Unit 12: Reproductive

An elderly client, who can void only while standing and pushing upward on the vagina, is ordered a pessary. Which comment from the client indicates a need for further teaching about this device?

"I will remove and clean it every day."

During a routine sports physical examination, the nurse practitioner recommends HPV vaccination for an 11-year-old girl. Which statements by the client's mother demonstrates understanding of HPV vaccinations?

"I will track follow-up appointments in my smartphone so she receives all three injections." Explanation: The Centers for Disease Control and Prevention recommends routine vaccination of boys and girls 11-12 years of age, before they become sexually active. The vaccination is administered in three intramuscular doses, with the initial dose followed by a second dose in 2 months and a third dose 6 months after the first dose. Completion of all three doses of the vaccine is important for immunity to develop;

A nurse is caring for a client who is being evaluated for a lump found on the lateral aspect of the right breast. The client is anxious and asks the nurse if the next step is to have a mastectomy. Which is the nurse's best response?

"Many times, an ultrasound is done to distinguish between a tumor and cyst." Explanation: Ultrasonography is often used with a mammogram or after a breast lump is found to provide additional data on the breast lump. An ultrasound can differentiate if the lump is a fluid filled cyst or other types of breast lesions.

A client who wishes to preserve childbearing asks the nurse to explain how taking oral contraceptives will work in the management of endometriosis. Which is the best response by the nurse?

"Symptoms of endometriosis are increased during normal menstrual cycle." Explanation: The use of estrogen-progestin contraceptives keeps the client in a non bleeding phase of the menstrual cycle, therefore decreasing ectopic tissue from shedding and causing extra uterine bleeding.

A nurse is examining a client's breasts. Which of the following would alert the nurse to a possible problem?

-Prominent venous pattern -Pitting of the breast skin -Nipple retraction with position changes -Spontaneous nipple discharge

Care for pt w/vulvectomy

-Relieving edema to the lower extremities may be a necessary part of care if the lymph nodes and blood vessels are disturbed. -may have colostomy -Address alterations in sexual function -care for catheter and surgical drains

Strategies for Women Approaching Menopause

-annual physicals -eat less fat and calories -increase fiber intake and whole grains -exercise 30min 3-4x/wk -involvement in outside activities to reduce anxiety/tension -freq sex helps maintain elasticity of vagina -use contraceptive until one year has passed w/no period -HRT for hot flashes -fatigue/stress worsen hot flashes -kegels daily to prevent decreased tone in perineal -lotion daily -increased vit D and calcium intake for bone loss -drink 6-8glasses water to prevent UTI

Decreased amount of estrogen can cause what physiologic changes?

-atrophy of breast tissue and genitals -loss of bone density -vascular changes

Testicular cancer is very responsive to _______, although it does _______ early.

-chemo -metastasize

BPH S/Sx

-difficulty initiating urination -abdominal straining with urination -possible UTI -urinary frequency -fever -nocturia -pelvic pain -n&v -fatigue -urine retention f/incomplete bladder emptying

risks for pelvic inflammatory disease

-early age intercourse -multi sex partners -freq intercourse -doesn't use condoms -sex w/person who was STI or hx of STI

cervical cancer risk factors

-early childbearing -exposure to DES in utero -exposure to HPV -Fam Hx -HIV infection -obesity -prolonged use of oral contraceptives -sex before 20yr -multi-partners -sex w/uncircumcised men -smoking/2nd hand smoke exposure

Side effects of external beam radiation to breast

-erythema -fatigue -breast edema

Breast cancer mass characteristics

-firm/hard -embedded in surrounding tissue -irregular shape -nontender -occurs as single mass in one breast

Risk factors for vulvovaginal infections include

-frequent douching -allergies -oral contraceptive use -use of broad-spectrum antibiotics (for bacterial infections) -low estrogen levels.

Clinical manifestations related to metastasis from prostate cancer

-hip pain -wt loss -backache -perineal/rectal pain -anemia -weakness -nausea -oliguria (decreased urine out <400ml/day) -spontaneous fractures

Rectocele interventions

-increased fiber intake -stool softeners daily -Kegels

Common causes of dyspareunia

-injury during birth -lack of lubrication -sexual abuse/assault -endometriosis -pelvic/vag infection -vag dryness f/menopause or breast feeding -GI disorders -fibroids -UTI

Prior to discharge from a uterine prolapse, cystocele, enterocele, or rectocele repair, what kind of education should the nurse give the patient?

-keep site clean -prevent constipation -recommend exercises (Kegels) -avoid lifting heavy objects -dont stand for long periods -report to HCP if pelvic pain, unusual discharge, increased bleeding, or inability to perform personal hygiene occurs -ask provider when it is safe to have sex

core need biopsy

-large bore needle used (11g-16g) -local anesthetic applied -tissue cores are removed thru a spring loaded device

If conception does not occur, ________ begins and the ________lining is shed.

-menstruation -uterus

What physical symptoms does the nurse recognize are consistent with PMS?

-moodiness -fluid retention -low back pain -headache -painful breasts -abdominal fullness r/t fluid retention

HPV can be transmitted to what other parts of the body?

-mouth -oropharynx -larynx

The incidence of ovarian cancer increases in clients who have:

-never been pregnant ->40yrs -infertile -have menstrual irregularities -family hx of breast, bowel, or endometrial cancer.

s/sx of breast cancer

-painless mass -bloody discharge f/nipple -dimpling of skin over lesion -retraction/new inversion of nipple -peau d'orange (orange peel) appearance of skin -breast size differences

Clinical manifestations r/t cystocele

-pelvic pressure -urinary inc., freq., or urgency -back pain

Prostatitis s/sx

-perineal discomfort -burning -urgency -freq urination -painful ejaculation

Discharge teaching plan for prostatectomy

-perineal exercises hourly -avoid bearing down (straining) when voiding; can increase risk for hematuria -avoid strenuous exercise(to avoid rebleed) -do not hold urine; void as soon as urge comes

Adverse effects of estrogen therapy

-pigmentation of nipple/areola

Care of a fistula w/o surgical intervention

-proper nutrition to promote wound healing -cleansing douches and enemas -rest -intestinal antibiotics -low residue diet specific to rectovaginal fistula

What are early s/sx of vulvar cancer?

-pruritus -genital burning -bloody discharge

What can reduce the risk of ovarian cancer?

-pt who has taken hormonal birth control -has had multibirths -had 1st child at young age

Preventive measures for cervical cancer

-reg pelvic exams and paps -delay first time intercourse -avoid HPV -safe sex only -cease smoking -getting HPV vax

Follicle-stimulating hormone (FSH)

-secreted by the pituitary gland -stimulates estrogen production and ovulation

What are two screening tools used to diagnose prostate cancer?

-serum prostate specific antigen level test -digital rectal exam

Cervix Cancer Risk Factors

-sex before 20yr -multi sex partners -early childbearing -exposure to HPV -HIV infection -smoking -nutritional deficits of folates, beta carotene, vit C

Hormone therapy increases the risk for:

-stroke -heart attack -blood clots

What are some s/sx of recurrent cervical cancer that could indicate metastasis?

-unintended wt loss -leg edema (unilateral) -pelvic pain -sciatica pain -ureteral obstruction

Mastectomy w/lymph removal post op guidelines

-use electric razor on armpit -dont lift more than 5-10# on side of mastectomy -avoid pressure or invasive procedures on that arm -no bp or blood draws -wear bug spray -wear gloves when gardening -wear cooking mitts -dont cut cuticles, only push back -wear sunscreen

Cone biopsy

-usually outpatient -associated with LEEP -removes cone shape tissue f/abnormal cervix -if pt received anesthesia: rest for 24hrs and leave any vaginal packing in place (usually removed next day)

Discharge Characteristics in Adv. Cervical Cancer

-watery/thin -dark -foul odor (f/necrotic tissue and infection) -irregular bleeding may also occur

Adverse effects of androgen therapy

-weight gain -increased appetite -fluid retention -increased libido

Prostate cancer incidence increases after what age?

50yrs

Endometriosis is a chronic disease affecting about

7-10% of women of reproductive age -more freq in women who have not had kids -can be genetic

The following patients call the outpatient clinic. Which phone call should the nurse return first?

A 34-year-old patient who is short of breath after having a pelvic CT with contrast dye

Which assessment finding in a 36-yr-old patient is most indicative of a need for further evaluation?

A breast nodule that is 1 cm in size, nontender, and nonmobile

Before a surgical repair of a rectocele, what is one preoperative nursing task?

A cleansing enema or laxative may be given prior to surgery

The nurse instructs a client about contraceptive options. The nurse explains that the intrauterine device (IUD) is a good contraceptive option for clients who:

Are in a monogamous relationship. Explanation Because of the increased risk of infection with an IUD if an STD occurs, the device is not appropriate for women with multiple partners or a history of STDs. Previous ectopic pregnancy is also a contraindication for an IUD because the incidence of ectopic implantation is slightly higher.

Which question is most pertinent for the nurse to ask a 43-yr-old patient about her risk for breast cancer?

At what age did you start having menstrual periods?

A client with Stage IV prostate cancer is to receive hormone therapy. The nurse would inform the client about possible adverse effects including which of the following?

Breast tenderness Explanation: Feminizing side effects occur with hormone therapy. The client's voice may become higher, hair and fat distribution may change, and breasts may become tender and enlarged. Libido and potency also are diminished.

A client who underwent an anterior colporrhaphy 6 hours ago has not voided. She reports some discomfort in her suprapubic area. Which of the following would the nurse expect to do?

Catheterize the client. Explanation: After repair of a cystocele (anterior colporrhaphy), the client is encouraged to void within a few hours. If the client does not void within this period and reports discomfort or pain in the bladder region after 6 hours, the client should be catheterized to prevent pressure on the suture line.

A 35-year-old African American woman who smokes regularly and had diabetes visits the health care unit with sustained elevated blood levels and is diagnosed with essential hypertension. Which contraceptive method is best for this client?

Cervical cap Explanation: Women who smoke and are 35 years of age or older should not take oral contraceptives because of an increased risk of cardiovascular disease. Mechanical barriers like cervical caps do not use hormonal therapy and are appropriate in this case.

Radical (Abdominal or Vaginal) Hysterectomy

Commonly used for cervical cancer and performed to remove: -uterus -ovaries -fallopian tubes -proximal vagina -bilat. lymph nodes

Which of the following recommendations would a nurse advocate during infancy and childhood to help reduce potential adult complications such as orchitis?

Ensure immunizations against infectious diseases such as mumps.

The client is asking if there is a pill that can be ordered to control the symptoms of menopause. Which assessment finding is most important in determining nursing care in association with hormone replacement therapy?

Family history of breast cancer Explanation: The risk of endometrial or breast cancer in women prescribed HRT may outweigh the benefits of relieving symptoms of menopause and preventing kyphosis or hip fractures associated with osteoporosis.

Breast cancer incidence is increased in women who are using

HRT

rectocele

Herniation of the rectum into vagina

The diagnosis of prostate cancer is confirmed by which of the following?

Histologic exam of tissue

A nurse is reviewing the medical record of a client who has come to the clinic for contraception. What condition would hormonal contraceptives be contraindicated for in a client?

History of thrombophlebitis

The nurse is obtaining a health history from a 58-year-old client stating that he is having difficulty obtaining an erection during sexual activity. The client asks how an "erectile medication" works and if there are any side effects to the medication. The nurse explains the action of the medication and directions for use and warns of which side effect related to the client's history?

Hypotension with nitrate use Explanation: Due to the action of the medication on the smooth muscles and blood vessels, clients are advised not to take medications to treat erectile dysfunction when also prescribed a nitrate drug for chest pain or heart problems. Combining medication could result in a serious drop in blood pressure.

A client comes to the clinic reporting dysmenorrhea and is diagnosed with primary dysmenorrhea. Which medication would the nurse most likely suggest for pain relief?

Ibuprofen

The nurse is relating health education to students when asked where sperm is actually made. Which location is most correct?

In the testes within the scrotum

A client has presented at the clinic with symptoms of benign prostatic hyperplasia. What diagnostic findings would suggest that this client has chronic urinary retention?

Increased blood urea nitrogen (BUN) Rationale: Hypertension, edema, and tachycardia would not normally be associated with benign prostatic hyperplasia. Azotemia is an accumulation of nitrogenous waste products, and kidney injury can occur with chronic urinary retention and large residual volumes

The nurse is assessing an older adult who has not seen their physician in 2 years. The nurse is assisting the patient into a gown and notices that the patient has edema and pitting of the skin on the right breast. What does the nurse understand is the significance of this finding?

It may result from a neoplasm blocking lymphatic drainage, indicating advanced breast cancer.

The expert nurse is assisting a novice nurse insert a Foley catheter. The novice nurse has tried unsuccessfully to insert the catheter, and the expert nurse is providing verbal guidance while spreading which area to reveal the urethral opening?

Labia majora and minora

What allergy should you always assess for when a pt is considering getting a pessary?

Latex allergy

A nurse is planning the postoperative care of a client who is scheduled for radical prostatectomy. What intraoperative position will place the client at particular risk for the development of deep vein thrombosis postoperatively?

Lithotomy Position -SCDs used as prevention

The nurse is providing care to a client who has had surgery as treatment for breast cancer. The nurse would be alert for the development of which of the following?

Lymphedema Explanation: Lymphedema occurs in some women after breast cancer surgery. It causes disfigurement and increases the lifetime potential for infection and poor healing

Sentinel lymph node mapping is done to validate the lack of lymph node metastasis. Which complication does this technique help avoid?

Lymphedema Explanation: Validating the lack of lymph node metastasis allows the surgeon to preserve more breast and axillary tissue and chest muscle. Leaving more normal lymph nodes intact reduces the potential for complications, such as lymphedema caused by the extensive disruption of lymphatic circulation.

The nurse is preparing a presentation for an older adult group of clients at a senior center. Which of the following would the nurse expect to include when describing the effects of aging on the reproductive system?

Men retain the ability to fertilize ova irrespective of age.

A nurse is obtaining health history from a young adult. Which of the following would alert the nurse to a possible problem?

Reports of dyspareunia Explanation: Dyspareunia, or pain with intercourse, is an abnormal finding associated with numerous potential problems.

A perimenopausal client informs the nurse they are having irregular vaginal bleeding. What should the nurse encourage the patient to do?

See their gynecologist as soon as possible. Explanation: Clients should be encouraged to have annual checkups, including a gynecologic examination. Any client who is experiencing irregular bleeding should be evaluated promptly by their gynecologist.

Stages of Cervical Cancer

Stage 1: carcinoma confined to cervix Stage 2: cancer invades beyond uterus but not in pelvic wall or vagina Stage 3: Tumor spreads to pelvic wall and/or vagina; can also cause hydronephrosis of kidneys Stage 4:

A client with vaginitis reports itching and burning of the perineum. Which suggestion would be most appropriate to relieve the client's symptoms?

Take sitz baths frequently. Explanation: Sitz baths are recommended to relieve the client's itching and burning as well as relieve swelling of the vulva and perineum

Students are reviewing information about the use of adjuvant hormonal therapy for breast cancer. They demonstrate understanding of this information when they identify which of the following as an example of a selective estrogen receptor modulator (SERM)?

Tamoxifen

A patient who is scheduled for a lumpectomy and axillary lymph node dissection tells the nurse, "I would rather not know much about the surgery." Which response by the nurse is best?

Tell me what you think is important to know about the surgery. Rationale: This response shows sensitivity to the individual patient's need for information about the surgery. The other responses are also accurate, but the nurse should tailor patient teaching to individual patient preferences

A 58-yr-old woman tells the nurse, ―I understand that I have stage 2 breast cancer and I need to decide on a surgery, but I feel overwhelmed. What do you think I should do?‖ Which response would the nurse provide?

Tell me what you understand about the surgical options that are available.

After having transurethral resection of the prostate (TURP), a client returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the client's catheter is occluded?

The client reports bladder spasms and the urge to void.

A new client has come to the clinic seeking an appropriate method of birth control. What would the nurse teach this client about a diaphragm?

The diaphragm may be cleaned with soap and water after use.

A pt had a sentinel node biopsy and informs the nurse that something is very wrong with her. The pt explains that her urine and stool are blue. What should the nurse inform her?

The dye that was used during her biopsy is safe and being excreted. -this may occur for up to 24hrs and may vary in blue-green color

A client comes to the clinic for a routine evaluation. During the physical examination, the nurse palpates the client's breast and finds a small lump. Which of the following would lead the nurse to suspect possible breast cancer?

The lump is irregularly shaped.

When assessing the breast, which assessment finding is characteristic of fibrocystic disease?

The lump is round and movable.

A nurse is reviewing a client's medical history. Which factor indicates the client is at risk for candidiasis?

Use of corticosteroids Explanation: A small quantity of the fungus Candida albicans commonly exists in the vagina. Because corticosteroids decrease host defense, they increase the risk of candidiasis. Candidiasis is rare before menarche and after menopause. Using hormonal contraceptives, not spermicidal jelly, and pregnancy, not nulliparity, increase the risk of candidiasis.

A nurse is preparing a presentation about contraception for a young adult community group. Which of the following would the nurse expect to address as the most effective means of contraception?

abstinence

When does the proliferation phase occur?

after menstruation

Urine becomes more ________ during menopause. This causes more susceptibility for infections to occur.

alkalotic

Gynecologic cancer

any cancer that starts in a woman's reproductive organs

An older female client reports pain during intercourse, disrupting the intimacy that she and her husband are accustomed to sharing. What might be the cause of her pain?

atrophy of Bartholin glands

The nurse is discussing nutritional needs for a postmenopausal patient. What dietary increase should the nurse recommend to the patient?

calcium Explanation: Postmenopausal women should be encouraged to observe recommended calcium and vitamin D intake, including calcium supplements, if indicated, to slow the process of osteoporosis

Menorrhagia

prolonged or excessive bleeding

Which cancer ranks second as the cause of death in American men?

prostate

A digital rectal examination (DRE) is performed to assess:

prostate for size as well as evidence of tumor.

Enterocele

protrusion of intestinal wall into vagina

On discharge, a client who underwent left modified radical mastectomy expresses relief that "the cancer" has been treated. When discussing this issue with the client, the nurse should stress that she:

should continue to perform breast self-examination on her right breast. Explanation: Having breast cancer on her left side puts the client more at risk for cancer on the opposite side and chest wall. Therefore, the nurse should stress the importance of monthly breast self-examinations and annual mammograms. Although the tumor was found, it was large enough to require a mastectomy, and could put the patient at risk for metastasis. Follow-up appointments should be monthly for the first few months and then scheduled at the direction of her health care provider.

Excisional biopsy

standard procedure for complete patho assessment of a palpable breast mass. -entire mass plus a margin of surrounding tissue is removed

After cystocele repair, if the patient does not void within 6 hours, what should be done?

straight cath -sometimes a catheter is placed for 2-4 days after repair

Cystocele and Rectocele most commonly occur from damage to structures related to

strain/injury during birth (multi-births also increase risk) -usually occur years later when aging process has causes genital atrophy

A fistula may heal on its own, but more commonly _______ is required

surgical intervention

Incisional biopsy

surgical removal of a portion of a mass

Perineorrhaphy

sutural repair of perineal lacerations.

Cervical Cancer rarely produces _______, however, thin, watery _________ may be one early symptom.

symptoms discharge

Cone biopsy describes a procedure in which cervical tissue is removed as result of detection of abnormal cells. Which statements by the client demonstrates that the client undergoing a cone biopsy understands the discharge instructions?

"I will avoid having sexual relations until I see the doctor again." Explanation The nurse or primary provider provides guidelines regarding postoperative sexual activity, bathing, and other activities. Because open tissue may be potentially exposed to HIV and other pathogens, the client is cautioned to avoid intercourse until healing is complete and verified at follow-up.

Ovarian cancer risk factors include

-nulliparity ->40yrs -infertile -menstrual irregularities -fam hx of breast/bowel/endometrial cancer

A nurse practitioner examines a patient suspected of having endometriosis. The nurse knows that although a definitive diagnosis could not be made without diagnostic treatment (transvaginal ultrasound), the most frequent symptom is:

Chronic pelvic pain.

Menopause marks the end of a reproductive capacity. Which of the following is a common complaint that may be due to a cystocele?

Dyspareunia

In educating a patient with PMS about changing her dietary practices, what would the nurse recommend that she increase her intake of?

MG

Which is the main cause of anemia in a client with active uterine leiomyoma?

Menorrhagia Explanation: Uterine leiomyomas or fibroids cause menorrhagia, which in turn can cause anemia. Poor dietary intake of iron does not cause anemia but aggravates the problem.

What are age-related functional reproductive changes that occur in women as they age?

-decreased ovulation -onset of menopause -hormonal fluctuations -decreased bone formation -decreased vaginal lubrication -increased pH of the vagina.

Clinical s/sx of ectopic pregnancy

-delay in menstruation 1-2wks -spotting -sharp/colicky pain

Cryotherapy of cervix

-destruction of tissue by freezing w/nitrous oxide -outpatient -can cause cramping, fainting, watery discharge

Cervix Cancer S/SX

-discharge -irregular bleeding -pain/bleeding after sex

HRT with _______ only is given to women following a _________.

-estrogen -hysterectomy These women do have an increased chance of having a stroke

Clinical manifestations of a rectocele

-flatus -constipation -fecal inc -rectal pressure

Uterine prolapse surgical options

-hysterectomy for post-menopausal women -Suturing uterus back in palce

S/Sx of Adv. Cervical Cancer

-increased bleeding -leg pain -dysuria -rectal bleeding -edema in extremities -back pain -extreme emaciation -anemia -fever -fistula formation

Clinical manifestations of menopause

-increased body fat (abdominal) -total and LDL cholesterol increase -hot flashes (altered thermoregulation) -sleep disturbances -fatigue -increased bone loss -thinning pubic hair -pH of vagina increases (alkalotic)=increased risk to infections -forgetfulness -irritability -depression/anxiety

Risk Factors for Breast Cancer

-obesity -nulliparity -children after 30yr -consumption of alcohol

Polycystic ovary syndrome (PCOS) features:

-obesity -sleep apnea -irregular menstrual periods

Primary dysmenorrhea is:

-painful menstruation -no identifiable pelvic pathology. -occurs at time of menarche or shortly thereafter. -crampy pain that begins before or shortly after the onset of menstrual flow and continues for 48 to 72 hours.

Treatments for endometriosis

-surgery -NSAIDs -oral contraceptives -GnRH agonists

Home care for a client with epididymitis and orchitis includes instructions to:

-take prescribed antibiotics, -take Sitz baths -apply local heat after scrotal swelling subsides -avoid lifting -refrain from sexual intercourse until symptoms are relieved.

The risk of ovarian cancer is reduced in clients who have

-taken hormonal contraceptives -had multiple births had a first child at a young age.

Changes of female genitalia during aging

-thinning of pubic hair -decreased size of labia majora and minora -shortening and narrowing of vagina -atrophy of bartholin's glands (lubrication lessened)

A school nurse is presenting information on human development and sexuality. When describing the role of hormones in sexual development, which hormone does the nurse teach the class is the most important one for developing and maintaining the female reproductive organs?

estrogen

menorrhagia

excessive menstrual bleeding

metrorrhagia

excessive/prolonged menstrual bleeding

Which structure is referred to as the vulva?

external female genitalia Explanation: The major external structures include the mons pubis, vaginal orifice (opening), labia majora, labia minora, and clitoris. These structures are also referred to as the vulva (collective term for external genitalia).

Within the female internal reproductive structures, where is the egg most commonly fertilized?

fallopian tubes Explanation: One or the other fallopian tube receives an extruded ovum every month and serves as the place where the ovum is most commonly fertilized.

Adnexa

fallopian tubes and ovaries

What happens in the proliferation phase?

follicle-stimulating hormone output increases --->stimulating estrogen secretion---> endometrium thickens---> become more vascular.

endometrium

inner, mucous membrane lining of the uterus

The vagina is considered:

internal female reproductive system structure

Paget Disease

intraductal carcinoma in the breast

The opening into the vagina on the perineum is called the:

introitus

LEEP stands for

loop electrosurgical excision procedure -removes abnormal cervical tissue

lithotomy position

lying on back with legs raised and feet in stirrups

When does secretory phase start?

near middle portion of the cycle -LH increases and stimulates ovulation

Fibroadenoma

occurrence of a single, nontender mass that is firm, mobile, and not fixed to breast tissue or chest wall

vesicovaginal fistula

opening between the bladder and vagina -urine escapes continuously into vagina

rectovaginal fistula

opening between the rectum and the vagina -flatus comes out vagina -fecal inc

estrogen is produced in the

ovaries

The ______ is a common site for cysts

ovary -usually benign -can be detected through routine pelvic exams

dyspareunia

painful intercourse

dysmenorrhea

painful menstruation

Dyschezia

painful or difficult bowel movement

PID

pelvic inflammatory disease

Menopause

permanent cessation of periods AEB 12 consecutive months w/no bleeding -Usually occurs at 41-59yrs old -decreased amt of estrogen

What can be used in place of surgery for treatment of prolapse?

pessary

A retroflexed uterus bends:

posteriorly

LEEP

procedure in which a laser is used to remove a thin layer of cervical tissue after abnormal biopsy

Colpoclesis

procedure of closing the vaginal orifice to keep from uterine prolapse -only if women does not plan to bear anymore children and does not want intercourse

colporrhaphy

procedure performed laparoscopically to repair structural damage causing cystocele, rectocele, and enterocele

progesterone

produced by corpus luteum that preps uterus for retrieving fertilized ovum

Following surgery for cervical cancer, follow ups are imperative because

recurrence is high and usually occurs within first 2 years post-op

After a TURP, urine color appears:

red-pink

luteinizing hormone (LH)

released by pituitary gland that stimulates progesterone production

oophorectomy

removal of ovary or ovaries

saplingectomy

removal of the fallopian tube

total hysterectomy

removal of the uterus and the cervix and ovaries

myoectomy

removal of uterine fibroids

Colporrhaphy

repair of the vagina

FSH (follicle stimulating hormone)

responsible for stimulating the ovaries to secrete estrogen.

Hydrocele

sac of clear fluid in the scrotum

Urethral stricture

section of the urethra is narrowed -pt will have weak urine stream

A client with vaginitis complains of itching and burning of the perineum. Which suggestion would be most appropriate to relieve the client's symptoms?

sitz baths frequently

luteal phase

stage in the menstrual cycle in which the endometrium becomes thicker and more vascular

menarche

the first menstrual period

perimenopause

the period around menopause; leading up to -has irregular periods -hormonal fluctuations

salpingo-oophorectomy

the surgical removal of a fallopian tube and ovary

s/sx of endometriosis

-chronic pelvic pain -low back pain -dyspareunia -dysuria -dyschezia -dysmenorrhea -menorrhagia

Changes in women associated with aging

-decreased lubrication -difficulty maintaining arousal or achieving orgasm -decreased libido/interest in sex

Which term describes a procedure in which cervical tissue is removed because abnormal cells are detected?

Cone biopsy (conization)

A patient is diagnosed with prostatitis. Which of the following is the most commonly isolated organism that will be present in this patient's laboratory results?

E. coli

A Prominent venous pattern of the breast may indicate:

increased blood supply required by a tumor

A client is scheduled for an abdominal ultrasound as a follow up to her pelvic examination. Which action by the nurse would be most appropriate?

Ensuring that the client has a full bladder

The nurse is teaching a patient with a small immobile breast lump about options for a breast biopsy. Which type of biopsy would be scheduled in an operating room?

Excisional biopsy

Which information is most important for the nurse to teach a patient recently diagnosed with polycystic ovary syndrome?

Methods to maintain a healthy weight -it exacerbates POS

A 32-year-old client has been diagnosed with an ovarian cyst and asks the nurse, "Should I be worried about cancer?" Which response by the nurse would be most appropriate?

"Most cysts are benign in younger women, but it's good to have it checked out."

A 34-year-old client has been diagnosed with endometriosis. What topic should the nurse emphasize during health education?

The importance of reporting a possible pregnancy as soon as it occurs.

Epididymitis

infection of epididymis that usually descends f/infected prostate or urinary tract

Endometriosis is a common cause of

infertility and chronic pelvic pain

salpingitis

inflammation of a fallopian tube

A nurse is preparing a presentation for a health class. The participants are high schoolers, and the topic will be the menstrual cycle. Which events would the nurse need to incorporate into the presentation as occurring during the proliferative phase?

-Rise in follicle-stimulating hormone secretion -Increasing estrogen secretion

Danazol side effects

-amenorrhea -fatigue -depression -wt gain -oily skin -decreased breast size -mild acne -hot flashes -vaginal atrophy

The nurse instructs a client with genital herpes on self-care management. Which client statement indicates that teaching has been effective?

"I will not touch the lesions when they occur."

The nurse instructs a client on self-care after having a mastectomy with lymph node removal. Which client statement indicates that teaching has been effective?

"I will shave under my arms with an electric razor."

A client is scheduled for a transurethral resection of the prostate (TURP). Which statement demonstrates that the expected outcome of "client demonstrates understanding of the surgical procedure and aftercare" has been met?

"The surgeon is going to insert a scope through my urethra to remove a portion of the gland."

The nurse is preparing a client for a pelvic examination. Which nursing question is essential for the nurse to ask?

"Would you like to void at this time?" Explanation: Prior to a pelvic examination, the nurse offers the client the use of the restroom to void. It is most important for the client to empty her bladder so that the physician can feel pelvic structures more clearly and also for the comfort of the client

Female clients with condylomata acuminata (genital warts) are at risk for cancer of:

-cervix -vulva

uterine cancer risk factors

-Age >50yr -obese -menopause after 52yr

Malignant Disorders of Female Reproductive Tract

-Cervical -Uterine -Ovarian

A pt with prostate cancer may undergo _________ as it helps suppress ___________ stimuli to the prostate. This occurs due to decreased levels of __________.

-HT (hormone therapy) -androgenic -testosterone

Uterine (endometrial) Cancer Risk Factors

-Older than 50yrs -obesity -estrogen therapy w/o progesterone -nulliparity -early menarche -late menopause (after 52yr) -Tamoxifen

Possible Complications of cervical surgery

-PE -Pulm edema -MI -cerebrovascular disease -hemorrhage -sepsis -small bowel obstruction -fistula formation -obstruction of ileal conduit -bladder dysfunction -pyelonephritis

Testicular cancer is most common in men of what age group?

15-35yr -painless enlargement of testicle

What is the avg length of time a pt may have an indwelling catheter after TURP?

2-4days on average -cath is only removed with physician's order

Average menstrual cycle

28 days -can vary 21-42 days though

Perimenopause usually begins on avg ____ years before the last period

4

During a breast examination, which finding most strongly suggests that a client has breast cancer?

A fixed nodular mass with dimpling of the overlying skin

What synthetic androgen medication can be used for endometriosis?

Danazol -inhibits release of gonadotropin

Medical management of BPH includes pharmacologic therapy. Which of the following medications would the nurse expect the health care provider to prescribe for this diagnosis?

Alpha-adrenergic blocker Explanation: Alpha-adrenergic blockers relax the smooth muscle of the bladder neck and prostate, improving urine flow and relieving BPH symptoms.

The nurse is providing information at the local YMCA about screenings for breast and cervical cancer. The nurse should inform young women that they should begin their screenings at what time?

Annual breast and pelvic examinations are important for all women 21 years of age or older and for those who are sexually active, regardless of age.

The nurse is obtaining a history from a client who states having difficulty achieving and sustaining an erection. When reviewing the medication history, which medication classification does the nurse anticipate?

Antihypertensives

How long after a mastectomy are breast protheses usually obtained?

Approximately 6wks

Fertility studies include a semen analysis to determine sperm count, sperm motility, and abnormal sperm. Which test can also be performed to determine infertility?

Blood test for luteinizing hormone (LH) Explanation: A decrease in the concentration of LH in the blood may be responsible for decreased testosterone production and infertility.

Which treatment involves implantation of interstitial radioactive seeds under anesthesia to treat prostate cancer?

Brachytherapy

What lab test is closely monitored for uterine cancer?

CA-125 -elevated levels can indicate extrauterine disease or metastasis

Which age-related change affects the male reproductive system?

Decreased plasma testosterone levels Explanation: Changes in gonadal function include a decline in plasma testosterone levels and reduced production of progesterone. The testes become smaller and more firm.

A nurse practitioner is conducting a history and physical on a 42-year-old client. One of the questions asked of someone in this age group is the type of medications that the patient's parent took during pregnancy. The nurse is assessing for a past history of ______ use.

Diethylstilbestrol Explanation: Diethylstilbestrol (DES) is a nonsteroidal estrogen that was given to pregnant women (1940-1970) to prevent pregnancy complications. After 30 years, it was found to cause vaginal cancer in daughters exposed to the drug in utero. The incidence of occurrence can be as high as 40%.

A client is scheduled to undergo a Papanicolaou test. The nurse should advise the client of which preparation?

Do not douche before the procedure Explanation: To avoid washing away cellular material, the client should be instructed not to douche before having a Pap test. A Pap test should be performed when a client is not menstruating because blood usually interferes with interpretation. The client should be instructed to avoid intercourse for 2 days prior to having the Pap test.

A patient who was admitted to the emergency department with severe abdominal pain is diagnosed with an ectopic pregnancy. The patient begins to cry and asks the nurse to leave her alone. Which action would the nurse take next?

Explain the reason for taking vital signs every 15 to 30 minutes Rationale: The patient is at risk for rupture of the fallopian tube and hemorrhage, frequent monitoring of vital signs is needed. Minimizing contact with her and closing the door of the room is unsafe because of the risk for hemorrhage. Because the patient has requested time to grieve, it would be inappropriate to provide teaching about options for pregnancy termination.

Menotropins

FSH and LH therapy used to stimulate ovaries to produce eggs

Culture of client's vaginal discharge reveals Gardnerella vaginalis. Which of the following would the nurse expect to assess?

Fishy-smelling watery discharge

Hematoma and seroma formation are complications of breast surgery. Which of the following is the indicator that should be reported to the surgeon?

Gross swelling

The examiner is preparing to perform a pelvic examination. Which of the following would be done first?

Inspection of the external genitalia

A patient is diagnosed with the most common type of uterine fibroid, an intramural fibroid. The nurse includes which information in teaching the patient about this type of fibroid?

It grows within the wall of the uterine muscle.

Which statement is true regarding hormonal contraception?

It increases risk for venous thromboembolism

If lymph is removed with a mastectomy, why should that arm be avoided?

It is as increased risk for infection and lymphedema

A public health nurse has been asked to provide a health promotion session for men at a wellness center. What should the nurse inform the participants about testicular cancer?

It is highly responsive to treatment.

A patient with endometriosis asks why she is being treated with an oral contraceptive. Which information would the nurse explain about this therapy?

It suppresses the menstrual cycle by mimicking pregnancy.

A patient asks the nurse if there are any available nonsurgical options to terminate a pregnancy if she is only 2 weeks pregnant. What information should the nurse provide to the patient about a medication that blocks progesterone?

Mifepristone (RU-486, Mifeprex) is used only in early pregnancy to terminate a pregnancy nonsurgically.

The nurse is preparing a presentation for a men's community group about health promotion. Which of the following would the nurse include as a current recommendation for screening?

Monthly testicular self-examination (TSE)

A client has a history of dysmenorrhea. During monthly menses, the client experiences incapacitating cramping and passes large clots. The client's primary care physician initiates conservative treatment. What interventions would the physician to recommend?

NSAIDs

The nurse teaches a premenopausal client to perform breast self-examination (BSE) at which interval?

On day 5 to day 7, counting the first day of menses as day 1 Explanation: BSE is best performed after menses, when less fluid is retained. Because of increased tenderness, lumpiness, and fluid retention before their menstrual period, BSE is not recommended with the onset of menses. Because these symptoms generally continue through menses, BSE is not recommended during that time.

Which term refers to the surgical removal of one or both testes?

Orchiectomy

A positive chandelier sign is indicative of which of the following?

Pelvic infection Explanation: Pain on gentle movement of the cervix is called a positive chandelier sign or positive cervical motion tenderness and usually indicates a pelvic infection.

A client is admitted to the health care center with abdominal pain, nausea, and vomiting. The client has a body mass index (BMI) of 30 and reports irregular menstrual cycles and feeling tired all the time. The nurse suspects the client's symptoms to indicate which condition?

Polycystic ovary syndrome (PCOS)

Which nursing action would be included in the plan of care for a patient returning to the surgical unit after a left modified radical mastectomy with dissection of axillary lymph nodes?

Post a sign at the bedside warning against venipunctures or blood pressures in the left arm.

Following a radical vulvectomy, the nurse is preparing the client for discharge to home. Which care intervention would be considered the priority for this client?

Prevention of wound complications Explanation: Prevention of complications and infection is paramount due to the location of the wound. The perineal area provides a warm, dark environment that supports the growth of microorganisms that can be introduced into the wound.

To prevent recurrence or cervical cancer, what are some courses of treatment?

Radiation -Can be delivered by external beam or brachytherapy or both Chemotherapy Pelvic exenteration -removal or some pelvic organs

At a follow-up visit, the client is informed that her breast cancer has recurred. The nurse knows that which situation places the client at risk for developing bone metastases?

Recurrence within 2 years of the original diagnosis

Stages of Endometriosis

Stage 1- superficial/minimal lesions Stage 2- mild involvement Stage 3- mod involvement Stage 4- extensive involvement and dense adhesions

A 53-yr-old woman who is experiencing menopause is discussing the use of hormone therapy (HT) with the nurse. Which information about the risk of breast cancer will the nurse provide?

The patient and her health care provider must weigh the benefits of HT against the risks of breast cancer.

Surgical Mgmt for Endometriosis

The surgery selected is solely based on the pt's condition/staging -Laparoscopic/Laser Surgery(cuts endometrial implants and release adhesions) -Endocoagulation/Electrocoagulation -Laparotomy -Abd. Hysterectomy -Oophorectomy -Bilat. salpingo-oophorectomy -Appendectomy -Total Hysterectomy is most definitive procedure

A client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client?

This condition puts them at a higher risk for cervical cancer; therefore, they should have a Papanicolaou (Pap) smear annually. Explanation: Female clients with condylomata acuminata are at risk for cancer of the cervix and vulva. Yearly Pap smears are very important for early detection. Because condylomata acuminata is a virus, there is no permanent cure. Because condylomata acuminata can occur on the vulva, a condom won't protect sexual partners.

The nurse is caring for a client who will be having artificial implants for breast reconstruction. The client is arriving at the physician's office for which procedure to be completed before the surgery can be done?

Tissue expansion

Which is the most common type of prostate surgery?

Transurethral resection of the prostate (TURP)

True or False: Cystoceles can cause a pt to have urinary inc.

True -esp w/coughing, sneezing, laughing, lifting

Uterine cancer has how many types?

Type 1: 90% cases; estrogen dependent Type 2: serous cell or clear cell; Elderly and African Americans at higher risk for developing

What is the most common location for breast cancer?

Upper outer quadrant of the breast

Following a vasectomy, which is the most important instruction to provide to the client?

Use another form of birth control until further notice. Explanation: It may take up to 10 ejaculations to clear sperm and prevent impregnation.

Which of the following would be most important to determine when assessing a client being admitted for suspected toxic shock syndrome (TSS)?

Use of superabsorbent tampons Explanation: TSS is commonly associated with the use of superabsorbent tampons that are not changed frequently and internal contraceptives that remain in place longer than necessary

A client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. Which nursing intervention is appropriate?

Use sterile technique when irrigating the catheter.

While examining the introitus, the nurse practitioner asks the client to "bear down." The nursing student observing the examination knows that the nurse practitioner is assessing the client for which condition?

Uterine prolapse Explanation: The introitus is the vaginal orifice. Uterine prolapse occurs when the cervix and uterus descend under pressure through the vaginal canal and can be seen at the introitus

During a follow-up visit, a client who underwent a mastectomy presents with an infection that requires an antibiotic. They admit they have been doing some gardening. What further instruction and reinforcement of teaching is needed?

Wear gloves and protective clothing to avoid any injuries. Explanation: The nurse should recommend that the client wear gloves and protective clothing when doing backyard work or housework to prevent injuries that may heal slowly or become infected

When is hormone therapy contraindicated?

When there is a hx of vascular thrombosis, active liver disease, uterine cancer, and undiagnosed vaginal bleeding.

When is hormone therapy beneficial?

Women who have a risk for osteoporosis -can also help relieve s/sx of menopause (vag dryness, hot flashes, and night sweats)

dysplasia

abnormal cells

urethrovaginal fistula

abnormal opening between the vagina and the urethra

Fistula

abnormal opening between two organs or from an internal organ to the exterior of the body

amenorrhea

absence of menstruation

Hormonal contraception decreases the risk for:

benign breast cancer and uterine cancer

What is endometriosis?

benign lesion(s) that contain endometrial tissue found in pelvic cavity outside the uterus

Pitting in a breast may indicate:

blocked lymphatic drainage resulting from a tumor

PSA assay

blood test that detects prostate cancer.

Mastalgia

breast pain

cystocele

bulging of the bladder out of the vagina

How can endometriosis be cured?

by natural or surgical menopause -birth control can help lessen s/sx by keeping pt in non bleeding phase

A pap smear can help diagnose:

cervical cancer -cervical secretions are taken and sent to lab

uterine prolapse

cervix and uterus descend into lower vagina

Progesterone

conditions endometrium in preparation for implantation of fertilized ovum

A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to balloon inflation, the functions of the three lumens include:

continuous inflow and outflow of irrigation solution and one lumen is for balloon inflation

A client is concerned about the lumps that have developed in her breasts and is fearful of cancer. The client reports variability in the size of the lumps. What could be causing this condition?

cyclical hormonal changes Explanation: The likely cause is fibrocystic disease, which results from hormonal changes during the menstrual cycle.

Estrogen

development/maintenance of female reproductive organs

Urethral stricture treatment

dilation of the urethra. -cannot determine if successful until a full year has passed (strictures can recur) -prostatitis can occur after dilation as a complication

A client has been diagnosed with breast cancer and is awaiting cytology results of a biopsy. During client education, the nurse discusses the possible types of breast malignancies. Which is the most common type?

ductal

A cystocele can cause:

dyspareunia and incontinence

PID is a major risk factor for

ectopic pregnancy

Laparoscopic exam helps confirm the diagnosis of _______ and stage the disease.

endometriosis -Ultrasound, MRI, and CT scans also helpful in dx

hysteroscopy/colposcopy

endoscopic procedure performed using long telescope like instrument inserted into cervix to dx uterine problems

A digital rectal exam can help identify

enlargement and irregularity of the prostate

Which of the following is an immediate danger after a prostate surgery?

hemorrhagic shock

Hormone therapy decreases the risk of

hot flashes

Brachytherapy

implanting of radioactive seeds under anesthesia

Anteversion uterus

tilts forward

postmenopause

time beginning 12 months after the last menstrual cycle

During an internal vaginal examination, the nurse practitioner notes a frothy and malodorous discharge. The nurse suspects the odor is caused by which bacteria?

trichomonas

Tamoxifen

used for estrogen-dependent breast tumors in premenopausal women

Raloxifene

used to prevent breast cancer -not used postmastectomy

Trastuzumab

used to treat tumors w/HER-2 receptor

Tamoxifen prevents breast cancer but can also increase the risk for what cancer?

uterine cancer

hysterectomy is the surgical removal of the

uterus

Metrorrhagia

vaginal bleeding between regular menstrual periods

Can fistulas reoccur?

yes -if surgical intervention is used, follow ups are for about 2 years to monitor for reoccurrence