Reproductive cancer disorders
A postmenopausal patient is told at her routine gynecological exam that the physician has found a cyst on her right ovary. The nurse notices that this does not cause worry for this patient. What should the nurse and/or physician tell this patient?
After menopause, a mass on an ovary is not a cyst; physiologic cysts can arise only from a follicle that has not ruptured or from the cystic degeneration of the corpus luteum.
A 30-year-old female is attending a health fair for women. The nurse at the fair is reviewing risk factors for cervical cancer. Which of the following is an important risk factor for the nurse to include at the fair?
Cervical cancer has several risk factors: early age of first intercourse (in first year of menarche), lower socioeconomic status, unprotected sex, family history of cervical cancer, exposure to DES in utero, HIV, use of oral contraceptives, HPV, and multiple male partners
A nurse is caring for a 30-year-old woman who was just diagnosed with cervical cancer. Which of the following psychosocial needs would be the priority for the nurse with her client?
Clear information on the disease, management, and treatment Explanation: Women diagnosed with cancer of the reproduction tract need to understand their disease, prognosis, and what treatment options they have. The nurse's role is to educate with effective and clear communication techniques. The nurse should be sincere and may provide realistic hope, but her role as educator is primary.
What is the most common GYN malignancy
Endometrial cancer, also known as uterine cancer, is the most common GYN malignancy. Because it is diagnosed in the early stages, endometrial cancer normally has a better prognosis than cervical or ovarian cancer.
A patient with ovarian cancer is admitted to the hospital for surgery. You are completing a health history on the patient. What clinical manifestations would you expect to assess?
Increased abdominal girth Explanation: Clinical manifestations of ovarian cancer include enlargement of the abdomen from an accumulation of fluid. Flatulence and feeling full after a light meal are significant symptoms.
A nurse is educating a 25-year-old client with a family history of cervical cancer. Which test should the nurse inform the client about to detect cervical cancer at an early stage?
Papanicolaou test Explanation: The client should have Papanicolaou tests regularly to detect cervical cancer during the early stages.
The nurse reviews the medical record of a woman diagnosed with ovarian cancer, stage II. In this stage the disease:
Involves one or both ovaries and extends into the pelvis Explanation: Stage II ovarian cancer involves one or both ovaries, with pelvic extension. Disease limited to the ovary characterizes stage I ovarian cancer. Stage III ovarian cancer has spread to the lymph nodes and other organs and structures inside the abdominal cavity. Stage IV disease typically involves metastasis to distant sites.
A nurse is conducting a session on education about cancers of the reproductive tract and is explaining the importance of visiting a health care professional if certain unusual symptoms appear. Which should the nurse include in her list of symptoms that merit a visit to a health care professional for further evaluation?
Irregular vaginal bleeding, persistent low backache not related to standing, and elevated or discolored vulvar lesions are some of the symptoms that should be immediately brought to the notice of the primary health care provider.
A client presents for a routine check-up at a local health care center. One of the client's distant relatives died of ovarian cancer, and the client wants to know about measures that can reduce the risk of ovarian cancer. The nurse inform the client about which measure to reduce the risk of ovarian cancer?
Only 5% of ovarian cancers are genetic in origin. However, the nurse needs to tell the client to seek genetic counseling and thorough assessment to reduce her risk of ovarian cancer. Oral contraceptives reduce the risk of ovarian cancer and should be encouraged. Breastfeeding should be encouraged as a risk-reducing strategy.
A middle-aged woman is seen in the OB/GYN clinic and reports abdominal bloating, fatigue, abdominal pain, urinary frequency, and constipation. She also says that she had lost 24 pounds in the last month without trying to lose. For which disease should the physician screen this patient?
Ovarian cancer Explanation: The most common early signs for ovarian cancer include abdominal bloating, early satiety, fatigue, vague abdominal pain, urinary frequency, diarrhea or constipation, and unexplained weight loss or gain.
A nurse working in the Family Birthing Center is answering the nurse hot line phone. A client calls in to schedule her annual Pap smear procedure. Which of the following strategies would be best to educate the client on before her procedure to make sure results are not affected?
Refrain from sexual intercourse 48 hours before testing to ensure clear results. Explanation: Nurses should use teaching guidelines with clients to optimize the Pap smear test results. Strategies to educate would include: No douche, no tampons, no jellies, no spermicides, no intercourse. The optimal time for testing is 2 weeks after the first day of your last menses
A client is waiting for the results of an endometrial biopsy for suspected endometrial cancer. She wants to know more about endometrial cancer and asks the nurse about the available treatment options. Which treatment information should the nurse give the client
Surgery involves removal of the uterus, fallopian tubes, and ovaries; adjuvant therapy is used if relevant. Explanation: The nurse should inform the client that surgery most often involves removal of the uterus (hysterectomy) and the fallopian tubes and ovaries (salpingo-oophorectomy). Removal of the tubes and ovaries, not just the uterus, is recommended because tumor cells spread early to the ovaries, and any dormant cancer cells could be stimulated to grow by ovarian estrogen. In advanced cancers, radiation and chemotherapy are used as adjuvant therapies to surgery. Routine surveillance intervals for follow-up care are typically every 3 to 4 months for the first 2 years.
A woman with ovarian cancer has been told that she is in stage three of the cancer. The nurse is reviewing the information with her. Which of the following statements would help in the woman's understanding of stage three ovarian cancer?
The growth has spread to the lymph nodes and other areas/organs in the abdominal cavity. Explanation: The staging and diagnosis is performed by a laparoscopy. The staging is 1-4. Stage three means the cancer has spread to the lymph nodes and other areas in the abdominal cavity. A five-year survival rate for this stage is 30%-60%
A client has been referred for a colposcopy by the physician. The client wants to know more about the examination. Which information regarding a colposcopy should the nurse give to the client?
The nurse should explain to the client that the colposcopy is done because the physician has observed abnormalities in Pap smears. The nurse should also explain to the client that the procedure is painless and there are no adverse effects, such as pain during urination.
A nurse is caring for a client who has been diagnosed with genital warts due to human papilloma virus (HPV). The nurse explains to the client that HPV increases the risk of vulvar cancer. Which preventive measure to reduce the risk of vulvar cancer should the nurse explain to the client?
The nurse should teach the client genital self-examination to assess for any unusual growths in the vulvar area. The nurse should instruct the client to seek care for any suspicious lesions and to avoid self-medication.
The endometrial biopsy of a client reveals cancerous cells, and the primary health care provider has diagnosed it as endometrial cancer. Which responsibilities of the nurse are part of the treatment of the client?
The responsibilities of a nurse while caring for a client with endometrial cancer include ensuring that the client understands all the treatment options available, suggesting the advantages of a support group and providing referrals, and offering the family explanations and emotional support throughout the treatment. The nurse should also discuss changes in sexuality with the client as well as stress the importance of regular follow-up care after the treatment and not just in cases where something unusual occurs.
When working in a local community health care center, a nurse is frequently asked about cervical cancer and ways to prevent it. Which information should be provided by the nurse?
To reduce the risk of cervical cancer, the nurse should encourage clients to avoid smoking and drinking. In addition, because STIs such as HPV increase the risk of cervical cancers, care should be taken to prevent STIs. Teenagers also should be counseled to avoid early sexual activity because it increases the risk of cervical cancer. The use of barrier methods of contraception, not IUDs, should be encouraged
A nurse is speaking to a local women's group about the various types of cancer affecting the female reproductive tract. The nurse explains that ovarian cancer is the leading cause of death from gynecologic malignancies based on the understanding that this type of cancer:
Tumors of the ovary have been lethal largely because they present with nonspecific symptoms and therefore frequently are far advanced and inoperable by the time they are diagnosed.
A nurse is assessing a 20-year-old female. Which of the data findings below taken during the history would indicate endometrial cancer?
Vaginal bleeding that is painless and abnormal Explanation: A finding of abnormal bleeding that is painless is a major sign of endometrial cancer.
The nurse is caring for a woman who has dysplasia (disordered growth of abnormal cells). The nurse educates her on dysplasia progression that is high-grade. Which of the following information is important for the nurse to include?
With cervical cancer, lesions start as dysplasia and progress over a period of time. Progression of a high-grade dysplasia takes about 2 years to develop into an invasive cancer.
A nursing student is going to speak at a local high school about women's health. She is planning to talk about sexually transmitted diseases (STDs) as well as routine checks, along with guidelines for Pap smears. What should she include in the Pap smear guidelines as far as when to have a "first" Pap smear?
at the age of 21 or within three years of first sexual intercourse Explanation: Amercian Cancer Society guidelines for Pap smears recommend that the first Pap smear is done at age 21 or within 3 years of first sexual intercourse. Other guidelines state that they should be done yearly until age 30 using the glass slide method and every two years using liquid-based method. At age 30-70 they should be done every 2-3 years if the previous three Pap smears were normal. They may be discontinued after age 70 if the previous three Paps were normal and no Paps in the previous 10 years were abnormal
A young woman is seen in the GYN clinic for a follow-up visit and is told that her recent Pap smear has come back abnormal. Which of the following tests can the nurse expect the physician to order for this patient?
colposcopy Explanation: A colposcopy is a follow-up exam that is commonly used to identify suspicious cells and obtain a biopsy.
A postmenopausal woman is seen in the clinic and reports vaginal bleeding that has lasted for the past 3-4 weeks. A pelvic exam is performed and shows no abnormalites. Which test does the nurse anticipate the physician will order next for this patient?
endometrial biopsy Explanation: The next test to be ordered would be an endometrial biopsy. It can detect up to 90% of cases of endometrial cancer and can be performed in the office without anesthesia. During this test the HCP can obtain a small sample of tissue for pathology.
An elderly patient who has been seen in the clinic for several months complaining of vulvar itching has been prescribed different creams and ointments but none of them have worked. What should the nurse practitioner suspect based solely on this symptom?
vulvar cancer Explanation: Diagnosis of vulvar cancer is often delayed significantly because there is no single specific clinical symptom that heralds it. The most common presentation is persistent vulvar itching that does not improve with the application of creams or ointments.
An elderly woman is seen in the clinic complaining of a lesion on her labia majora and states that she has experienced some bleeding and itching as well. She states that this has been going on for approximately three months. She tells the nurse that she has not been to a doctor in over 10 years. What diagnosis would the nurse expect the physician to make?
vulvar cancer Explanation: The correct diagnosis for this patient would be vulvar cancer due to the placement of the lesion, the itching, and the bleeding.
When assessing a woman, which of the following would lead the nurse to suspect cervical cancer? Select all that apply.
• Malodorous vaginal discharge • Dysuria • Vaginal bleeding after sexual intercourse Explanation: Clinically, the first symptom is abnormal vaginal bleeding, usually after sexual intercourse. Other signs and symptoms may include vaginal discomfort, malodorous discharge, and dysuria.
