Chapter 45 all: Disorders of the Female Reproductive System
A client is experiencing oligomenorrhea. The nurse interprets this as:
infrequent menstruation with periods more than 35 days apart.
Which of the following factors in a patient's history is most likely related to the diagnosis of cervical squamous dysplasia?
Human papillomavirus (HPV) infection.
A female client with blocked fallopian tubes seeks assistance at a fertility clinic. Which assisted reproductive technology will bring the greatest chance for conception?
In vitro fertilization (IVF)
A female client presents to her primary care physician with a report of very heavy bleeding during menstrual cycles. Tests indicate the condition is not from a hormone imbalance. Which intervention option is least invasive?
Oral contraceptives
A client has been diagnosed with a Bartholin gland cyst. The nurse expects the client may experience which symptoms if this becomes infected?
Pain, tenderness, and dyspareunia
The gonads of the female have a dual function. Which of the following is a function of the female gonads?
Storing female germ cells.
A malignant lesion extending into the endocervical canal was found on the yearly gynecological exam of a 20-year-old woman. Which treatment option would be most appropriate for this client?
Therapeutic conization
The connecting tube between the cervix and the vestibule is referred to as which of the following?
Vagina.
Which clinical manifestation is most likely to accompany a diagnosis of vulvodynia?
Vulvar pain
The nurse is checking the pH of a client's vagina tissue and finds the pH to be 4.3. The nurse interprets this finding as:
normal.
A female client reports that her mother-in-law was just diagnosed with cervical cancer and asks the nurse about her own risk. Which response by the nurse is correct?
"If you had the human papillomavirus (HPV) vaccine, your risk is greatly reduced."
A female patient informs the nurse that she is having hot flashes on occasion, has trouble sleeping, and thinks that she is having some symptoms of menopause. The patient asks the nurse how long these symptoms will last prior to experiencing menopause. Which of the following is the best response?
"Perimenopause can precede menopause by approximately 4 years."
What will the nurse teach the client who has a cervical polyp?
"Polyps typically are asymptomatic"
During a group prenatal class, the nurse teaching the course is explaining the thinning of the cervix that accompanies the stages of labor leading up to delivery. A participant admits that she is not familiar with either the location or normal role of the cervix. Which of the following responses by the nurse would be most appropriate?
"The cervix is the opening between the uterus and the vagina and so it opens wide during the lead-up to birth."
A client asks the health care provider to, "Explain brachytherapy, which is recommended for my cervical cancer." Which response by the nurse is most accurate?
"They will insert a radioactive device into your vagina and position it next to the cervix, so that curative levels of radiation are directly on the cancer site." Intracavitary irradiation or brachytherapy (i.e., insertion of radioactive materials into the body) can be used in the treatment of cervical cancer. Intracavitary radiation provides direct access to the central lesion and increases the tolerance of the cervix and surrounding tissues, permitting curative levels of radiation to be used.
The nurse is caring for a forty-eight-year-old female client who asks, "How do you know when you have reached menopause?" Which of the following is an appropriate response by the nurse?
"You are considered to be menopausal when you have not menstruated for a full year and the hormone that fluctuates with menstruation no longer fluctuates."
The nurse is teaching a group of fifth-grade girls about menstruation. One of the students asks, "Will I have periods the rest of my life?" Which of the following is an appropriate response by the nurse?
"You will have periods until you are about 48 to 55 years of age."
n asymptomatic client who is worried about developing breast cancer due to the fact that it runs in her family asks the nurse if she could have a mammogram to see if she has any lumps. The nurse informs the client that a tumor usually is undetectable until it has doubled 30 times and contains more than 1 billion cells. This means that at this point it measures approximately which size? 3 cm 4 cm 1 cm 5 cm
1 cm A tumor that measures anything over 1 cm including 3 cm, 4 cm, and 5 cm would definitely be detectable using radiography.
When a woman asks the nurse at what age menopause usually occurs, what should the nurse respond?
48 to 55 years of age.
A client who has a history of untreated cervicitis tells the nurse that she is concerned about the risk of experiencing problems with fertility. The nurse explains that problems may result from:
Ascending infection of the fallopian tubes.
A female client's assessment identifies symptoms of dyspareunia and burning. The nurse is aware that the client may have developed:
Atrophic vaginitis.
There are many cancers of the female reproductive system. The nursing student knows that the most readily detected and most easily cured cancer—if detected early—is:
Cervical
Which woman will the nurse encourage to have annual Papanicolaou (Pap) smears? Select all that apply.
Client age 63, postmenopausal for 10 years Client age 44, has multiple sexual partners Client age 27, history of human papillomavirus (HPV)
The vulva area is especially prone to skin infections. The nurse knows that this occurs because of:
Constant exposure to secretions and moisture
A 33-year-old client has sought care because her premenstrual symptoms have been having a negative effect on her quality of life, to the extent that she describes herself as being "unable to function" for several days each month. Which interventions are known to benefit this client's condition? Select all that apply.
Diuresis, Reduction in sugar intake, and Exercise, as tolerated.
The nurse working in a fertility clinic is assessing a patient's risk for fallopian tube obstruction. Which one of the following places the woman at greatest risk?
Endometriosis.
The endocrine system is highly involved in the female reproductive system. Which hormones are used to stimulate the primordial follicles?
FSH and LH.
A nurse educator is explaining the process of sexual intercourse, fertilization, and fetal development to a high school biology class. What process should the nurse describe?
Fertilization in the outer portion of the fallopian tube.
A client has just become pregnant and there is a consequent increase in secretions from the columnar epithelium of her endocervix. What effect will this have?
Formation of a mucoid plug to protect her uterus.
A woman with a regular 28-day menstrual cycle wishes to become pregnant. At which point in the menstrual cycle is the optimal time for intercourse to end in fertilization of the ovum?
Fourteenth day after menses begins.
A 38-year-old woman with proliferative breast changes of papilloma asks the nurse about her risk for breast cancer. Which statement of risk is correct?
Higher because of your papilloma
A female patient with a strong family history of cardiovascular disease asks the nurse if she should take estrogen replacement while in menopause. Which of the following is the nurse's best response?
"Estrogen has additional cardioprotective actions and you and your physician should determine if this would benefit you."
The environment of the vagina is moist with a pH 4.0 to 4.5. The major purpose of the acidic environment is which of the following?
Bacteriostatic.
A female client with anorexia nervosa tells the nurse that she has been experiencing amenorrhea. The nurse is aware that this is a result of:
Alteration of critical body fat-to-muscle ratio needed for menses to occur.
The nurse is caring for a client with lichen simplex chronicus. What assessment finding does the nurse expect? Gray-white plaques with an irregular surface Black patches of skin Bleeding Painful urination
Gray-white plaques with an irregular surface Lichen simplex chronicus presents as thickened gray white plaques with an irregular surface. It is thought to be a response of the genital skin to some type of irritant. Bleeding, pain, and black patches are not seen with this disorder.
The nurse practitioner is reviewing risk factors for the development of pelvic inflammatory disease (PID) with a client. Which information is appropriate to include? Select all that apply. Multiple sex partners Previous diagnosis of sexually transmitted infection Sexual intercourse before the age of 15 years Age older than 30 years Use of barrier contraception
Multiple sex partners Previous diagnosis of sexually transmitted infection Sexual intercourse before the age of 15 years Factors that predispose women to the development of PID include an age younger than 25 years; young age at first intercourse (younger than 15 years); use of nonbarrier contraception, especially intrauterine device or oral contraception; history of new, multiple, or symptomatic sex partners; and previous history of PID or sexually transmitted infection.
A pregnant patient asks the nurse what is causing her lower leg edema, nausea, and constipation that she is experiencing. Which of the following is the nurse's best response?
"The increase in progesterone during pregnancy is most likely the cause of these discomforts."
Select the structure primarily responsible for the secretions of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin.
Anterior pituitary gland.
The health care provider suspects a diagnosis of endometriosis. Which procedure provides a definitive diagnosis? Laparoscopy Computed tomography (CT) scan Magnetic resonance imaging (MRI) Loop electrosurgical excision procedure (LEEP)
Laparoscopy Endometriosis may be difficult to diagnose because its symptoms mimic those of other pelvic disorders. Definitive diagnosis can be accomplished only through laparoscopy and confirmed with histological testing.
A woman reports to the primary healthcare provider that she experiences monthly changes before her menstrual cycle. Which statement demonstrates understanding of premenstrual disorders?
Many women report premenstrual emotional or physical changes.
A client asks the nurse what hormone is responsible for temperature elevation that occurs with ovulation. The best response would be:
Progesterone.
Which of the following benefits are found from the secretions of the columnar epithelium of the endocervix? (Select all that apply.)
Protect the uterus from infection, form a mucous plug during pregnancy, and alter receptivity.
What is the most important discharge instruction for a female client with pelvic inflammatory disease (PID)?
Take all of the antibiotic
A nurse is teaching a class about the proper way to insert an indwelling catheter. Which of the following statements made by one of the students would demonstrate that the teaching has been effective?
"I will insert the catheter into the urethra."
A client with vulvodynia tells the nurse, "This is not getting better. I just can't live like this." What is the best response by the nurse?
"What bothers you the most about your condition?"
nurse who works in a fertility clinic is conducting a program on options for various fertility issues. The nurse judges that the participants understand the education when they identify that donor eggs are the best option for which woman? A 42-year-old A 28-year-old A 33-year-old A 38-year-old
A 42-year-old Donor eggs provide a much higher likelihood of success for women older than 40 years of age, when both egg numbers and egg quality decline.
What is a primary intervention for the nurse to implement for a client with pelvic inflammatory disease ?
Administer antibiotic therapy.
The nurse is explaining ovulation to a female client. The nurse explains that follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are important hormones needed to ovulate and are secreted by which of the following glands?
Anterior Pituitary.
A client with polycystic ovary syndrome (PCOS) visits a fertility clinic. Which intervention will best improve the chance for a successful pregnancy? Weight loss Metformin Clomiphene Spironolactone
Clomiphene Clomiphene is a hypothalamic-pituitary-stimulating drug that promotes ovulation. This is the agent of choice for improving successful pregnancy in clients with PCOS. Clients with PCOS are encouraged to lose weight tbecause obesity is known to increase insulin resistance and promote androgen production, which leads to development of multiple immature follicles. Metformin is an insulin-sensitizing agent that helps control blood glucose, but it is not directly beneficial in promoting pregnancy. Spironolactone may be useful in suppressing hirsutism that results from excess androgen production, but it will not affect pregnancy.
A client who has been diagnosed with premenstrual syndrome (PMS) asks if there is anything to help alleviate the symptoms. The best response would be: Eat a diet low in simple sugars and high in protein. Increase intake of caffeine products . Limit activities and maintain bed rest as necessary. Decrease intake of fluids reduces fluid retention.
Eat a diet low in simple sugars and high in protein. Treatment for PMS includes treating various symptoms. A diet low in sugar and high in protein and reduction in caffeine intake are recommended. Other suggestions include diuretics to reduce fluid retention, continue fluid intake as usual, regular exercise, and analgesics for pain.
A female patient informs the nurse that she had intercourse yesterday evening and is wondering if she could become pregnant. She asks the nurse that if she was pregnant, where it would be located at present. Which of the following should the nurse tell the patient?
Fertilization normally occurs in the middle to outer portion of the Fallopian tube.
In assessing a client with a fibroadenoma of the breast, what will the nurse find? Hard masses Unmovable masses Firm, rubbery masses Extreme pain during menstruation
Firm, rubbery masses The nurse will find firm, rubbery masses in a client with fibroadenoma. The masses will be moveable and there is not extreme pain. They are usually asymptomatic.
The nurse is assessing a 24-year-old client who states that she has infrequent menstrual periods that are approximately 40 to 42 days apart. She also states, "My periods are really light. It's almost like I hardly even need to use a pad sometimes." The nurse should document which medical terms associated with this client's menstruation? Select all that apply.
Hypomenorrhea Oligomenorrhea
The ovaries secrete both estrogen and progesterone. What is one function of progesterone in the body?
Increases body temperature at ovulation.
During the female menstrual cycle hormones are produced and excreted by various reproductive organs. The hormone progesterone is secreted and is metabolized in which of the following organs?
Liver.
The ovaries have a dual function. The nurse is able to explain to the client that any problems with the ovaries frequently cause which problem?
Menstrual and fertility problems
Polycystic ovary syndrome is an endocrine disorder and a common cause of chronic anovulation. In addition to the clinical manifestations of PCOS, long-term health problems, including cardiovascular disease and diabetes, have been linked to PCOS. What drug has emerged as an important part of PCOS treatment?
Metformin.
Which of the following interventions would the nurse expect to perform for a patient with primary dysmenorrhea? Select all that apply.
Oral contraceptives, and Nonsteroidal anti-inflammatory drugs (NSAIDs).
Leiomyomas are smooth-muscle fibroid tumors that usually develop in which part of the reproductive system? Fibrocystic breasts Ovaries Uterosacral ligaments The corpus of the uterus
The corpus of the uterus Leiomyomas, also known as myomas or fibroids, are benign uterine neoplasms of smooth-muscle origin. They usually develop as submucosal, subserosal, or intramural tumors in the corpus of the uterus. The uterosacral and other ligaments maintain the uterus and other pelvic structures in proper position; ligaments weaken with age without forming fibrous tumors. Fibrocystic changes, formerly called fibrocystic breast disease, are benign irregular fibrous breast lesions. The ovaries may develop follicular or corpus luteum cysts, which are generally benign.
A female patient presents to her primary healthcare provider stating, "I have such intense vulvar itching that it is driving me crazy." Which of the following assessments would correspond with a diagnosis of lichen sclerosus?
Thinning epithelium with introitus scarring.
A client has been diagnosed with breast cancer following a suspicious mammogram followed by biopsy. The nurse who is planning this client's care should recognize that her prognosis is primarily dependent on the:
extent to which lymph nodes are involved.
A client who is seeking to become pregnant has made an appointment with a fertility specialist. The clinician is describing the role of the fallopian tubes in response to a question from the client. Which physiologic processes should be explained to the client? Select all that apply.
Facilitating drainage of secretions into the uterus, Providing a passageway for ova, and Acting as a passage for sperm after coitus.
A client reporting low abdominal pain, purulent cervical discharge, and painful intercourse is diagnosed with pelvic inflammatory disease (PID). The provider educates the client about this disease mentioning which statement? Associated with chronic endometriosis Caused by a ruptured tubal pregnancy Is a polymicrobial infection of the upper reproductive tract Is associated with serous luteal ovarian cyst formation
Is a polymicrobial infection of the upper reproductive tract Pelvic inflammatory disease (PID) is an inflammation and polymicrobial infection of the upper reproductive tract that involves the uterus (endometritis), fallopian tubes (salpingitis), or ovaries (oophoritis) associated with sexually transmitted and endogenous organisms.
A female patient is being seen in the ED with complaints of lower abdominal pain, dyspareunia, back pain, purulent cervical discharge, and the presence of adnexal tenderness and painful cervix on bimanual pelvic examination. The nurse suspects the patient has pelvic inflammatory disease (PID), and will assess the patient for which of the following?
Number of sexual partners.
The nurse providing teaching about the female reproductive system includes which of the following?
Ovaries are responsible for ovulation and hormone production.
In the normal menstrual function which of the following is primarily responsible for controlling the cyclic changes and length of the menstrual cycle?
Ovaries.
A female client with uterine leiomyomas asks the nurse about her risk of uterine cancer. Which statement best answers the question?
"Your leiomyomas may cause heavy periods but will not become cancerous."
The nurse is teaching a client with polycystic ovary syndrome (PCOS) about the condition. Which statement by the client indicates a need for further instruction? "I developed this as a result of a sexually transmitted infection." "I may have inherited a tendency to this disorder." "I need to regulate my weight to help prevent complications." "I may need medical intervention when I want to conceive."
"I developed this as a result of a sexually transmitted infection." PCOS is an endocrine disorder with a genetic link. Clients with PCOS can prevent diabetes and improve fertility by controlling obesity. Infertility may be an issue for clients with PCOS even if they control their weight. For those women, additional medication may be necessary to improve ovulatory cycles.
The nurse has taught a 30-year-old female client to perform breast self-evaluation (BSE). Which statement by the client indicates correct understanding? "I will perform BSE on the first of every month during a shower." "I will let my partner examine my breasts on a monthly basis." "I will look in a mirror and call my doctor for breast asymmetry." "I will palpate my breasts for lumps a few days after my period."
"I will palpate my breasts for lumps a few days after my period." Premenopausal women should time the exam for a few days after menses begins. This is when the breast tissue is less tender or enlarged in response to estrogens that build up before menses. Men and postmenopausal women should select a convenient date.
A client diagnosed with endometriosis asks the nurse how it is that she did not know about this when she had it for so long. What is the nurse's best response? "It is a rare disease." "Its symptoms mimic those of other disorders " "There are no symptoms." "You needed to have surgery to diagnose it."
"Its symptoms mimic those of other disorders." Symptoms of endometriosis often mimic symptoms of other pelvic disorders and the severity of the symptoms does not always reflect the extent of the disease. There are no serum markers or non-invasive tests for the disease. It is not rare, and you do not need surgery to diagnose it; however, definitive diagnosis can be accomplished with laparoscopy and histological testing. Most cases are diagnosed on symptomatology.
After an office visit with her primary health provider, a female client with an elevated CA-125 test result asks the nurse if that means she has ovarian cancer. What is the nurse's best response?
"The test is not specific for ovarian cancer but suggests further evaluation to find the cause of the elevation." The CA-125 tumor marker is a cell surface antigen. The level may be elevated for a variety of reasons including inflammation, endometriosis, uterine fibroids, pregnancy, liver disease, and cancers of the cervix, fallopian tube, and pancreas. It is elevated in about 50% of cases with early stage ovarian cancer, but has more predictive value with postmenopausal women or women with more advanced stages of cancer.
The nurse is teaching a female client who has been prescribed hormone therapy. The client asks,, "What does this medication do?" Which of the following is an appropriate response by the nurse?
"This medication will help relieve hot flashes and other adverse symptoms of menopause."
A school nurse is providing an informational session about the prevention of cervical cancer in young girls and women. The most important information for the nurse to present would be: A. HPV vaccine before becoming sexually active B. Use of latex condom with each and every sexual encounter C. Abstinence of sexual activity until in a monogamous relationship D. Use of low-dose estrogen oral contraceptive pills or patches
A. HPV vaccine before becoming sexually active.
A patient is diagnosed with vulvar carcinoma, which appears as an inconspicuous thickening of the skin resembling eczema or dermatitis and may produce few symptoms other than pruritus, local discomfort, and exudation. The nurse understands that the cancer metastasizes readily through which mode?
.Multiple lymph channels The malignant lesion gradually spreads superficially or as a deep furrow involving all of one labial side. Because there are many lymph channels around the vulva, the cancer metastasizes freely to the regional lymph nodes.
Which female client is at risk for amenorrhea? 18-year-old with anorexia nervosa 25-year-old with peptic ulcer disease 32-year-old with hypertension 45-year-old with myocardial infarction
18-year-old with anorexia nervosa. Absence of a menstrual cycle may occur as a result of gonadal dysgenesis, or a hypothalamic-pituitary-ovarian axis disorder. Additional causes include ovarian dysfunction, intrauterine adhesions, infections, anorexia nervosa, and strenuous physical exercise that alters the fat-to-muscle ratio.
The client has a Bartholin cyst that has developed into an abscess. The nurse explains to the client the plan of care, including which treatments? A catheter may be inserted to drain the cyst for several weeks. Application of dry heat. A hysterectomy will be required. Antifungal cream will be administered.
A catheter may be inserted to drain the cyst for several weeks. The treatment of symptomatic Bartholin cysts consists of the administration of appropriate antibiotics, local application of moist heat, and incision and drainage. A Word catheter may be inserted to continue to drain the cyst for a few weeks.
What will the nurse assess in a client diagnosed with Paget disease as a cause of breast cancer?
A lesion of the nipple on the affected breast.
A woman comes to the clinic with complains of vague, lower abdominal symptoms. Upon physical exam, the healthcare provider recognizes the woman has symptoms of leiomyomas based on which assessment findings? Select all that apply.
Anemia Urinary frequency Rectal pressure Menorrhagia Abdominal distention
A 29-year-old client had a Papanicolaou smear performed during her most recent visit to her primary care provider. This diagnostic procedure aims to identify:
Atypical cervix cellular changes
A woman of child-bearing age asks the nurse about a natural method to avoid pregnancy. What is an appropriate response?
Avoid sex when cervical mucus is most stretchy.
What should the nurse teach the client about assessing for possible breast cancer? A. "There is no way for you to assess for this." B. "Perform monthly self-breast exams after menses." C. "Have an MRI every 6 months if you are high risk." D. "Have mammography yearly beginning at the time of menses."
B. "Perform monthly self-breast exams after menses." Self-breast exams should be conducted monthly at the beginning of the time of menses. MRIs are not currently recommended as routine screening. Mammography is not started when menses starts. (note: new recommendation no evidence BSE helps)
Which sexually active woman most likely faces the highest risk of developing an ectopic pregnancy? A. 14-year-old who experienced menarche 2 years earlier B. 42-year-old who has decided to try to have one more child and has had her tubal ligation reversed C. A 27-year-old who stopped using medroxyprogesterone contraceptive injection several months ago D. A 22-year-old who has a history of anorexia nervosa and who has a body mass index (BMI) of 12.0 (normal BMI = 18.5-24.9)
B. 42-year-old who has decided to try to have one more child and has had her tubal ligation reversed Previous tubal ligation is an identified risk factor for ectopic pregnancy. Young age, use of injection contraception, and low BMI are not specifically associated with ectopic pregnancy.
Which condition would the nurse expect a female client with human papillomavirus (HPV) to exhibit? Cervical intraepithelial neoplasia Lichen simplex chronicus Infertility Adenomyosis
Cervical intraepithelial neoplasia The presence of HPV increases cell dysplasia in the cervical transition zone, called cervical intraepithelial neoplasia, and ranked into three levels. The most common cause of dysplasia is HPV infection. Lichen simplex chronicus is a condition of intense itching of the vulva. HPV does not cause infertility or adenomyosis, which occurs when endometrial tissue becomes interspersed between smooth muscle fibers.
A 45-year-old client reports "needing to bear down with urination," frequency, and occasional loss of urine when coughing. Based on symptoms, which diagnosis is most appropriate for this client? Cystocele Enterocele Rectocele Spermatocele
Cystocele Cystocele is the herniation of the bladder into the vagina resulting in urinary symptoms. The bear-down sensation is common in this disorder and not found in the other disorders. Rectocele is the herniation of the rectum into the vagina. Enterocele can be asymptomatic or cause a dull, dragging sensation and occasionally low backache. Spermatocele is a male disorder.
A 59-year-old woman with a recent diagnosis of breast cancer has begun a course of hormone therapy. What is the goal of this pharmacologic treatment? A. Blocking the effects of progesterone on tumor growth B. Increasing serum hormone levels to promote tumor cell lysis C. Blocking the entry of malignant cells into the axillary lymph nodes D. Blocking effects of estrogen on the growth of malignant cells
D. Blocking effects of estrogen on the growth of malignant cells Hormone therapy is used to block the effects of estrogen on the growth of breast cancer cells. Among the most common drugs used for hormone therapy is tamoxifen, a nonsteroidal antiestrogen that binds to estrogen receptors and blocks the effects of estrogens on the growth of malignant cells in the breast. Such drugs do not directly block axillary node involvement or induce tumor cell lysis.
Ectopic pregnancies are true gynecologic emergencies and are considered the leading cause of maternal death in the first trimester. What diagnostic test would the nurse expect to have ordered for a suspected ectopic pregnancy? A. Serial β-human chorionic gonadotropin (hCG) with higher than normal hCG production B. Amniocentesis C. Transvaginal ultrasound if pregnancy is less than 5 weeks gestation D. Ultrasonography followed by serial hCG tests
D. Ultrasonography followed by serial hCG tests Diagnostic tests for ectopic pregnancy include a urine pregnancy test, ultrasonography, and β-hCG (hormone produced by placental cells) levels. Serial β-hCG tests may detect lower than normal hCG production. Transvaginal ultrasound studies after 5 weeks' gestation may demonstrate an empty uterine cavity or presence of the gestational sac outside the uterus. In a comparison of various protocols for diagnosing ectopic pregnancy, ultrasound followed by serial hCG levels was found to yield the best results.
A female client reports a grayish-green nipple discharge in one breast. Which additional manifestation corresponds with a diagnosis of ductal ectasia? Ductal inflammation with thickening Multiple nodules in the breast Firm, fixed, irregular nodule Tender, fluid-filled sac
Ductal inflammation with thickening Ductal ectasia occurs spontaneously in older women as a grayish-green discharge from one breast. Discharge increases with palpation and includes burning, itching, and a pulling sensation of the nipple. Inflammation and thickening occur in the involved duct.
The nurse in the ER is caring for a client with lower abdominal pain that is greater on the right side and who has light vaginal spotting. When the client's human chorionic gonadotropin (hCG) level is lower than normal, the nurse plans care for a client with: Ectopic pregnancy Appendicitis Cervical cancer Premenstrual syndrome
Ectopic pregnancy The symptoms described, and the positive but low hCG, would be most indicative of an ectopic pregnancy. Appendicitis could be suspected with right lower abdominal pain, but would not have a positive hCG and spotting. Neither PMS nor cervical cancer would present with all the above symptomology.
The nurse working in a fertility clinic is assessing a client's risk for fallopian tube obstruction. Which disorder places the woman at greatest risk for fallopian tube obstruction? Endometriosis Vaginitis Uterine prolapse Dysmenorrhea
Endometriosis Tubal patency is required for fertilization and can be disrupted secondary to PID, ectopic pregnancy, large myomas, endometriosis, pelvic adhesions, and previous tubal ligation. The remaining options do not relate to the fallopian tubes.
Events in the ovulatory cycle progress in a similar manner each month. Place the following events in the ovulatory cycle in the correct chronological order. Use all the options.
Formation of the theca, Formation of the corpus luteum, Formation of the antral follicle, Development of the zona pellicuda, and Bursting of the mature follicle.
There are two types of vulvar cancer. One type is found in older women, and one type is found in younger women, generally less than 40 years of age. The type found in younger women is thought to be caused by: Multiple sexual partners Human papillomavirus (HPV) Nonsquamous cell lesions Lichen sclerotic lesions
Human papillomavirus (HPV) 1/3 to 1/2 of vulvar intraepithelial neoplasia (VIN) cases appear to be caused by the cancer-promoting potential of certain strains (subtypes 16 and 18) of HPV that are sexually transmitted and are associated with the type of vulvar cancer found in younger women. The other answers are not thought to be associated with vulvar cancer in younger women.
Which factor in a client's history is most likely related to the diagnosis of cervical squamous dysplasia? Bartholin cysts Human papillomavirus (HPV) infection Endometriosis Infertility
Human papillomavirus (HPV) infection HPV is the most common cause of cell dysplasia, as the virus causes cell changes. Conditions that do not contribute to cell dysplasia include endometriosis, Bartholin cysts, and infertility. Bartholin cysts occur when the ducts from the Bartholin glands become blocked. Endometriosis occurs when the endometrial tissue is displaced in the body. Infertility is inability to conceive or maintain pregnancy.
The nurse performs a complete physical assessment on a client with polycystic ovary syndrome (PCOS). Which assessment findings support this diagnosis? Select all that apply. Elevated blood glucose Dysmenorrhea Increased dark facial hair Decreased luteinizing hormone (LH) level Obesity
Increased dark facial hair Elevated blood glucose Obesity PCOS is an endocrine disorder affecting between 5% and 10% of women of childbearing age. Common manifestations include irregular infrequent menstrual periods, signs of hyperandrogenism such as acne and excess body hair, elevated testosterone levels, obesity, insulin resistance, and polycystic ovaries. Also characteristic of the disorder is an imbalance between LH and FSH (follicle-stimulating hormone) where the LH levels are higher in proportion to FSH. This leads to anovulation and infertility.
The nurse performs a complete physical assessment on a patient with polycystic ovary syndrome (PCOS). Which of the following assessments support this diagnosis? Select all that apply.
Increased dark facial hair, Elevated blood pressure, and Obesity.
The client is diagnosed with vaginitis. What will the nurse assess? Select all that apply. Inflammation of the vagina Vaginal discharge Burning and itching Pain with urination Age over 60 Postmenopausal
Inflammation of the vagina Vaginal discharge Burning and itching Pain with urination Vaginitis represents an inflammation of the vagina that is characterized by discharge, burning, itching, and pain with urination. It can occur at any age and is not restricted to postmenopausal women.
The parents of a 9-year-old child ask the nurse for information about quadrivalent human papillomavirus recombinant vaccine. Which information is appropriate for the nurse to provide? Select all that apply. It can be given to boys and girls. It produces short-term immunity. It prevents a common cause of cervical cancer. It prevents sexually transmitted infections. It is ideally given before the child is sexually active.
It is ideally given before the child is sexually active. It prevents a common cause of cervical cancer. It can be given to boys and girls. The quadrivalent human papillomavirus recombinant vaccine is given to boys and girls between the ages of 9 and 26 years, before they begin sexual activity if possible, for the best protection. The vaccine provides long-term immunity from human papillomavirus (HPV), which is a common cause of cervical cancer. It does not protect against other sexually transmitted diseases.
A client has been diagnosed with acute cervicitis caused by Chlamydia trachomatis. Which clinical manifestation correlates to this diagnosis? Abscess formation Mucopurulent drainage Thick, gray-white plaques Persistent pruritic vulvitis
Mucopurulent drainage With acute cervicitis, the cervix becomes reddened and edematous; irritation from the infection Chlamydia trachomatis results in copious mucopurulent drainage and leukorrhea. Bartholin gland obstruction causes a cyst to form, becomes purulent, and results in abscess formation. Lichen simplex chronicus lesions are labial thick, gray-white plaques. Squamous cell vulvar carcinoma is characterized by a recurrent, persistent, pruritic vulvitis, sometimes as the only report.
he nurse practitioner is reviewing risk factors for the development of pelvic inflammatory disease (PID) with a client. Which information is appropriat
Multiple sex partners Previous diagnosis of sexually transmitted infection Sexual intercourse before the age of 15 years
A 14-year-old female client experiences headache and cramping abdominal pain 1 to 2 days before each menstrual period. Which symptoms correlate with a diagnosis of primary dysmenorrhea? Select all that apply. Nausea Diarrhea Fainting Drowsiness Psychiatric symptoms
Nausea Diarrhea Fainting Primary dysmenorrhea (pain) is menstrual pain that occurs without a physical abnormality or pathological condition. Symptoms usually occur 1 to 2 days before menses, peak on the first day of flow, and subside within several hours to days. Systemic symptoms that may accompany severe primary dysmenorrhea include nausea, vomiting, diarrhea, fatigue, irritability, dizziness, and syncope. The pain usually occurs in the lower abdomen and is commonly described as dull, aching, or cramping. It may radiate to the lower back, upper thighs, or labia majora.
A client reports irregular, very painful bleeding. While taking the history of this postmenopausal client, the health care provider is alert to which high-risk factor associated with ovarian cancer? Never had any children Lactation history Mammary duct ectasia Oral contraceptive use for many years
Never had any children Most significant risk for ovarian cancer appears to be ovulatory age-the length of time during a woman's life when her ovarian cycle is not suppressed by pregnancy, lactation, or oral contraceptive use. A family history of cancer (particularly breast and ovarian cancer) and nulliparity (not been pregnant) increase the risk of developing ovarian cancer, whereas oral contraceptive use, pregnancy, and lactation decrease the risk. There are no effective screening methods for ovarian cancer, and most cancers of the ovary produce no symptoms. Ductal ectasia manifests in older women as a spontaneous, intermittent, usually unilateral, grayish green nipple discharge.
A female client is being seen in the ED with complaints of lower abdominal pain, dyspareunia, back pain, purulent cervical discharge, and the presence of adnexal tenderness and painful cervix on bimanual pelvic examination. The nurse suspects the client has pelvic inflammatory disease (PID), and will assess the client for: Dietary habits Number of sexual partners Use of oral contraceptives Toileting habits
Number of sexual partners PID is a polymicrobial infection of the upper reproductive tract (uterus, fallopian tubes, or ovaries) often associated with STIs. Factors associated with development of PID includes an age of 16 to 24 years, nulliparity, history of multiple sexual partners, and previous history of PID. The symptoms of PID include lower abdominal pain, which may start just after a menstrual period; dyspareunia; back pain; purulent cervical discharge; and the presence of adnexal tenderness and exquisitely painful cervix on bimanual pelvic examination.
Polycystic ovary syndrome (PCOS) is a common endocrine disorder. The nurse understands that about 50% of the women who are diagnosed with PCOS have which problem? Obesity Diabetes insipidus Hyperprogesterone Hypoandrogen
Obesity About 50% of women who are diagnosed with PCOS are obese. Hyperinsulinemia and insulin resistance are thought to play a role in the pathogenesis
A female client is being evaluated for abdominal pain and unusual menstrual bleeding. What factors in her history will the nurse identify as increasing the risk for endometrial cancer? Select all that apply . Obesity Estrogen therapy Trichomonas infection Diabetes mellitus Polycystic ovary syndrome
Obesity Estrogen therapy Diabetes mellitus Polycystic ovary syndrome Unopposed estrogen stimulates endometrial hyperplasia, which can lead to cell abnormalities developing into cancers. Obesity, diabetes mellitus, polycystic ovary syndrome, and hormone replacement therapy with unopposed estrogen are all factors that produce a situation with increased estrogen levels that increase risk of endometrial cancer. Sexually transmitted infections such as trichomonas do not change estrogen levels.
A 24-year-old client with a body mass index (BMI) of 35 has been diagnosed with polycystic ovary syndrome (PCOS) and is exploring treatment options. What treatment options should the nurse share with the client? Select all that apply. Oral contraceptives A calorie-reduced diet Progesterone creams Corticosteroids Biguanide medication
Oral contraceptives A calorie-reduced diet Biguanide medication Polycystic ovary syndrome involves hyperinsulinemia and insulin resistance and results in irregular menses, hirsutism, and acne. Many clients are obese at the time of diagnosis and weight loss through a calorie-restricted diet is recommended. Treatments include oral contraceptives that contain estrogen and progestin as well as the metformin, a biguanide that helps increase insulin sensitivity and controls some of the symptoms of PCOS. Corticosteroids are not used for this condition and would actually worsen insulin resistance and other symptoms. Topical progesterone alone has not been recommended for treatment of PCOS.
A client has been diagnosed with a Bartholin gland cyst. The nurse expects the client may experience which symptoms if this becomes infected? Pain, tenderness, and dyspareunia Distention, hyperthermia, and dyspnea Pain, dysphagia, and tenderness Pain, erythema, and dystonia
Pain, tenderness, and dyspareunia (painful sex). A Bartholin gland cyst is a fluid-filled sac that results from occlusion of the duct system in the Bartholin gland. Acute symptoms are usually the result of infection and include pain, tenderness, and dyspareunia.
As women age they tend to lack support of breast tissue. The nurse understands that development of which of the following muscles supports the breast mass higher on the chest wall?
Pectoralis muscles.
Endometriosis is characterized by painful hemorrhagic lesions in the pelvis, which may develop into which potential complication?' Pelvic adhesions Endometrial cancer Candidiasis vaginitis Bladder herniation
Pelvic adhesions
Which disorder of the female genitourinary system is most likely to result from a disruption in normal endocrine function? Polycystic ovary syndrome (PCOS) Ovarian cancer Cervicitis Pelvic inflammatory disease (PID)
Polycystic ovary syndrome (PCOS) Women with PCOS typically have abnormal gonadotropin levels, a problem that is manifested by increased release of LH in relation to FSH release. This causes an increase in production of androstenedione and testosterone by the theca cells of the ovary. Ovarian cancer does not have an endocrine etiology, and both PID and cervicitis have infectious etiologies.
A client has been diagnosed with endometriosis. What assessment finding does the nurse expect? Select all that apply. Premenstrual pain Back pain Pelvic pain Increased fertility Referred chest pain
Premenstrual pain Back pain Pelvic pain Endometriosis symptoms present with pelvic pain and back pain, and most pain occurs premenstrually, subsiding after cessation of menstruation. There is decreased fertility with this condition. Chest pain is not a reported symptom.
Which hormone is responsible for breast development and the increase in body temperature that occurs with ovulation?
Progesterone.
The nurse is caring for a female client who has just given birth. The nurse knows that the hormone responsible for the client's ability to breastfeed is which of the following?
Prolactin.
A nurse who works on a urology-gynecology ward of a hospital is coming on shift and will be caring for a 34 year-old woman who has been admitted overnight for the treatment of a large endometriosis. What interventions should the nurse most realistically anticipate providing over the course of the shift and the next several days?
Providing pain control; preparing the client for a laparoscopic procedure or hysterectomy.
A client tells the nurse that her mother recently passed from ovarian cancer. The client asks why the survival rate from ovarian cancer is so low. The best response would be:
Symptoms of ovarian cancer are nonspecific and therefore difficult to interpret.
Which of the following is the most important discharge instruction for a female patient with pelvic inflammatory disease (PID)?
Take all of the antibiotic.
A female client reports to the health care provider that she has noticed a release of urine when she laughs or sneezes. Which interventions should the provider implement first? Insert a Foley catheter to measure daily output Teach the client to do pelvic floor exercises Provide information about the estrogen ring Refer the client to a surgeon
Teach the client to do pelvic floor exercises A female client who begins to experience unwanted release of urine when abdominal pressure increases (such as during coughing, sneezing, squatting, lifting, or laughing) may be experiencing a cystocele as a result of pelvic floor relaxation. Cystoceles can lead to difficulty in emptying the bladder and cystitis. The nurse should first determine if the condition is caused by cystitis. A mild cystocele can be controlled through pelvic floor strengthening exercises (Kegel exercises), An estrogen ring may help strengthen the muscles, the nurse must assess first. Referral for surgical consult will occur after evaluation.
A client with polycystic ovaries is being treated with an oral contraceptive medication. Which change in her condition indicates the treatment is effective?
The client begins a regular menstrual cycle.
Which client does the nurse determine is most likely at risk for cancer of the vagina? The client with diabetes The client who is 61 years of age The client who is 28 years of age The client who underwent multiple procedures for infertility
The client who is 61 years of age Primary cancers of the vagina are extremely rare, but are most prevalent in women 60 years of age and older.
A female patient is taking antibiotics to treat a skin infection and informs the nurse that she does not think the antibiotics are working because now she thinks she has a vaginal infection. Which of the following does the nurse believe has occurred due to the antibiotic use?
The use of the antibiotics decreases the number of lactobacilli in the vagina, which can result in a vaginal infection.
Fibrocystic changes in the breast are not uncommon. How is the diagnosis of fibrocystic changes made? Physical examination and client history Galactography and biopsy Mammography and galactography Ultrasonography and mammography
Ultrasonography and mammography Diagnosis of fibrocystic changes is made by physical examination, mammography, ultrasonography, and biopsy (i.e., aspiration of tissue sample). Client history and galactography are not used to diagnose fibrocystic changes in the breast.
For which cancers is a client infected with human papillomavirus (HPV) at increased risk? Select all that apply. Vulvar Cervical Endometrial Vaginal Ovarian
Vulvar Cervical Vaginal HPV is implicated in cancer of the vulva, vagina, and cervix. Endometrial cancer is primarily adenocarcinomas with about 2% sarcomas. Ovarian cancer has an inherited component and is also related to the number of years a woman has a menstrual cycle.
hen explaining polycystic ovary syndrome (PCOS) to a newly diagnosed client, the health care worker states, "This ovarian dysfunction is caused by: absent FSH." insulin deficit." elevated LH." low androgen."
elevated LH. The underlying etiology of PCOS is unknown, although most women have altered gonadotropin levels. Most women with PCOS have elevated luteinizing hormone (LH) levels with normal estrogen and follicle-stimulating hormone (FSH) production. This altered LH/FSH ratio often is used as a diagnostic criterion for this condition. The elevated LH level also results in increased androgen production. Hyperinsulinemia may also lead to the excess androgen production; the overall goal of PCOS treatment is to suppress the insulin-facilitated, LH-driven androgen production.
