Ch 71
How are leiomyomas defined?
Benign, slow growing solid tumors of the uterine myometrium
A patient with newly diagnosed gynecologic cancer is being discharged home. Which health care team member does the nurse contact to coordinate nursing care at home for this patient?
Case manager
Which statement about cervical cancer vaccines is accurate?
Gardasil is given as three injections over 6 months.
The nurse is teaching a patient about postsurgical care following a total vaginal hysterectomy. What statement made by the patient indicates a need for further teaching?
"I will monitor my temperature every other day for the first week after surgery."
The nurse is performing discharge teaching for a patient who is recovering from a total abdominal hysterectomy (TAH). Which patient statement indicates a need for clarification?
"I will need to find a new form of birth control."
The registered nurse is teaching a patient who underwent a total abdominal hysterectomy about self-care when discharged. Which statement made by the patient indicates the need for further teaching?
"I will refrain from coughing and deep breathing exercises."
The nurse is teaching care principles to a patient who plans uterus-sparing surgery to remove uterine fibroids. Which patient statement needs clarification?
"It is important to avoid having sexual intercourse for 3 weeks after surgery."
A patient had a total abdominal hysterectomy (TAH) 2 days ago and is to be discharged on antibiotics. What does the nurse include in her discharge teaching about antibiotics?
"It is important to take them as directed until they are all gone."
The registered nurse asked the student nurse to explain post-operative physical changes that occur to a patient who underwent a total abdominal hysterectomy. Which statement made by the student nurse indicates effective learning?
"You may have hot flushes, night sweats, and vaginal dryness, if your ovaries are removed."
Which gynecologic patients does the charge nurse assign to an LPN/LVN?
23-year-old who is nauseated after her laparotomy and needs to receive antiemetic drugs 42-year-old who had an abdominal hysterectomy whose health care provider wants to remove sutures at her bedside
How many layers of classification are there for the leiomyomas in the uterus?
3
Which symptom should the patient report immediately to the primary healthcare provider after undergoing total abdominal hysterectomy?
A burning sensation while urinating
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 test and cervical examination Safe sex practices Well-balanced diet
Which diagnostic test is used to examine organs such as the liver, gallbladder, spleen, pancreas, and kidneys?
Abdominal ultrasound
What is the most common type of tumor?
Adenocarcinoma
Which tumor arises from the glandular part of the endometrium and usually follows endometrial hyperplasia?
Adenocarcinoma
What risk factor is associated with cervical cancer?
African American
The nurse is reviewing laboratory results on a 34-year-old patient who is suspected of having endometrial (uterine) cancer. Which laboratory tests does the nurse expect to see?
Alpha-fetoprotein (AFP) test CA (cancer antigen)-125 test Human chorionic gonadotropin (hCG) level Hereditary nonpolyposis colon cancer (HNPCC) test
A patient is being discharged from the hospital after a total vaginal hysterectomy. What self-management measures does the nurse teach the patient?
Avoid crossing legs at the knees when sitting.
The nurse is teaching a patient how to adapt to physical and psychological changes after surgery for ovarian cancer. What is included in the teaching plan?
Encouraging the use of support groups and counseling Encouraging the expression of grief and fears Suggesting alternatives to vaginal intercourse
What is to be performed to help diagnose abnormalities of the uterus?
Endometrial biopsy
What are the gold standard tests that can be done to determine the presence of endometrial thickening and cancer?
Endometrial biopsy Transvaginal ultrasound
Which is the most common gynecologic malignancy?
Endometrial cancer
Which is related to the growth of leiomyomas?
Estrogen Progesterone Growth hormone
What is the other name for leiomyomas?
Fibroids
The nurse who is teaching a patient about ovarian cancer asks the patient to repeat the risk factors to ensure she has learned the information. Which patient response indicates a need for further teaching?
Having multiple sexual partners
What are the risk factors for endometrial (uterine) cancer?
Hypertension Uterine polyps Late menopause Diabetes mellitus
What factor would increase a patient's risk for cervical cancer?
Infection with the human papilloma virus (HPV)
The nurse is caring for a patient who underwent a uterine artery embolization without a closure device. What action does the nurse take?
Instruct the patient to report any flu-like illness.
What differentiates an intramural leiomyoma from a submucosal leiomyomas?
Intramural leiomyomas are contained in the myometrium.
The nurse is caring for a patient with stage III endometrial cancer. What must the nurse keep in mind?
It usually affects Caucasians more than African Americans.
What is the name of the surgery in which a very small incision is made and an organ can be removed such as an ovary, gallbladder, or appendix?
Laparoscopic surgery
A patient has been prescribed brachytherapy for gynecologic cancer. What does the nurse teach the patient?
Maintain bed rest and avoid excessive movement in bed.
What is a cardinal risk factor for cervical cancer?
Multiple sex partners
A patient is being discharged after having a total abdominal hysterectomy (TAH). What principle guides the nurse who is providing discharge planning and instructions for her?
No special home equipment will be necessary for the patient.
Which patient history places a woman at highest risk for developing endometrial (uterine) cancer?
Nulliparity, smoking, uterine polyps, hypertension
A patient underwent a total abdominal hysterectomy. Which patient activity would lead to a complication after surgery?
Sitting for 3 hours at a time
Which stage of endometrial cancer is confined to the endometrium?
Stage I
How are the uterus, cervix, adjacent lymph nodes, and the surrounding tissues (parametrium) removed?
Radical hysterectomy
Which gynecologic surgery involves the removal of the uterus, cervix, adjacent lymph nodes, the upper third of the vagina, and the surrounding tissues?
Radical hysterectomy
Who calculates the time needed for a specific dose of radiation during brachytherapy?
Radiologist
Which examinations usually reveal the presence of a uterine enlargement?
Rectal Vaginal Abdominal
Which fibroid protrudes into the cavity of the uterus and can cause bleeding and disrupt pregnancy?
Submucosal fibroid
A patient with a uterine leiomyoma has been advised to have a total hysterectomy. Which organs or tissues will be removed during this procedure?
The entire uterus including the cervix
Which statement about uterine fibroids is correct?
The incidence of fibroids increases as women get older.
Which statement about Bartholin cysts is accurate?
The patient may need no intervention if she is asymptomatic.
Which statement about cervical polyps is accurate?
They occur because of hyperplasia of the endocervical epithelium.
What is the purpose of brachytherapy?
To prevent disease recurrence of vaginal cancer
A patient has gynecologic cancer. Which patient statement demonstrates a correct understanding of her treatment options?
"External beam radiation therapy (EBRT) may be used after my cancer surgery."
What is a common disorder of the vulva?
Bartholin cyst
A patient has undergone a total vaginal hysterectomy without removal of the ovaries. What statement by the patient indicates a need for further teaching?
"I may experience hot flushes and night sweats."
Which polyps are pedunculated (on stalks) tumors that arise from the mucosa lining of the intestinal wall and extend through the opening of the cervical?
Cervical polyps
What are the symptoms that may result when an enlarged fibroid presses on other organs?
Constipation Pelvic pressure Urinary retention
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."
A 52-year-old patient has been diagnosed with endometrial (uterine) cancer. She says to the nurse, "I was told that my cancer is stage II. What does that mean?" How does the nurse respond?
"Your cancer has spread from your uterus to your cervix."
The nurse is providing postoperative care for a patient after a total abdominal hysterectomy. What are the postoperative priorities for the nurse?
Monitor vaginal bleeding. Monitor dressing and drains. Monitor and record urine output for 24 hours.
What discharge instructions should be provided to a patient who underwent an abdominal hysterectomy?
Refrain from lifting heavy objects
A patient is scheduled for a total hysterectomy with a laparoscopic vaginal approach after a diagnosis of microinvasive cervical cancer. What psychological and/or social changes does the nurse expect this patient to experience?
Sexual counseling may be needed, especially if the patient has doubts about her ability to feel like a woman and engage in sexual activities.
A patient underwent a magnetic resonance imaging (MRI) diagnostic exam of the abdomen that reveals a fibroid tumor larger than the size of a 16-week pregnancy. The recommended treatment is removal of uterus and cervix. Which gynecologic surgery is appropriate for this patient?
Total abdominal hysterectomy
Which surgery is performed for leiomyomas larger than the size of a 16-week pregnancy?
Total abdominal hysterectomy
Which surgery can be used to remove the entire uterus, including the cervix?
Total hysterectomy
What complication causes pain in women with fibroids?
Twisting of the fibroid on its stalk
Which organs are removed in a panhysterectomy?
Uterus, ovaries, and fallopian tubes
Which surgery requires the removal of the fallopian tubes and ovaries?
Bilateral salpingo-oophorectomy
Where is the intramural fibroid located?
Within the wall of the uterus
