Chapter 57: Management of Patients With Female Reproductive Disorders NCLEX

During a routine sports physical examination, the nurse practitioner recommends HPV vaccination for an 11-year-old girl. Which statements by the client's mother demonstrates understanding of HPV vaccinations? A. "I will track follow-up appointments in my smartphone so she receives all three injections." B. "If my daughter is immunized against HPV, she can delay her first scheduled Pap test." C. "This vaccination is not indicated for my son, since boys cannot receive the HPV vaccine." D. "It's nice that she can take this vaccination intranasally, to avoid repeated injections."

A ("I will track follow-up appointments in my smartphone so she receives all three injections." The Centers for Disease Control and Prevention recommends routine vaccination of boys and girls 11-12 years of age, before they become sexually active. The vaccination is administered in three intramuscular doses, with the initial dose followed by a second dose in 2 months and a third dose 6 months after the first dose. Completion of all three doses of the vaccine is important for immunity to develop; it does not replace other strategies important in the prevention of HPV. Women still need recommended cervical cancer screening.)

A 32-year-old client has been diagnosed with an ovarian cyst and asks the nurse, "Should I be worried about cancer?" Which response by the nurse would be most appropriate? A. "Most cysts are benign in younger women, but it's good to have it checked out." B. "Ovarian cysts can be malignant but this is a rare occurrence." C. "Ovarian cysts are just that, cysts and not a cause for concern." D. "Since you don't have any symptoms, the chances of having cancer are really remote."

A ("Most cysts are benign in younger women, but it's good to have it checked out." The risk of malignancy in postmenopausal women is much greater than in premenopausal women, with almost all pelvic masses in premenopausal women being benign. However, although typically benign, the cyst should be evaluated to exclude ovarian cancer. The most appropriate response would be to provide this information to the client but also reinforce her actions to have the cyst evaluated. Telling the client that the cyst is no cause for concern or that ovarian cysts are rarely malignant ignores the client's feelings and does not address the client's concern. The absence of symptoms does not eliminate the possibility of a malignancy. Often, ovarian cancer is difficult to detect and signs and symptoms are vague and nonspecific.)

A client is being treated for trichomoniasis. The client has received instructions about the prescribed drug therapy. The nurse determines that the client needs additional teaching when she states which of the following? A. "My partner will not need any treatment." B. "I might notice a metallic taste in my mouth while I'm taking the drug." C. "I need to take the medication three times a day for a week." D. "I need to avoid drinking any alcohol with this drug."

A ("My partner will not need any treatment." Trichomoniasis is treated with metronidazole. Both partners are treated and receive a one-time loading dose or smaller dose three times a day for a week. The client may experience a transient metallic taste when taking the drug. Client are strongly advised to abstain from alcohol when taking metronidazole because of a possible disulfiram-like reaction.)

Which of the following is a term used to describe excessive menstrual bleeding? A. Menorrhagia B. Metrorrhagia C. Amenorrhea D. Dysmenorrhea

A (Menorrhagia Menorrhagia is excessive menstrual bleeding. Amenorrhea is the absence of menses. Dysmenorrhea is painful menses. Metrorrhagia is excessive and prolonged menstrual bleeding.)

Which of the following is the preferred medication for bacterial vaginosis? A. Metronidazole B. Gyne-Lotrimin C. Terazol D. Monistat

A (Metronidazole The preferred medication for treatment of bacterial vaginosis is metronidazole 500 mg twice daily for seven days. Monistat, Gyne-Lotrimin, and Terazol are used in the management of candidiasis.)

A client is diagnosed with polycystic ovarian syndrome. Which of the following findings would the nurse expect to assess? Select all that apply. A. Impaired glucose tolerance B. Emaciated appearance C. Sleep apnea D. Menorrhagia E. Hirsutism

A, C, E (- Hirsutism - Impaired glucose tolerance - Sleep apnea Polycystic ovarian syndrome is associated with obesity, insulin resistance, impaired glucose tolerance, dyslipidemia, sleep apnea, and infertlity. In addition, menstrual periods may be irregular. Menorrhagia (excessive bleeding) is more commonly associated with fibroids.)

A client has been diagnosed with genital herpes. Knowing that education is an essential part of nursing care of the client with a genital herpes infection, the nurse plans to include which method(s) to minimize HIV transmission? Select all that apply. A. Avoiding multiple sexual partners B. Avoiding physical contact with others in crowded places C. Avoiding HPV vaccinations D. Avoiding IV drug use E. Avoiding unprotected sexual intercourse

A, D, E (- Avoiding unprotected sexual intercourse - Avoiding multiple sexual partners - Avoiding IV drug use Explanation: Intravenous drug use and risky sexual behaviors, which include multiple partners and unprotected sex, are factors that can put anybody at risk for HIV. Thus, the correct way to minimize HIV transmission would be to avoid these factors. HIV is not transmitted through simple physical contact. Open lesions related to HPV increase the likelihood that HIV can be transmitted; prevention includes administration of the HPV vaccine.)

Which statement by the nurse demonstrates effective communication techniques when initiating a discussion about sex with a 25-year-old female client? A. "Do you know how to properly apply a male condom?" B. "What questions do you have related to your sexual health?" C. "Have you had sex with more than one partner?" D. "Why didn't you start receiving annual Pap tests at an earlier age?"

B ("What questions do you have related to your sexual health?" Therapeutic communication techniques include a nonjudgmental attitude, use of open-ended questions, and allowing the client to lead the discussion. Educational counseling and role playing may be helpful. "Why" statements immediately place the client in a defensive position that may block communication.)

A client with challenging menopausal symptoms has discussed treatment options with the physician and now has some questions for the nurse. The client asks, "What are the potential risks of hormone replacement therapy?" What is the best answer? A. Heart disease B. All options are correct. C. Breast cancer D. Stroke (CVA)

B (All options are correct. In using hormonal replacement therapy, the risks of breast cancer and the seriousness of future myocardial infarction and stroke may outweigh the potential benefit of alleviating symptoms associated with menopause. The Women's Health Initiative study revealed an increase in breast cancer, blood clots, stroke, and heart disease in postmenopausal women taking HRT.)

Which of the following is the most effective treatment for trichomoniasis? A. Clindamycin (Cleocin) B. Metronidazole (Flagyl) C. Miconazole (Monistat) D. Clotrimazole (Gyne-Lotrimin)

B (Metronidazole The most effective treatment for trichomoniasis is metronidazole. Miconazole, clindamycin, and clotrimazole are not the most effective treatment for trichomoniasis.)

While caring for a patient who is being treated for severe pelvic inflammatory disease (PID), which of the following nursing actions minimizes transmission of infection? A. Keeping the patient in a sitting position B. Performing hand hygiene when entering the room C. Strictly adhering to the no visitation policy D. Implementing reverse isolation precautions

B (Performing hand hygiene when entering the room While caring for a client hospitalized with PID, the nurse has to reduce the risk of the spread of pathogenic microorganisms. Meticulous hand hygiene minimizes the transmission of infection. There is no reason to restrict visitors in this situation; however, visitors need to be educated in proper hand hygiene. Reverse isolation is not indicated for this client. A sitting position will not aid in preventing nosocomial infections.)

Which STD seems to accelerate in HIV-positive clients? A. Herpes B. Syphilis C. Trichomoniasis D. Gonorrhea

B (Syphilis seems to accelerate in HIV-positive clients and proceeds directly from primary to tertiary disease in some clients. Chlamydia is associated with a high risk of HIV.)

Which of the following would be most important to determine when assessing a client being admitted for suspected toxic shock syndrome (TSS)? A. Existence of menorrhagia B. Use of superabsorbent tampons C. Use of oral contraceptives D. Psychological trauma

B (Use of superabsorbent tampons TSS is commonly associated with the use of superabsorbent tampons that are not changed frequently and internal contraceptives that remain in place longer than necessary. Assessing the use of oral contraceptives, psychological trauma, or menorrhagia is not required for diagnosing the cause of TSS.)

The nurse is obtaining the history from a client who is suspected of having pelvic inflammatory disease (PID). Which client statement would help support the suspicion of PID? A. "I haven't had sex with anyone else except my current partner." B. "My partner and I use condoms during sexual intercourse." C. "I was 15 years old when I first had sex." D. "I've never had any sexually transmitted infection."

C ("I was 15 years old when I first had sex." Risk factors for PID include early age at first intercourse, mutliple sexual partners, frequent intercourse, intercourse without condoms, sex with a partner with a sexually transmitted infection, and a history of sexually transmitted infections or previous pelvic infections. Therefore, the statement about being 15 years old when the client first had sex suggest the presence of a risk factor that would support the suspicion of PID.)

A client reports loss of interest in sexual relations and discomfort during intercourse. Which is the best response by the nurse? A. "You need to discuss this with your spouse." B. "Hormone replacement therapy can resolve your symptoms." C. "These are normal, manageable symptoms of menopause." D. "Don't worry, every woman goes through this."

C ("These are normal, manageable symptoms of menopause." Diminished libido and/or dyspareunia are common symptoms associated with perimenopause. Explaining that this can be a normal finding may help to alleviate worries for the client and provide hope for management of the symptoms. The nurse should avoid telling a client "not to worry" or "talk to someone else" because these can negate client feelings and shut down communication. HRT may not be recommended for this client.)

A patient reports to the nurse that she has a sense of pelvic pressure and urinary problems such as incontinence, frequency, and urgency. The problem has gotten much worse since the birth of her third child. What does the nurse suspect the patient is experiencing? A. An enterocele B. A urinary tract infection C. A cystocele D. A rectocele

C (A cystocele Cystocele is a downward displacement of the bladder toward the vaginal orifice (Fig. 57-3) from damage to the anterior vaginal support structures. It usually results from injury and strain during childbirth. Because a cystocele causes the anterior vaginal wall to bulge downward, the patient may report a sense of pelvic pressure and urinary problems such as incontinence, frequency, and urgency. Back pain and pelvic pain may occur as well. The symptoms of rectocele resemble those of cystocele, with one exception: Instead of urinary symptoms, patients may experience rectal pressure. Constipation, uncontrollable gas, and fecal incontinence may occur in patients with complete tears.)

The nurse is collecting assessment data on a client who is reporting a vaginal discharge that is cottage cheese-like in appearance. Which pathogen is the most likely cause for this symptom? A. Trichomonas vaginalis B. Gardnerella vaginalis C. Candida albicans D. Gonococci

C (Candida albicans is a yeast infection that presents with a thick, curdy white discharge. Gonococcus is the organism that causes gonorrhea and presents with a yellow, mucopurulent discharge. Trichomonas vaginalis presents with a foamy, white, foul-smelling discharge and Gardnerella vaginalis is a watery, fishy-smelling discharge.)

A nurse practitioner examines a patient suspected of having endometriosis. The nurse knows that although a definitive diagnosis could not be made without diagnostic treatment (transvaginal ultrasound), the most frequent symptom is: A. Dyspareunia. B. Low back pain. C. Chronic pelvic pain. D. Dysuria.

C (Chronic pelvic pain is the most frequent symptom of endometriosis. Low back pain, dyspareunia, dysuria, dyschezia, dysmenorrhea, and menorrhagia are among the common complaints. The level of pain associated with endometriosis is not necessarily correlated with the stage of endometriosis.)

A client, age 42, visits the gynecologist. After examining the client, the physician suspects cervical cancer. The nurse reviews the client's history for risk factors for this disease. Which history finding is a risk factor for cervical cancer? A. Onset of sporadic sexual activity at age 17. B. Pregnancy complicated with eclampsia at age 27. C. Human papillomavirus infection at age 32. D. Spontaneous abortion at age 19

C (Human papillomavirus infection at age 32. Like other viral and bacterial venereal infections, human papillomavirus is a risk factor for cervical cancer. Other risk factors for this disease include frequent sexual intercourse before age 20, multiple sex partners, and multiple pregnancies. A spontaneous abortion and pregnancy complicated by eclampsia aren't risk factors for cervical cancer.)

Which abnormality is not considered a structural abnormality? A. Vaginal fistulas B. Pelvic organ prolapse C. Pelvic inflammatory disease D. Endometriosis

C (Pelvic inflammatory disease is an infection of the pelvic organs other than the uterus. These include the ovaries, fallopian tubes, pelvic vascular system, and pelvic supporting structures. Endometriosis is a condition in which tissue with a cellular structure and function resembling that of the endometrium is found outside the uterus. The atypical locations for endometrial tissue include the ovaries, the pelvic cavity, and occasionally the abdominal cavity. A fistula is an unnatural opening between two structures. The opening may be between a ureter and the vagina, between the bladder and the vagina, or between the rectum and the vagina. The term prolapse indicates a structural protrusion. Women experience any number of problems of this nature in the vagina. They include cystocele, rectocele, enterocele, and uterine prolapse.)

A patient has been diagnosed with a vaginal infection and received a prescription for metronidazole (Flagyl). The nurse knows that this is the recommended treatment for a vaginal infection caused by what organism? A. Escherichia coli B. Candida albicans C. Trichomonas vaginalis D. Streptococcus

C (Trichomonas vaginalis The most effective treatment for trichomoniasis is metronidazole or tinidazole (Tindamax). Both partners receive a one-time loading dose or a smaller dose three times a day for 1 week (CDC, 2010a).)

A client who wishes to preserve childbearing asks the nurse to explain how taking oral contraceptives will work in the management of endometriosis. Which is the best response by the nurse? A. "Trapping blood causes less pain or discomfort for clients with endometriosis." B. "Endometriosis is usually cured with surgical menopause." C. "Contraceptives will allow blood to be diverted to the peritoneal cavity." D. "Symptoms of endometriosis are increased during normal menstrual cycle."

D ("Symptoms of endometriosis are increased during normal menstrual cycle." The use of estrogen-progestin contraceptives keeps the client in a non bleeding phase of the menstrual cycle, therefore decreasing ectopic tissue from shedding and causing extra uterine bleeding. Blood that is trapped in the peritoneal cavity causes more pain as adhesions form. Endometriosis is cured by natural or surgical menopause but can be medically managed for periods of time with the use of oral contraceptives.)

A client has undergone a total abdominal hysterectomy and bilateral salpingo-oopherectomy as treatment for endometrial cancer. When providing postoperative care to this client the nurse would be alert for signs and symptoms of which of the following? A. Neurotoxicity B. Clotting deficiencies C. Leukopenia D. Bladder dysfunction

D (Bladder dysfunction After a total abdominal hysterectomy and bilateral salpingo-oopherectomy, the client is at risk for several complications, especially bladder dysfunction because the surgical site is close to the bladder. Leukopenia and neurotoxicity are adverse effects of chemotherapy agents such as paclitaxel and carboplatin used to treat ovarian cancer. Deep vein thrombosis, not clotting deficiencies are a potential complication after this type of surgery.)

A woman in her late 30s has been having unusually heavy menstrual periods combined with occasional urine and stool leakage over the past few weeks. Upon further enquiry, she reveals that she also has postcoital pain and bleeding. To which diagnosis will the investigation most likely lead? A. Hodgkin disease B. Colorectal cancer C. Cancer of the urinary tract D. Cervical cancer

D (Cervical cancer The client's symptoms are those of cervical cancer. Symptoms of cervical cancer include abnormal vaginal bleeding and persistent yellowish, blood-tinged, or foul-smelling discharge. Clients may complain of postcoital pain and bleeding, bleeding between menstrual periods, and unusually heavy menstrual periods. If the cancer has progressed into the pelvic wall, the Clients may experience pain in the flank regions of the body.)

Which of the following is the descent of the small intestine into the vaginal vault? A. Cystocele B. Uterine prolapse C. Rectocele D. Enterocele

D (Enterocele The descent of the small intestine into the vaginal vault is termed enterocele. A rectocele is the extrusion of the rectum into the posterior vagina. A cystocele is the herniation of the bladder into the anterior vagina. A uterine prolapsed is the downward descent of the uterus into the vagina.)

A patient is receiving chemotherapy with paclitaxel as treatment for ovarian cancer. The patient arrives at the facility for laboratory testing prior to her next dose of chemotherapy. The results are as follows: Hemoglobin: 12.9 gm/dL White blood cell count: 2,200 /cu mm Platelets: 250,000 /cu mm Red blood cell count: 4,400,00/cu mm Which result would be a cause for concern? A. Hemglobin level B. Platelet count C. Red blood cell count D. White blood cell count

D (The patient's white blood cell count is low, revealing leukopenia and placing the patient at an increased risk for infection. The other results are within normal parameters and would not be a cause for concern.)

A female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client? A. The potential for transmission to her sexual partner will be eliminated if condoms are used every time she and her partner have sexual intercourse. B. The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days. C. The human papillomavirus (HPV), which causes condylomata acuminata, can't be transmitted during oral sex. D. This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually.

D (This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually. Women with condylomata acuminata are at risk for cancer of the cervix and vulva. Yearly Pap smears are very important for early detection. Because condylomata acuminata is a virus, there is no permanent cure. Because condylomata acuminata can occur on the vulva, a condom won't protect sexual partners. HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx.)

While caring for a client who is being treated for severe pelvic inflammatory disease (PID), the nurse insists on keeping her in a semisitting position. What would be the best possible reason for the nurse's advice? A. To prevent nosocomial infections to other clients B. To facilitate easy distraction of the client C. To prevent movement as it increases pain D. To facilitate pelvic drainage and to minimize the upward extension of infection

D (To facilitate pelvic drainage and minimize the upward extension of infection. While caring for a client hospitalized with PID, the nurse has to reduce the risk of the systemic spread of pathogenic microorganisms. The nurse also has to monitor the symptoms in order to detect, manage, and minimize sepsis if it occurs. The client must also be advised to keep her upper body elevated. This facilitates pelvic drainage and minimizes the upward extension of infection. This position will not aid in the prevention of nosocomial infections, decrease pain, nor easily distract the client.)

A nurse is reviewing a client's medical history. Which factor indicates the client is at risk for candidiasis? A. Nulliparity B. Menopause C. Use of spermicidal jelly D. Use of corticosteroids

D (Use of corticosteroids A small quantity of the fungus Candida albicans commonly exists in the vagina. Because corticosteroids decrease host defense, they increase the risk of candidiasis. Candidiasis is rare before menarche and after menopause. Using hormonal contraceptives, not spermicidal jelly, and pregnancy, not nulliparity, increase the risk of candidiasis.)

A nurse who works in a gynecologist's office frequently cares for patients who are diagnosed with vulvovaginal candidiasis. The nurse should teach the patients how to manage and treat the most common symptom of: A. Dyspareunia. B. Dysuria. C. Vaginal pain. D. Vulvar pruritus.

D (Vulvar pruritus is the chief complaint of those diagnosed with candidiasis.)

A patient with HIV has recently completed a 7-day regimen of use of antibiotics. She reports vaginal itching and irritation. In addition, the patient has a white, cottage cheese-like vaginal discharge. Which of the following is the patient most likely suffering? A. Human papillomavirus (HPV) B. Trichomonas vaginalis C. Bacterial vaginosis D. Vulvovaginal candidiasis

D (Vulvovaginal candidiasis Use of antibiotics decreases bacteria, thereby altering the natural protective organisms usually present in the vagina, which can lead to candidiasis overgrowth. Clinical manifestations include a vaginal discharge that causes pruritus; the discharge may be watery or thick but usually has a white, cheeselike appearance. Bacterial vaginosis does not produce local discomfort or pain. Discharge, if noticed, is heavier than normal and is gray to yellowish white. Most HPV infections are self-limiting and without symptoms.)