Med surg Quiz 5

What is the priority nursing care most commonly seen preoperatively and postoperatively in a patient with leiomyomas?

Monitoring for bleeding

The surgical procedure for stage I disease of endometrial cancer involves removal of which components?

Uterus Fallopian tubes Ovaries

Which conditions does the nurse tell the patient to immediately report to the surgeon?

Vaginal drainage that becomes thicker or foul-smelling Temperature over 100 degrees F (38 degrees C) Burning during urination

A patient had a totally abdominal hysterectomy. Which patient behavior is the best indicator that she is coping and adapting successfully?

Asks questions about the wound care, but seems reluctant to do self-care

A patient tells the nurse that she was told that she had a "chocolate" cyst. What assessment is the nurse most likely to perform?

Assess onset and description of pain

What does the nurse assess for to further evaluate the patient's symptoms?

Assess the abdomen for distention or enlargement

Following a uterine embolization using a vascular closure device, what patient cause would the nurse provide?

Assist the patient to ambulate 2 hours after the procedure Assess the patient's pain level and administer analgesics as needed Raise the head of the bed

What task does the nurse delegate to the UAP?

Assist the patient to ambulate if she feels fatigue or tiredness

Which action by the student requires that you intervene immediately?

Assisting the client to the bedside commode for a bowel movement

What potential complication does a nurse anticipate when admitting a client with the diagnosis of severe procidentia (prolapse of the uterus)?

Ulcerations

Which postprocedure information does the nurse provide to the patient?

Avoid sitting for prolonged periods Do not list anything heavier than 5 to 10 lbs When sitting, do not cross the legs

What preventive measures does the nurse include?

Avoid the use of superabsorbent tampons Use sanitary napkins at night Avoid using internal contraceptives

what self-management strategy would the nurse recommend to a patient to prevent vulvovaginitis?

Avoid wearing tight-fitting clothing

A patient with cancer has also been diagnosed with uterine leiomyomas. Which procedure does the nurse prepare the patient for?

Hysterectomy

What is the nurse's most appropriate response?

"Some women may experience symptoms of menopause if their ovaries are removed with their uterus"

A patient who is very upset asks the nurse, "My doctor says I have endometriosis. What does this mean?" What is the nurse's best response?

"A special type of tissue, called endometrial tissue, is outside of your uterus"

Which question does the nurse ask to assess for a cystocele?

"Are you having urinary frequency or urgency"

What is the nurse's most appropriate response?

"Discuss this with your health care provider, because it is important to know your concerns"

A 20-year-old women is being evaluated for possible toxic shock syndrome. What question would the nurse ask?

"Do you use internal contraceptives"

Based on the knowledge about the common causes of vulvovaginitis which question would the nurse ask?

"Have you recently been taking antibiotics"

What question does the nurse ask in order to obtain a thorough menstrual history?

"How old were you when you started menstruation" "Typically, how long does your period last" "How would you describe your menstrual flow"

Which patient statement indicated that the procedure has achieved the desired therapeutic outcome?

"I have good control over my urination"

A client has an anterior and posterior surgical repair of a cystocele and rectocele and returns from the postanesthesia care unit (PACU) with an indwelling catheter in place. What should the nurse tell the client about the primary reasons for the catheter?

Discomfort is minimized Urinary retention is prevented Pressure on the suture line is relieved

A 15-year-old adolescent tells the school nurse, "I have persistent pain during my periods." What should the nurse encourage her to do?

Have a gynecologic examination

A patient is diagnosed with uterine leiomyomas. What does the nurse expect to see in the documentation for this patient as the chief presenting symptom?

Heavy vaginal bleeding

Vital signs show: T 98.9, P 120/min, R 24/min, BP 103/60. Which complication does the nurse suspect?

Hemorrhage

Which woman is at greatest risk for dysfunctional uterine bleeding?

45-year-old attorney with a stressful life

Which women is at greatest risk for developing pelvic organ prolapse?

48-year-old obese mother of four children

What types of examinations are done to reveal the presence of uterine enlargement related to fibroids?

Abdominal examination Vaginal examination Rectal examination Transvaginal ultrasound with saline infusion

The nurse is giving discharge teaching to a patient who had a transvaginal repair for pelvic organ prolapse using a surgical mesh. What does the nurse include?

Abstain from sexual intercourse for 6 weeks

A patient has had a posterior colporrhaphy. What is included in the nursing care of this patient?

Administer pain medication before a bowel movement Instruct to avoid straining during a bowel movement Provide sitz baths Provide a low-residue (low-fiber) diet

What complication does a nurse suspect?

An incisional nick in the bladder

What information would the nurse give to a sexually active 22-year-old woman about conventional Papanicolaou (Pap) smear testing?

Annual screening is recommended

A client with a third-degree uterine prolapse is schedules for a vaginoplasty. What should the nurse anticipate the surgeon will order?

Apply moist compresses to the uterus

What does the nurse instruct the patient to do?

Apply moist heat (e.g., sitz baths or hot wet packs) to the vulva

Which surgical procedure is most likely to induce menopausal symptoms?

Bilateral salpingo-oophorectomy

In recalling dietary intake for a recent 24-hour period, a female patient describes eating eggs, whole milk, and bacon for breakfast; fried chicken and French fries for lunch; three-cheese pizza and ice cream for dinner. This type of diet places her at increased risk for which disorder?

Cancer of the ovaries

The nurse encourages a teenage patient to receive the human papillomavirus (HPV) vaccine (Gardasil) because it protects against which type of cancer?

Cervical cancer

Young women who have intercourse as teenagers and/or have multiple sex partners are at high risk for which disease?

Cervical cancer

Which action should you take first?

Cover the wound with saline-soaked dressing

Which patient demeanor is the strongest indicator that there is a need for psychological referral?

Disheveled and lackluster and displays a lack of interest in questions

The nurse is taking a history on a patient with probable gynecologic cancer. Which clinical manifestation is a sign of metastasis?

Dysuria

A client past menopause undergoes an anterior-posterior colporrhaphy. What should the discharge teaching include?

Eating a high-fiber diet

What does the nurse do first to help the patient adapt to body changes?

Encourage the patient to ventilate feelings

A patient has excessive bleeding from uterine fibroids. Which therapy stops the blood flow to the fibroids?

Endometrial ablation

The nurse educates the patient for which diagnostic test that is used to evaluate for endometrial cancer?

Endometrial biopsy

What disease is strongly associated with prolonged exposure to estrogen without the protective effects of progesterone?

Endometrial cancer

What gynecologic diagnosis would the nurse expect to see as part of the patient's history?

Endometrial cancer

What additional clinical manifestation should the nurse assess for?

Hypotension

Which of these actions prescribed by the health care provider will you implement first?

Insert a straight catheter PRN for output of less than 300 mL/8 hr

A client who has a diagnosis of endometriosis is concerned about the side effect of hot flashes from her prescribed medication. She tells the nurse that her mother found them very uncomfortable during her menopause. Which medication causes this side effect?

Leuprolide (Lupron)

What does a nurse expect to be the priority concern of a 28-year-old woman who is to undergo a laparoscopic bilateral salpingo-oophorectomy?

Loss of childbearing potential

For a patient with endometriosis, which supplement might offer relief of the muscle cramping?

Magnesium

What signs/symptoms does the nurse assess in a patient with dysfunctional uterine bleeding?

Male hair pattern Thyroid enlargement Abdominal pain Abdominal masses

A current treatment of nonemergent dysfunctional uterine bleeding includes which medication?

Oral or patch contraceptives

A nurse is assessing a client who is being admitted for surgical repair of a rectocele. What signs/symptoms does the nurse expect the client to report?

Painful intercourse Bearing-down sensations

Which classic symptom is indicative of invasive gynecologic cancer in an older patient?

Painless vaginal bleeding

Which intervention will the nurse give to unlicensed assistive personnel (UAP)?

Patient is on bedrest and excessive movement is restricted

What is the nurse's priority action?

Prepare to administer combination hormonal therapy

What is the primary treatment for dysfunctional uterine bleeding in perimenopausal women?

Progestin or combination hormone therapy

A client at the women's health clinic tells the nurse she has endometriosis. What factors associated with endometriosis does the nurse anticipate the client will report?

Rectal pressure Abdominal pain

You are working in the ED when a client with possible toxic shock syndrome is admitted. Which prescribed intervention will you implement first?

Remove the client tampon

The nurse is giving discharge teaching to a woman who had a local cervical ablation. What information would be included?

Report heavy vaginal bleeding or foul-smelling drainage Showering is permitted, but no hot tub baths Avoid lifting heavy objects for 3 weeks

Which assessment finding should be immediately communicated to the surgeon?

Sharp, continuous, level 8 (out of 10) abdominal pain

In the discharge instructions, what does the nurse tell the patient to expect after the procedure?

Spotting

A patient is admitted with toxic shock syndrome. What organism is frequently associated with this syndrome when it occurs as a menstrually related infection?

Staphylococcus aureus

When taking the health history of a client who is admitted for repair of a cystocele and rectocele, the nurse should expect the client to report the occurrence of:

Stress incontinence and low abdominal pressure

What is the priority factor for the low survival rates for patients who are diagnosed with ovarian cancer?

Symptoms are mild and vague, therefore the cancer is often not detected until its late stage

Which point would be emphasized to avoid complications of this surgery?

Take temperature twice a day for the first 3 days after surgery

What assessment finding requires that you act most rapidly?

The abdomen is firm and tender to palpation above the symphysis pubis

Which information has the most immediate implications for planning of the client's care?

The client's right calf is swollen, and she reports calf tenderness

The nurse prepares the patient for which first-choice diagnostic test?

Transvaginal ultrasound

Which diagnostic tests are considered the gold standard tests for determining the presence of endometrial thickening and cancer?

Transvaginal ultrasound Endometrial biopsy

what is a self-care measure for this patient to ensure that the symptoms do not return after using the medication?

Wash clothes, linens, and disinfect the home environment

A patient has undergone a total hysterectomy with vaginal repair. The nurse advises her about careful intercourse and which over-the-counter product to decrease sexual discomfort related to intercourse?

Water-based lubricants

The nurse is giving instructions to a patient who is undergoing brachytherapy for cervical cancer. What information does the nurse include?

You are not radioactive between treatments Report any blood in the urine or severe diarrhea immediately You will be on bedrest during the treatment session