurse instructs the patient to report immediately to the emergency department. What does the nurse suspect as the surgical complication? 1. Possible complication related to the anesthesia 2. Possible injury to the ureters or bladder 3. Possible hemorrhage from the internal incision 4. Possible peritoneal venous thromboembolism

2 This is correct. Bloody urine and unmanaged pain could indicate a ureter injury from the surgery.

12. The nurse is assessing a 22-year-old female patient who arrives at the family clinic. The patient has finished her prescription for a urinary tract infection and now reports a milky discharge from her vagina and has a fishy odor. After microscopic examination of the vaginal discharge, the health care provider prescribed metronidazole gel to be inserted vaginally. What is the suspected medical diagnosis for this patient? 1. The patient has gonorrhea due to lowered immunity after antibiotic therapy. 2. The patient has bacterial vaginosis due to recent disruption of normal vaginal flora. 3. The patient has genital condylomas due to the recent UTI treatment. 4. The patient has candida vaginitis due to recent disruption of normal vaginal flora.

2 This is correct. Disruption of normal vaginal flora can increase the likelihood of bacterial vaginosis, and the symptoms are often described as milky vaginal discharge with a distinct "fishy" odor.

7. The nurse is assessing the 19-year-old female patient in the women's health clinic. She reports that for the past several months, she has had lower abdominal pain, elimination issues, and mood swings, and her acne is worse the week before menstruation. The health care provider has prescribed oral contraceptives. The patient asks the nurse for the reason for the prescription. Which response by the nurse is appropriate? 1. "Pregnancy should be avoided because the hormonal shift would place the fetus at risk for birth defects." 2. "The hormones in the oral contraceptives can maintain estrogen-progesterone hormones to alleviate discomfort." 3. "Oral contraceptives may provide an increase in the hormones to help with your possible infertility issues." 4. "Oral contraceptives may balance the chemical changes in your brain to alleviate the depression symptoms."

2 This is correct. PMS may be controlled, with oral contraceptives, as PMS might be related to hormonal changes related to the menstrual cycle. Estrogen-progesterone hormones found in oral contraceptives may provide relief from the symptoms.

17. The nurse is educating a 24-year-old female patient who was newly diagnosed with polycystic ovary syndrome (PCOS). The patient was prescribed an antidiabetic medication. Which medication effects should the nurse educate the patient about? Select all that apply. 1. A period of initial weight gain 2. A change in her integumentary system 3. Low blood sugar until her hormones stabilize 4. Decreased likelihood of pregnancy 5. A decrease in abdominal obesity and weight

2 This is correct. The patient may notice loss of hirsutism and acne while taking the antidiabetic medication. This is because this medication decreases testosterone levels. 3 This is correct. The nature of the antidiabetic medication can cause lower blood sugar, and the patient will need to take the proper precautions. 5 This is correct. This may lower the testosterone level, which may decrease the degree of acne, hirsutism, and abdominal obesity.

9. The nurse is providing care to a 35-year-old female patient who complains of low back pain, pain with defecation, pelvic pressure, and premenstrual spotting. The health care provider has prescribed the hormonal therapy Lupron for this condition. What is the goal of this prescription? 1. To prevent pregnancy at this time to promote healing 2. To suppress menstruation and further growth of the tissue 3. To prevent retrograde menstruation outside the uterine cavity 4. To increase blood flow to decrease the endometrial lining

2 This is correct. This is the goal of GnRH agonists, which suppresses menstruation and further growth of tissue.

2. A 32-year-old female patient arrives to the emergency department with heavy uterine bleeding. The nurse finds that the patient had a positive pregnancy test 1 month prior to the visit. What is the potential medical management for this patient's issue? 1. Endometrial biopsy 2. Dilation and curettage 3. Colposcopy 4. Laparoscopy

2. Dilation and curettage. This is correct. The patient may be experiencing an incomplete abortion and will need the remnants of the pregnancy removed.

11. The nurse is assessing a 16-year-old sexually active patient in the family practice clinic. The patient's symptoms include breakthrough vaginal bleeding, abdominal pain, nausea, and fever. The health care provider obtains cultures of the cervical epithelial cells during a Pap smear and orders doxycycline 100 mg orally twice a day for 7 days for her and her partner. The nurse understands that this prescription is consistent with the treatment of which medical diagnosis? 1. Herpes 2. Condylomas 3. Chlamydia 4. Gonorrhea

3 This is correct. Chlamydia is the most common bacterial STI in the United States and the leasing cause of preventable infertility. This is diagnosed by cultures of cervical epithelial cells and is treated with antibiotics. The partner needs to be treated to prevent reinfection.

13. The nurse is assessing a 64-year-old female patient. The patient states that she is able to reduce the risk of urinary tract infections (UTIs) by drinking a quart of cranberry juice a day. Which health condition, if present in this patient, contraindicates the use of cranberry juice? 1. Hypertension, managed with lisinopril 2. Diabetes type 1, managed with insulin 3. Atrial fibrillation, managed with warfarin 4. COPD, managed with inhaled steroids

3 This is correct. Studies have shown that cranberry juice can affect the liver and interfere with warfarin (Coumadin) levels. Cranberry juice should not be taken with warfarin (Coumadin), aspirin, or medications that effect the liver.

4. The nurse is providing preoperative education on the laparoscope-assisted vaginal hysterectomy. Which statement by the patient verifies understanding of the procedure? 1. "I will use a mild douche solution to keep the surgical area clean." 2. "I'm relieved that I won't have any visible scars on my abdomen." 3. "I understand that there will be some light vaginal bleeding for several days." 4. "I understand that I must remain on bedrest until cleared by the surgeon."

3 This is correct. There will be some light bleeding for several days, and the patient should be instructed to notify the surgeon if bleeding increases.

The nurse is assessing a 70-year-old female patient in the family practice clinic. The patient states that she has been experiencing sudden heavy vaginal bleeding the past 3 months. What is the expected diagnostic procedure for this patient? 1. Cervical conization 2. Colposcopy 3. Dilation and curettage 4. Endometrial biopsy

4. Endometrial biopsy. This is correct. The patient will need to have an endometrial biopsy to determine the cause of postmenopausal bleeding. The patient's age is past the average age of menopause.