Chapter 42. Nursing Care of Women With Reproductive System Disorders

The nurse is caring for a client who has been in menopause for 6 years. The client reports vaginal bleeding. Which response by the nurse is most appropriate? 1. "You need to contact your health-care provider (HCP) to look into this further." 2. "Bleeding may occur off and on throughout menopause." 3. "If you take oral contraceptives, you won't bleed anymore." 4. "There is no reason to be concerned; sometimes bleeding occurs."

1. "You need to contact your health-care provider (HCP) to look into this further." Periods cease during menopause. The spontaneous bleeding could be cancer, so there may be a cause for concern.

The nurse is teaching a client about breast self-examination (BSE). When should the nurse instruct the client to perform the exam? 1. 1 week after menses 2. First day of menses 3. 1 week before menses 4. Last day of menses

1. 1 week after menses 1 week after menses is the optimal time to perform a BSE because breast tissue is no longer swollen.

A female patient approaching menopause asks about the use of hormone replacement therapy. Which findings from a study on hormone replacement therapy should the nurse explain to the patient?

An increase in heart attacks A reduction in total fractures A decrease in colorectal cancer An increase in thromboembolism

The nurse is caring for a woman who has just had an uncomplicated abortion. What instructions should the nurse provide?

Call if you bleed for more than 3 days. Call if you have more bleeding than you would during a heavy period. You should abstain from sexual intercourse as directed by your physician.

The nurse is assisting in the development of a program to instruct female high school students on ways to prevent the development of toxic shock syndrome. What should the nurse include in this program?

Change tampons every 4 hours. Wash hands before inserting a new tampon Use sanitary pads instead of tampons overnight when menstruating.

A patient is being seen for the urinary bladder sagging into the vagina. How should the nurse document this health problem?

Cystocele

The nurse is assisting with a community education class on breast cancer prevention. Which risk factors should the nurse include in this training?

High-fat diet and alcohol intake

The nurse is preparing a presentation to educate the community about mammograms. Which of the following should the nurse include in the teaching? 1. Women age 45 to 54 should receive a mammogram every year. 2. Women ages 40 to 44 should not begin early mammograms. 3. Mammograms are no longer recommended. 4. Women ages 55 and older can stop receiving mammograms.

Women age 45 to 54 should receive a mammogram every year.

A patient is scheduled for a hysterectomy and bilateral salpingo-oophorectomy. She asks what this means. How should the nurse respond?

You are going to have your uterus, fallopian tubes, and ovaries removed.

A 50-year-old woman states, It is such a relief not to need birth control any more. I havent had a period in 3 months. How should the nurse respond?

You may still be fertile for several months after your last period. You should consult with your physician to know when to stop using birth control.

A woman tells the nurse, I am having terrible pain with my period. This has never happened before. What should I do? What is the best response by the nurse?

You should notify your doctor if this is a new experience for you.

The nurse is assisting a new mother who returns to a clinic for a 6-week visit. What instructions about birth control should the nurse provide?

You should plan to use birth control; breastfeeding is not a reliable form of contraception.

risk factor for receiving hormone replacement therapy (HRT)

breast cancer. Stoke Heart disease

Symptoms of PMS

-Fatigue and headaches -Swelling and tenderness of breasts -Joint discomfort -Water retention

The nurse is caring for a client about to undergo an endoscopic examination. Which of the following interventions should the nurse implement before the procedure? Select all that apply. 1. Ask the client when she last ate. 2. Assess vital signs. 3. Ask the client when the last void was. 4. Obtain consent for the procedure. 5. Assist the client into a gown.

1. Ask the client when she last ate. 2. Assess vital signs. 3. Ask the client when the last void was. 5. Assist the client into a gown.

A client asks the nurse about the difference between premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Which clinical manifestations set PMDD apart from PMS? 1. Depression 2. Headaches 3. Joint discomfort 4. Water retention

1. Depression

. A client reports dimpling of the breast tissue. Which of the following actions should the nurse take? 1. Notify the health-care provider (HCP). 2. Document the finding as normal. 3. Instruct the client to monitor for further changes. 4. Send the client for a mammogram.

1. Notify the health-care provider (HCP).

The nurse is caring for a client about to undergo a tubal ligation. The client has signed the consent but tells the nurse they aren't sure they want to have the procedure. Which action should the nurse take? 1. Notify the health-care provider immediately. 2. Assure the client that apprehension is normal. 3. Call the operating room (OR) and cancel the surgery. 4. Prepare the client for the procedure.

1. Notify the health-care provider immediately.

The nurse is caring for a client with mastitis. Which clinical manifestations can the nurse expect to find? Select all that apply. 1. Swelling 2. Cool skin 3. Redness 4. Pain 5. Lumps

1. Swelling 3. Redness 4. Pain

The nurse is caring for a client who underwent a total hysterectomy with bilateral salpingo-oophrectomy. Which of the following should the nurse expect to find? 1. Symptoms of menopause 2. Heavy bleeding for 2 weeks 3. Monthly symptoms of menses with no bleeding 4. Painful sexual intercourse for 1 year

1. Symptoms of menopause The client has no ovaries, uterus, or fallopian tubes. Menopause will occur.

A client asks the nurse what causes menstrual abnormalities. Which of the following should the nurse include in her explanation? Select all that apply. 1. Tumors 2. Stress 3. Pregnancy 4. Obesity 5. Age

1. Tumors 2. Stress 3. Pregnancy 4. Obesity

The nurse is caring for a client receiving miconazole (Monistat) for a yeast infection. Which statement made by the client requires correction by the nurse? 1. "I need to wash the single-use applicator with soap and hot water after use." 2. "When I am no longer itching, I can quit doing the treatment." 3. "I will fill the applicator and insert it into my vagina." 4. "If I have a change in symptoms, I should tell the health-care provider (HCP)."

2. "When I am no longer itching, I can quit doing the treatment." -This requires correction; even when symptoms subside, the client should continue treatment.

The nurse is caring for a group of clients. Which client is at highest risk for developing mastitis? 1. A client who takes hormones for menopause 2. A client who is breastfeeding 3. A client who has a history of breast cancer 4. A client who had a breast biopsy 2 months ago

2. A client who is breastfeeding

A client informs the nurse they have been diagnosed with a decrease in estrogen production and asks about the typical symptoms. Which of the following symptoms should the nurse discuss? Select all that apply. 1. Decreased cholesterol 2. Bone loss 3. Muscle cramps 4. Urinary incontinence 5. Breast swelling

2. Bone loss 4. Urinary incontinence

The nurse is caring for a client who underwent an endoscopic procedure. Which of the following warrants a phone call to the health-care provider? 1. Mild discomfort 2. Bright red bleeding 3. Blood pressure 114/74 4. Groggy

2. Bright red bleeding

A client is undergoing a Papanicolaou (Pap) smear. Which of the following instructions should the nurse provide? 1. Heavy bleeding is normal after this procedure. 2. If the results are abnormal, further testing will be performed. 3. The client should expect to have pain for 3 days after the procedure. 4. Abnormal results are indicative of cervical cancer.

2. If the results are abnormal, further testing will be performed.

The nurse is caring for a client with candida albicans. Which of the following describes the discharge the nurse can expect to find? 1. Gray, foul-smelling 2. White, cottage cheese-like 3. Frothy and foul-smelling 4. Watery yellow

2. White, cottage cheese-like

The nurse is caring for a client who has an allergy to dye and iodine. Which order should the nurse question? 1. An ultrasound 2. A hysterosalpingogram 3. A Papanicolaou (Pap) smear 4. A cervical biopsy

2. A hysterosalpingogram -it involves injection of dye.

A health care provider (HCP) is anticipating the use of RU-486 to provide a chemically induced abortion for a patient. What information should the nurse obtain from the patient before this medication is provided?

Date of the first day of the patients last period

The nurse is weighing the perineal pads of a patient bleeding after having an abortion. The weight of one pad increased in weight by 20 grams. How many mL of blood has this patient lost?

20 mL

The nurse is providing teaching to a client with a removable pessary. Which of the following statements made by the client indicates the need for further teaching? 1. "If I have bloody discharge, I should call the health-care provider (HCP)." 2. "I need to come back in a few weeks for a checkup." 3. "I should remove the pessary once per week to clean it." 4. "I may have an increase in vaginal discharge."

3. "I should remove the pessary once per week to clean it." The pessary should be removed every night at bedtime for cleaning.

The nurse is caring for a client with premenstrual dysphoric disorder (PMDD). Which statement made by the client should concern the nurse? 1. "I started walking 20 minutes every day." 2. "I have been eating more vegetables and fruits lately." 3. "I take double the amount of vitamins I used to." 4. "I took a Tylenol so my cramps feel a little better."

3. "I take double the amount of vitamins I used to." The nurse should notify the health-care provider because high doses of some vitamins can lead to physiological damage.

The nurse is providing teaching for a client with fibrocystic breast disease. Which statement made by the client indicates a need for further teaching? 1. "I should take Tylenol for discomfort." 2. "I should try to lower my fat intake." 3. "Increasing my caffeine intake will reduce discomfort." 4. "It may be more difficult for me to feel early cancerous lumps."

3. "Increasing my caffeine intake will reduce discomfort." -Reducing caffeine intake will reduce discomfort.

The nurse is teaching a client about a lumpectomy. Which statement made by the client indicates an understanding of the teaching? 1. "I will have to have my whole breast taken off." 2. "I will have all the muscle and lymph nodes removed." 3. "The doctor is just going to remove the tumor." 4. "The surgeon is removing part of the breast."

3. "The doctor is just going to remove the tumor."

The nurse is caring for a female client who has been experiencing difficulty conceiving due to a past sexually transmitted infection. The client is upset, crying, and states, "It is all my fault we can't get pregnant." Which response by the nurse is best? 1. "It will be okay. You can always adopt a child." 2. "Don't be upset. You can't change the past." 3. "You seem upset. Tell me more about how you are feeling." 4. "It's not your fault. Maybe your husband can't get you pregnant either."

3. "You seem upset. Tell me more about how you are feeling."

The nurse is caring for a group of clients. Which client is at highest risk for breast cancer? 1. A client who entered menopause at age 50 2. A client who had their first pregnancy at 22 3. A client who had ovarian cancer 10 years ago 4. A client who had their first menses at age 15

3. A client who had ovarian cancer 10 years ago

The nurse is caring for a client with cyclic breast discomfort. Which intervention should the nurse implement? 1. Encourage the client to schedule a mammogram. 2. Prepare the client for a biopsy. 3. Administer acetaminophen (Tylenol) as ordered. 4. Encourage the client to wear a loose-fitting bra.

3. Administer acetaminophen (Tylenol) as ordered.

The nurse is caring for a client who reports their mother, aunt, and sister have all had breast cancer. The nurse should educate the client about which test? 1. PSA 2. FSH 3. BRCA1 4. LH

3. BRCA1 This gene tests for breast cancer risk. If the gene is positive, they can undergo preventive treatment.

The nurse is taking a medication history on a client taking norethindrone acetate and ethinyl estradiol (Loestrin). For which medication taken by the client should the nurse provide education about a back-up method of birth control? 1. Metformin (Glucophage) 2. Furosemide (Lasix) 3. Clindamycin (Cleocin) 4. Atenolol (Tenormin)

3. Clindamycin (Cleocin) - The nurse should teach a client about use of an alternative birth control method while the client is taking an antibiotic; antibiotics decrease the effectiveness of oral contraceptives.

The nurse is caring for a client who underwent an abortion. Which of the following warrants notification of the health-care provider (HCP)? 1. Blood pressure 120/76 2. Temperature 98.7 3. Clots larger than a quarter 4. Odorless discharge

3. Clots larger than a quarter

Estrogen therapy alone is indicated for women who have undergone which of the following? 1. Appendectomy 2. Mastectomy 3. Hysterectomy 4. Thyroidectomy

3. Hysterectomy

The nurse is caring for a client receiving ketorolac (Toradol). Which of the following should the nurse consider before administering the medication? 1. Review current potassium level. 2. Assess for a cephalosporin allergy. 3. Only administer ketorolac for chronic pain. 4. Avoid use in clients taking anticoagulants.

4. Avoid use in clients taking anticoagulants. -Clients taking anticoagulants are at a higher risk of bleeding when taking ketorolac.

The nurse is caring for a client who is in perimenopause. Which clinical manifestations can the nurse expect to find? 1. pH shift toward acidity 2. Intolerance to cold 3. Regular menses 4. Decrease in natural lubrication

4. Decrease in natural lubrication Option 1: pH will shift toward alkalinity. Option 2: The client may experience hot flashes, not an intolerance to cold. Option 3: Menses become irregular.

. The nurse is preparing to assist the health-care provider with a pelvic exam. Which interventions should the nurse implement? 1. Cool the speculum by placing it under cold water. 2. Place the client in left side-lying position. 3. Instruct the client to hold their breath as the speculum is inserted. 4. Encourage the client to empty the bladder before the procedure.

4. Encourage the client to empty the bladder before the procedure.

The nurse is caring for a client receiving hormone replacement therapy (HRT). This treatment places the client at risk for which of the following conditions? 1. Liver failure 2. Kidney disease 3. Lung cancer 4. Stroke

4. Stroke

The nurse is reviewing the health histories of several patients scheduled for appointments in the health clinic. Which patient should the nurse recognize as being predisposed to developing a vaginal yeast infection?

A 28-year-old woman who sits at a desk 5 days a week

A female patient has just learned that she is infertile. She says, All I ever wanted in life was to have a baby. My life is over. What is the best response by the nurse?

A baby must have been very important to you. When you feel ready, we can talk about other alternatives.

A female patient is diagnosed with mild uterine prolapse into the vagina. For which areas should the nurse prepare to reinforce teaching to help this patient?

Avoid weight gain Take care of the pessary Consume a healthy diet Perform Kegel exercises

A patient comes to an outpatient clinic because of premenstrual syndrome (PMS) symptoms. What advice from the nurse may help her reduce her symptoms?

Avoidance of alcohol and caffeine may help reduce your discomfort.

A 16-year-old girl is admitted to the hospital with toxic shock syndrome (TSS). Which action by the nurse should take priority?

Determine what the girl understands about risk factors for TSS.

A female patient asks what can be done to reduce symptoms associated with menopause. What should the nurse suggest to this patient?

Eat a healthy diet. Dress in layers so clothing can be removed. Reduce intake of caffeine, sugar, and alcohol.

The nurse is providing care for a patient after a hysterectomy. Which interventions are appropriate to prevent constipation?

Encourage ambulation. Increase oral fluid intake Provide a high-fiber diet Provide stool softener as ordered.

The nurse is providing care for a woman experiencing premenstrual syndrome (PMS). Which nursing actions should be included in the plan of care?

Encourage the client to stop smoking. Teach client to limit alcohol consumption. Encourage the client to develop a regular exercise regimen.

The nurse notes that a female patient has been treated for vaginal yeast infections 6 times in one year. For which additional health problem should the nurse suspect the patient should be evaluated?

HIV

Nursing care for a client with mastitis.

Heat should be applied to the breast. A supportive bra is recommended. Cleocin is used to treat mastitis. NSAIDs are used for discomfort in cases of mastitis. Teach to continue breastfeeding Breastfeed as often as needed Good hand hygiene

The nurse enters the room of a patient with a new mastectomy and finds her crying. After confirming that the patient is crying because of the loss of her breast, which response by the nurse is best?

How have you coped with other problems in your life? Do you have someone you can talk to?

The nurse is teaching a patient how to use a daily vaginal suppository. Which statement indicates that teaching has been effective?

I should put the suppository in at night after I get into bed.

The nurse is providing care for a woman with trichomoniasis who is being treated with metronidazole (Flagyl). Which patient statements indicate that teaching has been effective?

I should take this medication until the symptoms are gone. I may have some vaginal dryness while taking this medication. My partner should see a physician for treatment as well. Drinking alcohol while taking this medication will cause nausea and vomiting.

A patient is diagnosed with polycystic ovary syndrome. When preparing teaching for this patient, which hormone should the nurse explain as being too abundant in the patients body?

Insulin

A 42-year-old woman is tearful after a hysterectomy. What information should the nurse use to respond appropriately to the patient?

Loss of reproduction function may cause grieving.

The nurse is assessing a patient after a mastectomy and thinks the patients affected arm appears swollen. What is the best way to verify this finding?

Measure and compare the circumferences of both arms.

A patient reports long, heavy, irregular menses accompanied by headache and back pain for the past several months. How should the nurse document these symptoms?

Menometrorrhagia

The nurse is caring for a patient with primary dysmenorrhea. Which medication should the nurse anticipate being prescribed because it blocks prostaglandin synthesis?

NSAIDs

A patient at a walk-in clinic requests oral contraceptives (OCs) because she heard they can prevent sexually transmitted infections (STI). What information should the nurse use to base a response to this patient?

Not enough research has been done to prove that OCs can prevent STIs.

A patient must prevent pregnancy while receiving chemotherapy that could harm a fetus. About which type of birth control should the nurse anticipate teaching the patient?

Oral contraceptive

The nurse is caring for a patient who had a left mastectomy earlier in the day and informs the nurse of several concerns. Which should the nurse attend to first?

Pain level of is 7 on a 0-to-10 scale.

The nurse is caring for a patient recovering from a hysterectomy earlier in the day. Four hours later, the woman is unable to urinate. What assessment should the nurse use to determine bladder distention and be comfortable for the patient?

Perform a scratch test.

A patient is seen in a clinic for contact vaginitis. What information from her history helps the nurse to plan teaching for the patient?

She takes bubble baths every night.

The nurse is concerned that a female patient is at risk for developing cervical cancer. What risk factors for cervical cancer did the nurse assess in the patient?

Smoking Having multiple sexual partners Being infected with herpes simplex virus type II Being infected with human papillomavirus

After collecting data the nurse suspects that a young female patient is experiencing manifestations of toxic shock syndrome. What findings did the nurse use to make this decision?

Sore throat Skin peeling Red palm and soles of feet Muscle pain and weakness

The nurse is assisting with teaching a woman who is having difficulty conceiving. What instruction should the nurse provide about keeping a basal body temperature chart?

Starting with the first day of your period, record your temperature first thing each morning.

The nurse is assisting with teaching a patient who has been placed on metronidazole (Flagyl) for bacterial vaginosis. What instruction by the nurse is appropriate?

Take the Flagyl as prescribed, even if your symptoms are gone.

The nurse is caring for a patient who had a mastectomy for breast cancer 2 days ago and is now developing pulmonary congestion. Why is a mastectomy patient at risk for pulmonary complications?

The chest incision makes the patient hesitant to deep breathe and cough.

The nurse is assisting in the preparation of an educational seminar about breast pathology. What characteristics of cancerous breast lesions should the nurse include in this teaching?

They tend to be harder. They tend to be less mobile. They tend to be more irregularly shaped.

An adolescent comes into the emergency department requesting the morning-after pill. What should the nurse assess in this patient?

Time of intercourse

A patient who is 6 weeks pregnant is contemplating having an abortion. What methods of abortion should the nurse explain as most commonly used to terminate a pregnancy of less than 14 weeks?

Vacuum suction Menstrual extraction Dilation and curettage (D&C)

The nurse is caring for a patient who is breastfeeding and receiving antibiotics for mastitis. What should be included in the patients teaching?

Wash hands before handling the breast. NSAIDs may be used to help control pain. Wear a bra to support the swollen painful breast. Change the infants feeding position on the breast frequently.

The nurse is teaching a woman with a menstrual disorder how to measure menstrual flow. Which instruction should the nurse include?

Weigh her perineal pads before and after use.

breast cancer risk factors

entered menopause late in life are at high risk for breast cancer. a first pregnancy after age 30 is at a high risk for breast cancer. personal history of cancer has a high risk of breast cancer. receiving hormone replacement therapy (HRT) early menarche is at a high risk for breast cancer. BRUCA gene