Ricci, Kyle & Carman - Chapter 7
After teaching a group of students about ovarian cysts, the instructor determines that the teaching was successful when the students identify which type of cyst as being associated with hydatiform mole? A) Theca-lutein cyst B) Corpus luteum cyst C) Follicular cyst D) Polycystic ovary syndrome
Ans: A Feedback: Although rare, theca-lutein cysts, which develop from prolonged abnormally high levels of human chorionic gonadotropin, are associated with hydatiform mole, choriocarcinoma, polycystic ovary syndrome, and Clomid therapy. Corpus luteum cysts form when the corpus luteum becomes cystic or hemorrhagic and fails to degenerate after 14 days. Follicular cysts are caused by the failure of the ovarian follicle to rupture at the time of ovulation. Both types typically require no treatment. Polycystic ovary syndrome (PCOS) involves the presence of multiple inactive follicle cysts within the ovary that interfere with ovarian function.
A woman is scheduled for an anterior and posterior colporrhaphy as treatment for a cystocele. When the nurse is explaining this treatment to the client, which of the following descriptions would be most appropriate to include? A) "This procedure helps to tighten the vaginal wall in the front and back so that your bladder and urethra are in the proper position." B) "Your uterus will be removed through your vagina, helping to relieve the organ that is putting the pressure on your bladder." C) "This is a series of exercises that you will learn to do so that you can strengthen your bladder muscles." D) "These are plastic devices that your physician will insert into your vagina to provide support to the uterus and keep it in the proper position."
Ans: A Feedback: An anterior and posterior colporrhaphy tightens the anterior and posterior vaginal wall, and the supportive tissue between the vagina and bladder is folded and sutured to bring the bladder and urethra into proper position. Removal of the uterus through the vagina refers to a vaginal hysterectomy. Exercises to strengthen the bladder muscles are called Kegel exercises. Plastic devices inserted to provide support are called pessaries.
When preparing the discharge teaching plan for the woman who had surgery to correct pelvic organ prolapse, which of the following would the nurse include? A) Care of the indwelling catheter at home B) Emphasis on coughing to prevent complications C) Return to usual activity level in a few days D) Daily douching with dilute vinegar solution
Ans: A Feedback: Following surgery to repair a pelvic organ prolapse, the nurse would teach the woman about caring for the indwelling catheter, which will remain in place for approximately 1 week. Activities that increase intra-abdominal pressure, such as straining, sneezing, or coughing, should be avoided. The woman also should avoid heavy lifting or straining for several weeks. Pelvic rest is prescribed until the operative area is healed in 6 weeks. Douching is indicated if the woman had a pessary inserted, not surgery.
Which of the following would the nurse include when teaching women about preventing pelvic support disorders? A) Performing Kegel isometric exercises B) Consuming low-fiber diets C) Using hormone replacement D) Voiding every 2 hours
Ans: A Feedback: Kegel exercises are an effective preventive measure for pelvic support disorders and are generally accepted as first-line treatment for stress and urge urinary incontinence. They may limit the progression of a mild prolapse and alleviate mild prolapse symptoms. High-fiber rather than low-fiber diets are appropriate to reduce straining associated with constipation. Hormone replacement therapy must be highly individualized and is not an appropriate option for every woman. Normal voiding patterns typically are every 3 to 5 hours. Too frequent or too infrequent voiding can lead to problems.
A client with polycystic ovary syndrome (PCOS) is receiving oral contraceptives as part of her treatment plan. The nurse understands that the rationale for this therapy is to: A) Restore menstrual regularity B) Induce ovulation C) Improve insulin uptake D) Alleviate hirsutism
Ans: A Feedback: Oral contraceptives are used as treatment for PCOS to restore menstrual irregularities and treat acne. Ovulation induction agents such as Clomid are used to induce ovulation. Glucophage is used to improve insulin uptake. Mechanical hair removal methods are used to treat hirsutism.
To assist the woman in regaining control of the urinary sphincter for urinary incontinence, the nurse should teach the client to do which of the following? A) Perform Kegel exercises daily. B) Void every hour while awake. C) Limit her intake of fluid. D) Take a laxative every night.
Ans: A Feedback: The client should perform Kegel exercises daily to strengthen the pelvic floor muscles. Bladder training with voiding every 3 to 5 hours helps to establish normal voiding intervals. Fluids should not be limited; however, the woman should avoid fluids that are irritants, such as caffeinated fluids, soda, and alcohol. Constipation is to be avoided, but a high-fiber diet rather than daily laxative use is recommended.
A woman with polycystic ovary syndrome tells the nurse, "I hate this disease. Just look at me! I have no hair on the front of my head but I've got hair on my chin and upper lip. I don't feel like a woman anymore." Further assessment reveals breast atrophy and increased muscle mass. Which nursing diagnosis would most likely be a priority? A) Situational low self-esteem related to masculinization effects of the disease B) Social isolation related to feelings about appearance C) Risk for suicide related to effects of condition and fluctuating hormone levels D) Ineffective peripheral tissue perfusion related to effects of disease on vasculature
Ans: A Feedback: The woman is verbalizing how she sees herself in light of the manifestations of PCOS. She is exhibiting a negative self-image. Therefore, the nursing diagnosis of situational low self-esteem would be a priority. There is no information about the woman's participation in social activities. Her statements do not reflect that she might hurt herself. PCOS is associated with long-term health problems, but this is not evidenced by the scenario.
A nurse is teaching a client how to perform Kegel exercises. Which of the following would the nurse include? (Select all that apply.) A) "Squeeze your rectal muscles as if you are trying to avoid passing flatus." B) "Tighten your pubococcygeal muscle for a count of 10." C) "Contract and relax your pubococcygeal muscle rapidly 10 times." D) "Try bearing down for about 10 seconds for no more than 5 times." E) "Do these exercises at least 5 times every hour."
Ans: A, C Feedback: To perform Kegel exercises, the nurse would tell the client to squeeze the muscles in her rectum as if she is trying to prevent passing flatus. Then the nurse would tell the client to stop and start urinary flow to help identify the pubococcygeus muscle. Once this is accomplished, the nurse would tell the client to tighten the pubococcygeus muscle for a count of 3, and then relax it. Next the nurse would tell the woman to contract and relax the pubococcygeus muscle rapidly 10 times and try to bring up the entire pelvic floor and bear down 10 times. Finally, the nurse would tell the client to repeat these exercises at least 5 times daily.
A nurse is reading a journal article about care of the woman with pelvic organ prolapse. The nurse would expect to find information related to which of the following? (Select all that apply.) A) Rectocele B) Fecal incontinence C) Cystocele D) Urinary incontinence E) Enterocele
Ans: A, C, E Feedback: The four most common types of pelvic or genital prolapse are cystocele, rectocele, enterocele, and uterine prolapse. Urinary and fecal incontinence along with pelvic organ and genital prolapse are classified as pelvic support disorders.
When developing the plan of care for a woman who has had an abdominal hysterectomy, which of the following would be contraindicated? A) Ambulating the client B) Massaging the client's legs C) Applying elasticized stockings D) Encouraging range-of-motion exercises
Ans: B Feedback: After an abdominal hysterectomy, massaging the client's legs would be contraindicated because the woman is at risk for venous stasis, thrombophlebitis, and thromboembolism. Ambulation, elasticized stockings, and range-of-motion exercises would be appropriate to reduce the woman's risk for thrombophlebitis.
After undergoing diagnostic testing, a woman is diagnosed with a corpus luteum cyst. The nurse anticipates that the woman will require: A) Biopsy B) No treatment C) Oral contraceptives D) Glucophage
Ans: B Feedback: Corpus luteum cysts form when the corpus luteum becomes cystic or hemorrhagic and fails to degenerate after 14 days. Typically these cysts appear after ovulation and resolve without intervention. Biopsy would be indicated if a malignancy was suspected. Oral contraceptives and Glucophage would be used to treat polycystic ovary syndrome.
After teaching a woman with pelvic organ prolapse about dietary and lifestyle measures, which of the following statements would indicate the need for additional teaching? A) "If I wear a girdle, it will help support the muscles in the area." B) "I should take up jogging to make sure I exercise enough." C) "I will try to drink at least 64 oz of fluid each day." D) "I need to increase the amount of fiber I eat every day."
Ans: B Feedback: High-impact aerobics, jogging, or jumping repeatedly should be avoided to reduce the risk of increasing intra-abdominal pressure. Wearing a girdle or abdominal support helps to support the muscles surrounding the pelvic organs. The woman should consume at least eight 8-oz glasses of fluid daily and replace refined low-fiber foods with high-fiber foods.
The nurse would be least likely to find which of the following in a client with uterine fibroids? A) Regularly shaped, shrunken uterus B) Acute pelvic pain C) Menorrhagia D) Complaints of bloating
Ans: B Feedback: Typically the woman with uterine fibroids complains of chronic pelvic pain, with menorrhagia and bloating. Palpation reveals an enlarged, irregularly shaped uterus.
A nurse is reviewing the medical record of a client. Which of the following would lead the nurse to suspect that the client is experiencing polycystic ovary syndrome? (Select all that apply.) A) Decreased androgen levels B) Elevated blood insulin levels C) Anovulation D) Waist circumference of 32 inches E) Triglyceride level of 175 mg/dL F) High-density lipoprotein level of 40 mg/dL
Ans: B, C, E Feedback: Polycystic ovary syndrome is a multifaceted disorder, and central to its pathogenesis are hyperandrogenemia and hyperinsulinemia. PCOS is associated with obesity, hyperinsulinemia, elevated luteinizing hormone levels (linked to ovulation), elevated androgen levels (virilization), hirsutism (male-pattern hair growth), follicular atresia (ovarian growth failure), ovarian growth and cyst formation, anovulation (failure to ovulate), infertility, diabetes type 2, sleep apnea, amenorrhea (absence of menstruation or irregular periods), metabolic syndrome characterized by abdominal obesity (waist circumference >35 in.), dyslipidemia (triglyceride level >150 mg/dL, high-density lipoprotein cholesterol [HDL-C] level <50 mg/dL), elevated blood pressure, a pro-inflammatory state characterized by an elevated C-reactive protein level, and a prothrombotic state characterized by elevated PAI-1 and fibrinogen levels.
After teaching a group of students about genital fistulas, the instructor determines that the teaching was successful when the students identify which of the following as a major cause? A) Radiation therapy B) Congenital anomaly C) Female genital cutting D) Bartholin's gland abscess
Ans: C Feedback: Although genital fistulas may be due to radiation therapy, congenital anomaly, or Bartholin's gland abscess, the majority of fistulas are caused by obstetric trauma and female genital cutting.
A client is diagnosed with an enterocele. The nurse interprets this condition as: A) Protrusion of the posterior bladder wall downward through the anterior vaginal wall B) Sagging of the rectum with pressure exerted against the posterior vaginal wall C) Bulging of the small intestine through the posterior vaginal wall D) Descent of the uterus through the pelvic floor into the vagina
Ans: C Feedback: An enterocele occurs when the small intestine bulges through the posterior vaginal wall, especially when straining. A cystocele is a protrusion of the posterior bladder wall downward through the anterior vaginal wall. A rectocele occurs when the rectum sags and pushes against or into the posterior vaginal wall. Uterine prolapse occurs when the uterus descends through the pelvic floor and into the vaginal canal.
When teaching a woman how to perform Kegel exercises, the nurse explains that these exercises are designed to strengthen which muscles? A) Gluteus B) Lower abdominal C) Pelvic floor D) Diaphragmatic
Ans: C Feedback: Kegel exercises strengthen the pelvic floor muscles to support the inner organs and prevent further prolapse. They have no effect on the gluteal, lower abdominal, or diaphragmatic muscles.
A nurse is providing care to a female client receiving treatment for a Bartholin's cyst. The client has had a small loop of plastic tubing secured in place to allow for drainage. The nurse instructs the client that she will have a follow-up appointment for removal of the plastic tubing at which time? A) 1 week B) 2 weeks C) 3 weeks D) 4 weeks
Ans: C Feedback: The follow-up visit for removal of the plastic tubing is in approximately 3 weeks. After the Word catheter is inserted, the balloon tip is inflated and it is left in place for 4 to 6 weeks.
A woman is being evaluated for pelvic organ prolapse. A postvoid residual urine specimen is obtained via a catheter. Which residual volume finding would lead the nurse to suspect the need for further testing? A) 50 mL B) 75 mL C) 100 mL D) 120 mL
Ans: D Feedback: A postvoid residual urine specimen of greater than 100 mL indicates the need for further urodynamic evaluation and testing.
A woman is admitted for repair of cystocele and rectocele. She has nine living children. In taking her health history, which of the following would the nurse expect to find? A) Sporadic vaginal bleeding accompanied by chronic pelvic pain B) Heavy leukorrhea with vulvar pruritus C) Menstrual irregularities and hirsutism on the chin D) Stress incontinence with feeling of low abdominal pressure
Ans: D Feedback: Cystocele and rectocele are examples of pelvic organ prolapse. Manifestations typically include stress incontinence and lower abdominal pressure or pain. Complaints of sporadic vaginal bleeding and chronic pelvic pain are associated with uterine fibroids. Leukorrhea and vulvar pruritus commonly are associated with an infection. Menstrual irregularities and hirsutism are associated with polycystic ovary syndrome.
A group of students are preparing a class presentation about polyps. Which of the following would the students most likely include in the presentation? A) Polyps are rarely the result of an infection. B) Endocervical polyps commonly appear after menarche. C) Cervical polyps are more common than endocervical polyps. D) Endocervical polyps are most common in women in their 50s.
Ans: D Feedback: Endometrial polyps are solitary, and they rarely occur in women younger than 20 years of age. The incidence of these polyps rises steadily with increasing age, peaks in the fifth decade of life, and gradually declines after menopause. The exact cause of polyps is unknown but they are frequently the result of infection. Cervical polyps often appear after menarche. Endocervical polyps are more common than cervical polyps.
After teaching a group of students about pelvic organ prolapse, the instructor determines that the teaching was successful when the group identifies leiomyomas as which of the following? A) Cysts B) Pelvic organ prolapse C) Fistula D) Fibroid
Ans: D Feedback: Leiomyomas are also called uterine fibroids. Cysts are fluid-filled sac-like structures. A fistula is an abnormal opening. Pelvic organ prolapse is an abnormal descent or herniation of the pelvic organs from their original attachment sites or their normal position in the pelvis.
After teaching a local woman's group about incontinence, the nurse determines that the teaching was successful when the group identifies which of the following as characteristic of stress incontinence? A) Feeling a strong need to void B) Passing a large amount of urine C) Most common in women after childbirth D) Sneezing may be an initiating stimulus
Ans: D Feedback: Stress incontinence is characterized by the involuntary passage of a small amount of urine in response to an increase in intra-abdominal pressure, such as with sneezing, coughing, laughing, or physical exertion. It is most common in women in their 40s and 50s due to the weakening of the muscles and the ligaments in the pelvis after childbirth.
A nurse is assessing a female client and suspects that the client may have endometrial polyps based on which of the following? A) Bleeding after intercourse B) Vaginal discharge C) Bleeding between menses D) Metrorrhagia
Ans: D Feedback: The most common clinical manifestation of endometrial polyps is metrorrhagia (irregular, acyclic uterine bleeding). Cervical and endocervical polyps are often asymptomatic, but they can produce mild symptoms such as abnormal vaginal bleeding (after intercourse or douching, between menses) or discharge.
A postmenopausal woman with uterine prolapse is being fitted with a pessary. The nurse would be most alert for which side effect? A) Increased vaginal discharge B) Urinary tract infection C) Vaginitis D) Vaginal ulceration
Ans: D Feedback: Use of a pessary can lead to pressure necrosis. Postmenopausal women with thin vaginal mucosa are highly susceptible to vaginal ulceration. Increased vaginal discharge, urinary tract infections, and vaginitis are possible side effects that could be seen in any woman fitted with a pessary.
