51.TB

31. The nurse is caring for a 63-year-old client with ovarian cancer. The client is to receive chemotherapy consisting of paclitaxel and carboplatin. For what adverse effect of this treatment should the nurse monitor the client? A. Leukopenia B. Metabolic acidosis C. Hyperphosphatemia D. Respiratory alkalosis

ANS: A Rationale: Chemotherapy is usually administered IV on an outpatient basis using a combination of platinum and taxane agents. Paclitaxel (Taxol) plus carboplatin (Paraplatin) are most often used because of their excellent clinical benefits and manageable toxicity. Leukopenia, neurotoxicity, and fever may occur. Acid-base imbalances and elevated phosphate levels are not anticipated. PTS: 1 REF: p. 1701 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

6. A client comes to the free clinic reporting a gray-white discharge that clings to the external vulva and vaginal walls. A nurse practitioner assesses the client and diagnoses Gardnerella vaginalis. What would be the most appropriate nursing action at this time? A. Advise the client that this is an overgrowth of normal vaginal flora. B. Discuss the effect of this diagnosis on the client's fertility. C. Document the vaginal discharge as normal. D. Administer acyclovir as ordered.

ANS: A Rationale: Gray-white discharge that clings to the external vulva and vaginal walls is indicative of an overgrowth of Gardnerella vaginalis. The client's discharge is not a normal assessment finding. Antiviral medications are ineffective because of the bacterial etiology. This diagnosis is unlikely to have a long-term bearing on the client's fertility. PTS: 1 REF: p. 1678 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

9. A nurse is caring for a pregnant client with active herpes. The teaching plan for this client should include which of the following? A. Babies delivered vaginally may become infected with the virus. B. Recommended treatment is excision of the herpes lesions. C. Pain generally does not occur with a herpes outbreak during pregnancy. D. Pregnancy may exacerbate the pregnant client's symptoms, but poses no risk to the infant.

ANS: A Rationale: In pregnant women with active herpes, babies delivered vaginally may become infected with the virus. There is a risk for fetal morbidity and mortality if this occurs. Lesions are not controlled with excision. Itching and pain accompany the process as the infected area becomes red and swollen. Aspirin and other analgesics are usually effective in controlling the pain. PTS: 1 REF: p. 1682 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

7. A female client has just been diagnosed with condylomata acuminata (genital warts). What information is most appropriate for the nurse to tell this client? A. The warts may require surgical removal or cryotherapy B. The most common treatment is metronidazole, which should eradicate the problem within 7 to 10 days. C. The potential for transmission to the sexual partner will be eliminated if condoms are used every time they have sexual intercourse. D. The human papillomavirus (HPV), which causes condylomata acuminata, cannot be transmitted during oral sex.

ANS: A Rationale: Options for treatment of external genital warts by a primary provider include topical application of trichloroacetic acid, podophyllin (Podofin, Podocon), cryotherapy, and surgical removal. Because condylomata acuminata is a virus, there is no permanent cure. Because condylomata acuminata can occur on the vulva, a condom will not protect sexual partners. HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx. PTS: 1 REF: p. 1681 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

13. A female client tells the nurse that they think they have a vaginal infection because the client has noted inflammation of the vulva and the presence of a frothy, yellow-green discharge. The nurse recognizes that the clinical manifestations described are typical of what vaginal infection? A. Trichomonas vaginalis B. Candidiasis C. Gardnerella D. Gonorrhea

ANS: A Rationale: The clinical manifestations indicate T. vaginalis, which is treated with metronidazole in the form of oral tablets. Candidiasis produces a white, cheese-like discharge. Gardnerella is characterized by gray-white to yellow-white discharge clinging to external vulva and vaginal walls. Gonorrhea often produces no symptoms. PTS: 1 REF: p. 1678 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

2. A client with trichomoniasis comes to the walk-in clinic. In developing a care plan for this client the nurse would know to include what as an important aspect of treating this client? A. Both partners will be treated with metronidazole. B. Constipation and menstrual difficulties may occur. C. The client should perform Kegel exercises 30 to 80 times daily. D. Care will involve hormone therapy to control the pain.

ANS: A Rationale: The most effective treatment for trichomoniasis is metronidazole. Both partners receive a one-time loading dose or a smaller dose three times a day for 1 week. In pelvic inflammatory disease, menstrual difficulties and constipation may occur. Kegel exercises are prescribed to help strengthen weakened muscles associated with cystocele and other structural deficits. Hormone therapy does not address the etiology of trichomoniasis. PTS: 1 REF: p. 1679 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

39. The nurse is caring for a client who has been diagnosed with genital herpes. When preparing a teaching plan for this client, what general guidelines should be taught? A. Thorough handwashing is essential. B. Exposure to ultraviolet light assists in eradicating the virus. C. Lesions should be gently massaged with ointment. D. Self-infection cannot occur from touching lesions during a breakout.

ANS: A Rationale: The risk of reinfection and spread of infection to others or to other structures of the body can be reduced by handwashing, use of barrier methods with sexual contact, and adherence to prescribed medication regimens. The lesions should be allowed to dry. Touching of lesions during an outbreak should be avoided; if touched, appropriate hygiene practices must be followed. Light does not eradicate th

21. Following a recent history of dyspareunia and lower abdominal pain, a client has received a diagnosis of pelvic inflammatory disease (PID). When providing health education related to self-care, the nurse should address what topics? Select all that apply. A. Use of condoms to prevent infecting others B. Appropriate use of antibiotics C. Taking measures to prevent pregnancy D. The need for a Pap smear every 3 months E. The importance of weight loss in preventing symptoms

ANS: A, B Rationale: Clients with PID need to take action to avoid infecting others. Antibiotics are frequently required. Pregnancy does not necessarily need to be avoided, but there is a heightened risk of ectopic pregnancy. Weight loss does not directly alleviate symptoms. Regular follow-up is necessary, but Pap smears do not need to be performed every 3 months. PTS: 1 REF: p. 1686 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Select

37. A female client is being admitted postoperatively to the surgical floor after a radical vulvectomy. What minimum equipment and interventions should the nurse anticipate and prepare for? Select all that apply. A. An intravenous infusion pump for antibiotics B. A Bair hugger warming blanket to prevent hypothermia C. A private or single room for neutropenic isolation D. Portable suction for postoperative nausea and vomiting E. Sequential compression devices to reduce the risk of venous thromboembolism

ANS: A, E Rationale: Antibiotics and heparin prophylaxis may be prescribed postoperatively to prevent deep vein thrombosis (DVT) and pulmonary embolism (PE). Intravenous infusion pumps are recommended since antibiotics need to be accurately administered on a specific timeline. Sequential compression devices (SCDs) are applied to reduce the risk of venous thromboembolism (VTE). A Bair hugger warming blanket to prevent hypothermia is not typically needed (nor initially anticipated) when a client is admitted to a surgical floor since they are stabilized in the recovery room. A private or single room for neutropenic isolation is not indicated for this client at this time. It may be needed in the future if the client receives chemotherapy and/or radiation that decreases their white blood count (WBC). Wall suction is typically standard in client rooms; portable suction is usually used if the client is going off the floor for testing or procedures. Nausea and vomiting are usually handled with antiemetics. PTS: 1 REF: p. 1698 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select

22. A middle-aged female client has been offered testing for HIV/AIDS upon admission to the hospital for an unrelated health problem. The nurse observes that the client is visibly surprised and embarrassed by this offer. How should the nurse best respond? A. "Most women with HIV don't know they have the disease. If you have it, it's important we catch it early." B. "This testing is offered to every adolescent and adult regardless of their lifestyle, appearance or history." C. "The rationale for this testing is so that you can begin treatment as soon as testing comes back, if it's positive." D. "You're being offered this testing because you are actually in the prime demographic for HIV infection."

ANS: B Rationale: Because clients may be reluctant to discuss risk-taking behavior, routine screening should be offered to all women between the ages of 13 and 64 years in all health care settings. Assuring a client that the offer of testing is not related to a heightened risk may alleviate the anxiety. Middle-aged women are not the prime demographic for HIV infection. The nurse should avoid causing fear by immediately discussing treatment or the fact that many clients are unaware of their diagnosis. PTS: 1 REF: p. 1687 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Caring BLM: Cognitive Level: Apply NOT: Multiple Choice

32. The nurse is caring for a client with a diagnosis of vulvar cancer who has returned from the PACU after undergoing a wide excision of the vulva. How should this client's analgesic regimen be best managed? A. Analgesia should be withheld unless the client's pain becomes unbearable. B. Scheduled analgesia should be administered around-the-clock to prevent pain. C. All analgesics should be given on a PRN, rather than scheduled, basis. D. Opioid analgesics should be avoided and NSAIDs exclusively provided.

ANS: B Rationale: Because of the wide excision, the client may experience severe pain and discomfort even with minimal movement. Therefore, analgesic agents are administered preventively (i.e., around the clock at designated times) to relieve pain, increase the client's comfort level, and allow mobility. Opioids are usually required. PTS: 1 REF: p. 1699 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

3. When teaching clients about the risk factors of cervical cancer, what would the nurse identify as the most important risk factor? A. Late childbearing B. Human papillomavirus (HPV) C. Postmenopausal bleeding D. Tobacco use

ANS: B Rationale: HPV is the most salient risk factor for cervical cancer, exceeding the risks posed by smoking, late childbearing, and postmenopausal bleeding. PTS: 1 REF: p. 1681 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand NOT: Multiple Choice

28. A client is postoperative day 1 following a vaginal hysterectomy. The nurse notes an increase in the client's abdominal girth and the client reports "bloating." What is the nurse's most appropriate action? A. Provide the client with an unsweetened, carbonated beverage. B. Apply warm compresses to the client's lower abdomen. C. Provide an ice pack to apply to the perineum and suprapubic region. D. Assist the client into a prone position.

ANS: B Rationale: If the client has abdominal distention or flatus, a rectal tube and application of heat to the abdomen may be prescribed. Ice and carbonated beverages are not recommended, and prone positioning would be uncomfortable. PTS: 1 REF: p. 1703 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

27. A recent colposcopy revealed precursor lesions for a female client. A procedure was recommended to evaluate and remove any abnormal cells in the cervix. The client is most likely scheduled for what outpatient procedure? A. Cryotherapy B. Loop electrocautery excision procedure C. Cone biopsy D. Pelvic exenteration

ANS: B Rationale: Loop electrocautery excision procedure (LEEP) is an outpatient procedure where a thin, wire loop laser is used to cut away a thin layer of cervical tissue and remove any abnormal cells. It allows the pathologist to examine the removed tissue samples and determine if the borders of the tissue are disease-free. Cryotherapy is a conservative treatment that consists of freezing cervical tissues with liquid nitrogen. A cone biopsy or conization is a procedure where a cone-shaped portion of the cervix is removed. This procedure is done when biopsy findings demonstrate severe dysplasia and preinvasive cervical cancer. Pelvic exenteration is utilized for clients with recurrences of cervical cancer in several pelvic organs. Pelvic exenteration is an inpatient, complex and extensive surgical procedure that is reserved for women with a high likelihood of cure. PTS: 1 REF: p. 1696 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

11. A 36-year-old female client is being evaluated for fibroids with accompanying symptoms of menorrhagia, chronic constipation, abdominal pain and pressure. The client is a very busy lawyer who wants children and requests that any treatments be accomplished on an outpatient basis. What is the best treatment option for this client? A. Magnetic resonance-guided focused ultrasound surgery. B. Hysteroscopic resection of myomas C. Abdominal myomectomy D. Uterine artery embolization

ANS: B Rationale: Overall goals of treating a client that has fibroids and wants children should be conservative. Hysteroscopic resection of myomas is when a laser is used through a hyteroscope passed through the cervix with no incision or overnight stay needed. All of the choices are alternatives to a hysterectomy when the client has excessive bleeding (menorrhagia) due to fibroids. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is when ultrasonic energy is passed through the abdominal wall to target and destroy fibroids. Although a non-invasive outpatient procedure, it is only approved for premenopausal women who do not want children. Abdominal myometry is the surgical removal of uterine fibroids and not an outpatient procedure. Uterine artery embolization (UAE) involves injecting polyvinyl alcohol particles into blood vessels that supply the fibroid. Infrequent but serious complications are associated with this procedure. Caution is especially warranted if the client desires to have children. PTS: 1 REF: p. 1693 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice

19. A client has been diagnosed with endometriosis. When planning this client's care, the nurse should prioritize what nursing diagnosis? A. Anxiety related to risk of transmission B. Acute pain related to misplaced endometrial tissue C. Ineffective tissue perfusion related to hemorrhage D. Excess fluid volume related to abdominal distention

ANS: B Rationale: Symptoms of endometriosis vary but include dysmenorrhea, dyspareunia, and pelvic discomfort or pain. Dyschezia (pain with bowel movements) and radiation of pain to the back or leg may occur. Ineffective tissue perfusion is not associated with endometriosis and there is no plausible risk of fluid overload. Endometriosis is not transmittable. PTS: 1 REF: p. 1694 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

29. A 31-year-old client has returned to the postsurgical unit following a hysterectomy. The client's care plan addresses the risk of hemorrhage. How should the nurse best monitor the client's postoperative blood loss? A. Have the client void and have bowel movements using a commode rather than toilet. B. Count and inspect each perineal pad that the client uses. C. Swab the client's perineum for the presence of blood at least once per shift. D. Leave the client's perineum open to air to facilitate inspection.

ANS: B Rationale: To detect bleeding, the nurse counts the perineal pads used or checks the incision site, assesses the extent of saturation with blood, and monitors vital signs. The perineum is not swabbed and there is no reason to prohibit the use of the toilet. Absorbent pads are applied to the perineum; it is not open to air. PTS: 1 REF: p. 1703 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

16. A client comes to the clinic reporting a tender, inflamed vulva. Testing does not reveal the presence of any known causative microorganism. What aspect of this client's current health status may account for the client's symptoms of vulvitis? A. The client is morbidly obese. B. The client has type 1 diabetes. C. The client has chronic kidney disease. D. The client's mother had similar problems in mid-adulthood.

ANS: B Rationale: Vulvitis, an inflammation of the vulva, may occur as a result of other disorders, such as diabetes, dermatologic problems, or poor hygiene. Obesity, kidney disease, and family history are less likely causes than diabetes. PTS: 1 REF: p. 1691 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

17. A teenage girl is brought to the clinic by a parent. The parent explains to the nurse that the daughter has just started using tampons, but is not yet sexually active. The parent states, "I am very concerned because my daughter is having a lot of stabbing pain and burning." Assessment reveals no signs of infection, so the nurse should suspect what health problem? A. Vulvitis B. Vulvodynia C. Vaginitis D. Bartholin cyst

ANS: B Rationale: Vulvodynia is a chronic vulvar pain syndrome. Symptoms may include burning, stinging, irritation, or stabbing pain and may follow the initial use of tampons or first sexual experience. Vulvitis is an inflammation of the vulva that is normally infectious. Bartholin cyst results from the obstruction of a duct in one of the paired vestibular glands located in the posterior third of the vulva, near the vestibule. PTS: 1 REF: p. 1691 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

14. A female client with diabetes and heart failure is taking an antibiotic, loop diuretic, corticosteroid, and an antipyretic medication. What medicines and conditions would likely increase the client's risk of developing the infection Candida albicans? Select all that apply. A. Heart failure B. Antibiotics C. Corticosteroid D. Antipyretics E. Diabetes F. Diuretics

ANS: B, C, E Rationale: Many women with a healthy vaginal ecosystem harbor Candida but are asymptomatic. Certain conditions favor the change from an asymptomatic state to colonization with symptoms. The use of antibiotic agents decreases bacteria, thereby altering the natural protective organisms usually present in the vagina. Although infections can occur at any time, they occur more commonly in pregnancy or with a systemic condition such as diabetes or human immune deficiency virus (HIV) infection, or when clients are taking medications such as corticosteroids or oral contraceptive agents. Heart failure, antipyretics, and diuretics are not typically and directly linked to this infection. PTS: 1 REF: p. 1678 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Select

10. A client with ovarian cancer is admitted to the hospital for surgery and the nurse is completing the client's health history. What clinical manifestation would the nurse expect to assess? Select all that apply. A. Fish-like vaginal odor B. Increased abdominal girth C. Fever and chills D. Lower abdominal pelvic pain E. Pleuritic chest pain

ANS: B, D Rationale: Clinical manifestations of ovarian cancer include enlargement of the abdomen from an accumulation of fluid and pelvic pain. Flatulence and feeling full after a light meal are significant symptoms. In bacterial vaginosis, a fish-like odor, which is noticeable after sexual intercourse or during menstruation, occurs as a result of a rise in the vaginal pH. Fever, chills, and pleuritic chest pain are atypical. PTS: 1 REF: p. 1701 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Select

1. While taking a health history on a 20-year-old female client, the nurse learns that the client is taking miconazole. The nurse is justified in presuming that this client has what medical condition? A. Bacterial vaginosis B. Human papillomavirus (HPV) C. Candidiasis D. Toxic shock syndrome (TSS)

ANS: C Rationale: Candidiasis is a fungal or yeast infection caused by strains of Candida. Miconazole (Monistat) is an antifungal medication used in the treatment of candidiasis. This agent is inserted into the vagina with an applicator at bedtime and may be applied to the vulvar area for pruritus. HPV, bacterial vaginosis, and TSS are not treated by Monistat. PTS: 1 REF: p. 1678 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

30. A client diagnosed with cervical cancer will soon begin a round of radiation therapy. When planning the client's subsequent care, the nurse should prioritize actions with what goal? A. Preventing hemorrhage B. Ensuring the client knows the treatment is palliative, not curative C. Protecting the safety of the client, family, and staff D. Ensuring that the client adheres to dietary restrictions during treatment

ANS: C Rationale: Care must be taken to protect the safety of clients, family members, and staff during radiation therapy. Hemorrhage is not a common complication of radiation therapy and the treatment can be curative. Dietary restrictions are not normally necessary during treatment. PTS: 1 REF: p. 1705 NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

23. A female client is being evaluated due to increased menstrual bleeding and dysmenorrhea. A history and physical suggest the diagnosis of endometriosis rather than uterine fibroids. What finding would support the diagnosis of endometriosis? A. Genetic predisposition B. Menstrual cycle longer than 35 days C. Familial predisposition D. Having multiple children at a younger age.

ANS: C Rationale: Clients with endometriosis often have a familiar predisposition to the condition. It is more common in women whose close female relatives are affected. Endometriosis carries a high incidence among clients who bear children late and among those who have fewer children. Factors that may increase the likelihood of endometriosis include a shorter menstrual cycle (less than every 27 days). Uterine fibroids are genetically predisposed. It is estimated that by the age of 50, up to 70% of Caucasian women and 80% of African-American women will experience uterine fibroids. PTS: 1 REF: p. 1693 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

20. When reviewing the electronic health record of a female client, the nurse reads that the client has a history of adenomyosis. The nurse should be aware that this client experiences symptoms resulting from what pathophysiologic process? A. Loss of muscle tone in the vaginal wall B. Excessive synthesis and release of unopposed estrogen C. Invasion of the uterine wall by endometrial tissue D. Proliferation of tumors in the uterine wall

ANS: C Rationale: In adenomyosis, the tissue that lines the endometrium invades the uterine wall. This disease is not characterized by loss of muscle tone, the presence of tumors, or excessive estrogen. PTS: 1 REF: p. 1695 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

25. A female client is being evaluated at the gynecologist's office for painful urination, and dark and foul-smelling vaginal discharge after intercourse. Recently the client has noticed a small amount of blood coming from the rectum after bowel movements and increased leg pain after work. The client is most likely experiencing what stage of cervical cancer? A. Stage I B. Stage III C. Stage IV D. Stage II

ANS: C Rationale: In stage IV, the tumor has extended beyond the pelvis and involves the bladder or rectum. In advanced cervical cancer, the vaginal discharge gradually increases and becomes watery and, finally, dark and foul-smelling from necrosis and infection. This discharge usually occurs after mild trauma or pressure such as from intercourse. Leg pain, dysuria, rectal bleeding, and edema of the extremities signal advanced disease. Signs and symptoms are evaluated, and x-rays, laboratory tests and special examinations such as biopsy and colposcopy are needed to fully diagnose and stage the disease. PTS: 1 REF: p. 1696 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

15. The nurse is planning health education for a client who has experienced a vaginal infection. What guidelines should the nurse include in this program regarding prevention? A. Wear tight-fitting synthetic underwear. B. Douche weekly to eradicate perineal bacteria. C. Avoid commercial feminine hygiene products, such as sprays. D. Restrict daily washing.

ANS: C Rationale: Instead of tight-fitting synthetic, nonabsorbent, heat-retaining underwear, cotton underwear is recommended to prevent vaginal infections. Douching is generally discouraged, as is the use of feminine hygiene products. Daily washing is not restricted. Some studies have found that submersion in particularly hot baths and/or adding salts or fragrances disrupts the vaginal PH (potential hydrogen) and may contribute to vaginal infections. PTS: 1 REF: p. 1680 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

24. A female client with large uterine fibroids is scheduled for a hysterectomy next month and is started on leuprolide. The client requests information about the medication's route, duration of treatment and any side effects. What is the nurse's best response? A. This medical regimen will consist of weekly subcutaneous injections. B. This is a medication that works best if taken consistently over a long period of time. C. The medication induces a temporary menopause-like environment in the body. D. The medication may temporarily increase vaginal secretions creating an environment for bacterial growth.

ANS: C Rationale: Leuprolide is in a class of medications called gonadotropin releasing hormone agonists. It essentially reduces the amount of estrogen in women. Leuprolide induces a temporary menopausal-like environment that helps shrink the fibroids. Treatments consist of monthly injections, which may cause hot flashes and vaginal dryness. This treatment allows easier surgery and alleviates anemia. Treatment is typically temporary due to vasomotor symptoms and loss of bone density. PTS: 1 REF: p. 1693 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Caring BLM: Cognitive Level: Analyze NOT: Multiple Choice

18. A client has been diagnosed with polycystic ovary syndrome (PCOS). The nurse should encourage what health promotion activity to address the client's hormone imbalance and infertility? A. Kegel exercises B. Increased fluid intake C. Weight loss D. Topical antibiotics as prescribed

ANS: C Rationale: Lifestyle modification is critical in the treatment of PCOS, and weight management is part of the treatment plan. As little of a weight loss as 5% to 10% of total body weight can help with hormone imbalance and infertility. Antibiotics are irrelevant, as PCOS does not have an infectious etiology. Fluid intake and Kegel exercises do not influence the course of the disease. PTS: 1 REF: p. 1693 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

33. A 45-year-old client has just undergone a radical hysterectomy for invasive cervical cancer. Prior to the surgery the health care provider explained to the client that after the surgery a source of radiation would be placed near the tumor site to aid in reducing recurrence. What is the placement of the source of radiation called? A. Internal beam radiation B. Trachelectomy C. Brachytherapy D. External radiation

ANS: C Rationale: Radiation, which is often part of the treatment to reduce recurrent disease, may be delivered by an external beam or by brachytherapy (method by which the radiation source is placed near the tumor) or both. PTS: 1 REF: p. 1697 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

12. A student nurse is caring for a client who has undergone a wide excision of the vulva. What action is contraindicated in the immediate postoperative period? A. Placing client in low Fowler position B. Application of compression stockings C. Ambulation to a chair D. Provision of a low-residue diet

ANS: C Rationale: Sitting on a chair would not be recommended immediately in the postoperative period. This would place too much tension on the incision site. A low Fowler position or, occasionally, a pillow placed under the knees will reduce pain by relieving tension on the incision. Application of compression stocking would prevent a deep vein thrombosis from occurring. A low-residue diet would be ordered to prevent straining on defecation and wound contamination. PTS: 1 REF: p. 1699 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

26. A client is being discharged home after a hysterectomy. When providing discharge education for this client, the nurse has cautioned the client against sitting for long periods. This advice addresses the client's risk of what surgical complication? A. Pudendal nerve damage B. Fatigue C. Venous thromboembolism D. Hemorrhage

ANS: C Rationale: The client should resume activities gradually. This does not mean sitting for long periods because doing so may cause blood to pool in the pelvis, increasing the risk of thromboembolism. Sitting for long periods after a hysterectomy does not cause postoperative nerve damage; it does not increase the fatigue factor after surgery or the risk of hemorrhage. PTS: 1 REF: p. 1704 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

5. A client has returned to the postsurgical unit after vulvar surgery. What intervention should the nurse prioritize during the initial postoperative period? A. Placing the client in high Fowler position B. Administering sitz baths every 4 hours C. Monitoring the integrity of the surgical site D. Avoiding analgesics unless the client's pain is unbearable

ANS: C Rationale: An important intervention for the client who has undergone vulvar surgery is to monitor closely for signs of infection in the surgical site, such as redness, purulent drainage, and fever. The client should be placed in low Fowler position to reduce pain by relieving tension on the incision. Sitz baths are discouraged after wide excision of the vulva because of the risk of infection. Analgesics should be administered preventively on a scheduled basis to relieve pain and increase the client's comfort level. PTS: 1 REF: p. 1699 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

34. A 25-year-old client diagnosed with invasive cervical cancer expresses a desire to have children. What procedure might the care team offer as treatment? A. Radical hysterectomy B. Radical cystectomy C. Modified radical hysterectomy D. Radical trachelectomy

ANS: D Rationale: A procedure called a radical trachelectomy is an alternative to hysterectomy in women with invasive cervical cancer who are young and want to have children. In this procedure, the cervix is gripped with retractors and pulled down into the vagina until it is visible. The affected tissue is excised while the rest of the cervix and uterus remain intact. A drawstring suture is used to close the cervix. For a client who wants to have children, a radical hysterectomy, a modified radical hysterectomy, or a radical cystectomy would not provide that option. PTS: 1 REF: p. 1696 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

36. A client with genital herpes is having an acute exacerbation. What medication would the nurse expect to be ordered to suppress the symptoms and shorten the course of the infection? A. Clotrimazole B. Metronidazole C. Podophyllin D. Acyclovir

ANS: D Rationale: Acyclovir is an antiviral agent that can suppress the symptoms of genital herpes and shorten the course of the infection. It is effective at reducing the duration of lesions and preventing recurrences. Clotrimazole is used in the treatment of yeast infections. Metronidazole is the most effective treatment for trichomoniasis. Podophyllin is used to treat external genital warts. Acyclovir is used in the treatment of genital herpes. PTS: 1 REF: p. 1682 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

38. A client has herpes simplex 2 viral infection (HSV-2). The nurse recognizes that which of the following should be included in teaching the client? A. The virus also causes "cold sores" of the lips. B. The virus may be cured with topical antibiotics. C. The client's family history is an important part of assessment. D. Treatment is aimed at relieving symptoms.

ANS: D Rationale: HSV-2 causes genital herpes and is known to ascend the peripheral sensory nerves and remain inactive after infection, becoming active in times of stress. The virus is not curable, but treatment is aimed at controlling symptoms. HSV-1 causes "cold sores," and varicella zoster causes shingles. Family history is not relevant because the infection is viral. PTS: 1 REF: p. 1682 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice

8. The nurse is teaching a client preventative measures regarding vaginal infections. The nurse should include which factor as an important risk? A. High estrogen levels B. Late menarche C. White ethnicity D. Frequent douching

ANS: D Rationale: Risk factors associated with vulvovaginal infections include pregnancy, premenarche, low estrogen levels, and frequent douching. White clients are not more susceptible than Black, Hispanic, or Asian clients. PTS: 1 REF: p. 1678 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

35. A nurse providing prenatal care to a pregnant client is addressing measures to reduce postpartum risk of cystocele, rectocele, and uterine prolapse. What action should the nurse recommend? A. Maintenance of good perineal hygiene B. Prevention of constipation C. Increased fluid intake for 2 weeks' postpartum D. Performance of pelvic muscle exercises

ANS: D Rationale: Some disorders related to "relaxed" pelvic muscles (cystocele, rectocele, and uterine prolapse) may be prevented. During pregnancy, early visits to the primary care provider permit early detection of problems. During the postpartum period, the client can be taught to perform pelvic muscle exercises, commonly known as Kegel exercises, to increase muscle mass and strengthen the muscles that support the uterus and then to continue them as a preventive action. Fluid intake, prevention of constipation, and hygiene do not reduce this risk. PTS: 1 REF: p. 1688 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

4. The nurse is providing preoperative education for a client diagnosed with endometriosis. A hysterectomy has been scheduled. What education topic should the nurse be sure to include for this client? A. Menstrual periods will continue to occur for several months, some of them heavy. B. Normal activity will be permitted within 48 hours following surgery. C. After a hysterectomy, hormone levels remain largely unaffected. D. The bladder must be emptied prior to surgery and a catheter may be placed during surgery.

ANS: D Rationale: The intestinal tract and the bladder need to be empty before the client is taken to the OR to prevent contamination and injury to the bladder or intestinal tract. The client is informed that their periods are now over, but the client may have a slightly bloody discharge for a few days. The client is instructed to avoid straining, lifting, or driving until the surgeon permits the client to resume these activities. The client's hormonal balance is upset, which usually occurs in reproductive system disturbances. The client may experience depression and heightened emotional sensitivity to people and situations. PTS: 1 REF: p. 1704 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 51: Management of Clients With Female Reproductive Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice