Chapter 51

Following a colposcopy, the confirmation of in situ carcinoma of the cervix has been determined. Which comment by the client indicates an appropriate understanding of the diagnosis? a. "I will need surgery and chemotherapy to increase my odds for survival." b. "I will not need any further treatment." c. "The cancer has not spread." d. "I can wait until I have finished having babies to seek treatment."

"The cancer has not spread."

Which statement by the nurse demonstrates effective communication techniques when initiating a discussion about sex with a 25-year-old client? a. "Do you know how to properly apply a male condom?" b. "What questions do you have related to your sexual health?" c. "Why didn't you start receiving annual Pap tests at an earlier age?" d. "Have you had sex with more than one partner?"

"What questions do you have related to your sexual health?"

A patient reports to the nurse that she has a sense of pelvic pressure and urinary problems such as incontinence, frequency, and urgency. The problem has gotten much worse since the birth of her third child. What does the nurse suspect the patient is experiencing? a. A urinary tract infection b. An enterocele c. A rectocele d. A cystocele

A cystocele

A client with challenging menopausal symptoms has discussed treatment options with the physician and now has some questions for the nurse. The client asks, "What are the potential risks of hormone replacement therapy?" What is the best answer? a. All options are correct. b. stroke (CVA) c. breast cancer d. heart disease

All options are correct.

The nurse documents the following history obtained from a patient:No known allergiesDouching 2 to 3 times per weekUse of barrier methods for contraceptionRecent viral upper respiratory infectionEstrogen levels within acceptable parametersWhich of the following would the nurse identify as a risk factor for the patient developing a vulvovaginal infection? a. Barrier contraception b. Douching c. Normal estrogen levels d. Viral upper respiratory infection

Douching

Which of the following is the descent of the small intestine into the vaginal vault? a. Rectocele b. Enterocele c. Uterine prolapse d. Cystocele

Enterocele

The nurse is providing an educational presentation on toxic shock syndrome (TSS) to a group of adolescents. Which preventive measure does the nurse focus on for this group? a. Use good personal hygiene. b. If using tampons, change frequently. c. Toxin is associated with multiple sex partners. d. Do not use vaginal devices for birth control.

If using tampons, change frequently.

A client is ordered a vaginal cream for the treatment of a yeast infection. What teaching should the nurse include for inserting the vaginal medication? a. Insert the medication into the vagina using an applicator. b. Eat yogurt daily. c. Do not use once menses begins. d. Lie down for 1 hour after insertion of the medication.

Insert the medication into the vagina using an applicator.

Which of the following is a term used to describe excessive menstrual bleeding? a. Menorrhagia b. Amenorrhea c. Metrorrhagia d. Dysmenorrhea

Menorrhagia

Which drug is the most effective treatment for trichomoniasis? a. Metronidazole b. Clindamycin c. Miconazole d. Clotrimazole

Metronidazole

Which of the following is the preferred medication for bacterial vaginosis? a. Gyne-Lotrimin b. Monistat c. Metronidazole d. Terazol

Metronidazole

The nurse is reviewing the medical record of a client diagnosed with uterine cancer. Which of the following, if noted, would the nurse identify as a risk factor? a. Vitamin deficiencies b. Nulliparity c. Exposure to diethylstilbestrol (DES) d. Early age at first sexual intercourse

Nulliparity

Which position occurs when the uterus turns posteriorly as a whole unit? a. Retroflexion b. Anteversion c. Retroversion d. Anteflexion

Retroversion

A client with vaginitis reports itching and burning of the perineum. Which suggestion would be most appropriate to relieve the client's symptoms? a. Avoid yogurt with active lactobacilli cultures. b. Use skin protectants containing zinc oxide. c. Use a pure vinegar douche daily. d. Take sitz baths frequently.

Take sitz baths frequently.

Which term describes an opening between the bladder and the vagina? a. Rectovaginal fistula b. Cystocele c. Vesicovaginal fistula d. Rectocele

Vesicovaginal fistula

Over the past 2 months, a client has been receiving treatment for multiple ear infections and tonsillitis. The client reports vaginal discharge and itching. What is likely the cause of the client's vaginitis? a. regulated diabetes b. antibiotics c. infrequent douching d. increased estrogen

antibiotics

Which is the earliest and the most common symptom of endometrial cancer? a. bleeding b. loss of weight c. pain d. pressure on the bladder

bleeding

Which client has the highest risk of ovarian cancer? a. 40-year-old client with three children b. 36-year-old client who had their first child at age 22 c. 30-year-old client taking hormonal contraceptives d. 45-year-old client who has never been pregnant

45-year-old client who has never been pregnant

A nurse is developing a plan of care for a client experiencing their first outbreak of genital herpes. Which issue would the nurse most likely identify as the priority? a. Acute pain related to the development of the genital lesions b. Hyperthermia related to body's response to an infectious process c. Ineffective coping related to the increased stress associated with the infection d. Deficient knowledge related to the disease and its transmission

Acute pain related to the development of the genital lesions

During consultations with the oncologist, a client with cervical cancer is informed that radioactive materials will be inserted in the area of the tumor. She has to undergo these sessions over a period of 3 weeks. Which method of cancer treatment is being described? a. Chemotherapy b. Antineoplastic therapy c. Needle aspiration biopsy d. Brachytherapy

Brachytherapy

Assessment of a client reveals evidence of a cystocele. The nurse interprets this as which of the following? a. Bulging of the bladder into the vagina b. Protrusion of intestinal wall into the vagina c. Herniation of the rectum into the vagina d. Downward displacement of the cervix

Bulging of the bladder into the vagina

A client in their late 30s has been having unusually heavy menstrual periods combined with occasional urine and stool leakage over the past few weeks. Upon further inquiry, they also report post coital pain and bleeding. To which diagnosis will the investigation most likely lead? a. Colorectal cancer b. Cancer of the urinary tract c. Hodgkin disease d. Cervical cancer

Cervical cancer

A nurse practitioner examines a patient suspected of having endometriosis. The nurse knows that although a definitive diagnosis could not be made without diagnostic treatment (transvaginal ultrasound), the most frequent symptom is: a. Low back pain. b. Dysuria. c. Dyspareunia. d. Chronic pelvic pain.

Chronic pelvic pain.

A client has just received a diagnosis of premature ovarian failure. How would this diagnosis be confirmed? a. menstrual diary b. follicular biopsy c. FSH level determination d. CT scan

FSH level determination

The client is asking if there is a pill that can be ordered to control the symptoms of menopause. Which assessment finding is most important in determining nursing care in association with hormone replacement therapy? a. Symptoms of hot flashes b. History of osteoporosis c. Presence of kyphosis d. Family history of breast cancer

Family history of breast cancer

A patient presents with vulvar itching and diffuse green vaginal discharge. Upon evaluation, she is prescribed metronidazole. What is the paramount nursing intervention in discharge planning? a. Reassure the patient further sexually transmitted infection (STI) testing is not indicated. b. Instruct the patient not to drink alcohol with this treatment. c. Advise the patient to take medication with a glass of milk. d. Counsel the patient to refrain from sex for 2 weeks.

Instruct the patient not to drink alcohol with this treatment.

A client comes to the emergency department reporting vaginal discharge and pelvic pain that increases with urination. The client also reports nausea and vomiting, headache, and anorexia. A pelvic examination reveals cervical motion tenderness. The client is diagnosed with acute pelvic inflammatory disease (PID) and is admitted. Which of the following would be most appropriate to include in this client's plan of care? a. Inserting an indwelling urinary (Foley) catheter b. Instituting airborne inf

Maintaining bedrest in the semi-Fowler's position

Which is the main cause of anemia in a client with active uterine leiomyoma? a. Hemolysis b. Menorrhagia c. Pressure of the fibroid on the pelvic veins d. Poor intake of foods containing iron

Menorrhagia

While caring for a client who is being treated for severe pelvic inflammatory disease (PID), which nursing action minimizes transmission of infection? a. Performing hand hygiene when entering the room b. Strictly adhering to the no visitation policy c. Keeping the client in a sitting position d. Implementing reverse isolation precautions

Performing hand hygiene when entering the room

A patient has had a pessary inserted for long-term treatment of a prolapsed uterus. As part of the teaching plan, what should the nurse advise the patient to do? a. Avoid climbing stairs as much as possible. b. Keep the insertion site clean and dry. c. Avoid sexual intercourse. d. See her gynecologist to remove and clean the pessary at regular intervals.

See her gynecologist to remove and clean the pessary at regular intervals.

A 34-year-old client has been diagnosed with endometriosis. What topic should the nurse emphasize during health education? a. The need to complete the full course of antibiotics, regardless of symptoms b. The importance of reporting a possible pregnancy as soon as it occurs c. The need to have the client's partner undergo diagnostic testing as well d. Signs and symptoms of infection

The importance of reporting a possible pregnancy as soon as it occurs

A client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client? a. The most common treatment is metronidazole, which should eradicate the problem within 7 to 10 days. b. This condition puts them at a higher risk for cervical cancer; therefore, they should have a Papanicolaou (Pap) smear annually. c. The human papillomavirus (HPV), which causes condylomata acuminata, can't be transmitted during oral sex. d. The potential for transm

This condition puts them at a higher risk for cervical cancer; therefore, they should have a Papanicolaou (Pap) smear annually.

Which of the following would be most important to determine when assessing a client being admitted for suspected toxic shock syndrome (TSS)? a. Use of superabsorbent tampons b. Existence of menorrhagia c. Psychological trauma d. Use of oral contraceptives

Use of superabsorbent tampons

The nurse is interviewing a postmenopausal client during an annual gynecologic exam. Which assessment finding presents the greatest concern in the care of this client? a. Use of pessary b. Urinary stress incontinence c. Vaginal bleeding d. Positive for human papillomavirus (HPV)

Vaginal bleeding

A client is experiencing symptoms associated with menopause. What is a likely recommendation to increase the client's interest in sexual activity? a. low-dose androgens b. antidepressants c. herbal aphrodisiacs d. bisphosphates

low-dose androgens

A nurse is preparing a teaching plan for a client with a vulvovaginal infection. Which teaching would not be appropriate for the nurse to include? a. Maintain a reclining position for 30 minutes after inserting vaginal medication. b. Wear cotton underwear that is loose-fitting and allows for air flow. c. Refrain from unprotected sexual intercourse with partners. d. Douche with a dilute vinegar solution twice a day.

Douche with a dilute vinegar solution twice a day.

A patient diagnosed with endometriosis asks for an explanation of the disease. What should the nurse explain to the patient? a. She has developed an infection in the lining of her uterus. b. The lining of the uterus is too thin because endometrial tissue has implanted outside the uterus. c. The lining of the uterus is thicker than usual, causing heavy bleeding and cramping. d. Tissue from the lining of the uterus has implanted in areas outside the uterus.

Tissue from the lining of the uterus has implanted in areas outside the uterus.

A patient is receiving chemotherapy with paclitaxel as treatment for ovarian cancer. The patient arrives at the facility for laboratory testing prior to her next dose of chemotherapy. The results are as follows:Hemoglobin: 12.9 gm/dLWhite blood cell count: 2,200 /cu mmPlatelets: 250,000 /cu mmRed blood cell count: 4,400,00/cu mm Which result would be a cause for concern? a. White blood cell count b. Red blood cell count c. Hemoglobin level d. Platelet count

White blood cell count

A nurse is reviewing the health history of a client who has been diagnosed with endometrial cancer. Which of the following would the nurse identify as a factor increasing this client's risk? Select all that apply. a. Use of estrogen-progesterone replacement therapy b. Menopause at age 45 years c. Age 50 years d. Obesity e. Nulliparity

d. Obesity e. Nulliparity

An elderly client, who can void only while standing and pushing upward on the vagina, is ordered a pessary. Which comment from the client indicates a need for further teaching about this device? a. "I will report any signs of irritation or bleeding." b. "I will remove and clean it every day." c. "I should have greater ease of emptying my bladder." d. "I should report any foul odor or drainage."

"I will remove and clean it every day."

Which abnormality is not considered a structural abnormality? a. pelvic organ prolapse b. pelvic inflammatory disease c. vaginal fistulas d. endometriosis

pelvic inflammatory disease

Which of the following is an early symptom of vulvar cancer? a. Pruritus with genital burning b. Dyspareunia c. Severe abdominal pain d. Fever accompanied by chills

Pruritus with genital burning

A client is prescribed androgen therapy. Which of the following would the nurse explain as a possible adverse effect? a. Areolar pigmentation b. Severe bleeding from the vagina c. Weight gain d. Decreased libido

Weight gain

The nurse instructs a client with genital herpes on self-care management. Which client statement indicates that teaching has been effective? a. "I will avoid casual contact with others when the lesions occur." b. "I will take a bubble bath to help the lesions heal faster." c. "The medication valacyclovir will cure the infection." d. "I will not touch the lesions when they occur."

"I will not touch the lesions when they occur."

A client reports loss of interest in sexual relations and discomfort during intercourse. Which is the best response by the nurse? a. "These are normal, manageable symptoms of menopause." b. "You need to discuss this with your spouse." c. "Don't worry, every woman goes through this." d. "Hormone replacement therapy can resolve your symptoms."

"These are normal, manageable symptoms of menopause."

In which group is it most important for the client to understand the importance of an annual Papanicolaou test? a. Clients with a pregnancy before age 20 b. Clients with a long history of hormonal contraceptive use c. Clients with a history of recurrent candidiasis d. Clients infected with the human papillomavirus (HPV)

Clients infected with the human papillomavirus (HPV)

Which condition is a downward displacement of the bladder toward the vaginal orifice? a. Fistula b. Rectocele c. Cystocele d. Vulvodynia

Cystocele

While caring for a patient who is treated for severe pelvic inflammatory disease (PID), the nurse insists on keeping her in a semisitting position. Which of the following is correct rationale for this positioning? a. Prevention of nosocomial infections to other patients b. Prevention movement as it increases pain c. Facilitation of pelvic drainage and minimize the upward extension of infection d. Facilitation of easy distraction of the patient

Facilitation of pelvic drainage and minimize the upward extension of infection

The nurse is providing education regarding sexually transmitted diseases. Which statement regarding herpes virus 2 (herpes genitalis) is accurate? a. In pregnant women with active herpes, babies delivered vaginally may become infected with the virus. b. The virus is very difficult to kill. c. Transmission of the virus only occurs when a carrier is symptomatic d. Transmission of the virus requires sexual contact.

In pregnant women with active herpes, babies delivered vaginally may become infected with the virus.

A young client presenting at the health clinic with fever and mucopurulent vaginal drainage is diagnosed with acute pelvic inflammatory disease (PID). Which long-term affect is of greatest concern in the care of this client? a. Infertility b. Pelvic pain c. Ascending infection d. Chronic pelvic inflammatory disease

Infertility

The nurse in the gynecology clinic is interviewing a patient who informs the nurse that her mother and aunt had carcinoma of the cervix. What does the nurse recognize are two chief symptoms of early carcinoma that the patient should be questioned about? a. Dyspareunia and foul-smelling vaginal discharge b. Leukorrhea and irregular vaginal bleeding or spotting c. Leukoplakia and metrorrhagia d. "Strawberry" spots and menorrhagia

Leukorrhea and irregular vaginal bleeding or spotting

A client receives a sealed radiation implant for the treatment of cervical cancer. What should the nurse do when caring for the client? a. Consider the client's urine, feces, and vomitus to be highly radioactive. b. Allow soiled linens to remain in the room until after the client is discharged. c. Notify the healthcare provider if the vaginal packing is dislodged. d. Consider the client to be radioactive for 10 days after implant removal.

Notify the healthcare provider if the vaginal packing is dislodged.

A client is admitted to the health care center with abdominal pain, nausea, and vomiting. The client has a body mass index (BMI) of 30 and reports irregular menstrual cycles and feeling tired all the time. The nurse suspects the client's symptoms to indicate which condition? a. Cancer of the cervix b. Endometriosis c. Polycystic ovary syndrome (PCOS) d. Bacterial vaginosis

Polycystic ovary syndrome (PCOS)

Following a radical vulvectomy, the nurse is preparing the client for discharge to home. Which care intervention would be considered the priority for this client? a. Prevention of wound complications b. Relieving edema to lower extremities c. Alterations for sexual function d. Care of colostomy site

Prevention of wound complications

A client comes to the clinic complaining of intense vulvar pruritus and irritation accompanied by a vaginal discharge. A specimen of the discharge is examined to determine the cause. Which of the following would the nurse interpret as indicative of candidiasis? a. Evidence of clue cells b. Spores and hyphae c. pH greater than 4.5 d. Absence of lactobacilli

Spores and hyphae

A patient has been diagnosed with a vaginal infection and received a prescription for metronidazole (Flagyl). The nurse knows that this is the recommended treatment for a vaginal infection caused by what organism? a. Trichomonas vaginalis b. Candida albicans c. Streptococcus d. Escherichia coli

Trichomonas vaginalis

A client who had intracavity radiation treatment for cervical cancer 1 month earlier reports small amounts of vaginal bleeding. This finding most likely represents: a. recurrence of the carcinoma. b. an expected effect of the radiation therapy. c. infection secondary to a change in vaginal flora. d. development of a rectovaginal fistula.

an expected effect of the radiation therapy.

A client has undergone a total abdominal hysterectomy and bilateral salpingo-oophorectomy as treatment for endometrial cancer. When providing postoperative care to this client the nurse would be alert for signs and symptoms of which of the following? a. Clotting deficiencies b. Leukopenia c. Bladder dysfunction d. Neurotoxicity

Bladder dysfunction

Culture of client's vaginal discharge reveals Gardnerella vaginalis. Which of the following would the nurse expect to assess? a. Reddish-white discharge b. Fishy-smelling watery discharge c. Foul, foamy discharge d. Thick, curdy, white discharge

Fishy-smelling watery discharge