Chapter 53: Caring for Clients with Disorders of the Female Reproductive System

A client has been diagnosed with endometriosis. When planning this client's care, the nurse should prioritize what nursing diagnosis? a. Anxiety related to risk of transmission b. Acute pain related to misplaced endometrial tissue c. Ineffective tissue perfusion related to hemorrhage d. Excess fluid volume related to abdominal distention

b Symptoms of endometriosis vary but include dysmenorrhea, dyspareunia, and pelvic discomfort or pain. Dyschezia (pain with bowel movements) and radiation of pain to the back or leg may occur. Ineffective tissue perfusion is not associated with endometriosis and there is no plausible risk of fluid overload. Endometriosis is not transmittable.

Upon examination, the nurse practitioner notes a backward positioning of the client's uterus. How would the nurse document this finding? a. Anteversion b. Retroflexion c. Retroversion d. Anteflexion

c In retroversion, the uterus turns posteriorly as a whole unit. In anteversion, the uterus tilts forward as a whole unit. In retroflexion, the fundus bends posteriorly. In anteflexion, the uterus bends anteriorly.

The nurse is providing education regarding sexually transmitted infections. 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. Transmission of the virus requires sexual contact. c. The virus is very difficult to kill. d. Usually, the virus is killed at room temperature by drying.

a A cesarean birth may be performed if the virus recurs near the time of delivery. Asexual transmission by contact with wet surfaces or self-transmission (i.e., touching a cold sore and then touching the genital area) can occur. Transmission is possible even when the carrier does not have symptoms.

Which of the following is the extrusion of the rectum into the posterior vagina? a. Rectocele b. Cystocele c. Enterocele d. Uterine prolapse

a A rectocele is the extrusion of the rectum into the posterior vagina. A cystocele is the herniation of the bladder into the anterior vagina. The descent of the small intestine into the vaginal vault is termed enterocele. A uterine prolapsed is the downward descent of the uterus into the vagina.

A nurse is caring for a client who had a vulvectomy. Included in the client's care plan are interventions to reduce the risk for infection. Which intervention would not be included in the nursing care plan? a. Empty surgical drains and catheter drainage bag with clean techniques. b. Inspect and change the perineal dressing following principles of asepsis. c. Perform conscientious hand hygiene and don gloves before caring for the wound. d. Cleanse the anus after donning gloves with moistened antiseptic wipes after bowel elimination.

a A drain or catheter provides a portal through which microorganisms can enter the client's body. Principles of asepsis should be maintained. Using aseptic principles and universal precautions reduces the potential for transmitting pathogens. Hand hygiene is the best method for preventing the transmission of microorganisms; gloves are one type of universal precautions that act as a barrier to prevent contact with blood and infectious microorganisms. Stool contains pathogens that can be introduced into the wound.

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. See her gynecologist to remove and clean the pessary at regular intervals. b. Keep the insertion site clean and dry. c. Avoid sexual intercourse. d. Avoid climbing stairs as much as possible.

a A pessary can be used to avoid surgery (Lone, Thakar, Sultan, et al., 2011). This device is inserted into the vagina and positioned to keep an organ, such as the bladder, uterus, or intestine, properly aligned when a cystocele, rectocele, or prolapse has occurred. Pessaries are usually ring- or doughnut shaped and are made of various materials, such as rubber or plastic (Fig. 57-4). Rubber pessaries must be avoided in women with latex allergy. The size and type of pessary are selected and fitted by a gynecologic health care provider. The patient should have the pessary removed, examined, and cleaned by her health care provider at prescribed intervals.

A patient had a pessary inserted for long-term treatment of a prolapsed uterus. As part of a teaching plan, the nurse would advise the patient to: a. see her gynecologist to remove and clean the pessary at regular intervals. b. keep the insertion site clean and dry. c. avoid sexual intercourse. d. avoid climbing stairs as much as possible.

a A pessary should be removed, examined, and cleaned by a health care provider at prescribed intervals. At this time, the vaginal wall should be examined for pressure points or signs of irritation.

The nurse is caring for a 63-year-old client with ovarian cancer. The client is to receive chemotherapy consisting of paclitaxel and carboplatin. For what adverse effect of this treatment should the nurse monitor the client? a. Leukopenia b. Metabolic acidosis c. Hyperphosphatemia d. Respiratory alkalosis

a Chemotherapy is usually administered IV on an outpatient basis using a combination of platinum and taxane agents. Paclitaxel (Taxol) plus carboplatin (Paraplatin) are most often used because of their excellent clinical benefits and manageable toxicity. Leukopenia, neurotoxicity, and fever may occur. Acid-base imbalances and elevated phosphate levels are not anticipated.

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 cystocele b. A rectocele c. An enterocele d. A urinary tract infection

a Cystocele is a downward displacement of the bladder toward the vaginal orifice (Fig. 57-3) from damage to the anterior vaginal support structures. It usually results from injury and strain during childbirth. Because a cystocele causes the anterior vaginal wall to bulge downward, the patient may report a sense of pelvic pressure and urinary problems such as incontinence, frequency, and urgency. Back pain and pelvic pain may occur as well. The symptoms of rectocele resemble those of cystocele, with one exception: Instead of urinary symptoms, patients may experience rectal pressure. Constipation, uncontrollable gas, and fecal incontinence may occur in patients with complete tears.

A client reports irregular menses, changes in mood, and heavy menstrual bleeding. The nurse asks the client to start keeping a menstrual diary. The purpose of this request is to: a. record symptoms for at least 2 months. b. assist the client in processing feelings. c. record medications taken while symptomatic. d. All options are correct.

a Diagnosis of premenstrual syndrome and premenstrual dysphoric disorder is based on data from a menstrual diary in which the client keeps daily recordings of symptoms for at least 2 months. The classic finding is that the client is symptom free during the period between the onset of menstruation and ovulation.

A client has a history of dysmenorrhea. During monthly menses, the client experiences incapacitating cramping and passes large clots. The client's primary care physician initiates conservative treatment. What interventions would the physician to recommend? a. NSAIDs b. ultrasonography c. corticosteroids d. oral hypoglycemia agents

a Dysmenorrhea is treated with mild non-narcotic analgesics and by treating the underlying cause if one is identified. Symptomatic relief is accomplished with NSAIDs, which reduce prostaglandins. Prostaglandins are biologic chemicals that exist in endometrial tissue, where they exert a stimulating effect on the uterus, producing cramping and pain.

A client who has been diagnosed with endometriosis has been provided with treatment options and is feeling anxious about making the right decision. Which suggestion would be the least effective in assisting the client with this process? a. Stress that this is a serious condition and an immediate decision needs to be made. b. Offer the option of seeking a second opinion. c. Suggest that the client's significant other be included in discussion of options. d. Reinforce or clarify explanations of treatment options and the consequences of each option.

a Emphasize that the condition does not require an immediate decision and avoid giving advice or influencing the client's opinions.

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. breast cancer c. stroke (CVA) d. heart disease

a In using hormonal replacement therapy, the risks of breast cancer and the seriousness of future myocardial infarction and stroke may outweigh the potential benefit of alleviating symptoms associated with menopause. The Women's Health Initiative study revealed an increase in breast cancer, blood clots, stroke, and heart disease in postmenopausal women taking HRT.

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

a Pelvic inflammatory disease is an infection of the pelvic organs other than the uterus. These include the ovaries, fallopian tubes, pelvic vascular system, and pelvic supporting structures. Endometriosis is a condition in which tissue with a cellular structure and function resembling that of the endometrium is found outside the uterus. The atypical locations for endometrial tissue include the ovaries, the pelvic cavity, and occasionally the abdominal cavity. A fistula is an unnatural opening between two structures. The opening may be between a ureter and the vagina, between the bladder and the vagina, or between the rectum and the vagina. The term prolapse indicates a structural protrusion. Women experience any number of problems of this nature in the vagina. They include cystocele, rectocele, enterocele, and uterine prolapse.

Which of the following should be a nurse's priority in considering causes for amenorrhea? a. Pregnancy b. Diet c. Exercise patterns d. Contraceptive use

a Pregnancy should always be excluded first when determining causes of amenorrhea.

An adolescent patient comes to the clinic with complaints of "terrible pain" during menstruation. What should the nurse document this subjective data as? a. Dysmenorrhea b. Amenorrhea c. Menorrhagia d. Metrorrhagia

a Primary dysmenorrhea is painful menstruation, with no identifiable pelvic pathology. It occurs at the time of menarche or shortly thereafter. It is characterized by crampy pain that begins before or shortly after the onset of menstrual flow and continues for 48 to 72 hours. Amenorrhea is the absence of menstruation. Menorrhagia is prolonged or excessive bleeding at the time of the regular menstrual flow. Metrorrhagia is vaginal bleeding between regular menstrual periods.

The history of a female patient reveals the following:First coitus at age 16 yearsFirst pregnancy at age 28 yearsSexual intercourse with circumcised partnerWeight appropriate for heightWhich of the following would alert the nurse to a possible risk factor for developing cervical cancer? a. Age at first coitus b. Age of first pregnancy c. Weight d. Sexual partner

a Risk factors for developing cervical cancer include an early age with first coitus, early childbearing, overweight status, and sexual intercourse with uncircumcised males.

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. Nulliparity b. Early age at first sexual intercourse c. Exposure to diethylstilbestrol (DES) d. Vitamin deficiencies

a Risk factors for uterine cancer include age of 55 years or more, obesity, unopposed estrogen therapy, nulliparity, truncal obesity, late menopause (after age 52 years), and use of tamoxifen. Early age at first sexual intercourse, exposure to diethylstilbestrol, and vitamin deficiencies are risk factors associated with cervical cancer.

During the health history, a client informs the nurse that the client's mother was prescribed DES early in her pregnancy for the client. The nurse must stress the need for frequent gynecological examinations for this client in order to: a. prevent the onset of cervical cancer. b. ensure regular menstruation cycles. c. ensure that the client has a complication-free pregnancy. d. prevent the onset of vulvar cancer.

a Studies have shown a relation between taking diethylstilbestrol (DES) during an early pregnancy and the development of cervical cancer in (young) female offspring. Therefore, DES is no longer used to treat problems associated with pregnancy.

A 27-year-old female client is diagnosed with invasive cervical cancer and is told she needs to have a hysterectomy. One of the nursing diagnoses for this client is "disturbed body image related to perception of femininity." What intervention would be most appropriate for this client? a. Reassure the client that she will still be able to have children. b. Reassure the client that she does not have to have sex to be feminine. c. Reassure the client that you know how she is feeling and that you feel her anxiety and pain. d. Reassure the client that she will still be able to have intercourse with sexual satisfaction and orgasm.

a The client needs reassurance that she will still have a vagina and that she can experience sexual intercourse after temporary postoperative abstinence while tissues heal. Information that sexual satisfaction and orgasm arise from clitoral stimulation rather than from the uterus reassures many women. Most women note some change in sexual feelings after hysterectomy, but they vary in intensity. In some cases, the vagina is shortened by surgery, and this may affect sensitivity or comfort. It would be inappropriate to reassure the client that she will still be able to have children; there is no reason to reassure the client about not being able to have sex. There is no way you can know how the client is feeling and it would be inappropriate to say so.

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

a The descent of the small intestine into the vaginal vault is termed enterocele. A rectocele is the extrusion of the rectum into the posterior vagina. A cystocele is the herniation of the bladder into the anterior vagina. A uterine prolapsed is the downward descent of the uterus into the vagina.

A nurse practitioner is examining a client who presented at the free clinic with vulvar pruritus. For which assessment finding would the practitioner look that may indicate the client has an infection caused by Candida albicans? a. Cottage cheese-like discharge b. Yellow-green discharge c. Gray-white discharge d. Watery discharge with a fishy odor

a The symptoms of C. albicans include itching and a scant white discharge that has the consistency of cottage cheese. Yellow-green discharge is a sign of T. vaginalis. Gray-white discharge and a fishy odor are signs of G. vaginalis.

A client with HIV has recently completed a 7-day regimen of antibiotics. She reports vaginal itching and irritation. In addition, the client has a white, cheese-like vaginal discharge. Which condition is the client most likely experiencing? a. Vulvovaginal candidiasis b. Bacterial vaginosis c. Trichomonas vaginalis vaginitis d. Human papillomavirus

a Use of antibiotics decreases bacteria, thereby altering the natural protective organisms usually present in the vagina, which can lead to candidiasis overgrowth. Clinical manifestations include a vaginal discharge that causes pruritus; the discharge may be watery or thick but usually has a white, cheese-like appearance. Bacterial vaginosis does not produce local discomfort or pain. Discharge, if noticed, is heavier than normal and is gray to yellowish white. Most HPV infections are self-limiting and without symptoms.

While caring for a client who is being treated for severe pelvic inflammatory disease (PID), the nurse insists on keeping the client in a semi-sitting position. The nurse advises this in order to: a. facilitate pelvic drainage and minimize the upward extension of the infection. b. prevent nosocomial infections to other clients. c. prevent movement that may increase pain. d. facilitate easy distraction of the client.

a While caring for a client hospitalized with PID, the nurse has to reduce the risk of the systemic spread of pathogenic microorganisms. The client must be advised to keep the upper body elevated; this facilitates pelvic drainage and minimizes the upward extension of infection.

A female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client? a. This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually. b. The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days. c. The potential for transmission to her sexual partner will be eliminated if condoms are used every time she and her partner have sexual intercourse. d. The human papillomavirus (HPV), which causes condylomata acuminata, can't be transmitted during oral sex.

a Women with condylomata acuminata are at risk for cancer of the cervix and vulva. Yearly Pap smears are very important for early detection. Because condylomata acuminata is a virus, there is no permanent cure. Because condylomata acuminata can occur on the vulva, a condom won't protect sexual partners. HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx.

A client has been diagnosed with genital herpes. Knowing that education is an essential part of nursing care of the client with a genital herpes infection, the nurse plans to include which method(s) to minimize HIV transmission? Select all that apply. a. Avoiding unprotected sexual intercourse b. Avoiding multiple sexual partners c. Avoiding physical contact with others in crowded places d. Avoiding IV drug use e. Avoiding HPV vaccinations

a, b, d Intravenous drug use and risky sexual behaviors, which include multiple partners and unprotected sex, are factors that can put anybody at risk for HIV. Thus, the correct way to minimize HIV transmission would be to avoid these factors. HIV is not transmitted through simple physical contact. Open lesions related to HPV increase the likelihood that HIV can be transmitted; prevention includes administration of the HPV vaccine.

A patient informs the nurse that she believes she has premenstrual syndrome and is having physical symptoms as well as moodiness. What physical symptoms does the nurse recognize are consistent with PMS? Select all that apply. a. Fluid retention b. Low back pain c. Fever d. Headache e. Hypotension

a, b, d Major symptoms of PMS include physical symptoms such as headache, fatigue, low back pain, painful breasts, and a feeling of abdominal fullness, caused by fluid retention. Fever and hypotension are not typical symptoms of PMS.

A patient is diagnosed with the most common type of uterine fibroid, an intramural fibroid. The nurse includes which information in teaching the patient about this type of fibroid? a. It lies underneath the outermost layer of the uterus. b. It grows within the wall of the uterine muscle. c. It grows below the inner uterine surface. d. It arises from inside or outside the surface of the uterine muscle.

b

A woman in her late 30s has been having unusually heavy menstrual periods combined with occasional urine and stool leakage over the past few weeks. Upon further enquiry, she reveals that she also has postcoital pain and bleeding. To which diagnosis will the investigation most likely lead? a. Hodgkin disease b. Cervical cancer c. Colorectal cancer d. Cancer of the urinary tract

b The client's symptoms are those of cervical cancer. Symptoms of cervical cancer include abnormal vaginal bleeding and persistent yellowish, blood-tinged, or foul-smelling discharge. Clients may complain of postcoital pain and bleeding, bleeding between menstrual periods, and unusually heavy menstrual periods. If the cancer has progressed into the pelvic wall, the Clients may experience pain in the flank regions of the body.

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

b A cystocele results from damage to the anterior vaginal support structures. A rectocele is a bulging of the rectum into the vagina. Vulvodynia is a painful condition that affects the vulva. A fistula is an abnormal opening between two organs or sites.

A client reports stress incontinence, pelvic pain, and a feeling like "something is dropping out of my vagina." The client is diagnosed as having a pelvic organ prolapse and the treatment plan includes using a pessary. Which instructions will the nurse include in client education? a. Void at least every two hours for the first week after beginning to use the pessary. b. Apply a sterile lubricant to the pessary before it is reinserted. c. Maintain bedrest for 24 to 48 hours until accustomed to the pessary. d. Maintain bedrest for 48 to 72 hours until accustomed to the pessary.

b A pessary should be lubricated before insertion. Bedrest and alterations to voiding are not necessary to use the device safely and effectively.

A client who underwent an anterior colporrhaphy 6 hours ago has not voided. She reports some discomfort in her suprapubic area. Which of the following would the nurse expect to do? a. Administer a stool softener. b. Catheterize the client. c. Obtain an order for an analgesic. d. Apply ice to the area.

b After repair of a cystocele (anterior colporrhaphy), the client is encouraged to void within a few hours. If the client does not void within this period and reports discomfort or pain in the bladder region after 6 hours, the client should be catheterized to prevent pressure on the suture line. Stool softeners may be appropriate after a posterior colporrhaphy (repair of a rectocele) or repair of a complete perineal laceration. Ice can be applied locally after an external perineal repair. Because the client is post surgery, analgesics most likely would have been ordered already. In this situation, the pain is from bladder distention; relief of this distention through catheterization would subsequently relieve the client's pain.

A perimenopausal woman informs the nurse that she is having irregular vaginal bleeding. What should the nurse encourage the patient to do? a. Stop taking her Premarin (hormonal therapy). b. See her gynecologist as soon as possible. c. Disregard this phenomenon because it is common during this life stage. d. Mention it to her physician during her next annual examination.

b All women should be encouraged to have annual checkups, including a gynecologic examination. Any woman who is experiencing irregular bleeding should be evaluated promptly.

The nurse is caring for a client with a diagnosis of vulvar cancer who has returned from the PACU after undergoing a wide excision of the vulva. How should this client's analgesic regimen be best managed? a. Analgesia should be withheld unless the client's pain becomes unbearable. b. Scheduled analgesia should be administered around-the-clock to prevent pain. c. All analgesics should be given on a PRN, rather than scheduled, basis. d. Opioid analgesics should be avoided and NSAIDs exclusively provided.

b Because of the wide excision, the client may experience severe pain and discomfort even with minimal movement. Therefore, analgesic agents are administered preventively (i.e., around the clock at designated times) to relieve pain, increase the client's comfort level, and allow mobility. Opioids are usually required.

While taking a health history on a 20-year-old female client, the nurse learns that the client is taking miconazole. The nurse is justified in presuming that this client has what medical condition? a. Bacterial vaginosis b. Human papillomavirus (HPV) c. Candidiasis d. Toxic shock syndrome (TSS)

b Candidiasis is a fungal or yeast infection caused by strains of Candida. Miconazole (Monistat) is an antifungal medication used in the treatment of candidiasis. This agent is inserted into the vagina with an applicator at bedtime and may be applied to the vulvar area for pruritus. HPV, bacterial vaginosis, and TSS are not treated by Monistat.

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. Tissue from the lining of the uterus has implanted in areas outside the uterus. c. The lining of the uterus is thicker than usual, causing heavy bleeding and cramping. d. The lining of the uterus is too thin because endometrial tissue has implanted outside the uterus.

b Endometriosis is a chronic disease affecting between 6% and 10% of women of reproductive age (Falcone & Lebovic, 2011) and consisting of a benign lesion or lesions that contain endometrial tissue (similar to that lining the uterus) found in the pelvic cavity outside the uterus.

A 31-year-old client has returned to the postsurgical unit following a hysterectomy. The client's care plan addresses the risk of hemorrhage. How should the nurse best monitor the client's postoperative blood loss? a. Have the client void and have bowel movements using a commode rather than toilet. b. Count and inspect each perineal pad that the client uses. c. Swab the client's perineum for the presence of blood at least once per shift. d. Leave the client's perineum open to air to facilitate inspection.

b To detect bleeding, the nurse counts the perineal pads used or checks the incision site, assesses the extent of saturation with blood, and monitors vital signs. The perineum is not swabbed and there is no reason to prohibit the use of the toilet. Absorbent pads are applied to the perineum; it is not open to air.

A client diagnosed with cervical cancer will soon begin a round of radiation therapy. When planning the client's subsequent care, the nurse should prioritize actions with what goal? a. Preventing hemorrhage b. Ensuring the client knows the treatment is palliative, not curative c. Protecting the safety of the client, family, and staff d. Ensuring that the client adheres to dietary restrictions during treatment

c Care must be taken to protect the safety of clients, family members, and staff during radiation therapy. Hemorrhage is not a common complication of radiation therapy and the treatment can be curative. Dietary restrictions are not normally necessary during treatment.

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. Dysuria. b. Low back pain. c. Chronic pelvic pain. d. Dyspareunia.

c Chronic pelvic pain is the most frequent symptom of endometriosis. Low back pain, dyspareunia, dysuria, dyschezia, dysmenorrhea, and menorrhagia are among the common complaints. The level of pain associated with endometriosis is not necessarily correlated with the stage of endometriosis.

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

c In retroversion, the uterus turns posteriorly as a whole unit. In anteversion, the uterus tilts forward as a whole unit. In retroflexion, the fundus bends posteriorly. In anteflexion, the uterus bends anteriorly.

The nurse is planning health education for a client who has experienced a vaginal infection. What guidelines should the nurse include in this program regarding prevention? a. Wear tight-fitting synthetic underwear. b. Douche weekly to eradicate perineal bacteria. c. Avoid commercial feminine hygiene products, such as sprays. d. Restrict daily bathing.

c Instead of tight-fitting synthetic, nonabsorbent, heat-retaining underwear, cotton underwear is recommended to prevent vaginal infections. Douching is generally discouraged, as is the use of feminine hygiene products. Daily bathing is not restricted.

A 30-year-old client has come to the clinic for her yearly examination. The client asks the nurse about ovarian cancer. What should the nurse state when describing risk factors for ovarian cancer? a. "Use of oral contraceptives increases the risk of ovarian cancer." b. "Most cases of ovarian cancer are attributed to tobacco use." c. "Most cases of ovarian cancer are considered to be random, with no obvious causation." d. "The majority of women who get ovarian cancer have a family history of the disease."

c Most cases of ovarian cancer are random, with only 5% to 10% of ovarian cancers having a familial connection. Contraceptives and tobacco have not been identified as major risk factors.

During a routine sports physical examination, the nurse practitioner recommends HPV vaccination for an 11-year-old girl. Which statements by the client's mother demonstrates understanding of HPV vaccinations? a. "This vaccination is not indicated for my son, since boys cannot receive the HPV vaccine." b. "If my daughter is immunized against HPV, she can delay her first scheduled Pap test." c. "I will track follow-up appointments in my smartphone so she receives all three injections." d. "It's nice that she can take this vaccination intranasally, to avoid repeated injections."

c The Centers for Disease Control and Prevention recommends routine vaccination of boys and girls 11-12 years of age, before they become sexually active. The vaccination is administered in three intramuscular doses, with the initial dose followed by a second dose in 2 months and a third dose 6 months after the first dose. Completion of all three doses of the vaccine is important for immunity to develop; it does not replace other strategies important in the prevention of HPV. Women still need recommended cervical cancer screening.

A client is being discharged home after a hysterectomy. When providing discharge education for this client, the nurse has cautioned the client against sitting for long periods. This advice addresses the client's risk of what surgical complication? a. Pudendal nerve damage b. Fatigue c. Venous thromboembolism d. Hemorrhage

c The client should resume activities gradually. This does not mean sitting for long periods, because doing so may cause blood to pool in the pelvis, increasing the risk of thromboembolism. Sitting for long periods after a hysterectomy does not cause postoperative nerve damage; it does not increase the fatigue factor after surgery or the risk of hemorrhage.

A client with advanced vaginal cancer asks the nurse, "What is the usual treatment for this type of cancer?" Which treatment should the nurse name? a. Surgery b. Chemotherapy c. Radiation d. Immunotherapy

c The usual treatment for advanced vaginal cancer is radiation. Chemotherapy typically is ordered only if vaginal cancer is diagnosed in an early stage, which is rare. Rarely, surgery may be combined with radiation. Immunotherapy isn't used to treat vaginal cancer.

When a female client reports profuse purulent discharge, dysuria, and bleeding, the advance practice nurse is most likely to prescribe which medication to treat this condition? a. Terconazole cream, inserted into the vagina at bedtime b. Metronidazole, administered orally twice a day for 1 week c. Tinidazole, one time for both the client and her partner d. Doxycycline for 1 week

d Chlamydia causes a profuse purulent discharge and may be accompanied by dysuria and bleeding. The Centers for Disease Control and Prevention recommends treating chlamydia with doxycycline for 1 week or a single dose of azithromycin. Trichomonas vaginalis causes a frothy yellow-white or yellow-green vaginal discharge. Treatment for Trichomonas vaginalis is metronidazole or tinidazole. Both partners receive a one-time loading dose. Candidiasis causes a white, cheese-like discharge clinging to the vaginal epithelium. Terconazole cream inserted into the vagina with an applicator at bedtime and is the appropriate treatment for Candidiasis. Gardnerella vaginalis causes a gray-white to yellow-white discharge clinging to the external vulva and vaginal walls. Metronidazole is taken orally twice a day for 1 week to treat Gardnerella vaginalis.

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. Leukoplakia and metrorrhagia b. Dyspareunia and foul-smelling vaginal discharge c. "Strawberry" spots and menorrhagia d. Leukorrhea and irregular vaginal bleeding or spotting

d Early cervical cancer rarely produces symptoms. If symptoms are present, they may go unnoticed as a thin, watery vaginal discharge often noticed after intercourse or douching. When symptoms such as discharge, irregular bleeding, or pain or bleeding after sexual intercourse occur, the disease may be advanced.

A client has herpes simplex 2 viral infection (HSV-2). The nurse recognizes that which of the following should be included in teaching the client? a. The virus also causes "cold sores" of the lips. b. The virus may be cured with topical antibiotics. c. The client's family history is an important part of assessment. d. Treatment is aimed at relieving symptoms.

d HSV-2 causes genital herpes and is known to ascend the peripheral sensory nerves and remain inactive after infection, becoming active in times of stress. The virus is not curable, but treatment is aimed at controlling symptoms. HSV-1 causes "cold sores," and varicella zoster causes shingles. Family history is not relevant because the infection is viral.

Which is a risk factor for cervical cancer? a. Sex with circumcised males b. Underweight status c. Late childbearing d. Exposure to HPV

d Risk factors for cervical cancer include exposure to HPV, sex with uncircumcised males, overweight, and early childbearing.

A nurse providing prenatal care to a pregnant woman is addressing measures to reduce her postpartum risk of cystocele, rectocele, and uterine prolapse. What action should the nurse recommend? a. Maintenance of good perineal hygiene b. Prevention of constipation c. Increased fluid intake for 2 weeks postpartum d. Performance of pelvic muscle exercises

d Some disorders related to "relaxed" pelvic muscles (cystocele, rectocele, and uterine prolapse) may be prevented. During pregnancy, early visits to the primary provider permit early detection of problems. During the postpartum period, the woman can be taught to perform pelvic muscle exercises, commonly known as Kegel exercises, to increase muscle mass and strengthen the muscles that support the uterus and then to continue them as a preventive action. Fluid intake, prevention of constipation, and hygiene do not reduce this risk.

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

d The incidence of ovarian cancer increases in women who have never been pregnant, are older than age 40, are infertile, or have menstrual irregularities. Other risk factors include a family history of breast, bowel, or endometrial cancer. The risk of ovarian cancer is reduced in women who have taken hormonal contraceptives, have had multiple births, or have had a first child at a young age.

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. Candida albicans b. Escherichia coli c. Streptococcus d. Trichomonas vaginalis

d The most effective treatment for trichomoniasis is metronidazole or tinidazole (Tindamax). Both partners receive a one-time loading dose or a smaller dose three times a day for 1 week (CDC, 2010a).

A client undergoing treatment for vaginosis is also counseled about measures to prevent its recurrence. Which statement by the client best indicates effective counseling? a. "My sexual partner will avoid using condoms until I'm better." b. "I will insert a vaginal suppository after intercourse." c. "I will void immediately after intercourse." d. "I will avoid douching after my period."

d Vaginitis is a condition in which the vagina is inflamed. Frequent douching predisposes the client to vaginitis. Treatment of a client' partners does not seem to be effective, but use of condoms may be helpful. Antiprotozoal vaginal suppositories should be used at regular intervals rather than only after intercourse. Voiding will not prevent the recurrence of vaginitis.

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

a Menorrhagia is excessive menstrual bleeding. Amenorrhea is the absence of menses. Dysmenorrhea is painful menses. Metrorrhagia is excessive and prolonged menstrual bleeding.

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

a Bleeding is the earliest and the most common sign of endometrial cancer.

A client undergoing treatment for vaginitis is also counseled about measures to prevent recurrence. Which client statement tells the nurse that the client effectively understands the prevention protocol? a. "My sexual partner will also need to be treated." b. "I shall insert a vaginal suppository after intercourse." c. "I will void immediately after intercourse." d. "I will always douche immediately after intercourse."

a Vaginitis is a condition in which the vagina is inflamed. If not already infected, the sexual partner may contract the infection from the client. If both are not treated simultaneously, the infection will pass back and forth. Antiprotozoal vaginal suppositories should be used at regular intervals rather than only after intercourse. Voiding will not prevent the recurrence of vaginitis. Frequent douching predisposes the client to vaginitis.

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. antibiotics b. infrequent douching c. regulated diabetes d. increased estrogen

a When antibiotics are taken for a long time or repeated courses of antibiotic therapy are necessary, an overgrowth of yeast-like fungi that usually exists in small numbers in the vagina can occur, resulting in vaginitis. Antibiotics or frequent douching eliminate the bacilli that promote an acidic vaginal environment, which can lead to vaginitis. Unregulated diabetes causes an excess of glycogen in vaginal mucus, which supports the growth of microorganisms, which can lead to vaginitis. Decreased estrogen at menopause reduces the thick, moist consistency of vaginal tissue which can lead to vaginitis.

A client has returned to the postsurgical unit after vulvar surgery. What intervention should the nurse prioritize during the initial postoperative period? a. Placing the client in high Fowler position b. Administering sitz baths every 4 hours c. Monitoring the integrity of the surgical site d. Avoiding analgesics unless the client's pain is unbearable

c An important intervention for the client who has undergone vulvar surgery is to monitor closely for signs of infection in the surgical site, such as redness, purulent drainage, and fever. The client should be placed in low Fowler position to reduce pain by relieving tension on the incision. Sitz baths are discouraged after of wide excision of the vulva because of the risk of infection. Analgesics should be administered preventively on a scheduled basis to relieve pain and increase the client's comfort level.

A client is being treated for trichomoniasis. The client has received instructions about the prescribed drug therapy. The nurse determines that the client needs additional teaching when she states which of the following? a. "I might notice a metallic taste in my mouth while I'm taking the drug." b. "I need to avoid drinking any alcohol with this drug." c. "My partner will not need any treatment." d. "I need to take the medication three times a day for a week."

c Trichomoniasis is treated with metronidazole. Both partners are treated and receive a one-time loading dose or smaller dose three times a day for a week. The client may experience a transient metallic taste when taking the drug. Client are strongly advised to abstain from alcohol when taking metronidazole because of a possible disulfiram-like reaction.

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

c Uterine leiomyomas or fibroids cause menorrhagia, which in turn can cause anemia. Poor dietary intake of iron does not cause anemia but aggravates the problem. Though there can be a feeling of pressure in the pelvic region, this does not cause anemia.

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

c While caring for a client hospitalized with PID, the nurse has to reduce the risk of the spread of pathogenic microorganisms. Meticulous hand hygiene minimizes the transmission of infection. There is no reason to restrict visitors in this situation; however, visitors need to be educated in proper hand hygiene. Reverse isolation is not indicated for this client. A sitting position will not aid in preventing nosocomial infections.

A client has a routine Papanicolaou (Pap) test during a yearly gynecologic examination. The result reveals a class V finding. What should the nurse tell the client about this finding? a. It's normal and requires no action. b. It calls for a repeat Pap test in 3 months. c. It calls for a repeat Pap test in 6 weeks. d. It calls for a biopsy as soon as possible.

d A class V finding in a Pap test suggests probable cervical cancer; the client should have a biopsy as soon as possible. Only a class I finding, which is normal, requires no action. A class II finding, which indicates inflammation, calls for a repeat Pap test in 3 months. A class III finding, which indicates mild to moderate dysplasia, calls for a repeat Pap test in 6 weeks to 3 months. A class IV finding indicates possible cervical cancer; like a class V finding, it warrants a biopsy as soon as possible.

The nurse notes that a patient has a history of "fibroids" and is aware that this term refers to a benign tumor of the uterus. What is a more appropriate term for a fibroid? a. Bartholin's cyst b. Dermoid cyst c. Hydatidiform mole d. Leiomyoma

d A leiomyoma is a usually benign tumor of the uterus, commonly referred to as a "fibroid." A Bartholin's cyst is a cyst in a paired vestibular band in the vulva, whereas a dermoid cyst is a benign tumor that is thought to arise from parts of the ovum and normally disappears with maturation. A hydatidiform mole is a type of gestational neoplasm.

A nurse is using a diagram to educate a client with a pelvic organ prolapse. Which condition would the client have based on the illustration? a. Cystocele b. Rectocele c. Enterocele d. Uterine prolapse

d A uterovaginal prolapse is the downward displacement of the cervix anywhere from low in the vagina to outside the vagina. An enterocele is a protrusion of the intestinal wall into the vagina. A rectocele is a herniation of the rectum into the vagina. A cystocele is the bulging of the bladder into the vagina.

A nurse is developing a plan of care for a client with gonorrhea who has presented at the clinic. The nurse should include what in the care plan for this client? a. The client may benefit from oral contraceptives. b. The client must avoid use of tampons. c. The client is susceptible to urinary incontinence. d. The client should also be treated for chlamydia.

d Because of the high incidence of coinfection with chlamydia and gonorrhea, the client should also be treated for chlamydia. Avoiding the use of tampons is part of the self-care management of a client with possible toxic shock syndrome (TSS). The client is not susceptible to incontinence and there is no indication for the use of oral contraceptives.