Maternity Ch. 10/11 Exam IV

What are the top three cancers of the reproductive system?

1.Endometrial/uterine 2.Ovarian 3.Cervical

A woman has preinvasive cancer of the cervix. Which modality would the nurse discuss as an available option for a client with this condition? a.Cryosurgery b.Colposcopy c.Hysterectomy d.Internal radiation

ANS: A Cryosurgery, laser surgery, and loop electrosurgical excision procedure (LEEP) are several techniques used to treat preinvasive lesions.

Which woman has the highest risk for endometrial cancer? a.Postmenopausal woman with hypertension b.Woman who has an intrauterine device (IUD) c.Client who has been on birth control for 15 years d.Perimenopausal woman who has a cystocele

ANS: A Endometrial cancer is most often seen in postmenopausal women between the ages of 50 and 65 years. Hypertension is a risk factor associated with the development of this malignancy.

Which condition is the most common malignancy of the reproductive system? a.Endometrial cancer b.Cervical cancer c.Ovarian cancer d.Vulvar and vaginal cancer

ANS: A Endometrial cancer occurs most frequently in Caucasian women and after menopause.

A postmenopausal woman has been diagnosed with two leiomyomas (fibroids). Which clinical finding is most commonly associated with the presence of leiomyomas? a.Abnormal uterine bleeding b.Diarrhea c.Weight loss d.Acute abdominal pain

ANS: A Most women are asymptomatic. Abnormal uterine bleeding is the most common symptom of leiomyomas.

With regard to the treatment plan for a pregnant woman with gynecologic cancer, which statement about timing or type of treatment is correct? a.The fetus is most at risk during the first trimester. b.The fetus is most at risk during the second trimester. c.The fetus is most at risk during the third trimester. d.Surgery is more risky than chemotherapy in the first trimester.

ANS: A The first trimester is the most vulnerable period for the growing fetus. Women may be faced with making a decision about terminating the pregnancy, depending on the stage and extent of the disease.

What is the most common reproductive tract cancer associated with pregnancy? a.Cervical b.Uterine c.Ovarian d.Fallopian tube

ANS: A The incidence of cervical cancer concurrent with pregnancy is reported to be 1 in 2000 pregnancies making it the most common reproductive tract cancer associated with pregnancy.

A woman exhibits symptoms that may lead to a possible diagnosis of polycystic ovary syndrome (PCOS). While completing the initial assessment of the client, which clinical finding would the nurse not anticipate? a.Anorexia b.Hirsutism c.Irregular menses d.Infertility

ANS: A These clients often are obese rather than anorexic with weight loss. Approximately 40% of these women also display glucose intolerance and hyperinsulinemia. Excessive hair growth is often present in women with PCOS. This client is likely to have irregular menses or even amenorrhea. Infertility as a result of decreased levels of follicle-stimulating hormone is common with this syndrome.

The client is undergoing treatment for ovarian cancer. Which common nutritional problems are related to gynecologic cancers and the treatment thereof? (Select all that apply.) a.Stomatitis b.Constipation c.Increased appetite d.Diarrhea e.Nausea and vomiting

ANS: A, B, D, E Altered taste, stomatitis, constipation, anorexia, diarrhea, and nausea and vomiting are all possible nutritional complications related to gynecologic cancers and their treatment. The nurse must assess accordingly and adapt the client's plan of care. To ensure recovery, these women should consume a diet high in iron and protein, drink plenty of fluids, and eat foods high in vitamins C, B, and K.

The client has undergone hysteroscopic uterine ablation to destroy a number of smaller fibroids. The nurse is preparing to provide discharge instructions. Which information is a priority for the patient and should be included in the teaching plan? (Select all that apply.) a.Analgesics and nonsteroidal antiinflammatory drugs can be used for pain control. b.Vaginal discharge is to be expected for 5 to 7 days. c.Sexual activity can be resumed after 48 hours. d.Next menstrual period will be irregular. e.Provider should be notified if heavy bleeding occurs.

ANS: A, D, E Before discharging the client, the following information should be given: analgesics can be used for pain relief as needed, normal activities can be resumed within several days, vaginal discharge is to be expected for 4 to 6 weeks, and the use of tampons and sexual activity should be avoided for 2 weeks. The next menstrual period will be irregular, and the provider should be notified for heavy bleeding or signs of infection.

A 48-year-old woman has just had a hysterectomy for endometrial cancer. Which statement alerts the nurse that further teaching is needed? a."I can't wait to go on the cruise that I have planned for this summer." b."I know that the surgery saved my life, but I will miss having sexual intercourse with my husband." c."I have asked my daughter to come and stay with me next week after I am discharged from the hospital." d."Well, I don't have to worry about getting pregnant anymore."

ANS: B Stating that she will miss having sexual intercourse with her husband indicates that further teaching is needed for this client regarding sexual activities after a hysterectomy.

Leiomyomas (also known as fibroid tumors) are benign tumors arising from the muscle tissue of the uterus. Which information related to these tumors is accurate? (Select all that apply.) a.Are rapid growing b.Are more common in African-American women c.Are more common in women who have never been pregnant d.Obesity is a risk factor with leiomyomas e.Become malignant if left untreated

ANS: B, C, D The exact cause of leiomyomas remains unknown, although genetic factors may be involved in their development. Most are found in the body of uterus and are classified according to their location on the uterine wall. They are benign, slow growing, and often spontaneously shrink after menopause.

When caring for clients with neoplasms of the reproductive system, the nurse must begin by assessing the woman's knowledge of the disorder, its management, and prognosis. This assessment should be followed by a nursing diagnosis. Which diagnosis fails to address the psychologic effect of these disorders? a.Anxiety, related to surgical procedures b.Disturbed body image, as a result of changes in anatomy c.Risk for injury, related to lack of skill for self-care d.Interrupted family processes

ANS: C Although risk for injury, related to lack of skill for self-care, is appropriate to this client's condition, this diagnosis is more suited to the client's learning needs than the psychologic effect. Anxiety, related to surgical procedures, is appropriate for addressing psychosocial concerns.

A woman has arrived for her preoperative testing appointment. She is scheduled for a myomectomy the following day. What condition would require the client to undergo this procedure for symptom relief? a.Numerous small fibroid tumors b.Bartholin cysts c.Fibroid tumors near the outer wall of the uterus with a uterine size no larger than at 12 weeks of gestation d.Leiomyomas (also known as fibroid tumors) in a uterus larger than 14 weeks of gestation

ANS: C If a fibroid tumor lies near the outer wall of the uterus and the uterine size is no larger than at 12 to 14 weeks of gestation and the symptoms are significant, a myomectomy (i.e., removal of the tumor) may be performed.

The nurse provides education to a client about to undergo external radiation therapy. Which statement by the client reassures the nurse that the teaching has been effective? a."I am using ointment to keep my skin from drying out." b."I wash the irradiated area with deodorant soap." c."My diet is high in protein, and I drink at least 2000 ml of fluid a day." d."I wash off the markings for the radiation site after each treatment."

ANS: C To maintain good nutrition, the woman should eat high-protein meals or use protein supplements and should have a high daily fluid intake of 2 to 3 L.

Which woman is at the greatest risk for psychologic complications after hysterectomy? a.55-year-old woman who has been having abnormal bleeding and pain for 3 years b.46-year-old woman who has had three children and has just been promoted at work c.62-year-old widow who has three friends who have had uncomplicated hysterectomies d.19-year-old woman who had a ruptured uterus after giving birth to her first child

ANS: D The 19-year-old woman is still in her childbearing years. Often the uterus is related to self-concept in women in this age group, and they may feel that sexual functioning is related to having a uterus.

What are the genetic genes that are a risk factor for Breast Cancer?

BRCA1 BRCA2

What is the post mastectomy care?

Elevate affected side Do not take BP or injections on affected side What for edema (lymphedema) Limit arm exercise to 24 hrs post op Assess dressing-drainage Provide privacy for patient No tight clothing on affected side Turn-Cough-Deep Breathing

What is the most common reproductive cancer?

Endometrial cancer

What causes cervical cancer?

HPV

What is the most common finding with uterine fibroids?

Menorrhagia

How are fibroids treated?

NSAIDs-oral contraceptives-green tea Vit.D-uterine artery emoblization

What are uterine fibroids?

Noncancerous tumors of smooth muscle in the uterus fibromas-myomas-fibromyomas

What is the most lethal reproductive cancer?

Ovarian cancer

How is cervical cancer diagnosed?

Pap smear; if abnormal, repeat again

Most common age for ovarian cancer?

ages 60-64

What is ovarian cancer?

cancer of the ovaries the "silent killer" usually, few symptoms until its too late, spreads easily

What side effects do fibroids cause?

dysmenorrhea preterm labor dystocia constipation urinary incontinence

What are the signs and symptoms of ovarian cancer?

early s/sx are very vague - bloating, mild abdominal discomfort, constipation. If not detected early, it will metastasize intra-abdominally causing pain, ascities, dyspepsia, vomiting, and alterations in bowel movements.

How do you diagnosis Breast cancer?

fine needle aspiration or biopsy

What are the late signs of cervical cancer?

leg pain, dysuria, rectal bleeding, edema, worsened bleeding

What are the risk factors for breast cancer?

mostly related to estrogen exposure: 1. Female gender; 2. Age (post-menopausal women) 3. Early menarche/late menopause; 4. Obesity 5. Atypical hyperplasia; 6. 1st degree relative (mother)with breast cancer; 7.Diet/Alcohol/Smoking/lack exercise

What other cancer can HPV be related to?

vulvar cancer