Assessment: Assessing Female Genitalia and Rectum

A client asks the nurse when a colonoscopy is recommended. Which advice provided by the nurse is most appropriate?

"A flexible sigmoidoscopy should be done every five years starting at age 50." Explanation: Beginning at age 50, men and women should have a fecal occult blood test or a flexible sigmoidoscopy every 5 years. Both of these are preferred over either one separately. All screening should start at age 50, not 65 years of age. Health care providers should adhere to the screening guidelines, not make their own decisions.

A female client tells the nurse that she may be experiencing premenstrual syndrome. An appropriate question for the nurse to ask the client is

"Do you experience mood swings or bloating?" Explanation: Headache, weight gain, mood swings, abdominal cramping, and bloating are common complaints before or during the menstrual period. Some women experience premenstrual syndrome (PMS), in which the symptoms become severe enough to impair the woman's ability to function.

Which statement by a client in regards to her ability to conceive should prompt a nurse to ask additional questions about infertility?

"My husband and I have had unprotected intercourse for over a year" Explanation: Infertility is defined as unprotected sex for one year without becoming pregnant. Multiple sex partners increases a woman's risk of sexually transmitted diseases and cervical cancer. A normal menstrual cycle occurs approximately every 28-45 days and lasts 3-7 days. Vaginal dryness may be a sign of entering menopause.

A 57-year-old woman calls the clinic reporting painful intercourse followed by spotting. She tells the nurse that she hasn't had a period in 2 years. What should the nurse tell her?

"These findings are common in postmenopausal women." Explanation: Menopause usually occurs between 48 and 51 years of age, although variability is wide. The ovaries stop producing estrogen and progesterone, causing the uterus to droop and the cervix to shrink. Associated findings include thinning of the genital hair, thinning and loss of elasticity of vaginal mucosa, and diminished vaginal secretions as a result of lower estrogen levels. The fat pads atrophy and the labia and clitoris decrease in size.

A 29-year-old woman with a longstanding diagnosis of genital herpes has presented to the clinic because of a recent "flare-up." What should the nurse expect during inspection of this recurrence of herpes?

A local patch of small, painful lesions on the client's vulva Explanation: Small, painful ulcers characterize herpes infection. Recurrent infections are usually marked by a local patch of lesions that is less extensive than the initial infection. A firm, round cystic nodule is more likely an epidermoid cyst, while cauliflower-like growths are associated with venereal warts.

While inspecting the labia minora, a nurse notices that they are asymmetric. Which of the following does this finding most likely point to?

Abscess Explanation: Asymmetric labia may indicate abscess. Urinary frequency, burning, and pain are signs of urinary tract infection. Candidal vaginitis is caused by the overgrowth of yeast in the vagina. It causes a thick, white, cheesy discharge. Cervical cancer may produce lesions.

A female client with a history of endometriosis tests positive with a urine pregnancy test. She complains of right lower quadrant pain and nausea. During an ultrasound, an empty gestational sac is seen. What is the nurse's priority action?

Advise client to seek treatment right away. Explanation: Risk factors for ectopic pregnancy include previous ectopic pregnancy, past pelvic infection, endometriosis, or abnormalities of the fallopian tube. The most common symptoms are lower quadrant pain, nausea, and referred pain in the neck or shoulder. Since the client's ultrasound revealed no baby in the uterus, an ectopic pregnancy cannot be ruled out based on the client's history and symptoms. The priority is to prevent complications due to internal bleeding. The client should seek care immediately. Though the other statements are not incorrect; preventing potential hemorrhage is the priority of care.

After an assessment, the nurse identifies that a female client is at risk for the development of colorectal cancer. Which non-modifiable risk factors did the nurse assess to make this clinical determination? Select all that apply.

Age 53 African American race Treatment for type 2 diabetes mellitus Explanation: Non-modifiable risk factors for the development of colorectal cancer include age over 50, African American race, and having type 2 diabetes mellitus. Smoking and a sedentary lifestyle are modifiable risk factors that can be altered to reduce the risk of developing the disease.

A client is explaining to the nurse how vaginal dryness has decreased her enjoyment of sexual intercourse. The nurse is aware that which of the following are the glands that produce mucus that lubricates the vagina during intercourse?

Bartholin's glands Explanation: Bartholin's glands in the vaginal orifice secrete mucus, which lubricates the area during sexual intercourse. Cowper's glands are located at the base of the penis in the male and secrete a fluid that helps to lubricate the urethra for sperm to pass through. Sebaceous glands are oil glands in the skin that secrete sebum. Eccrine glands secrete sweat.

When examining the genitalia of a client, a nurse observes cauliflower-like growth on the client's cervix. The nurse recognizes this finding as indicative of what condition?

Cancer of the cervix Explanation: Lesions that develop into cauliflower-like growths are indicative of cancer of the cervix. The presence of columnar epithelium that extends onto the vaginal wall indicates exposure to DES as a fetus. DES is a drug that was used more than 50 years ago to prevent spontaneous abortion and premature labor. A mucopurulent yellowish discharge from the external os is observed in a client with mucopurulent cervicitis; it usually indicates infection with Chlamydia or gonorrhea. A yellow-green, frothy, and foul-smelling discharge is observed in a client with trichomonas vaginitis.

A 28-year-old married clothing sales clerk comes to the clinic for her annual examination. She requests a refill on her birth control pills. Her only complaint is painless bleeding after intercourse. She denies any other symptoms. Her past medical history consists of two spontaneous vaginal births. Her past six Pap smears have all been normal. She is married with two children. Her mother is in good health, and her father has high blood pressure. Examination shows a young woman appearing healthy and relaxed. Her vital signs are unremarkable, and her head, eyes, ears, throat, neck, cardiac, lung, and abdominal examinations are normal. Visualization of the perineum shows no lesions or masses. Speculum examination shows a red mass at the os. On taking a Pap smear the mass bleeds easily. Bimanual examination shows no cervical motion tenderness. Both ovaries are palpated and nontender. What is the most likely diagnosis related to the abnormality of her cervix?

Cervical polyp Explanation: Cervical polyps are polyps of endometrial cells arising from either the uterus or the cervix. They are benign and usually painless but can bleed during intercourse.

The school nurse is presenting a class on female reproductive health. While discussing prevention the nurse teaches what about a Pap smear?

Detect cervical cancer. Explanation: The test should be performed when the client is not menstruating, and douching washes away cellular material. The test detects cervical cancer, and false-negative Pap smear results occur mostly from sampling errors or improper technique. A Pap smear should be done annually.

A client presents to the health care clinic for a routine pelvic examination. The client tells the nurse that she has experienced several yeast infections over the past year. The nurse should ask the client about the presence of which disease process?

Diabetes mellitus Explanation: Diabetes mellitus predisposes women to yeast infections because the increased glucose levels are a good medium for yeast to grow. Heart disease, kidney stones, and sexually transmitted diseases do not predispose a woman to yeast infections.

Which of the following terms refers to difficult or painful sexual intercourse?

Dyspareunia Explanation: Dyspareunia is a common problem of the aged female. Amenorrhea refers to absence of menstrual flow. Dysmenorrhea refers to painful menstruation. Endometriosis is a condition in which endometrial tissue seeds in other areas of the pelvis.

A risk factor for cervical cancer includes:

Exposure to HPV Explanation: Risk factors for cervical cancer include exposure to HPV, sex with uncircumcised males, overweight status, and early childbearing.

The nurse selects the diagram shown to use when teaching a female client. What health problem is the nurse reviewing with this client?

Fibroids Explanation: Uterine fibroids appear as single or multiple tumors within the wall of the uterus, often extending from it on stalks or pedunculations. Manifestations of cancer include abnormal bleeding, pain, and alterations in other body systems. Endometrial tissue is found outside the uterus because of a retrograde flow of menstrual fluid into the peritoneal cavity. This tissue adheres to other organs and causes pelvic pain, dyspareunia, dysmenorrhea, and possibly infertility. In an ectopic pregnancy, a fertilized ovum implants in a site other than the uterine endometrium.

A client presents to the health care clinic and reports a 7-day history of vaginal discharge and swelling of the labia. During the examination of the external genitalia, the nurse notices an enlarged Bartholin's gland. The nurse should prepare to culture this client for which condition?

Gonorrhea Explanation: Abscess of Bartholin's gland with the presence of vaginal discharge can be sign of infection with Neisseria gonorrhoeae (gonorrhea). Drainage from the urethra indicates possible urethritis, which may have many causes. Trichomoniasis causes a greenish discharge with a fishy odor. Lice infestation causes irritation and a whitish dandruff appearance on the pubic hairs but does not cause vaginal discharge or swelling.

What is the greatest risk factor for cervical cancer?

HPV Explanation: The greatest risk factor for cervical cancer is infection with HPV.

Inspection of the female external genitalia begins with what?

Mons pubis Explanation: Inspection begins with the mons pubis. Inspection of the inguinal area, pubic hair, and skin follows inspection of the mons pubis.

The nurse is working with an anorexic client who complains that sexual intercourse with her partner is painful. The nurse suspects that the client may lack the fat pad that is typically located over the pubic bone in women and that functions to absorb force and protect the pubic bone. Which of the following is the name of this structure?

Mons pubis Explanation: The mons pubis is the fat pad located over the symphysis pubis. The normal adult mons pubis is covered with pubic hair in a triangular pattern. It functions to absorb force and to protect the symphysis pubis during coitus (sexual intercourse). The area of the female external genitalia is sometimes referred to as the vulva, or pudendum, and extends from the mons pubis to the anal opening. The clitoris is located at the anterior end of the labia minora. It is a small, cylindrical mass of erectile tissue and nerves with three parts: the glans, the corpus, and the crura. Inside the labia majora are the thinner skin folds of the labia minora. These folds join anteriorly at the clitoris and form a prepuce, or hood; posteriorly the two folds join to form the frenulum.

A nurse inspects the cervix of a 52-year-old client during a routine assessment. Which coloration of the cervix may indicate that the woman is postmenopausal?

Pale Explanation: Redness of the cervix may indicate inflammation. The surface of the cervix is normally smooth, pink, and even. In a nonpregnant client, a bluish cervix may indicate cyanosis. In pregnant clients, the cervix appears blue; this is also referred to as Chadwick's sign. In a non-menopausal client, a pale cervix may indicate anemia; in older clients the cervix may appear pale after menopause.

The nurse is present during a pelvic examination of a 21-year-old female client. Which action should the nurse prepare for first?

Pap smear specimen collection Explanation: Collection of cells from the endocervix or cervix may cause some spotting or bleeding; this can occur with a Pap or with an STI screening. It is important to do the Pap smear first so that bleeding is minimal on the cytology specimen. The cultures for chlamydia (CT) and gonorrhea (GC) are done after the Pap smear. Spray fixative is applied after a specimen is collected and applied to a slide.

An 18-year-old college freshman comes to the clinic complaining of severe left-sided lower abdominal pain and a foul yellow discharge. The pain began last night while she was having intercourse with her boyfriend. Afterwards the pain became more severe and the discharge started. By this morning she had a fever of 38.3°C and walking was making the pain worse. Only lying very still makes the pain better. She has tried ibuprofen and acetaminophen without any improvement. She denies any nausea, vomiting, diarrhea, or constipation. Her past medical history is unremarkable. She has had two past sexual partners. She uses the birth control patch instead of condoms. She smokes a half pack of cigarettes a day and drinks four to five beers per weekend night. She denies any illegal drug use. Her parents are both healthy. Examination shows a young woman who appears ill. Her temperature is 38.9°C and her pulse is elevated at 110. She is tender in the left lower quadrant but has no guarding or rebound. Speculum examination reveals yellow purulent drainage from the os. On palpation there is cervical motion tenderness and the left adnexa is swollen and tender. A urine analysis is unremarkable and the urine pregnancy test is pending. What is the best choice of diagnosis for this adnexal swelling?

Pelvic inflammatory disease Explanation: PID is common in young sexually active woman and is usually caused by sexually transmitted bacteria. It is often associated with fever, pelvic pain, and a purulent cervical discharge. On examination there is often cervical motion tenderness and adnexal swelling and pain. A purulent discharge is often seen in the cervical os. Causes of cervical infection are gonorrhea, Chlamydia, and sometimes herpes. This woman should be made aware that barrier methods of contraception may prevent transmission of these diseases while the contraceptive patch or pill will not. It would be prudent to consider further history and screening for HIV in this client.

Which of the following is the most important risk factor for cervical cancer?

Persistent HPV infections Explanation: High-risk strains of HPV constitute the most significant risk factor for cervical cancer. Immunosuppressive illnesses, poor nutrition, and smoking are not noted risk factors. Failure to seek screening is a risk factor, but of less significance than HPV infection.

A nurse inspects the cervix of a 33-year-old, nonpregnant client during a routine assessment. Which coloration of the cervix would indicate normal health in this client?

Pink Explanation: Redness of the cervix may indicate inflammation. The surface of the cervix is normally smooth, pink, and even. In a nonpregnant client, a bluish cervix may indicate cyanosis. In pregnant clients, the cervix appears blue; this is also referred to as Chadwick's sign. In a non-menopausal client, a pale cervix may indicate anemia; in older clients the cervix may appear pale after menopause.

The nurse is reviewing the functions of the ovaries, uterus, clitoris and vagina with a group of nursing students. Based on this information, what would be the best response by a nursing student about the function of the ovaries?

Produces female gametes (ova) and secretes female sex hormones. Explanation: The ovaries functions to produce female gametes or ova and secretes female sex hormones. The uterus functions to receive the fertilized ovum and provides housing and nourishment for a fetus. The vagina functions to receive sperm provide an exit for menstrual flow and serve as the birth canal. The clitoris is a small erectile structure that responds to sexual stimulation.

The client states that she does not enjoy sex because she does not attain adequate vaginal lubrication. The nurse should be aware of what potential causes of sexual dysfunction? (Select all that apply.)

Psychiatric conditions Medical illness Lack of estrogen Sexual dysfunction is classified by the phase of sexual response. A woman may lack desire, she may fail to become aroused and attain adequate vaginal lubrication, or, despite adequate arousal, she may be unable to reach orgasm. Causes include lack of estrogen, medical illness, and psychiatric conditions.

The nurse is reviewing the functions of the ovaries, uterus, clitoris and vagina with a group of high school students. Based on this information, what would be the best response by a high school student about the function of the vagina?

Receives sperm, provides an exit for menstrual flow and serves as the birth canal. Explanation: The ovaries function to produce female gametes or ova and secrete female sex hormones. The uterus functions to receive the fertilized ovum and provides housing and nourishment for a fetus. The vagina functions to receive sperm provide an exit for menstrual flow and serve as the birth canal. The clitoris is a small erectile structure that responds to sexual stimulation.

Which position occurs when the uterus turns posteriorly as a whole unit?

Retroversion Explanation: In retroversion the uterus turns posteriorly as a whole unit. In anteversion the uterus tilts forward as a whole unit. In retroflexion, the fundus bends posteriorly. In anteflexion, the uterus bends anteriorly.

When examining the uterus, a nurse finds that the cervix and the body of the uterus are tilted backward. How should the nurse document this uterine finding?

Retroverted Explanation: Retroverted uterus is a normal variation that consists of the cervix and body of the uterus tilting backward. Anteflexed uterus is a normal variation that consists of the uterine body flexed anteriorly in relation to the cervix. Retroflexed uterus is a normal variation that consists of the uterine body being flexed posteriorly in relation to the cervix. Anteverted uterus is the most typical position of the uterus; wherein the cervix is pointed posteriorly, and the body of the uterus is at the level of the pubis over the bladder.

The nurse is reviewing the functions of the ovaries, uterus, clitoris and vagina with a group of high school students. Based on this information, what would be the best response by the high school student about the function of the clitoris?

Small erectile structure that responds to sexual stimulation. Explanation: The ovaries function to produce female gametes or ova and secrete female sex hormones. The uterus functions to receive the fertilized ovum and provides housing and nourishment for a fetus. The vagina functions to receive sperm provide an exit for menstrual flow and serve as the birth canal. The clitoris is a small erectile structure that responds to sexual stimulation.

A client reports the new onset of mucus in the stool. How should the nurse document this in the client's history?

Steatorrhea Explanation: The proper term for mucus in the stool is steatorrhea, which indicates the presence of excessive fat in the stool. Diarrhea is an increase in the frequency of loose stool. Change in bowel habits is not specific to the problem that the client reported. Fecal incontinence is the inappropriate release or inability to control the bowels.

A client calls the clinic and tells the nurse they have a white, curd-like discharge from the vagina. The client asks the nurse what the significance of this discharge is. What should the nurse responds?

The client may have a Candida species infection. Explanation: Mucus or white discharge from the vagina is physiologic and normal. Drainage caused by Candida is curd-like and white, while infection with Trichomonas is often frothy/yellow green in color. Vaginal dryness causes scant and mucoid drainage that may be blood-tinged.

A female client tells the nurse that she thinks she has a vaginal infection because she has noted inflammation of her vulva and a yellowish green discharge. The nurse recognizes that the clinical manifestations described are typical of what vaginal infections?

Trichomonas vaginalis Explanation: The clinical manifestations indicate T. vaginalis, which is treated with metronidazole in the form of oral tablets.

When the female client reports a frothy yellow-green or brown vaginal discharge, the nurse suspects the client has a vaginal infection caused by which of the following?

Trichomonas vaginalis Explanation: Trichomonas vaginalis causes a frothy yellow-green or yellow-brown vaginal discharge. Candidiasis causes a white, cheese-like discharge clinging to the vaginal epithelium. Gardnerella vaginalis causes a gray-white to yellow-white discharge clinging to the external vulva and vaginal walls. Chlamydia causes a profuse purulent discharge.

When examining the genitalia of a client, a nurse observes a yellow-green, frothy, and foul-smelling discharge from the vagina. The nurse recognizes this finding as indicative of what condition?

Trichomonas vaginitis Explanation: A yellow-green, frothy, and foul-smelling discharge is observed in a client with trichomonas vaginitis. The presence of columnar epithelium that extends onto the vaginal wall indicates exposure to DES as a fetus. DES is a drug that was used more than 50 years ago to prevent spontaneous abortion and premature labor. A mucopurulent yellowish discharge from the external os is observed in a client with mucopurulent cervicitis; it usually indicates infection with Chlamydia or gonorrhea. Lesions that develop into cauliflower-like growths are indicative of cancer of the cervix.

In the female client, the tube of muscular tissue that extends from the vaginal introitus to the uterus is called what?

Vagina Explanation: The vagina is a tube of muscular tissue that extends from the vaginal introitus to the uterus. The clitoris is the organ of sexual excitement in the female. The mons pubis and vesicovaginal septum are other female genital organs.

The nurse is caring for a 17-year-old girl who is 16 weeks pregnant. The client's history shows infection with multiple STIs. What should the nurse do?

Verify that prior STIs were treated according to protocol. Explanation: Screening, treating, and counseling of and about chlamydia and gonorrhea are currently recommended for all sexually active adolescents.

Which client should the nurse assess for possible primary amenorrhea?

an 18-year-old who has never started menses Explanation: Failure of periods to initiate is called primary amenorrhea whereas the cessation of periods after they have been established is termed secondary amenorrhea. Pregnancy, lactation, and menopause are physiologic causes of secondary amenorrhea. Irritability and anxiety associated with menses may indicate premenstrual syndrome.

The nurse is planning to inspect the anal area of an adult female client. To assess for any bulges or lesions, the nurse should ask the client to

bear down. Explanation: Ask the client to bear down to promote relaxation of the sphincter and insert your index finger into the vaginal orifice and your middle finger into the rectum. While pushing down on the abdominal wall with your other hand, palpate the internal reproductive structures through the anterior rectal wall.

The nurse is assessing the genitalia of a female client and detects a bulging anterior wall in the vagina. The nurse should plan to refer the client to a physician for

cystocele. Explanation: A cystocele is a bulging in the anterior vaginal wall caused by thickening of the pelvic musculature. As a result, the bladder, covered by vaginal mucosa, prolapses into the vagina.

The outer layer of the vaginal wall is under the direct influence of

estrogen. Explanation: The outer layer is under the direct influence of the hormone estrogen and contains many mucus-producing cells.

While performing a gynecologic examination, the nurse observes small, painful, ulcer-like lesions with red bases on the client's labia. The nurse should refer the client to a physician for possible

herpes simplex virus infection. Explanation: Small, painful, red-based, ulcer-like lesions are consistent with herpes simplex virus, type 2.

The outermost layer of the vaginal wall is composed of

pink squamous epithelium and connective tissue. Explanation: The vaginal wall comprises four layers. The outer layer is composed of pink squamous epithelium and connective tissue.

The visible portion of the clitoris is termed the

pink squamous epithelium and connective tissue. Explanation: The vaginal wall comprises four layers. The outer layer is composed of pink squamous epithelium and connective tissue.

What information should a nurse give a client who reports a routine of frequent douching?

predisposes the vagina to yeast infections Explanation: The nurse should inform the client that frequent douching changes the natural flora of the vagina, predisposing the vagina to yeast infections. It does not contaminate the vagina and urethra, cause toxic shock syndrome, or cause abrasions that bleed easily. Wiping the perineal area from back to front can contaminate the vaginal and urethral openings. Toxic shock syndrome is a life-threatening infection that can be prevented by frequently changing tampons. Atrophic vaginitis causes itching, burning, dryness, and painful urination.

A female client tells the nurse that she has pain while urinating. Besides obtaining a urinalysis, the nurse should assess the client for

sexually transmitted disease. Explanation: Urinary frequency, burning, or pain (dysuria) are signs of infection (urinary tract or sexually transmitted infections [STIs].