Exam 3-Adult Health-GI/GU

The community nurse is conducting a health promotion program at a local school and is discussing the risk factors associated with cervical cancer. Which are risk factors for cervical cancer? Select all that apply. A. Smoking B. Multiple sex partners C. Human papillomavirus infection D. Annual gynecological examinations E. First intercourse before 17 years of age

A,B,C,E. Risk factors for cervical cancer include human papillomavirus infection, active and passive cigarette smoking, and certain high-risk sexual activities (first intercourse before 17 years of age, multiple sex partners, and male partners with multiple sex partners). Screening via regular gynecological examinations and Papanicolaou (Pap) tests with treatment of precancerous abnormalities decreases the incidence and mortality of cervical cancer.

The nurse is assessing a 53-year-old woman who has been experiencing dysmenorrhea. What questions should the nurse include in an assessment of the patients menstrual history? Select all that apply. A) Do you ever experience bleeding after intercourse? B) How long is your typical cycle? C) Did you have any sexually transmitted infections in early adulthood? D) When did your mother and sisters get their first periods? E) Do you experience cramps or pain during your cycle?

A,B,E. Menstrual history addresses such factors as the length of cycles, duration and amount of flow, presence of cramps or pain, and bleeding between periods or after intercourse. Family members menarche and prior STIs are not likely to affect the patients current cycles.

A nurse practitioner is examining a patient who presented at the free clinic with vulvar pruritus. For which assessment finding would the practitioner look that may indicate the patient has an infection caused by Candida albicans? A) Cottage cheese-like discharge B) Yellow-green discharge C) Gray-white discharge D) Watery discharge with a fishy odor

A. The symptoms of C. albicans include itching and a scant white discharge that has the consistency of cottage cheese. Yellow-green discharge is a sign of T. vaginalis. Gray-white discharge and a fishy odor are signs of G. vaginalis.

A patient has been diagnosed with endometriosis. When planning this patients care, the nurse should prioritize what nursing diagnosis? A) Anxiety related to risk of transmission B) Acute pain related to misplaced endometrial tissue C) Ineffective tissue perfusion related to hemorrhage D) Excess fluid volume related to abdominal distention

B. Symptoms of endometriosis vary but include dysmenorrhea, dyspareunia, and pelvic discomfort or pain. Dyschezia (pain with bowel movements) and radiation of pain to the back or leg may occur. Ineffective tissue perfusion is not associated with endometriosis and there is no plausible risk of fluid overload. Endometriosis is not transmittable.

A patient has presented at the clinic with symptoms of benign prostatic hyperplasia. What diagnostic findings would suggest that this patient has chronic urinary retention? A) Hypertension B) Peripheral edema C) Tachycardia and other dysrhythmias D) Increased blood urea nitrogen (BUN)

D. Hypertension, edema, and tachycardia would not normally be associated with benign prostatic hyperplasia. Azotemia is an accumulation of nitrogenous waste products, and renal failure can occur with chronic urinary retention and large residual volumes.

A nursing student is doing a presentation on human papillomavirus (HPV) for a young adult group aged 18 to 20 years old. What information should the nursing student include in this presentation? Select all that apply. A."Some forms of HPV can lead to cervical ca ncer." B. "You cannot get HPV if you have had only 1 sex partner." C. "There are no vaccinations available to protect against HPV." D. "HPV is most commonly spread during vaginal or anal sexual contact." E. "In some types, HPV will go away on its own and does not cause health issues."

A,D,E. HPV has now become the most common sexually transmitted infection. Some types of HPV have been found to have a strong link to cervical cancer, while other types of HPV may resolve without any intervention. HPV may be contracted with any sexual partner. There is a vaccine for the known strains that may lead to cervical cancer, which can be administered to females from ages 9 to 26 years. HPV is spread through vaginal or anal sexual contact.

A nurse is collecting assessment data from a premenopausal patient who states that she does not have menses. What term should the nurse use to document the absence of menstrual flow? A) Amenorrhea B) Dysmenorrhea C) Menorrhagia D) Metrorrhagia

A. Amenorrhea refers to absence of menstrual flow, whereas dysmenorrhea is painful menstruation. Menorrhagia, also called hypermenorrhea, is defined as prolonged or excessive bleeding at the time of the regular menstrual flow. Metrorrhagia refers to vaginal bleeding between regular menstrual periods.

A female client is suspected of having a vaginal infection caused by the organism Candida albicans. Which assessment question would elicit data associated with this infection? A. "Have you had any vaginal discharge?" B. "Do you have any blood in your urine?" C. "Have you had any flank pain or headaches?" D. "Have you noticed any swelling in your feet?"

A. Clinical manifestations of a Candida infection include vaginal pain, itching, and a thick white vaginal discharge. Hematuria, edema, flank pain, and headache are clinical manifestations associated with urinary tract infections.

An adolescent is brought to the clinic by her mother because of abnormal uterine bleeding. The nurse should understand that the most likely cause of this dysfunctional bleeding pattern is what? A) Lack of ovulation B) Chronic vaginitis C) A sexually transmitted infection D) Ectopic pregnancy

A. Dysfunctional uterine bleeding can occur at any age, but is most common at opposite ends of the reproductive life span. It is usually secondary to anovulation (lack of ovulation) and is common in adolescents. It is not suggestive of vaginitis, an STI, or ectopic pregnancy.

A client is admitted to the nursing unit after undergoing radical prostatectomy for cancer. The nurse anticipates that which problem would be of most concern to the client in the immediate postoperative period? A. Concern about the outcome of surgery B. Continuous pain because of the effects of cancer C. Appearance disturbance as a result of the presence of a suprapubic catheter D. Concern about caring for self at home because of insufficient help after discharge

A. In the immediate postoperative period, the client who has had surgery for cancer may experience fear or concern related to the uncertain outcome of surgery. Postoperative pain is classified as acute, not continuous. The client may experience an alteration in appearance, but this is more likely to be related to the anticipated change in sexual function than the presence of the suprapubic catheter. The priority focus in the immediate postoperative period is not on concerns that apply to hospital discharge.

A patient who is postoperative day 12 and recovering at home following a laparoscopic prostatectomy has reported that he is experiencing occasional dribbling of urine. How should the nurse best respond to this patients concern? A) Inform the patient that urinary control is likely to return gradually. B) Arrange for the patient to be assessed by his urologist. C) Facilitate the insertion of an indwelling urinary catheter by the home care nurse. D) Teach the patient to perform intermittent self-catheterization.

A. It is important that the patient know that regaining urinary control is a gradual process; he may continue to dribble after being discharged from the hospital, but this should gradually diminish (usually within 1 year). At this point, medical follow-up is likely not necessary. There is no need to perform urinary catheterization.

A 21-year-old woman has sought care because of heavy periods and has subsequently been diagnosed with menorrhagia. The nurse should recognize which of the following as the most likely cause of the patients health problem? A) Hormonal disturbances B) Cervical or uterine cancer C) Pelvic inflammatory disease D. A sexually transmitted infection (STI)

A. Menorrhagia is prolonged or excessive bleeding at the time of the regular menstrual flow. In young women, the cause is usually related to endocrine disturbance; in later life, it usually results from inflammatory disturbances, tumors of the uterus, or hormonal imbalance. STIs, pelvic inflammatory disease, and cancer are less likely causes.

A patient has experienced occasional urinary incontinence in the weeks since his prostatectomy. In order to promote continence, the nurse should encourage which of the following? A) Pelvic floor exercises B) Intermittent urinary catheterization C) Reduced physical activity D) Active range of motion exercises

A. Pelvic floor muscles can promote the resumption of normal urinary function following prostate surgery. Catheterization is normally unnecessary, and it carries numerous risks of adverse effects. Increasing or decreasing physical activity is unlikely to influence urinary function.

A nurse is teaching a 53-year-old man about prostate cancer. What information should the nurse provide to best facilitate the early identification of prostate cancer? A) Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. B) Have a transrectal ultrasound every 5 years. C) Perform monthly testicular self-examinations, especially after age 60. D) Have a complete blood count (CBC), blood urea nitrogen (BUN) and creatinine assessment performed annually.

A. The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and the PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that should be done yearly. Testicular self-examinations wont identify changes in the prostate gland due to its location in the body. A transrectal ultrasound and CBC with BUN and creatinine assessment are usually done after diagnosis to identify the extent of disease and potential metastases.

A patient calls the clinic and tells the nurse she has thick white, curd-like discharge from her vagina. How should the nurse best interpret this preliminary data? A) The drainage is physiologic and normal. B) The patient may have a Candida species infection. C) The patient needs a Pap smear as soon as possible. D) The patient may have a Trichomonas infection.

B. Drainage caused by Candida is typically curd-like and white. Trichomonas infections usually cause copious, frothy yellowish-green discharge. There is no immediate need for a Pap smear, as malignancy is an unlikely cause.

When teaching patients about the risk factors of cervical cancer, what would the nurse identify as the most important risk factor? A) Late childbearing B) Human papillomavirus (HPV) C) Postmenopausal bleeding D) Tobacco use

B. HPV is the most salient risk factor for cervical cancer, exceeding the risks posed by smoking, late childbearing, and postmenopausal bleeding.

A patient is post-operative day 1 following a vaginal hysterectomy. The nurse notes an increase in the patients abdominal girth and the patient complains of bloating. What is the nurses most appropriate action? A) Provide the patient with an unsweetened, carbonated beverage. B) Apply warm compresses to the patients lower abdomen. C) Provide an ice pack to apply to the perineum and suprapubic region. D) Assist the patient into a prone position

B. If the patient has abdominal distention or flatus, a rectal tube and application of heat to the abdomen may be prescribed. Ice and carbonated beverages are not recommended and prone positioning would be uncomfortable.

The nurse should include which intervention in the care of a client who has undergone a vaginal hysterectomy for the treatment of cancer? Select all that apply. A. Elevate the knee gatch on the bed. B. Encourage ambulation as prescribed. C. Remove antiembolism stockings twice daily. D. Assist with range-of-motion (ROM) leg exercises. E. Check placement of pneumatic compression boots.

B,C,D,E,F. The client is at risk for deep vein thrombosis (DVT) or thrombophlebitis after this surgery, as with any other major surgery. The nurse should avoid using the knee gatch in the bed because doing so inhibits venous return, thus placing the client at greater risk for DVT or thrombophlebitis. The nurse will implement measures that prevent DVT or thrombophlebitis; ROM exercises, ambulation, antiembolism stockings, and pneumatic compression boots are all helpful.

A patient who is scheduled for an open prostatectomy is concerned about the potential effects of the surgery on his sexual function. What aspect of prostate surgery should inform the nurses response? A) Erectile dysfunction is common after prostatectomy as a result of hormonal changes. B) All prostatectomies carry a risk of nerve damage and consequent erectile dysfunction. C) Erectile dysfunction after prostatectomy is expected, but normally resolves within several months. D) Modern surgical techniques have eliminated the risk of erectile dysfunction following prostatectomy.

B. All prostatectomies carry a risk of impotence because of potential damage to the pudendal nerves. If this damage occurs, the effects are permanent. Hormonal changes do not affect sexual functioning after prostatectomy.

A 31-year-old patient has returned to the post-surgical unit following a hysterectomy. The patients care plan addresses the risk of hemorrhage. How should the nurse best monitor the patients postoperative blood loss? A) Have the patient void and have bowel movements using a commode rather than toilet. B) Count and inspect each perineal pad that the patient uses. C) Swab the patients perineum for the presence of blood at least once per shift. D) Leave the patients perineum open to air to facilitate inspection.

B. To detect bleeding, the nurse counts the perineal pads used or checks the incision site, assesses the extent of saturation with blood, and monitors vital signs. The perineum is not swabbed and there is no reason to prohibit the use of the toilet. Absorbent pads are applied to the perineum; it is not open to air

The nurse is caring for a client with a diagnosis of endometriosis. The client asks the nurse to describe this condition. How should the nurse respond? Select all that apply. A. "It causes the cessation of menstruation." B. "It is pain that occurs during ovulation." C. "It is the presence of tissue outside the uterus that resembles the endometrium." D. "It is also known as primary dysmenorrhea and causes lower abdominal discomfort." E. "Major symptoms of endometriosis are pelvic pain, dysmenorrhea, and dyspareunia."

C,E. Endometriosis is defined as the presence of tissue outside the uterus that resembles the endometrium in both structure and function. Major symptoms include pelvic pain, dysmenorrhea, and dyspareunia (painful intercourse). The response of this tissue to the stimulation of estrogen and progesterone during the menstrual cycle is identical to that of the endometrium. Amenorrhea is the cessation of menstruation for at least 3 cycles or 6 months in a woman who has an established pattern of menstruation. Amenorrhea can be caused by a variety of factors. Mittelschmerz refers to pelvic pain that occurs midway between menstrual periods. Primary dysmenorrhea refers to menstrual pain without identified pathology.

A nurse is providing an educational event to a local mens group about prostate cancer. The nurse should cite an increased risk of prostate cancer in what ethnic group? A) Native Americans B) Caucasian Americans C) African Americans D) Asian Americans

C. African American men have a high risk of prostate cancer; furthermore, they are more than twice as likely to die from prostate cancer as men of other racial or ethnic groups.

While taking a health history on a 20-year-old female patient, the nurse ascertains that this patient is taking miconazole (Monistat). The nurse is justified in presuming that this patient has what medical condition? A) Bacterial vaginosis B) Human papillomavirus (HPV) C) Candidiasis D) Toxic shock syndrome (TSS)

C. Candidiasis is a fungal or yeast infection caused by strains of Candida. Miconazole (Monistat) is an antifungal medication used in the treatment of candidiasis. This agent is inserted into the vagina with an applicator at bedtime and may be applied to the vulvar area for pruritus. HPV, bacterial vaginosis, and TSS are not treated by Monistat

A patient diagnosed with cervical cancer will soon begin a round of radiation therapy. When planning the patients subsequent care, the nurse should prioritize actions with what goal? A) Preventing hemorrhage B) Ensuring the patient knows the treatment is palliative, not curative C) Protecting the safety of the patient, family, and staff D) Ensuring that the patient adheres to dietary restrictions during treatment

C. Care must be taken to protect the safety of patients, family members, and staff during radiation therapy. Hemorrhage is not a common complication of radiation therapy and the treatment can be curative. Dietary restrictions are not normally necessary during treatment.

A community health nurse is providing an educational session on cancer of the cervix for women living in the community. The nurse informs the community residents that which is an early sign of this type of cancer? A. Abdominal pain B. Constant and profuse bleeding C. Irregular vaginal bleeding or spotting D. Dark and foul-smelling vaginal drainage

C. Early cancer of the cervix usually is asymptomatic. The 2 chief symptoms are leukorrhea (vaginal discharge) and irregular vaginal bleeding or spotting. The vaginal discharge increases gradually in amount and becomes watery and finally dark and foul-smelling because of necrosis and infection of the tumor mass. As the disease progresses, the bleeding may become constant and may increase in amount.

An adolescent seen in the health care clinic has been diagnosed with endometriosis. The client asks the clinic nurse to describe this condition. Which response should the nurse provide? A. "It always causes infertility." B. "It causes the cessation of menstruation." C. "It is the presence of tissue outside the uterus." D. "It is also is known as primary dysmenorrhea."

C. Endometriosis is defined as the presence of tissue outside the uterus that resembles the endometrium in both structure and function. The response of this tissue to the stimulation of estrogen and progesterone during the menstrual cycle is identical to that of the endometrium. Endometriosis can lead to pelvic scarring, pain, and possible infertility. Amenorrhea is the cessation of menstruation for a period of at least 3 cycles or 6 months in a woman who has established a pattern of menstruation and can be due to a variety of causes. Primary dysmenorrhea refers to menstrual pain without identified pathology.

A 45-year-old woman has just undergone a radical hysterectomy for invasive cervical cancer. Prior to the surgery the physician explained to the patient that after the surgery a source of radiation would be placed near the tumor site to aid in reducing recurrence. What is the placement of the source of radiation called? A) Internal beam radiation B) Trachelectomy C) Brachytherapy D) External radiation

C. Radiation, which is often part of the treatment to reduce recurrent disease, may be delivered by an external beam or by brachytherapy (method by which the radiation source is placed near the tumor) or both

The nurse is caring for a client with cancer of the prostate who has undergone a prostatectomy. Which action should the nurse include in discharge instructions? A. Avoid driving the car for a few days. B. Restrict fluid intake to prevent incontinence. C. Avoid lifting objects heavier than 20 lb (9 kg) for at least 6 weeks. D. Notify the health care provider if small blood clots are noticed during urination.

C. The client who has undergone a prostatectomy should avoid lifting objects heavier than 20 lb (9 kg) for at least 6 weeks. Driving a car and sitting for long periods are restricted for at least 3 weeks. A high daily fluid intake should be maintained to limit clot formation and prevent infection. Small pieces of tissue or blood clots may be passed during urination for up to 2 weeks after surgery; this is an expected occurrence.

A patient is being discharged home after a hysterectomy. When providing discharge education for this patient, the nurse has cautioned the patient against sitting for long periods. This advice addresses the patients risk of what surgical complication? A) Pudendal nerve damage B) Fatigue C) Venous thromboembolism D) Hemorrhage

C. The patient should resume activities gradually. This does not mean sitting for long periods, because doing so may cause blood to pool in the pelvis, increasing the risk of thromboembolism. Sitting for long periods after a hysterectomy does not cause postoperative nerve damage; it does not increase the fatigue factor after surgery or the risk of hemorrhage.

A nurse is planning the postoperative care of a patient who is scheduled for radical prostatectomy. What intraoperative position will place the patient at particular risk for the development of deep vein thrombosis postoperatively? A) Fowlers position B) Prone position C) Supine position D) Lithotomy position

D. Elastic compression stockings are applied before surgery and are particularly important for prevention of deep vein thrombosis if the patient is placed in a lithotomy position during surgery. During a prostatectomy, the patient is not placed in the supine, prone, or Fowlers position

The nurse notes that a patient has a history of fibroids and is aware that this term refers to a benign tumor of the uterus. What is a more appropriate term for a fibroid? A) Bartholins cyst B) Dermoid cyst C) Hydatidiform mole D) Leiomyoma

D. A leiomyoma is a usually benign tumor of the uterus, commonly referred to as a fibroid. A Bartholins cyst is a cyst in a paired vestibular band in the vulva, whereas a dermoid cyst is a benign tumor that is thought to arise from parts of the ovum and normally disappears with maturation. A hydatidiform mole is a type of gestational neoplasm.

The nurse is providing preoperative education for a patient diagnosed with endometriosis. A hysterectomy has been scheduled. What education topic should the nurse be sure to include for this patient? A) Menstrual periods will continue to occur for several months, some of them heavy. B) Normal activity will be permitted within 48 hours following surgery. C) After a hysterectomy, hormone levels remain largely unaffected. D) The bladder must be emptied prior to surgery and a catheter may be placed during surgery.

D. The intestinal tract and the bladder need to be empty before the patient is taken to the OR to prevent contamination and injury to the bladder or intestinal tract. The patient is informed that her periods are now over, but she may have a slightly bloody discharge for a few days. The patient is instructed to avoid straining, lifting, or driving until her surgeon permits her to resume these activities. The patients hormonal balance is upset, which usually occurs in reproductive system disturbances. The patient may experience depression and heightened emotional sensitivity to people and situations.

A 27-year-old female patient is diagnosed with invasive cervical cancer and is told she needs to have a hysterectomy. One of the nursing diagnoses for this patient is disturbed body image related to perception of femininity. What intervention would be most appropriate for this patient? A) Reassure the patient that she will still be able to have children. B) Reassure the patient that she does not have to have sex to be feminine. C) Reassure the patient that you know how she is feeling and that you feel her anxiety and pain. D) Reassure the patient that she will still be able to have intercourse with sexual satisfaction and orgasm.

D. The patient needs reassurance that she will still have a vagina and that she can experience sexual intercourse after temporary postoperative abstinence while tissues heal. Information that sexual satisfaction and orgasm arise from clitoral stimulation rather than from the uterus reassures many women. Most women note some change in sexual feelings after hysterectomy, but they vary in intensity. In some cases, the vagina is shortened by surgery, and this may affect sensitivity or comfort. It would be inappropriate to reassure the patient that she will still be able to have children; there is no reason to reassure the patient about not being able to have sex. There is no way you can know how the patient is feeling and it would be inappropriate to say so.

A patient is 24 hours postoperative following prostatectomy and the urologist has ordered continuous bladder irrigation. What color of output should the nurse expect to find in the drainage bag? A) Red wine colored B) Tea colored C) Amber D) Light pink

D. The urine drainage following prostatectomy usually begins as a reddish pink, then clears to a light pink 24 hours after surgery.