Chapter 27: Assessing Female Genitalia and Rectum

A woman who has undergone a total hysterectomy asks a nurse about follow-up Pap smears. Which statement by the nurse is correct? a) "Cervical screening is not necessary once a total hysterectomy is performed." b) "If you had 3 or more Pap smears that were normal, you can stop the screening." c) "If you are still sexually active, a Pap smear is recommended every 5 years." d) "You should continue to have Pap smears every 3 years."

a) "Cervical screening is not necessary once a total hysterectomy is performed." Cervical screening is not necessary once a total hysterectomy (with removal of the cervix) is performed unless the surgery was for cervical cancer. A pap smear is recommended every 3 years for women 21 to 65 years old, regardless of normalcy of previous smears or of sexual activity. Women over the age of 65 who have had adequate prior screening exams and are not otherwise at high risk for cervical cancer may choose to stop cervical cancer screening.

Which statement by a client in regards to her ability to conceive should prompt a nurse to ask additional questions about infertility? a) "My husband and I have had unprotected intercourse for over a year" b) "My menses comes about every 40 days and lasts 3 days" c) "Vaginal dryness has been a problem for about six (6) months" d) "I have had three (3) sex partners in the past two (2) years"

a) "My husband and I have had unprotected intercourse for over a year" 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.

In a nonpregnant woman, where should a nurse anticipate palpating for the fundus of the uterus? a) At the level of the pubis b) Halfway between the pubis & the umbilicus c) Above the level of the pubis d) Level with the top of the iliac crest

a) At the level of the pubis In a nonpregnant woman, the fundus, or large upper end of the uterus, should be at the level of the pubis. Above this level is considered enlarged and further examination should be completed.

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? a) Bartholin's glands b) Cowper's glands c) Sebaceous glands d) Eccrine glands

a) Bartholin's glands 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.

A nurse assesses a 22-year-old client who has never had a Pap test. Which factor should the nurse explain to the client as being a risk for cervical cancer? a) Having multiple sexual partners b) Lack of exercise c) Having the human papillomavirus (HPV) vaccination d) Smoking

a) Having multiple sexual partners The nurse should inform the client that having multiple sexual partners is a risk factor for cervical cancer. Having the HPV vaccine lowers the risk. Smoking and lack of exercise are not associated with an increased risk for cervical cancer.

While inspecting a client's vagina, the nurse notes transverse folds in the outer layer of pink squamous epithelium. These folds are known as which of the following? a) Rugae b) Peritoneum c) Myometrium d) Endometrium

a) Rugae The outer layer of the vaginal wall is composed of pink squamous epithelium that lies in transverse folds called rugae. These transverse folds allow the vagina to expand during intercourse; they also facilitate vaginal delivery of a fetus. The endometrium, the myometrium, and the peritoneum are the three layers of the uterine wall.

What information should a nurse give a client who reports a routine of frequent douching? a) predisposes the vagina to yeast infections b) contaminates the vagina and the urethra c) Can cause abrasion that bleeds easily d) May cause toxic shock syndrome

a) predisposes the vagina to yeast infections 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 client asks the nurse when a colonoscopy is recommended. Which advice provided by the nurse is most appropriate? a) "Either a fecal occult blood test or a colonoscopy is acceptable." b) "A flexible sigmoidoscopy should be done every five years starting at age 50." c) "Your doctor will decide what schedule is best for you." d) "A colonoscopy should be done every year starting at age 65."

b) "A flexible sigmoidoscopy should be done every five years starting at age 50." 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 nurse begins the speculum examination and finds the vaginal orifice tight. What is the appropriate action by the nurse to facilitate the insertion of the speculum? a) Rotate the speculum until the blades are in a horizontal position b) Ask the client to bear down to relax the muscles of the perineum c) Apply a small amount of lubricant to the end of the speculum d) Slightly open the blades of the speculum to relax the labia

b) Ask the client to bear down to relax the muscles of the perineum If the vaginal opening seems tight or if the examiner experiences difficulty inserting the speculum, ask the client to bear down to relax the muscles of the perineum and promote opening. Lubricant should not be applied to the speculum because these are typically bacteriostatic and will alter the pH and the cell specimens collected for cytology. The speculum should be held vertical and the blades closed until the base of the speculum touches the examiner's fingertips that are inside the vagina.

When asking a client to bear down as the labia minora is separated, a nurse notices a bulging of the anterior wall of the vaginal musculature. How should this finding be documented by the nurse? a) Uterine prolapse b) Cystocele c) Rectocele d) Decreased uterine tone

b) Cystocele Bulging of the anterior vaginal wall may indicate a cystocele. Bulging of the posterior vaginal wall may indicate a rectocele. Uterine prolapse is seen when the cervix or uterus protrudes downward. Decreased uterine tone is assessed by asking the client to squeeze the examiner's finger.

A nurse is interviewing a client who is from Bangladesh. Which of the following should the nurse not find unusual, based on this client's country of origin? a) Early menarche b) Late menarche c) Severe premenstrual syndrome symptoms d) Amenorrhea

b) Late menarche Menarche (beginning of menstruation) tends to begin earlier in women living in developed countries and later in women who live in undeveloped countries. Neither severe premenstrual syndrome symptoms nor amenorrhea is necessarily associated with women from undeveloped countries.

Which position is it most logical for the nurse to place the female client in for the anus and rectum examination? a) Knee-chest b) Lithotomy c) Supine d) Standing

b) Lithotomy Although many positions may be used for this exam—the standing, knee- chest, lithotomy, left lateral, or squatting positions—the most logical one is the lithotomy, as the client will already be in this position from the vaginal exam.

A college student presents to the health center for a routine Pap smear. She states that she is thinking about becoming sexually active with her boyfriend of 1 year but is afraid that she might become pregnant. She reports a history of no cigarette smoking, no substance abuse or use, and occasionally drinks alcohol on the weekends. She asks the nurse about birth control options and their safety. What is the appropriate diagnosis for this client that the nurse can confirm from this information? a) Health Seeking Behavior b) Readiness for Enhanced Health Management c) Ineffective Sexuality Patterns d) Readiness for Enhanced Health Maintenance

b) Readiness for Enhanced Health Management This client is asking for information about birth control to prevent pregnancy and therefore the diagnosis of Readiness for Enhanced Health Management: requests information on birth control is appropriate.

A nurse inspects the cervix of a 28-year-old, nonpregnant client during a routine assessment. Which coloration of the cervix may indicate inflammation? a) Blue b) Red c) Pink d) Pale

b) Red Redness of the cervix may indicate inflammation. The surface of the cervix is normally smooth, pink, and even. In a non-pregnant 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.

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? a) Retroflexed b) Retroverted c) Anteflexed d) Anteverted

b) Retroverted 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.

A male nurse greets a new client in the waiting room of a gynecologist's office. The woman is wearing a burka and does not make eye contact with the nurse. How should the nurse respond to this client? a) Explain to the client his educational credentials and nursing experience b) Ask the gynecologist to come out and greet the client c) Ask the client whether she would prefer to be seen by a female nurse d) Escort the client back to the examination room without speaking

c) Ask the client whether she would prefer to be seen by a female nurse Clients from some cultures (e.g., Islam) may insist on having a female nurse for both the nursing history and physical assessment of the female genitalia, anus, and rectum. The best approach would be for the nurse to offer this option to the client. Explaining his educational credentials and nursing experience to the client would not alleviate her primary concern. It may not be feasible for the gynecologist to come and greet the client. Escorting the client back to the examination room without speaking would be awkward and would not resolve the clients likely concern.

A 35-year-old client has a Pap test with a normal test result. The client has had two previous tests with normal results. Which information is correct for the nurse to tell this client with regard to future screening for cervical cancer? a) Because of the client's age, exams should be done every year b) Option to stop screening can be considered c) Continue exams every 3 years d) Lengthen time to every 7 years because of her test results

c) Continue exams every 3 years The U.S. Preventive Services Task Force recommends a variety of screening protocols based on age and a combination of cervical cancer and human papillomavirus (HPV) screenings. Recommendations include the following: screening for cervical cancer in women ages 21 to 65 years with cytology (Pap smear) every 3 years or screening with a combination of cytology and HPV testing every 5 years for women ages 30 to 65 years who want to lengthen the screening interval

What care should a nurse take when using a speculum to assess a client's cervix? Select all that apply. a) Lubricate the blades using commercial ointments b) Choose the instrument that is the correct size for the client c) Encourage the client to take deep breaths and keep her feet in the stirrups d) Place the fingers of the dominant hand against the anterior vagina e) Insert the speculum at a 45-degree angle downward

c) Encourage the client to take deep breaths and keep her feet in the stirrups, b) Choose the instrument that is the correct size for the client, e) Insert the speculum at a 45-degree angle downward When assessing a client using a speculum, the nurse should encourage the client to take deep breaths and keep her feet in the stirrups with her knees resting in an open, relaxed fashion. The nurse should choose the instrument that is the correct size for the client. The nurse should insert the speculum between the fingers into the posterior portion of the vaginal orifice at a 45- degree angle downward. The nurse should place two fingers of the nondominant hand against the posterior vaginal wall and wait for relaxation to occur. The blades should not be lubricated using commercial ointments because lubricants are typically bacteriostatic and will alter vaginal pH and the cell specimens collected for cytologic, bacterial, and viral analysis.

When examining the genitalia of a client, a nurse observes a columnar epithelium that extends onto the vaginal wall. The nurse recognizes this finding as indicative of what condition? a) Mucopurulent cervicitis b) Cancer of the cervix c) Exposure to diethylstilbestrol d) Trichomonas vaginitis

c) Exposure to diethylstilbestrol The presence of columnar epithelium that extends onto the vaginal wall indicates exposure to diethylstilbestrol (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 cauliflowerlike growths are indicative of cancer of the cervix. A yellowgreen, frothy, and foul smelling discharge is observed in a client with trichomonas vaginitis.

A nurse assesses a 47-year-old client who reports irregular menstrual cycles. The nurse should assess the client for which additional symptoms related to irregular menstrual cycles? Select all that apply. a) Bloating b) Night sweats c) Hot flashes d) Headache e) Spotting

c) Hot flashes, e) Spotting, b) Night sweats Because of this client's age, she may be entering menopause. The nurse should inform the client about hot flashes, spotting, and night sweats which are also symptoms of menopause. Other symptoms include mood swings, decreased appetite, vaginal dryness, and irregular vaginal bleeding. Bloating and headaches are common complaints before or during the menstrual period or in clients with premenstrual syndrome.

A nurse observes a think, white, cheesy discharge at the vaginal opening, with irritation and swelling of the labia. The nurse recognizes this finding as most likely indicating what type vaginal infection? a) Trichomoniasis b) Chlamydia c) Moniliasis d) Vaginosis

c) Moniliasis Candidal vaginitis (moniliasis) is caused by an overgrowth of yeast in the vagina. It causes a thick, white, cheesy discharge. Trichomoniasis vaginal infection is caused by a protozoan organism and is sexually transmitted. The discharge is typically yellow-green, frothy, and foul smelling. Chlamydia produces a mucopurulent, yellowish discharge from the cervical os and is not always visible on the external genitalia. Bacterial vaginosis produces a thin, gray-white discharge that has a positive amine (fishy smell) and coats the vaginal walls and ectocervix.

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? a) Vulva b) Clitoris c) Mons pubis d) Frenulum

c) Mons pubis 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 observes a few small, yellow nodules on the cervix of a client during the speculum exam. They are not painful or odorous, and a thin, clear discharge is present. The nurse recognizes that these are most indicative of what type of condition? a) Cervical eversion b) Chlamydia infection c) Nabothian cysts d) Columnar epithelium

c) Nabothian cysts Nabothian cysts are normal findings on the cervix after childbirth. They are small retention cysts, yellow, translucent, odorless, nonirritating, with clear to cloudy, thin to thick discharge. Chlamydia infection causes a mucopurulent, yellowish discharge that is irritating to the cervix and may cause bleeding and redness of the cervical opening. Cervical eversion is a normal finding after childbirth. The columnar epithelium from within the cervical canal is everted and appears as a deep red, rough ring round the cervical os, surrounded by the normal pink color of the cervix.

What intervention should a nurse follow when obtaining the specimen for a gonorrhea culture? a) Leave applicator in place for just 10 seconds. b) Rotate applicator into the cervical os in a half circle. c) Spread specimen in a "Z" pattern onto a special culture plate. d) Moisten cotton-tipped applicator with saline.

c) Spread specimen in a "Z" pattern onto a special culture plate. The nurse should spread the specimen in a "Z" pattern onto a special culture plate for Neisseria gonorrhoeae cultures. A cotton-tipped applicator is inserted into the cervical os and rotated in a full circle. The applicator is left in place for approximately 20 seconds to make sure it becomes saturated with specimen.

A client reports the new onset of mucus in the stool. How should the nurse document this in the client's history? a) Diarrhea b) Fecal incontinence c) Steatorrhea d) Change in bowel habits

c) Steatorrhea 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 35-year-old client tells the nurse that she is concerned that she may be already starting menopause. The nurse should explain that the normal range of years for menopause to occur is which of the following? a) 30 to 48 years b) 45 to 63 years c) 35 to 53 years d) 40 to 58 years

d) 40 to 58 years Menopause is a normal physiologic process that occurs in women between the ages of 40 to 58 years, with a mean age of 50. Menopause occurring before age 30 is termed premature menopause; menopause between ages 31 and 40 is considered early; menopause occurring in women older than age 58 years is termed delayed menopause.

While inspecting the labia minora, a nurse notices that they are asymmetric. Which of the following does this finding most likely point to? a) Cervical cancer b) Urinary tract infection c) Candidal vaginitis d) Abscess

d) Abscess 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 lesion

A client has been ordered to have a physical examination of the genitalia. Which information should a nurse give a client scheduled for her first Pap test to improve the accuracy of the test? a) Lie supine during the examination b) Drink plenty of water and ensure a full bladder c) Place the hands behind and over the head d) Avoid douching 48 hours before the examination

d) Avoid douching 48 hours before the examination The nurse should ask the client to avoid douching 48 hours before the examination. The nurse should ask the client to urinate before the examination so that she does not experience bladder discomfort. The client is helped by the nurse into a dorsal lithotomy position, which is a supine position with the feet in the stirrups. The client's head and shoulders may be elevated to allow the nurse to maintain eye contact with the client. The client should be asked not to place the hands over the head as this tightens the abdominal muscles

In an interview with a client, the client tells the nurse that she is currently taking estrogen replacement therapy. The nurse should mention which of the following conditions that this therapy is a risk factor for? Select all that apply. a) Colorectal cancer b) Diabetes mellitus c) Hemorrhoids d) Breast cancer e) Yeast infections

d) Breast cancer, e) Yeast infections Undergoing estrogen therapy (ET) alone sometimes alleviates the symptoms of menopause. However, estrogen has been linked to some types of cancer (i.e., breast, endometrial) and it increases the glycogen content in vaginal secretions, predisposing clients to yeast infections. In women who use ET alone, there does not seem to be any effect on the risk of colorectal cancer. There is no known link between ET and hemorrhoids or diabetes mellitus.

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? a) Kidney stones b) Sexually transmitted diseases c) Heart disease d) Diabetes mellitus

d) Diabetes mellitus 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.

How should the normal cervix feel to the nurse's fingers? Select all that apply a) Immobile b) Soft c) Hard d) Firm e) Round

d) Firm, b) Soft, e) Round The normal cervix should feel firm and soft (like the tip of the nose). It is rounded and can be moved slightly form side to side without tenderness. A hard, immobile cervix may indicate cancer.

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? a) Trichomoniasis b) Lice infestation c) Urethritis d) Gonorrhea

d) Gonorrhea 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.

A nurse inspects the genitalia of an elderly client and notices that the mucosa is dry and atrophied. The nurse should educate the client about her increased risk of what condition? a) Vaginal bleeding b) Incontinence c) Straining to urinate d) Infection

d) Infection The older client is more susceptible to vaginal infection because of atrophy of the vaginal mucosa associated with aging. Incontinence and difficulty urinating may be signs of infection or a sexually transmitted disease. Vaginal bleeding may indicate a more serious condition such as endometrial or cervical cancer.

A nurse is describing some of the complications of sexually transmitted diseases (STDs) to a teenaged girl. Which of the following should the nurse mention? Select all that apply a) Scarring and adhesions on the fallopian tubes b) Infertility c) Breast cancer d) Pelvic inflammatory disease e) Ectopic pregnancy

d) Pelvic inflammatory disease, a) Scarring and adhesions on the fallopian tubes, b) Infertility, e) Ectopic pregnancy STDs can increase the client's risk of pelvic inflammatory disease, which leads to scarring and adhesions on the fallopian tubes. Scarred fallopian tubes increase the risk for infertility and ectopic pregnancy. There is no association between STDs and breast cancer.

A nurse is preparing a client for a Pap smear. The nurse knows that the area where 90% of the neoplasms of the lower genital track originate and the area from which cells will be obtained for the Pap smear is which of the following? a) Fallopian tubes b) Fimbriae c) Squamocolumnar junction d) Transformational zone

d) Transformational zone The transformational zone, which is the area created by the migration of the squamocolumnar junction toward the cervical os with maturation or with increased estrogen levels, is the area where 90% of the neoplasms of the lower genital track originate and where cells are obtained for cervical cytology or the Papanicolaou smear (Pap test). The squamocolumnar junction is the point where the two types of epithelium meet at the cervical os. The ovum travels from the ovary to the uterus through the fallopian tubes. These 8- to 12-cm long tubes begin near the ovaries and enter the uterus just beneath the fundus. The end of the tube near the ovary has fringe0like extensions called fimbriae

A nurse assesses a 30-year-old client who has never had a Pap test. Which factors should the nurse explain to the client are a risk for cervical cancer? Select all that apply. a) History of Chlamydia infection b) Multiple pregnancies c) Diet rich in folate d) Sexual monogamy e) Diet low in fruits

e) Diet low in fruits, b) Multiple pregnancies, a) History of Chlamydia infection The nurse should inform the client that a diet low in fruits, multiple pregnancies, and a history of Chlamydia infection are possible risk factors for cervical cancer. Sexual monogamy and a diet rich in folate are factors that reduce risk. Multiple sexual partners, especially unprotected sex beginning at a young age, are risk factors for cervical cancer.