Chapter 57: Management of Patients With Female Reproductive Disorders

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?

Correct response: "The cancer has not spread." Carcinoma in situ means the cancer has not left the original site and therefore has not invaded other tissues. Further treatment is required, which usually consists of cryosurgery or hysterectomy. Surgery with adjuvant chemotherapy is usually reserved for cancers that are more advanced. Even though cervical cancers tend to be slower growing, treatment should not be delayed.

The nurse is obtaining the history from a client who is suspected of having pelvic inflammatory disease (PID). Which client statement would help support the suspicion of PID? A. "I haven't had sex with anyone else except my current partner." B. "My partner and I use condoms during sexual intercourse." C. "I was 15 years old when I first had sex." D. "I've never had any sexually transmitted infection."

"I was 15 years old when I first had sex." Risk factors for PID include early age at first intercourse, mutliple sexual partners, frequent intercourse, intercourse without condoms, sex with a partner with a sexually transmitted infection, and a history of sexually transmitted infections or previous pelvic infections. Therefore, the statement about being 15 years old when the client first had sex suggest the presence of a risk factor that would support the suspicion of PID.)

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?

"I will remove and clean it every day." Pessaries should be removed, cleaned, and replaced periodically (at least every 2 months). If the client is unable to manage the pessary, then follow-up appointments should be made with the practitioner. Ill-fitting pessaries can cause irritation and erosion of tissue resulting in irritation, bleeding, or infection. The placement of the pessary should support the uterus in the pelvis and lessen urinary and pelvic symptoms.

A 32-year-old client has been diagnosed with an ovarian cyst and asks the nurse, "Should I be worried about cancer?" Which response by the nurse would be most appropriate? A. "Most cysts are benign in younger women, but it's good to have it checked out." B. "Ovarian cysts can be malignant but this is a rare occurrence." C. "Ovarian cysts are just that, cysts and not a cause for concern." D. "Since you don't have any symptoms, the chances of having cancer are really remote."

"Most cysts are benign in younger women, but it's good to have it checked out." The risk of malignancy in postmenopausal women is much greater than in premenopausal women, with almost all pelvic masses in premenopausal women being benign. However, although typically benign, the cyst should be evaluated to exclude ovarian cancer. The most appropriate response would be to provide this information to the client but also reinforce her actions to have the cyst evaluated. Telling the client that the cyst is no cause for concern or that ovarian cysts are rarely malignant ignores the client's feelings and does not address the client's concern. The absence of symptoms does not eliminate the possibility of a malignancy. Often, ovarian cancer is difficult to detect and signs and symptoms are vague and nonspecific.)

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?

"My partner will not need any treatment." 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

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

"These are normal, manageable symptoms of menopause." Diminished libido and/or dyspareunia are common symptoms associated with perimenopause. Explaining that this can be a normal finding may help to alleviate worries for the client and provide hope for management of the symptoms. The nurse should avoid telling a client "not to worry" or "talk to someone else" because these can negate client feelings and shut down communication. HRT may not be recommended for this client.)

Which of the following statements made by the nurse demonstrates effective communication techniques when initiating a discussion about sex with a 25-year-old female patient?

"What questions do you have related to your sexual health?" Therapeutic communication techniques include a nonjudgmental attitude, use of open-ended questions, and allowing the patient to lead the discussion. Educational counseling and role playing may be helpful. "Why" statements immediately place the patient in a defensive position that may block communication

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

45-year-old woman who has never been pregnant Explanation: 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 public health nurse is participating in a campaign aimed at preventing cervical cancer. What strategies should the nurse include is this campaign? Select all that apply. A) Promotion of HPV immunization B) Encouraging young women to delay first intercourse C) Smoking cessation D) Vitamin D and calcium supplementation E) Using safer sex practices

A, B, C, E. Preventive measures relevant to cervical cancer include regular pelvic examinations and Pap tests for all women, especially older women past childbearing age. Preventive counseling should encourage delaying first intercourse, avoiding HPV infection, participating in safer sex only, smoking cessation, and receiving HPV immunization. Calcium and vitamin D supplementation are not relevant.

Following a recent history of dyspareunia and lower abdominal pain, a patient has received a diagnosis of pelvic inflammatory disease (PID). When providing health education related to self-care, the nurse should address which of the following topics? Select all that apply. A) Use of condoms to prevent infecting others B) Appropriate use of antibiotics C) Taking measures to prevent pregnancy D) The need for a Pap smear every 3 months E) The importance of weight loss in preventing symptoms

A, B. Patients with PID need to take action to avoid infecting others. Antibiotics are frequently required. Pregnancy does not necessarily need to be avoided, but there is a heightened risk of ectopic pregnancy. Weight loss does not directly alleviate symptoms. Regular follow-up is necessary, but Pap smears do not need to be performed every 3 months.

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

B ("What questions do you have related to your sexual health?" Therapeutic communication techniques include a nonjudgmental attitude, use of open-ended questions, and allowing the client to lead the discussion. Educational counseling and role playing may be helpful. "Why" statements immediately place the client in a defensive position that may block communication.)

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. Heart disease B. All options are correct. C. Breast cancer D. Stroke (CVA)

B (All options are correct. 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 STD seems to accelerate in HIV-positive clients? A. Herpes B. Syphilis C. Trichomoniasis D. Gonorrhea

B (Syphilis seems to accelerate in HIV-positive clients and proceeds directly from primary to tertiary disease in some clients. Chlamydia is associated with a high risk of HIV.)

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

B (Use of superabsorbent tampons TSS is commonly associated with the use of superabsorbent tampons that are not changed frequently and internal contraceptives that remain in place longer than necessary. Assessing the use of oral contraceptives, psychological trauma, or menorrhagia is not required for diagnosing the cause of TSS.)

A patient comes to the clinic complaining of a tender, inflamed vulva. Testing does not reveal the presence of any known causative microorganism. What aspect of this patients current health status may account for the patients symptoms of vulvitis? A) The patient is morbidly obese. B) The patient has type 1 diabetes. C) The patient has chronic kidney disease. D) The patient has numerous allergies.

B. Vulvitis, an inflammation of the vulva, may occur as a result of other disorders, such as diabetes, dermatologic problems, or poor hygiene. Obesity, kidney disease, and allergies are less likely causes than diabetes.

A client has undergone a total abdominal hysterectomy and bilateral salpingo-oopherectomy 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?

Bladder dysfunction fter a total abdominal hysterectomy and bilateral salpingo-oopherectomy, the client is at risk for several complications, especially bladder dysfunction because the surgical site is close to the bladder. Leukopenia and neurotoxicity are adverse effects of chemotherapy agents such as paclitaxel and carboplatin used to treat ovarian cancer. Deep vein thrombosis, not clotting deficiencies are a potential complication after this type of surgery.

The nurse is teaching a patient preventative measures regarding vaginal infections. The nurse should include which of the following as an important risk factor? A) High estrogen levels B) Late menarche C) Nonpregnant state D) Frequent douching

D. Feedback: Risk factors associated with vulvovaginal infections include pregnancy, premenarche, low estrogen levels, and frequent douching.

Which of the following is true regarding endometriosis?

It affects women of reproductive age. Endometriosis affects women of reproductive age. It is a benign lesion or lesions with cells similar to those lining the uterus. Extensive endometriosis causes few symptoms.Causation has been linked to infertility.

Which of the following is the main cause of anemia in a patient with active uterine leiomyoma?

Menorrhagia Uterine leiomyomas or fibroids cause menorrhagia, which in turn causes anemia. A 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

Which of the following is the most effective treatment for trichomoniasis?

Metronidazole (Flagyl) The most effective treatment for trichomoniasis is Flagyl. Monistat, Cleocin, and Gyne-Lotrimin are not the most effective treatment for trichomoniasis.

A perimenopausal woman informs the nurse that she is having irregular vaginal bleeding. What should the nurse encourage the patient to do?

See her gynecologist as soon as possible. Explanation: All women should be encouraged to have annual checkups, including a gynecologic examination. Any woman who is experiencing irregular bleeding should be evaluated promptly.

A 12-year-old adolescent is being seen in the primary care office where you practice nursing. She has just had her first menses, and you are advising her on how to use a tampon. Your instructions include using the least absorbent tampon and to change tampons frequently, at least every 4 to 6 hours. Which of the following conditions are you most likely trying to prevent?

Toxic shock syndrome TSS is a type of septic shock that is a life-threatening systemic reaction to the toxin produced by several kinds of bacteria. TSS is associated with the use of superabsorbent tampons that are not changed frequently and internal contraceptive devices that remain in place longer than necessary.

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/dL White blood cell count: 2,200 /cu mm Platelets: 250,000 /cu mm Red blood cell count: 4,400,00/cu mm Which result would be a cause for concern?

White blood cell count The patient's white blood cell count is low, revealing leukopenia and placing the patient at an increased risk for infection. The other results are within normal parameters and would not be a cause for concern.

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 cystocele 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.

You are caring for a patient who has been diagnosed with genital herpes. When preparing a teaching plan for this patient, what general guidelines should be taught? A) Thorough handwashing is essential. B) Sun bathing assists in eradicating the virus. C) Lesions should be massaged with ointment. D) Self-infection cannot occur from touching lesions during a breakout.

A. Feedback: The risk of reinfection and spread of infection to others or to other structures of the body can be reduced by handwashing, use of barrier methods with sexual contact, and adherence to prescribed medication regimens. The lesions should be allowed to dry. Touching of lesions during an outbreak should be avoided; if touched, appropriate hygiene practices must be followed.

A patient is post-operative day 1 following a vaginal hysterectomy. The nurse notes an increase in the patients abdominal girth and the patient complains of bloating. What is the nurses most appropriate action? A) Provide the patient with an unsweetened, carbonated beverage. B) Apply warm compresses to the patients lower abdomen. C) Provide an ice pack to apply to the perineum and suprapubic region. D) Assist the patient into a prone position.

B. If the patient has abdominal distention or flatus, a rectal tube and application of heat to the abdomen may be prescribed. Ice and carbonated beverages are not recommended and prone positioning would be uncomfortable.

Assessment of a client reveals evidence of a cystocele. The nurse interprets this as which of the following?

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

Samantha Velasquez, a 24-year-old preschool teacher, is being seen by the physician in the primary care group where you practice nursing. Over the past 2 months, she has been receiving treatment for multiple ear infections and tonsillitis. She reports a curdy white vaginal discharge and burning with urination. What is the most likely cause of her symptoms?

Candida albicans Explanation: Candida albicans presents with a thick, curdy white discharge, accompanied by a strong odor and burning with urination. Trichomonas vaginalis presents with a foamy, yellow-white discharge, accompanied by a foul odor and severe itching. Gardnerella vaginalis presents with a watery, gray-white discharge, accompanied by a fishy odor and more discharge after intercourse.

A woman in her late thirties has been having unusually heavy menstrual periods combined with occasional urine and stool leakage over the last few weeks. On further enquiry, she reveals that she also has postcoital pain and bleeding. To which of the following diagnoses do you think the investigations are most likely to lead?

Cervical cancer The patient's symptoms are those of cervical cancer. The symptoms of cervical cancer include abnormal vaginal bleeding and persistent discharge that is yellowish, blood tinged, or foul smelling. Patients 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 patient may experience pain in the flank regions of the body.

A nurse who works in a gynecologist's office frequently cares for patients who are diagnosed with vulvovaginal candidiasis. The nurse should teach the patients how to manage and treat the most common symptom of:

Vulvar pruritus. Vulvar pruritus is the chief complaint of those diagnosed with candidiasis.

A client who wishes to preserve childbearing asks the nurse to explain how taking oral contraceptives will work in the management of endometriosis. Which is the best response by the nurse? A. "Trapping blood causes less pain or discomfort for clients with endometriosis." B. "Endometriosis is usually cured with surgical menopause." C. "Contraceptives will allow blood to be diverted to the peritoneal cavity." D. "Symptoms of endometriosis are increased during normal menstrual cycle."

D ("Symptoms of endometriosis are increased during normal menstrual cycle." The use of estrogen-progestin contraceptives keeps the client in a non bleeding phase of the menstrual cycle, therefore decreasing ectopic tissue from shedding and causing extra uterine bleeding. Blood that is trapped in the peritoneal cavity causes more pain as adhesions form. Endometriosis is cured by natural or surgical menopause but can be medically managed for periods of time with the use of oral contraceptives.)

A 25-year-old patient diagnosed with invasive cervical cancer expresses a desire to have children. What procedure might the physician offer as treatment? A) Radical hysterectomy B) Radical culposcopy C) Radical trabeculectomy D) Radical trachelectomy

D. A procedure called a radical trachelectomy is an alternative to hysterectomy in women with invasive cervical cancer who are young and want to have children. In this procedure, the cervix is gripped with retractors and pulled down into the vagina until it is visible. The affected tissue is excised while the rest of the cervix and uterus remain intact. A drawstring suture is used to close the cervix. For a woman who wants to have children, a radical hysterectomy would not provide the option of children. A radical culposcopy and a radical trabeculectomy are simple distracters for this question.

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 ìrelaxedî 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.

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

D. The patient 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 patient that she will still be able to have children; there is no reason to reassure the patient about not being able to have sex. There is no way you can know how the patient is feeling and it would be inappropriate to say so.

A pelvic examination reveals that a woman's uterus is retroflexed. Which of the following best depicts this position?

Explanation: In retroflexion, the uterus bends posteriorly, as shown in option B. In retroversion, the uterus turns posteriorly as a whole unit, as shown in option A. In anteversion, the uterus tilts forward as a whole unit, as shown in option C. In anteflexion, the uterus bends anteriorly, as shown in option D.

While caring for a patient who is being treated for severe pelvic inflammatory disease (PID), which of the following nursing actions minimizes transmission of infection? A. Keeping the patient in a sitting position B. Performing hand hygiene when entering the room C. Strictly adhering to the no visitation policy D. Implementing reverse isolation precautions

Performing hand hygiene when entering the room 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.)

Which of the following is the extrusion of the rectum into the posterior vagina?

Rectocele 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.

Which position occurs when the uterus turns posteriorly as a whole unit?

Retroversion 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

A client with vaginitis complains of itching and burning of the perineum. Which suggestion would be most appropriate to relieve the client's symptoms?

Take sitz baths frequently. Sitz baths are recommended to relieve the client's itching and burning as well as relieve swelling of the vulva and perineum. Skin protectants containing zinc oxide promote healing. A vinegar (1 to 2 tablespoons) and water (1 pint) douche daily may be used to combat the vaginitis when the client is symptomatic. Taking Lactobacillus acidophilus in capsule form or eating yogurt containing active cultures of lactobacilli can help restore normal vaginal microorganisms.

A patient has a diagnosis of stage III ovarian cancer and wants to know what organs are involved. What information should be provided to the patient?

The cancer involves metastases outside the pelvis. Explanation: *Stage III* ovarian cancer involves one or both ovaries, and one or both of the following are present: (1) cancer has spread beyond the pelvis to the lining of the abdomen; (2) cancer has spread to lymph nodes. *Stage I* ovarian cancer is contained within the ovary (or ovaries). *Stage II* ovarian cancer is in one or both ovaries and has involved other organs (i.e., uterus, fallopian tubes, bladder, the sigmoid colon, or the rectum) within the pelvis. *Stage IV* involves distant metastasis to the liver, lungs, or other organs outside the peritoneal cavity.

A client who has cervical cancer is scheduled to undergo internal radiation. In teaching the client about the procedure, the nurse should tell the client that:

a bowel-cleansing procedure will precede radioactive implantation. The nurse should tell the client that she'll receive an enema before the procedure because bowel motility during cervical radiation implant therapy can disrupt or dislodge the implants. The client will be in a private room, but activities will be restricted to keep the implants in place. To keep the bladder empty, an indwelling catheter will be used. Positioning in bed shouldn't exceed a 20-degree elevation because sitting up can cause the implants to move from their intended locations. Semi-Fowler's position is 45 degrees

A patient has been diagnosed with genital herpes. Knowing patient education is an essential part of nursing care of the patient with a genital herpes infection, the nurse plans to include which of the following methods to minimize HIV transmission? Select all that apply.

• Avoiding unprotected sexual intercourse • Avoiding multiple partners for sexual intercourse • Avoiding IV drug use 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.

During a routine sports physical examination, the nurse practitioner recommends HPV vaccination for an 11-year-old girl. Which of the following statements made by the patient's mother demonstrates understanding of HPV vaccinations?

"I will track follow-up appointments in my smart phone so she receives all three injections." Explanation: The Centers for Disease Control and Prevention (CDC) 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 prevention of HPV. Women still need cervical cancer screening as recommended

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. "I will track follow-up appointments in my smartphone so she receives all three injections." B. "If my daughter is immunized against HPV, she can delay her first scheduled Pap test." C. "This vaccination is not indicated for my son, since boys cannot receive the HPV vaccine." D. "It's nice that she can take this vaccination intranasally, to avoid repeated injections."

A ("I will track follow-up appointments in my smartphone so she receives all three injections." 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 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. "My partner will not need any treatment." B. "I might notice a metallic taste in my mouth while I'm taking the drug." C. "I need to take the medication three times a day for a week." D. "I need to avoid drinking any alcohol with this drug."

A ("My partner will not need any treatment." 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 of the following is a term used to describe excessive menstrual bleeding? A. Menorrhagia B. Metrorrhagia C. Amenorrhea D. Dysmenorrhea

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

Which of the following is the preferred medication for bacterial vaginosis? A. Metronidazole B. Gyne-Lotrimin C. Terazol D. Monistat

A (Metronidazole The preferred medication for treatment of bacterial vaginosis is metronidazole 500 mg twice daily for seven days. Monistat, Gyne-Lotrimin, and Terazol are used in the management of candidiasis.)

A client is diagnosed with polycystic ovarian syndrome. Which of the following findings would the nurse expect to assess? Select all that apply. A. Impaired glucose tolerance B. Emaciated appearance C. Sleep apnea D. Menorrhagia E. Hirsutism

A, C, E (- Hirsutism - Impaired glucose tolerance - Sleep apnea Polycystic ovarian syndrome is associated with obesity, insulin resistance, impaired glucose tolerance, dyslipidemia, sleep apnea, and infertlity. In addition, menstrual periods may be irregular. Menorrhagia (excessive bleeding) is more commonly associated with fibroids.)

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 multiple sexual partners B. Avoiding physical contact with others in crowded places C. Avoiding HPV vaccinations D. Avoiding IV drug use E. Avoiding unprotected sexual intercourse

A, D, E (- Avoiding unprotected sexual intercourse - Avoiding multiple sexual partners - Avoiding IV drug use Explanation: 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.)

The nurse is caring for a patient who has just been told that her ovarian cancer is terminal and that no curative options remain. What would be the priority nursing care for this patient at this time? A) Provide emotional support to the patient and her family. B) Implement distraction and relaxation techniques. C) Offer to inform the patients family of this diagnosis. D) Teach the patient about the importance of maintaining a positive attitude.

A. Emotional support is an integral part of nursing care at this point in the disease progression. It is not normally appropriate for the nurse to inform the family of the patient's diagnosis. It may be inappropriate and simplistic to focus on distraction, relaxation, and positive thinking.

The nurse is caring for a 63-year-old patient with ovarian cancer. The patient is to receive chemotherapy consisting of Taxol and Paraplatin. For what adverse effect of this treatment should the nurse monitor the patient? A) Leukopenia B) Metabolic acidosis C) Hyperphosphatemia D) Respiratory alkalosis

A. Feedback: 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. Acidñbase imbalances and elevated phosphate levels are not anticipated.

A female patient with HIV has just been diagnosed with condylomata acuminata (genital warts). What information is most appropriate for the nurse to tell this patient? A) This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) test 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 they have sexual intercourse. D) The human papillomavirus (HPV), which causes condylomata acuminata, cannot be transmitted during oral sex.

A. Feedback: HIV-positive women have a higher rate of HPV. Infections with HPV and HIV together increase the risk of malignant transformation and cervical cancer. Thus, women with HIV infection should have frequent Pap smears. Because condylomata acuminata is a virus, there is no permanent cure. Because condylomata acuminata can occur on the vulva, a condom will not protect sexual partners. HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx.

A nurse practitioner is examining a patient who presented at the free clinic with vulvar pruritus. For which assessment finding would the practitioner look that may indicate the patient 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 patient comes to the free clinic complaining of a gray-white discharge that clings to her external vulva and vaginal walls. A nurse practitioner assesses the patient and diagnoses Gardnerella vaginalis. What would be the most appropriate nursing action at this time? A) Advise the patient that this is an overgrowth of normal vaginal flora. B) Discuss the effect of this diagnosis on the patients fertility. C) Document the vaginal discharge as normal. D) Administer acyclovir as ordered.

A. Gray-white discharge that clings to the external vulva and vaginal walls is indicative of an overgrowth of Gardnerella vaginalis. The patient's discharge is not a normal assessment finding. Antiviral medications are ineffective because of the bacterial etiology. This diagnosis is unlikely to have a long-term bearing on the patient's fertility.

A nurse is caring for a pregnant patient with active herpes. The teaching plan for this patient should include which of the following? A) Babies delivered vaginally may become infected with the virus. B) Recommended treatment is excision of the herpes lesions. C) Pain generally does not occur with a herpes outbreak during pregnancy. D) Pregnancy may exacerbate the mothers symptoms, but poses no risk to the infant.

A. In pregnant women with active herpes, babies delivered vaginally may become infected with the virus. There is a risk for fetal morbidity and mortality if this occurs. Lesions are not controlled with excision. Itching and pain accompany the process as the infected area becomes red and swollen. Aspirin and other analgesics are usually effective in controlling the pain.

A female patient tells the nurse that she thinks she has a vaginal infection because she has noted inflammation of her vulva and the presence of a frothy, yellow-green discharge. The nurse recognizes that the clinical manifestations described are typical of what vaginal infection? A) Trichomonas vaginalis B) Candidiasis C) Gardnerella D) Gonorrhea

A. The clinical manifestations indicate T. vaginalis, which is treated with metronidazole in the form of oral tablets. Candidiasis produces a white, cheese-like discharge. Gardnerella is characterized by gray-white to yellow-white discharge clinging to external vulva and vaginal walls. Gonorrhea often produces no symptoms.

A patient with trichomoniasis comes to the walk-in clinic. In developing a care plan for this patient the nurse would know to include what as an important aspect of treating this patient? A) Both partners will be treated with metronidazole (Flagyl). B) Constipation and menstrual difficulties may occur. C) The patient should perform Kegel exercises 30 to 80 times daily. D) Care will involve hormone therapy to control the pain.

A. The most effective treatment for trichomoniasis is metronidazole (Flagyl). Both partners receive a one-time loading dose or a smaller dose three times a day for 1 week. In pelvic inflammatory disease, menstrual difficulties and constipation may occur. Kegel exercises are prescribed to help strengthen weakened muscles associated with cystocele and other structural deficits. Hormone therapy does not address the etiology of trichomoniasis.

Which of the following is the most effective treatment for trichomoniasis? A. Clindamycin (Cleocin) B. Metronidazole (Flagyl) C. Miconazole (Monistat) D. Clotrimazole (Gyne-Lotrimin)

B (Metronidazole The most effective treatment for trichomoniasis is metronidazole. Miconazole, clindamycin, and clotrimazole are not the most effective treatment for trichomoniasis.)

The nurse is caring for a patient with a diagnosis of vulvar cancer who has returned from the PACU after undergoing a wide excision of the vulva. How should this patients analgesic regimen be best managed? A) Analgesia should be withheld unless the patients 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 patient 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 patient's comfort level, and allow mobility. Opioids are usually required.

A patient with ovarian cancer is admitted to the hospital for surgery and the nurse is completing the patients health history. What clinical manifestation would the nurse expect to assess? A) Fish-like vaginal odor B) Increased abdominal girth C) Fever and chills D) Lower abdominal pelvic pain

B. Clinical manifestations of ovarian cancer include enlargement of the abdomen from an accumulation of fluid. Flatulence and feeling full after a light meal are significant symptoms. In bacterial vaginosis, a fish-like odor, which is noticeable after sexual intercourse or during menstruation, occurs as a result of a rise in the vaginal pH. Fever, chills, and abdominal pelvic pain are atypical.

A middle-aged female patient has been offered testing for HIV/AIDS upon admission to the hospital for an unrelated health problem. The nurse observes that the patient is visibly surprised and embarrassed by this offer. How should the nurse best respond? A) Most women with HIV dont know they have the disease. If you have it, its important we catch it early. B) This testing is offered to every adolescent and adult regardless of their lifestyle, appearance or history. C) The rationale for this testing is so that you can begin treatment as soon as testing comes back, if its positive. D) Youre being offered this testing because you are actually in the prime demographic for HIV infection.

B. Feedback: Because patients may be reluctant to discuss risk-taking behavior, routine screening should be offered to all women between the ages of 13 to 64 years in all health care settings. Assuring a woman that the offer of testing is not related to a heightened risk may alleviate her anxiety. Middle-aged women are not the prime demographic for HIV infection. The nurse should avoid causing fear by immediately discussing treatment or the fact that many patients are unaware of their diagnosis.

When teaching patients about the risk factors of cervical cancer, what would the nurse identify as the most important risk factor? A) Late childbearing B) Human papillomavirus (HPV) C) Postmenopausal bleeding D) Tobacco use

B. Feedback: HPV is the most salient risk factor for cervical cancer, exceeding the risks posed by smoking, late childbearing, and postmenopausal bleeding.

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

B. Feedback: 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 patient has been diagnosed with endometriosis. When planning this patients 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.

A 14-year-old is brought to the clinic by her mother. The mother explains to the nurse that her daughter has just started using tampons, but is not yet sexually active. The mother states I am very concerned because my daughter is having a lot of stabbing pain and burning. What might the nurse suspect is the problem with the 14-year-old? A) Vulvitis B) Vulvodynia C) V aginitis D) Bartholins cyst

B. Vulvodynia is a chronic vulvar pain syndrome. Symptoms may include burning, stinging, irritation, or stabbing pain and may follow the initial use of tampons or first sexual experience. Vulvitis is an inflammation of the vulva that is normally infectious. Bartholin's cyst results from the obstruction of a duct in one of the paired vestibular glands located in the posterior third of the vulva, near the vestibule.

A patient with a genital herpes exacerbation has a nursing diagnosis of acute pain related to the genital lesions. What nursing intervention best addresses this diagnosis? A) Cover the lesions with a topical antibiotic. B) Keep the lesions clean and dry. C) Apply a topical NSAID to the lesions. D) Remain on bed rest until the lesions resolve.

B. Feedback: To reduce pain, the lesions should be kept clean and proper hygiene practices maintained. Topical ointments are avoided and antibiotics are irrelevant due to the viral etiology. Activity should be maintained as tolerated.

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. An enterocele B. A urinary tract infection C. A cystocele D. A rectocele

C (A cystocele 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.)

The nurse is collecting assessment data on a client who is reporting a vaginal discharge that is cottage cheese-like in appearance. Which pathogen is the most likely cause for this symptom? A. Trichomonas vaginalis B. Gardnerella vaginalis C. Candida albicans D. Gonococci

C (Candida albicans is a yeast infection that presents with a thick, curdy white discharge. Gonococcus is the organism that causes gonorrhea and presents with a yellow, mucopurulent discharge. Trichomonas vaginalis presents with a foamy, white, foul-smelling discharge and Gardnerella vaginalis is a watery, fishy-smelling discharge.)

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. Dyspareunia. B. Low back pain. C. Chronic pelvic pain. D. Dysuria.

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.)

A client, age 42, visits the gynecologist. After examining the client, the physician suspects cervical cancer. The nurse reviews the client's history for risk factors for this disease. Which history finding is a risk factor for cervical cancer? A. Onset of sporadic sexual activity at age 17. B. Pregnancy complicated with eclampsia at age 27. C. Human papillomavirus infection at age 32. D. Spontaneous abortion at age 19

C (Human papillomavirus infection at age 32. Like other viral and bacterial venereal infections, human papillomavirus is a risk factor for cervical cancer. Other risk factors for this disease include frequent sexual intercourse before age 20, multiple sex partners, and multiple pregnancies. A spontaneous abortion and pregnancy complicated by eclampsia aren't risk factors for cervical cancer.)

Which abnormality is not considered a structural abnormality? A. Vaginal fistulas B. Pelvic organ prolapse C. Pelvic inflammatory disease D. Endometriosis

C (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.)

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. Escherichia coli B. Candida albicans C. Trichomonas vaginalis D. Streptococcus

C (Trichomonas vaginalis 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).)

While taking a health history on a 20-year-old female patient, the nurse ascertains that this patient is taking miconazole (Monistat). The nurse is justified in presuming that this patient has what medical condition? A) Bacterial vaginosis B) Human papillomavirus (HPV) C) Candidiasis D) Toxic shock syndrome (TSS)

C. 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 has returned to the post-surgical unit after vulvar surgery. What intervention should the nurse prioritize during the initial postoperative period? A) Placing the patient in high Fowlers position B) Administering sitz baths every 4 hours C) Monitoring the integrity of the surgical site D) Avoiding analgesics unless the patients pain is unbearable

C. Feedback: An important intervention for the patient 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 patient should be placed in low Fowler's 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 patient's comfort level.

A patient diagnosed with cervical cancer will soon begin a round of radiation therapy. When planning the patients subsequent care, the nurse should prioritize actions with what goal? A) Preventing hemorrhage B) Ensuring the patient knows the treatment is palliative, not curative C) Protecting the safety of the patient, family, and staff D) Ensuring that the patient adheres to dietary restrictions during treatment

C. Feedback: Care must be taken to protect the safety of patients, 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.

When reviewing the electronic health record of a female patient, the nurse reads that the patient has a history of adenomyosis. The nurse should be aware that this patient experiences symptoms resulting from what pathophysiologic process? A) Loss of muscle tone in the vaginal wall B) Excessive synthesis and release of unopposed estrogen C) Invasion of the uterine wall by endometrial tissue D) Proliferation of tumors in the uterine wall

C. Feedback: In adenomyosis, the tissue that lines the endometrium invades the uterine wall. This disease is not characterized by loss of muscle tone, the presence of tumors, or excessive estrogen.

A 45-year-old woman has just undergone a radical hysterectomy for invasive cervical cancer. Prior to the surgery the physician explained to the patient that after the surgery a source of radiation would be placed near the tumor site to aid in reducing recurrence. What is the placement of the source of radiation called? A) Internal beam radiation B) Trachelectomy C) Brachytherapy D) External radiation

C. Feedback: Radiation, which is often part of the treatment to reduce recurrent disease, may be delivered by an external beam or by brachytherapy (method by which the radiation source is placed near the tumor) or both.

A patient is being discharged home after a hysterectomy. When providing discharge education for this patient, the nurse has cautioned the patient against sitting for long periods. This advice addresses the patients risk of what surgical complication? A) Pudendal nerve damage B) Fatigue C) Venous thromboembolism D) Hemorrhage

C. Feedback: The patient 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.

The nurse is planning health education for a patient who has experienced a vaginal infection. What guidelines should the nurse include in this program regarding prevention? A) Wear tight-fitting synthetic underwear. B) Use bubble bath to eradicate perineal bacteria. C) Avoid 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 patient has been diagnosed with polycystic ovary syndrome (PCOS). The nurse should encourage what health promotion activity to address the patients hormone imbalance and infertility? A) Kegel exercises B) Increased fluid intake C) Weight loss D) Topical antibiotics as ordered

C. Lifestyle modification is critical in the treatment of PCOS, and weight management is part of the treatment plan. As little as a weight loss of 5% of total body weight can help with hormone imbalance and infertility. Antibiotics are irrelevant, as PCOS does not have an infectious etiology. Fluid intake and Kegel exercises do not influence the course of the disease.

A 30-year-old patient has come to the clinic for her yearly examination. The patient 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.

A student nurse is caring for a patient who has undergone a wide excision of the vulva. The student should know that what action is contraindicated in the immediate postoperative period? A) Placing patient in low Fowlers position B) Application of compression stockings C) Ambulation to a chair D) Provision of a low-residue diet

C. Sitting in a chair would not be recommended immediately in the postoperative period. This would place too much tension on the incision site. A low Fowler's position or, occasionally, a pillow placed under the knees, will reduce pain by relieving tension on the incision. Application of compression stocking would prevent a deep vein thrombosis from occurring. A low-residue diet would be ordered to prevent straining on defecation and wound contamination.

A client has undergone a total abdominal hysterectomy and bilateral salpingo-oopherectomy 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. Neurotoxicity B. Clotting deficiencies C. Leukopenia D. Bladder dysfunction

D (Bladder dysfunction After a total abdominal hysterectomy and bilateral salpingo-oopherectomy, the client is at risk for several complications, especially bladder dysfunction because the surgical site is close to the bladder. Leukopenia and neurotoxicity are adverse effects of chemotherapy agents such as paclitaxel and carboplatin used to treat ovarian cancer. Deep vein thrombosis, not clotting deficiencies are a potential complication after this type of surgery.)

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. Colorectal cancer C. Cancer of the urinary tract D. Cervical cancer

D (Cervical cancer 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 of the following is the descent of the small intestine into the vaginal vault? A. Cystocele B. Uterine prolapse C. Rectocele D. Enterocele

D (Enterocele 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 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/dL White blood cell count: 2,200 /cu mm Platelets: 250,000 /cu mm Red blood cell count: 4,400,00/cu mm Which result would be a cause for concern? A. Hemglobin level B. Platelet count C. Red blood cell count D. White blood cell count

D (The patient's white blood cell count is low, revealing leukopenia and placing the patient at an increased risk for infection. The other results are within normal parameters and would not be a cause for concern.)

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

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

While caring for a client who is being treated for severe pelvic inflammatory disease (PID), the nurse insists on keeping her in a semisitting position. What would be the best possible reason for the nurse's advice? A. To prevent nosocomial infections to other clients B. To facilitate easy distraction of the client C. To prevent movement as it increases pain D. To facilitate pelvic drainage and to minimize the upward extension of infection

D (To facilitate pelvic drainage and minimize the upward extension of infection. While caring for a client hospitalized with PID, the nurse has to reduce the risk of the systemic spread of pathogenic microorganisms. The nurse also has to monitor the symptoms in order to detect, manage, and minimize sepsis if it occurs. The client must also be advised to keep her upper body elevated. This facilitates pelvic drainage and minimizes the upward extension of infection. This position will not aid in the prevention of nosocomial infections, decrease pain, nor easily distract the client.)

A nurse is reviewing a client's medical history. Which factor indicates the client is at risk for candidiasis? A. Nulliparity B. Menopause C. Use of spermicidal jelly D. Use of corticosteroids

D (Use of corticosteroids A small quantity of the fungus Candida albicans commonly exists in the vagina. Because corticosteroids decrease host defense, they increase the risk of candidiasis. Candidiasis is rare before menarche and after menopause. Using hormonal contraceptives, not spermicidal jelly, and pregnancy, not nulliparity, increase the risk of candidiasis.)

A nurse who works in a gynecologist's office frequently cares for patients who are diagnosed with vulvovaginal candidiasis. The nurse should teach the patients how to manage and treat the most common symptom of: A. Dyspareunia. B. Dysuria. C. Vaginal pain. D. Vulvar pruritus.

D (Vulvar pruritus is the chief complaint of those diagnosed with candidiasis.)

A patient with HIV has recently completed a 7-day regimen of use of antibiotics. She reports vaginal itching and irritation. In addition, the patient has a white, cottage cheese-like vaginal discharge. Which of the following is the patient most likely suffering? A. Human papillomavirus (HPV) B. Trichomonas vaginalis C. Bacterial vaginosis D. Vulvovaginal candidiasis

D (Vulvovaginal candidiasis 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, cheeselike 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.)

The nurse is providing preoperative education for a patient diagnosed with endometriosis. A hysterectomy has been scheduled. What education topic should the nurse be sure to include for this patient? A) Menstrual periods will continue to occur for several months, some of them heavy. B) Normal activity will be permitted within 48 hours following surgery. C) After a hysterectomy, hormone levels remain largely unaffected. D) The bladder must be emptied prior to surgery and a catheter may be placed during surgery.

D. The intestinal tract and the bladder need to be empty before the patient is taken to the OR to prevent contamination and injury to the bladder or intestinal tract. The patient is informed that her periods are now over, but she may have a slightly bloody discharge for a few days. The patient is instructed to avoid straining, lifting, or driving until her surgeon permits her to resume these activities. The patient's hormonal balance is upset, which usually occurs in reproductive system disturbances. The patient may experience depression and heightened emotional sensitivity to people and situations.

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) Bartholins 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 ìfibroid.î 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 student nurse is doing clinical hours at an OB/GYN clinic. The student is helping to develop a plan of care for a patient with gonorrhea who has presented at the clinic. The student should include which of the following in the care plan for this patient? A) The patient may benefit from oral contraceptives. B) The patient must avoid use of tampons. C) The patient is susceptible to urinary incontinence. D) The patient should also be treated for chlamydia.

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

A patient with genital herpes is having an acute exacerbation. What medication would the nurse expect to be ordered to suppress the symptoms and shorten the course of the infection? A) Clotrimazole (Gyne-Lotrimin) B) Metronidazole (Flagyl) C) Podophyllin (Podofin) D) Acyclovir (Zovirax)

D. Feedback: Acyclovir (Zovirax) is an antiviral agent that can suppress the symptoms of genital herpes and shorten the course of the infection. It is effective at reducing the duration of lesions and preventing recurrences. Clotrimazole is used in the treatment of yeast infections. Metronidazole is the most effective treatment for trichomoniasis. Posophyllin is used to treat external genital warts. Acyclovir is used in the treatment of genital herpes.

A patient has herpes simplex 2 viral infection (HSV2). The nurse recognizes that which of the following should be included in teaching the patient? A) The virus causes cold sores of the lips. B) The virus may be cured with antibiotics. C) The virus, when active, may not be contracted during intercourse. 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. HSVñ1 causes ìcold sores,î and varicella zoster causes shingles.

A patient is diagnosed with the most common type of uterine fibroid, an intramural fibroid. The nurse includes which of the following information in teaching the patient about this type of fibroid?

It grows within the wall of the uterine muscle.

The nurse is preparing a teaching plan for a client with a vulvovaginal infection. Which of the following would be least appropriate for the nurse to include? A. Maintaining a reclining position for 30 minutes after inserting vaginal medication B. Performing douching with a dilute vinegar solution twice a day C. Wearing cotton underwear that is loose-fitting and allows for air flow D. Refraining from unprotected sexual intercourse with partners

Performing douching with a dilute vinegar solution twice a day Explanation: Research has shown that douching provides no benefit in the prevention or care of vulvovaginal infections. Douching usually is unnecessary because daily baths or showers and proper hygiene after voiding and defecation keep the perineal area clean. In addition, douching tends to eliminate normal flora, reducing the body's ability to ward off infection. Repeated douching may result in vaginal epithelial breakdown and chemical irritation. The client should recline for approximately 30 minutes after inserting any vaginal medication to prevent the medication from escaping from the vagina. Loose-fitting cotton underwear is advised rather than tight-fitting synthetic, nonabsorbent, heat-retaining underwear. Unprotected sexual intercourse is associated with risks and should be avoided.

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?

See her gynecologist to remove and clean the pessary at regular intervals. 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 nurse is reviewing a client's medical history. Which factor indicates the client is at risk for candidiasis?

Use of corticosteroids Explanation: A small quantity of the fungus Candida albicans commonly exists in the vagina. Because corticosteroids decrease host defense, they increase the risk of candidiasis. Candidiasis is rare before menarche and after menopause. Using hormonal contraceptives, not spermicidal jelly, and pregnancy, not nulliparity, increase the risk of candidiasis

(see full question) The nurse is caring for a patient postoperatively who had a simple vulvectomy. What nursing interventions should be provided to this patient? (Select all that apply.)

• Cleansing the wound daily • Offering a low-residue diet • Positioning the patient with pillows The wound is usually cleansed daily with warm, normal saline irrigations or other antiseptic solutions as prescribed, or a transparent dressing may be in place over the wound to minimize exposure to the air and subsequent pain. A low-residue diet prevents straining on defecation and wound contamination. Positioning the patient on her side, with pillows between her legs and against the lumbar region, provides comfort and reduces tension on the surgical wound. After the dressings are removed, a bed cradle may be used to keep the bed linens away from the surgical site. Antibiotic ointment should not be applied to the site.