gyno

A male client is given 1000 mg of oral azithromycin (Zithromax) to treat his chlamydia infection. Two weeks later, he returns to the clinic and says to the nurse, "My symptoms have returned." What does the nurse do first?

Asks him whether his partner was also treated for chlamydia Because recurrence of chlamydia is frequently caused by re-infection with a new or untreated partner, the nurse should first assess whether the client's partner was treated.

Anal itching, foul-smelling vaginal discharge, and painful urination are typical clinical manifestations for

a gonorrheal infection

Stages of endometrial cancer....

1. Cancer that remains confined to the endometrium (innermost lining) of the uterus 2. cancer has spread from the uterus to the cervix 3. Vaginal and lymph node areas of involvement 4. The spread of cancer that is beyond the pelvic area

A client who had an anterior colporrhaphy is being discharged. How long should they wait to have sex?

6 weeks

The nurse is teaching a group of young boys and girls about getting vaccinated for human papilloma virus (HPV). What info should be included?

-The same vaccine is advised to be given to both girls and women, as well as to boys and men. -It protects men from genital warts and from some strains of HPV. -Having the vaccine will help women from getting cancer of the cervix. -You will need to have all three injections to be protected from the disease -It is better to have the vaccination before you start having sexual relations. -It is typically given between ages 9 and 10 and 25 and 26.

A client has gynecologic cancer. Which client statement demonstrates a correct understanding of her treatment options?

"External beam radiation therapy (EBRT) may be used after my cancer surgery." EBRT may be used to treat any stage of gynecologic cancer in combination with surgery. Chemotherapy is used as palliative treatment for advanced and recurrent disease when it has spread to other parts of the body. External treatment, not brachytherapy, is given on an ambulatory care basis after surgery, if needed. The purpose of brachytherapy is to assist in preventing disease recurrence.

A client who had an anterior colporrhaphy is being discharged. What does the nurse tell the client before her discharge?

"Take a hot bath or use a moist heating pad for discomfort." For discomfort, the client should be instructed to use heat—either a moist heating pad or warm compresses applied to the abdomen. A hot bath may also be helpful. The client must avoid lifting anything heavier than 5 pounds. Sutures do not need to be removed because they may be absorbable or they may fall out (slough off) as healing occurs.

Gonorrhea is spread through

contact with the penis, vagina, mouth, or anus.

Regulation of the female reproductive system is achieved by hormones from the....

Hypothalamus Pituitary gland Ovaries

The nurse is teaching a female client about managing her sexually transmitted disease with antibiotics. Which client statement indicates that teaching has been effective?

"My oral contraceptive may not be effective while I take antibiotics." If the client is taking oral contraceptives, the client should discuss with the health care provider whether the antibiotics will decrease their effectiveness, as is often the case. Sexual intercourse should be avoided until after antibiotic therapy is completed. If the client's partner is being treated, sex can resume after the partner also completes his or her treatment. Antacids containing calcium, magnesium, or aluminum (Tums, Maalox, or Mylanta) should not be taken with antibiotics because they may decrease their effectiveness. Antibiotics should be taken on an empty stomach unless the provider instructs the client to take them with food.

Hypothalamus secretes

(GnRH) gonadotropin-releasing hormone

Which sexually transmitted diseases are vaginal infections?

-Chlamydia -Gonorrhea -Syphilis

Dyspareunea

painful sexual intercourse

Chlamydia can be transmitted during...

vaginal, anal, or oral sex.

The nurse is assessing a male client who has been diagnosed with Chlamydia trachomatis. What clinical manifestation does the nurse expect to see?

Dysuria

The client with an anterior and posterior colporrhaphy is showing signs of postoperative infection including.....

an elevated heart rate and an oral temperature of 101.2° and warrants frequent assessments that need to be communicated to the surgeon in charge of care.

The nurse is reviewing laboratory results on a 34-year-old client who is suspected of having endometrial (uterine) cancer. Which laboratory tests does the nurse expect to see?

-AFP and CA-125 may be elevated when the cancer has spread to the ovaries; they would be checked for this client. -The hCG level should be checked to rule out pregnancy in a client of this age as a precaution before treatment is started. -Testing for HNPCC is done if a family history is reported because a connection has been noted between HNPCC and endometrial cancer.

The nurse is teaching a client with gonorrhea. What does the nurse tell the client about the disease?

-Gonorrhea can be asymptomatic in both men and women, but women have asymptomatic, or "silent," infections more often than men. -Treatment failure is rare when gonorrhea is treated according to Centers for Disease Control and Prevention recommendations. -Clients should avoid sexual activity until antibiotic therapy is completed and they no longer have physical symptoms.

The appearance of an ulcer called a chancre is the first sign of....

primary syphilis.

A 32-year-old client has a laparoscopic removal of endometrial adhesions at a same-day surgery center. What does the nurse tell her to expect postprocedure?

Clients 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. This procedure should not interrupt the client's menstrual cycle for longer than a month, if at all. If this procedure was done because the couple is having fertility problems, the nurse can never guarantee any sort of outcome, especially pregnancy. Fever and vaginal discharge would be abnormal findings following the procedure.

risk factors for cervical cancer.

Multiparity HPV smoking African-American ethnicity

are all risk factors for ovarian cancer.

Nulliparity endometriosis diabetes mellitus first pregnancy at older than 20 years

risk factors for endometrial cancer.

Nulliparity smoking uterine polyps hypertension

risk factors for a thrombus

Oral contraceptive use smoking localized pain in the thigh

Both gonorrhea and chlamydia can also be spread

from an infected mother to her baby during vaginal childbirth.

Pustules on the glans of the penis are a clinical manifestation of ...

herpes simplex type 2.

Sexual function may be (or feel) different after a ......

hysterectomy. Couples may need counseling about intercourse or alternative sexual activities.

The primary problem for clients with PID is ....

infection; this is related to invasion of pelvic organs by pathogens

Endometritis is the infection of the...

innermost lining of the uterus (the endometrium).

Vaginal bleeding in a postmenopausal woman .....

is abnormal and may be an indication of serious problems such as endometrial cancer.

Vaginal bleeding after menopause or hysterectomy.....

is cause for concern and needs to be looked at

The use of douches or feminine hygiene sprays....

is not recommended because they disturb the balance of both pH and bacteria and can aggravate irritation.

The highest priority action for clients with toxic shock is to

maintain adequate gas exchange, so administration of oxygen should be the nurse's first action. Giving cefazolin (Ancef) 500 mg IV will need to be implemented rapidly for this client because she must be on antibiotics to fight infection and sepsis. Infusing normal saline IV at 500 mL/hr must be implemented rapidly for this client because she needs hydration and treatment for shock. Obtaining blood cultures will need to be implemented rapidly, prior to administration of antibiotics (cefazolin) for the best opportunity to identify the organizm, but her oxygenation is the priority.

Gonadotropin-releasing hormone agonists....

may cause a decrease in bone density

Proctitis is an inflammation of the

rectum that causes discomfort, bleeding, and, occasionally, a discharge of mucus or pus.

Discharge instructions for The client who has had a total abdominal hysterectomy (TAH).....

-can no longer become pregnant; therefore, birth control is no longer necessary. -avoid any strenuous activity for 2 to 6 weeks. -take temperature twice a day for the first days after surgery as a precaution to monitor for infection. -The client will no longer have a period, although she may have some vaginal discharge for a few days after going home.

The nurse is teaching a local young women's group about health promotion and maintenance measures for prevention of gynecologic cancers. Which preventive factors does the nurse stress?

-Annual Pap tests are recommended starting 3 years after a woman becomes sexually active or at the age of 21, whichever is sooner. Young women should have the test done annually. -Using barrier protection, especially if a woman has multiple sexual partners, is recommended. Knowing the history of partners is also a factor in having safe sex. -Eating a diet that includes a variety of healthy food choices (fruits, vegetables, low-fat protein, and healthy dairy products) is known to help a woman have a healthy reproductive system.

The nurse at the public health clinic is assessing a female client with possible gonorrhea. Which client symptom is of greatest concern to the nurse?

Abdominal tenderness. It indicates that the infection may have ascended into the pelvic structures, increasing the risk for pelvic inflammatory disease or systemic infection.

What items decrease the risk for acquiring an STD?

Abstinence, latex condoms, polyurethane condoms, and mutual monogamy all Barrier contraceptive devices such as the cervical cap do not ensure protection from STDs.

The nurse is evaluating a client's response to antibiotic treatment for pelvic inflammatory disease (PID). Which finding indicates that the treatment is effective?

Decreased pelvic tenderness Pain management of PID begins with treatment of the infection. Antibiotic therapy relieves pain by decreasing the inflammation caused by infection. Vaginal discharge may be increased at first as the infection drains.

The nurse is teaching a client how to prevent vaginal inflammation and itching. What information does the nurse include?

Do not have unprotected sex with multiple partners.

Estrogen is a general term for 3 different hormones....

Estradiol Estrone Estriol

As ovarian follicles mature, they secrete the female sex hormones...

Estrogen Progesterone

A clinic nurse is providing expedited partner treatment (EPT) to a client who is newly diagnosed with chlamydia. What does the nurse do first?

Gives the drug and directions to the client for the partner EPT is successful in reducing chlamydia infection rates. Clients are given the drug or a prescription with specific instructions for administration to their partners, without direct evaluation by a health care provider. Although there has been some discussion about the legality of this practice, it is supported by the Centers for Disease Control and Prevention. It is not required for the nurse to confirm the diagnosis of the partner or to make an appointment for the partner.

The nurse is teaching a group of young women about screening for chlamydia. Which client statement shows a correct understanding of these practices?

If I am a 40-year-old woman with a 'new' partner, I should be screened again. Women older than 25 years with new or multiple partners should be screened annually for chlamydia. All sexually active women 25 years old or younger should be screened annually for chlamydia. The urine self-collection method has been found to be more acceptable and highly sensitive and specific, and has resulted in increased identification of asymptomatic clients with chlamydia.

A 60 year-old client with a long-term smoking history, who is being treated for dysfunctional uterine bleeding (DUB), reports heavy vaginal bleeding, abdominal pain, and anemia. What medication used for hormone manipulation would be preferable for her?

Long-acting progestins (e.g., Depo-Provera)

The nurse is teaching a group of clients with endometriosis about complementary and alternative medicine (CAM) therapies that may bring relief to them. What does the nurse suggest?

Low-level heat applications can provide temporary relief from the pain that frequently accompanies endometriosis. Massage, relaxation techniques, and yoga may decrease tissue hypoxia and hypertonicity and relieve ischemia by increasing blood flow (oxygen) to affected areas.

The nurse is planning care for a client who has a sexually transmitted disease (STD). Which interventions address the client's psychosocial needs?

Many clients with STDs have fears and anxieties about having such diseases. They are reluctant to share a very private and personal side of their lives. It is therapeutic for a nurse to encourage clients' expressions about these feelings. Nurses must always be completely nonjudgmental about communicating with clients; it is not appropriate to allow personal feelings and biases to be any part of their approaches. Support groups can be very helpful to clients with STDs; hearing how others with similar circumstances have problem-solved in sensitive (sexually intimate) situations can be reassuring to someone who is faced with a new life crisis. Nurses have a responsibility to encourage clients with STDs to contact their sexual partners, but if the client will not disclose whom they may have received the infection from, or to whom they may have given it, the nurse has no means of "ensuring" contact. Reporting the occurrence to a public health agency is a medical responsibility

The nurse is discussing the prevention of sexually transmitted diseases (STDs) with a group of young adults. What information does the nurse include?

STD risk factors for sexually active people include multiple sexual partners. Female condoms (polyurethane sheaths in the vagina) are effective for preventing transmission of STDs, including human immunodeficiency virus. The use of spermicide with condoms, either lubricated condoms or vaginal application, has not been proved to be more or less effective against STDs than use without spermicide. Latex condoms do not completely prevent the spread of STDs; they do substantially decrease the risk.

The nurse is teaching a client how to adapt to physical and psychological changes after surgery for ovarian cancer. What is included in the teaching plan?

Support groups such as Gilda's Club are advisable for clients with ovarian cancer because the loss of reproductive organs involves a grief reaction. Ovarian cancer particularly carries the connotation of being serious and incurable in the view of many women. Because the client must refrain from having sexual intercourse for 6 weeks after surgery, it is appropriate to discuss alternatives. These could include expressing affection in other ways, such as cuddling or being close with her partner. The use of a vaginal dilator is not indicated. After the woman becomes sexually active, she may have a problem with vaginal dryness as the result of hormonal changes. Water-based, rather than oil-based, lubricants should be suggested.

The nurse is teaching care principles to a client who plans uterus-sparing surgery to remove uterine fibroids

The client must avoid having sexual intercourse for at least 6 weeks (not 3 weeks) after the surgery. Most clients can return to their usual activities within 2 weeks of having uterus-sparing surgery for fibroids. Most clients do go home on the day of the surgery. Postoperative pain is less and complications fewer with these procedures than with routine hysterectomies.

A client had a total abdominal hysterectomy 2 days ago and is to be discharged on antibiotics. What does the nurse include in her discharge teaching about antibiotics?

The client must finish her entire course of antibiotics. She must take them even after she has diminished signs or symptoms. This is a fundamental principle of antibiotic administration. The client should never be instructed to stop a course of antibiotics. In cases in which clients are unable to take an antibiotic (due to nausea or another problem), an alternative antibiotic will be prescribed.

A client with newly diagnosed pelvic inflammatory disease (PID) is being started on antibiotics as an outpatient. What does the nurse tell the client about her home treatment regimen?

The client should be instructed to maintain rest in a semi-Fowler's position to promote gravity drainage of the infection. This may also help relieve the pain involved with PID. Clients must be taught to report an increase in temperature to their health care provider. Nurses should instruct women treated as outpatients to avoid sexual intercourse. The client must be seen by the provider within 72 hours of starting the antibiotics and then 1 and 2 weeks from the time of the initial diagnosis.

A 42-year-old woman with an intramural leiomyoma (myomas or fibroids) has been taking estrogen replacement therapy for menopausal symptoms. What does the nurse tell her about estrogen replacement therapy and how it relates to her fibroids?

The fibroids may continue to grow because of the estrogen stimulation. Therefore, the client should be instructed to see her provider to monitor their growth. The client's estrogen dose will most likely need to be decreased at some point or eliminated.

The nurse is discussing transvaginal repair for pelvic organ prolapse (POP) using surgical vaginal mesh with a client who plans to have the procedure. What teaching does the nurse include?

The manufacturer's labeling and information is included so that the client has an understanding of the product, its qualifications, and the recommendations from the U.S. Food and Drug Administration (FDA). Although rare, infection is one of the possible complications, so women should know the signs and symptoms. Clients who have had this procedure need to know when to seek help from their gynecologist/surgeon, so the nurse should include these criteria. Since 2008, client reports of complications associated with the use of transvaginal mesh has required the FDA to release an initial report and update advising about the safety and effectiveness of the use of this product for POP. Such complications include vaginal mesh erosion, painful sexual intercourse, infection, urinary problems, bleeding, organ perforation, and possibly death. No surgical incision is involved with the procedure.

The nurse is administering benzathine penicillin G (Bicillin C-R) intramuscularly to a client with primary syphilis. The client has never been treated with this particular form of the drug. What precaution does the nurse implement?

The nurse should keep all clients on-site for at least 30 minutes after they have received this antibiotic so that manifestations of an allergic reaction can be detected and treated. The nurse must be sure that the client who has never had any form of penicillin has a skin test before receiving the injection. The nurse should recommend sexual abstinence until the treatment of both the client and his or her partner(s) is completed.

The nurse is teaching a 19-year-old female with genital warts about her condition.

There is no known treatment that will cure genital warts The warts may actually disappear or resolve without any treatment at all Genital warts may reappear at the same site The nurse must teach clients that over-the-counter wart treatments should not be used on genital tissue The desired outcomes of management are to remove the warts and treat the symptoms.

How do oral contraceptives work to prevent pregnancy?

They prevent fertilization by inhibiting ovulation

A client is being discharged after having a total abdominal hysterectomy (TAH). What principle guides the nurse who is providing discharge planning and instructions for her?

Usually, no special home equipment is needed for the client who has undergone a TAH. Generally, clients adjust better to the surgery if they have completed their childbearing years, among other factors. Psychological reactions can occur months to years after surgery, particularly if sexual functioning and libido are diminished. The client who has undergone a TAH should be taught about the expected physical changes, including any activity restrictions. A 4- to 6-week convalescent period is usually required.

Depo-Provera is....

an injectable form of progestin. It is given every 2 weeks to once a month, depending on the severity of the client's symptoms.

Endostatins....

block the formation of new blood vessels and are used to decrease ectopic endometrial growth.

Epididymitis is an inflammation of the

coiled tube (epididymis) at the back of the testicle that stores and carries sperm; pain and swelling are the most common signs and symptoms.

Hormone manipulation is usually the treatment of choice for women with anovulatory DUB. The drugs used depend on the severity of bleeding and age of the client. Progestin-only pills or long-acting progestins (e.g., injectable medroxyprogesterone acetate [Depo-Provera]) are preferable for women

older than 35 years who smoke or are at risk for thrombophlebitis. Progestin or combination hormone therapy (estrogen and progestin) may be given when bleeding is heavy and acute. For nonemergent bleeding, contraceptives (oral or patch) provide the progestin (artificial progesterone) needed to stabilize the endometrial lining. Abnormal uterine bleeding may be induced by corticosteroid use.

During a bath or shower, the inner labial mucosa should be cleansed with....

only water, not soap; soap is an irritant to the sensitive skin in those areas.

A condom should be used for every sexual encounter, including ....

oral, vaginal, and anal. Female condoms (polyurethane sheaths in the vagina) are effective for preventing the transmission of sexually transmitted diseases, including HIV. Latex or polyurethane condoms should be used rather than natural membrane condoms. A condom should never be used more than once.

The most common cause of recurrence of gonorrhea and chlamydia is

re-infection by an infected partner. Research indicates that giving clients antibiotics to take to their partners will decrease recurrence rates.

Syphilis is a bacterial infection usually spread by

sexual contact which starts as a painless sore, typically on the genitals, rectum, or mouth. Syphilis spreads from person to person via skin or mucous membrane contact, such as vaginally.

Syphilis spreads from person to person via ...

skin or mucous membrane contact, such as vaginally.

When women enter menopause at about age 50-55, the ovaries....

stop secreting estrogen

Generalized rash is a common manifestation of.....

the secondary stage of syphilis.

The HPV vaccine is comprised of

three injections administered over a 6-month period.

Unprotected sex with multiple partners can lead to

vaginal infection. Tight clothing, such as pantyhose or tight jeans, should be avoided because it can cause chafing. Tight clothing can also cause the vaginal area to get hot and sweaty, which can lead to infection.