PrepU Chapter 50: Assessment and Management of Patients with Female Physiologic Processes

Which term refers to painful menstruation?

Dysmenorrhea

The nurse is preparing a client for a pelvic examination. The client asks the nurse, "Why do I need to urinate and empty my bladder?" Which response by the nurse would be most appropriate?

"It helps make you more comfortable and the exam easier."

The nurse instructs a female client about contraceptive options. The nurse explains that the intrauterine device (IUD) is a good contraceptive option for women who:

Are in a monogamous relationship. -The IUD is suitable for clients who desire long-term contraceptive use and are in a monogamous relationship. Because of the increased risk of infection with an IUD if an STD occurs, the device is not appropriate for women with multiple partners or a history of STDs. Previous ectopic pregnancy is also a contraindication for an IUD because the incidence of ectopic implantation is slightly higher.

Which term describes a procedure in which cervical tissue is removed because abnormal cells are detected?

Cone biopsy (conization) -Cone biopsy is a procedure done to remove abnormal cervical tissue. Colporrhaphy refers to repair of the vagina. Cryotherapy refers to destruction of tissue by freezing. Perineorrhaphy refers to sutural repair of perineal lacerations.

A client is scheduled to undergo a Papanicolaou test. The nurse should advise the client of which preparation?

Do not douche before the procedure -To avoid washing away cellular material, the client should be instructed not to douche before having a Pap test. A Pap test should be performed when a client is not menstruating because blood usually interferes with interpretation. Consuming food that contains iodine is not contraindicated for a Papanicolaou test. The client should be instructed to avoid intercourse for 2 days prior to having the Pap test.

The nurse is preparing a woman for an abdominal ultrasound. Which instruction would be appropriate for the nurse to include?

Drink at least 1 quart of water an hour before the test. -Drinking at least 1 quart of water 45 minutes to 1 hour before the test and not voiding until after the test ensures a full bladder and facilitates transmission of the ultrasound waves. It also elevates the bowel away from the other pelvic organs. The client should restrict solid food intake for 6 to 8 hours before the test to avoid having images of the test obscured by gas and intestinal contents. There is no restriction on douching for this test. A full bladder, not an empty one, facilitates this test.

Menopause marks the end of a woman's reproductive capacity. Which of the following is a common complaint that may be due to a cystocele? - Dyspareunia - Irregular menses - Decreased pH of the vagina - Atrophic vaginitis

Dyspareunia

Which of the following diagnostic tests is used for severe bleeding that is unresponsive to other therapies?

Endometrial ablation -Endometrial ablation is performed in cases of severe bleeding not responsive to other therapies. A D & C is used as a therapeutic measure for incomplete miscarriage. Laparoscopy involves inserting a laparoscope into the peritoneal cavity through a small incision below the umbilicus to allow visualization of the pelvic structures. An endometrial biopsy is a method of obtaining endometrial tissue by placing a flexible suction tube through the cervix into the uterus.

Which diagnostic test is indicated for postmenopausal bleeding?

Endometrial biopsy -For postmenopausal bleeding, an endometrial biopsy or D&C is indicated.

The nurse is caring for a client who is being supplemented with the hormone responsible for developing and maintaining the female reproductive organs. This client is being treated with what hormone?

Estrogen -Estrogens are responsible for developing and maintaining the female reproductive organs. Progesterone is the most important hormone for conditioning the endometrium in preparation for implantation of the fertilized ovum. Androgens, secreted by the ovaries in small amounts, are involved in the early development of the follicle and affect the female libido. Follicle-stimulating hormone is responsible for stimulating the ovaries to secrete estrogen.

The nurse is relating health education to male students when asked where sperm is actually made. Which location is most correct?

In the testes within the scrotum

The examiner is preparing to perform a pelvic examination. Which of the following would be done first?

Inspection of the external genitalia -The pelvic examination begins with inspection of the external genitalia. This is followed by a speculum examination in which the cervix is inspected and then specimens for Pap smear and other testing are obtained. As the speculum is removed, the vagina is inspected. A bimanual examination follows.

A client has a routine Papanicolaou (Pap) test during a yearly gynecologic examination. The result reveals a class V finding. What should the nurse tell the client about this finding?

It calls for a biopsy as soon as possible. -A class V finding in a Pap test suggests probable cervical cancer; the client should have a biopsy as soon as possible. Only a class I finding, which is normal, requires no action. A class II finding, which indicates inflammation, calls for a repeat Pap test in 3 months. A class III finding, which indicates mild to moderate dysplasia, calls for a repeat Pap test in 6 weeks to 3 months. A class IV finding indicates possible cervical cancer; like a class V finding, it warrants a biopsy as soon as possible.

The expert nurse is assisting a novice nurse insert a Foley catheter. The novice nurse has tried unsuccessfully to insert the catheter, and the expert nurse is providing verbal guidance while spreading which area to reveal the urethral opening?

Labia majora and minora -The labia majora and minora are a portion of the external genitalia and when parted reveals the urethral opening. The meatus refers to an opening or passage. The clitoris is sensitive erectile tissue considered the site of sexual pleasure. The fourchette is the area beneath the vaginal opening at the base of the labia majora.

The nurse is assisting a patient in preparing for a pelvic examination. What position will the nurse place the patient in for the examination?

Lithotomy -The supine lithotomy position is used most commonly (Weber & Kelley, 2010). This position offers several advantages: 1) It is more comfortable for some women. 2) It allows better eye contact between patient and examiner. 3) It may provide an easier means for the examiner to carry out the bimanual examination. 4) It enables the woman to use a mirror to see her anatomy (if she chooses) to visualize any conditions that require treatment or to learn about using certain contraceptive methods.

During which phase of the menstrual cycle is progesterone secreted by the corpus luteum?

Luteal -In the luteal phase, which begins after ovulation, progesterone is secreted by the corpus luteum. In the proliferative phase, FSH output increases, stimulating estrogen secretion. The secretory phase is near the middle of the cycle, and LH output increases. Premenstrual phase is the phase before menstruation.

A patient asks the nurse if there are any available nonsurgical options to terminate a pregnancy if she is only 2 weeks pregnant. What information should the nurse provide to the patient about a medication that blocks progesterone?

Mifepristone (RU-486, Mifeprex) is used only in early pregnancy to terminate a pregnancy nonsurgically.

A nurse is providing care to a client who was just admitted with a diagnosis of ectopic pregnancy. When reviewing the client's history, which of the following would the nurse identify as a major risk factor for this client?

Pelvic inflammatory disease (PID) -PID is a major risk factor for ectopic pregnancy. Other risk factors include salpingitis, peritubal adhesions, structural abnormalities of the tube, previous ectopic pregnancy, previous tubal surgery, multiple previous induced abortions, tumors that distort the tube, and IUD and progestin-only contraceptives. Combined hormonal contraceptive use, in vitro fertilization, and habitual abortions are not risk factors for ectopic pregnancy.

The nurse is documenting the results of a pelvic examination on a client's medical record. Which of the following would alert the nurse to the need for additional follow up?

Positive cervical motion tenderness -Positive cervical motion tenderness usually indicates a pelvic infection that necessitates additional follow up. A cervix that is uniformly firm on palpation, a uterus that is tipped toward the abdominal wall, and ovaries that are slightly tender on palpation are considered normal findings.

Ovulation occurs midway between days 17 and 22 (usually at day 14) in a normal 28-day menstrual cycle. Conception occurs during ovulation. If an egg is fertilized, this hormone will continue to be produced to protect the egg until the placenta takes over. Which of the following is the correct hormone?

Progesterone -The corpus luteum produces progesterone for 12 to 16 days during the cycle. If fertilization happens, progesterone will continue to be secreted.

A client presents with symptoms of menstrual difficulties and infertility. Which hormone is essential in the maintenance of the endometrium?

Progesterone -Without a high level of progesterone, the endometrium (uterine lining) degenerates and shreds. Estrogen is a hormone that is essential for menstruation and prepares the uterus for pregnancy. Women produce testosterone, which maintains muscle mass, bone strength, and sex drive. Prolactin is produced by the pituitary gland and stimulates lactation.

Which of the following positions may be utilized for a patient who is unable to maintain the supine lithotomy position?

Sims' -Although several positions may be used for the pelvic examination, the supine lithotomy position is used most commonly. Sims' position may be used with a patient who is unable to maintain the supine lithotomy position due to acute illness or disability. The prone, semi-Fowler's, and Trendelenburg position would not be used.

An instructor is preparing a teaching plan for a group of students about reproductive structures and sexual arousal. Which female reproductive structure would the instructor include?

The clitoris -At the superior junction of the labia, there is a fleshy protrusion of tissue called the clitoris. The clitoris is an erectile tissue that enlarges and becomes sensitive when stimulated by the penis or touching that accompanies sexual foreplay. The mons pubis, labia minora, and labia majora are female reproductive structures but do not play as prominent a role in sexual arousal.

The nurse is instructing clients at a prenatal class. Which term does the nurse state as the medical name of what is removed during this procedure?

The prepuce -The prepuce or foreskin is removed during circumcision. The prepuce covers the glans. The shaft is tubular and composed of erectile tissue. The corpora cavernosa is a column of erectile tissue.

A postmenopausal patient is experiencing dyspareunia. What methods can the nurse recommend she use to diminish the discomfort?

Water-based lubricant -For postmenopausal women experiencing dyspareunia (painful intercourse) due to vaginal dryness, the nurse should recommend a water-soluble lubricant (e.g., K-Y Jelly, Astroglide, Replens), hormone cream, or contraceptive foam. Petroleum jelly is not water-soluble. An analgesic, such as ibuprofen or aspirin, would not address the primary problem, which is vaginal dryness.

An older female client reports pain during intercourse, disrupting the intimacy that she and her husband are accustomed to sharing. What might be the cause of her pain?

atrophy of Bartholin glands -The female genitalia change during the aging process. Changes include thinning of pubic hair; decrease in the size of the labia majora and minora; shortening and narrowing of the vagina; and atrophy of Bartholin's glands, which results in less lubrication.

A nurse is preparing a presentation for a health class. The participants will be high-school girls, and the topic will be the menstrual cycle. Which events would the nurse need to incorporate into the presentation as occurring during the proliferative phase? Select all that apply.

- Rise in follicle-stimulating hormone secretion - Increasing estrogen secretion

Because of a client's reluctance to begin hormone therapy, the advance nurse practitioner prescribes venlafaxine to decrease the risk of - hot flashes. - stroke. - heart attack. - blood clots.

- hot flashes.

After 2 years of infertility, a couple is interested in assisted reproduction. Which nursing interventions are appropriate when working with couples during infertility treatment? Select all that apply.

- Refer them to a smoking cessation program. - Recommend a folic acid supplement. - Assess the couple's stress relief practices.

A client who is 6 weeks' pregnant is scheduled for an induced abortion. Which laboratory test(s) will the nurse schedule for the client before the procedure? Select all that apply.

- Rh factor - Pregnancy test - Hematocrit level

A 52-year-old client asks the nurse how she is to remember when to schedule her clinical breast examination. Which response by the nurse is most correct?

"The clinical breast evaluation will be completed with annual gynecologic examination." -A clinical breast examination is completed by a physician, nurse, or physician's assistant as part of the gynecologic examination, an annual examination, or before a mammogram. Unless there is an abnormality, a clinical breast examination does not need to be completed more than annually as the client is completing the monthly self-breast examinations. The examination is typically performed in the physician's office and not a diagnostic center unless the client happens to be also scheduled for a mammogram.

A patient who is scheduled for a gynecologic examination and Pap smear informs the nurse that she just began her menstrual cycle. What is the best response by the nurse? A) "We will do the test and take into consideration that you are menstruating." B) "We will proceed with the examination and reschedule your Pap smear for next week." C) "This will have no bearing on your test today." D) "We will reschedule your examination when you have finished menstruating."

"We will reschedule your examination when you have finished menstruating." -The nurse should not obtain a Papanicolaou (Pap) smear if the woman is menstruating or has other frank bleeding; the examination should be rescheduled to after her menstruation.

The nurse is preparing a client for a pelvic examination. Which nursing question is essential for the nurse to ask?

"Would you like to void at this time?" -Prior to a pelvic examination, the nurse offers the client the use of the restroom to void. It is most important for the client to empty her bladder so that the physician can feel pelvic structures more clearly and also for the comfort of the client. Asking client history questions is completed at the beginning of the appointment. It is important to offer assistance to those who may need help in assuming the lithotomy position.

The nurse is scheduling an appointment for Pap test with a client. What information should the nurse provide to the client to ensure the test is accurate? Select all that apply.

- "Avoid sexual intercourse for at least 2 days prior to the test." - "Use a sanitary pad instead of tampon 2 to 3 days prior to the test."

A client has decided to use a transdermal contraceptive patch. The nurse instructs her that she can apply the patch to which area? Select all that apply.

- Chest - Torso - Arms - Thighs

A young adult woman comes to the clinic for a routine physical examination. During the assessment, the woman asks the nurse about what she can do to reduce her risk for osteoporosis because "My mother has it." Which of the following would be appropriate for the nurse to suggest? Select all that apply.

- Engage in regular weight-bearing exercise. - Take a calcium supplement daily. - Avoid caffeine-containing food and drink. - Try to decrease or stop smoking.

The nurse, who is conducting a Papanicolaou (Pap) smear, performs which actions to promote client comfort during the procedure? Select all that apply.

- Ensure warming of the speculum - Lubricate the blades of the speculum - Explain to the client that some discomfort is normal

A patient informs the nurse that she believes she has premenstrual syndrome and is having physical symptoms as well as moodiness. What physical symptoms does the nurse recognize are consistent with PMS? Select all that apply.

- Fluid retention - Low back pain - Headache

The nurse is providing information at the local YMCA about screenings for breast and cervical cancer. The nurse should inform young women that they should begin their screenings at what time? A) annual breast and pelvic examinations are important for all women 21 years of age or older and for those who are sexually active, regardless of age. B) Annual breast and pelvic examinations should begin at age 14 years old. C) Annual breast and pelvic examinations should begin when a woman becomes sexually active. D) Annual breast and pelvic examinations should be performed when a woman begins taking birth control.

Annual breast and pelvic examinations are important for all women 21 years of age or older and for those who are sexually active, regardless of age.

The nurse is about to begin conducting a pelvic examination of a client. The client reports having lower back and hip pain anytime she has to lie on her back. What is the best way for the nurse to proceed with the examination?

Ask the client to lie on her left side with the right leg bent

The nurse is utilizing the PLISSIT model of sexual health assessment during an interaction with a new client. According to this model, the nurse should begin with what action?

Asking the client's permission to discuss sexuality -The PLISSIT model of sexual assessment begins with permission and subsequently includes limited information, specific suggestions, and intensive therapy.

A woman visits her primary health care provider with a complaint of pain and swelling in the vaginal area. The pain is present when she sits and walks; intercourse is painful. The nurse prepares the patient for an examination. The nurse and health care provider suspect that the patient may have an inflammation or infection of the:

Bartholin glands. -The Bartholin glands are two bean-sized glands on either side of the entrance to the vagina that secrete fluid into the vaginal area. They can become blocked (cyst formation) or infected (abscess formation). Treatment is different for each, but pain is common with both. Pain can interfere with sitting and walking. A culture is necessary to diagnose the bacteria causing an abscess.

The nurse is discussing nutritional needs for a postmenopausal patient. What dietary increase should the nurse recommend to the patient?

Calcium -Postmenopausal women should be encouraged to observe recommended calcium and vitamin D intake, including calcium supplements, if indicated, to slow the process of osteoporosis. Iron and vitamin K need not be increased unless there are signs of deficiency. Salt should be eaten in moderation, not increased, to prevent hypertension.

Which of the following is an age-related functional change of the female reproductive system?

Decreased ovulation - Functional changes of the female reproductive system include decreased ovulation, onset of menopause, hormonal fluctuations, decreased bone formation, decreased vaginal lubrication, and increased pH of the vagina.

A female client severely reduced her body fat through extreme caloric restriction and exercise. Which reproductive abnormalities could she acquire as a result of the reduction in body fat?

Delay or cessation of menstruation -She could acquire reproductive abnormalities, such as delay or cessation of menstruation. A cause of infertility in women is polycystic ovarian syndrome a complex endocrine disorder linked to insulin resistance. High caffeine consumption may also put a client at risk for fibrocystic breast disease.

A nurse practitioner is conducting a history and physical on a 42-year-old woman. One of the questions asked of someone in this age group is the type of medications that the patient's mother took during her pregnancy. The nurse is assessing for a past history of ______ use.

Diethylstilbestrol -Diethylstilbestrol (DES) is a nonsteroidal estrogen that was given to pregnant women (1940-1970) to prevent pregnancy complications. After 30 years, it was found to cause vaginal cancer in daughters exposed to the drug in utero. The incidence of occurrence can be as high as 40%.

A client is scheduled for an abdominal ultrasound as a follow up to her pelvic examination. Which action by the nurse would be most appropriate?

Ensuring that the client has a full bladder -An abdominal ultrasound is a simple procedure that requires no specific preparation other than ensuring that the client has a full bladder to enhance visualization of abdominal area. A mild sedative, laxatives, and an enema would be used prior to a hysterosalpingography. A hysteroscopy should be done about 5 days after menstruation ceases.

A 13-year-old who started her menstrual cycle at age 12 asks the nurse practitioner how frequently her "period" should come. The nurse takes a calendar and has the girl circle the date of her last period, which started on January 7. The nurse then circles when her next period should start based on the average number of days in a normal cycle. What date did the nurse circle?

February 4 -February 5 is 28 days from the start of the last cycle, based on the average number of days in a normal cycle. However, cycles can vary from 21 to 42 days, depending on a variety of factors.

A nurse is reviewing the medical record of a client who has come to the clinic for contraception. What condition would hormonal contraceptives be contraindicated for in a client?

History of thrombophlebitis -Absolute contraindications to the use of hormonal contraceptives include a history of thrombophlebitis because of the increased risk for emboli formation. Hypertension, if controlled in an otherwise healthy young nonsmoker, is not a contraindication for the use of combination agents. However, the client would require a low dose and careful monitoring. Hormonal contraceptives may decrease acne in some situations and help to establish a regular bleeding cycle. An irregular menstrual cycle is not a contraindication.

A client comes to the clinic reporting dysmenorrhea and is diagnosed with primary dysmenorrhea. Which medication would the nurse most likely suggest for pain relief?

Ibuprofen - Prostaglandin inhibitors such as aspirin, ibuprofen, naproxen, and mefenamic acid would be recommended. Acetaminophen (Tylenol) would be the least likely choice. Calcium is a supplement for bone health. Cholecalciferol is a vitamin D supplement used for bone health.

Nursing students are reviewing information about the age-related changes in the reproductive system and their effects. The students demonstrate a need for additional study when they identify which of the following as an expected change?

Increased labial thickness -Age-related changes include a thinning of the labia, decreased bone formation, increased vaginal pH, and decreased vaginal lubrication.

Which statement is true regarding hormonal contraception?

It increases risk for venous thromboembolism. -Clients taking hormonal contraception have an increased risk for venous thromboembolism but a decreased risk for benign breast cancer and uterine cancer. Fetal anomalies are not a concern.

The menstrual cycle is dependent on the interplay among a number of hormones. The hormone(s) responsible for stimulation of progesterone is (are):

Luteinizing hormone. -The female pituitary gland releases follicle-stimulating (FSH) and luteinizing hormone (LH). Progesterone production and the release of mature eggs is dependent on luteinizing hormone.

A 32-year-old woman has had three consecutive normal Pap tests. Which of the following recommendations for screening would be appropriate?

Pap testing every 2 to 3 years - After an initial screening, a woman should undergo a Pap test with conventional cervical cytology smears annually with conventional cervical cytology or biennially with liquid-based cytology. At or after age 30, those women who have had three consecutive normal screening tests may be screened every 2 to 3 years unless they have high risk factors for developing cervical cancer.

A positive chandelier sign is indicative of which of the following?

Pelvic infection -Pain on gentle movement of the cervix is called a positive chandelier sign or positive cervical motion tenderness and usually indicates a pelvic infection.

A client reports a pain rating of 6 (on a 1-to-10 pain scale, with 10 being the worst possible pain) when the nurse examiner gently moves the cervix. This finding is most consistent with which condition?

Pelvic infection -Pain upon gentle movement of the cervix is called a positive chandelier sign or positive cervical motion tenderness and usually indicates a pelvic infection.

A client is prescribed a combination hormonal contraceptive. What condition would the nurse instruct the client to report to the healthcare provider immediately?

Pregnancy -A client taking combined hormonal contraceptives should immediately report thrombophlebitis or known or suspected pregnancy because of serious complications like pulmonary emboli or miscarriage. Although nausea and mood changes are bothersome adverse effects, they do not need to be reported immediately. Difficulty hearing is not associated with combined hormonal contraceptive use.

Which hormone is absent during menstruation?

Progesterone -During menstruation, progesterone is absent. Estrogen is low, FSH is increased, and LH is low during menstruation.

A nurse is employed by a fertility clinic. Diagnostic testing is being completed to determine the source of the male not producing viable sperm to enable ovum fertilization. Which male structures does the nurse consider if the problem is narrowed to sperm survivability?

Prostate gland -The accessory structure of the prostate gland contains secretory cells that produce alkaline fluid. The prostatic fluid mixes with sperm. The alkalinity of the prostatic fluid neutralizes the acidic metabolic wastes released by the sperm and counteracts the acid pH within the vagina to ensure mass survival of the sperm. The Cowper's glands add lubrication for penetration of the vagina.

A nurse practitioner is preparing to perform a client's scheduled Pap smear, and the client asks the nurse to ensure that the speculum is well lubricated. How should the nurse proceed with assessment?

Reassure the client that a water-based lubricant or warm water will be used. -Petroleum-based lubricants may obscure cells on a Pap smear. However, a water-based lubricant or warm water can be used. Warming the speculum can also reduce discomfort. The client will likely feel the insertion and manipulation of the speculum as a sensation of pressure or fullness.

Nursing students are reviewing information about natural family planning methods in preparation for a quiz the next day. The students demonstrate a need for additional study when they identify which of the following as an example?

Spermicide -Spermicides are considered a barrier method of contraception. Natural family planning methods include the calendar, basal body temperature, symptothermal, and ovulation methods.

A new client has come to the clinic seeking an appropriate method of birth control. What would the nurse teach this client about a diaphragm? - One size fits all females. - The diaphragm may be cleaned with soap and water after use. - A diaphragm eliminates the need for spermicidal jelly. - The diaphragm should be removed 1 hour following intercourse.

The diaphragm may be cleaned with soap and water after use. -The diaphragm may be cleaned with soap and water after use. It must be left in 6 hours after intercourse and should be used with spermicidal jelly. There are different sizes of diaphragms and the client needs to be fitted by the health care practitioner.

While examining the introitus, the nurse practitioner asks the client to "bear down." The nursing student observing the examination knows that the nurse practitioner is assessing the client for which condition?

Uterine prolapse -The introitus is the vaginal orifice. Uterine prolapse occurs when the cervix and uterus descend under pressure through the vaginal canal and can be seen at the introitus. To identify such protrusions, the examiner asks the client to "bear down." Examinations for colorectal cancer or female genital mutilation do not improve when the client bears down. A Pap test reveals atypical cells; the liquid method allows for human papillomavirus testing. This procedure does not require the client to bear down.

A patient has been diagnosed with a Trichomoniasis vaginal infection. The nurse would expect which color of discharge?

Yellow-green -Vaginal discharge associated with Trichomoniasis vaginal infection is copious and often frothy/yellow-green. Candida infection is associated with thin to thick, curd-like, white discharge. White discharge is associated with a normal discharge. Bacterial vaginosis is associated with thin and grayish or yellow discharge.

Which structure is referred to as the vulva?

external female genitalia -The major external structures include the mons pubis, vaginal orifice (opening), labia majora, labia minora, and clitoris. These structures are also referred to as the vulva (collective term for external genitalia).

Within the female internal reproductive structures, where is the egg most commonly fertilized?

fallopian tubes -One or the other fallopian tube receives an extruded ovum every month and serves as the place where the ovum is most commonly fertilized.

A woman comes to the clinic complaining of vaginal itching and a discharge. Inspection reveals a thick curd-like white discharge. The nurse suspects which of the following?

Candida infection -Complaints of vaginal itching with a thin to thick, curd-like white vaginal discharge suggests a Candida (yeast) infection. Bacterial vaginosis would be manifested by a discharge that is thin and grayish or yellow with a fishy odor. Trichomonas infection is manifested by a malodorous, copious, often frothy yellow-green vaginal discharge. Atrophic vaginitis is manifested by vulvar or vaginal dryness with a scant, often mucoid, but possibly blood-tinged vaginal discharge.

The nurse is caring for a client who has been admitted to hospital for uterine bleeding after incomplete miscarriage. The nurse knows what will be included in this client's treatment?

Dilation and curettage -Dilation and curettage (D&C) can be used as a diagnostic or therapeutic tool. The cervical canal is dilated and the endometrium is scraped. D&C can be used to gather endometrial tissue for cytologic examination, control abnormal uterine bleeding, and as a therapeutic measure for incomplete miscarriage. In this case, D&C is being used as a therapeutic intervention to control bleeding from the incomplete passage of residual tissue in the uterus. Endometrial ablation is performed in cases of severe bleeding not responsive to other therapies. Performed in an outpatient setting under general, regional, or local anesthesia, the uterus is distended with a fluid infusion. Ultrasonography is useful adjunct to the physical examination for patients with abnormal pelvic findings but is not useful as a therapeutic treatment of uterine bleeding. A hysteroscopy allows direct visualization of all parts of the uterine cavity by means of a lighted optical instrument. It is used as a diagnostic tool, not a treatment for bleeding.

A nurse has assessed a woman in the hospital emergency department who was struck several times in the face by her intimate partner. As the woman is having her facial injuries assessed, she tells the nurse she does not want to return home. Which action should the nurse take?

Provide the woman with a list of phone numbers for shelters -The nurse can provide teaching, resources and support to the client when managing domestic abuse. This should include information about possible shelters that she can access while decided her next plan of action if she does not want to return to the abusing intimate partner. The client must independently make the decision to go to a shelter, without the perception of pressure to make this decision from the health care provider. For this reason, it is important that the client call the shelter on her own accord. The nurse should not call the 24-hour hotline for the client. This is a resource for victims of violence to utilize when needing emotional support or developing a plan to leave the abusive situation. A safety plan is a tool that the nurse can assist the client in developing if she decides to return home. The plan needs to be individualized to meet the client's unique needs for her situation, the nurse should not provide a premade plan.

During an internal vaginal examination, the nurse practitioner notes a frothy and malodorous discharge. What bacteria does the practitioner suspect is causing this disorder?

Trichomonas -A Trichomonas species infection is typically malodorous and presents with a copious, often frothy yellow-green appearance. Candida species infections are characterized by either a yeast odor or none, along with a thin to thick, curd-like, white appearance. Eschar and Escherichia coli bacteria are not associated with vaginal discharges.

The nurse is seeing a client who has been told her Papanicolaou smear results are abnormal. The client states, "I can't believe I have cancer." What is the nurse's best response?

"Abnormal results happen for many different reasons, not just cancer." -Although patients may assume (incorrectly) that an abnormal Pap smear signifies cancer, this is not generally the case. It simply means just that, it is abnormal: Under the microscope, the appearance of a few cells differs in some way from the classic appearance of healthy, intact cervical cells. The difference could be due to local irritation, a non- HPV, infection, a low-risk or high-risk HPV type, or even a mistake in the preparation of the cell sample. In this case, the best response from the nurse is to tell the client there are many different reasons for an abnormal result. The next step would be to refer the client on for follow up diagnostic testing. It would be incorrect to inform the client that most of the time there has been a mistake in the sample. Although this can happen, it does not happen most of the time. By saying this to the client, the nurse is discouraging follow up that can prevent a more serious reproductive health problem. By informing the client that cervical cancer has a very good prognosis, the nurse is incorrectly confirming with the client that this is her diagnosis. Further diagnostic testing is required to determine the cause of the abnormal result. Although menstruating can interfere with the sample quality, providing an immediate reason for the positive result may also discourage follow up.

Cone biopsy describes a procedure in which cervical tissue is removed as result of detection of abnormal cells. Which statements by the client demonstrates that the client undergoing a cone biopsy understands the discharge instructions?

"I will avoid having sexual relations until I see the doctor again." -Cone biopsy is a procedure done to remove abnormal cervical tissue. The nurse or primary provider provides guidelines regarding postoperative sexual activity, bathing, and other activities. Because open tissue may be potentially exposed to HIV and other pathogens, the client is cautioned to avoid intercourse until healing is complete and verified at follow-up. Routine repeat cone biopsy is not normally indicated. Perineorrhaphy refers to sutural repair of perineal lacerations; sutures are not required with a cone biopsy. Cryotherapy refers to destruction of tissue by freezing; no freezing is involved with a cone biopsy.

A 35-year-old African American woman who smokes regularly and had diabetes visits the health care unit with sustained elevated blood levels and is diagnosed with essential hypertension. Which contraceptive method is best for this client?

Cervical cap -Women who smoke and are 35 years of age or older should not take oral contraceptives because of an increased risk of cardiovascular disease. Mechanical barriers like cervical caps do not use hormonal therapy and are appropriate in this case. Menotropins, a combination of follicle-stimulating hormone and luteinizing hormone, may be used to stimulate the ovaries to produce eggs. An etonogestrel/ethinyl estradiol vaginal ring is a combination hormonal contraceptive that releases estrogen and progestin and is contraindicated for this client.

Which term refers to difficult or painful sexual intercourse? Amenorrhea Dyspareunia Dysmenorrhea Endometriosis

Dyspareunia -Dyspareunia is a common problem in older women. Amenorrhea refers to the absence of menstrual flow. Dysmenorrhea refers to painful menstruation. Endometriosis is a condition in which endometrial tissue seeds in other areas of the pelvis.

Which test is an x-ray study of the uterus and the fallopian tubes after injection of a contrast agent?

Hysterosalpingography -Hysterosalpingography is an x-ray study of the uterus and the fallopian tubes after injection of a contrast agent. Laparoscopy allows the pelvic structures to be visualized. A hysteroscopy allows direct visualization of all parts of the uterine cavity be means of a lighted optical instrument. Endometrial ablation is the destruction of the uterine lining.

A newly pregnant client is being assessed in an obstetric clinic. The client states that she has been experiencing intense abdominal pain and the nurse anticipates that the client will be assessed for ectopic pregnancy. In addition to ultrasonography, what diagnostic test should the nurse anticipate?

Human chorionic gonadotropin (hCG) testing -If an ectopic pregnancy is suspected, the client is assessed using ultrasound and hCG testing. CT and x-rays are contraindicated during pregnancy and estrogen and progesterone levels are not diagnostic of ectopic pregnancy.

A woman who is 10 weeks pregnant arrives at the emergency department reporting vaginal bleeding and cramping. She states, "I've passed some small clots." Inspection of the perineal pad reveals moderate bleeding and some tissue. The client's cervix is dilated. The nurse interprets these findings as indicative of which of the following?

Incomplete abortion -The client is most likely experiencing an incomplete abortion as evidenced by the cramping, passage of tissue, vaginal bleeding, and cervical dilation. Cervical dilation would be absent in a threatened abortion. An inevitable abortion is indicated by the continued signs and symptoms of an abortion despite measures to prevent it. Habitual abortion involves successive, repeated, spontaneous abortions of unknown cause.

Which of the following is the period of transition from normal periods to the complete cessation of menses for 1 year?

Perimenopause - Perimenopause is the period of transition from normal periods to the complete cessation of menses for 1 year. Menopause marks the end of a woman's reproductive capacity and generally occurs between 45 and 52 years of age. Menstruation is the cyclic shedding of the uterine lining that occurs when pregnancy has not been established. Menarche is the first menstrual cycle.

In the menstrual cycle, every month the female reproductive system generates an ovum. When the ovum is not fertilized, production of which of the following leads to menstruation?

Progesterone by the corpus luteum beginning to decrease

A client is diagnosed with hypertension. The client also reports skin discoloration, weight gain, and nausea. Which contraceptive preparations would the nurse practitioner recommend for this client?

Progestin-only -Progestin-only preparations are useful for women who have experienced estrogen-related side effects (e.g., headaches, hypertension, leg pain, chloasma or skin discoloration, weight gain, or nausea) when taking combination pills. Combined preparations can be monophasic, biphasic, and or triphasic. Monophasic preparations supply the same dose of estrogen and progestin for 21 days. Biphasic preparations and triphasic pills vary the amount of hormonal components during the cycle.

When the nurse places the patient in the stirrups for a pelvic exam she observes a bulge caused by rectal cavity protrusion. What does the nurse know this protrusion is called?

Rectocele -Childbirth trauma may have affected the posterior vaginal wall, producing a bulge caused by rectal cavity protrusion (rectocele). Trauma to the anterior vaginal wall during childbirth may have resulted in incompetency of the musculature, and a bulge caused by the bladder protruding into the submucosa of the anterior vaginal wall (cystocele) may be seen. The cervix and uterus may descend under pressure through the vaginal canal and be seen at the introitus (uterine prolapse). Hemorrhoids would not cause a bulge in the pelvic region.

A group of students are reviewing information related to the male reproductive system structures. The students demonstrate understanding of the information when they identify which structure as an accessory organ?

Seminal vesicles -Accessory structures include the seminal vesicles, which join with the ductus deferens to become the ejaculatory duct, the prostate gland, and the bulbourethral glands. The vas deferens and epididymis are internal male reproductive structures. The scrotum is an external male reproductive structure.

The nurse is caring for a client who states having an irregular menstrual period. Which diagnostic test provides information of the body's ability to ovulate?

Serum follicle-stimulating hormone -The anterior pituitary hormone known a follicle-stimulating hormone (FSH) initiates ovulation monthly. Monitoring the FSH level provides information about the timing of ovulation. Thyroid level, estrogen level, and serum luteinizing hormone do not give information about the ability to ovulate

A group of students are reviewing the female reproductive system in preparation for a test. Which of the following if identified by the students as an internal structure indicates successful learning?

Vagina -The vagina is considered an internal female reproductive system structure. The vulva, labia majora, and mons pubis are external structures.

During physical examination of the male reproductive system, which method would best provide the nurse information about the prostate's size as well as evidence of tumor?

digital rectal examination -A digital rectal examination (DRE) is performed to assess the prostate for size as well as evidence of tumor.