NUR 230 EXAM 4

The nurse is performing a genitourinary assessment on a 42-year-old client and has explained to her that the assessment will require rectovaginal palpation. The client winces and asks, "Is that really necessary?" Which of the nurse's responses would provide the best rationale for rectovaginal palpation?

"I know this is probably unpleasant, but it's important for me to determine if your uterus is where it's expected."

A 17-year-old male client expresses concern about feeling lumps on his testicles. What response by the nurse would best address the client's concerns

"The normal testicle contains internal structures that cause lumps on the surface."

genital herpes simplex in women

-HSV-1 oral herpes, cold sores and fever blisters around mouth -HSV-2- genital herpes, responsible for genital herpes outbreaks -spread from person -painful blistering sores, pain with urination, and itching -diagnosed with blood test, culture or physical exam -will have for rest of life

rectocele

-a bulge of the front wall of the rectum into the back wall of the vagina caused by weakness of pelvic floor muscles -symptoms: soft bulges of tissue in your vagina, splinting, pressure or fullness, feeling of not empting bowels causes: pregnancy, constipation, chronic cough, heavy lifting and obesity treatment: surgery

syphilitic chancre

-begins within 2-4 weeks of infection -small, solitary, silvery papule that erodes to red, round or oval ulcer with a yellowish serous drainage -painless -sign of syphilis

bacterial vaginitis

-caused by overgrowth of bacteria when our natural balance is thrown off -thin, gray, white or green vaginal discharge, foul-smelling "fishy" vaginal odor, itching and burning during urination caused by multiple sex partners or bacterial imbalance

pregnancy difference

-cervix soften, vaginal mucosa & cervix look blue -cervical & vaginal secretions increase -mucous plug forms -uterus grows to accomadate baby

benign prostatic hypertrophy (BPH)

-changes in the prostate -enlarged, smooth, firm, slightly elastic -typically in males age 50+

herpes simplx 2

-clusters of small visciles with surrounding erythema -painful -erupt on the glans or foreskin -can rupture and form superficial ulcers -contagious

hydrocele

-collection of serous fluid in the scrotum -appears as swelling in the scrotum -usually painless

testicular torsion

-excurciating pain in the testicle -sudden onset -red, swollen scrotum, one testis (usually left) -cord feels thick, swollen, tender -sudden twisting of spermatic cord -occurs late in childhood, early adolescents -rare after age 18 -blood supply is cut off, this an emergency surgery

phimosis

-foreskin is advanced and tixed tight and it is impossible to retract over glans -caused by poor hygiene constriction impedes circulation, so glan swell

menstural history

-last menstrual period -regular or irregular -length -symptoms -age of menarche -contraceptive use -spotting

cervix

-located at neck of uterus -separates the upper end of the vagina from the isthmus of the uterus

episadias

-meatus opens on the upper (dorsal) side of glans or shaft -rare -more disabling -associated with urinary incontinence -separation of pubic bones

colorectal cancer

-more common in men than women -orginate in large intestine or rectum =begins as a polyp -screening age 50 top 75 years -fecal occult blood testing, sigmoidoscopy, or colonoscopy

genital warts in women

-most common STI -spread by having vaginal, anal, or oral sex with someone who has the virus -can be spread with no symptoms -can cause cervical or other cancers -moist, fleshy lesions -painless treatments: medication, cryo, or resolve on their own

cervical cancer

-orginated in uterine cervix -slow developing cancer -virtually all caused by HPV

cervical screenings

-pap smear every 3 years for women age 21 to 65 -pap and HPV. testing every 5 years for women 30 to 65

uterus

-pear-shaped organ three layers -endometrium -myometrium -peritoneum

HPV vaccine

-protects against certain types of HPV -series of 3 injections, given over 6 months -ages 15-45 -series of 2 injections ages 9-14

testicular cancer

-rare -high cure rate -white males are more likely to get it -typcially occurs in younger men

prostate cancer

-second most common cancer in men -slow growing -one of the leading causes of cancer death in men -lower melatonin levels can lead to this

trichomonas vagnitis

-sexually transmitted infection -caused by protozoan organism -symptoms: yellow-green discharge, frothy, foul smelling, itching, and urinary frequency diagnosed by culture, antigen test or visual microscopic exam

vestibule

-skin fold of the labia majora and labia minora contains severe openings -urethral meatus -skene glands -vaginal orifice -openings to bartholin glands

genital warts

-soft pointed, moist, fleshy, painless papules -may vary in color based on patient's race -occur on shaft of penis or around anus -caused by HPV -most common STD

hemorrhoids

-swollen and inflamed veins in the lower rectum and anus causes: straining, pregnancy, sitting for long periods, constipations, diarrhea, obesity, and intercourse symptoms: bleeding, itching, irritation, pain, discomfort, or swelling -treatment: creams, suppositories, stool softeners, hemorrhoid destruction or surgery

uterine prolapse

-the uterus descends towards or into the vagina -symptoms: heaviness, tissue protruding from vagina, urinary problems, trouble moving bowels, and feeling of sitting on small ball -causes: preganacy, difficult delivery, large baby, obesity

hyposadias

-urethral meatus opens on the under-side (ventral) of glans or shaft -genital defect -important to recognize at birth -circumcision should not be done

cystocele

-when supportive tissue between a women's bladder and vaginal wall weakens and stretches, allowing the bladder to bulge from the vagina -symptoms: fullness or pressure, discomfort when strained, cough, feeling that you haven't completely emptied your bladder causes: pregnancy, obesity, heavy lifting treatment: pessary or surgery

candidal vaginitis

-yeast infection -caused by c albicans -discharge, itching, irritation, pain with sex, and spotting diagnosed by microscopic examination, pelvic exam or culture

toddler

1 to 3 years

adolescent

12 to 18+ years

preschooler

3 to 6 years

The nurse suspects a client weighing 161 pounds may be exhibiting signs of sepsis. Which urinary output value indicates acute oliguria?

50 ml in past 2 hours

school-ager

6 to 12 years

Francis is a middle-aged man who noted right sided lower abdominal pain after straining with yardwork. Which of the following findings would make a hernia a more likely diagnosis?

Absence of symmetry of the inguinal areas with straining

acute prostatitis

Acute inflammation of the prostate usually due to bacteria -prostate is swollen and tender

A 72-year-old male presents at a local clinic and states: "I have to urinate all the time, and I never feel like my bladder is emptied. It really bothers me at night." What condition might the nurse suspect related to this chief complaint?

Benign prostatic hyperplasia (BPH)

Which of the following terms refers to difficult or painful sexual intercourse?

Dyspareunia

A male infant is born with the urethral meatus opening on the underside of the penis. When providing information to the parents, what is the correct terminology to use for this condition?

Hypospadias

A nurse observes a few small, yellow nodules on the cervix of a client during the speculum exam. They are not painful or odorous, and a thin, clear discharge is present. The nurse recognizes that these are most indicative of what type of condition?

Nabothian cysts

The nurse is present during a pelvic examination of a 21-year-old female client. Which action should the nurse prepare for first?

Pap smear specimen collection

If the anal sphincter tightens as the nurse palpates it, what should he or she do?

Pause, reassure the client, and proceed.

Which finding in a female client's history would alert the nurse to assess for signs of diabetes mellitus?

Recurrent candidiasis infections

The nurse is reviewing the functions of the ovaries, uterus, clitoris and vagina with a group of high school students. Based on this information, what would be the best response by the high school student about the function of the clitoris?

Small erectile structure that responds to sexual stimulation.

A 57-year-old woman has come to the OB/GYN clinic for her annual physical. She tells the nurse that it has been 14 months since her last period. What should the nurse further assess?

The client is postmenopausal.

A client calls the clinic and tells the nurse they have a white, curd-like discharge from the vagina. The client asks the nurse what the significance of this discharge is. What should the nurse responds?

The client may have a Candida species infection.

An uncircumcised male client has just come to the recovery room following a 4-hour back surgery. Before surgery a urinary catheter was placed. During the postoperative assessment, the recovery nurse discovers that the client has developed paraphimosis. What might have happened to the client to cause this?

The foreskin was not pulled back over the head of the penis after catheter placement

When assessing a pregnant female, the nurse documents Gravida 3, Para 2 regarding obstetrical history in the health record. Which situation correctly corresponds to the obstetrical history of the woman?

The woman has been pregnant three times and has delivered two live children.

When the female client reports a frothy yellow-green or brown vaginal discharge, the nurse suspects the client has a vaginal infection caused by which of the following?

Trichomonas vaginalis

When examining the genitalia of a client, a nurse observes a yellow-green, frothy, and foul-smelling discharge from the vagina. The nurse recognizes this finding as indicative of what condition?

Trichomonas vaginitis

The nurse is caring for a 17-year-old girl who is 16 weeks pregnant. The client's history shows infection with multiple STIs. What should the nurse do?

Verify that prior STIs were treated according to protocol

Which of the following would lead the nurse to suspect a hydrocele versus other causes of scrotal swelling?

a positive transillumination test

menopause

absence of menses for 12 months

A nurse is palpating the prostate of a client and finds it to be swollen, tender, firm, and warm to the touch. Which condition should the nurse most suspect?

acute prostatitis

What ethnic group has a significantly higher incidence rate of prostate cancer?

african american

You are giving an educational event to a local men's group about prostate cancer. What group should you be sure to tell the attendees of this event should receive information regarding the predisposition of prostate cancer?

african americans

Which client should the nurse assess for possible primary amenorrhea?

an 18-year-old who has never started menses

Before beginning the examination of the genitalia of an adult male client, the nurse should....

ask the client to empty his bladder

A client has been ordered to have a physical examination of the genitalia. Which information should a nurse give a client scheduled for her first Pap test to improve the accuracy of the test?

avoid douching 48 hours before the examination

A client is explaining to the nurse how vaginal dryness has decreased her enjoyment of sexual intercourse. The nurse is aware that which of the following are the glands that produce mucus that lubricates the vagina during intercourse?

bartholin's glands

A client visits the clinic and tells the nurse that her stools have been pale for the past 2 days and her skin has been itching. The nurse should refer the client to a physician for possible

billary disease

infant

birth to 1 year

The nurse notes a white curd-like discharge when inspecting a female client's labia. What should the nurse suspect this client is experiencing

candida vaginitis

Which type of yeast infection is manifested by white, cottage cheese-like discharge?

candidiasis

A nurse examining a client's external genitalia notices that his scrotum and testes draw up and he shivers. This phenomenon is known as which of the following?

cremasteric reflex

An older adult client visits the clinic complaining of urinary incontinence. The nurse should explain to the client that this is often due to

decreased urethral elasticity.

A young adult woman presents at the clinic stating, "I think I have a yeast infection." The nurse notes this is the third time in the past 90 days that this client has been to the clinic for yeast infections. What should the nurse consider as a comorbidity to be discussed with this client?

diabetes

Which of the following would the nurse expect to be done to assess the size of the prostate?

digital rectal examination

A client is scheduled for a routine pelvic examination. What should the nurse do to prepare the client for this examination?

drapes the client from the mid-abdomen to the knees

While reviewing the medical record before examining a male clinic client, the nurse notes that the urinary meatus is located on the top of the glans of the penis. The nurse understands the correct term for this congenital defect is

epispadias

vagina

external opening to the cervix

Upon inspection and palpation of the front of the client's thigh, the nurse discovers a bulge that appears when the client coughs. The nurse should document this finding as which type of hernia?

femoral

neonate

first 28 days of life

A client presents to the health care clinic with reports of black stool. The client denies the ingestion of iron supplements or taking Pepto-Bismol. The nurse recognizes that the black stools could be an indication of what disease process?

gastrointestinal bleeding

prostate cancer subjective data

hard, fixed, irregular nodules on the prostate

The nurse is assessing male genitalia and finds clusters of pimple-like clear vesicles. The nurse recognizes this as what?

herpes

While performing a gynecologic examination, the nurse observes small, painful, ulcer-like lesions with red bases on the client's labia. The nurse should refer the client to a physician for possible

herpes simplex virus infection.

The nurse is preparing a presentation for a local community group about prostate cancer and possible dietary risk factors. Which of the following would the nurse most likely include?

high-fat diet

A nurse is teaching a sex education class at the local university. In a pre-lecture quiz, the nurse asks what the two small folds that extend from the clitoral hood to the posterior fourchette of the vagina are called. What would be the correct answer?

labia minora

What is a lay term for the spontaneous loss of pregnancy?

miscarriage

A female client has a history of multiple sexual partners, which puts her in the high-risk group for developing HPV and cervical cancer. What should the nurse recommend to this client to help prevent these problems? Select all that apply.

monogamy abstinence consistent use of condoms

The nurse is working with an anorexic client who complains that sexual intercourse with her partner is painful. The nurse suspects that the client may lack the fat pad that is typically located over the pubic bone in women and that functions to absorb force and protect the pubic bone. Which of the following is the name of this structure?

mons pubis

symptoms of perimenopause

night sweats, mood swings, irritability, lack of appetite, vaginal dryness, or spotting

A nurse recognizes that which finding is normal upon palpation of the prostate?

nontender and rubbery

What information should nurse include in the teaching plan for a client considering a vasectomy?

offers permanent birth control

At the completion of a reproductive health history, a female client tells the nurse about having pain with penetration during intercourse. What should the nurse assess at this time? (Select all that apply.)

onset of the problem severity of the problem what makes it better or worse

vaginal orfice

opening of the vagina

A nurse inspects the cervix of a 52-year-old client during a routine assessment. Which coloration of the cervix may indicate that the woman is postmenopausal?

pale

During a comprehensive assessment, a female client complains of intense external genital itching. The nurse should carefully assess for which condition that commonly presents with this symptom?

pediculosis pubis

piaget

periods of cognitive/intellectual development

Which of the following is the most important risk factor for cervical cancer?

persistent HPV infections

family centered care

philosophy of care that acknowledges the importance of the family unit as the fundamental focus of all health care interventions

An uncircumcised, 78 year-old male has presented at the clinic complaining that he cannot retract his foreskin over his glans. On examination it is noted that the foreskin is very constricted. What is this condition called?

phimosis

When performing the physical assessment of a client, the nurse notes the presence of a small cyst that contains hair, which is located midline in the sacrococcygeal area and has a palpable sinus tract. How should the nurse document this finding?

pilonidal cyst

What information should a nurse give a client who reports a routine of frequent douching?

predisposes the vagina to yeast infections

On inspecting a client's external genitalia, a nurse notes that he is uncircumcised. This means that which of the following covers the glans of the penis?

prepuce

On palpation of a client's prostate, a nurse detects hard, fixed, and irregular nodules on the prostate. Which condition should the nurse most suspect in this client?

prostate cancer

During assessment of an elderly male client, the client tells the nurse that he has had difficulty urinating for the past few weeks. The nurse should refer the client to the physician for possible

prostate enlargement

A nurse observes that the mucosa of the rectum and the rectal wall of a female client protrudes out through the anal opening. It appears as a red, doughnut-like mass with radiating folds. How should the nurse document this condition of the rectum?

rectal prolaspe

skene glands

secrete mucus to lubricate and maintain moist vaginal environment

bartholin glands

secretes lubricant for intercourse, either side of the vagina

To best secure accurate assessment information, the nurse should complete which part of the reproductive history last?

sexual

The client tells the nurse that he has little or no interest in sex. He says he is concerned and he knows his wife is unhappy with his lack of libido. What can the nurse tell the client often causes lack of libido?

side effects of medication

The nurse identifies a cheesy white material that has accumulated under a male client's foreskin of the penis. What does this finding suggest to the nurse?

smegma

kohlberg

stages of moral development

freud

stages of psychosexual development

erikson

stages of pyschosocial development

A client reports the new onset of mucous in the stool. How should the nurse document this in the client's history?

steatorrhea

Which of the following positions is utilized for a pelvic examination?

supine lithotomy

A client comes to the Emergency Department complaining of sudden sharp testicular pain. Further examination reveals torsion of the spermatic cord. Which of the following would the nurse expect to do next?

testicular torsion

A client presents at the clinic with severe scrotal pain. What is the presumptive diagnosis?

testicular torsion

pediatric nursing

the art and science of giving nursing care to children from birth through adolescence with a holistic family-centered approach, including emphasis on their physical growth, mental, emotional, psychosocial, and spiritual development

An adult male client comes to the clinic for his annual physical examination. During the nursing assessment, the nurse asks, "Do you have any current or chronic illnesses such as diabetes, hypertension, respiratory problems, or cardiovascular disease?" Why does the nurse ask this question?

to assess risk of erectile dysfunction