The Point: Chapter 27 Female Genitalia

Sexual monogamy and a diet rich in folate are

Sexual monogamy and a diet rich in folate are factors that reduce risk of cervical cancer

Urinary frequency, burning, and pain are signs of

UTI

Vaginal dryness may be

Vaginal dryness may be a sign of entering menopause.

In pregnant clients, the cervix appears blue;

this is also referred to as Chadwick's sign.

Anteflexed uterus

. Anteflexed uterus is a normal variation that consists of the uterine body flexed anteriorly in relation to the cervix.

A 35-year-old client tells the nurse that she is concerned that she may be already starting menopause. The nurse should explain that the normal range of years for menopause to occur is which of the following?

40 to 58 years Menopause is a normal physiologic process that occurs in women between the ages of 40 to 58 years, with a mean age of 50.

A pap smear is recommended

A pap smear is recommended every 3 years for women 21 to 65 years old, regardless of normalcy of previous smears or of sexual activity.

A yellow- green, frothy, and foul smelling discharge is observed in

A yellow- green, frothy, and foul smelling discharge is observed in a client with trichomonas vaginitis.

Lesions that develop into cauliflowerlike growths are indicative of

Lesions that develop into cauliflowerlike growths are indicative of cancer of the cervix.

A client presents to the health care clinic and reports a 7-day history of vaginal discharge and swelling of the labia. During the examination of the external genitalia, the nurse notices an enlarged Bartholin's gland. The nurse should prepare to culture this client for which condition?

Gonorrhea Abscess of Bartholin's gland with the presence of vaginal discharge can be sign of infection with Neisseria gonorrhoeae (gonorrhea).

While inspecting a client's vagina, the nurse notes transverse folds in the outer layer of pink squamous epithelium. These folds are known as which of the following?

Rugae The outer layer of the vaginal wall is composed of pink squamous epithelium that lies in transverse folds called rugae. These transverse folds allow the vagina to expand during intercourse; they also facilitate vaginal delivery of a fetus.

A nurse is describing some of the complications of sexually transmitted diseases (STDs) to a teenaged girl. Which of the following should the nurse mention? Select all that apply

Scarring and adhesions on the fallopian tubes Infertility Pelvic inflammatory disease Ectopic pregnancy STDs can increase the client's risk of pelvic inflammatory disease, which leads to scarring and adhesions on the fallopian tubes. Scarred fallopian tubes increase the risk for infertility and ectopic pregnancy.

The ovum travels from

The ovum travels from the ovary to the uterus through the fallopian tubes. These 8- to 12-cm long tubes begin near the ovaries and enter the uterus just beneath the fundus. The end of the tube near the ovary has fringe0like extensions called fimbriae.

Steatorrhea

The proper term for mucus in the stool is steatorrhea, which indicates the presence of excessive fat in the stool.

A nurse is preparing a client for a Pap smear. The nurse knows that the area where 90% of the neoplasms of the lower genital track originate and the area from which cells will be obtained for the Pap smear is which of the following?

The transformational zone, which is the area created by the migration of the squamocolumnar junction toward the cervical os with maturation or with increased estrogen levels, is the area where 90% of the neoplasms of the lower genital track originate and where cells are obtained for cervical cytology or the Papanicolaou smear (Pap test).

Uterine prolapse is

Uterine prolapse is seen when the cervix or uterus protrudes downward

Vaginal bleeding may indicate a

Vaginal bleeding may indicate a more serious condition such as endometrial or cervical cancer.

Women over the age of 65 who have had adequate prior screening exams and are not otherwise at high risk for cervical cancer....

Women over the age of 65 who have had adequate prior screening exams and are not otherwise at high risk for cervical cancer may choose to stop cervical cancer screening.

In an interview with a client, the client tells the nurse that she is currently taking estrogen replacement therapy. The nurse should mention which of the following conditions that this therapy is a risk factor for? Select all that apply.

Yeast infections Breast cancer Undergoing estrogen therapy (ET) alone sometimes alleviates the symptoms of menopause. However, estrogen has been linked to some types of cancer (i.e., breast, endometrial) and it increases the glycogen content in vaginal secretions, predisposing clients to yeast infections.

Bulging of the posterior vaginal wall may indicate

a rectocele.

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

predisposes the vagina to yeast infections The nurse should inform the client that frequent douching changes the natural flora of the vagina, predisposing the vagina to yeast infections.

A normal menstrual cycle occurs

A normal menstrual cycle occurs approximately every 28-45 days and lasts 3-7 days.

Retroflexed uterus is a

Retroflexed uterus is a normal variation that consists of the uterine body being flexed posteriorly in relation to the cervix

Cervical cancer

Cervical cancer may produce lesions.

A client asks the nurse when a colonoscopy is recommended. Which advice provided by the nurse is most appropriate?

"A flexible sigmoidoscopy should be done every five years starting at age 50." Beginning at age 50, men and women should have a fecal occult blood test or a flexible sigmoidoscopy every 5 years. Both of these are preferred over either one separately. All screening should start at age 50, not 65 years of age. Health care providers should adhere to the screening guidelines, not make their own decisions.

A woman who has undergone a total hysterectomy asks a nurse about follow-up Pap smears. Which statement by the nurse is correct?

"Cervical screening is not necessary once a total hysterectomy is performed." Cervical screening is not necessary once a total hysterectomy (with removal of the cervix) is performed unless the surgery was for cervical cancer.

Which statement by a client in regards to her ability to conceive should prompt a nurse to ask additional questions about infertility?

"My husband and I have had unprotected intercourse for over a year" Infertility is defined as unprotected sex for one year without becoming pregnant.

While inspecting the labia minora, a nurse notices that they are asymmetric. Which of the following does this finding most likely point to?

Abscess Asymmetric labia may indicate abscess.

Anteverted uterus is the

Anteverted uterus is the most typical position of the uterus; wherein the cervix is pointed posteriorly, and the body of the uterus is at the level of the pubis over the bladder.

A nurse begins the speculum examination and finds the vaginal orifice tight. What is the appropriate action by the nurse to facilitate the insertion of the speculum?

Ask the client to bear down to relax the muscles of the perineum If the vaginal opening seems tight or if the examiner experiences difficulty inserting the speculum, ask the client to bear down to relax the muscles of the perineum and promote opening. Lubricant should not be applied to the speculum because these are typically bacteriostatic and will alter the pH and the cell specimens collected for cytology. The speculum should be held vertical and the blades closed until the base of the speculum touches the examiner's fingertips that are inside the vagina.

A male nurse greets a new client in the waiting room of a gynecologist's office. The woman is wearing a burka and does not make eye contact with the nurse. How should the nurse respond to this client?

Ask the client whether she would prefer to be seen by a female nurse Clients from some cultures (e.g., Islam) may insist on having a female nurse for both the nursing history and physical assessment of the female genitalia, anus, and rectum. The best approach would be for the nurse to offer this option to the client.

In a nonpregnant woman, where should a nurse anticipate palpating for the fundus of the uterus?

At the level of the pubis In a nonpregnant woman, the fundus, or large upper end of the uterus, should be at the level of the pubis. Above this level is considered enlarged and further examination should be completed.

Atrophic vaginitis

Atrophic vaginitis causes itching, burning, dryness, and painful urination.

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 The nurse should ask the client to avoid douching 48 hours before the examination. The nurse should ask the client to urinate before the examination so that she does not experience bladder discomfort. The client is helped by the nurse into a dorsal lithotomy position, which is a supine position with the feet in the stirrups. The client's head and shoulders may be elevated to allow the nurse to maintain eye contact with the client. The client should be asked not to place the hands over the head as this tightens the abdominal muscles.

Trichomoniasis causes

Trichomoniasis causes a greenish discharge with a fishy odor.

Bacterial vaginosis produces

Bacterial vaginosis produces a thin, gray-white discharge that has a positive amine (fishy smell) and coats the vaginal walls and ectocervix.

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 Bartholin's glands in the vaginal orifice secrete mucus, which lubricates the area during sexual intercourse.

Chlamydia produces

Chlamydia produces a mucopurulent, yellowish discharge from the cervical os and is not always visible on the external genitalia.

What care should a nurse take when using a speculum to assess a client's cervix? Select all that apply.

Choose the instrument that is the correct size for the client Encourage the client to take deep breaths and keep her feet in the stirrups Insert the speculum at a 45-degree angle downward When assessing a client using a speculum, the nurse should encourage the client to take deep breaths and keep her feet in the stirrups with her knees resting in an open, relaxed fashion. The nurse should choose the instrument that is the correct size for the client. The nurse should insert the speculum between the fingers into the posterior portion of the vaginal orifice at a 45-degree angle downward. The nurse should place two fingers of the nondominant hand against the posterior vaginal wall and wait for relaxation to occur. The blades should not be lubricated using commercial ointments because lubricants are typically bacteriostatic and will alter vaginal pH and the cell specimens collected for cytologic, bacterial, and viral analysis.

Candidal vaginitis

Candidal vaginitis is caused by the overgrowth of yeast in the vagina. It causes a thick, white, cheesy discharge.

Cervical eversion

Cervical eversion is a normal finding after childbirth. The columnar epithelium from within the cervical canal is everted and appears as a deep red, rough ring round the cervical os, surrounded by the normal pink color of the cervix.

Chlamydia infection causes

Chlamydia infection causes a mucopurulent, yellowish discharge that is irritating to the cervix and may cause bleeding and redness of the cervical opening.

A 35-year-old client has a Pap test with a normal test result. The client has had two previous tests with normal results. Which information is correct for the nurse to tell this client with regard to future screening for cervical cancer?

Continue exams every 3 years The U.S. Preventive Services Task Force recommends a variety of screening protocols based on age and a combination of cervical cancer and human papillomavirus (HPV) screenings. Recommendations include the following: screening for cervical cancer in women ages 21 to 65 years with cytology (Pap smear) every 3 years or screening with a combination of cytology and HPV testing every 5 years for women ages 30 to 65 years who want to lengthen the screening interval.

Cowper's glands are located

Cowper's glands are located at the base of the penis in the male and secrete a fluid that helps to lubricate the urethra for sperm to pass through.

When asking a client to bear down as the labia minora is separated, a nurse notices a bulging of the anterior wall of the vaginal musculature. How should this finding be documented by the nurse?

Cystocele Bulging of the anterior vaginal wall may indicate a cystocele.

Trichomoniasis vaginal infection is

Trichomoniasis vaginal infection is caused by a protozoan organism and is sexually transmitted. The discharge is typically yellow-green, frothy, and foul smelling.

When examining the uterus, a nurse finds that the cervix and the body of the uterus are tilted backward. How should the nurse document this uterine finding?

Retroverted Retroverted uterus is a normal variation that consists of the cervix and body of the uterus tilting backward.

A nurse is interviewing a client who is from Bangladesh. Which of the following should the nurse not find unusual, based on this client's country of origin?

Late menarche Menarche (beginning of menstruation) tends to begin earlier in women living in developed countries and later in women who live in undeveloped countries.

Decreased uterine tone is assessed

Decreased uterine tone is assessed by asking the client to squeeze the examiner's finger.

A client presents to the health care clinic for a routine pelvic examination. The client tells the nurse that she has experienced several yeast infections over the past year. The nurse should ask the client about the presence of which disease process?

Diabetes mellitus Diabetes mellitus predisposes women to yeast infections because the increased glucose levels are a good medium for yeast to grow.

Diarrhea is

Diarrhea is an increase in the frequency of loose stool

When examining the genitalia of a client, a nurse observes a columnar epithelium that extends onto the vaginal wall. The nurse recognizes this finding as indicative of what condition?

Exposure to diethylstilbestrol The presence of columnar epithelium that extends onto the vaginal wall indicates exposure to diethylstilbestrol (DES) as a fetus. DES is a drug that was used more than 50 years ago to prevent spontaneous abortion and premature labor.

How should the normal cervix feel to the nurse's fingers? Select all that apply

Firm Soft Round The normal cervix should feel firm and soft (like the tip of the nose). It is rounded and can be moved slightly form side to side without tenderness. A hard, immobile cervix may indicate cancer.

A nurse assesses a 22-year-old client who has never had a Pap test. Which factor should the nurse explain to the client as being a risk for cervical cancer?

Having multiple sexual partners The nurse should inform the client that having multiple sexual partners is a risk factor for cervical cancer. Having the HPV vaccine lowers the risk.

A nurse assesses a 30-year-old client who has never had a Pap test. Which factors should the nurse explain to the client are a risk for cervical cancer? Select all that apply.

History of Chlamydia infection Multiple pregnancies Diet low in fruits The nurse should inform the client that a diet low in fruits, multiple pregnancies, and a history of Chlamydia infection are possible risk factors for cervical cancer. Multiple sexual partners, especially unprotected sex beginning at a young age, are risk factors for cervical cancer.

A nurse assesses a 47-year-old client who reports irregular menstrual cycles. The nurse should assess the client for which additional symptoms related to irregular menstrual cycles? Select all that apply.

Hot flashes Night sweats Spotting Because of this client's age, she may be entering menopause. The nurse should inform the client about hot flashes, spotting, and night sweats which are also symptoms of menopause. Other symptoms include mood swings, decreased appetite, vaginal dryness, and irregular vaginal bleeding

In a nonmenopausal client, a pale

In a nonmenopausal client, a pale cervix may indicate anemia;

In a nonpregnant client, a bluish cervix

In a nonpregnant client, a bluish cervix may indicate cyanosis.

Incontinence and difficulty urinating may be signs of

Incontinence and difficulty urinating may be signs of infection or a sexually transmitted disease.

A nurse inspects the genitalia of an elderly client and notices that the mucosa is dry and atrophied. The nurse should educate the client about her increased risk of what condition?

Infection The older client is more susceptible to vaginal infection because of atrophy of the vaginal mucosa associated with aging.

Inside the labia majora are

Inside the labia majora are the thinner skin folds of the labia minora. These folds join anteriorly at the clitoris and form a prepuce, or hood; posteriorly the two folds join to form the frenulum.

Which position is it most logical for the nurse to place the female client in for the anus and rectum examination?

Lithotomy Although many positions may be used for this exam—the standing, knee- chest, lithotomy, left lateral, or squatting positions—the most logical one is the lithotomy, as the client will already be in this position from the vaginal exam.

A nurse observes a think, white, cheesy discharge at the vaginal opening, with irritation and swelling of the labia. The nurse recognizes this finding as most likely indicating what type vaginal infection?

Moniliasis Candidal vaginitis (moniliasis) is caused by an overgrowth of yeast in the vagina. It causes a thick, white, cheesy discharge.

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 The mons pubis is the fat pad located over the symphysis pubis. The normal adult mons pubis is covered with pubic hair in a triangular pattern. It functions to absorb force and to protect the symphysis pubis during coitus (sexual intercourse)

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 Nabothian cysts are normal findings on the cervix after childbirth. They are small retention cysts, yellow, translucent, odorless, nonirritating, with clear to cloudy, thin to thick discharge.

A nurse inspects the cervix of a 28-year-old, nonpregnant client during a routine assessment. Which coloration of the cervix may indicate inflammation?

Red Redness of the cervix may indicate inflammation. The surface of the cervix is normally smooth, pink, and even.

Drainage from the urethra indicates

Possible urethritis

A college student presents to the health center for a routine Pap smear. She states that she is thinking about becoming sexually active with her boyfriend of 1 year but is afraid that she might become pregnant. She reports a history of no cigarette smoking, no substance abuse or use, and occasionally drinks alcohol on the weekends. She asks the nurse about birth control options and their safety. What is the appropriate diagnosis for this client that the nurse can confirm from this information?

Readiness for Enhanced Health Management This client is asking for information about birth control to prevent pregnancy and therefore the diagnosis of Readiness for Enhanced Health Management: requests information on birth control is appropriate.

What intervention should a nurse follow when obtaining the specimen for a gonorrhea culture?

Spread specimen in a "Z" pattern onto a special culture plate. The nurse should spread the specimen in a "Z" pattern onto a special culture plate for Neisseria gonorrhoeae cultures. A cotton-tipped applicator is inserted into the cervical os and rotated in a full circle. The applicator is left in place for approximately 20 seconds to make sure it becomes saturated with specimen.

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

Steatorrhea The proper term for mucus in the stool is steatorrhea, which indicates the presence of excessive fat in the stool.

The U.S. Preventive Services Task Force recommends a variety of screening protocols based on age and a combination of cervical cancer and human papillomavirus (HPV) screenings.

The U.S. Preventive Services Task Force recommends a variety of screening protocols based on age and a combination of cervical cancer and human papillomavirus (HPV) screenings. Recommendations include the following: screening for cervical cancer in women ages 21 to 65 years with cytology (Pap smear) every 3 years or screening with a combination of cytology and HPV testing every 5 years for women ages 30 to 65 years who want to lengthen the screening interval.

The area of the female external genitalia is

The area of the female external genitalia is sometimes referred to as the vulva, or pudendum, and extends from the mons pubis to the anal opening.

The clitoris is located

The clitoris is located at the anterior end of the labia minora. It is a small, cylindrical mass of erectile tissue and nerves with three parts: the glans, the corpus, and the crura.

Toxic shock syndrome is

Toxic shock syndrome is a life-threatening infection that can be prevented by frequently changing tampons.

Menopause occurring in women older than age 58 years is termed

delayed menopause

Menopause between ages 31 and 40 is

early

In older clients the cervix may appear pale

in older clients the cervix may appear pale after menopause.

The squamocolumnar junction

is the point where the two types of epithelium meet at the cervical os.

A mucopurulent yellowish discharge from the external os is observed in a client with

with mucopurulent cervicitis; it usually indicates infection with Chlamydia or gonorrhea.

Menopause occurring before age 30 is

premature menopause