Week. Female: endometrial cancer

2. When taking a nursing history from a patient with BPH, the nurse would expect the patient to report a. nocturia, dysuria, and bladder spasms. b. urinary frequency, hematuria, and perineal pain. c. urinary hesitancy, postvoid dribbling, and weak urinary stream. d. urinary urgency with a forceful urinary stream and cloudy urine.

✅c. Classic symptoms of uncomplicated BPH are those associated with irritative symptoms, including nocturia, frequency, urgency, dysuria, bladder pain, and incontinence associated with inflammation or infection. Obstructive symptoms caused by prostate enlargement include diminished caliber and force of the urinary stream, hesitancy or difficulty initiating voiding, intermittent urination, dribbling at the end of urination, and a feeling of incomplete bladder emptying because of urinary retention. Bladder spasms, hematuria, perineal pain, and cloudy urine do not occur with BPH. 54 Male Reproductive Problems

37. The 24-year-old female client presents to the clinic with lower abdominal pain on the left side she rates as a "9" on a 1-to-10 scale. Which diagnostic procedure should the nurse prepare the client for? 1. A computed tomography scan. 2. A lumbar puncture. 3. An appendectomy. 4. A pelvic sonogram.

1. The client has symptoms of an ovarian cyst, usually diagnosed by a pelvic sonogram. 2. The client has abdominal pain, not back or neurological pain, which is when a lumbar puncture is performed. 3. The appendix is in the right lower abdomen, not the left. ✅4. Ovarian cysts are fluid-filled sacs located on the surface of the ovary. A lower pelvic sonogram is the preferred diagnostic tool. It is not invasive and usually not painful.

45. The female client has a mother who died from ovarian cancer and a sister diagnosed with ovarian cancer. Which recommendations should the nurse make regarding early detection of ovarian cancer? 1. The client should consider having a prophylactic bilateral oophorectomy. 2. The client should have a transvaginal ultrasound and a CA-125 laboratory test every six (6) months. 3. The client should have yearly magnetic resonance imaging (MRI) scans. 4. The client should have a biannual gynecological examination with flexible sigmoidoscopy.

1. This is appropriate information if the client is in her mid- to late-30s and has completed her family, but this is not discussing early detec- tion of ovarian cancer. ✅2. A transvaginal ultrasound is a sonogram in which the sonogram probe is inserted into the vagina and sound waves are directed toward the ovaries. The CA-125 tumor marker is elevated in several cancers. It is nonspecific but, coupled with the sono- gram, can provide information about ovar- ian cancer for early diagnosis. 3. Yearly MRI scans will not provide the infor- mation the two (2) tests will, and every 12 months is too long an interval. 4. A flexible sigmoidoscopy provides the HCP with a visual examination of the sigmoid colon, not the ovaries.

31. The client diagnosed with uterine cancer is complaining of lower back pain and unilateral leg edema. Which statement best explains the scientific rationale for these signs/symptoms? 1. This is expected pain for this type of cancer. 2. This means the cancer has spread to other areas of the pelvis. 3. The pain is a result of the treatment of uterine cancer. 4. Radiation treatment always causes some type of pain in the region.

1. This pain indicates metastasis to the retro- peritoneal region. If caught early, a complete hysterectomy is usually the only therapy rec- ommended. This type of pain indicates the cancer is advanced and the prognosis is poor. ✅2. This pain indicates the cancer is in the retroperitoneal region and the prognosis is poor. 3. Pain is not part of the treatment of cancer. Surgery may cause pain, but most treatments do not. 4. Radiation therapy does not always result in pain; it depends on the area irradiated. TEST-TAKING HINT: Option "4" has the abso- lute word "always" and should be eliminated as a correct answer. The stem is describing symptoms in regions other than the lower pelvis, so an educated choice is option "2." Content - Medical: Integrated Nursing Process - Diagnosis: Client Needs - Physiological Integrity, Physi- ological Adaptation: Cognitive Level - Analysis: Concept - Cellular Regulation.

43. The client diagnosed with ovarian cancer has had eight (8) courses of chemotherapy. Which laboratory data warrant immediate intervention by the nurse? 1. Absolute neutrophil count of 3,500. 2. Platelet count of 150x10^3. 3. Red blood cell count of 5x 10^6. 4. Urinalysis report of 100 WBCs.

1.An absolute neutrophil count of 3,500 indi- cates the client has sufficient mature white blood cells, or granulocytes, to act as a defense against infections. 2. A platelet count of 150,000 is within normal range (150x 10^3 [1,000] =150,000). Thrombocytopenia is less than 100,000. 3. A red blood cell count of 5,000,000 is within normal limits (5x10^6 [1,000,000] = 5,000,000). ✅4. A normal urinalysis contains one (1) to two (2) WBCs. A report of 100 WBCs indicates the presence of an infection. A clean voided specimen should be obtained and a urine culture should be done. This client should be prescribed antibiotics immediately. TEST-TAKING HINT: The test taker should memorize normal values for common labora- tory tests. Urine will not have a large number of white blood cells unless there is a patho- logical process occurring. The kidneys filter the blood but do not process the destruction of blood cells. Content - Medical: Integrated Nursing Process - Assessment: Client Needs - Physiological Integrity, Reduc- tion of Risk Potential: Cognitive Level - Analysis: Concept - Cellular Regulation

27. The nurse is admitting a client diagnosed with Stage Ia cancer of the cervix to an outpatient surgery center for a conization. Which data would the client most likely report? 1. Diffuse watery discharge. 2. No symptoms. 3. Dyspareunia. 4. Intense itching.

1.Diffuse, watery, foul-smelling discharge occurs at a much later stage. ✅2. At this stage the client is asymptomatic and the cancer has been determined by a Pap smear. 3. Dyspareunia is painful sexual intercourse; the client is asymptomatic. 4. Intense itching occurs with vaginal yeast infections. TEST-TAKING HINT: The test taker could either choose option "2" because it is the least presenting symptom or discard it. Stag- ing for all cancers starts with "0" or "1," indicating the least detectable cancer. Content - Surgical: Integrated Nursing Process - Assessment: Client Needs - Physiological Integrity, Reduc- tion of Risk Potential: Cognitive Level - Analysis: Concept - Female Reproduction.

Question 5 of 5 A patient diagnosed with advanced ovarian cancer states, "I'm not going to do treatment." Which response by the nurse is most appropriate? A. "Tell me more about not wanting to do treatment." B. "I am going to notify the healthcare provider of your refusal." C. "I will document this in the chart." D. "Why are you refusing treatment?"

ANS: A ✅"Tell me more about not wanting to do treatment." Open-ended questions facilitate spontaneous responses and interactive discussion. It encourages the client to explore feelings and thoughts and avoids yes or no answers. "Why are you refusing treatment?" Asking "why" questions or asking for explanations is a barrier to effective communication and should be avoided "I will document this in the chart." To collect data effectively, nurses must ask clients appropriate questions. Nurses must recognize the need to collect assessment data prior to interventions. "I am going to notify the healthcare provider of your refusal." Responding disapprovingly is a barrier to effective communication and should be avoided. 02.10 Ovarian Cancer

25. The nurse is caring for a 30-year-old nulliparous client who is complaining of severe dysmenorrhea. Which diagnostic test should the nurse prepare the client to undergo to determine the diagnosis? 1. A bimanual vaginal exam. 2. A pregnancy test. 3. An exploratory laparoscopy. 4. An ovarian biopsy.

1. A vaginal examination does not provide a definitive diagnosis to determine the cause of the pain. 2.A pregnancy test is not usually ordered un- less the client has a reason to think she may be pregnant. Pregnancy temporarily allevi- ates the symptoms of endometriosis because neither ovulation nor menses occurs during pregnancy. ✅3. There is a high incidence of endometrio- sis among women who have never had children (nulliparity) and those who have children later in life. The most common way to diagnose this condition is through an exploratory laparoscopy. 4. The ovaries lie deep within the pelvic cavity. To reach the ovaries, some form of abdomi- nal procedure must be performed, such as a laparoscopy. However, the symptoms are not those of an ovarian cyst. TEST-TAKING HINT: The test taker could eliminate answer option "1" because "diag- nosis" is in the stem. The stem is asking for a procedure providing a definitive diagnosis. Option "2" could be eliminated because, if the client is menstruating (dysmenorrhea means "painful menstruation"), then the client is usually not pregnant. Content - Medical: Integrated Nursing Process - Diagnosis: Client Needs - Physiological Integrity, Reduction of Risk Potential: Cognitive Level - Analysis: Concept - Female Reproduction.

39. The female client presents to the gynecologist's office for the fifth time with an ovarian cyst and is scheduled for an exploratory laparoscopy. The client asks the nurse, "Why do I need to have another surgery? The other cysts have all been benign." Which statement is the nurse's best response? 1. "Because eventually the cysts will become cancerous." 2. "All abnormal findings in the ovary should be checked out." 3. "The surgery will not be painful and you will have peace of mind." 4. "Are you afraid of having surgery? Would you like to talk about it?"

1. All cysts do not become cancerous; 98% of ovarian cysts in clients younger than age 29 are benign, whereas in women older than age 50, about half are benign. ✅2. Any abnormal ovary that cannot be diagnosed with a transvaginal ultrasound should be examined laparoscopically. 3. Any time the client has surgery, she should be prepared to experience some pain. This is a false statement and could cause a breach in the nurse-client relationship. 4. This is a therapeutic statement TEST-TAKING HINT: The test taker should read the stem of the question carefully. Option "1" has a form of absolute, "eventually will become," so it can be eliminated. Option "3" is a false statement. Option "4" is a therapeu- tic response and the stem asks the nurse to provide information.

42. The nurse writes a problem of "anticipatory grieving" for a client diagnosed with ovarian cancer. Which nursing intervention is priority for this client? 1. Request the HCP to order an antidepressant medication. 2. Refer the client to a CanSurmount volunteer for counseling. 3. Encourage the client to verbalize feelings about having cancer. 4. Give the client an advance directive form to fill out.

1. An antidepressant may be needed at some time, but at this point the nurse should offer his or her time and interest and encourage the client to discuss the feeling of having cancer. 2. CanSurmount volunteers are extremely help- ful in talking about having cancer with the client, but they do not provide counseling. The programs work based on the fact some- one who has had cancer and gone through treatment can relate to the client about to begin treatment. ✅3. The nurse should plan to spend time with the client and allow the client to discuss the feelings of having cancer, dying, fear of the treatments, and any other concerns. 4. The client will need to complete an advance directive, but this action does not address the client's grieving process.

33. The client is diagnosed with benign uterine fibroid tumors. Which question should the nurse ask to determine if the client is experiencing a complication? 1. "How many periods have you missed?" 2. "Do you get short of breath easily?" 3. "How many times have you been pregnant?" 4. "Where is the location of the pain you are having?"

1. Benign fibroid tumors in the uterus cause the client to bleed longer with a heavier flow, not miss periods. ✅2. Many women delay surgery until anemia has occurred from the heavy menstrual flow. A symptom of anemia is shortness of breath. 3. The number of pregnancies does not matter at this time; the client has a different problem. 4. The pain is in the pelvic region to low back, where the uterus lies. TEST-TAKING HINT: This is a high-level ques- tion requiring the test taker to make several judgments before arriving at the answer. First, the test taker must decide what hap- pens when a client has fibroid tumors and then which symptoms the client will exhibit. Content - Medical: Integrated Nursing Process - Assessment: Client Needs - Safe Effective Care Environ- ment, Management of Care: Cognitive Level - Analysis: Concept - Female Reproduction.

30. The client has had a total abdominal hysterectomy for cancer of the uterus. Which discharge instruction should the nurse teach? 1. The client should take HRT every day to prevent bone loss. 2. The client should practice pelvic rest until seen by the HCP. 3. The client can drive a car as soon as she is discharged from the hospital. 4. The client should expect some bleeding after this procedure.

1. Clients who are diagnosed with cancer of the uterus have the ovaries removed to reduce hormone production. The client will not be taking HRT. ✅2. Pelvic rest means nothing is placed in the vagina. The client does not need a tampon at this time, but sexual intercourse should be avoided until the vaginal area has healed. 3. The sitting position a client assumes when driving a vehicle places stress on the lower abdomen. The client should wait until the HCP releases her to drive 4. The client should not have any vaginal bleeding TEST-TAKING HINT: The test taker should apply basic postoperative concepts when an- swering questions and realize bleeding is not expected postoperatively and safety should always be addressed. Content - Surgical: Integrated Nursing Process - Planning: Client Needs - Physiological Integrity, Physiologi- cal Adaptation: Cognitive Level - Synthesis: Concept - Female Reproduction.

40. The client has had an exploratory laparotomy to remove an ovarian tumor. The pathology report classifies the tumor as a "low malignancy potential" (LMP) tumor. Which statement explains the scientific rationale for this pathology report? 1. The client does not have cancer but will need adjuvant therapy. 2. The client would have developed cancer if the tumor had not been removed. 3. These borderline tumors resemble ovarian cancer but have better outcomes. 4. The client has a very poor prognosis and has less than six (6) months to live.

1. The client has a low-grade cancer occurring in approximately 15% of ovarian tumors. The affected ovary usually is removed, and the cli- ent may or may not require adjuvant therapy. Women with this type of tumor are usually younger than age 40 years 2. The tumor is classified as cancer. The follow- up care is not as extensive because of the characteristics the tumor displays. ✅3. These tumors are low-grade cancers with fewer propensities for metastasis than most ovarian cancers. 4. This client has a better prognosis than 85% of clients diagnosed with ovarian cancer. TEST-TAKING HINT: The test taker could eliminate option "4" because "low malig- nancy potential" and "poor prognosis" do not match. The statement in option "1" says the client does not have cancer but will need therapy for cancer, so the test taker could eliminate this option. Content - Medical: Integrated Nursing Process - Diagnosis: Client Needs - Safe Effective Care Environ- ment, Management of Care: Cognitive Level - Analysis: Concept - Female Reproduction.

32. The client diagnosed with endometriosis experiences pain rated a "5" on a 1-to-10 pain scale during her menses. Which intervention should the nurse teach the client? 1. Teach the client to take a stool softener when taking morphine, a narcotic. 2. Instruct the client to soak in a tepid bath for 30 to 45 minutes when the pain occurs. 3. Explain the need to take the nonsteroidal anti-inflammatory drugs with food. 4. Discuss the possibility of a hysterectomy to help relieve the pain.

1. The client taking a narcotic medication should be placed on a bowel regimen, but this client would not be prescribed narcotic medication. 2. A tepid bath for 30 to 45 minutes is not appropriate because the lukewarm water gets cold. A heating pad to the abdomen some- times helps with the pain. ✅3. The medication of choice for mild to moderate dysmenorrhea is an NSAID. NSAIDs cause gastrointestinal upset and should be taken with food. 4. This may be an option eventually, but the stem did not give an age nor state the client has decided she does not want to get pregnant. TEST-TAKING HINT: The test taker should not read into the question. Option "4" is only correct when more information is provided. The test taker must know about the scales used to rate pain, nausea, or depression. The client's report of midrange symptoms does not indicate the need for routine narcotic administration.

34. The HCP has prescribed two (2) IV antibiotics for the female client diagnosed with diabetes and pneumonia. Which order should the nurse request from the HCP? 1. Request written information on antibiotic- caused vaginal infections. 2. Request yogurt to be served on the client's meal trays. 3. Request a change of one of the antibiotics to an oral route. 4. Request L. acidophilus, a probiotic medication, three (3) times a day.

1. The nurse does not require an order to teach. Teaching is an independent nursing function. 2. The nurse can request the dietitian to include yogurt in the client's calorie restrictions with- out an order 3. If the HCP has ordered an IV antibiotic, then there is no reason to request a change to an oral route. ✅4. Female clients on antibiotics are at risk for killing the good bacteria, which keep yeast infections in check. This is especially true in clients diagnosed with diabetes. Lactobacillus acidophilus is a yeast replace- ment medication. TEST-TAKING HINT: The test taker must be aware of independent nursing functions. This eliminates options "1" and "2." Content - Medical: Integrated Nursing Process - Implementation: Client Needs - Physiological Integrity, Pharmacological and Parenteral Therapies: Cognitive Level - Application: Concept - Medication.

44. The client diagnosed with ovarian cancer is prescribed radiation therapy for regional control of the disease. Which statement indicates the client requires further teaching? 1. "I will not wash the marks off my abdomen." 2. "I will have a treatment every day for six (6) weeks." 3. "Nausea caused by radiation therapy cannot be controlled." 4. "I need to drink a nutritional shake if I don't feel like eating."

1. The radiation markings on a client are there to guide the technician to irradiate only the area within the marks. The marks must remain until the client has completed the treatments. 2. Radiation therapy is administered in fraction- ated (divided) doses to allow for regeneration of normal cells. Cancer cells do not regener- ate as rapidly as normal cells. ✅3. There are many medications prescribed for cancer or treatment-induced nausea. The client should notify the HCP if adequate relief is not obtained. 4. Cancer treatments frequently interfere with the client's appetite, but supporting the nutri- tional status of the client is important. TEST-TAKING HINT: The question is an "except" question. All options except one (1) will be statements indicating the client does understand the teaching. If the test taker missed the information making this an "except" question, finding two (2) options with correct answers might clue the test taker to reread the stem. Content - Medical: Integrated Nursing Process - Evaluation: Client Needs - Safe Effective Care Environ- ment, Management of Care: Cognitive Level - Synthesis: Concept - Cellular Regulation

35. The nurse and an unlicensed assistive personnel (UAP) are caring for clients on a gynecology surgery floor. Which intervention cannot be delegated to the UAP? 1. Empty the indwelling catheter on the three (3)-hour postoperative client. 2. Assist the client who is two (2) days post- hysterectomy to the bathroom. 3. Monitor the peri-pad count on a client diagnosed with fibroid tumors. 4. Encourage the client who is refusing to get out of bed to walk in the hall.

1. Theunlicensedassistivepersonnelcanempty the indwelling catheter and record the output. 2. This is an appropriate assignment. ✅3. Monitoring a peri-pad count is done to determine if the client is bleeding exces- sively; the nurse should do this as part of the assessment. 4. All personnel should encourage the client to ambulate. TEST-TAKING HINT: The nurse cannot del- egate assessment. "Monitor" is a word in- terpreted as "assess." This is an "except" question, so the test taker should not jump to option "1" as the correct answer because the UAP can perform this task. Content - Medical: Integrated Nursing Process - Planning: Client Needs - Safe Effective Care Environment, Management of Care: Cognitive Level - Synthesis: Concept - Nursing Roles.

36. The nurse is caring for a client diagnosed with uterine cancer who has been receiving systemic therapy for six (6) months. Which intervention should the nurse implement first? 1. Determine which antineoplastic medication the client has received. 2. Ask the client if she has had any problems with mouth ulcers at home. 3. Administer the biologic response modifier filgrastim (Neupogen). 4. Encourage the client to discuss feelings about having cancer.

1. This can be done to determine specific prob- lems resulting from the specific side effects of the medication, but it is not the first action. The nurse can ask general assessment ques- tions to determine how the client is tolerating the treatments. ✅2. The systemic side effects of chemotherapy are not always apparent, and the develop- ment of stomatitis can be extremely dis- tressing for the client. The nurse should assess the client's tolerance to treatments. 3. This is done if the white blood cell count is low. The nurse assesses the WBC count and then obtains an order from the HCP. 4. This is an appropriate action but not before assessing physical problems. The nurse does not require an order to teach. TEST-TAKING HINT: When prioritizing nursing interventions, the test taker should apply the nursing process, and assessment is the first step. Content - Medical: Integrated Nursing Process - Implementation: Client Needs - Safe Effective Care Envi- ronment, Management of Care: Cognitive Level - Synthesis: Concept - Cellular Regulation.

46. The client has had a total abdominal hysterectomy for cancer of the ovary. Which diet should the nurse discuss when providing discharge instructions? 1. A low-residue diet without seeds. 2. A low-sodium, low-fat diet with skim milk. 3. A regular diet with fruits and vegetables. 4. A full liquid-only diet with milkshake supplements.

1. This diet is appropriate for a client diagnosed with diverticulitis. 2. This diet applies to a client with coronary ar- tery disease and hypertension. ✅3. The client is not placed on a specific diet, but it is always a good recommendation to include fruits and vegetables in the diet. 4. There is no reason to limit the consistency of the foods consumed to full liquids. TEST-TAKING HINT: The test taker should rec- ognize option "3" as a recommended diet for all clients without a specific disease process limiting the types of foods consumed. Content - Medical: Integrated Nursing Process - Planning: Client Needs - Physiological Integrity, Basic Care and Comfort: Cognitive Level - Synthesis: Concept - Female Reproduction.

41. The 50-year-old female client complains of bloating and indigestion and tells the nurse she has gained two (2) inches in her waist recently. Which question should the nurse ask the client? 1. "What do you eat before you feel bloated?" 2. "Have you had your ovaries removed?" 3. "Are your stools darker in color lately?" 4. "Is the indigestion worse when you lie down?"

1. This statement would be appropriate if not for the abdominal girth change. This should alert the nurse to some internal reason for the change in girth. Ascites causes a change in abdominal girth. ✅2.Ovarian cancer has vague symptoms of abdominal discomfort, but increasing abdominal girth is the most common symptom. If the client has had the ovaries removed, then the nurse could assess for another cause. 3. This could be assessing for a peptic ulcer, but ulcers do not cause increasing abdominal girth. 4. This is a question to determine if the client has gastroesophageal reflux, but this does not cause increased waist size.

29. The postmenopausal client reveals it has been several years since her last gynecological examination and states, "Oh, I don't need exams anymore. I am beyond having children." Which statement should be the nurse's response? 1. "As long as you are not sexually active, you don't have to worry." 2. "You should be taking hormone replacement therapy now." 3. "You are beyond bearing children. How does that make you feel?" 4. "There are situations other than pregnancy that should be checked."

1.This client is at risk for cancer of the ovary and uterus because of advancing age, regard- less of sexual activity, and should see an HCP yearly. 2. Hormone replacement therapy (HRT) is not recommended for most postmenopausal clients because research has shown HRT in- creases the risk of myocardial infarctions and cerebrovascular accidents (strokes). 3. This is a therapeutic response and the client did not state a feeling. ✅4. The client should have a yearly clinical examination of the breasts and pelvic area for the detection of cancer. TEST-TAKING HINT: If the stem is not ask- ing for a therapeutic response, then factual information should be provided to the cli- ent. This eliminates option "3" as a possible answer. Content - Medical: Integrated Nursing Process - Implementation: Client Needs - Health Promotion and Maintenance: Cognitive Level - Application: Concept - Female Reproduction.

Question 4 of 5 A nurse is working with a client who has been diagnosed with ovarian cancer. The nurse gives the client information materials about her treatment options. Which best describes plain language as used in teaching materials? A. Content that is addressed to someone who is simple minded B. Short words at the 2nd grade level C. Materials that make the client feel good about herself D. Information that is easy to both read and understand

ANS: d ✅Information that is easy to both read and understand Plain language is straightforward and easy to understand. Many types of client education materials now utilize this for people who need to learn about health conditions but who do not necessarily understand medical jargon. The nurse should try to use plain language when explaining the client's treatment to best convey important information and to reduce the risk of misunderstanding. Content that is addressed to someone who is simple minded Rather, plain language is utilized to maximize comprehension. Persons with extensive education can have trouble understanding medical jargon, so there is a need for plain language in the healthcare world for many different types of people and levels of education Short words at the 2nd grade level Plain language does not exclude words above the second grade level, but in general excludes wording that is complicated and difficult for a person with low literacy to understand. Low literacy does not mean illiterate. Low literacy refers to people who have a limited ability to read, speak, and write English, but still have some ability to do so. Materials that make the client feel good about herself The goal is comprehension, not making the client feel good about herself. 02.10 Ovarian Cancer

Question 3 of 5 A client with ovarian cancer is getting ready to undergo external radiation therapy. The client has a lot of questions about the process and is very nervous. What information should the nurse give to this client about receiving external radiation therapy? Select all that apply. A. The client will need to be on bed rest for 48 hours after the treatment B. The tissues directly within the path of the beam are the only tissues affected C. The client will emit radiation after the procedure D. The client will be awake during the procedure E. Skin in the irradiated area should not be exposed to sunlight

The client will need to be on bed rest for 48 hours after the treatment Bedrest is not prescribed in this situation. The client may go about their daily activities as they feel able ANS:B ✅The tissues directly within the path of the beam are the only tissues affected External radiation therapy is a form of cancer treatment in which a beam of radiation penetrates cancer cells to destroy them. This method of radiation differs from internal radiation because the source of radiation in external beam radiation is outside of the client, while internal radiation involves implantation or instillation of radiation into body cavities. With external beam radiation, once the beam is off, the client does not pose a hazard to anyone because they do not emit radiation. Careful planning is involved in determining the radiation field, so as to maximize the exposure to cancer cells and minimize exposure to healthy tissue. However, external beam radiation therapy is not without side effects. Some side effects are acute, and some are chronic. Erythema and mucositis are a few acute side effects. Chronic effects can include fibrosis of muscle tissue and delayed wound healing. Additionally, the skin affected by radiation must be treated carefully. The client must avoid sunlight, heat, lotions and creams to the irradiated area, and must wash the skin daily and pat dry. The client will emit radiation after the procedure With external beam radiation, once the beam is off, the radiation is gone and the client will not pose a hazard to others. ANS: c ✅Skin in the irradiated area should not be exposed to sunlight The client must avoid exposing irradiated skin to sunlight, as this will profoundly irritate the skin. ANS d ✅The client will be awake during the procedure The client is not sedated for external beam radiation therapy. . 02.10 Ovarian Cancer

3. The extent of urinary obstruction caused by BPH can be determined by which diagnostic study? a. Uroflowmetry b. A cystometrogram c. Transrectal ultrasound d. Postvoiding catheterization

✅ a. Uroflowmetry is used to measure the volume of urine expelled from the bladder to determine the extent of urethral blockage. Cystourethroscopy may also evaluate the degree of obstruction, but a cystometrogram measures bladder tone. A transrectal ultrasound may determine the size and configuration of the prostate gland. Postvoiding catheterization measures residual urine. 54 Male Reproductive Problems

7. Which treatment for BPH uses a low-wave radiofrequency to precisely destroy prostate tissue? a. Laser prostatectomy b. Transurethral needle ablation (TUNA) c. Transurethral microwave thermotherapy (TUMT) d. Transurethral electrovaporization of prostate (TUVP)

✅ b. The transurethral needle ablation (TUNA) uses low-wave radiofrequency to heat the prostate, causing necrosis. Laser prostatectomy uses a laser beam. Transurethral microwave thermotherapy (TUMT) uses microwave radiating heat to produce coagulative necrosis of the prostate and is not used for men with rectal problems. Transurethral electrovaporization of prostate (TUVP) uses electrosurgical vaporization and desiccation to destroy prostate tissue. 54 Male Reproductive Problems

25. A patient has been diagnosed with ovarian cancer. In planning care for the patient, the nurse recognizes that treatment of the patient depends on what? a. Results of a direct-needle biopsy of the ovary b. Results of a laparotomy with multiple biopsies c. Whether the patient desires to maintain fertility d. The findings of metastasis by ultrasound or CT scan

✅ b. Treatment of ovarian cancer is determined by staging from the results of laparotomy with multiple biopsies of the ovaries and other tissue throughout the pelvis and lower abdomen. The patient's desire for fertility is not a consideration because of the high mortality rate associated with ovarian cancer. Although diagnosis of ovarian tumors may be made by transvaginal ultrasound or CT scan, the treatment of ovarian cancer depends on the staging of the tumor.

15. Priority Decision: When caring for a patient after a radical prostatectomy with a perineal approach, what is the priority nursing intervention the nurse should use to prevent complications? a. Use chemotherapy to prevent metastasis. b. Administer sildenafil (Viagra) as needed for erectile dysfunction (ED). c. Provide wound care after each bowel movement to prevent infection. d. Insert a smaller indwelling urinary catheter to prevent urinary retention.

✅ c. A prostatectomy performed with a perineal approach has a high risk for infection because of the proximity of the wound to the anus, so wound care is the priority. Chemotherapy is usually not the first choice of drug therapy after surgery, nor is sildenafil. The catheter size would not be changed but the catheter would be removed. Urinary incontinence is a bigger problem than retention. 54 Male Reproductive Problems

5. On admission to the ambulatory surgical center, a patient with BPH informs the nurse that he is going to have a laser treatment of his enlarged prostate. The nurse plans patient teaching with the knowledge that the patient will need to know what? a. The effects of general anesthesia b. The possibility of short-term incontinence c. Home management of an indwelling catheter d. Monitoring for postoperative urinary retention

✅ c. Because of edema, urinary retention, and delayed sloughing of tissue that occurs with a laser prostatectomy, the patient will have a postprocedure urinary catheter for up to 7 days. The procedure is done under local anesthetic, and incontinence or urinary retention is not usually a problem with laser prostatectomy. 54 Male Reproductive Problems

20. The patient is suspected of having endometriosis and/or uterine leiomyoma. What best describes what is found with these conditions? a. Endometriosis and uterine leiomyoma increase in incidence with the onset of menopause. b. Danazol and Lupron (GnRH analog) are used to treat endometriosis and leiomyomas to create a pseudopregnancy. c. Treatment of endometriosis and leiomyomas depends on the severity of symptoms and the woman's desire to maintain her fertility. d. The presence of ectopic uterine tissue that bleeds and causes pelvic and abdominal adhesions, cysts, and pain is known as uterine leiomyoma.

✅ c. The treatment of endometriosis and leiomyomas is surgical when the patient does not tolerate the symptoms. The type of surgery for endometriosis depends on the desire for pregnancy. Endometriosis and leiomyomas subside with the onset of menopause. Therefore the medications to treat them create a pseudomenopause. The ectopic uterine tissue is endometriosis, while leiomyomas are fibrous smooth muscle tumors. 53 Female Reproductive Problems

17. What differentiates chronic bacterial prostatitis from acute prostatitis? a. Postejaculatory pain b. Frequency, urgency, and dysuria c. Symptoms of a urinary tract infection (UTI) d. Most common reason for recurrent UTIs in adult men

✅ d. Chronic bacterial prostatitis commonly causes urinary tract infections (UTIs) in adult men and recurs frequently. The other options are true of both chronic and acute prostatitis, although not as severe with chronic. 54 Male Reproductive Problems

11. Following a TURP, a patient has continuous bladder irrigation. Four hours after surgery, the catheter is draining thick, bright red clots and tissue. What should the nurse do? a. Release the traction on the catheter. b. Clamp the drainage tube and notify the patient's health care provider (HCP). c. Manually irrigate the catheter until the drainage is clear. d. Increase the rate of the irrigation and take the patient's vital signs.

✅ d. Bleeding and blood clots from the bladder are expected after a TURP. Continuous irrigation is used to keep clots from obstructing the urinary tract. The rate of the irrigation may be titrated to keep the clots from forming, if ordered, but the nurse should check the vital signs because hemorrhage is the most common complication of prostatectomy. The traction on the catheter applies pressure to the operative site to control bleeding and should be relieved on schedule. The catheter will be manually irrigated only to release a blockage. Clamping the drainage tube is contraindicated because it would distend the bladder. 54 Male Reproductive Problems

26. Which cancer is associated with intrauterine exposure to diethylstilbestrol (DES) or metastasis from another gynecologic cancer? a. Vaginal b. Ovarian c. Cervical d. Endometrial

✅. a. Vaginal cancer is usually related to metastases of other cancers or intrauterine exposure to diethylstilbestrol (DES). Cervical, endometrial, and ovarian cancer have other or unknown causes 53 Female Reproductive Problems

48. The nurse is caring for a client who is one (1) day postoperative hysterectomy for cancer of the ovary. Which nursing interventions should the nurse implement? Select all that apply. 1. Assess for calf enlargement and tenderness. 2. Turn, cough, and deep breathe every six (6) hours. 3. Assess pain on a 1-to-10 pain scale. 4. Apply sequential compression devices to legs. 5. Assess bowel sounds every four (4) hours.

✅. 1. All clients who have had surgery are at risk for developing deep vein thrombosis (DVT), and an enlarged, tender calf is a sign of DVT. 2. The client should be turned and encouraged to cough and deep breathe at least every two (2) hours. ✅3. Clients who have had surgery should be assessed for pain on a pain scale and by observing for physiological markers indicating pain. ✅4. Sequential compression hose are used prophylactically to prevent deep vein thrombosis. ✅5. The client should be assessed for the return of bowel sounds. TEST-TAKING HINT: Option "2" has a time frame in it, and the test taker should ask if the time frame is correct for the intervention. Content - Surgical: Integrated Nursing Process - Implementation: Client Needs - Safe Effective Care Envi- ronment, Management of Care: Cognitive Level - Analysis: Concept - Female Reproduction.

28. The client diagnosed with cancer of the uterus is scheduled to have radiation brachytherapy. Which precautions should the nurse implement? Select all that apply. 1. Place the client in a private room. 2. Wear a dosimeter when entering the room. 3. Encourage visitors to come and stay with the client. 4. Plan to spend extended time with the client. 5. Notify the nuclear medicine technician.

✅. 1. Brachytherapy is the direct implantation of radioactive seeds through the vagina into the uterus. The client should be in a pri- vate room at the end of the hall to prevent radiation exposure to the rest of the unit. ✅2. Nurses wear a dosimeter registering the amount of radiation they have been ex- posed to. When a certain level is reached, the nurse is no longer allowed to care for clients undergoing internal radiation therapy. 3. Visitors are limited while the radiation is in place. 4. In this case, spending extra time with a client is not done. The nurse does only what must be done and leaves the room. ✅5. The nuclear medicine technician will assist with the placement of the implants and will deliver the implants in a lead- lined container. The technician will also scan any items (linens and wastes) leaving the room for radiation contamination. TEST-TAKING HINT: This is an alternate-type question, which requires the test taker to select more than one correct answer. The test taker must select all the correct answers to receive credit for the question. Content - Medical: Integrated Nursing Process - Implementation: Client Needs - Safe Effective Care Envi- ronment, Management of Care: Cognitive Level - Application: Concept - Cellular Regulation.

16. What accurately describes prostate cancer detection and/or treatment (select all that apply)? a. The symptoms of lumbosacral pain and lower urinary tract symptoms may be present. b. Orchiectomy is a treatment option for all patients with prostatic cancer except those with stage IV tumors. c. Palpation of the prostate reveals hard and asymmetric enlargement with areas of induration or nodules. d. The preferred hormonal therapy for treatment of prostate cancer includes estrogen and androgen receptor blockers. e. Early detection of prostate cancer is increased with annual rectal examinations and serum prostatic acid phosphatase (PAP) measurements. f. An annual prostate examination is recommended starting at age 45 years for black men with a first-degree relative with prostate cancer at an early age.

✅. a, c, f. Typically, prostate cancer is asymptomatic, but lumbosacral pain radiating to the hips or legs and a hard, asymmetric, enlarged prostate may be present. Annual prostate examination is recommended starting at a younger age for black men because of increased diagnosis and mortality from prostate cancer in this ethnic group. An orchiectomy may be done with prostatectomy or for metastatic stages of prostate cancer. Hormonal treatment includes androgen deprivation therapy, luteinizing hormone-releasing hormone agonists, and androgen receptor blockers. Early detection of prostate cancer is best detected with annual rectal examinations and serum PSA. High prostatic acid phosphatase (PAP) will be seen with metastasis, not a new diagnosis. 54 Male Reproductive Problems

35. What is an appropriate outcome for a patient who undergoes an anterior colporrhaphy? a. Maintain normal bowel patterns b. Adjust to temporary ileal conduit c. Urinate within 8 hours postoperatively d. Have healing of excoriated vaginal and vulvar tissue

✅. a. An anterior colporrhaphy involves repair of a cystocele and an indwelling urinary catheter is left in place for several days postoperatively while healing occurs. Bowel function should not be altered and is maintained with a low-residue diet and a stool softener if necessary, to avoid straining and pressure on the incision. 53 Female Reproductive Problem

28. During assessment of the patient with vulvar cancer, what should the nurse expect to find? a. Soreness and itching of the vulva b. Labial lesions with purulent exudate c. Severe excoriation of the labia and perineum d. Painless, firm nodules embedded in the labia

✅. a. Early signs of cancer of the vulva include pruritus, or burning, soreness of the vulva, and discharge or bleeding of the vulva, with edema of the vulva and lymphadenopathy occurring as the disease progresses. Labial lesions and excoriation more commonly occur with infections, and nodules are more often cysts or lipomas. 53 Female Reproductive Problems

4. What is the effect of finasteride (Proscar) in the treatment of BPH? a. A reduction in the size of the prostate gland b. Relaxation of the smooth muscle of the urethra c. Increased bladder tone that promotes bladder emptying d. Relaxation of the bladder detrusor muscle promoting urine flow

✅. a. Finasteride results in suppression of dihydroxytestosterone (DHT) formation, which reduces the size of the prostate gland. Drugs affecting bladder tone are not indicated. α-Adrenergic receptor blockers are used to cause smooth muscle relaxation in the prostate, which improves urine flow. 54 Male Reproductive Problems

32. When teaching a patient with problems of pelvic support to perform Kegel exercises, what should the nurse tell the patient to do? a. Contract the muscles used to stop rectal gas expulsion. b. Tighten the lower abdominal muscles over the bladder area. c. Squeeze all of the perineal muscles as if trying to close the vagina. d. Lie on the floor and do leg lifts to strengthen the abdominal muscles.

✅. a. The muscles that should be exercised are those affected by trying to stop an expulsion of gas from the rectum or stop urine midflow. Kegel exercises help strengthen muscular support of the perineum, pelvic floor, and bladder and are beneficial for problems with pelvic support and stress incontinence. 53 Female Reproductive Problem

9. Which therapies for BPH are done on an outpatient basis (select all that apply)? a. Intraprostatic urethral stents b. TUNA c. Photovaporization of the prostate (PVP) d. Transurethral incision of prostate (TUIP) e. TUMT

✅. b, c, d, e. PVP, TUNA, TUIP, and TUMT can be done on an outpatient basis or in a HCP's office. 54 Male Reproductive Problems

13. The nurse provides discharge teaching to a patient after a TURP and determines that the patient understands the instructions when he makes which statement? a. "I should use daily enemas to avoid straining until healing is complete." b. "I will avoid heavy lifting, climbing, and driving until my follow-up visit." c. "At least I don't have to worry about developing cancer of the prostate now." d. "Every day I should drink 10 to 12 glasses of liquids, such as coffee, tea, or soft drinks."

✅. b. Activities that increase intraabdominal pressure should be avoided until the HCP approves these activities at a follow-up visit. Stool softeners and high-fiber diets may be used to promote bowel elimination. Enemas should not be used because they increase intraabdominal pressure and may start bleeding. Because TURP does not remove the entire prostate gland, the patient needs annual prostatic examinations to screen for cancer of the prostate. Fluid intake should be high, but caffeine and alcohol should not be used because they have a diuretic effect and increase bladder distention. 54 Male Reproductive Problems

12. Priority Decision: A patient with continuous bladder irrigation after a prostatectomy tells the nurse that he has bladder spasms and leaking of urine around the catheter. What should the nurse do first? a. Slow the rate of the irrigation. b. Assess the patency of the catheter. c. Encourage the patient to try to urinate around the catheter. d. Administer a belladonna and opium (B&O) suppository as prescribed.

✅. b. The nurse should first check for the presence of clots obstructing the catheter or tubing and remove them by irrigation. Pain management interventions should be implemented as indicated and ordered. The flow rate of the irrigation fluid may be decreased if orders permit because fast- flowing, cold fluid may also contribute to spasms. The patient should not try to void around the catheter because this will increase the spasms 54 Male Reproductive Problems

21. Serum tumor markers that may be elevated on diagnosis of testicular cancer and used to monitor the response to therapy include a. tumor necrosis factor (TNF) and C-reactive protein (CRP). b. α-fetoprotein (AFP) and human chorionic gonadotropin (hCG). c. PSA and PAP. d. carcinoembryonic antigen (CEA), antinuclear antibody (ANA) and human epidermal growth factor receptor 2 (HER-2).

✅. b. α-Fetoprotein (AFP) and human chorionic gonadotropin (hCG) are glycoproteins that may be high in testicular cancer. If they are high before surgical treatment, the levels are noted, and if response to therapy is positive, the levels will decrease. Lactate dehydrogenase (LDH) may be increased. Tumor necrosis factor (TNF) is a normal cytokine responsible for tumor surveillance and destruction. C-reactive protein (CRP) is found in inflammatory conditions and widespread malignancies. PSA and PAP are used for screening of prostatic cancer. Carcinoembryonic antigen (CEA) is a tumor marker for cancers of the gastrointestinal (GI) system. Antinuclear antibody (ANA) is found most frequently in autoimmune disorders. HER-2 is used as a marker in breast cancer. 54 Male Reproductive Problems

22. A patient with a stage 0 cervical cancer identified from a Papanicolaou (Pap) test asks the nurse what this finding means. The nurse's response should include which information? a. Atypical cells characteristic of inflammation are present. b. Cancer cells have extended beyond the cervix to the upper vagina. c. Cancer cells are present and are confined to the epithelial layer of the cervix. d. This is a common finding on Pap testing, and she will be examined often to see if the abnormal cells spread beyond the cervix.

✅. c. A stage 0 cervical cancer indicates cancer in situ that is confined to the epithelial layer of the cervix and requires treatment. Stage 0 is the least invasive. Stage I is confined to the cervix. Stage II has spread beyond the cervix to the upper two-thirds of the vagina but not the tissues around the uterus. Stage III involves the pelvic wall, lower third of the vagina, and/or kidney problems. Stage IV indicates spread to distant organs. 53 Female Reproductive Problems

33. The patient is describing a feeling of something coming down her vagina and having a backache. What is most likely the cause of this discomfort? a. Cystocele b. Dysmenorrhea c. Uterine prolapse d. Abdominal distention

✅. c. A uterine prolapse occurs when the uterus is displaced through the vagina, causing the feeling of something coming down her vagina, a backache, dyspareunia, or a heavy feeling in the pelvis. 53 Female Reproductive Problem

14. A 55-year-old man with a history of prostate cancer in his family asks the nurse what he can do to decrease his risk of prostate cancer. What should the nurse teach him about prostate cancer risks? a. Nothing can decrease the risk because prostate cancer is primarily a disease of aging. b. Treatment of any enlargement of the prostate gland will help prevent prostate cancer. c. Substituting fresh fruits and vegetables for high-fat foods in the diet may lower the risk of prostate cancer. d. Using a natural herb, such as saw palmetto, has been found to be an effective protection against prostate cancer.

✅. c. Most prostate cancers (about 75%) are considered sporadic. About the only modifiable risk factor for prostate cancer is its association with a diet high in red and processed meat and high-fat dairy products along with a low intake of vegetables and fruits. Age, ethnicity, and family history are risk factors for prostate cancer but are not modifiable. Environment may also play a role. Simple enlargement or hyperplasia of the prostate is not a risk factor for prostate cancer. There is no evidence that saw palmetto is more effective than a placebo. 54 Male Reproductive Problems

10. Before undergoing a TURP, what should the patient be taught? a. This surgery requires an external incision. b. The procedure is done under local anesthesia. c. Recurrent urinary tract infections are likely to occur. d. An indwelling catheter will be used to maintain urinary output until healing is complete.

✅. d. An indwelling urinary catheter is placed to provide hemostasis and facilitate urinary drainage. This procedure does not have an external incision and is done using a resectoscope inserted into the urethra. Urinary infections are not increased and this procedure is not done under local anesthesia. 54 Male Reproductive Problems

1. A patient asks the nurse what the difference is between benign prostatic hyperplasia (BPH) and prostate cancer. The best response by the nurse includes what information about BPH? a. BPH is a benign tumor that does not spread beyond the prostate gland. b. BPH is a precursor to prostate cancer but does not yet show any malignant changes. c. BPH is an enlargement of the gland caused by an increase in the size of existing cells. d. BPH is a benign enlargement of the gland caused by an increase in the number of normal cells.

✅. d. Hyperplasia is an increase in the number of cells and in benign prostatic hyperplasia (BPH). It is thought that the enlargement caused by the increase in new cells results from hormonal changes associated with aging. The hyperplasia is not considered a tumor, nor has BPH been proven to predispose to cancer of the prostate. Hypertrophy refers to an increase in the size of existing cells. 54 Male Reproductive Problems

34. Priority Decision: The patient with a large rectocele is undergoing surgery. What nursing interventions will be the priority postoperatively? a. An ice pack to relieve swelling b. An enema each day to relieve constipation c. Administration of a stool softener each night d. Perineal care after each urination or defecation

✅. d. The primary goal of care is to prevent wound infection and pressure on the vaginal incision, which requires perineal cleansing at least twice daily and after each urination and defecation. While an ice pack and stool softener will be used, they are not the priority. The enema would have been done preoperatively. 53 Female Reproductive Problem

6. What is the most common screening intervention for detecting BPH in men over age 50 years? a. Prostate-specific antigen (PSA) level b. Urinalysis c. Cystoscopy d. Digital rectal examination

✅. d. The prostate gland can be easily palpated by rectal examination, and enlargement of the gland is detected early if yearly examinations are performed. If symptoms of prostatic hyperplasia are present, further diagnostic testing, including prostate-specific antigen (PSA), a urinalysis, and cystoscopy may be indicated. 54 Male Reproductive Problems

8. Which characteristics describe transurethral resection of the prostate (TURP) (select all that apply)? a. Best used for a very large prostate gland b. Inappropriate for men with rectal problems c. Involves an external incision prostatectomy d. Uses transurethral incision into the prostate e. Most common surgical procedure to treat BPH f. Resectoscopic excision and cauterization of prostate tissue

✅. e, f. The transurethral resection of the prostate (TURP) is the most common surgical procedure to treat BPH and uses a resectoscopic excision and cauterization of prostate tissue. Photovaporization of the prostate (PVP) or a simple open prostatectomy may be used for a very large prostate and has an external incision. TUMT is not approved for men with rectal problems. Transurethral incision into the prostate to expand the urethra for a small to moderate-sized prostate is done with a transurethral incision of the prostate (TUIP). 54 Male Reproductive Problems

47. The nurse is preparing an educational presentation for women in the community. Which primary nursing intervention should the nurse discuss regarding the development of ovarian cancer? 1. Instruct the clients not to use talcum powder on the perineum. 2. Encourage the clients to consume diets with a high-fat content. 3. Teach the women to have a lower pelvic sonogram yearly. 4. Discuss the need to be aware of the family history of cancer.

✅1. Research has shown the use of talcum powder perineally increases the risk for developing ovarian cancer, although there is no explanation known for this occur- rence. Other risk factors include a high- fat diet, nulliparity, infertility, older age (70 to 80 years) has the greatest incidence, mumps before menarche, and family his- tory of ovarian cancer. 2. Nursesshouldneverencourageahigh-fatdiet. 3. Only clients in a high-risk category should have routine sonograms. The time frame for the high-risk group of clients is six (6) months. This is not primary intervention; early detection is secondary intervention. 4. This alerts the client to participate in ac- tivities detecting cancer early, a secondary intervention TEST-TAKING HINT: The test taker could eliminate options "3" and "4" because of the word "primary" in the stem. Option "2" could be eliminated because of the recom- mendation of a high-fat diet. Content - Medical: Integrated Nursing Process - Planning: Client Needs - Health Promotion and Mainte- nance: Cognitive Level - Synthesis: Concept - Promoting Health.

26. The client in the gynecology clinic asks the nurse, "What are the risk factors for developing cancer of the cervix?" Which statement is the nurse's best response? 1. "The earlier the age of sexual activity and the more partners, the greater the risk." 2. "Eating fast foods high in fat and taking birth control pills are risk factors." 3. "A Chlamydia trachomatis infection can cause cancer of the cervix." 4. "Having yearly Pap smears will protect you from developing cancer."

✅1. Risk factors for cancer of the cervix include sexual activity before the age of 20 years; multiple sexual partners; early childbearing; exposure to the human papillomavirus; HIV infection; smoking; and nutritional deficits of folates, beta carotene, and vitamin C. 2. High-fat diets place clients at risk for some cancers but not for cervical cancer. The use of birth control pills may allow increased sexual freedom because of the protection from preg- nancy, but it does not 3. increase the risk for cancer of the cervix. Infections with the human papillomavirus are a risk factor for cancer of the cervix. 4. Having ayearly Papsmear increases the chance of detecting cellular changes early, but it does not decrease the risk for developing cancer. TEST-TAKING HINT: The test taker could dis- card option "4" as a possible answer because it is a yearly test for the early detection of cervical cancer, not a risk factor. Content - Medical: Integrated Nursing Process - Implementation: Client Needs - Health Promotion and Maintenance: Cognitive Level - Application: Concept - Female Reproduction.

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. DIF: Remembering/Knowledge REF: 1468 KEY: Cancer| pathophysiology| reproductive problems MSC: Integrated Process: Communication NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

38. The nurse is caring for a client newly diagnosed with Stage IV ovarian cancer. What is the scientific rationale for detecting the tumors at this stage? 1. The client's ovaries lie deep within the pelvis and early symptoms are vague. 2. The client has regular gynecological examinations and this helps with detection. 3. The client had a history of dysmenorrhea and benign ovarian cysts. 4. The client had a family history of breast cancer and was being checked regularly.

✅1.The ovaries are anatomically positioned deep within the pelvis, and because of this, signs and symptoms of cancer are vague and nonspecific. Symptoms include increased abdominal girth, pelvic pres- sure, indigestion, bloating, flatulence, and pelvic and leg pain. Increasing abdomen size as a result of accumulation of fluid is the most common sign. Many women ignore the symptoms because they are so nonspecific. 2.Regular gynecological examinations are rec- ommended, but this is advanced disease. 3 Dysmenorrhea is not a risk factor for devel- oping ovarian cancer. Any enlarged ovary should be evaluated, especially if the client is postmenopausal, when the ovaries shrink in size. 4. A family history of breast cancer is a cause for the client to be assessed regularly for breast and ovarian cancer, but this is late disease.

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. DIF: Analyzing/Analysis REF: 1473 KEY: Cancer| nursing assessment MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

12. 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. DIF: Applying/Application REF: 1470 KEY: Cancer| caring| patient education MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

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. DIF: Applying/Application REF: 1467 KEY: Postoperative nursing| reproductive problems| nursing assessment MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

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. DIF: Applying/Application REF: 1467 KEY: Postoperative nursing| reproductive problems| discharge planning/teaching MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Health Promotion and Maintenance

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. DIF: Remembering/Knowledge REF: 1469 KEY: Cancer| nursing assessment MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

1. A 28-year-old client is diagnosed with endometriosis and is experiencing severe symptoms. Which actions by the nurse are the most appropriate at this time? (Select all that apply.) a. Reduce the pain by low-level heat. b. Discuss the high risk of infertility with this diagnosis. c. Relieve anxiety by relaxation techniques and education. d. Discuss in detail the side effects of laparoscopic surgery. e. Suggest resources such as the Endometriosis Association.

✅ANS: A, C, E With endometriosis, pain is the predominant symptom, with anxiety occurring because of the diagnosis. Interventions should be directed to pain and anxiety relief, such as low-level heat, relaxation techniques, and education about the pathophysiology and possible treatment of endometriosis. The nurse could suggest resources to give more information about the diagnosis. Discussion of the possibility of infertility and side effects of laparoscopic surgery is premature and may increase the anxiety. DIF: Applying/Application REF: 1460 KEY: Pain| caring| nursing intervention MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort

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. DIF: Applying/Application REF: 1470 KEY: Cancer| reproductive problems| radiation MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

4. A 55-year-old post-menopausal woman is assessed by the nurse with a history of dyspareunia, backache, pelvis pressure, urinary tract infections, and a frequent urinary urgency. Which condition does the nurse suspect? a. Ovarian cyst b. Rectocele c. Cystocele d. Fibroid

✅ANS: C Dyspareunia, backache, pelvis pressure, urinary tract infections, and urinary urgency are all symptoms of a cystocelea protrusion of the bladder through the vaginal wall. Ovarian cysts are rare after menopause. A rectocele is associated with constipation, hemorrhoids, and fecal impaction. Fibroids are associated with heavy bleeding. DIF: Remembering/Knowledge REF: 1463 KEY: Pain| reproductive system MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

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. DIF: Remembering/Knowledge REF: 1470 KEY: Cancer| reproductive problems| patient education MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

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 clients 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. DIF: Applying/Application REF: 1469 KEY: Cancer| caring| coping MSC: Integrated Process: Caring NOT: Client Needs Category: Psychosocial Integrity

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. DIF: Applying/Application REF: 1464 KEY: Delegation| Unlicensed assistive personnel (UAP)| comfort measures| postoperative nursing MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

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. DIF: Applying/Application REF: 1466 Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 600 KEY: Sexuality| postoperative nursing| hormone therapy MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

Question 1 of 5 A 56-year-old client with ovarian cancer is undergoing external radiation therapy for treatment. Which of the following is appropriate for the nurse to teach the client about irradiated skin? Select all that apply. A. Allow the skin to be exposed to the sun for a few minutes each day B. Avoid heat exposure C. Remove the markings for the radiation beam after each session with a gentle soap and water D. Wash the irradiated area each day with warm water E. Avoid applying skin care products to the irradiated area

✅Avoid applying skin care products to the irradiated area The client should be counseled to avoid applying skin care products to the area unless prescribed by their provider. ✅Avoid heat exposure External radiation therapy can damage the skin and cause symptoms similar to a sunburn. The client may have pain, swelling, and blisters over the affected skin site, so any skin care should focus on keeping the area clean and dry, and being gentle with the skin. ✅Wash the irradiated area each day with warm water It is recommended to wash the irradiated area each day. This must be done gently with warm water and a mild soap, or no soap at all. Allow the skin to be exposed to the sun for a few minutes each day Irradiated skin should not be exposed to sun. Remove the markings for the radiation beam after each session with a gentle soap and water The client must take care NOT to remove the markings, as they show the provider exactly where to focus the beam at each session. 02.10 Ovarian Cancer

Question 2 of 5 Following diagnostic imaging, an adolescent patient is scheduled for a biopsy with possible oophorectomy. Which of the following topics should the nurse discuss with the patient prior to the procedure? A. Chemotherapy B. Colostomy care C. Genetic counseling D. Oocyte preservation

✅D. Oocyte preservation Removing an ovary can lead to fertility problems. Options for preserving fertility should be discussed with the patient. Chemotherapy Although chemotherapy is required for all patients except low-risk stage I, this patient is still in the staging process, so it is difficult to predict if they will require chemotherapy. This should be discussed following staging. Genetic counseling Genetic counseling should be considered, but there is no reason it needs to be done prior to biopsy. Colostomy care A radical hysterectomy, pelvic exoneration, or HIPEC may lead to the patient requiring a colostomy; however, the extent of the disease is not yet determined. 02.10 Ovarian Cancer

27. Which factors are associated with endometrial cancer (select all that apply)? a. Obesity b. Smoking c. Family history d. Early sexual activity e. Early menarche and late menopause f. Unopposed estrogen-only replacement therapy

✅a, b, e, f. Endometrial cancer is at higher risk in obese patients because adipose cells store estrogen, which is the major risk factor, especially unopposed estrogen. Smoking is a risk factor for endometrial and cervical cancers. Early menarche and late menopause are risk factors for endometrial cancer. Early sexual activity is a risk factor for cervical cancer. Family history is a risk factor for ovarian cancer. 53 Female Reproductive Problems

24. A woman who has been postmenopausal for 10 years calls the clinic because of vaginal bleeding. The nurse schedules a visit for the patient and informs her to expect to have which diagnostic procedure? a. An endometrial biopsy b. Abdominal radiography c. A laser treatment to the cervix d. Only a routine pelvic examination and Pap test

✅a. Postmenopausal vaginal bleeding is an early sign of endometrial cancer. When it occurs, a sample of endometrial tissue must be taken to exclude cancer. An endometrial biopsy can be done as an office procedure and is indicated in this case. Abdominal x-rays and Pap tests are not reliable tests for endometrial cancer. Laser treatment of the cervix is indicated only for cervical dysplasia. 53 Female Reproductive Problems

29. A 44-year-old woman undergoing a total abdominal hysterectomy asks whether she will need to take estrogen until she reaches the age of menopause. What is the best response by the nurse? a. "Yes, it will help prevent the more intense symptoms caused by surgically induced menopause." b. "You are close enough to normal menopause that you probably won't need additional estrogen." c. "Because your ovaries won't be removed, they will continue to secrete estrogen until your normal menopause." d. "There are so many risks associated with estrogen replacement therapy that it is best to begin menopause now."

✅c. A total hysterectomy involves the removal of the uterus and cervix, with the fallopian tubes and ovaries left intact. Although menstruation is terminated, normal ovarian production of estrogen continues. When the uterus, tubes, and ovaries are removed, it is called a total hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO). 53 Female Reproductive Problems

23. Fertility and normal reproductive function can be maintained when a cancer of the cervix is successfully treated with which therapy? a. External radiation therapy b. Internal radiation implants c. Conization or laser surgery d. Cryotherapy or subtotal hysterectomy

✅c. Conization (an excision of a cone-shaped section of the cervix) and laser treatment both are effective to locally remove or destroy malignant cells of the cervix and preserve fertility. Radiation treatments often impair ovarian and uterine function and lead to sterility. A subtotal hysterectomy would be contraindicated in the treatment of cervical cancer because the cervix would be left intact in this procedure. 53 Female Reproductive Problems

21. An 18-year-old patient with irregular menstrual periods, hirsutism, and obesity has been diagnosed with polycystic ovary syndrome (PCOS). What is an accurate rationale for the expected treatment? a. Hirsutism may be treated with leuprolide to decrease an altered body image. b. The medication used will cure the hormonal abnormality of excess testosterone. c. Untreated PCOS leads to cardiovascular disease and abnormal insulin resistance. d. Since weight loss will improve all the symptoms, this will be the first treatment tried.

✅c. Left untreated, polycystic ovary syndrome (PCOS) may lead to cardiovascular disease and abnormal insulin resistance with type 2 diabetes. Hirsutism may be treated with spironolactone. Leuprolide is used to treat hyperandrogenism, but PCOS cannot be cured. Severity of symptoms is associated with obesity, but the hormone abnormalities will be treated along with the obesity to prevent complications. If other treatment is not successful, a hysterectomy with bilateral salpingectomy and oophorectomy may be done. 53 Female Reproductive Problems