MedSurg Quiz 5

The nurse is working in the emergency department when a client with possible toxic shock syndrome is admitted. Which prescribed intervention will the nurse implement first?

Remove the clients tampon

The nurse is giving discharge teaching to a woman who had cervical ablation. What information would be included?

Report heavy vaginal bleeding or foul-smelling drainage

A 15 year old adolescent tells the school nurse, "I have persistent pain during my periods." What should the nurse encourage her to do?

Have a gynecologic examination

A patient is diagnoses with uterine leiomyomas. What does the nurse expect to see in the documentation as the patient's chief presenting symptom?

Heavy vaginal bleeding

A patient reports the sensation of feeling as if "something is falling out" along with painful intercourse, backache, and a feeling of heaviness or pressure in the pelvis. Which question does the nurse ask to assess for a cystocele?

"Are you having urinary frequency or urgency?"

The nurse is teaching a group of women about prevention of toxic shock syndrome. What preventative measure does the nurse include?

"Change your tampon every 3-6 hours."

After a hysterosalpingo-oophorectomy, a client wants to know whether it would be wise for her to take hormones right away to prevent symptoms of menopause. What is the nurse's most appropriate response?

"Discuss this with your health care provider, because it is important to know your concerns."

A 20 year old woman is being evaluated for possible toxic shock syndrome. What question would the nurse ask?

"Do you use internal contraceptives?"

The patient needs diagnostic testing to determine the presence of endometrial thickening and possible cancer. Which brochure will the nurse prepare for the patient?

"How Transvaginal Ultrasound and Endometrial Biopsy Are Used in Cancer Diagnosis."

An obese 59 year old patient described excessive menstrual bleeding that occurs approximately every 10 days. Which question should the nurse ask first?

"How many pads (or tampons) do you use per day?"

A patient had an anterior colporrhaphy and is returning to the clinic for the follow up appointment. Which patient statement indicates that the procedure has achieved the desired therapeutic outcome?

"I have good control over my urination."

The nurse is giving instructions to a patient who is undergoing brachytherapy for cervical cancer. What information does the nurse include?

"Report any blood in the urine or severe diarrhea immediately."

A client is diagnosed with uterine fibroids, and the health care provider advises a hysterectomy. The client expresses concern about having a hysterectomy at age 45 because she has heard from friends that she will undergo severe symptoms of menopause after surgery. What is the nurse's most appropriate response?

"Some women may experience symptoms of menopause if their ovaries are removed with their uterus."

The nurse is interviewing a young woman who is considering the option of uterine artery embolization for the treatment of uterine fibroids. Which question would the nurse ask to assist the patient in making a decision?

"What did the health care provider tell you about the procedure?"

The nurse is caring for a patient with a radioactive implant in the uterus. Which instruction will the nurse give to unlicensed assistive personnel?

Patient is on bedrest and excessive movement is restricted

The patient reports itching, change in vaginal discharge, and an odor. The nurse suspects that the patient has vulvovaginitis. Based on knowledge about the common causes of vulvovaginitis, which questions would the nurse ask? Select all that apply.

-"Have you recently been taking antibiotics?" -"Do you consistently wipe from front to back?" -"Do you use tampons?" -"Do you douche or use vaginal sprays?" -"Have you had problems with vaginal yeast infections?"

Following a uterine embolization using a vascular closure device, what patient care would the nurse provide? Select all that apply.

-Assist the patient to ambulate 2 hours after the procedure -Raise the head of the bead -Assess pain level and provide analgesics as needed

A patient who had a total abdominal hysterectomy is anxious to resume her activities because she has young children at home. What post procedure information does the nurse provide to the patient? Select all that apply.

-Avoid sitting for prolonged periods -Do not lift anything heavier than 5-10 lbs -When sitting, do not cross the legs

A client has an anterior and posterior surgical repair of a cystocele and rectocele and returns from the post anesthesia care unit (PACU) with an indwelling catheter in place. What should the nurse tell the client about the primary reasons for the catheter? Select all that apply.

-Discomfort is minimized -Urinary retention is prevented -Pressure on the suture line is relieved

The nurse is caring for a patient who had a hysteroscopic surgery. The nurse is vigilant to assess for signs and symptoms of which potential complications? Select all that apply.

-Fluid overload -Embolism -Perforation of uterus -Hemorrhage -Ureter injury

A nurse is assessing a client who is being admitted for surgical repair of a rectocele. What signs or symptoms does the nurse expect that client to report? Select all that apply.

-Painful intercourse -Bearing down sensations

A client at the women's health clinic tells the nurse she has endometriosis. What factors associated with endometriosis does the nurse anticipate the client will report? Select all that apply.

-Rectal pressure -Abdominal pain

The surgical procedure for stage 1 disease of endometrial cancer involves removal of which components? Select all that apply.

-Uterus -Fallopian tubes -Ovaries -Peritoneum fluid for cytologic examination

The nurse is teaching a patient who is being discharged after having a total abdominal hysterectomy. Which conditions does the nurse tell the patient to immediately report to the surgeon? Select all that apply.

-Vaginal drainage that becomes thicker or foul smelling -Temperature over 100 -Burning during urination -Pain, tenderness, redness, or swelling in calves

The nurse is teaching a class about laparoscopic or hysteroscopic myomectomy. Which patient should be invited to attend the teaching session?

23 year old woman with uterine fibroids who would like to have children in the future

Which patient is most likely to be accepting of surgery and demonstrate better coping behaviors?

44 year old woman with two children and supportive partner had an abdominal hysterectomy for uterine fibroids

Which woman is at greatest risk for pelvic organ prolapse?

48 year old obese mother of four children

Which patient has the greatest need for evaluation of possible endometrial cancer?

63 year old woman who is having painless vaginal bleeding

The nurse is caring for a patient who is one day post-op for a total abdominal hysterectomy. Which assessment finding is cause for greatest concern?

Patient reports saturating one pad in an hour with dark red blood

The nurse is giving discharge teaching to a patient who had a transvaginal repair for pelvic organ prolapse using a surgical mesh. What does the nurse include?

Abstain from sexual intercourse for 6 weeks

After an abdominal hysterectomy the client returns to the unit with an indwelling catheter. The nurse identifies that the urine in the client's collection bag has become increasingly sanguineous. What complication does the nurse suspect?

An incisional nick in the bladder

A 36 year old patient is diagnosed with dysfunctional uterine bleeding. During the pelvic exam, the health care provider determines that the bleeding is acute. What is the nurse's priority action?

Anticipate an order for oral contraceptive therapy

A client with a third degree uterine prolapse is scheduled for a vaginoplasty. What should the nurse anticipate the surgeon will order?

Apply moist compress to the uterus

A patient had a total abdominal hysterectomy. Which patient behavior is the best indicator that she is coping and adapting successfully?

Asks questions about the wound care but seems reluctant to do self care

Three years after the patient was diagnosed and treated for endometrial cancer, the patient and family are told that the cancer is recurring. Which intervention is the nurse most likely to use?

Assess for readiness to explore palliate care and hospice

A patient with uterine leimyomas reports a feeling of pelvic pressure, constipation, and urinary retention. She says, "I can't button my pants anymore." What does the nurse do to further evaluate the patient's condition?

Assess the abdomen for distention or enlargement

A patient is receiving external radiation therapy for treatment of endometrial cancer. What task does the nurse delegate to unlicensed assistive personnel?

Assist the patient to ambulate if she feels fatigue or tiredness

The nurse is caring for a patient who had a posterior colporrhaphy. Which task is most appropriate to delegate to unlicensed assistive personnel?

Assist the patient with a site bath to relieve discomfort

The nurse is supervising a student nurse who is caring for a client who has an intracavity radioactive implant in place to treat cervical cancer. Which action by the student requires that the nurse intervene immediately?

Assisting the client to the bedside commode for a bowel movement

A young woman had minimally invasive surgery for the removal of uterine fibroids. The nurse emphasizes that this information should be included when giving health history; however for which future scenario is the history most essential?

Becomes pregnant and is looking forward to a home deliver with midwife assistance

The nurse is preparing patient teaching for several young women who will undergo surgical procedures for gynecologic problems. Which surgical procedure is most likely to induce menopausal symptoms?

Bilateral salpingo-oophorectomy

In recalling dietary intake for a recent 24 hour period, a female patient describes eating eggs, whole milk, and bacon for breakfast; fried chicken and french fries for lunch; three cheese pizza and ice cream for dinner. This type of diet places her at increased risk for which disorder?

Cancer of the ovaries

The nurse encourages a teenage patient to receive the human papillomavirus (HPV) vaccine because it protects against which type of cancer?

Cervical cancer

Young women who have intercourse as teenagers and/or have multiple sex partners are at high risk for which disease/disorder?

Cervical cancer

Three days after undergoing a pelvic exenteration procedure, a client reports dizziness after experiencing a sudden "giving" sensation along her abdominal incision. The nurse finds that the wound edges are open, and loops of intestine are protruding. Which action should the nurse take first?

Cover the wound with saline-soaked dressings

The home health nurse is reviewing the patient's medication list and sees that the patient was given doxorubicin at the hospital. What gynecologic diagnosis would the nurse expect to see as part of the patient's history?

Endometrial cancer

Which disorder is strongly associated with prolonged exposure to estrogen without the protective effects of progesterone?

Endometrial cancer

What information would the nurse give to a sexually active 35 year old women about conventional Papanicolaou (Pap) smear and human papillomavirus (HPV) testing?

Every 5 years is sufficient

A patient has had a posterior colporrhaphy. What is included in the nursing care of this patient?

Give pain medication before a bowel movement

The nurse is caring for several patients who had total abdominal hysterectomies. All patients are coming to the clinic for this 6 week follow up appointment. Which patient demeanor is the strongest indicator that there is a need for psychological referral?

Disheveled and lackluster and display a lack of interest in questions

The nurse is taking a history on a patient with probably gynecologic cancer. Which clinical manifestation is a sign of metastasis?

Dysuria

A client past menopause undergoes an anterior posterior colporrhaphy. What should the discharge teaching include?

Eating a high fiber diet

A patient receiving chemotherapy treatments reports fatigue, loss of energy, and experiencing an "emotional crisis every day and my hair is falling out." What does the nurse do first to help the patient adapt to body changes?

Encourage the patient to ventilate feelings

The nurse is caring for a patient who had hysteroscopic surgery. The patient reports severe lower abdominal pain, appears pale, and has trouble focusing on the nurse's questions about the pain. Vital signs show T 98.6, P 120/min, R 24/min, BP 103/60. Which complication does the nurse suspect?

Hemorrhage

An 86 year old woman had an anterior and posterior colporrhaphy (A & P repair) several days ago. Her retention catheter was removed 8 hours ago. Which assessment finding requires that the nurse act most rapidly?

Her abdomen is firm and tender to palpation above the symphysis pubis

Which therapies would the nurse expect to use for a patient who is being treated for a rectocele?

High fiber diet, stool softeners, and laxatives

A patient with a fever, myalgia, sore throat, and sunburn-like rash is admitted with the diagnosis of toxic shock syndrome. What additional clinical manifestation should the nurse assess for?

Hypotension

A client who had an abdominal hysterectomy 3 days ago reports burning with urination. Her urine output during the previous shift was 210 mL, and her temperature is 101.3. Which of these actions prescribed by the health care provider will the nurse implement first?

Insert a straight catheter as needed (PRN) for output of less than 300 mL/8hr

A client who has a diagnosis of endometriosis is concerned about the side effect of hot flashes from her prescribed medication. She tells the nurse that her mother found them very uncomfortable during her menopause. Which medication causes this side effect?

Leuprolide (Lupron)

What does a nurse expect to be the priority concern of a 28 year old woman who is to undergo a laparoscopic bilateral salpingo-oophorectomy?

Loss of childbearing potential

What is the priority preoperative and postoperative nursing care for a patient with leiomyomas?

Monitoring for bleeding

Which classic symptom is indicative of invasive gynecologic cancer?

Painless vaginal bleeding unrelated to menses

Which laboratory result indicates that the primary goal of treatment of the patient's uterine fibroids has been successful?

Red blood cell count is within normal limits

The nurse is working in the postanesthesia care unit caring for a 32 year old client who has just arrived after undergoing dilation and curettage to evaluate infertility. Which assessment finding should be immediately communicated to the surgeon?

Sharp, continuous, level 8 abdominal pain (on a scale of 0 to 10)

A patient had loop electrosurgical excision procedure for treatment and diagnosis of cervical cancer. In the discharge instructions, what does the nurse tell the patient to expect after the procedure?

Spotting

A patient is admitted with toxic shock syndrome. What organism is frequently associated with this syndrome when it occurs as a menstrual related infection?

Staphylococcus aureus

When taking the health history of a client who is admitted for repair of a cystocele and rectocele, the nurse should expect the client to report the occurrence of:

Stress incontinence and low abdominal pressure

What is the primary factor for the low survival rates for patients who are diagnosed with ovarian cancer?

Symptoms are mild and vague; therefore, the cancer is often not detected until its late stage

The nurse is teaching self care management to a 39 year old woman who had an abdominal hysterectomy. Which point would be emphasized to avoid complications of this surgery?

Take temperature twice a day for 3 days after surgery

When assessing a client with cervical cancer who had a total abdominal hysterectomy yesterday, the nurse obtains the following data. Which information has the most immediate implications for planning of the client's care?

The clients right calf is swollen, and she reports mild calf tenderness

A patient had a pelvic examination and needs an additional diagnostic test for possible uterine leiomyomas. The nurse prepares the patient for which diagnostic test?

Transvaginal ultrasound

What potential complication does a nurse anticipate when admitting a client with the diagnosis of severe procidentia (prolapse of the uterus)?

Ulcerations

The nurse reads in the patient's chart that the patient is experiencing surgical menopause after having a total hysterectomy and bilateral salpingo-oophorectomy. What expected sign/symptom does the nurse anticipate that the patient will report?

Vaginal changes

The nurse sees that a patient has been advised by the health care provider to apply lindane to the affected area. What is a self care measure for this patient to ensure that the symptoms do not return after using the medication?

Wash clothes and linens, and disinfect the home environment

A patient has undergone a total hysterectomy with vaginal repair. Which over the counter product will the nurse recommend to decrease sexual discomfort related to intercourse?

Water-based lubricants

What self management strategy would the nurse recommend to a patient to prevent vulvovaginitis?

Wear breathable fabrics, such as cotton