Med Surge II: Exam 5 Study guide
A nurse is discussing pelvic inflammatory disease with a student nurse. Which statement made by the student nurse indicates need for further discussion? 1. "Patients should always practice safe sex." 2. "A female patient should use a tampon when the infection is active." 3. "The patient should call the primary health-care provider if pain worsens." 4. "The patient should complete the entire prescribed therapy."
"A female patient should use a tampon when the infection is active." --The patient should NEVER use a tampon if diagnosed with PID. P. 1561 (Ch. 67)
A patient with pelvic inflammatory disease is prescribed metronidazole. Which instruction provided by the nurse is most beneficial to the patient in this condition? 1. "Avoid sun exposure." 2. "Avoid alcohol intake." 3. "Take the medication twice when there is increased vaginal discharge." 4. "Discontinue the medication once the symptoms disappear."
"Avoid alcohol intake." --This medication results in potentially serious side effects when taken with alcohol. **Avoid sun exposure: Patients prescribed doxycycline should follow this instruction, due to sensitivity to sunlight. **Report to PCP when there is vaginal discharge and increased pain. **Complete the entire prescribed therapy because the patient may develop a resistance to antibiotics if the entire treatment regimen is not completed. P. 1567 (Ch. 67)
A young adolescent patient is concerned about experiencing severe cramps with menstruation. How should the nurse respond to this patient? 1. "You have cramps because you started your periods early" 2. "This is not normal but is something that can be treated.'' 3. "Cramps happen when you first start having periods and should become less severe as you get older." 4. "You need to see a gynecologist for a pelvic exam"
"Cramps happen when you first start having periods and should become less severe as you get older." P. 1513 (Ch. 65)
A patient was diagnosed with benign prostatic hyperplasia (BPH), and the primary health-care provider decides that watchful waiting is appropriate. Which statement made by the patient requires further teaching? 1. "I should receive yearly examinations." 2. "I should avoid over-the-counter drugs." 3. "I should drink lots of fluids in the evening." 4. "I should return to the clinic if I have symptoms."
"I should drink lots of fluids in the evening." --Consuming excess fluids in the evening may worsen the symptoms of nocturia. **The patient SHOULD have yearly physical exams to monitor BPH. **OTC drugs should be avoided, they can worsen the obstructive symptoms. **If symptoms worsen, a PCP should be consulted. P. 1535 (Ch. 66)
The nurse is discussing precautions to be followed to manage gonorrhea with a student nurse. Which statement by the student nurse indicates effective understanding? 1. "Increase the drug dose if pain worsens." 2. "Get tested every year to check for reinfection." 3. "Report your history of infections to your sexual partners." 4. "Discontinue the antibiotics if vaginal discharge continues."
"Report your history of infections to your sexual partners." --The patient should report this due to early treatment prevents complications of the infection. **The patient should NOT alter his or her own drug dose. **The patient should be re-tested every 3 months to check for reinfection. **Antibiotics should be used until the completion of the course, discontinuing may develop antibiotic resistance. P. 1563 (Ch. 67)
The nurse is talking with a patient who says his friend has a procedure where hot water is used for causing coagulation necrosis of the prostate tissue. The patient says, "That's just crazy, I don't believe him." How should the nurse respond? 1. "It sounds like your friend is talking about an open prostatectomy." 2. "A transurethral needle ablation includes the use of hot water." 3. "That would be water-induced thermotherapy (WIT)." 4. "Yes, that's a transurethral ethanol ablation of the prostate (TEAP)."
"That would be water-induced thermotherapy (WIT)." --It is a 45-minute procedure performed using topical anesthesia. Hot water is used to cause coagulation necrosis of the prostatic tissue that will compress the urethra. **Open prostatectomy: An incision is made near the patient's lower abdomen to access the prostate gland. **Transurethral needle ablation: A cystoscope is passed through the urethra. *Transurethral ethanol ablation of the prostate (TEAP): Involves injection of ethanol into arterioles and venules. P. 1534 (Ch. 66)
Which statement by the patient indicates teaching has been effective in regard to her Pap smear? 1. "I have to have this done every year even if it's negative, right?" 2. "This is a test to see if I have cervical cancer." 3. "This is a test for ovarian cancer." 4. "This will test for the HPV, right?
"This is a test to see if I have cervical cancer."
The nurse is teaching a group of men with benign prostatic hyperplasia about different surgical management procedures. Which statement by the nurse indicates effective teaching? 1. "Open prostatectomies may be used for men taking anticoagulants." 2. "Transurethral microwave therapy causes shrinkage of the prostate gland." 3. "Prostatic stents can be used for the long-term treatment." 4. "A transurethral incision of the prostate involves the removal of the entire outer layer of the prostate."
"Transurethral microwave therapy causes shrinkage of the prostate gland." --This procedure uses microwave energy to heat the inner portion of the prostate, this destroys the prostate tissue and causes the gland to shrink. **Open prostatectomy: A surgical procedure that often requires blood transfusion, not indicated for men taking anticoagulants. **Prostatic stents: Cause urinary tract infections and pain during urination, not preferred for long-term treatment. **Transurethral incision of the prostate: Two small incisions are made in the prostate to open the urethral channel by relieving compression. P. 1534 (Ch. 66)
Which statement indicates teaching has been effective in regard to PSA testing? 1. "I don't need a PSA test if that digital rectal examination is negative." 2. "I understand the new recommendations state men should have a PSA done annually." 3. "I may need an MRI if my PSA level is high." 4. "Typically, the PSA and digital rectal examination are evaluated together."
"Typically, the PSA and digital rectal examination are evaluated together."
A client with benign prostatic hyperplasia has a new prescription for tamsulosin. Which statement about tamsulosin is most important to include when teaching this client? 1. "The force of your urinary stream will probably increase." 2. "You should avoid sitting up or standing up too quickly." 3. "This medication will improve your symptoms by shrinking the prostate." 4. "Your blood pressure might decrease as a result of taking this medication."
"You should avoid sitting up or standing up too quickly." --Tamsulosin blocks alpha receptors in the peripheral arterial system, the most significant side effects are orthostatic hypotension and dizziness. --To avoid falls, it is important that the client change positions slowly.
Which statement by the patient diagnosed with benign prostatic hyperplasia (BPH) indicates the need for further teaching about this disease process? 1. 'An elevated PSA level indicates that I have prostate cancer.' 2. 'I am at an increased risk for urinary tract infection.' 3. 'Since I have minimal symptoms, the doctor says we will enter "watchful waiting".' 4. 'Medications may be prescribed if my symptoms begin to interfere with life.'
'An elevated PSA level indicates that I have prostate cancer.' P. 1532 (Ch. 66)
Which patient statement about endometriosis indicates the need for further teaching? 1. 'Excessive bleeding during my menstrual period is expected with my condition.' 2. 'I should increase my intake of calcium-rich foods to decrease pain.' 3. 'I will maintain a menstrual calendar to document my symptoms in relation to my cycle.' 4. 'The gonadotropin-releasing hormone agonists prescribed by my doctor will decrease symptoms.'
'I should increase my intake of calcium-rich foods to decrease pain.' P. 1516 (Ch. 65)
What should the patient be educated on related to receiving brachytherapy?
-Abstain from sex for 2 weeks. -Wear a condom to protect his partner from radiation exposure.
What are risk factors for developing chlamydia?
-Age (25 years or younger) -Low socioeconomic status -Multiple sexual partners -History of STIs -Unmarried status -Immature cervix -Diagnosis of mucopurulent inflammation of the cervix
What are risk factors for developing gonorrhea?
-Age (particularly under 25 years old). -Low socioeconomic status -Multiple sexual partners -History of STIs (including PID) -Unmarried status
When should the PSA be drawn?
-Age 40 to 45 for African Americans or family history -Age 50 for all other males
What medications are prescribed for Benign Prostatic Hyperplasia?
-Alpha-adrenergic blockers -Anti-cholinergic (Oxybutynin)
What are clinical manifestations of Local prostate cancer?
-Asymptomatic -Elevated PSA -Weak urinary stream -Hesitancy -Sensation of incomplete emptying of the bladder -Frequency -Urgency -Urge incontinence -UTI
What are treatments associated with Prostate cancer?
-Brachytherapy -Prostatectomy -Cryotherapy -Ablative hormone therapy -Chemotherapy
Pathophysiology related to Primary dysmenorrhea?
-Build up of phospholipids of cell membranes after ovulation. -Related to high levels of omega-6 fatty acids in Western diet (released when progesterone levels in the body begin to fall). -When omega-6 fatty acids are released it causes the release of prostaglandins and leukotrienes in the uterus --> Prostaglandins and leukotrienes cause an inflammatory response in the uterus that results in the complaints associated with Primary Dysmenorrhea.
What is the treatment for outpatient pelvic inflammatory disease (PID)?
-Ceftriaxone: Single IM dose -Oral antibiotics (Metronidazole or doxycycline)
Where are common sites for genital herpes to be present in females?
-Cervix -Vulva/Perineum -Legs -Buttocks -Anus
Which STI's require reporting to the Health Department?
-Chlamydia -Gonorrhea -Syphilis
What are treatments associated with nononcogenic (non-cancer strains) HPV?
-Creams (imiquimod 5% cream) -Gels (podofilox 0.5% solution or gel) -Ointments (sinecatechins 15%) --These treatments work by modifying or enhancing the immune response to the wart or by breaking down the skin on the wart. -Cryotherapy (destroys the wart through thermal-induced cytolysis -- breakdown of cells). -Surgical excision (reoccurrence is possible).
What are clinical manifestations of Benign Prostatic Hyperplasia (BPH)?
-Difficulty starting flow of urine -Weak urine stream -Multiple interruptions during urination -Dribbling once urination is complete -Urgency, frequency to urinate -Nocturia -Bladder outlet obstruction
How is Benign prostatic hyperplasia diagnosed?
-Digital rectal examination (enlarged prostate can be palpated this way). -Urinalysis (done to rule out the presence of an infection that may be causing the symptoms). -Prostate-specific antigen (a protein produced by the prostate gland and may be considered a tumor maker) --> This method is not able to distinguish between cancer and BPH.
What are nursing diagnoses related to Benign Prostatic Hyperplasia?
-Disturbed sleep patterns r/t nocturia -Risk for infection r/t urinary stasis
What are clinical manifestations of gonorrhea in males?
-Dysuria (occurs before purulent discharge) -Copious purulent urethral discharge (gold standard manifestation of gonococcal urethritis) -Rectal pain (bleeding or purulent discharge)
What are clinical manifestations of chlamydia in females?
-Dysuria (painful urination) -Dyspareunia (painful sexual intercourse) -Lower abdominal pain -Abnormal vaginal bleeding (postcoital, intermenstrual) -Vagina discharge (clear or cloudy) -Cervical abnormalities (friable, tender, inflamed) -Proctitis (inflammation of the rectum or anus) -Rectal discharge (clear or cloudy)
What are clinical manifestations of chlamydia in males?
-Dysuria (painful urination) -Urethral discharge (clear or cloudy) -Meatitis (inflammation of the urinary meatus) -Proctitis (inflammation of the rectum or anus) -Rectal discharge (clear or cloudy)
What lab values are expected when it comes to a patient with endometriosis?
-Elevated serum CA-125 levels (Less than 46 U/mL). -Estrogen levels (elevated). -Aromatase levels (elevated).
What are complications in males if chlamydia is left untreated?
-Epididymitis (inflammation of the epididymis) -Prostate gland infection
What are risk factors for developing prostate cancer?
-Family history -Diets high in red meat -Consumption of calcium -High BMI
What are other genital herpes symptoms that may occur with vesicles in females?
-Fever -Headache -Dysuria (painful/difficult urination) -Myalgias (pain in the muscles) -Burning and tingling
What are details affiliated with primary syphilis?
-First symptoms occur between days 10-90 (after exposure). -Chancre lasts 3-6 weeks. -Ulcers and chancres appear where syphilis enters the body. -Without treatment, the infection progresses to secondary stage.
What are risk factors for developing endometriosis?
-First-degree relative with endometriosis (immediate family) -Monozygotic twins (75% chance) -Bleeding disorders
Foods high in Omega-3?
-Fish (especially cold-water fatty fish such as salmon, mackerel, tuna, herring, and sardines). -Nuts and seeds (flaxseed, chia seeds, and walnuts). -Plant oils (flaxseed oil, soybean oil, canola oil).
What are clinical manifestations of primary syphilis?
-Genital ulcer -Chancre (firm, round, and painless)
What are clinical manifestations of locally invasive prostate cancer?
-Hematuria (blood in urine) -Dysuria -Perineal and suprapubic pain -Erectile dysfunction (ED) -Incontinence -Loin pain or anuria resulting from obstruction of the ureters -Symptoms of renal failure -Hemospermia (blood in the semen) -Rectal symptoms, including tenesmus (rectal pain or cramping, a sensation of incomplete defecation).
Side effects of Prostatectomy?
-Impotence (unless the nerve-sparing prostatectomy approach is used) -Urinary incontinence -Dry orgasm (no ejaculation) -UTI
Side effects of Brachytherapy?
-Incontinence -Impotence
What are PRODROMAL (period between the appearance of initial symptoms) SYMPTOMS of genital herpes in females?
-Itching -Burning -Tingling or an abnormal sensation prior to presence of a vesicle or ulcer.
What are PRODROMAL (period between the appearance of initial symptoms) SYMPTOMS of genital herpes in males?
-Itching -Burning -Tingling or an abnormal sensation prior to presence of a vesicle or ulcer.
What are other genital herpes symptoms that may occur with vesicles in males?
-Itching (localized to groin area) -Swollen lymph nodes (in groin area) -Flu-like symptoms
What diagnostics can be done if secondary dysmenorrhea is suspected?
-Laboratory tests -Abdominal or transvaginal ultrasonography -Hysterosalpingography -Hysteroscopy -Laparoscopy
What are considered normal values for PSA?
-Less than 2.5 ng/mL.
What are the types of prostate cancer?
-Local (Cancer has not spread outside of the prostate). -Locally invasive (Cancer has spread to nearby organs outside the prostate, but not to distant sites). -Metastatic (Spread to more distant sites).
What are clinical manifestations of PID?
-Lower abdominal pain -Uterine tenderness -Adnexal tenderness -Cervical motion tenderness
What are common pharmacologic treatments for Dysmenorrhea?
-NSAIDs (Most recommended) -Combined oral contraceptives (Limits the amount of endometrial growth, which reduces the amount of endometrium available for prostaglandin and leukotriene production). -Prohibiting ovulation (With other forms of contraceptives can interfere with ovarian progesterone secretion).
What are diagnostic tests to diagnose dysmenorrhea?
-No tests are specific to diagnose primary dysmenorrhea. -Studies may be needed to determine if dysmenorrhea is secondary (related to pelvic pathology) and if so there are further tests that can determine the specific cause.
What are complications in females if chlamydia is left untreated?
-Pelvic inflammatory disease (PID): By traveling to the uterus and fallopian tubes. -Infertility -Tubal abscesses -Ectopic pregnancy -Chronic pelvic pain -Fitz-Hugh-Curtis syndrome (inflammation of the peritoneal covering of the liver) -Reiter's syndrome (rare autoimmune arthritic condition that causes urethritis -- inflammation of the urinary genital tract & inflammation of the mucous membranes lining the eyes).
Where are common sites for genital herpes to be present in males?
-Penis -Prepuce (foreskin) -Scrotum -Anus -Buttocks -Thighs -Inside urethra
Patient education related to HPV:
-Practicing safe sex to minimize transmission of HPV -Healthy practices (diet, limiting drinking, no smoking). -Completing the full series of HPV vaccinations. -Report infection history to sexual partners. -How to apply gels, creams, or ointments for genital warts.
What types of patients would require inpatient treatment of PID with parenteral or IV antibiotic treatments for a minimal of 24 hours and then moved to oral antibiotics once clinical manifestations improve?
-Pregnancy -Severe illness -Differential diagnoses such as appendicitis -Suspected ectopic pregnancy
What are some patient education points when it comes to PID?
-Prevention, manifestations, transmission of STIs. -Avoid douching, tub baths, tampon use, sexual intercourse during active infection. -Take the entire prescribed medication therapy (due to risk of developing resistance to the antibiotic if regimen isn't completed). -Contact provider if pain worsens and/or vaginal discharge occurs (may be sign of worsening condition or complication).
What are details affiliated with secondary syphilis?
-Rash can appear when the primary chancre is healing or several weeks AFTER the chancre has healed. -Symptoms can go away with or without treatment. -Without treatment, the infection progresses to latent or tertiary stage.
What are the THREE groups at high risk for chlamydia?
-Sexually active females under the age of 25 -Persons over the age of 25 who frequently engage in sexual intercourse with a new partner -MSM (Gay, bisexual, males who have sex with other males)
What are clinical manifestations of secondary syphilis?
-Skin rashes: Lesions (including palms and soles), macular, papular, pustular. -Mucous patches (painless, silvery ulcerations of mucous membrane with surrounding erythema). -Condyloma lata (large, raised gray or white lesions). -Generalized lymphadenopathy (abnormally large lymph nodes). -Fever (low grade), malaise, anorexia, arthralgias, and myalgias -CNS: Headache, meningitis, cranial neuropathies. -Renal: Glomerulonephritis, nephritic syndrome -Liver: Hepatitis -Bone and joint: Arthritis
What are Nonpharmacological therapies recommended to help with primary dysmenorrhea?
-TENS Unit (Transcutaneous nerve stimulation) -Herbal preparations -Heat -Physical therapy -Dietary supplementation (with Omega-3 fatty acids)
What are risk factors associated with pelvic inflammatory disease (PID)?
-Unprotected sexual intercourse -Sexual intercourse at 25 years old or younger -Oral contraceptive use -Multiple sexual partners -Previous history of PID -Bacterial vaginosis -Douching -Sexual intercourse during menses -IUDs
What are clinical manifestations of gonorrhea in females?
-Vaginal discharge -Intermenstrual bleeding (bleeding outside of normal menstrual days) -Anorectal discomfort -Dysuria (painful or difficult urination) -Cervicitis (inflammation of the cervix)
How can a patient non-pharmacologically manage outbreaks/discomfort with genital herpes?
-Warm salt baths as needed (assists with drying the lesions and easy physical discomfort due to pain or itching from the vesicles or ulcers). -Ice to the affected area -Loose-fitting clothing (increased airflow can help with promoting healing and reducing discomfort).
What is taught to patients with Benign Prostatic Hyperplasia?
-Watchful waiting (recognition of worsening symptoms, when to seek further treatment). -Decreased liquid intake in the evenings (Decrease nocturia) -Follow-up (this helps to determine when disease process has worsened that may require further interventions). -Avoiding tranquilizers and OTC medications that contain decongestants (due to worsening of obstructive symptoms).
A patient is diagnosed with benign prostatic hyperplasia (BPH) and has minimal symptoms. The primary health-care provider recommends active surveillance of the patient. What should the nurse include with discharge teaching? Select all that apply. 1. "I should advise the patient to avoid sedatives." 2. "I should advise the patient to avoid all over-the-counter (OTC) medications." 3. "I should advise the patient to visit the provider yearly." 4. "I should advise the patient to increase fluid intake until bed time." 5. "I should advise the patient to avoid consumption of selenium-rich foods."
1 & 3 -"I should advise the patient to avoid sedatives." (Sedatives may worsen the symptoms). -"I should advise the patient to visit the provider yearly." (This is to undergo a yearly digital rectal examination as well). **OTC drugs do not need to be avoided, the patient should avoid medications that contain decongestants (it may worsen the patient's symptoms). **The patient should avoid excess fluid intake in the evenings to decrease the chances of nocturia and sleep interruptions. **Selenium-rich foods SHOULD BE consumed to reduce the risk of prostate cancer. P. 1535 (Ch. 66)
A patient reports frequency in urination leading to awakening at night, a weak stream of urine, and a feeling that the bladder has not completely emptied. Which diagnostic tests are beneficial to confirm the condition? Select all that apply. 1. Urinalysis 2. Ultrasound of the abdomen 3. Digital rectal exam 4. Magnetic resonance imaging 5. Prostate specific androgen (PSA) levels
1 & 3 -Urinalysis (Performed to rule out the presence of infection). -Digital rectal exam (Confirms benign prostatic hyperplasia [BPH]). **Prostate specific androgen (PSA) levels: Used to confirm prostate cancer. P. 1531 (Ch. 66)
A 25-year-old female patient reports severe abdominal cramping along with headache and vomiting during menses. Which treatments would be beneficial for the patient if she wishes to get pregnant in the future? Select all that apply. 1. Heat therapy 2. Intrauterine devices 3. Oral contraceptive pills 4. Nonsteroidal anti-inflammatory drugs (NSAIDs) 5. Gonadotropin releasing hormone agonist therapy (GnRH agonist)
1 & 4 -Heat therapy (Helps reduce the symptoms of dysmenorrhea & doesn't affect fertility). -Nonsteroidal anti-inflammatory drugs (NSAIDs) (First-line therapy for patients with dysmenorrhea and safe if the patient wishes to get pregnant in the near future). **Intrauterine devices: Type of hormonal therapy to treat dysmenorrhea but not advised if the patient wishes to become pregnant in the near future. **Oral contraceptive pills: Releases progesterone and estrogen to help with dysmenorrhea but isn't given to patients wishing to become pregnant. **Gonadotropin releasing hormone agonist therapy (GnRH agonist): Is used to treat endometriosis. P. 1514 (Ch. 65)
The primary health-care provider is talking with the nursing student about the causes of bladder stones. Which symptoms does the nurse expect to be related to bladder stones? Select all that apply. 1. Blood in the urine 2. Mineral deposits 3. Obstructed urine flow 4. Stretching of bladder muscles 5. Decreased bladder contraction
1, 2, 3 -Blood in the urine (hematuria). -Mineral deposits (clinical manifestation of bladder stones). -Obstructed urine flow. **Stretching of bladder muscles: Occurs in bladder damage from incomplete emptying of the bladder. **Decreased bladder contraction: Occurs in bladder damage. P. 1531 (Ch. 66)
The nurse assesses a patient's condition and suspects that the patient has pelvic inflammatory disease. Which assessment findings are responsible for the nurse's suspicion? Select all that apply. 1. Oral temperature of 102.2°F (39°C) 2. Lower abdominal pain 3. Increased C-reactive protein 4. Treponema pallidum infection 5. Decreased erythrocyte sedimentation rate
1, 2, 3 -Oral temperature of 102.2°F (39°C) (Caused by acute inflammatory process). -Lower abdominal pain (Caused by upper genital tract inflammation). -Increased C-reactive protein (Helps in the diagnosis of PID). **Erythrocyte sedimentation rate: Increased in a patient with PID. P. 1565 (Ch. 67)
The nurse monitors for which clinical manifestations in the patient being treated for locally invasive prostate cancer? Select all that apply. 1. Tenesmus 2. Hematuria 3. Hemospermia 4. Urge incontinence 5. Weak urinary stream
1, 2, 3 -Tenesmus -Hematuria -Hemospermia P. 1568, Table 66.2 (Ch. 66)
Which female patient is at high risk for endometrial cancer? Select all that apply. 1. A patient who is obese 2. A patient with liver cirrhosis 3. A patient who is 20 years old 4. A patient who is on tamoxifen 5. A patient who is on progesterone therapy
1, 2, 4 - A patient who is obese (Endogenous source of elevated estrogen levels). -A patient with liver cirrhosis (Causes elevation of estrogen levels). -A patient who is on tamoxifen (Increased risk due to endometrial hyperplasia). **Postmenopausal woman (age 55-65) have higher risks of endometrial cancer. *Estrogen therapy in the absence of progesterone is at risk for endometrial cancer. P. 1524 (Ch. 65)
In preparing an educational presentation about risk factors for prostate cancer, the nurse includes which information? Select all that apply. 1. Age older than 65 2. Diets high in red meat 3. Diet low in calcium 4. Family history of prostate cancer 5. History of sexual transmitted infection
1, 2, 4 -Age older than 65 -Diets high in red meat -Family history of prostate cancer P. 1537 (Ch. 66)
The nurse is caring for a patient during the primary stage of syphilis. What assessments are anticipated? Select all that apply. 1. Chancre 2. Genital ulcers 3. Aortic regurgitation 4. Regional lymphadenopathy 5. Generalized lymphadenopathy
1, 2, 4 -Chancre (A painless, hard lesion located at the exposure site, and it is observed during primary stage syphilis). -Genital ulcers -Regional lymphadenopathy (Presence of abnormal lymph nodes, is observed during primary syphilis stage). **Aortic regurgitation: A cardiovascular condition developed by patients during the late or tertiary syphilis stage. **Generalized lymphadenopathy: Observed during the second stage of syphilis. P. 1554 (Ch. 67)
The nurse is caring for a patient undergoing treatment for a chlamydia infection. Which assessments made by the nurse are most appropriate to check the effectiveness of the treatment? Select all that apply. 1. Vaginal bleeding 2. Body temperature 3. Skin of the buttocks 4. History of pain during intercourse 5. Use of birth control devices
1, 2, 4 -Vaginal bleeding -Body temperature (To evaluate the course of infection and response to the treatment). -History of pain during intercourse (Chlamydia infection is associated with painful intercourse). **Skin of the buttocks: Blisters in this area are indicative of a herpes infection. **Birth control devices: Poses a risk for pelvic inflammatory disease. P. 1562 (Ch. 67)
Which symptoms in a patient indicate benign prostatic hyperplasia (BPH) to the primary health-care provider? Select all that apply. 1. Dribbling once urination is complete 2. Frequent nocturia 3. Erectile dysfunction 4. Swelling and hardness in the scrotum 5. Multiple interruptions during urination
1, 2, 5 -Dribbling once urination is complete. -Frequent nocturia. -Multiple interruptions during urination **Swelling and hardness in the scrotum: Symptom of testicular cancer. P. 1531 (Ch. 66)
The nurse is presenting at a conference on men's health about prostate cancer. What information should the nurse include? Select all that apply. 1. Prostate cancer may run in families. 2. Prostate cancer progresses very rapidly. 3. Metastasized prostate cancer may be curable. 4. Prostate cancer generally occurs in older males. 5. Symptoms appear immediately after the formation of tumors.
1, 3, 4 -Prostate cancer may run in families. -Metastasized prostate cancer may be curable. -Prostate cancer generally occurs in older males. (median age is 72). ** Tumors in the prostate generally develop on the periphery of the gland, the tumors do not obstruct the flow of urine. Symptoms such as pain occur in the later stages. **Prostate cancer is a slow-growing cancer. P. 1538 (Ch. 66)
The nurse is educating a group of licensed practical nurses (LPNs) about the pathophysiology of gonorrhea. Which statements made by an LPN indicate the need for further teaching? Select all that apply. 1. "Gonococci cause gonorrhea." 2. "Gonococci are gram-positive intracellular diplococci." 3. "Gonococci replicate and invade host immune cells." 4. "Gonococci incubate in females for 14 days." 5. "Gonococci are transmitted from oral to genital contact."
2 & 4 - "Gonococci are gram-positive intracellular diplococci." (Gonococci are gram-negative intracellular diplococci). -"Gonococci incubate in females for 14 days." (Gonococci incubate in females for 10 days). **Gonococci replicate and invade host immune cells leading to dissemination and systemic infection. P. 1563 (Ch. 67)
The nurse recognizes which of the following statements are true about PID? Select all that apply. 1. Pelvic inflammatory disease is an acute infection that routinely descends from the upper genital tract to the cervix or vagina. 2. If the patient is diagnosed with PID and is pregnant, inpatient admission should be considered. 3. Symptoms such as lower abdominal pain and elevated blood pressure are specific criteria for PID. 4. Laparoscopy is the only definitive test to diagnosis PID. 5. Tubo-ovarian abscess is a severe complication of PID.
2 & 5 -If the patient is diagnosed with PID and is pregnant, inpatient admission should be considered. -Tubo-ovarian abscess is a severe complication of PID.
The nurse understands which of the following are correct about syphilis? Select all that apply. 1. A chancre is a common symptom in tertiary syphilis. 2. Neurosyphilis invades the CNS and may occur at any stage of syphilis. 3. The most infectious stages of syphilis are the primary and secondary stages. 4. Latent infections are detected primarily by visual inspection. 5. Penicillin G is the preferred treatment for all stages of syphilis.
2, 3, 5 -Neurosyphilis invades the CNS and may occur at any stage of syphilis. -The most infectious stages of syphilis are the primary and secondary stages. -Penicillin G is the preferred treatment for all stages of syphilis.
Which are complications of chlamydia in a female patient? Select all that apply. 1. Endocarditis 2. Chronic pelvic pain 3. Meningitis 4. Tubal abscesses 5. Ectopic pregnancy
2, 4, 5 -Chronic pelvic pain -Tubal abscesses -Ectopic pregnancy P. 1561 (Ch. 67)
The nurse recognizes which statements are true when discussing gonorrhea? Select all that apply. 1. Gonococci are viruses caused by N. gonorrhoeae. 2. Concomitant infection with Chlamydia can occur; therefore, test for both. 3. Gonorrhea remains localized to an expectant mother; therefore, there is very low risk of vertical transmission to the infant. 4. The NAAT is effective in detection of genitourinary infection of N. gonorrhoeae. 5. A hallmark symptom in males with gonorrhea is copious purulent urethral discharge.
2, 4, 5 -Concomitant infection with Chlamydia can occur; therefore, test for both. -The NAAT is effective in detection of genitourinary infection of N. gonorrhoeae. -A hallmark symptom in males with gonorrhea is copious purulent urethral discharge.
The nurse monitors for which clinical manifestations in the male patient with chlamydia? Select all that apply. 1. Diarrhea 2. Dysuria 3. Incontinence 4. Rectal discharge 5. Urethral discharge
2, 4, 5 -Dysuria -Rectal discharge -Urethral discharge P. 1559 (Ch. 67)
A patient's orders include the placement of a catheter as a temporary treatment of his BPH. The nurse understands the rationale for this intervention is which of the following? Select all that apply. 1. Exact monitoring of intake and output 2. Retrieving a sterile sample for urinalysis 3. To evaluate PVR volume 4. To facilitate complete emptying of the bladder 5. To avoid unnecessary surgical procedures
3 & 4 -To evaluate PVR volume -To facilitate complete emptying of the bladder
Which are psychological factors that contribute to the onset of a herpes simplex virus (HSV) outbreak in a patient? Select all that apply. 1. Immunosuppression 2. Menstruation 3. Emotional stress 4. Fatigue 5. Traumatic stress
3 & 5 -Emotional stress (psychological trigger). -Traumatic stress (psychological trigger). **Physiological triggers: Immunosuppression, menstruation, and fatigue. P. 1559 (Ch. 67)
What are the lab values for PSA that may need further evaluation?
4.0 ng/mL or higher.
The nurse is comparing patients who have a normal prostate cancer risk based on prostate-specific antigen (PSA) levels. Which patient would the nurse expect to be normal? 1. A 48-year-old man with a PSA level of 4 to 10 mg/mL 2. A 45-year-old man with a PSA level > 10 ng/mL 3. A 73-year-old man with a PSA level of 5 mg/mL 4. A 50-year-old man with a PSA level of 3.9 mg/mL
A 73-year-old man with a PSA level of 5 mg/mL. --Prostate-specific antigen (PSA) levels are also affected by age. **A man with a PSA of 4-10 mg/mL has a 20% - 25% chance of being diagnosed with prostate cancer. **A man with a PSA level greater than 10 ng/mL has an approximately 60% change of developing prostate cancer. **A man with a 3.9 mg/mL may indicate prostate cancer for a 50 year old. P. 1538 (Ch. 66)
Which statement is correct when providing discharge instructions to a patient with genital herpes? 1. Genital herpes is an infection that is always symptomatic. 2. Genital herpes is a low contagious infection. 3. Genital herpes is an infection that can be cured by antivirals. 4. A person can transmit HSV to others without displaying any symptoms.
A person can transmit HSV to others without displaying any symptoms.
What is Brachytherapy (treatment for prostate cancer)?
A procedure that places radioactive seeds or pellets in the prostate through the perineum. --Targeted therapy --Used with cancer that has not metastasized outside the prostate.
The nurse monitors for which clinical manifestation as a prodromal sign of genital herpes? 1. Swollen lymph nodes 2. Muscle pain 3. Dysuria 4. Abnormal sensation
Abnormal sensation. P. 1559, Table 67.3 (Ch. 67)
What is important to educate patients on who are prescribed metronidazole for PID?
Abstain from alcohol due to the potential of serious side effects.
Mechanism of action of Alpha-adrenergic blockers on BPH?
Act on the alpha receptors in the prostate, causing the smooth muscles of the prostate to relax. --Prostate muscle relaxation = decrease in constriction of the urethra.
The nurse monitors for which clinical manifestations in the patient diagnosed with pelvic inflammatory disease (PID)? 1. Rectal tenderness 2. Periumbilical pain 3. Adnexal tenderness 4. Urinary frequency
Adnexal tenderness. P. 1566 (Ch. 67)
A patient reports multiple interruptions during urination and dribbling after urination. A digital rectal exam reveals an enlarged prostate and the prostate-specific androgen levels were found to be elevated. Which therapy is indicated for an early improvement of symptoms? 1. Alprostadil 2. Alpha-adrenergic blockers 3. Sildenafil 4. Phosphodiesterase-5 inhibitors
Alpha-adrenergic blockers. --To relax the prostate muscles and decrease urethral constriction. --These meds may relieve symptoms in 2 weeks to 4 months. **Alprostadil: Used in treatment of erectile dysfunction (ED). **Sildenafil: Used in treatment of ED. **Phosphodiesterase-5 inhibitors: Used in the management of ED. P. 1532 (Ch. 66)
The nurse recognizes which patient is at the greatest risk for C. trachomatis? 1. An 18-year-old single female 2. A 45-year-old married female 3. A 60-year-old single female 4. A 30-year-old married male
An 18-year-old single female.
What is Open prostaectomy?
An incision is made in the patient's lower abdomen to access and remove the prostate gland. --Used in patients with a very large prostate who experiences complications such as bladder stones or bladder damage. --This procedure carries a higher risk of complications.
What types of medications are recommended for genital herpes?
Antivirals. --Suppresses the infection and provide symptom relief. --Helps to decrease the duration and severity of the infection.
What is a line of treatment for endometriosis that is only used for severe, refractory pain associated with the disease?
Aromatase inhibitors. --Blocks local estrogen biosynthesis that occurs outside of the ovaries. --Administered in combination with a progestin, a combo oral contraceptive, or a GnRH analog.
What is important to warn against for a patient prescribed doxycycline for chlamydia?
Avoid excessive sun exposure.
Which of the following is true of BPH? 1. It is a form of metastatic cancer. 2. Benign prostatic hyperplasia is not a form of cancer. 3. Males as young as 25 years old are equally at risk. 4. Benign prostatic hyperplasia is a precursor to testicular cancer.
Benign prostatic hyperplasia is not a form of cancer.
Which procedure can confirm suspected endometriosis? 1. CT scan 2. Ultrasound 3. MRI 4. Biopsy
Biopsy. --Through laparoscopy must be done to confirm a suspected diagnosis.
What can occur if a patient's BPH isn't treated?
Bladder outlet obstruction, which includes: -Acute urinary retention (AUR): Obstruction of urine flow -Urinary tract infection (UTI): Secondary to urinary stasis -Bladder stones: Crystallization of mineral deposits in concentrated urine. -Bladder damage: Due to stretching and weakening of the bladder wall muscles from incomplete emptying. -Kidney damage: Due to increased pressure in the kidney secondary to urinary retention and backflow of urine. --> It can cause hydronephrosis (swelling of urine-collecting structures in the kidney) and postrenal AKI. **It can also cause pyelonephritis (UTI migrating from the bladder to the kidney).
The nurse is caring for a client who has just returned to the surgical unit after a transurethral resection of the prostate (TURP). Which assessment finding will require the most immediate action? 1. Client not wearing antiembolism hose 2. Blood pressure reading of 153/88 mm Hg 3. Client report of abdominal cramping 4. Catheter that is draining deep red blood
Catheter that is draining deep red blood.
Which of these reproductive cancers is primarily caused by a virus? 1. Breast cancer 2. Cervical cancer 3. Endometrial cancer 4. Ovarian cancer
Cervical cancer. --It is caused by human papillomavirus (HPV), a STI.
A patient is undergoing treatment for genital warts. During a follow-up visit, the nurse observes that the pelvic outlet is obstructed by genital warts. Which treatment option is beneficial for the patient in this condition? 1. Topical cidofovir 2. Cesarean section 3. Intramuscular ceftriaxone 4. Loop electrosurgical excision procedure (LEEP)
Cesarean section. --Obstruction of the pelvic outlet by genital wards indicates an emergency situation that requires a cesarean section. **Topical cidofovir: Recommended in patients with genital warts, this is not beneficial if pelvic outlet is obstructed. **Intramuscular ceftriaxone: Recommended for treatment of gonorrhea. **Loop electrosurgical excision procedure (LEEP): Recommended when the patient has cervical cancer. P. 1552 (Ch. 67)
While assessing a patient with endometriosis, the nurse finds the patient shows signs of anxiety. Which might be the reason for the patient's condition? 1. Infertility 2. Chronic pelvic pain 3. Inflammation of endometrial implants 4. Scarring of endometrial implants
Chronic pelvic pain. **Infertility: Hopelessness. **Chronic pain: Associated with inflammation of endometrial implants and scarring of endometrial implants. P. 1516 (Ch. 65)
Which information obtained when taking a client's health history will be most important in determining whether the client should receive the human papillomavirus (HPV) immunization? 1. Client has a positive pregnancy test result. 2. Client is sexually active. 3. Client has tested positive for HPV previously. 4. Client has a positive pregnancy test result.
Client has a positive pregnancy test result. --CDC and prevention guidelines indicate that the HPV immunization should not be given during pregnancy. --Immunization series should start at age 11 or 12 years for girls and boys, but it may be started up through age 26 years.
A client who is being treated as an outpatient for pelvic inflammatory disease (PID) with oral antibiotics returns to the clinic after 3 days of treatment. Which finding by the nurse is of highest concern? 1. Client reports nausea after taking the antibiotics. 2. Client's abdominal rebound pain is unchanged. 3. Client says she feels ashamed to have the infection. 4. Client's cervical culture report shows gonorrhea.
Client's abdominal rebound pain is unchanged. --Clinical manifestations of PID should improve with 3 days of effective antibiotic treatment. Ongoing pain can indicate hospitalization for IV antibiotic therapy.
A patient diagnosed with secondary syphilis is admitted to a hospital. The patient is allergic to penicillin. Which treatment option is most appropriate for this patient? 1. Azithromycin 2. Cephalosporin 3. Laser conization 4. Desensitization procedure
Desensitization procedure. --This is performed under close observation in a hospital in patients who are allergic to penicillin. In this procedure penicillin is administered after administering methylprednisolone and diphenhydramine to counteract a potential reaction. **Azithromycin: Prescribed for outpatient patients with syphilis who are allergic to penicillin. **Cephalosporin: Recommended drug of choice for treatment of gonorrhea. **Laser conization: Surgical procedure performed in patients with cervical cancer. P. 1557 (Ch. 67)
A patient reports abdominal pain and vomiting during menses. The nurse finds that the patient takes high levels of omega-6 fatty acids. Which nonpharmacological therapy would be beneficial to the patient? 1. Use of vaginal rings 2. Use of an intrauterine device 3. Decreased physical activity 4. Diet rich in omega-3 fatty acids
Diet rich in omega-3 fatty acids. --The patient's symptoms are indicative of dysmenorrhea, increase in omega-3 fatty acids may reduce the pain. **Pharmacological therapies: Vaginal rings & intrauterine device. **Increased physical activity may reduce symptoms of dysmenorrhea. P. 1514 (Ch. 65)
What are recommendations for diet when it comes to dysmenorrhea?
Dietary supplementation with Omega-3 fatty acids.
A patient reports frequent and urgent urination. Upon palpation, an enlarged prostate is observed. Which test should be performed to confirm benign prostatic hyperplasia? 1. Urinalysis 2. Digital rectal exam 3. Alpha-fetoprotein levels 4. Prostate-specific androgen (PSA) levels
Digital rectal exam. --Should be performed to confirm benign prostatic hyperplasia. **Urinalysis: Helps to rule out the presence of infection-causing symptoms, but does not confirm the presence of benign prostatic hyperplasia. **Alpha-fetoprotein levels: Is checked to detect testicular tumors rather than benign prostatic hyperplasia. **Prostate-specific androgen (PSA) levels: May increase because of infections. P. 1532 (Ch. 66)
A 19-year-old patient reports painful sexual intercourse. The nurse observes inflammation in the urinary tract in the magnetic resonance imaging (MRI) test reports and conjunctivitis. Which treatment should the nurse expect to manage the condition? 1. Penicillin 2. Doxycycline 3. Methylprednisolone 4. Diphenhydramine
Doxycycline. --These symptoms are indicative of Reiter's syndrome, which is an autoimmune arthritic condition and a complication of CHLAMYDIA infection. This treatment is beneficial. **Penicillin: Recommended for patients with syphilis. **Methylprednisolone: An anti-inflammatory medication administered before penicillin is given in syphilis treatment to counteract potential reaction. **Diphenhydramine: Antihistamine drug administered before penicillin is given in syphilis treatment to counteract a potential reaction. P. 1561 (Ch. 67)
What are treatments for gonorrhea?
Dual therapy with: -Ceftriaxone (cephalosporin -- administered IM or IV) -Azithromycin (Semisynthetic macrolide antibiotic)
What is the most common gynecological complaint for young women? 1. Dysmenorrhea 2. Endometriosis 3. Uterine cancer 4. Breast cancer
Dysmenorrhea.
A sexually active patient who smokes is at risk for developing which disease condition? 1. Fibroids 2. Endometriosis 3. Dysmenorrhea 4. Uterine cancer
Dysmenorrhea. --Nicotine causes uterine contractions, which results in abdominal cramping. **Patients who are diabetic, start menstruating at an early age, and who are older age at the time of first pregnancy are at risk for fibroids. **Excessive bleeding during menstruation places a patient at risk for endometriosis. **Patients who are obese and at menopause stage are at high risk for uterine cancer. P. 1513 (Ch. 65)
The nurse monitors for which clinical manifestation in the female patient diagnosed with chlamydia? 1. Constipation 2. Rectal pain 3. Dyspareunia 4. Vaginal dryness
Dyspareunia. P. 1567, Table 67.4 (Ch. 67)
Which condition may occur due to deficiency of 17-β hydroxysteroid dehydrogenase type 2? 1. Fibroids 2. Menopause 3. Ovarian cancer 4. Endometriosis
Endometriosis. --Deficiency of 17-β hydroxysteroid dehydrogenase type 2 inhibits the inactivation of estradiol to estrogen, raising estrogen levels in the tissue. High estrogen is implicated in the development of endometriosis. P. 1515 (Ch. 65)
Which condition is observed in a patient with endometriosis? 1. Estrogen production is decreased. 2. Cell-mediated immunity is activated. 3. Estradiol concentration is decreased. 4. 17-β hydroxysteroid dehydrogenase type 2 is increased.
Estradiol concentration is decreased. --Estradiol is converted to estrogen and results in the concentration of estradiol to decrease. **Estrogen production is increased in endometriosis **Cell-mediated immunity is deactivated when it comes to endometriosis. **17-β hydroxysteroid dehydrogenase type 2 is decreased with endometriosis. P. 1515 (Ch. 65)
The nurse realizes which clinical manifestation is an expected finding of BPH? 1. Increased urinary output 2. Swelling of the penis and scrotum 3. Frequent nocturia 4. Tea-colored urine
Frequent nocturia.
What is the second-line of treatment when it comes to endometriosis?
Gonadotropin releasing hormone (GnRH) agonists. --It results in a systemic hypoestrogenic state that impairs the action of the endometriosis.
What is Laser surgery related to BPH?
High-energy lasers are used to annihilate and/or remove overgrown prostate tissue. --Used in patients with smaller or moderately large prostate glands.
While assessing the Pap test reports of a 32-year-old female patient, the nurse observes the presence of abnormal cells in the cervix region. Which diagnostic test would the nurse use to determine the patient's condition? 1. Biopsy 2. Colposcopy 3. Human papillomavirus (HPV) DNA testing 4. Dark-field microscopy
Human papillomavirus (HPV) DNA testing. --This involves an evaluation of the cells scraped from the cervix, this procedure is used to detect high-risk oncogenic HPV. **Biopsy: Performed when a HPV DNA test shows positive results of cervical carcinoma in females. **Colposcopy: The magnified examination of the cervix, vagina, and vulva. This procedure is indicated when the HPV DNA test is positive. **Dark-field microscopy: A quick, traditional method of testing the presence of primary and secondary syphilis. P. 1552 (Ch. 67)
Which is true regarding human papillomavirus (HPV)? 1. Human papillomavirus (HPV) is a precursor to some head and neck cancers. 2. A low-risk strain causes genital warts that lead to cervical cancer. 3. Exposure to the high-risk strain increases the risk of cervical cancer for women under age 20. 4. Nearly 100 types of HPV are linked to the lower genital tract of males and females.
Human papillomavirus (HPV) is a precursor to some head and neck cancers. --HPV is a precursor to: Cancers of the cervix, vulva, vagina, as well as some head and neck cancers. **Low-risk strain of HPV: causes nearly 90% of genital warts, but these strains are not commonly known to lead to cervical cancer. INTERMEDIATE and HIGH-RISK TYPES: Are known to cause cervical cancer. **Exposure to the high-risk strain increases the risk of cervical cancer for women under age 20: Cervical carcinoma is relatively rare in patients under 21 years of age, this is more true for women who are over 30 years of age. **There are nearly 100 known types of HPV, only 40 are linked to the lower genital tract of males and females. P. 1551 (Ch. 67)
The nurse recognizes that the virus responsible for cervical cancer is called: 1. Cytomegalovirus 2. Herpes simplex virus 3. Human parvovirus 4. Human papillomavirus
Human papillomavirus.
Ms. Harris has large uterine fibroids that are causing her pain and heavy bleeding. The nurse is educating her on her treatment options. Which option is considered the only definitive treatment for fibroids? 1. Uterine Artery artery embolization 2. Hysterectomy 3. Lupron administration 4. Myomectomy
Hysterectomy. --The only definitive treatment for fibroids.
A patient with benign prostatic hyperplasia is diagnosed with bladder damage from the outlet obstruction and asks the nurse why that occurred. Which could be the cause for the bladder damage? 1. Urinary stasis 2. Painful urination 3. Mineral deposits in the bladder 4. Incomplete emptying of bladder
Incomplete emptying of bladder. --This may result in stretching of the muscle walls of the bladder, which may cause bladder damage. **Urinary stasis: May cause UTI. **Painful urination: And inability to urinate results in acute urinary retention. **Mineral deposits in the bladder: May cause infection and bladder stones. P. 1535 (Ch. 66)
In developing a teaching session for a group of young women about strategies to relieve menstrual cramping, the nurse includes what content as the focus of these strategies? 1. Minimization of menstrual flow 2. Increase of blood flow to the uterine muscle 3. Decrease in estrogen production 4. Avoidance of uterine contraction
Increase of blood flow to the uterine muscle. P. 1514 (Ch. 65)
What should occur if a patient's PSA is between 2.5 and 4.0 ng/mL?
Individualized risk assessment which includes: -Race -Family history -Results of previous biopsies -Digital rectal exam (DRE)
A patient visits the primary health-care provider because of painful urination. The digital exam shows the image provided. Which medication is most likely to be prescribed? 1. Tadalafil 2. Sildenafil 3. Indoramin 4. Alprostadil
Indoramin. --Prescribed to treat benign prostatic hyperplasia. --The drug decreases the constriction of the urethra and relaxes the smooth muscles. **Tadalafil, sildenafil: Used to treat ED. **Alprostadil: A medication that consists of pellets that are inserted into the urethra before intercourse, it is used to treat ED. P. 1532 (Ch. 66)
A patient with benign prostatic hyperplasia is on treatment with 5-alpha-reductase inhibitors. Which action of the nurse is most beneficial to the patient? 1. Suggesting the patient perform only light activities 2. Suggesting the patient increase fluid intake in the evening 3. Informing the patient that erectile dysfunction may occur during the therapy 4. Ensuring the patient that over-the-counter drugs can be safely coadministered
Informing the patient that erectile dysfunction may occur during the therapy. --They have a low chance of causing ED. P. 1535 (Ch. 66)
What are complications associated with Human papillomavirus (HPV) if left untreated?
It can lead to the following cancers: -Cervix -Penis -Anus -Mouth -Throat
Why is a Prostate-specific antigen (PSA) drawn?
It is a protein produced by the prostate gland and may be considered a tumor marker.
Why is brachytherapy used for prostate cancer?
It is a targeted therapy, so the cancer receives most of the radiation and nearby healthy tissue receives a minimal dose of radiation.
What is recommended if treatment is not working for a patient with dysmenorrhea?
Laparoscopy is indicated to evaluate for endometriosis.
A patient with dysmenorrhea is receiving treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and oral contraceptive pills (OCPs). During a follow-up visit after 6 months, the patient still complains of menstrual abdominal cramps. Which test should the primary healthcare provider recommend for this patient? 1. Laparoscopy 2. Pelvic ultrasound 3. Color Doppler studies 4. Surgical dilation and curettage
Laparoscopy. **Pelvic ultrasound: Identifies the thickened endometrium and aids in the diagnosis of UTERINE cancer. **Color doppler studies: Identify the vasculature of fibroids. **Surgical dilation and curettage: Beneficial in patients with a negative endometrial biopsy and normal pelvic ultrasound who continue to have abnormal bleeding. P. 1529 (Ch. 65)
The nurse is taking care of Ms. Davis, a 19-year-old with significant pelvic pain not related to her menstrual cycles. After 6 months of oral contraceptive use and NSAIDs, she has had no relief. The nurse understands the next course of treatment indicated includes: 1. Narcotics 2. Laparoscopy 3. Hysterectomy 4. Oophorectomy
Laparoscopy. --To determine if the patient has endometritis.
Four patients have been admitted to the medical surgical unit from recovery after a radical prostatectomy secondary to prostate cancer. The patients have an abdominal scar running vertically down the lower abdomen. It is day 2 postop, and after the initial morning assessment, the nurse contacts the provider because she is concerned about which of the following patients? 1. Mr. X, who has blood-tinged urine in his indwelling catheter 2. Mr. Y, who complains of chills, nausea, and vomiting 3. Mr. Z, who complains of increased pain at the incision site 4. Mr. W, who has no urine output in his catheter
Mr. W, who has no urine output in his catheter. --Which may signal a blocked catheter or indications of hypovolemia or renal failure.
A 23-year-old female patient is undergoing treatment for pelvic inflammatory disease (PID). Which risk factor may be responsible for the patient's condition? 1. Organ transplantation 2. Multiple sexual partners 3. Low socioeconomic status 4. Occasional IV drug use
Multiple sexual partners. --This is a risk for PID. **Organ transplantation: Requires immunosuppression, which is a risk factor for HPV, this can lead to cervical cancer. **Low socioeconomic status: Increased risk for gonorrhea. **Occasional IV drug use: Increases the risk of HIV infection. P. 1566 (Ch. 67)
How is chlamydia treated?
Non-pregnant females, males, and HIV-infected individuals: -Doxycycline (twice daily for 7 days) OR -Azithromycin (one dose) Pregnant females: -Erythromycin
What labs are analyzed specifically in patients with chlamydia?
Nucleic acid amplification test (NAAT). --Men: Swab is placed in the urethral meatus about 2 - 3 cm --Women: Samples are taken from vagina or endocervix. --Urine samples: Obtained first void in the morning.
A patient is diagnosed with benign prostate hyperplasia (BPH) and failed to respond to alpha-adrenergic receptor blockers. The laboratory reports of the patient revealed that there are bladder stones of 2.5 cm. Which surgical procedure would the nurse expect to be beneficial for the patient? 1. Laser surgery 2. Open prostatectomy 3. Transurethral incision of the prostate (TUIP) 4. Transurethral resection of the prostate (TURP)
Open prostatectomy. --A surgical procedure that is performed in patients with Benign prostate hyperplasia (BPH) along with complications such as bladder stones. **Laser surgery: High-energy lasers used to remove the overgrown prostate tissue, results in immediate symptom relief with a lower risk for adverse effects than the transurethral resection of the prostate (TURP) procedure. **Transurethral incision of the prostate (TUIP): Performed in patients with small to moderately enlarged prostates. **Transurethral resection of the prostate (TURP): Most common surgery for BPH and usually used to treat smaller prostates. P. 1541 (Ch. 66)
A patient is diagnosed with a very large prostate and bladder stones. The primary health-care provider suggests surgery to remove the prostate. Which surgery does the nurse expect the primary health-care provider will advise? 1. Laser surgery 2. Open prostatectomy 3. Transurethral microwave therapy 4. Transurethral resection of the prostate
Open prostatectomy. --Performed when the patient is diagnosed with a very large prostate and bladder stones. **Laser surgery: Performed to remove overgrown prostate tissue, MOST PREFERRED FOR PATIENTS WHO ARE ON ANTICOAGULANT THERAPY. **Transurethral microwave therapy: Used to shrink the gland by destroying the inner portion of the prostate gland by heat. **Transurethral resection of the prostate: Used to remove the inner portion of the prostate, it is used to treat diseased small prostates. P. 1533 (Ch. 66)
What is the first-line of treatment when it comes to endometriosis?
Oral contraceptives
What is Primary Dysmenorrhea?
Painful menstruation that is related to normal menstrual cycles and not related to pelvic pathology.
What is Secondary Dysmenorrhea?
Painful menstruation that is related to pelvic pathology such as endometriosis.
The nurse is caring for patients who are undergoing treatment for different sexually transmitted infections. Which patient needs a revision in the treatment? 1. Patient A 2. Patient B 3. Patient C 4. Patient D
Patient A. --A chlamydia infection is caused by C trachomatis, Doxycycline is appropriate for this patient not tetracycline. **Patient B: HPV is treated with topical cidofovir ointment. *Patient C: T. Palladium infection causes syphilis, penicillin treats the infection. **Patient D: N. gonorrhoeae causes gonorrhea, cephalosporins are used to treat gonorrhea. P. 1561 (Ch. 67)
The nurse is documenting the assessment of four patients with sexually transmitted infections (STIs). Which patient does the nurse suspect to have genital herpes? 1. Patient A 2. Patient B 3. Patient C 4. Patient D
Patient A. --Symptoms of genital herpes: One or several clear vesicles or blisters in the genital area, the vesicles rupture and form painful ulcers several days later. **Patient B: Chancre, genital ulcers, and regional lymphadenopathy are clinical manifestations of primary syphilis. **Patient C: Clinical manifestations of gonorrhea include cervicitis, dysuria, intermenstrual bleeding, and vaginal discharge. **Patient D: Clinical manifestations of pelvic inflammatory disease include lower abdominal pain, uterine and adnexal tenderness, tubo-ovarian abscess (inflammatory mass involving the fallopian tubes, ovaries and neighboring organs). P. 1558 (Ch. 67)
Which patient should be prescribed doxycycline as the first line of treatment for the management of a sexually transmitted infection? 1. Patient infected with herpes simplex-1 2. Patient infected with syphilis 3. Patient infected with human papillomavirus (HPV) 4. Patient infected with Chlamydia trachomatis
Patient infected with Chlamydia trachomatis. --Doxycycline and azithromycin are the first line of drugs for the treatment of chlamydia trachomatis. **Herpes simplex-1 patients: Are prescribed antivirals. **Syphilis patients: Treated with penicillin. **HPV patients: Treated with creams such as imiquimod 5% and podofilox 0.5% gels. P. 1561 (Ch. 67)
The nurse is caring for a patient who reports lower abdominal pain. The oral temperature of the patient is 104°F (40°C). The patient also has vaginal mucopurulent discharge. Which kind of sexually transmitted infection is the nurse most likely to suspect from the findings? 1. Gonorrhea 2. Chlamydia 3. Pelvic inflammatory disease (PID) 4. Genital herpes
Pelvic inflammatory disease (PID). --All symptoms of PID. **Symptoms of gonorrhea: Anorectal discharge, cervicitis (inflammation of the cervix), and dysuria. **Symptoms of chlamydia: Females: Abnormal vaginal bleeding, cervical abnormalities, or proctitis. Males: Meatitis or urethral discharge. **Symptoms of genital herpes: Fever, dysuria, myalgias, as well as swollen lymph nodes in the groin area. P. 1561 (Ch. 67)
In planning care for a 28 weeks pregnant female patient who is diagnosed with syphilis and allergic to penicillin, the nurse is aware that which is the best treatment for this patient? 1. Ceftriaxone 2. Penicillin desensitization 3. Tetracycline 4. Doxycycline
Penicillin desensitization. P. 1557 (Ch. 67)
The nurse is providing orientation for a new RN on the medical-surgical unit who is caring for a client with severe pelvic inflammatory disease (PID). Which action by the new RN is most important to correct quickly? 1. Offering the client an ice pack to decrease her abdominal pain 2. Telling the client that she should avoid using tampons in the future 3. Positioning the client flat in bed while helping her take a bath 4. Teaching the client that she should not have intercourse for 2 months
Positioning the client flat in bed while helping her take a bath. --The client should be positioned in a semi-fowler position to decrease pain and minimize the risk of abscess development higher in the abdomen. **Tampon is not contraindicated after a PID episode, although it is recommended to not use tampons during acute infection. **Heat application to the abdomen and pelvis is used for pain relief. **Intercourse is safe a few weeks after effective treatment for PID.
What are treatments associated with oncogenic (cancer strains) HPV?
Procedures completed once high-grade squamous intraepithelial lesions (HSIL) are confirmed: -Loop electrosurgical excision procedure (Wire loop is used to transmit a painless current to the affected abnormal cervical tissue). -Ablation (Burns or freezes abnormal cervical tissue --Most common types are cryosurgery & laser ablation). -Excision (Resection of abnormal tissue) -Laser conization (A beam of light is used to excise abnormal cervical tissue).
A patient with a surgical history for prostate cancer reports erectile dysfunction. A diagnosis confirms that the prostate gland and the seminal vesicles were previously removed. Which surgical treatment has the patient likely undergone? 1. Open prostatectomy 2. Radical prostatectomy 3. Open retropubic technique 4. Transurethral needle ablation
Radical prostatectomy. --A technique where the surgeon removes the prostate gland and seminal vesicles, this can lead to erectile dysfunction. **Open prostatectomy: A procedure performed on patient with very large prostates who have complications such as bladder stones and damage. This surgery can lead to retrograde ejaculation. **Open retropubic technique: Surgical technique in which the prostate and lymph nodes are removed. **Transurethral needle ablation: A surgical intervention in which the prostate tissue is destroyed by the heat of radio waves. This may not show immediate relief from symptoms. P. 1541 (Ch. 66)
What is suppressive therapy in patients with genital herpes?
Regular daily dosing of an antiviral, that is used to reduce the incidence of outbreaks by 70% to 80%. --This is encouraged for individuals who have six or more outbreaks in a year. --Outbreaks tend to lessen with time, resulting in determination of continuing suppressive therapy.
After a radical prostatectomy, a client is ready to be discharged. Which nursing action included in the discharge plan should be assigned to an experienced LPN/LVN? 1. Reinforcing the client's need to check his temperature daily. 2. Teaching the client how to care for his retention catheter. 3. Instructing the client about the prescribed narcotic analgesic. 4. Documenting a discharge assessment in the client's chart.
Reinforcing the client's need to check his temperature daily. --Reinforcement of previous teaching is an expected role of the LPN/LVN.
What are complications related to Endometriosis?
Scarring: -Leads to chronic pain -Leads to infertility Catamenial Pneumothorax: -Due to endometrial implants on the lungs --Results in cyclic pneumothorax associated with the menstrual cycle.
What should the patient be educated on related to a prostatectomy?
Signs of infection postsurgical: -Fever -Increasing pain -Swelling -Increasing pain -Bleeding -N/V
Ms. Green is a 16-year-old who has missed 2 days of school each month this year because of painful menses. She has seen her healthcare provider for treatment. The school nurse is reinforcing the prescribed treatment of oral contraceptives and NSAIDs. The nurse teaches Ms. Green to do which of the following? 1. Take her OCPs every other day 2. Take the NSAIDs at the onset of symptoms and then as needed 3. Start NSAIDs 2 days prior to menses and continue on schedule until symptoms resolve 4. Stop the oral contraceptives if she has any vaginal bleeding
Start NSAIDs 2 days prior to menses and continue on schedule until symptoms resolve.
What is recommended when it comes to treating Dysmenorrhea with NSAIDs?
Start the medication 1 or 2 days prior to the onset of menses and continue until symptoms resolve (1 - 2 days after menses starts).
A patient asks the nurse about this strange rash on the palms of his hands. The nurse observes this. What should the nurse be concerned with and perform additional assessments? 1. Syphilis 2. Condylomata 3. Genital herpes 4. Chlamydia trachomatis
Syphilis. --Secondary syphilis symptoms include: maculopapular rash on the palms, this rash can appear macular, papular, and/or pustular on the palms, soles, or trunk. **Condylomata acuminata: Genital warts in the perianal region, resemble a cauliflower appearance. **Genital herpes: Clear vesicles or blisters in the genital area. **Chlamydia trachomatis: Affects the urethra and cervix and is a bacterial infection. P. 1555 (Ch. 67)
The nurse incorporates which information into the teaching plan for the patient receiving gonadotropin-releasing hormone (GnRH) agonists for the treatment of endometriosis? 1. Avoid milk products in diet 2. Decrease protein in diet 3. Minimize aerobic exercise 4. Take a vitamin D supplement daily
Take a vitamin D supplement daily. P. 1516 (Ch. 65)
The nurse is reviewing medication lists for several clients. Which medication is most important for the nurse to question? 1. Sildenafil for a client who is also taking hydrochlorothiazide for hypertension 2. Testosterone transdermal gel for a client who has prostate cancer 3. Methoprogesterone for a client who has infertility associated with endometriosis 4. Metformin for a client whose only diagnosis is polycystic ovary syndrome
Testosterone transdermal gel for a client who has prostate cancer. --Testosterone is contraindicated in clients who have prostate cancer due to it promoting growth of prostate cancer. **Metformin is most commonly prescribed for type 2 diabetes, it can be helpful in restoring ovulation in clients with polycystic ovary syndrome. **Sildenafil lowers blood pressure and should not be used by clients who are taking nitrates or alpha-adrenergic blockers but may be used in clients taking other Antihypertensives. **Progestin therapy alone will not treat infertility caused by endometriosis but may be used to shrink endometrial tissue.
The nurse obtains the following assessment data about a client who has had a transurethral resection of the prostate (TURP) and has continuous bladder irrigation. Which finding indicates the most immediate need for nursing intervention? 1. The client reports painful bladder spasms. 2. The catheter drainage is light pink with occasional clots. 3. The client states that he feels a continuous urge to void. 4. The catheter is taped to the client's thigh.
The client reports painful bladder spasms. --Bladder spasms may indicate that blood clots are obstructing the catheter. Requiring irrigation of the catheter with 30 to 50 mL of normal saline using a piston syringe.
What is Transurethral resection of the prostate (TURP)?
The entire inner prostate is removed, leaving just the outer layer, easing the flow of urine. --The most common surgery, used to treat smaller prostates.
What education is provided to patient's on who they need to report and tell about his or her STI condition?
The patient NEEDS to report any history of infection with current and/or previous sexual partners.
Which is true regarding the image shown? 1. The patient appears to have genital herpes. 2. The manifestation is a common symptom of primary syphilis. 3. The primary outbreak of the infection is in the form of an ulcer. 4. The infection is not contagious.
The patient appears to have genital herpes. --Vesicles and blisters indicate genital herpes. **Primary syphilis symptoms: Presence of chancre (painless, hard lesion at the site of exposure). P. 1559 (Ch. 67)
What is Prostatectomy (treatment for prostate cancer)?
The patient's prostate, seminal vesicles, and if deemed necessary the pelvic lymph nodes are removed under general anesthesia.
A patient is being discharged after receiving brachytherapy for prostate cancer. What is important to include in discharge planning? 1. The use of a condom for 2 weeks post-treatment 2. Increased fluid intake for 2 weeks post-treatment 3. Sterile wound dressings to the affected surgical site 4. Bedrest for 48 hours post-treatment
The use of a condom for 2 weeks post-treatment.
The prostate is best palpated: 1. Through the scrotal wall 2. Through a digital exam 3. Through a transurethral exam 4. Through the abdominal wall
Through a digital exam.
Why is prostatectomy used for prostate cancer?
To remove all of the prostate cancer, as long as the cancer is confined to the prostate gland.
Which surgical option is beneficial for a patient with a medium size prostate who has benign prostatic hyperplasia? 1. Laser surgery 2. Open prostatectomy 3. Transurethral incision of the prostate (TUIP) 4. Transurethral resection of the prostate (TURP)
Transurethral incision of the prostate (TUIP). --Performed if the patient has a small to medium sized prostate. **Laser surgery: Recommended if overgrowth of prostate tissue is seen. **Open prostatectomy: Done for large prostates. **Transurethral resection of the prostate (TURP): Performed for smaller prostates. P. 1533 (Ch. 66)
What is primary therapy in patients with genital herpes?
Treats all newly diagnosed outbreaks in patients (fever, malaise, and headache), to help lessen the severity and duration of symptoms.
What is episodic therapy in patients with genital herpes?
Treats symptoms that occur intermittently, it is MOST EFFECTIVE if treatment begins in the prodromal stage or within the first 24 hours.
A patient does not understand how he can be diagnosed with late-stage prostate cancer because he has never had any difficulty urinating. What is the appropriate answer the nurse may provide? 1. Tumors of the prostate often develop near the edges of the prostate, so they do not interfere with urination. 2. The tumor has already metastasized away from the urethra so does not interfere with urination. 3. There is interference with urination only when there is underlying urethral stricture. 4. Tumors of the prostate do not interfere with urination in the early stages of the disease. Answer: A Rationale: Tumors that develop in the prostate tend to develop on the periphery of the gland, which does not obstruct the flow of urine.
Tumors of the prostate often develop near the edges of the prostate, so they do not interfere with urination.
What is Transurethral incision of the prostate (TUIP)?
Two small incisions are made into the prostate, which relieves compression of the urethra and opens up the channel, easing the flow of urine. --Used in patients with a small to moderately enlarged prostate.
The nurse is caring for a patient who is diagnosed with prostate cancer as evidenced with this image. Which patient symptom will the nurse suspect? 1. Urinary incontinence 2. Weak urinary stream 3. Urinary tract infections 4. Incomplete emptying of the bladder
Urinary incontinence. --The disease is locally advanced, due to the loss of bladder control. **Weak urinary stream: Occurs when prostate cancer is local. **Urinary tract infections: Presenting symptoms for local prostate cancer. **Incomplete emptying of the bladder: Presenting symptoms for local prostate cancer. P. 1541 (Ch. 66)
Mechanism of action of Anticholinergics on BPH?
Used to relax the smooth muscle of the bladder. --Used if patients with BPH have an overactive bladder.
