Ovarian/Cervical Cancer

Which symptom should the patient report immediately to the primary health care provider after undergoing total abdominal hysterectomy? A.) A burning sensation while urinating B.) A small amount of abdominal bleeding after the surgery C.) A small amount of vaginal leakage 4 days after the surgery D.) A persistent temperature of 99.5°F 4 days after the surgery

ANS: A A burning sensation while urinating should be immediately reported to the primary health care provider, because it can complicate the patient's condition. A small amount of abdominal bleeding after the surgery is normal. A small amount of vaginal leakage may occur for a few weeks after the surgery. A temperature of more than 100°F is a matter of concern, which should be immediately reported to the primary healthcare provider.

What is the other name for leiomyomas? A. Fibroids B. Intramural C. Subserosal D. Submucosal

ANS: A Fibroids is the other name for leiomyomas. Fibroids are benign, slow growing solid tumors of the uterine myometrium (muscle layer). Intramural, subserosal, and submucosal are the layers of the uterus.

What is the other name for leiomyomas? A.) Fibroids B.) Intramural C.) Subserosal D.) Submucosal

ANS: A Fibroids is the other name for leiomyomas. Fibroids are benign, slow growing solid tumors of the uterine myometrium (muscle layer). Intramural, subserosal, and submucosal are the layers of the uterus.

A client with newly diagnosed gynecologic cancer is being discharged home. Which health care team member does the nurse contact to coordinate nursing care at home for this client? A.) Case manager B.) Primary Health care provider C.) Hospice D.) Social services

ANS: A If nursing care is needed at home, the hospital nurse or case manager makes referrals to a home health care agency.The primary health care provider is not the correct team member to coordinate home care. Hospice care is provided for clients who are at the end of their lives. This type of care is not necessary (or indicated) for this client. A referral to a social service agency is needed if the client is unable to meet the financial demands of treatment and long-term care follow-up.

2. A client has scheduled brachytherapy sessions and states that she feels as though she is not safe around her family. What is the best response by the nurse? a. "You are only reactive when the radioactive implant is in place." b. "To be totally safe, it is a good idea to sleep in a separate room." c. "It is best to stay a safe distance from friends or family between treatments." d. "You should use a separate bathroom from the rest of the family."

ANS: A In brachytherapy, the surgeon inserts an applicator into the uterus. After placement is verified, the radioactive isotope is placed in the applicator for several minutes for a single treatment. There are no restrictions for the woman to stay away from her family or the public between treatments.

6. A nurse is caring for four postoperative clients who each had a total abdominal hysterectomy. Which client should the nurse assess first upon initial rounding? a. Client who has had two saturated perineal pads in the last 2 hours b. Client with a temperature of 99° F and blood pressure of 115/73 mm Hg c. Client who has pain of "4" on a scale of 0 to 10 d. Client with a urinary catheter output of 150 mL in the last 3 hours

ANS: A Normal vaginal bleeding should be less than one saturated perineal pad in 4 hours. Two saturated pads in such a short time could indicate hemorrhage, which is a priority. The other clients also have needs, but the client with excessive bleeding should be assessed first.

2. The nurse is giving discharge instructions to a client who had a total abdominal hysterectomy. Which statements by the client indicate a need for further teaching? (Select all that apply.) a. "I should not have any problems driving to see my mother, who lives 3 hours away." b. "Now that I have time off from work, I can return to my exercise routine next week." c. "My granddaughter weighs 23 pounds, so I need to refrain from picking her up." d. "I will have to limit the times that I climb our stairs at home to morning and night."e. "For 1 month, I will need to refrain from sexual intercourse."

ANS: A, B Driving and sitting for extended periods of time should be avoided until the surgeon gives permission. For 2 to 6 weeks, exercise participation should also be avoided. All of the other responses demonstrate adequate knowledge for discharge. The client should not lift anything heavier than 10 pounds, should limit stair climbing, and should refrain from sexual intercourse

3. The nurse is taking the history of a 24-year-old client diagnosed with cervical cancer. What possible risk factors would the nurse assess? (Select all that apply.) a. Smoking b. Multiple sexual partners c. Poor diet d. Nulliparity e. Younger than 18 at first intercourse

ANS: A, B, C, E Smoking, multiple sexual partners, poor diet, and age less than 18 for first intercourse are all risk factors for cervical cancer. Nulliparity is a risk factor for endometrial cancer.

Which gynecologic clients does the charge nurse assign to an LPN/LVN? A.) A 23-year-old who is nauseated after her laparotomy and needs to receive antiemetic drugs B.) A 34-year-old who had a total hysterectomy for invasive cervical cancer and has a blood pressure (BP) of 88/54 mm Hg C.) A 42-year-old who had an abdominal hysterectomy whose primary health care provider wants to remove sutures at her bedside D.)A 48-year-old who is receiving IV chemotherapy to treat stage II cervical cancer E.)A 52-year-old who just returned to the unit following a total abdominal hysterectomy

ANS: A, C Both the client who is nauseated after laparotomy and needs to receive antiemetic drugs and the client who had an abdominal hysterectomy and whose primary health care provider wants to remove sutures can be cared for by an LPN/LVN.The client with a total hysterectomy and low BP has a deteriorating status (dropping BP) and requires treatment that only an RN can administer. Also, the client who is receiving IV chemotherapy requires treatment that only an RN can administer. The client who has just returned from surgery must first be assessed by the RN to determine if she is stable.

6. A postmenopausal client is experiencing low back and pelvic pain, fatigue, and bloody vaginal discharge. What laboratory tests would the nurse expect to see ordered for this client if endometrial cancer is suspected? (Select all that apply. )a. Cancer antigen-125 (CA-125) b. White blood cell (WBC) count c. Hemoglobin and hematocrit (H&H) d. International normalized ratio (INR) e. Prothrombin time (PT)

ANS: A, C Serum tumor markers such as CA-125 assess for metastasis, especially if elevated. H&H would evaluate the possibility of anemia, a common finding with postmenopausal bleeding with endometrial cancer. WBC count is not indicated since there are no signs of infection. The INR and PT are coagulation tests to measure the time it takes for a fibrin clot to form. They are used to evaluate the extrinsic pathway of coagulation in clients receiving oral warfarin.

The nurse is reviewing laboratory results on a 34-year-old client who is suspected of having endometrial (uterine) cancer. Which laboratory tests does the nurse expect to see? A.) Alpha-fetoprotein (AFP) test B.) Cancer antigen (CA)-125 test C.) Human chorionic gonadotropin (hCG) level D.) Complete Blood Count (CBC) E.) Serum electrolytes F.) Hereditary nonpolyposis colon cancer (HNPCC) test

ANS: A,B,C,D,F Serum tumor markers to assess for metastasis include alpha-fetoprotein (AFP) and CA-125 (cancer antigen-125), both of which may be elevated when ovarian cancer is present (Pagana and Pagana, 2014). A human chorionic gonadotropin (hCG) level may be taken to rule out pregnancy before treatment for cancer begins. A complete blood count (CBC) typically shows anemia because the client has heavy bleeding. Testing for HNPCC is done if a family history is reported because a connection has been noted between HNPCC and endometrial cancer.Serum electrolytes are not routinely checked in the diagnostic process for endometrial cancer but might be performed later.

The nurse is teaching a client how to adapt to physical and psychological changes after surgery for ovarian cancer. What is included in the teaching plan? A.) Encouraging the use of support groups and counseling B.) Encouraging the expression of grief and fears C.) Offering vaginal dilators D.) Refraining from sexual intercourse for 6 weeks after surgery. E.) Suggesting the use of oil-based lubricants

ANS: A,B,D Support groups such as Gilda's Club are advisable for clients with ovarian cancer because the loss of reproductive organs involves a grief reaction. Ovarian cancer particularly carries the connotation of being serious and incurable in the view of many women. The client needs to refrain from sexual intercourse for 6 weeks after surgery.The use of a vaginal dilator is not indicated. After the woman becomes sexually active, she may have a problem with vaginal dryness as the result of hormonal changes. Water-based, rather than oil-based, lubricants would be suggested.

Which are risk factors for endometrial cancer? Select all that apply. A. Obesity B. Smoking C. Multiparity D. Uterine polyps E. Diabetes mellitus

ANS: A,B,D,E Risk factors for endometrial cancer include obesity, smoking, uterine polyps, and diabetes mellitus, along with nulliparity, being in one's reproductive years, hypertension, late menopause, and tamoxifen given for breast cancer. There is no specific risk of endometrial cancer related to multiparity.

Which are risk factors for endometrial cancer? Select all that apply. A.) Obesity B.) Smoking C.) Multiparity D.) Uterine polyps E.) Diabetes mellitus

ANS: A,D,E Risk factors for endometrial cancer include obesity, smoking, uterine polyps, and diabetes mellitus, along with nulliparity, being in one's reproductive years, hypertension, late menopause, and tamoxifen given for breast cancer. There is no specific risk of endometrial cancer related to multiparity.

Which is related to the growth of leiomyomas? Select all that apply. A.) Estrogen B.) Pregnancy C.) Menopause D.) Progesterone E.) Growth hormone

ANS: A,D,E The growth of leiomyomas may be related to stimulation by estrogen, progesterone, and the growth hormone. Leiomyomas are common in pregnancy and enlarge during pregnancy and diminish in size after menopause.

A patient with a uterine leiomyoma has been advised to have a total hysterectomy. Which organs or tissues will be removed during this procedure? A.) Fallopian tubes and both ovaries B.) The entire uterus including the cervix C.) Uterus, ovaries, and fallopian tubes of both sides D.) Uterus, cervix, adjacent lymphnodes, and part of the vagina

ANS: B A total hysterectomy involves removal of the entire uterus including the cervix. It may be done as a vaginal or an abdominal procedure. The fallopian tubes and ovaries of both sides are removed in a bilateral salpingo-oophorectomy. Uterus, ovaries, and fallopian tubes of both sides are removed in a panhysterectomy. The uterus, cervix, adjacent lymphnodes, and part of the vagina as well as the parametrium are removed in a radical hysterectomy.

The nurse who is teaching a patient about ovarian cancer asks the patient to repeat the risk factors to ensure she has learned the information. Which patient response indicates a need for further teaching? A.) Having diabetes B.) Having multiple sexual partners C.) Eating a high fat-diet and being obese D.) Being older than 30 at the time of a first pregnancy

ANS: B Being older than age 30 years at a first pregnancy, a diet high in fat, obesity, and having diabetes are some risk factors for ovarian cancer. Having multiple sexual partners is a risk factor for cervical cancer. Test tip: There's a lot of trick questions that'll ask about ovarian cancer versus cervical cancer risks. Also, don't be a hoe. You're welcome

Which statement about cervical cancer vaccines is accurate? A.) Cervarix is also given to boys and men. B.) Gardasil is given as three injections over 6 months. C.) Gardasil provides longer-lasting protection than Cervarix. D.) Cervarix protects against human papilloma virus (HPV) strains 6 and 11.

ANS: B Both Cervarix and Gardasil are given as three injections over 6 months. These vaccines protect against HPV infection, which is a risk factor for cervical cancer. Gardasil protects against HPV strains 6 and 11 and prevents genital warts. Gardasil is given to boys and men. Cervarix provides longer-lasting protection than Gardasil.

14. A 20-year-old client is interested in protection from the human papilloma virus (HPV) since she may become sexually active. Which response from the nurse is the most accurate? a. "You are too old to receive an HPV vaccine." b. "Either Gardasil or Cervarix can provide protection." c. "You will need to have three injections over a span of 1 year." d. "The most common side effect of the vaccine is itching at the injection site."

ANS: B Current HPV vaccines are Gardasil and Cervarix, which should be given before the first sexual contact to protect against the highest risk HPV types associated with cervical cancer. The client is not too old since it is recommended that young women up to 26 years should receive an HPV vaccine. The entire series consists of three injections over 6 months, not 1 year. Local pain and redness surrounding the injection site are very common, but this does not include itching.

A client has gynecologic cancer. Which client statement demonstrates a correct understanding of her treatment options? A.) "Chemotherapy will be used to shrink my cancer before I have my operation." B.) "External beam radiation therapy (EBRT) may be used after my cancer surgery." C.) "Brachytherapy is given on an outclient basis for 4 to 6 weeks before surgery." D.) "The purpose of brachytherapy will be to dissolve the cancer."

ANS: B EBRT may be used to treat any stage of gynecologic cancer in combination with surgery.Chemotherapy is used as palliative treatment for advanced and recurrent disease when it has spread to other parts of the body. External beam treatment, not brachytherapy, is given on an ambulatory care basis after surgery, if needed. The purpose of brachytherapy is to assist in preventing disease recurrence. Brachytherapy involves a radiologist placing an applicator within the woman's uterus through the vagina, and after checking for correct position of the applicator, the radioactive isotope is placed in the applicator and remains for several minutes.

A 32-year-old client has small uterine fibroids and is considering options for treatment. To assist the woman to make a decision about whether to have magnetic resonance-guided focused ultrasound or uterine artery embolization, what will the nurse determine? a) If the woman has had one or more children b) Whether the woman wants to preserve her fertility and desires to have children. c) The age of onset of the woman's first menstrual period d) The woman's risk for uterine cancer

ANS: B If the woman wants to preserve her fertility, magnetic resonance-guided focused ultrasound is a good option. If the client does not desire pregnancy, then uterine artery embolization may be used.The woman's previous childbearing history, the age of menarche, and the risk for uterine cancer do not influence the decision about which of these two types of procedures are used.

9. The nurse is doing preoperative teaching for a client who is scheduled for removal of cervical polyps in the office. Which statement by the client indicates a correct understanding of the procedure? a. "I hope that I do not have cancer of the cervix." b. "There should be little or no discomfort during the procedure." c. "There may be a lot of bleeding after the polyp is removed." d. "This may prevent me from having any more children."

ANS: B Polyp removal is a simple office procedure with the client feeling no pain. The other responses are incorrect. Cervical polyps are the most common benign growth of the cervix. Cautery is used to stop any bleeding, and there is no evidence that cervical polyps have a relationship to childbearing.

10. A client has recently been diagnosed with stage III endometrial cancer and asks the nurse for an explanation. What response by the nurse is correct about the staging of the cancer? a. "The cancer has spread to the mucosa of the bowel and bladder." b. "It has reached the vagina or lymph nodes." c. "The cancer now involves the cervix." d. "It is contained in the endometrium of the cervix."

ANS: B Stage III of endometrial cancer reaches the vagina or lymph nodes. Stage I is confined to the endometrium. Stage II involves the cervix, and stage IV spreads to the bowel or bladder mucosa and/or beyond the pelvis.

The nurse is teaching care principles to a client who plans uterus-sparing surgery to remove uterine fibroids. Which client statement indicates that further teaching is needed? A.) "I will be able to return to my usual activities in about 2 weeks." B.) "It is important to avoid having sexual intercourse for 3 weeks after surgery." C.) "Probably I will be able to go home on the day of the surgery." D.) "Fewer complications occur with this procedure than with hysterectomies."

ANS: B The client must avoid having sexual intercourse for at least 6 weeks (not 3 weeks) after the surgery.Most clients can return to their usual activities within 2 weeks of having uterus-sparing surgery for fibroids. Most clients do go home on the day of the surgery. Postoperative pain is less and complications fewer with these procedures than with routine hysterectomies.

A client had a total abdominal hysterectomy 2 days ago and is to be discharged on antibiotics. What does the nurse include in her discharge teaching about antibiotics? A.) "After your first day at home, you can stop them if you do not have a fever." B.) "It is important to take them as directed until they are all gone." C.) "Stop the antibiotic if you feel nauseated because it will lose its effectiveness." D.) "You will need to take the drug until your incision heals."

ANS: B The client must finish her entire course of antibiotics and take them even after she has diminished signs or symptoms. This is a fundamental principle of antibiotic administration.The client would never be instructed to stop a course of antibiotics. In cases in which clients are unable to take an antibiotic (due to nausea or another problem), an alternative antibiotic will be prescribed. The client's incision would be healed by the time that the antibiotic course is completed.

A patient underwent a total abdominal hysterectomy. Which patient activity would lead to a complication after surgery? A.) Lifting an object of 4 lbs B.) Sitting for 3 hours at a time C.) Gradually increasing walking D.) Climbing stairs 2 times daily

ANS: B The patient should refrain from being in the sitting position for a long period of time because it may create pressure on the stitches, which can complicate the patient's condition. The patient should not lift objects heavier than 5 to 10 lbs. The patient should gradually increase walking as an exercise but should stop before being fatigued. The patient should climb stairs less than five times in a day.

A patient has undergone a total vaginal hysterectomy without removal of the ovaries. What statement by the patient indicates a need for further teaching? A.) "I will no longer have a period." B.) "I may experience hot flushes and night sweats." C.) "I will no longer need to use birth control methods." D.) "I may need more sleep and rest for a few weeks."

ANS: B The patient will not experience hot flushes and night sweats after a vaginal hysterectomy, which are menopausal symptoms. Such symptoms are experienced only if the patient's ovaries are removed. The patient will no longer have a period because the uterus will have been removed. The patient will no longer need birth control methods as she will not be able to become pregnant. The patient may need more sleep and rest for a few weeks following surgery as it will be normal to tire easily.

A client is being discharged after a total abdominal hysterectomy (TAH). What principle guides the nurse in planning discharge care and teaching? A.) Clients in their childbearing years generally adapt better. B.) No special home equipment will be necessary for the client. C.) Psychological reactions would be evident by discharge. The client can resume normal activities upon discharge. D.) The client can resume normal activities upon discharge.

ANS: B Usually, no special home equipment is needed for the client who has undergone a TAH.Generally, clients adjust better to the surgery if they have completed their childbearing years. Psychological reactions can occur months to years after surgery, particularly if sexual functioning and libido are diminished. The client who has undergone a TAH would be taught about the expected physical changes, including any activity restrictions. A 2-6 week convalescent period is usually required.

4. A client is scheduled to start external beam radiation therapy (EBRT) for her endometrial cancer. Which teaching by the nurse is accurate? (Select all that apply.) a. "You will need to be hospitalized during this therapy." b. "Your skin needs to be inspected daily for any breakdown." c. "It is not wise to stay out in the sun for long periods of time." d. "The perineal area may become damaged with the radiation." e. "The technician applies new site markings before each treatment."

ANS: B, C, D EBRT is usually performed in ambulatory care and does not require hospitalization. The client needs to know to evaluate the skin, especially in the perineal area, for any breakdown, and avoid sunbathing. The technician does not apply new site markings, so the client needs to avoid washing off the markings that indicate the treatment site.

What are the risk factors for endometrial (uterine) cancer? Select all that apply. A.) HIV/AIDS B.) Hypertension C.) Uterine polyps D.) Late menopause E.) Diabetes mellitus F.) Oral contraceptive use

ANS: B,C,D,E Endometrial cancer (cancer of the inner uterine lining) is the most common gynecologic malignancy. It is strongly associated with conditions causing prolonged exposure to estrogen without the protective effects of progesterone. Hypertension, uterine polyps, late menopause, and diabetes mellitus are a few of the risk factors for endometrial (uterine) cancer. HIV/AIDS and oral contraceptive use are risk factors for cervical cancer.

What physical changes can a patient who has undergone a total vaginal hysterectomy expect? A.) Should use birth control B) Can conceive after six months C.) Will tire easily and requires more sleep D.) Can expect vaginal discharge for a few months

ANS: C A patient who undergoes a total vaginal hysterectomy tires easily and requires more sleep. The patient will never become pregnant, and so she does not require birth control. The patient may have vaginal discharge for a few days following the procedure but should not expect it for months.

Which gynecologic surgery involves the removal of the uterus, cervix, adjacent lymph nodes, the upper third of the vagina, and the surrounding tissues? A.) Panhysterectomy B.) Total hysterectomy C.) Radical hysterectomy D.) Bilateral salpingo-oophorectomy

ANS: C A radical hysterectomy involves the removal of the uterus, cervix, adjacent lymph nodes, the upper third of the vagina, and the surrounding tissues. In a panhysterectomy, the uterus, ovaries, and fallopian tubes are removed. Total hysterectomy involves the removal of the uterus, including the cervix. In bilateral salpingo-oophorectomy, the fallopian tubes and ovaries are removed.

Which is the most common gynecologic malignancy? A.) Cervical cancer B.) Adenocarcinoma C.) Endometrial cancer D.) Squamous cell cancer

ANS: C Endometrial cancer(cancer of the inner uterine lining) is the most common gynecologic malignancy. Cervical cancer is a cancer arising from the cervix, and it is not the most common gynecologic malignancy. Adenocarcinoma and squamous cell cancer are the two main types of cervical cancer.

How are leiomyomas defined? A. The reduction of a rectal bulge B. Tightening of the pelvic muscles for better bladder support C. Benign, slow-growing solid tumors of the uterine myometrium D. An alternative to surgery for a woman who does not want to become pregnant

ANS: C Leiomyomas are benign, slow-growing solid tumors of the uterine myometrium (muscle layer). Posterior colporrhaphy (posterior repair) reduces rectal bulging. An anterior colporrhaphy (anterior repair) tightens the pelvic muscles for better bladder support. Uterine artery embolization is an alternative to surgery for the woman who does not want to become pregnant.

How many layers of classification are there for the leiomyomas in the uterus? A.) 5 B.) 8 C.) 3 D.) 6

ANS: C Leiomyomas are classified according to their position in the layers of the uterus. They include intramural, submucosal, and subserosal.

Which client history places a woman at highest risk for developing endometrial (uterine) cancer? A.) Multiparity, human papilloma virus (HPV), smoking, and African-American ethnicity B.) Nulliparity, endometriosis, diabetes mellitus, first pregnancy at older than 20 years C.) Nulliparity, smoking, uterine polyps, hypertension D.) Oral contraceptive use, smoking, localized pain in the thigh

ANS: C Nulliparity, smoking, uterine polyps, and hypertension are all risk factors for endometrial cancer.Multiparity, HPV, smoking, and African-American ethnicity are all risk factors for cervical cancer. Nulliparity, endometriosis, diabetes mellitus, and first pregnancy at older than 30 years are all risk factors for ovarian cancer. Oral contraceptive use, smoking, and localized pain in the thigh are all risk factors for a thrombus.

What is a cardinal risk factor for cervical cancer? A.) Nulliparity B.) Late menopause C.) Multiple sex partners D.) Presence of uterine polyps

ANS: C One of the risks for cervical cancer is having multiple sex partners. If the patient's sexual partner had a previous partner who developed cervical cancer, the patient is at high risk for contracting the disease. Infection with human papillomavirus, multiparity, history of sexually transmitted diseases, and a family history of cervical cancer are other factors that increase the risk for cervical cancer. Presence of uterine polyps, nulliparity (no child births), and late menopause are known to be risks for endometrial (uterine) cancer. Test tip: Don't be a hoe. You're welcome

A client is scheduled for a total hysterectomy with a laparoscopic vaginal approach after a diagnosis of microinvasive cervical cancer. What psychological and/or social changes does the nurse expect this client to experience? A.) Because the surgery does not affect a visible site, altered body image issues are not as common. B.) The client will be actively involved in her own care in the immediate postoperative period. C.) Sexual counseling may be needed, especially if the client has doubts about her ability to feel like a woman and engage in sexual activities. D.) The client would demonstrate reality testing and would experience a grief reaction immediately after her surgery.

ANS: C Sexual function may be (or feel) different after a hysterectomy. Couples may need counseling about intercourse or alternative sexual activities. The nurse assesses the need for sexual counseling by listening for cues about altered perceptions of body image and anxiety in either of the sexual partners' responses.For many women, hysterectomy can mean the loss of their femininity, so altered body image issues must be expected with the client. Hysterectomy is major surgery, so the client will be recovering for days to a week or longer. Active involvement in her self-care will be delayed until she has moved past the initial surgical procedure recovery period. Reality testing is a later step in the grief and acceptance processes experienced by women who have had hysterectomies.

The nurse is performing discharge teaching for a client who is recovering from a total abdominal hysterectomy (TAH). Which client statement indicates a need for clarification? A.) "I cannot jog for 2 to 6 weeks." B.) "I must take my temperature twice a day for the first few days after surgery." C.) "I will need to find a new form of birth control." D.) "I will no longer have menstrual periods."

ANS: C The client who has had a TAH can no longer become pregnant. Therefore, birth control is no longer necessary.The client must avoid jogging, aerobic exercise, participating in sports, or any strenuous activity for 2 to 6 weeks. The client must take her temperature twice a day for the first few days after surgery as a precaution to monitor for infection. The client will no longer have a period, although she may have some vaginal discharge for a few days after going home.

A 42-year-old woman with an intramural leiomyoma (myomas or fibroids) has been taking estrogen replacement therapy for menopausal symptoms. What does the nurse tell her about estrogen replacement therapy and how it relates to her fibroids? A.) "Estrogen will help shrink your fibroids." B.) "Increasing the amount of estrogen you are taking will be necessary." C.) "The fibroids may continue to grow." D.) "Your estrogen dosage will not change."

ANS: C The fibroids may continue to grow because of the estrogen stimulation.The client would be instructed to see her primary health care provider to monitor their growth. The client's estrogen dose will most likely need to be decreased at some point or eliminated.

Which statement about uterine fibroids is correct? A.) Fibroids often regress in size during pregnancy. B.) Subserosal leiomyomas protrude into the uterine cavity. C.) The incidence of fibroids increases as women get older. D.) The most common type of fibroids is pedunculated leiomyoma

ANS: C Uterine fibroids tend to occur mostly in older women. The incidence increases with age but does diminish after menopause because hormone levels significantly drop. Intramural, submucosal, and subserosal leiomyomas are the common types of fibroids. Pedunculated leiomyomas are less common. Submucosal leiomyomas protrude into the uterine cavity. The growth of fibroids is related to the change in estrogen, progesterone, and growth hormone levels, so the size increases during pregnancy.

5. The nurse is teaching a client who is undergoing brachytherapy about what to immediately report to her health care provider. Which signs and symptoms would be included in this teaching? (Select all that apply.) a. Constipation for 3 days b. Temperature of 99° F c. Abdominal pain d. Visible blood in the urine e. Heavy vaginal bleeding

ANS: C, D, E Health teaching for a client having brachytherapy should emphasize reporting abdominal pain, visible blood in the urine, and heavy vaginal bleeding. Severe diarrhea (not constipation), urethral burning, extreme fatigue, and a fever over 100° F should also be reported.

What are the gold standard tests that can be done to determine the presence of endometrial thickening and cancer? Select all that apply. A.) Pap tests B.) Genetic testing C.) Endometrial biopsy D.) Transvaginal ultrasound E.) Intravenous pyelography test

ANS: C,D Endometrial biopsy and transvaginal ultrasound are the gold standard tests to determine the presence of endometrial thickening and cancer. Pap tests help determine cervical cancer. Genetic testing may be done for the mutation causing hereditary nonpolyposis colorectal cancer if there is a family history of this disease. An intravenous pyelogram is a special x-ray examination of the kidneys, bladder, and ureters.

The nurse is reviewing laboratory results on a 34-year-old patient who is suspected of having endometrial (uterine) cancer. Which laboratory tests does the nurse expect to see? Select all that apply. A.) Serum electrolytes B.) Liver function tests (LFTs) C.) Alpha-fetoprotein (AFP) test D.) CA (cancer antigen)-125 test E.) Human chorionic gonadotropin (hCG) level F.) Hereditary nonpolyposis colon cancer (HNPCC) test

ANS: C,D,E,F AFP and CA-125 may be elevated when the cancer has spread to the ovaries; they would be checked for this patient. The hCG level should be checked to rule out pregnancy in a patient of this age as a precaution before treatment is started. Testing for HNPCC is done if a family history is reported because a connection has been noted between HNPCC and endometrial cancer. LFTs and serum electrolytes are not routinely checked in the diagnostic process for endometrial cancer, but might be performed later.

11. The client is emotionally upset about the recent diagnosis of stage IV endometrial cancer. Which action by the nurse is best? a. Let the client alone for a long period of reflection time. b. Ask friends and relatives to limit their visits. c. Tell the client that an emotional response is unacceptable. d. Create an atmosphere of acceptance and discussion.

ANS: D Discussion of a client's concerns about the presence of cancer and the potential for recurrence will provide emotional support and allay fears. Coping behaviors are encouraged with the support of friends and relatives. An emotional response should be accepted.

A client who had an anterior colporrhaphy is being discharged. What does the nurse tell the client before her discharge? A.) "Avoid lifting more than 25 pounds (11.3 kg)." B.) "Do not have sexual intercourse for at least 2 weeks." C.) "Return to the clinic in 6 weeks for suture removal." D.) "Take a hot bath or use a moist heating pad for discomfort."

ANS: D For discomfort, the client would be instructed to use heat—either a moist heating pad or warm compresses applied to the abdomen. A hot bath may also be helpful.The client must avoid lifting anything heavier than 5 pounds (2.3 kg) and avoid sexual intercourse for 6 weeks. Sutures do not need to be removed because they may be absorbable or they may fall out (slough off) as healing occurs.

Which surgery requires the removal of the fallopian tubes and ovaries? A.) Panhysterectomy B.) Total hysterectomy C.) Radical hysterectomy D.) Bilateral salpingo-oophorectomy

ANS: D In bilateral salpingo-oophorectomy surgery, the fallopian tubes and ovaries are removed. In panhysterectomy surgery, the uterus, ovaries, and fallopian tubes are removed. In total hysterectomy surgery, the entire uterus, including the cervix, is removed. In radical hysterectomy surgery, the uterus, cervix, adjacent lymph nodes, the upper third of the vagina, and the surrounding tissues (parametrium) are removed.

A 52-year-old client has been diagnosed with endometrial (uterine) cancer. She says to the nurse, "I was told that my cancer is stage II. What does that mean?" How does the nurse respond? A.) "It means that your cancer remains confined to your uterus." B.) "The spread of your cancer is beyond your pelvic area." C.) "The cancer is in your vagina or lymph node areas." D.) "Your cancer has spread from your uterus to your cervix."

ANS: D Stage II means that the cancer now also involves the client's cervix.Cancer that remains confined to the endometrium (innermost lining) of the uterus is classified as stage I. The spread of cancer that is beyond the pelvic area is classified as stage IV cancer. Vaginal or lymph node areas of involvement indicate that the cancer is classified as stage III.

13. A client has just returned from a total abdominal hysterectomy and needs postoperative nursing care. What action can the nurse delegate to the unlicensed assistive personnel (UAP)? a. Assess heart, lung, and bowel sounds. b. Check the hemoglobin and hematocrit levels. c. Evaluate the dressing for drainage. d. Empty the urine from the urinary catheter bag.

ANS: D The UAP is able to empty the urinary output from the catheter. The nurse would assess the heart, lung, and bowel sounds; check the hemoglobin and hematocrit levels; and evaluate the drainage on the dressing.

5. The nurse is caring for a postoperative client following an anterior colporrhaphy. What action can be delegated to the unlicensed assistive personnel (UAP)? a. Reviewing the hematocrit and hemoglobin results b. Teaching the client to avoid lifting her 4-year-old grandson c. Assessing the level of pain and any drainage d. Drawing a shallow hot bath for comfort measures

ANS: D The UAP is able to provide comfort through a bath. The registered nurse should review any laboratory results, complete any teaching, and assess pain and discharge.

Which client does the RN assess first after receiving change-of-shift report? A.) A 45-year-old with a history of hypothyroidism who is scheduled for a hysterectomy and bladder suspension B.) A 48-year-old who is reporting abdominal pain and light vaginal spotting after an endometrial biopsy C.) A 50-year-old who is receiving morphine through a client-controlled analgesia (PCA) device after a hysterectomy and who rates her pain at a level 3 (0-to-10 scale) D.) A 54-year-old with an anterior and posterior colporrhaphy who has an elevated heart rate and an oral temperature of 101.2°F (38.4°C)

ANS: D The client with an anterior and posterior colporrhaphy with an elevated heart rate and fever is showing signs of postoperative infection and warrants frequent assessments. This information needs to be communicated to the surgeon as soon as possible.The client with a history of hypothyroidism who is scheduled for a hysterectomy and bladder suspension, the client with abdominal pain and light vaginal spotting after an endometrial biopsy, and the client receiving morphine through a PCA device with a pain level of 3 are not unusual cases and do not require rapid intervention by the nurse.

The nurse is caring for a female client with uterine leiomyoma. What is the most likely problem this client will experience as a result of this condition? A.) Pain B.) Constipation C.) Infection D.) Bleeding

ANS: D The most likely problem for women with fibroids is the potential for prolonged or heavy bleeding.Pain is not common but may occur if the fibroid becomes twisted. Constipation may occur if fibroids are large and press on other organs. Infection is not common as a result of fibroids

The registered nurse is teaching a patient who underwent a total abdominal hysterectomy about self-care when discharged. Which statement made by the patient indicates the need for further teaching? A.) "I will start ambulating." B.) "I will drink lots of water." C.) "I will refrain from doing any strenuous activities." D.) "I will refrain from coughing and deep breathing exercises."

ANS: D The patient performs coughing and deep breathing exercises because these help to reduce the lung complications after surgery. Ambulation helps to stabilize the patient's mental and physical status. The patient should be hydrated because it helps to increase the healing process. After surgery, the patient should avoid strenuous activity because it increases blood pressure, pulse rate, and the breathing rate.

7. A client has undergone a vaginal hysterectomy with a bilateral salpingo-oophorectomy. She is concerned about a loss of libido. What intervention by the nurse would be best? a. Suggest increasing vitamins and supplements daily. b. Discuss the value of a balanced diet and exercise. c. Reinforce that weight gain may be inevitable. d. Teach that estrogen cream inserted vaginally may help.

ANS: D Use of vaginal estrogen cream and gentle dilation can help with vaginal changes and loss of libido. Weight gain and masculinization are misperceptions after a vaginal hysterectomy. Vitamins, supplements, a balanced diet, and exercise are helpful for healthy living, but are not necessarily going to increase libido.

Four women phone the gynecology clinic about having new-onset vaginal bleeding. Which call does the RN decide to return first? A.) 23-year-old using medroxyprogesterone acetate (Depo-Provera) reporting bleeding B.) A 34-year-old with a history of multiple leiomyomas C.) A 48-year-old who had an endocervical curettage yesterday D.) A 62-year-old with no previous gynecologic problems reports bleeding.

ANS: D Vaginal bleeding in a postmenopausal woman is abnormal and may be an indication of serious problems such as endometrial cancer.Bleeding in the 23-year-old using medroxyprogesterone acetate (Depo-Provera), the 34-year-old with a history of multiple leiomyomas, and the 48-year-old who had endocervical curettage yesterday is not unusual. The nurse will need to follow up with these clients.

The nurse is teaching a local young women's group about health promotion and maintenance measures for prevention of gynecologic cancers. Which preventive factors does the nurse stress? A.) Annual endometrial biopsy B.) Annual human papilloma virus (HPV) vaccination C.) Annual Papanicolaou (Pap) test D.) Safe sex practices E.) Well-balanced diet

ANS: D,E Using barrier protection, especially if a woman has multiple sexual partners, is recommended. Knowing the history of partners is also a factor in having safe sex. Eating a diet that includes a variety of healthy food choices (fruits, vegetables, low-fat protein, and healthy dairy products) is known to help a woman have a healthy reproductive system.Endometrial biopsies are not routinely performed annually except when risk for the development of the disease is increased. HPV vaccination is given to young girls (and boys) in a series of three injections over a 6-month time frame. It is best administered before they become sexually active. Women need to begin screening precautions at the age of 21 years. Between ages 21 and 29 years, women need to have a Pap test every 3 years. Women between ages 30 and 65 years need to have a Pap test plus a human papilloma virus (HPV) test (co-testing) every 5 years. In the absence of co-testing, this population needs to still have a Pap test every 3 years.