Chapter 40: Disorders of the Female Genitourinary System-Patho Level 3

A female patient with a strong family history of cardiovascular disease asks the nurse if she should take estrogen replacement while in menopause. Which of the following is the nurse's best response?

"Estrogen has additional cardioprotective actions and you and your physician should determine if this would benefit you." Estrogens have additional cardioprotective actions including direct antiatherosclerotic effects on the arterial wall, vasodilatation through endothelium-independent mechanisms, antioxidant activity, reduction of levels of angiotensin-converting enzyme and renin, reduction of homocysteine levels, improvement of peripheral glucose metabolism with subsequent decreased circulating insulin levels, and direct effects on cardiac function. The decision of whether hormone replacement therapy would be beneficial for this client should be made after consultation with the physician.

What should the nurse teach the client about assessing for possible breast cancer?

"Perform monthly self-breast exams after menses." Monthly self breast exams should be conducted monthly at the beginning of the time of menses. MRIs are not currently recommended as routine screening. Mammography is not started when menses starts.

A female patient informs the nurse that she is having hot flashes on occasion, has trouble sleeping, and thinks that she is having some symptoms of menopause. The patient asks the nurse how long these symptoms will last prior to experiencing menopause. Which of the following is the best response?

"Perimenopause can precede menopause by approximately 4 years." Menopause is the cessation of menstrual cycle. Like menarche, it is more of a process than a single event. Most women stop menstruating between 48 and 55 years of age. -Perimenopause precedes menopause by approximately 4 years and is characterized by menstrual irregularity and other menopausal symptoms. -The nurse is not using therapeutic communication techniques by dismissing her concerns and informing her that there is nothing to worry about or to tell the patient to tell her physician.

A pregnant patient asks the nurse what is causing her lower leg edema, nausea, and constipation that she is experiencing. Which of the following is the nurse's best response?

"The increase in progesterone during pregnancy is most likely the cause of these discomforts." Smooth muscle relaxation under the influence of progesterone plays an important role in maintaining pregnancy by decreasing uterine contractions and is responsible for many of the common discomforts of pregnancy, such as edema, nausea, constipation, flatulence, and headaches.

The nurse is discussing the menstrual cycle with a female client. The client asks, "Why do my hands get puffy and I gain weight right before my periods?" Which of the following is an appropriate response by the nurse?

"The level of estrogen increases in your body before your period, and this causes fluid retention." Estrogens are secreted throughout the menstrual cycle. Two peaks occur: one before ovulation and one in the middle of the luteal phase. The estrogens cause moderate retention of sodium and water. Most women retain sodium and water and gain weight just before menstruation.

After an office visit with her primary health provider, a female patient with an elevated CA-125 test result asks the nurse if that means she has ovarian cancer. Which of the following is the nurse's best response?

"The test is not specific for ovarian cancer but suggests further evaluation to find the cause of the elevation." The CA-125 tumor marker is a cell surface antigen. The level may be elevated for a variety of reasons including inflammation, endometriosis, uterine fibroids, pregnancy, liver disease, and cancers of the cervix, fallopian tube, and pancreas. -It is elevated in about 50% of cases with early stage ovarian cancer, but has more predictive value with postmenopausal women or women with more advanced stages of cancer. Therefore, the CA-125 test should not be used as an exclusive test to screen for ovarian cancer, but a patient with an elevation should have further testing to determine the cause. -It is appropriate for the nurse to provide basic education when a client has seen the health provider but still has questions.

A client asks the health care provider to, "Explain this brachytherapy they want to do for my cervical cancer again." The response should include which of the following statements?

"They will insert a radioactive device into your vagina, position it next to the cervix, so that curative levels of radiation are directly on the cancer site." External-beam irradiation and intracavitary irradiation or brachytherapy (i.e., insertion of radioactive materials into the body) can be used in the treatment of cervical cancer. Intracavitary radiation provides direct access to the central lesion and increases the tolerance of the cervix and surrounding tissues, permitting curative levels of radiation to be used. None of the other answers describe this process. It usually is inserted in radiology, and then the client is transported to a private room until an allotted timeframe.

An older adult female comes in to the clinic for her yearly gynecology appointment and informs the nurse that she is having pain when having intercourse with her spouse. The patient has been postmenopausal for at least 5 years. Which of the following is the nurse's best response?

"This is caused by a decrease in estrogen levels, but there are things that you may be able to use to help." Decreased estrogen stimulation after menopause causes the vaginal mucosa to become thin and dry, often resulting in dyspareunia, atrophic vaginitis, and occasional vaginal bleeding. Low-dose estrogen suppositories may be used and the patient should be encouraged to use a water-soluble vaginal lubricant. This does not mean that the patient will not be able to have, or not enjoy, sex any longer. It is not caused by increased progesterone levels.

A client with a family history of breast cancer has just learned that she carries the BRCA1 and BRCA2 mutation. When educating this client about follow-up care, which of the following statements would be most appropriate?

"You should have more frequent breast evaluations using an MRI rather than standard mammography." Mutations in two breast cancer susceptibility genes—BRCA1 on chromosome 17 and BRCA2 on chromosome 13—may account for most inherited forms of breast cancer. A woman with known mutations in BRCA1 has a lifetime risk of approximately 57% for breast cancer and approximately 40% for ovarian cancer. BRCA2 is another susceptibility gene that elevates lifetime breast cancer risk to 49% and ovarian cancer risk to 18%. - Breast evaluation using MRI is generally preferred over standard mammography for these women because of its enhanced sensitivity and lack of radiation exposure, which may be safer for them. - Prophylactic surgery, in the form of bilateral mastectomy, bilateral oophorectomy, or both, has been shown to decrease the risk of developing cancer. These controversial surgeries can have physical and psychological side effects that warrant careful consideration before proceeding.

Which of the following female patients is at risk for amenorrhea?

18-year-old with anorexia nervosa Absence of a menstrual cycle may occur as a result of gonadal dysgenesis, or a hypothalamic-pituitary-ovarian axis disorder. Additional causes include ovarian dysfunction, intrauterine (within the uterus) adhesions, infections, anorexia nervosa, and strenuous physical exercise that alters the fat-to-muscle ratio.

When a woman asks the nurse at what age menopause usually occurs, what should the nurse respond?

48 to 55 years of age The typical age for menopause is between 48 and 55 years of age.

The nurse is explaining ovulation to a female client. The nurse explains that follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are important hormones needed to ovulate and are secreted by which of the following glands?

Anterior Pituitary After puberty, the anterior pituitary secretes follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

Select the structure primarily responsible for the secretions of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin.

Anterior pituitary gland The anterior pituitary gland is responsible for the secretion of LH, FSH, and prolactin. The hypothalamus is stimulated by GnRH to secrete only LH and FSH. The endometrium undergoes proliferative changes and sloughing during the menstrual cycle. (

A female client's assessment identifies symptoms of dyspareunia and burning. The nurse is aware that the client may have developed:

Atrophic vaginitis Symptoms of atrophic vaginitis include vaginal itching, burning, and dyspareunia. Adenomyosis includes heavy, painful periods with clots and dyspareunia. -Endometrial cancer usually causes abnormal (postmenopausal) bleeding. -Symptoms of cystocele include bearing-down sensation, difficulty in emptying the bladder, frequency and urgency of urination, and cystitis.

A woman of child-bearing age asks the nurse about a natural method to avoid pregnancy. What is an appropriate response?

Avoid sex when cervical mucus is most stretchy Correct Explanation: When ovulation occurs there is increased secretion of watery cervical mucus that is stretchy. Avoiding sexual intercourse at that time is a natural way to avoid pregnancy. Vaginal douching is not recommended unless it is treating an infection. Showering will not remove sperm from the vagina or fallopian tubes. Position after intercourse will not decrease pregnancy because sperm are mobile.

The environment of the vagina is moist with a pH 4.0 to 4.5. The major purpose of the acidic environment is which of the following?

Bacteriostatic The vagina is lined with mucus-secreting stratified squamous epithelial cells. Vaginal tissue is usually moist, with a pH maintained within the bacteriostatic range of 4.0 to 4.5.

A client who has been diagnosed with premenstrual syndrome (PMS) asks if there is anything to help alleviate the symptoms.

Eat a diet low in simple sugars and high in protein Treatment for PMS includes treating various symptoms. A diet low in sugar and high in protein and reduction in caffeine intake are recommended. Other suggestions include diuretics to reduce fluid retention, continue fluid intake as usual, regular exercise, and analgesics for pain.

The endocrine system is highly involved in the female reproductive system. Which hormones are used to stimulate the primordial follicles?

FSH and LH After puberty, the pituitary gonadotropic hormones—follicle stimulating hormone (FSH) and luteinizing hormone (LH)—stimulate the primordial follicles to develop into mature graafian follicles. The graafian follicle produces estrogen, which begins to stimulate the thickening of the endometrium in the uterus.

A female patient informs the nurse that she had intercourse yesterday evening and is wondering if she could become pregnant. She asks the nurse that if she was pregnant, where it would be located at present. Which of the following should the nurse tell the patient?

Fertilization normally occurs in the middle to outer portion of the Fallopian tube. If coitus has occurred recently, fertilization normally occurs in the middle to the outer portion of the Fallopian tube. Besides providing a passageway for ova and sperm, the Fallopian tubes provide for drainage of tubal secretions into the uterus.

A woman with a regular 28-day menstrual cycle wishes to become pregnant. At which point in the menstrual cycle is the optimal time for intercourse to end in fertilization of the ovum?

Fourteenth day after menses begins Ovulation usually occurs around the 14th day after menstruation begins. It is the best time to expect the ovum and sperm to join in fertilization.

A school nurse is providing an informational session about the prevention of cervical cancer in young girls and women. The most important information for the nurse to present would be:

HPV vaccine before becoming sexually active Two types of HPV vaccines are currently available to prevent HPV infection: a quadrivalent vaccine (Gardasil) to prevent infection by HPV subtypes 16, 18, 6, and 11 and a bivalent vaccine (Cervarix) to prevent infection by subtypes 16 and 18. The quadrivalent vaccine has been approved for females and males between the ages of 9 and 26 years, optimally before initiation of sexual activity. -Abstinence and condoms may help, also but the vaccine is recommended.

A 29 year-old woman has been trying for many months to become pregnant, and fertilization has just occurred following her most recent ovulation. What process will now occur that will differentiate this ovulatory cycle from those prior?

Human chorionic gonadotropin will be produced, preventing luteal regression. Fertilization is followed by the release of human chorionic gonadotropin. The corpus luteum, not primary follicles, provides hormonal support for early pregnancy. The atrophy of corpus luteum and its replacement by corpus albicans only occurs when fertilization does not take place. The endometrium will be preserved following fertilization.

There are two types of vulvar cancer. One type is found in older women, and one type is found in younger women, generally less than 40 years of age. What is the type found in younger women thought to be caused by?

Human papillomavirus One third to one half of vulvar intraepithelial neoplasia (VIN) cases appear to be caused by the cancer-promoting potential of certain strains (subtypes 16 and 18) of HPV that are sexually transmitted and are associated with the type of vulvar cancer found in younger women. -The other answers are not thought to be associated with vulvar cancer in younger women.

The ovaries secrete both estrogen and progesterone. What is one function of progesterone in the body?

Increases body temperature at ovulation Although the mechanism is uncertain, progesterone increases basal body temperature and is responsible for the increase in body temperature that occurs with ovulation. The other answers are effects of estrogen.

During the female menstrual cycle hormones are produced and excreted by various reproductive organs. The hormone progesterone is secreted and is metabolized in which of the following organs?

Liver Although the word progesterone refers to a substance that maintains pregnancy, progesterone is secreted as part of the normal menstrual cycle. The hormone circulates in the blood attached to a specific plasma protein. It is metabolized in the liver and conjugated for excretion in the bile

A woman reports to the primary healthcare provider that she experiences monthly changes before her menstrual cycle. Which of the following statements demonstrates understanding of premenstrual disorders?

Many women report premenstrual emotional or physical changes. Premenstrual mood disorders fall into a continuum of severity of symptoms and dysfunction. Most women report some premenstrual changes. In premenstrual molimina the symptoms are mild. -In PMS women present with at least one mild to moderate physical or psychological symptom that occurs between 3 and 14 days before the menstrual period and is relieved by onset of menses. - In PMDD, the patient experiences at least 5 of 11 characteristic symptoms and has severe dysfunction, which is often associated with mood disorders. -Common symptoms include irritability and emotional lability (a tendency to laugh or cry unexpectedly at what might seem the wrong moment), food cravings, change in bowel habits, edema, breast and pelvic congestion, incoordination, weight gain, and insomnia.

The ovaries have a dual function. The nurse is able to explain to the patient that any problems with the ovaries frequently cause which of the following problems?

Menstrual and fertility problems The ovaries have a dual function: they produce germ cells, or ova, and they synthesize the female sex hormones. Disorders of the ovaries frequently cause menstrual and fertility problems. Benign conditions of the ovaries can present as primary lesions of the ovarian structures or as secondary disorders related to hypothalamic, pituitary, or adrenal dysfunction.

A female patient is being seen in the ED with complaints of lower abdominal pain, dyspareunia, back pain, purulent cervical discharge, and the presence of adnexal tenderness and painful cervix on bimanual pelvic examination. The nurse suspects the patient has pelvic inflammatory disease (PID), and will assess the patient for which of the following?

Number of sexual partners PID is a polymicrobial infection of the upper reproductive tract (uterus, fallopian tubes, or ovaries) associated with the sexually transmitted organisms such as N. gonorrhoeae or C. trachomatis as well as endogenous organisms, including anaerobes, such as Haemophilus influenza, enteric gram-negative rods, and streptococci. Factors that predispose women to the development of PID include an age of 16 to 24 years, nulliparity, history of multiple sexual partners, and previous history of PID. The symptoms of PID include lower abdominal pain, which may start just after a menstrual period; dyspareunia (difficult or painful sexual intercourse); back pain; purulent (pus) cervical discharge; and the presence of adnexal tenderness and exquisitely painful cervix on bimanual pelvic examination.

An older postmenopausal adult female fractured her left femoral head. She has sustained several fractures in the past 4 years and has been taking calcium and vitamin D supplements. Which of the following is a common problem that this patient is most likely suffering from?

Osteoporosis Estrogens decrease the rate of bone resorption by antagonizing the effects of parathyroid hormone on bone. For this reason, osteoporosis is a common problem in estrogen-deficient postmenopausal women. - Polycystic ovary disease does not cause osteoporosis. - Osteogenesis imperfecta or brittle bone disease would be diagnosed early in life and is not a result of decreased estrogen. -There is no indication that the patient is taking too many vitamins; this would not cause osteoporosis.

A client asks the nurse what hormone is responsible for temperature elevation that occurs with ovulation. The best response would be:

Progesterone Progesterone increases basal body temperature and is responsible for the temperature elevation that occurs with ovulation.

Which hormone is responsible for breast development and the increase in body temperature that occurs with ovulation?

Progesterone Progesterone is the hormone responsible for breast development and increase in body temperature during ovulation. The other options are not involved in either of these processes.

A client tells the nurse that her mother recently passed from ovarian cancer. The client asks why the survival rate from ovarian cancer is so low. The best response would be:

Symptoms of ovarian cancer are nonspecific and therefore difficult to interpret. Symptoms are often present and reported by women before diagnosis but are nonspecific and therefore difficult to interpret. Surgery and/or chemotherapy may be used to treat the disease. The incidence of ovarian cancer and mortality rate increase with age, with most cases occurring in women older than 50 years of age.

Which of the following is the most important discharge instruction for a female patient with pelvic inflammatory disease (PID)?

Take all of the antibiotic PID is an infection of the upper reproductive tract associated with sexually transmitted organisms. The most important intervention to minimize complications is to complete the course of antibiotic therapy. - Rest, fluids, and a well-balanced diet all enhance recovery.

The nursing student is studying the structure and function of the female reproductive system. The student wants to know why the urinary system is included in the content. The best reason for inclusion of the information is which of the following?

The urethra and the vagina, although two separate openings, exist in close proximity. Located in the vestibule are the urethra and vaginal openings, and the Bartholin lubricating glands, which are referred to as the greater vestibular glands. The urethra, or urinary meatus, is the external opening of the internal urinary bladder. The urethra is located posterior to the clitoris and is usually closer to the vaginal opening than to the clitoris.

A female patient is taking antibiotics to treat a skin infection and informs the nurse that she does not think the antibiotics are working because now she thinks she has a vaginal infection. Which of the following does the nurse believe has occurred due to the antibiotic use?

The use of the antibiotics decreases the number of lactobacilli in the vagina, which can result in a vaginal infection. Glycogen is fermented to lactic acid by the lactobacilli that are part of the normal vaginal flora, accounting for the mildly acid pH of vaginal fluid. The vaginal ecology can be disrupted at many levels, rendering it susceptible to infection. The use of systemic antibiotics may decrease the number of lactobacilli in the vagina and render it susceptible to vaginal infections.

Fibrocystic changes in the breast are not uncommon. How is the diagnosis of fibrocystic changes made?

Ultrasonography and mammography Diagnosis of fibrocystic changes is made by physical examination, mammography, ultrasonography, and biopsy (i.e., aspiration or tissue sample). -Client history and galactography are not used to diagnose fibrocystic changes in the breast.

The connecting tube between the cervix and the vestibule is referred to as which of the following?

Vagina Connecting the internal and external genitalia is a fibromuscular tube called the vagina. The vagina, which is essentially free of sensory nerve fibers, is located behind the urinary bladder and urethra and anterior to the rectum. It connects the vestibule to the cervix.

The nurse is caring for a 54-year-old female client who reports vaginal dryness and painful intercourse. The nurse expects which of the following prescriptions will be ordered for this client?

Vaginal estrogen preparation Problems that can arise as a result of urogenital atrophy include vaginal dryness, urinary stress incontinence, urgency, nocturia (waking during the night to urinate), vaginitis, and urinary tract infection. Women may find intercourse painful and traumatic. Vaginal estrogen cream may be recommended for vaginal dryness and atrophy

What should the nurse teach clients who are risk factors for breast cancer? Select all that apply.

• Increasing age • Family history • Obesity The nurse should teach that risk factors for breast cancer are increasing age, a family history, and obesity. -Early menstruation is not a known risk factor.

A nurse who works on a urology-gynecology ward of a hospital is coming on shift and will be caring for a 34 year-old woman who has been admitted overnight for the treatment of a large endometriosis. What interventions should the nurse most realistically anticipate providing over the course of the shift and the next several days?

Providing pain control; preparing the client for a laparoscopic procedure or hysterectomy. Pain control is central to treatment of endometriosis and surgical treatment is ideally performed laparoscopically, though hysterectomy is sometimes indicated. Bleeding is not a common symptom of endometriosis, and neither corticosteroids nor male androgens are common treatments