Exam 3-Gyno problems

1. The nurse is teaching a woman's group about gynecologic cancers. Which does the nurse teach are risk factors? (Select all that apply.) a. Nulliparity b. Multiple sex partners c. Obesity d. Smoking e. Delayed first intercourse

ANS: A, B, C, D Nulliparity, smoking, and obesity are risk factors for uterine cancer. Risk factors for cervical cancer include multiple sex partners, obesity, and smoking. Early age at first intercourse (before 18) is a risk factor for cervical cancer.

17. A client has returned to the nursing unit after a total abdominal hysterectomy. The nurse auscultates the client's abdomen and does not hear bowel sounds. Which is the nurse's priority intervention? a. Document the finding in the chart. b. Position the client on the right side. c. Irrigate the nasogastric tube. d. Measure abdominal girth.

ANS: A Absence of bowel sounds for 1 to 2 days after abdominal surgery is an expected finding that should be documented. No intervention specific to this finding is needed.

24. A client is scheduled to have a hysteroscopic myomectomy. Which statement by the client indicates that she understands the procedure? a. "I will need to deliver future children by cesarean section." b. "I need to schedule this during the last part of my cycle." c. "My uterus will be removed through tiny incisions." d. "This operation will make me infertile."

ANS: A Because of the risk for uterine rupture after this procedure, future deliveries will be done by cesarean section. The procedure is done during the early part of the menstrual cycle to limit blood loss and reduce the possibility of interrupting a pregnancy. This operation is a uterus-sparing procedure. The woman will not be infertile after the myomectomy.

16. A client had a uterine artery embolization and has just returned to the nursing unit. She is asking when she can get up to go to the bathroom. Which question does the nurse ask during hand-off report? a. "Was a vascular closure device used?" b. "What was her estimated blood loss?" c. "Is there an order for a catheter?" d. "When was the client's last sedation?"

ANS: A If a vascular closure device was used after the procedure, the client can get up in about 2 hours. If a closure device was not used, the client needs to be on bedrest for 4 hours. Although all questions are important during hand-off report, the question specific for activity restrictions is the one that asks about the vascular closure device.

4. A 48-year-old woman reports to the nurse about new "flooding" with her periods. Which other complaint is the nurse prepared to investigate more thoroughly? a. Hot flashes and sweating episodes b. Fatigue during typical activity c. More frequent periods than usual d. Abdominal cramping with periods

ANS: B A description of "flooding" during the menstrual cycle indicates heavy bleeding, which may be due to dysfunctional uterine bleeding (DUB). DUB usually occurs at the beginning or at the end of a woman's reproductive years. Because this woman is 48, she might be entering the perimenopausal period. Fatigue during usual activities can indicate anemia. Hot flashes with sweating are a manifestation of menopause. More frequent menstrual bleeding also occurs in DUB. Abdominal cramping may be normal for this client.

28. A woman had returned to the nursing unit after a total abdominal hysterectomy. After settling the client and performing a thorough assessment including vital signs, which action by the nurse is most important? a. Consult with physical therapy about ambulating the client. b. Obtain and apply sequential compression devices. c. Order the client's next-day chest x-ray and laboratory work. d. Assist the client to order light food items for dinner.

ANS: B Care of a client post-abdominal hysterectomy includes measures to prevent deep vein thrombosis and pulmonary embolism. The client needs sequential compression devices ordered and applied. The other actions might be needed, but they are not the priority.

20. Which intervention is essential for the nurse to perform for a client who had a total abdominal hysterectomy? a. Instruct the client on a low-fat diet. b. Monitor for the onset of menopause. c. Assess for problems with intercourse. d. Teach exercises to prevent incontinence.

ANS: C A hysterectomy and the accompanying menopause can lead to vaginal changes. Pain or difficulty with intercourse can occur, and the client should be reassured that gentle dilation will overcome this problem. Sexuality concerns should always be assessed in clients, particularly after they undergo procedures that can alter sexuality. The client would not necessarily need a low-fat diet, and the onset of menopause occurs with surgery. The client will not necessarily have incontinence.

12. A client had a posterior colporrhaphy. Which statement by the client indicates an adequate understanding of discharge instructions? a. "I'll eat a high-fiber diet so I won't get constipated again." b. "I'll expect my periods to decrease within the next 6 months." c. "I'll need to eat a low-residue diet." d. "I'll call the surgeon if I saturate more than one pad in 4 hours."

ANS: C A posterior colporrhaphy is a treatment for a rectocele. After-care instructions include a low-residue (fiber) diet and stool softeners to decrease stool numbers and straining. A high-fiber diet is used when rectoceles are managed medically. The repair will have no effect on vaginal bleeding or on the number of periods.

10. A client with pelvic organ prolapse has chosen treatment with a vaginal mesh. Which action by the nurse before the procedure is most important? a. Administering the preoperative sedative medication b. Giving the woman the manufacturer's labeling information c. Ensuring that the woman has a ride home after she recovers d. Witnessing the client signature on the informed consent

ANS: D All activities are important before surgery. However, the priority before any operation is to obtain informed consent. The nurse's main responsibilities regarding informed consent including having the client sign the form and witnessing the signature.

13. A woman is receiving radiation via brachytherapy for endometrial cancer. Which statement by the woman indicates a need for further education about the procedure? a. "I can go about my usual activities between sessions." b. "I might experience more fatigue than usual during therapy." c. "I should report any fever over 100 degrees to my doctor." d. "I must stay away from my young grandchildren for 6 weeks."

ANS: D Brachytherapy is provided mostly on an outpatient basis, and the client does not have restrictions placed on her interactions with her family during this time. The radiologist inserts an applicator into the woman's uterus through which the radioactive isotope is placed for treatment. After the treatment, the isotope and the applicator are removed. The other statements show good understanding of brachytherapy.

14. Which clinical manifestation in a client with invasive cervical cancer alerts the nurse to the possibility of metastasis? a. Amenorrhea b. Weight gain c. Breast tenderness d. Swelling of one leg

ANS: D Leg pain or unilateral swelling of a leg is a symptom of disease progression as the tumor enlarges, or of recurrent disease.

19. A client had a total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node dissection 2 days ago. The nurse finds the client short of breath, tachycardic, and anxious. What intervention takes priority? a. Assess oxygen saturation and apply oxygen if needed. b. Have the client cough and deep breathe or use the spirometer. c. Call respiratory therapy to provide a nebulizer treatment. d. Prepare to administer furosemide (Lasix) IV push.

ANS: A Pulmonary embolism is a risk of major abdominal surgery. The client is exhibiting signs of pulmonary embolism. The nurse should first assess and treat oxygenation problems, then notify the Rapid Response Team. Pulmonary hygiene will not be aggressive enough to help this client. No indications suggest that the client needs a nebulizer treatment. Lasix is not warranted.

15. A client has undergone cryosurgery for stage I cervical cancer. Which precaution or action does the nurse teach this client? a. "Use sanitary napkins to manage discharge for the next several weeks." b. "Avoid sexual intercourse or becoming pregnant for the next 12 months." c. "If you should become pregnant, you will be at increased risk for preterm labor." d. "Your next menstrual cycle will be delayed because of this procedure."

ANS: A The effects of cryosurgery include a heavy, watery vaginal discharge for 3 to 6 weeks after the procedure. Clients are cautioned to avoid the use of tampons and intercourse during this time to reduce the risk for infection. The other statements are inaccurate.

2. A woman reports cyclical abdominal pain, and her pelvic examination reveals tender nodules in the posterior vagina. The nurse plans to educate the woman about which treatment? a. Medroxyprogesterone (Depo-Provera) b. Radiation therapy c. Doxycycline (Vibramycin) d. Endometrial ablation

ANS: A This client has manifestations of endometriosis, and menstrual cycle control is a common therapy. Oral contraceptives or injectables such as Depo-Provera are often used. Radiation therapy is used for cancer. Doxycycline is an antibiotic used for bacterial infection. Endometrial ablation is a treatment used for dysfunctional uterine bleeding.

25. A client is recovering from a hysteroscopic myomectomy. The nurse assesses the client and finds the following: 2+ bilateral pedal edema; pulse, 108 beats/min; and respiratory rate, 28 breaths/min. Which action by the nurse takes priority? a. Assess lung sounds and oxygen saturation. b. Call for an immediate electrocardiogram (ECG). c. Notify the health care provider as soon as possible. d. Review the client's intake and output pattern.

ANS: A This client has signs of fluid overload, which is a possible complication of hysteroscopic surgery. The nurse should assess the client's oxygenation status, then should notify the provider or call the Rapid Response Team. An ECG may be ordered but is not the priority, nor is reviewing intake and output patterns. Although the provider does need to be notified, the nurse needs further assessment data to report.

8. Which action does the nurse teach the client to prevent toxic shock syndrome? a. "Use a barrier method of contraception." b. "Wash your hands before inserting a tampon." c. "Avoid intercourse with more than one partner." d. "Empty your bladder immediately after intercourse."

ANS: B Certain strains of Staphylococcus aureus, commonly found on skin surfaces, produce a toxin that can enter the bloodstream through the vaginal mucosa. Handwashing before tampon insertion reduces the chance that the organism will enter the vagina.

26. A woman has been told she has cervical polyps. Which statement by the client indicates a good understanding of the teaching the nurse provided? a. "I hope my polyp doesn't turn cancerous like colon polyps can." b. "These can be removed easily in the doctor's office with little pain." c. "I will need to have more frequent screening for cervical cancer." d. "I will need to finish all my medication before having sex again."

ANS: B Cervical polyps are benign growths. They can be removed easily in the physician's office with little to no pain. The other statements are inaccurate: Polyps are not related to cancer or to sexually transmitted diseases.

3. A woman has endometriosis and is visibly upset. She tells the nurse that she just got married and wants to have children but is distressed because now she will be infertile. Which response by the nurse is most appropriate? a. "Treatment for endometriosis often causes infertility; I can refer you to a support group." b. "Endometriosis is more common in infertile women, but not all treatments cause infertility." c. "You shouldn't worry about fertility until after we know that this didn't cause cancer." d. "Unfortunately, you will have to take birth control pills for the rest of your life."

ANS: B Endometriosis is more common among infertile women than in the general population. However, treatments can be chosen on the basis of symptoms, extent of the disease, and the woman's desire to remain fertile. Menstrual cycle control with hormones is often a choice and would not leave the woman infertile. Endometriosis only rarely causes cancer. The woman would not have to take birth control pills for the rest of her life.

23. A client has recently undergone an anterior colporrhaphy. Which is the most important discharge instruction that the nurse can provide? a. "Avoid sexual intercourse for 2 weeks." b. "Call us for fever and pain that does not improve." c. "Sutures will need to be removed in 2 weeks." d. "An ice pack on your incision will help the pain."

ANS: B Fever and pain may indicate an infection and should be reported. Sexual activity is restricted for 6 weeks. Sutures will absorb or fall out. Discomfort can be lessened with heat, not cold, therapy.

18. Why are the death rates from ovarian cancer so high? a. The causative oncovirus is resistant to chemotherapy and to radiation. b. No symptoms are obvious during the early stages of this disorder. c. Radiation therapy is ineffective because the ovaries are located deep in the pelvis. d. Ovarian cancer occurs mostly in women over the age of 70 who have other health problems.

ANS: B Ovarian cancer is poorly detected in its early stages, when the chances for cure or control are better. The other statements are inaccurate.

21. A woman has had recurrent Bartholin cysts. Which intervention is most appropriate for the nurse to add to the client's care plan? a. Assess the woman for sexually transmitted diseases (STDs). b. Prepare a family diagram to investigate a familial pattern. c. Teach the woman about surgical marsupialization. d. Instruct the woman to wear only cotton underwear.

ANS: C Bartholin cysts tend to recur and can be treated with surgical marsupialization, the creation of a pouch as a new opening for the cysts, so it does not become obstructed again. The woman should have already been screened for STDs, Bartholin cysts are not genetic in nature, and wearing cotton underwear will not prevent them from occurring.

5. For which problem are Kegel exercises recommended? a. Cyst b. Fistula c. Cystocele d. Rectocele

ANS: C Kegel exercises, alternately tightening and relaxing the pelvic floor muscles, can strengthen muscles sufficiently to support the bladder and reduce the discomfort that accompanies a cystocele. They are not used for treatment for a cyst or fistula. A rectocele, another type of pelvic organ prolapse, is managed by promoting bowel elimination.

9. A young woman calls the clinic to report a fever and a funny rash with peeling skin on the palms of her hands and the soles of her feet. Which action by the nurse is most appropriate? a. Make an appointment for her to be seen the next day at the clinic. b. Instruct her to take warm baths with oatmeal added to the water. c. Tell her to go to the emergency department immediately. d. Have her take acetaminophen (Tylenol) every 4 hours and drink fluids.

ANS: C These signs are consistent with toxic shock syndrome, a potentially life-threatening bacterial infection often associated with tampon use in menstruating women. The client requires immediate medical attention and should go to the nearest emergency department. Waiting until the next day, taking warm baths, and using symptom control measures such as Tylenol and fluids only lead to delay in obtaining necessary care.

11. Which statement made by a woman who is being discharged after a hysterectomy indicates understanding and acceptance? a. "I wish I had delayed this surgery so that I could have had one more child." b. "I will diet to prevent the weight gain most women have after hysterectomy." c. "Now that my uterus will be gone, I'll probably develop stress incontinence." d. "My husband and I hope to have more sex because I won't have so much bleeding."

ANS: D Discontent with loss of fertility and misconceptions about the effects of hysterectomy are common contributors to psychological or adjustment problems following hysterectomy. Positive attitudes and family support decrease the risk for psychological problems. Wanting to delay the surgery for childbearing indicates unresolved grief for fertility. Gaining weight and developing incontinence are misconceptions about the operation.

7. Which symptom experienced by a woman in her 20s alerts the nurse to the possibility of endometriosis? a. Bleeding between periods b. Cessation of menstruation c. Premenstrual tension headache d. Pain before the onset of menstrual flow

ANS: D Pain is the most common symptom of endometriosis. The peak of pain usually occurs just before the menstrual flow.

27. A client is crying because her endometrial cancer is scheduled to be treated with chemotherapy agents that will cause hair loss. Which is the most appropriate response from the nurse? a. "You should prepare yourself for total hair loss all over your body." b. "You can start shopping for wigs and scarves now so you'll have them available." c. "Why not shave your hair off now so that you can have it made into a wig?" d. "Would you like me to put you in touch with a former client so that you can talk?"

ANS: D The client should be given the opportunity to talk with someone who has undergone treatment with chemotherapy that causes hair loss. It would be ineffective for the nurse to suggest that the client should simply start shopping for wigs/scarves or shave her head. This would prevent the client from making her own decision. It would be incorrect for the nurse to tell the client that total body hair loss will occur. This may not happen. It depends completely on the agent given.

6. When the history of a female client is taken, which client statement does the nurse refer to the health care provider? a. "I had a fibroadenoma of the breast when I was 22 years old." b. "I had my first child when I was 26 years old and my second child when I was 32." c. "I stopped using oral contraceptives when I was no longer sexually active." d. "I had my menopause 2 years ago and have started to have vaginal bleeding again."

ANS: D Vaginal bleeding that occurs after menopause can indicate cancer and should be promptly evaluated. The other statements by the client would not be cause for alarm and would not need to be reported to the provider.

22. The client has been diagnosed with possible vulvovaginitis pending the outcome of laboratory tests. What information does the nurse teach the client? a. "Use sanitary pads, not tampons, when you have your period." b. "Limit douching to once a month or so, after your period." c. "Scrub your vulvar area with antibacterial soap when you bathe." d. "Wear only cotton underwear and wear looser jeans or slacks."

ANS: D Vulvovaginitis occurs as a result of imbalances in the hormones and florae of the vulva and/or vagina. Several causative factors are known, and self-care includes wearing cotton underwear and not wearing tight-fitting jeans or pants. Using tampons will not prevent it. Douching and washing the area with antibacterial soap should be avoided.