Female reproductive cancers
A group of second year nursing students are planning a community function to teach about ovarian cancer for their group project. What should they list as risk-reduction strategies on their poster board? (Check all that apply.) a) breastfeeding b) avoidance of talc and hygiene sprays on genitals c) use of oral contraceptives d) eating high fiber foods e) pregnancy
a, b, c, e: Education is a major focus of nursing care. Risk-reduction strategies for ovarian cancer which the nurse should teach include pregnancy, breastfeeding, use of oral contraceptives, and avoiding talc and hygiene sprays on genitals
A middle-aged woman is seen in the OB/GYN clinic and reports abdominal bloating, fatigue, abdominal pain, urinary frequency, and constipation. She also says that she had lost 24 pounds in the last month without trying to lose. For which disease should the physician screen this patient? a) Ovarian cancer b) Fibroids c) Breast cancer d) Pelvic organ prolapse (POP)
a: The most common early signs for ovarian cancer include abdominal bloating, early satiety, fatigue, vague abdominal pain, urinary frequency, diarrhea or constipation, and unexplained weight loss or gain. Fibroids do not have these same symptoms, nor does breat cancer or POP
A postmenopausal woman is seen in the clinic and reports vaginal bleeding that has lasted for the past 3-4 weeks. A pelvic exam is performed and shows no abnormalites. Which test does the nurse anticipate the physician will order next for this patient? a) endometrial biopsy b) colposcopy c) endoscopy d) colonoscopy
a: The next test to be ordered would be an endometrial biopsy. It can detect up to 90% of cases of endometrial cancer and can be performed in the office without anesthesia. During this test the HCP can obtain a small sample of tissue for pathology. A colposcopy is done when suspecting cervical cnacer. An endoscopy looks at the upper GI tract while the colonoscopy looks at the lower GI tract and some of the upper
A nurse is caring for a 30-year-old woman who was just diagnosed with cervical cancer. Which of the following psychosocial needs would be the priority for the nurse with her client? a) Clear information on the disease, management, and treatment b) Offering words of hope to the client c) Touching the client's hand for comfort d) Remaining cheerful through all of the interactions
a: Women diagnosed with cancer of the reproduction tract need to understand their disease, prognosis, and what treatment options they have. The nurse's role is to educate with effective and clear communication techniques. The nurse should be sincere and may provide realistic hope, but her role as educator is primary
A nurse assesses and suspects vulvar cancer based on which assessment finding? a) Vulvar bleeding b) Vulvar itching that responds to creams c) Fleshy, ulcerated mass on the labia majora d) Dysuria
c: A vulvar lump or mass is most often noted, and it may be fleshy, ulcerated, leukoplakic, or warty. Vulvar itching that does not respond to creams or ointments is a common complaint associated with vulvar cancer. Vulvar bleeding and dysuria may be seen with vulvar cancer but would be uncommon findings.
An elderly woman who has not seen a doctor in 15 years comes to the gynecology (GYN) clinic with complaints of pelvic and back pain, along with weight loss which she attributes to her lack of appetite. She states that she has been very weak and fatigued for the last 12 months and attributes this to depression. What should the nurse expect this patient to be diagnosed with? a) ovarian cancer b) vaginal cancer c) advanced cervical cancer d) endometrial cancer
c: The health care worker should expect advanced cervical cancer in women with pelvic, back, or leg pain, weight loss, anorexia, weakness and fatigue, and fractures.
A woman with ovarian cancer has been told that she is in stage three of the cancer. The nurse is reviewing the information with her. Which of the following statements would help in the woman's understanding of stage three ovarian cancer? a) The growth involves one or both ovaries. b) The cancer is limited to the ovaries. c) The growth has spread to the lymph nodes and other areas/organs in the abdominal cavity. d) The cancer has spread to distant sites.
c: The staging and diagnosis is performed by a laparoscopy. The staging is 1-4. Stage three means the cancer has spread to the lymph nodes and other areas in the abdominal cavity. A five-year survival rate for this stage is 30%-60%
A young woman is seen in the GYN clinic for a follow-up visit and is told that her recent Pap smear has come back abnormal. Which of the following tests can the nurse expect the physician to order for this patient? a) cryotherapy b) colposcopy c) hysterectomy d) colonoscopy
b: A colposcopy is a follow-up exam that is commonly used to identify suspicious cells and obtain a biopsy. A colonoscopy is a test to examine the colon and take samples of tissue. Cryotherapy uses liquid nitrogen to freeze cervical tissue and a hysterectomy is a surgical procedure used to remove the uterus
The nurse is assisting a woman in scheduling an appointment for a Pap smear. The woman's last menstrual period was May 2. Which date would be most appropriate for the appointment? a) May 30 b) May 7 c) May 9 d) May 17
d: A Pap smear should be scheduled about 2 weeks (10 to 18 days) after the first day of the woman's last menstrual period to increase the chance of getting the best sample of cervical cells without menses. In this case, the date would be May 17
A 47-year-old woman was just diagnosed with a cancer of her reproductive tract. The public health nurse is aiding in counseling. Which of the following nursing interventions would be supportive in counseling this woman? Select all that apply. a) Give post-operative care and instructions when prescribed b) Validate the client's feelings and provide realistic hope c) Use sincere basic communication techniques d) Give care based on all woman diagnosed with cancer e) Be judgmental of the women's previous lifestyle
a, b, c: Nursing interventions in caring for women with cancers of the female reproductive tract include the following: Validate the client's feelings and provide realistic hope; use basic communication skills in a caring way; give useful, nonjudgmental information to all women; give individual care for each person; and give discharge and postoperative care when ordered
The nurse is teaching women at a local clinic about vaginal cancer. Which of the following risk factors would be important to include in her presentation? Select all that apply. a) Smoking b) History of HIV c) Persistent ovulation over time d) Having taken any type of hormone replacement therapy for longer than 10 years e) Increasing age
a, b, e: Direct risk factors for vaginal cancer have not been proved. However, risk factors associated with vaginal cancer are as follows: smoking, age greater than 60 years, HIV, vaginal trauma, HPV, cervical cancer, exposure to DES in utero, and pelvic radiation. Use of hormone replacement therapy for longer than 10 years and persistent ovulation are risk factors associated with ovarian cancer
A 25-year-old woman is at the doctor for her annual check-up. The nurse educated the woman on risks for cervical cancer. Which of the following questions would be important to ask as part of a risk screening? a) "Were you sexually active at an early age?" b) "Do you have a history of high blood pressure?" c) "Have you had problems trying to get pregnant?" d) "How long have you been severely overweight?"
a: Women that have a history of sexual activity within the first year of getting their menstrual cycle are at increased risk cervical cancer later in life. Infertility, obesity, and high blood pressure put woman more at risk for endometrial cancer.
A 47-year-old woman was just diagnosed with a cancer of her reproductive tract. The public health nurse is aiding in counseling. Which of the following nursing interventions would be supportive in counseling this woman? Select all that apply. a) Give post-operative care and instructions when prescribed b) Validate the client's feelings and provide realistic hope c) Be judgmental of the women's previous lifestyle d) Give care based on all woman diagnosed with cancer e) Use sincere basic communication techniques
a, b, e: Nursing interventions in caring for women with cancers of the female reproductive tract include the following: Validate the client's feelings and provide realistic hope; use basic communication skills in a caring way; give useful, nonjudgmental information to all women; give individual care for each person; and give discharge and postoperative care when ordered
A nurse is reviewing the symptoms of ovarian cancer with a recently diagnosed 60-year-old woman. Which of the following are common symptoms of ovarian cancer? Select all that apply. a) Abdominal fullness b) Decrease in urination c) Back pain d) Abdominal pressure
a, c, d: Ovarian cancer, the "silent killer", develops slowly. The symptoms usually do not show up until the advanced stages. The most common symptoms are gastrointestinal; therefore women sometimes think stress is the cause and further investigation is not done. Symptoms include urine frequency, constipation, unusual bloating, abdominal fullness, back pain, and abdominal pressure
The women's health clinic nurse is giving a presentation on cancers of the reproductive tract. Which of the following signs and symptoms are abnormal and, if present, should result in notification of a health care provider? Select all that apply. a) Continuous low back pain b) Irregular bowel movements c) Irregular vaginal bleeding d) Increased frequency of urination e) Vulvar lesions of abnormal color that are raised
a, c, e: Abnormal findings that should be reported to the health care provider and could indicate risk of cancer of the reproductive tract are as follows: irregular vaginal bleeding, persistent low backache, and raised or discolored vulvar lesions. Any of these should be reported immediately. Reproductive cancer symptoms do not include urinary frequency and irregular bowel movements
When assessing a woman, which of the following would lead the nurse to suspect cervical cancer? Select all that apply. a) Vaginal bleeding after sexual intercourse b) Pain with vaginal examination c) Postmenopausal bright-red bleeding d) Dysuria e) Malodorous vaginal discharge
a, d, e: Clinically, the first symptom is abnormal vaginal bleeding, usually after sexual intercourse. Other signs and symptoms may include vaginal discomfort, malodorous discharge, and dysuria. Postmenopausal bright-red bleeding and pain during a vaginal examination suggest endometrial cancer
Which of the following risk factors have been linked to ovarian cancers? Select all that apply. a) Gene mutations BRCA-1 and BRCA-2 b) Early menopause c) Very low body weight d) Nulliparity
a, d: An inherited gene mutation (BRAC-1, BRAC-2 ) is linked to ovarian cancer. Other risk factors include nulliparity, obesity, early menarche, late menopause, and a high fat diet, as well as a history of breast and colon cancers
An experienced nurse has just read that women have a one-in-three lifetime risk of developing cancer and becomes concerned that she has provided enough education. What should this nurse do to help prevent deaths from cancer? (Check all that apply.) a) focus on screening b) tell the physcians to do a better job c) there is nothing she can do d) focus on educating all women
a, d: Women do have a one-in-three lifetime risk of developing cancer and one out of every four deaths is from cancer. Therefore, nurses must focus on screening and educating all women regardless of risk factors. The other options are not acceptable
Health clinic nurses are presenting a health fair at a local women's shelter. They are discussing the topic of cervical cancer. Which of the following preventions should be included? Select all that apply. a) Smoking cessation and prohibiting of alcohol consumption b) Maintenance of normal blood pressure and reduction of stress c) Prevention of STIs to decrease risk d) IUD used as a type of contraception e) Encouraging teens to refrain from early sexual activity
a, e: In cervical cancer, high-risk behaviors have been identified as early sexual activity, use of contraception barriers, contracting STIs, and smoking and drinking. Avoidance of these activities is the primary prevention method, along with obtaining the HPV vaccine. Barrier methods, not IUDs, should be used. Avoiding high blood pressure and stress will not prevent cancer
A 24-year-old female patient with a family history of cervical cancer is in the office. For which test should the nurse prepare the client to detect early stages of cervical cancer? a) Papanicolaou test b) Transvaginal ultrasound c) Blood test for mutations in BRCA genes d) Serum CA-125 tests
a: A Papanicolaou (Pap) test should be done regularly to detect the early stages of cervical cancer. The BRCA gene is present in breast and ovarian cancers. Serum CA-125 can be a marker in ovarian cancer at 100%. Transvaginal ultrasound cannot detect early stages
A young woman has been referred for a colposcopy by the health care provider. The nurse is educating the woman on the procedure. Which of the following information about the colposcopy should the nurse provide? a) The results of the Pap smear were abnormal; therefore this procedure must be done. b) Sexual intercourse should be avoided for 2 weeks. c) The procedure may be painful. d) There may be some pain while urinating for up to a week after the test.
a: A colposcopy is performed when results of a Pap smear are abnormal. This is a painless procedure with no after effects, so urinating afterwards is not a problem, and sexual intercourse need not be avoided
A nurse is assessing a 20-year-old female. Which of the data findings below taken during the history would indicate endometrial cancer? a) Vaginal bleeding that is painless and abnormal b) Severe back pain c) Diagnosis of diabetes mellitus d) Diagnosis of liver disease
a: A finding of abnormal bleeding that is painless is a major sign of endometrial cancer. The diagnoses of liver disease and diabetes mellitus are risk factors for women. Back pain can be associated with many things including ovarian cancer
A 30-year-old woman had a Pap smear 4 weeks ago. The results of the test are classified as ASC-H, as per the Bethesda System. Which of the following therapeutic management interventions should the nurse expect the health care provider to order? a) Refer for a colposcopy with HPV testing. b) Repeat the Pap smear in 4 to 6 months, or refer for a colposcopy c) Discontinue any further Pap smear screenings d) Send for an immediate colposcopy, and follow up based on results
a: A result of ASC-H for Pap smear testing is classified by the Bethesda System. This system gives a uniform diagnostic term to Pap smear results. This classification means that the health care provider should refer the patient for a colposcopy with HPV testing. A result of ASC-US means that the health care provider should refer to repeat the test in 4 to 6 months, or should refer to colposcopy. Results of AGC or AIS indicate the need for an immediate colposcopy with follow-up based on results.
A nurse prepares a woman with an abnormal Pap smear for further diagnostic evaluation. Which of the following would the nurse expect to be done? a) Colposcopy b) Transvaginal ultrasound c) HSV testing d) Endometrial biopsy
a: An abnormal Pap smear typically requires further evaluation, usually with a colposcopy. HSV testing would not be warranted. A transvaginal ultrasound would be used to identify endometrial thickness to determine the need for an endometrial biopsy for endometrial cancer. An endometrial biopsy would be done to evaluate for endometrial canc
A nurse is caring for a woman who has just been diagnosed with cancer (CIS) of the cervix. The nurse should prepare the women for which of the following treatments? a) Cervical conization with follow-up Pap smears and colposcopy b) Uterine artery embolization (UAE) c) Hysterectomy d) Internal and external radiation therapy
a: CIS is atypical and noninvasive, therefore a conization with Pap smears and follow-up is the treatment of choice. UAE is the treatment for removal of fibroid tumors. The other two choices are radical since this is noninvasive
While obtaining the history, a client reports that her mother was treated with diethylstilbestrol (DES) during her pregnancy. The nurse determines that this client is at risk for which of the following? a) Cervical cancer b) Endometrial cancer c) Vulvar cancer d) Breast cancer
a: Cervical cancer affects the lowest portion of the uterus and is associated with the risk factor of being born to mothers treated with DES during their pregnancy. DES is not a risk factor associated with vulvar or breast cancers. Endometrial cancer occurs in women who take estrogens without the addition of progesterone for 5 or more years during and after menopause
An elderly patient who has been seen in the clinic for several months complaining of vulvar itching has been prescribed different creams and ointments but none of them have worked. What should the nurse practitioner suspect based solely on this symptom? a) vulvar cancer b) endometrial cancer c) uterine cancer d) cervical cancer
a: Diagnosis of vulvar cancer is often delayed significantly because there is no single specific clinical symptom that heralds it. The most common presentation is persistent vulvar itching that does not improve with the application of creams or ointments
A client presents for her annual Pap test. She wants to know about the risk factors that are associated with cervical cancer. Which should the nurse inform the client is a risk factor for cervical cancer? a) Early age at first intercourse b) Infertility c) Obesity (at least 50 lb [22.7 kg] overweight) d) Hypertension
a: Early onset of sexual activity, within the first year of menarche, increases the risk of acquiring cervical cancer later on. Obesity, infertility, and hypertension are risk factors that are associated with endometrial cancer
The nursing instructor is teaching a class on gynecologic (GYN) malignancies and realizes a need for further instruction when a student makes which of the following statements? a) Cervical cancer is the most common GYN malignancy. b) Endometrial cancer is the most common GYN malignancy. c) Endometrial cancer is also known as uterine cancer. d) Endometrial cancer usually has a better prognosis than cervial cancer.
a: Endometrial cancer, also known as uterine cancer, is the most common GYN malignancy. Because it is diagnosed in the early stages, endometrial cancer normally has a better prognosis than cervical or ovarian cancer
A nurse is educating a 25-year-old client with a family history of cervical cancer. Which test should the nurse inform the client about to detect cervical cancer at an early stage? a) Papanicolaou test b) CA-125 blood test c) Transvaginal ultrasound d) Blood tests for mutations in the BRCA genes
a: The client should have Papanicolaou tests regularly to detect cervical cancer during the early stages. Blood tests for mutations in the BRCA genes indicate the lifetime risk of the client of developing breast or ovarian cancer. CA-125 is a biologic tumor marker associated with ovarian cancer, but it is not currently sensitive enough to serve as a screening tool. The transvaginal ultrasound can be used to detect endometrial abnormalities
The nursing student correctly identifies which of the following to be a major causative factor in the development of cervical cancer? a) human papillomavirus (HPV) b) National Institutes of Health (NIH) c) American Cancer Society (ACS) d) human immunodeficiency virus (HIV)
a: The development of cervical cancer has been linked to the human papillomavirus (HPV). HIV is the human immunodeficiency virus. ACS stands for the American Cancer Society and NIH stands for the National Institute of Health
A nurse is speaking to a local women's group about the various types of cancer affecting the female reproductive tract. The nurse explains that ovarian cancer is the leading cause of death from gynecologic malignancies based on the understanding that this type of cancer: a) Typically manifest with vague symptoms resulting in late diagnosis b) Is closely associated with highly resistant sexually transmitted infections c) Arises from extremely rare types of cells that are resistant to treatment d) Spreads more easily than other female reproductive cancers
a: Tumors of the ovary have been lethal largely because they present with nonspecific symptoms and therefore frequently are far advanced and inoperable by the time they are diagnosed. Ease of spread and types of cells involved are not reasons underlying the fatal nature of this type of cancer. Ovarian cancer is not associated with sexually transmitted infections. Cervical cancer is linked to human papilloma virus infection.
The nurse understands when caring for a patient with ovarian cancer that survival depends upon numerous factors, which include which of the following? (Check all that apply.) a) age of patient b) effectiveness of adjunct treatment post-operatively c) grade of differentiation d) amount of residual tumor after surgery e) gross findings at surgery f) stage of tumor
b, c, d, e, f: Early detection of ovarian cancer requires bimanual annual pelvic exams and transvaginal ultrasounds to catch early stages. Pap smears and x-rays are not sufficient to detect early stages of ovarian cancer. It is not recommended to use serum CA-125 as testing because it is nonspecific
The nurisng student correctly identifies vaginal cancer as one of the rarest forms of genital cancers. It is mostly asymptomatic, which makes the diagnosis even harder. She further states that it peaks at 60-65 years of age. What does she identify to be symptoms of this disease? (Check all that apply.) a) painful vaginal bleeding b) constipation c) dysuria d) painless vaginal bleeding e) abnormal vaginal discharge f) pelvic pain
b, c, d, e, f: Most women with vaginal cancer are asymptomatic. Those with symptoms have painlesss vaginal bleeding, abnormal vaginal discharge, dysuria, constipation, and pelvic pain.
The nursing student asks the OB/GYN physician why the Pap smear has such a high rate of false-negative results. His best answer would be which of the following? (Check all that apply.) a) performing it too frequently b) human screening c) errors in patient preparation d) errors in preparing the slide e) errors in sampling the cervix
b, c, d, e: Althought the Pap smear is very effective, it does have a high rate of false-negative results which are attributed to human screening, errors in sampling, preparing the slides, and preparing the patient. The frequency of Pap smears do not influence their results
Which risk factors are associated with vaginal cancer? Select all that apply. a) Persistent ovulation over time b) HIV infection c) Hormone replacement therapy for more than 10 years d) Smoking e) Advancing age
b, d, e: Although direct risk factors for the initial development of vaginal cancer have not been identified, associated risk factors include advancing age ( greater than 60 years old), human immunodeficiency virus (HIV) infection, smoking, previous pelvic radiation, exposure to diethylstilbestrol (DES) in utero, vaginal trauma, history of genital warts (human papilloma virus [HPV] infection), cervical cancer, chronic vaginal discharge, and low socioeconomic level. Persistent ovulation over time and hormone replacement therapy for more than 10 years are risk factors associated with ovarian cancer
A nurse is conducting a session on education about cancers of the reproductive tract and is explaining the importance of visiting a health care professional if certain unusual symptoms appear. Which should the nurse include in her list of symptoms that merit a visit to a health care professional for further evaluation? Select all that apply. a) Irregular bowel movements b) Irregular vaginal bleeding c) Increase in urinary frequency d) Elevated or discolored vulvar lesions e) Persistent low backache not related to standing
b, d, e: Irregular vaginal bleeding, persistent low backache not related to standing, and elevated or discolored vulvar lesions are some of the symptoms that should be immediately brought to the notice of the primary health care provider. Increase in urinary frequency and irregular bowel movements are not symptoms related to cancers of the reproductive tract
As a class project a group of student nurses are developing a care plan for patients being screened for cervical cancer. When teaching patients about the risk factors of cervical cancer, what would the nurse identify as the most important risk factor? a) Postmenopausal bleeding b) Human papillomavirus (HPV) c) Late childbearing d) Obesity
b: Adenocarcinomas of the cervix begin in the mucus-producing glands and are often due to HPV infection. Risk factors for cervical cancer include multiple sex partners, IV infection, smoking, and early childbearing. Postmenopausal bleeding and obesity are risk factors for uterine cancer.
A nursing student is going to speak at a local high school about women's health. She is planning to talk about sexually transmitted diseases (STDs) as well as routine checks, along with guidelines for Pap smears. What should she include in the Pap smear guidelines as far as when to have a "first" Pap smear? a) at the age of 16 b) at the age of 21 or within three years of first sexual intercourse c) at the age of 18 or within two years of first sexual intercourse d) two years after first sexual intercourse
b: Amercian Cancer Society guidelines for Pap smears recommend that the first Pap smear is done at age 21 or within 3 years of first sexual intercourse. Other guidelines state that they should be done yearly until age 30 using the glass slide method and every two years using liquid-based method. At age 30-70 they should be done every 2-3 years if the previous three Pap smears were normal. They may be discontinued after age 70 if the previous three Paps were normal and no Paps in the previous 10 years were abnormal
The patient has just been diagnosed with cervical cancer and after discussing her options with her physician and husband she chooses to have cryotherapy. This procedure does which of the following? a) destroys diseased cervical tissue by using a focused beam to vaporize it b) destroys abnormal cervical tissue by freezing it with liquid nitrogen c) removes a section of cervical tissue d) uses a cold knife (surgical scapel) to remvove tissue
b: Cryotherapy destroys cervical tissue by freezing with liquid nitrogen. Cone biopsy removes a cone-shaped section of cervical tissue. Laser therapy destroys diseased cervical tissue by using a focused beam of high-energy light to vaporize it. A cold knife cone biopsy uses a surgical scalpel instead of heated wire to remove the tissue.
The nurse is teaching the community about ovarian cancer and early detection. Which of the following diagnostic tests would the nurse recommend for early detection? a) X-ray of the pelvic area b) Bimanual annual pelvic exam c) Serum CA-125 d) Pap smear
b: Early detection of ovarian cancer requires bimanual annual pelvic exams and transvaginal ultrasounds to catch early stages. Pap smears and x-rays are not sufficient to detect early stages of ovarian cancer. It is not recommended to use serum CA-125 as testing because it is nonspecific
A client presents for a routine check-up at a local health care center. One of the client's distant relatives died of ovarian cancer, and the client wants to know about measures that can reduce the risk of ovarian cancer. The nurse inform the client about which measure to reduce the risk of ovarian cancer? a) Instruct the client to avoid use of oral contraceptives. b) Provide genetic counseling and thorough assessment. c) Instruct the client to avoid breastfeeding. d) Instruct the client to use perineal talc or hygiene sprays
b: Only 5% of ovarian cancers are genetic in origin. However, the nurse needs to tell the client to seek genetic counseling and thorough assessment to reduce her risk of ovarian cancer. Oral contraceptives reduce the risk of ovarian cancer and should be encouraged. Breastfeeding should be encouraged as a risk-reducing strategy. The nurse should instruct the client to avoid using perineal talc or hygiene sprays.
A nurse is teaching women at a senior center. Which type of cancer listed below would the nurse explain is the most common type for women between 50 and 65 years of age? a) Ovarian cancer b) Endometrial cancer c) Vaginal cancer d) Cervical cancer
b: Overall, breast cancer is the most common type of cancer in women in the United States. It is also the 2nd leading cancer for deaths related to cancer. However, endometrial cancer or uterine cancer is the most common gynecologic type of cancer and accounts for 6% of all cancers in the United States. It is uncommon to find it in women younger than 40; the risk increases as the woman ages. Cervical cancer typically is found in women younger than 35. Ovarian cancer occurs in women 55 to 76 years old. Ovarian cancer is the 8th most common cause of cancer among women in the United States. It is, however, the cause of the greatest number of deaths in reproductive cancers. Vaginal cancer occurs in women 60 to 65 years of age and accounts for 3% of all genital cancers in the United States
Which of the following is an early symptom of vulvar cancer? a) Severe abdominal pain b) Pruritus with genital burning c) Fever accompanied by chills d) Dyspareunia
b: Pruritus and genital burning are the most frequent early symptoms of vulvar cancer, followed by a bloody discharge from the vagina. Abdominal pain can be a result of a surgery related to ovary, such as salpingo-oophorectomy, or formation of cysts in the ovary. Dyspareunia and fever accompanied by chills are not the early symptoms of vulvar cancer
The nursing student is studying gynecological cancers and is excited when she reads that birth control pills can have a positive effect on preventing which of the following diseases? a) vaginal cancer b) ovarian cancer c) endometrial cancer d) uterine cancer
b: Risk-reduction strategies for preventing ovarian cancer include pregnancy, use of oral contraceptives, and breastfeeding. No research states that oral contraceptives help to prevent the other cancers.
The nursing student correctly identifies which of the following to be the treatment of choice for endometrial cancer? a) hysterectomy b) hysterectomy and salpingo-oophorectomy c) dilation and curettage (D&C;) d) salpingo-oophorectomy
b: Surgery is the usual and best treatment for endometrial cancer. It usually involves remmoval of the uterus (hysterectomy) and the fallopian tubes and ovaries (salpingo-oophorectomy). In a D&C;the surgeon dilates the cervix and removes part of the lining of the uterus and/or contents of the uterus.
In a postmenopausal woman with abnormal vaginal bleeding, which diagnostic test would the nurse expect the physician to order to determine whether an endometrial biopsy is needed? a) Pap smear b) CA-125 c) Transvaginal ultrasound d) Mammogram
c: In this situation, a transvaginal ultrasound is used to measure the endometrial thickness to determine if an endometrial biopsy is needed. CA-125 is a nonspecific blood test used as a tumor marker. A Pap smear aids in detecting abnormal cells of the cervix. A mammogram detects calcifications, densities, and nonpalpable cancer lesions of the breast
A 65-year-old client presents at a local community health care center for a routine check-up. While obtaining her medical history, the nurse learns that the client had her menarche when she was 13 years old. She experienced menopause at 51. She is between 5 and 10 lb (2.3 and 4.5 kg) underweight but is otherwise in good physical condition. The nurse should inform the client of which factor that increase the client's risk of getting ovarian cancer? a) The client's age at menarche b) The client's present age c) The client's age at menopause d) The client's weight
b: The client's present age increases her risk of developing ovarian cancer, as women who are older than 50 are at a greater risk. The client's age at menarche (older than 12) and menopause (younger than 55) are both normal. The client is underweight and not obese, so her weight is not a risk factor for ovarian cancer
The nursing instructor is teaching the student about cervical cancer and tells her that it is the one cancer whose incidence and mortality rates have greatly decreased in the past several decades. This can be attributed to which of the following? a) dilation and curettage (D&C;) b) pap tests c) vaginal ultrasounds d) biopsies
b: The incidence and mortality rates of cervical cancer have decreased noticeably in the past several decades, with most of the reduction attributed to the Pap test. The other tests are not used to screen for cervical cancer
A client has been referred for a colposcopy by the physician. The client wants to know more about the examination. Which information regarding a colposcopy should the nurse give to the client? a) Intercourse should be avoided for at least a week afterward. b) The test is conducted because of abnormal results in Pap smears. c) Client may feel pain in the vaginal area during the examination. d) Client may experience pain during urination for a week following the test.
b: The nurse should explain to the client that the colposcopy is done because the physician has observed abnormalities in Pap smears. The nurse should also explain to the client that the procedure is painless and there are no adverse effects, such as pain during urination. There is no need to avoid intercourse for a week after the colposcopy
A nurse is assessing a woman who has a history of genital warts (HPV). The nurse understands that this increases the risk of vulvar cancer. The nurse should teach which of the following prevention methods to decrease the risk of cancer? a) The woman should use oral contraceptives instead of using barrier methods. b) The woman should avoid tight undergarments. c) A genital exam should be done by the woman herself only. d) A genital exam should be completed by the health care provider only. e) The woman should take OTC drugs to self-medicate and treat lesions.
b: The nurse should instruct the woman to wear loose fitting undergarments. The woman should do a genital exam herself and seek an exam from a provider. The woman should not self-medicate and should seek assistance to treat lesions. A barrier method should be used to decrease transmission of STIs
A client presents at a community health care center for a routine check-up. The client wants to know about any tests that can effectively detect ovarian cancer early. About which test that can aid in the detection of ovarian cancer should the nurse inform the client? a) Serum CA-125 b) Yearly bimanual pelvic examinations c) Pap smear d) Regular x-rays of the pelvic area
b: To identify ovarian masses in their early stages, the client needs to have yearly bimanual pelvic examinations. Pap smears are not effective enough to detect ovarian masses. The U.S. Preventive Services Task Force recommends against routine screening for ovarian cancer with serum CA-125 because the potential harm could outweigh the potential benefits. X-rays of the pelvic area do not detect ovarian masses
The nursing student correctly identifies which of the following age group to be when ovarian cancer occurs more frequently? a) 35-55 years of age b) over 70 years of age c) 55-75 years of age d) 25-50 years of age
c: Older women are at risk for ovarian cancer. It occurs most frequently in women between 55 and 75 years of age
The endometrial biopsy of a client reveals cancerous cells, and the primary health care provider has diagnosed it as endometrial cancer. Which responsibilities of the nurse are part of the treatment of the client? Select all that apply. a) Inform the client that follow-up care is not required unless something unusual occurs. b) Inform the client that changes in sexuality are normal and need not be reported. c) Offer the family explanations and emotional support throughout the treatment. d) Make sure the client understands all the available treatment options. e) Inform the client about the possible advantages of a support group.
c, d, e: The responsibilities of a nurse while caring for a client with endometrial cancer include ensuring that the client understands all the treatment options available, suggesting the advantages of a support group and providing referrals, and offering the family explanations and emotional support throughout the treatment. The nurse should also discuss changes in sexuality with the client as well as stress the importance of regular follow-up care after the treatment and not just in cases where something unusual occurs
When working in a local community health care center, a nurse is frequently asked about cervical cancer and ways to prevent it. Which information should be provided by the nurse? Select all that apply. a) Avoid stress and high blood pressure. b) Encourage the use of an intrauterine device (IUD) for contraception. c) Encourage cessation of smoking and drinking. d) Encourage prevention of sexually-transmitted infections (STIs) to reduce risk factors. e) Counsel teenagers to avoid early sexual activity.
c, d, e:To reduce the risk of cervical cancer, the nurse should encourage clients to avoid smoking and drinking. In addition, because STIs such as HPV increase the risk of cervical cancers, care should be taken to prevent STIs. Teenagers also should be counseled to avoid early sexual activity because it increases the risk of cervical cancer. The use of barrier methods of contraception, not IUDs, should be encouraged. Avoiding stress and high blood pressure will not have a significant impact on the risk of cervical cancer
A 30-year-old client asks the nurse about risk factors for ovarian cancer. Which risk factor should be included in client education? a) Menopause before age 50 b) Breastfeeding c) Infertility d) Less than 40 years of age
c: Pregnancy decreases a woman's risk for ovarian cancer; infertility increases that risk. Risk increases in women older than 50 years, and for women who experienced late menopause (older than 55 years). Breastfeeding may have a protective effect
A 28-year-old woman had a pap smear 4 weeks ago. The results of the test are classified as ASC-US as per the Bethesda System. Which of the following therapeutic management interventions should the nurse expect the health care provider to order? a) Discontinue any further Pap smear screenings. b) Refer for a colposcopy with HPV testing. c) Repeat the Pap smear in 4 to 6 months, or refer for a colposcopy. d) Send for an immediate colposcopy, with follow-up based on results
c: A result of ASC-US for Pap smear testing is classified by the Bethesda System. This system gives a uniform diagnostic term to Pap smear results. This means the health care provider should repeat the test in 4 to 6 months or refer for a colposcopy. Results of AGC or AIS indicate the need for an immediate colposcopy and follow-up based on results. A colposcopy with HPV testing is the treatment when results are ASC-
While reviewing the history of a client diagnosed with cancer of the vagina, the nurse would expect the client to report which of the following as the major complaint? a) Abdominal discomfort b) Urinary frequency c) Abnormal vaginal bleeding d) Ascites
c: Abnormal vaginal bleeding is the predominant symptom of vaginal cancer. Abdominal discomfort, urinary frequency, and ascites are more commonly associated with ovarian cancer
While reviewing the history of a client diagnosed with cancer of the vagina, the nurse would expect the client to report which of the following as the major complaint? a) Ascites b) Abdominal discomfort c) Abnormal vaginal bleeding d) Urinary frequency
c: Abnormal vaginal bleeding is the predominant symptom of vaginal cancer. Abdominal discomfort, urinary frequency, and ascites are more commonly associated with ovarian cancer.
The results of a Pap smear test have been classified as atypical squamous cells with possible HSIL (ASC-H) as per the 2001 Bethesda system. Which interpretation of the result is correct? a) Repeat the Pap smear in 4 to 6 months, or refer for a colposcopy. b) No need for any further Pap smear screenings. c) Refer for a colposcopy without human papilloma virus (HPV) testing. d) Immediate colposcopy; follow-up is based on the results of findings.
c: According to the 2001 Bethesda system for classifying Pap smear results, a result of ASC-H means that the client is to be referred for colposcopy without HPV testing. Atypical squamous cells of undetermined significance (ASC-US) means that the test has to be repeated in 4 to 6 months or the client has to be referred for colposcopy. Atypical glandular cells (AGC) or adenocarcinoma in situ (AIS) results indicate immediate colposcopy, with the follow-up based on the results of findings
A postmenopausal patient is told at her routine gynecological exam that the physician has found a cyst on her right ovary. The nurse notices that this does not cause worry for this patient. What should the nurse and/or physician tell this patient? a) She is correct not to be concerned; after all, it is only a cyst. b) You may get a second opinion if you would like. c) After menopause a mass on an ovary is not a cyst and should be considered cancerous until proven otherwise. d) We will keep a eye on it and re-check it at your next yearly appointment
c: After menopause, a mass on an ovary is not a cyst; physiologic cysts can arise only from a follicle that has not ruptured or from the cystic degeneration of the corpus luteum. Brushing it off is not responsible and waiting a full year would put the patient at serious risk from dying from the cancer. Suggesting a second opinion instead of explaining the seriousness of it to the patient would not be responsible or ethical
A specialty nurse working in the OB-GYN clinic cares for pregnant women who have been diagnosed with cancer during the pregnancy. The most common cancer in the pregnant population in regards to reproductive malignancies is which of the following? a) endometrial cancer b) ovarian cancer c) cervical cancer d) breast cancer
c: Cervical cancer is more common in the pregnant population than other reproductive malignancies, and can affect the woman's health status and the pregnancy.
A patient with ovarian cancer is admitted to the hospital for surgery. You are completing a health history on the patient. What clinical manifestations would you expect to assess? a) Fever and chills b) Fish-like odor of the vagina c) Increased abdominal girth d) Lower abdominal pelvic pain
c: Clinical manifestations of ovarian cancer include enlargement of the abdomen from an accumulation of fluid. Flatulence and feeling full after a light meal are significant symptoms. In bacterial vaginosis, a fish-like odor, which is noticeable after sexual intercourse or during menstruation, occurs as a result of a rise in the vaginal pH. Fever and chills occur in toxic shock syndrome (TSS). A symptom associated with pelvic inflammatory disease (PID) is lower abdominal pelvic pain
After teaching a local woman's community group about cervical cancer, which of the following if stated by the group as a risk factor indicates a successful teaching program? a) Vulvar dermatosis b) Chronic vulvitis c) Genital herpes d) Obesity and menopause
c: Genital herpes increases the risk for cervical cancer. Chronic vulvitis and vulvar dermatosis are risk factors for vulvar cancer. Obesity and menopause are risk factors for pelvic relaxation alteration
In which group is it most important for the client to understand the importance of an annual Papanicolaou test? a) Clients with a long history of oral contraceptive use b) Clients with a history of recurrent candidiasis c) Clients infected with the human papillomavirus (HPV) d) Clients with a pregnancy before age 20
c: HPV causes genital warts, which are associated with an increased incidence of cervical cancer. Recurrent candidiasis, pregnancy before age 20, and use of oral contraceptives don't increase the risk of cervical cancer
A woman has been referred for laser therapy for her diagnosis of cervical cancer. The client wants to know more about the procedure. Which of the following information regarding laser therapy should the nurse give to the client? a) The client may experience abdominal cramping. b) The client may experience urinary frequency. c) The client may experience a watery brown discharge for a few weeks. d) The client may experience bleeding for 2 weeks.
c: In Laser therapy a high beam light destroys the cancer and vaporizes it. Women may experience a watery brown discharge for few weeks. This is the only after-effect
In a postmenopausal woman with abnormal vaginal bleeding, which diagnostic test would the nurse expect the physician to order to determine whether an endometrial biopsy is needed? a) CA-125 b) Pap smear c) Transvaginal ultrasound d) Mammogram
c: In this situation, a transvaginal ultrasound is used to measure the endometrial thickness to determine if an endometrial biopsy is needed. CA-125 is a nonspecific blood test used as a tumor marker. A Pap smear aids in detecting abnormal cells of the cervix. A mammogram detects calcifications, densities, and nonpalpable cancer lesions of the breast
The nurse reviews the medical record of a woman diagnosed with ovarian cancer, stage II. The nurse interprets this information, understanding that the disease: a) Is limited to the ovary b) Has metastasized to distant sites c) Involves one or both ovaries and extends into the pelvis d) Has spread to the lymph nodes and other organs within the abdomen
c: Stage II ovarian cancer involves one or both ovaries, with pelvic extension. Disease limited to the ovary characterizes stage I ovarian cancer. Stage III ovarian cancer has spread to the lymph nodes and other organs and structures inside the abdominal cavity. Stage IV disease typically involves metastasis to distant sites
An elderly woman is seen in the clinic complaining of a lesion on her labia majora and states that she has experienced some bleeding and itching as well. She states that this has been going on for approximately three months. She tells the nurse that she has not been to a doctor in over 10 years. What diagnosis would the nurse expect the physician to make? a) polyps b) cervical cancer c) vulvar cancer d) vaginal cancer
c: The correct diagnosis for this patient would be vulvar cancer due to the placement of the lesion, the itching, and the bleeding. The other cancers would have different symptoms and not apply to this patient.
A client is waiting for the results of an endometrial biopsy for suspected endometrial cancer. She wants to know more about endometrial cancer and asks the nurse about the available treatment options. Which treatment information should the nurse give the client? a) Follow-up care after the relevant treatment should last for at least 6 months after the treatment. b) Surgery involves removal of the uterus only. c) Surgery involves removal of the uterus, fallopian tubes, and ovaries; adjuvant therapy is used if relevant. d) In advanced cancers, radiation and chemotherapy are used instead of surgery.
c: The nurse should inform the client that surgery most often involves removal of the uterus (hysterectomy) and the fallopian tubes and ovaries (salpingo-oophorectomy). Removal of the tubes and ovaries, not just the uterus, is recommended because tumor cells spread early to the ovaries, and any dormant cancer cells could be stimulated to grow by ovarian estrogen. In advanced cancers, radiation and chemotherapy are used as adjuvant therapies to surgery. Routine surveillance intervals for follow-up care are typically every 3 to 4 months for the first 2 years
A female client is diagnosed with carcinoma in situ of the endometrium. The nurse interprets this as which of the following? a) The malignancy involves the uterine body and cervix b) Cancer is confined to the body of the uterus c) Cancer extends outside the uterus d) The malignancy is localized
d: A localized malignancy is referred to as carcinoma in situ. Stage I endometrial cancer is confined to the body (corpus) of the uterus; Stage II involves the corpus and cervix; Stage III extends outside the uterus but not the true pelvis
When preparing a presentation about screening for cervical cancer, the nurse would include which of the following recommendations? a) Every 2 to 3 years for women over the age of 70 b) Discontinuation of Pap smears between 30 and 70 years if last three were normal c) Initial Pap smear at age 18 d) Pap smears every 3 years until age 30
d: A woman should have an initial Pap smear at age 21 and then every 3 years until age 30. Between the ages of 31 and 65, a woman should have a Pap smear and HPV testing every 5 years. Women whom have had regular cervical testing with normal results should not be tested for cervical cancer. Women with a history of serious cervical pre-cancer lesions should continue testing for at least 20 years after that diagnosis, even if it continues after age 65.
A 30-year-old female is attending a health fair for women. The nurse at the fair is reviewing risk factors for cervical cancer. Which of the following is an important risk factor for the nurse to include at the fair? a) First intercourse after age 25 b) Protected sexual intercourse c) One life partner d) Exposure to diethylstilbestrol (DES) in utero
d: Cervical cancer has several risk factors: early age of first intercourse (in first year of menarche), lower socioeconomic status, unprotected sex, family history of cervical cancer, exposure to DES in utero, HIV, use of oral contraceptives, HPV, and multiple male partners
A nurse is conducting a class at a women's clinic about reproductive cancers. When describing the incidence of reproductive tract cancers in pregnant women, which of the following would the nurse include? a) Many cases of endometrial cancer are detected in pregnant women because of the increase in surveillance. b) Ovarian cancer is detected much later in the pregnant woman because of the hormonal changes that are occurring. c) Reproductive cancers overall are more common in pregnant women. d) Cervical cancer is more common in the pregnant population than other reproductive cancers.
d: Cervical cancer is more common in the pregnant population, affecting the health of the woman and her fetus. Ovarian cancer occurring during pregnancy is found at early stages and is associated with a good prognosis for both the mother and newborn. Few cases of endometrial cancer would be detected during the relatively young pregnancy population, since routine screening is currently not recommended in the general population. Reproductive tract cancers can occur in a pregnant woman, but their incidence is highly variable
A nurse is preparing a woman for a Pap smear procedure. The nurse has already washed her hands and gathered all necessary equipment (maintaining sterility). Which of the following is the next step in the Pap smear procedure? a) Provide support to the client as the provider obtains the sample. b) Transfer the specimen to a container or a slide. c) Drape the client with a sheet, leaving the perineal area exposed. d) Position the client in stirrups or foot pedals so that her knees fall outward.
d: During a Pap smear procedure, the next step would be to position the client in stirrups or foot pedals so that her knees fall outward. This would be followed by draping a sheet over the client and leaving the perineal area exposed. Next would be to support the client while the sample is obtained. Lastly, transfer the specimen to a container or slide
The school nurse is teaching middle-school students about cervical cancer and the HPV virus. She is planning on administering the vaccine to protect them from this precursor of cervical cancer. Which vaccine will she administer to the young girls for this purpose? a) MMR b) DTP c) varicella d) gardasil
d: Gardasil is the first vaccine developed to protect girls and women from HPV. Varicella is to protect against chicken pox. The MMR is the vaccine for measles, mumps and rubella. DTP is the vaccine for diptheria, tetanus, and pertussis
A menopausal woman is prescribed estrogen along with progestin. She asks the nurse why she has to take both of them as she only wants to take the estrogen. What should the nurse tell this patient? a) The physician always orders it this way. b) It is given to most patients this way. c) This is what the drug book recommends. d) Estrogen without progestin can lead to cancer of the endometrium.
d: Giving estrogen without progestin for hormone replacement can lead to an increased risk for endometrial cancer. The other explanations are not accurate or informative. They also do not give the rationale for ordering the two medications together.
The postmenopausal woman who has bleeding and spotting and cannot tolerate a endometrial biopsy in the office would expect to have which of the following tests done to rule out endometrial cancer? a) pelvic exam b) abdominal ultrasound c) pap smear d) transvaginal ultrasound
d: If an endometrial biopsy is inconclusive for cancer, then the patient would have a transvaginal ultrasound to evaluate the endometrial cavity and measure the thickness of the endometrial lining. A pelvic exam and pap smear are not tests used to diagnose this disease
The nurse is reviewing information with a client who was just diagnosed with endometrial cancer. Which of the following treatment options should the nurse review for this diagnosis? a) Removal of uterus b) Follow-up care after treatment, which should last for at least 6 months c) Radiation and chemotherapy if advanced stages d) Removal of uterus, fallopian tubes, and ovaries
d: In endometrial cancer, the best treatment is have surgery and remove the uterus, fallopian tubes, and ovaries. It is best to remove tubes and ovaries because in this cancer, tumor cells spread early to the ovaries, and any cells that are left dormant are at risk for being stimulated to grow by estrogen. Radiation and chemotherapy are for advanced stages. Follow-up should be provided every 3 to 4 months for 2 years
The Obstetric Educator Nurse is reviewing vulvar cancer with nursing staff as part of their continuing education seminar. Which of the following risk factors would the nurse list? a) Gardasil use b) Previous exposure to pelvic irradiation c) Being exposed to DES in utero d) Lichen sclerosus
d: Lichen sclerosus is a skin condition that is a risk factor for or is linked to vulvar cancer. Previous radiation exposure and DES exposure in utero are risk factors for vaginal cancer. Gardasil is used to prevent types of HPV disease
A nurse working in the Family Birthing Center is answering the nurse hot line phone. A client calls in to schedule her annual Pap smear procedure. Which of the following strategies would be best to educate the client on before her procedure to make sure results are not affected? a) It is safe to use tampons 72 hours before testing. b) Make sure your appointment is 5 days after your last menses. c) You make douche at least 48 hours before testing. d) Refrain from sexual intercourse 48 hours before testing to ensure clear results.
d: Nurses should use teaching guidelines with clients to optimize the Pap smear test results. Strategies to educate would include: No douche, no tampons, no jellies, no spermicides, no intercourse. The optimal time for testing is 2 weeks after the first day of your last menses
A student in clinical caring for a woman who has been diagnosed with ovarian cancer consults her nursing instructor. The student demonstrates an understanding of ovarian cancer when she states which of the following? a) It is easy to diagnose. b) It is usually diagnosed in its early stage. c) It is easy to notice its symptoms. d) It is known as the "silent killer."
d: Ovarian cancer has been described as "the overlooked disease" or the "silent killer" because women and/or health care workers often ignore or rationalize the early symptoms. It is typically diagnosed in advanced stages
When reviewing the history of a woman diagnosed with endometrial cancer, the nurse would identify which of the following as increasing the woman's risk? a) Menarche at age 14 years b) Vaginal delivery of 4 children c) Menopause at age 47 years d) Use of tamoxifen
d: Use of tamoxifen is a risk factor for the development of endometrial cancer, as are nulliparity, early menarche (before the age of 12), and late onset of menopause (after age 52 years).
The nurse is caring for a woman who has dysplasia (disordered growth of abnormal cells). The nurse educates her on dysplasia progression that is high-grade. Which of the following information is important for the nurse to include? a) High-grade dysplasia progresses to invasive cervical cancer in about 9 years. b) High- grade dysplasia progresses to invasive cervical cancer in about 7 years. c) High-grade dysplasia progresses to invasive cervical cancer in about 4 years. d) High-grade dysplasia progresses to invasive cervical cancer in about 2 years.
d: With cervical cancer, lesions start as dysplasia and progress over a period of time. Progression of a high-grade dysplasia takes about 2 years to develop into an invasive cancer
