7.7 Ch. 53 Female Reproductive Problems

15. The nurse is assessing the client diagnosed with a rectocele. Which signs and symptoms should the nurse expect? Select all that apply. 1. Rectal pressure. 2. Flatus. 3. Fecal incontinence. 4. Constipation. 5. Urinary frequency.

1, 2, 3, 4 1. A rectocele causes the rectum to be pouched upward, causing rectal pressure. 2. When the rectum pushes against the posterior wall of the vagina, the result is flatus. 3. Clients with a rectocele experience fecal incontinence. 4. Clients with a rectocele frequently are constipated. 5. A client who has a rectocele does not experience urinary frequency.

28. The client diagnosed with cancer of the uterus is scheduled to have radiation brachytherapy. Which precautions should the nurse implement? Select all that apply. 1. Place the client in a private room. 2. Wear a dosimeter when entering the room. 3. Encourage visitors to come and stay with the client. 4. Plan to spend extended time with the client. 5. Notify the nuclear medicine technician.

1, 2, 5 1. Brachytherapy is the direct implantation of radioactive seeds through the vagina into the uterus. The client should be in a private room at the end of the hall to prevent radiation exposure to the rest of the unit. 2. Nurses wear a dosimeter registering the amount of radiation they have been exposed to. When a certain level is reached, the nurse is no longer allowed to care for clients undergoing internal radiation therapy. 3. Visitors are limited while the radiation is in place. 4. In this case, spending extra time with a client is not done. The nurse does only what must be done and leaves the room. 5. The nuclear medicine technician will assist with the placement of the implants and will deliver the implants in a lead-lined container. The technician will also scan any items (linens and wastes) leaving the room for radiation contamination.

48. The nurse is caring for a client who is one (1) day postoperative a hysterectomy for cancer of the ovary. Which nursing interventions should the nurse implement? Select all that apply. 1. Assess for calf enlargement and tenderness. 2. Turn, cough, and deep breathe every six (6) hours. 3. Assess pain on a one (1)-to-ten (10) pain scale. 4. Apply sequential compression devices to legs. 5. Assess bowel sounds every four (4) hours.

1, 3, 4, 5 1. All clients who have had surgery are at risk for developing deep vein thrombosis (DVT), and an enlarged, tender calf is a sign of DVT. 2. The client should be turned and encouraged to cough and deep breathe at least every two (2) hours. 3. Clients who have had surgery should be assessed for pain on a pain scale and by observing for physiological markers indicating pain. 4. Sequential compression hose are used prophylactically to prevent deep vein thrombosis. 5. The client should be assessed for the return of bowel sounds.

24. An elderly woman is diagnosed with pelvic relaxation disorder secondary to age-related changes. Which medication should the nurse expect to administer? 1. Estrogen, a hormone. 2. Cervidil, a cervical ripening agent. 3. Progesterone, a hormone. 4. Pitocin, an oxytocic agent.

1. Estrogen changes the pelvic floor muscles and lining of the uterus and may help improve a pelvic relaxation disorder.

47. The nurse is preparing an in-service for women in the community. Which primary nursing intervention should the nurse discuss regarding the development of ovarian cancer? 1. Instruct the clients not to use talcum powder on the perineum. 2. Encourage the clients to consume diets with a high fat content. 3. Teach the women to have a lower pelvic sonogram yearly. 4. Discuss the need to be aware of the family history of cancer.

1. Research has shown the use of talcum powder perineally increases the risk for developing ovarian cancer, although there is no explanation known for this occurrence. Other risk factors include a high-fat diet, nulliparity, infertility, older age (70 to 80 years) has the greatest incidence, mumps before menarche, and family history of ovarian cancer.

26. The client in the gynecology clinic asks the nurse, "What are the risk factors for developing cancer of the cervix?" Which statement is the nurse's best response? 1. "The earlier the age of sexual activity and the more partners, the greater the risk." 2. "Eating fast foods high in fat and taking birth control pills are risk factors." 3. "A Chlamydia trachomatis infection can cause cancer of the cervix." 4. "Having yearly Pap smears will protect you from developing cancer."

1. Risk factors for cancer of the cervix include sexual activity before the age of 20 years; multiple sexual partners; early childbearing; exposure to the human papillomavirus; HIV infection; smoking; and nutritional deficits of folates, beta carotene, and vitamin

8. The client has an infected Bartholin's cyst and the HCP has performed an incision and drainage (I & D) of the area. Which discharge instructions should the nurse teach the client? 1. Complete all antibiotics as ordered. 2. Report any drainage immediately. 3. Keep all water away from the area. 4. Lie prone as much as possible.

1. The client has an infection and should complete the ordered antibiotics.

13. Which question is most important for the nurse to ask the client with a cystocele who is scheduled to have a pessary inserted? 1. "Do you know if you are allergic to latex?" 2. "When did you start having incontinence?" 3. "When was your last bowel movement?" 4. "Are you experiencing any pelvic pressure?"

1. The client should be assessed for allergies to latex as a result of the composition of the pessary.

19. Which information should the nurse include in the discharge teaching for the client recovering from an abdominal hysterectomy? 1. The client should report any vaginal bleeding or cramping to the surgeon. 2. The client should start a vigorous exercise routine to restore her muscle tone. 3. The client should continue sitting in the bedside chair at least six (6) hours daily. 4. The client should soak in a warm tub bath each night for one (1) hour.

1. The client should report any vaginal bleeding or gastrointestinal changes such as distention, cramping, or changes in bowel habits.

14. The client has failed to conceive after many attempts over a three (3)-year time period and asks the nurse, "I have tried everything. What should I do now?" Which statement is the nurse's best response? 1. "By 'everything' do you mean you have consulted an infertility specialist?" 2. "You have tried everything. This must be hard for you. Would you like to talk?" 3. "You should get on an adoption list because it can take a long time." 4. "You need to relax and not try so hard. It is your nerves preventing conception."

1. The nurse should investigate which fertility measures have been attempted. There are many reasons for infertility, and only a specialist in the area can identify the cause.

38. The nurse is caring for a client newly diagnosed with Stage IV ovarian cancer. What is the scientific rationale for detecting the tumors at this stage? 1. The client's ovaries lie deep within the pelvis and early symptoms are vague. 2. The client has regular gynecological examinations and this helps with detection. 3. The client had a history of dysmenorrhea and benign ovarian cysts. 4. The client had a family history of breast cancer and was being checked regularly.

1. The ovaries are anatomically positioned deep within the pelvis, and because of this, signs and symptoms of cancer are vague and nonspecific. Symptoms include increased abdominal girth, pelvic pressure, indigestion, bloating, flatulence, and pelvic and leg pain. Increasing abdomen size as a result of accumulation of fluid is the most common sign. Many women ignore the symptoms because they are so nonspecific.

39. The female client presents to the gynecologist's office for the fifth time with an ovarian cyst and is scheduled for an exploratory laparoscopy. The client asks the nurse, "Why do I need to have another surgery? The other cysts have all been benign." Which statement is the nurse's best response? 1. "Because eventually the cysts will become cancerous." 2. "All abnormal findings in the ovary should be checked out." 3. "The surgery will not be painful and you will have peace of mind." 4. "Are you afraid of having surgery? Would you like to talk about

2. Any abnormal ovary which cannot be diagnosed with a transvaginal ultrasound should be examined laparoscopically.

9. The client is diagnosed with vulvar cancer. Which are the most common symptoms of cancer of the vulva? 1. Red, painful lesions. 2. Vulvar itching. 3. Thin, white vulvar skin. 4. Vaginal dryness.

2. Cancer of the vulva may be asymptomatic, but the client usually presents with persistent long-term itching.

23. The nurse is preparing the client for an insertion of a pessary. Which information should the nurse teach the client? 1. The pessary does not need to be changed. 2. The client should clean the pessary routinely. 3. The pessary must be inserted in surgery. 4. Estrogen cream is necessary for effective use of a pessary.

2. Clients do need to clean the pessary routinely.

15. The nurse writes a problem of "potential for complications related to ovarian hyperstimulation" for a client who is taking clomiphene (Clomid), an ovarian stimulant. Which intervention should be included in the plan of care? 1. Instruct the client to delay intercourse until menses. 2. Schedule the client for frequent pelvic sonograms. 3. Explain the infusion therapy will take 21 days. 4. Discuss that this may cause an ectopic pregnancy.

2. Frequent sonograms are needed to monitor follicular stimulation. The ovaries are monitored to prevent overstimulation, which can cause ascites, pleural effusions, and acute respiratory distress syndrome (ARDS).

33. The client is diagnosed with benign uterine fibroid tumors. Which question should the nurse ask to determine if the client is experiencing a complication? 1. "How many periods have you missed?" 2. "Do you get short of breath easily?" 3. "How many times have you been pregnant?" 4. "Where is the location of the pain you are having?"

2. Many women delay surgery until anemia has occurred from the heavy menstrual flow. A symptom of anemia is shortness of breath.

7. The client is diagnosed with a rectovaginal fistula which is to be managed medically. Which information should the nurse teach the client prior to discharge? 1. Douche with normal saline. 2. Eat a low-residue diet. 3. Keep ice packs to the area. 4. Use an abdominal binder.

2. Measures to assist the client to heal without surgical interventions include proper nutrition with a low-residue diet to minimize contamination of the tissues with feces, cleansing douches, enemas, and rest.

41. The 50-year-old female client complains of bloating and indigestion and tells the nurse she has gained two (2) inches in her waist recently. Which question should the nurse ask the client? 1. "What do you eat before you feel bloated?" 2. "Have you had your ovaries removed?" 3. "Are your stools darker in color lately?" 4. "Is the indigestion worse when you lie down?"

2. Ovarian cancer has vague symptoms of abdominal discomfort, but increasing abdominal girth is the most common symptom. If the client has had the ovaries removed, then the nurse could assess for another cause.

30. The client has had a total abdominal hysterectomy for cancer of the uterus. Which discharge instruction should the nurse teach? 1. The client should take HRT every day to prevent bone loss. 2. The client should practice pelvic rest until seen by the HCP. 3. The client can drive a car as soon as she is discharged from the hospital. 4. The client should expect some bleeding after this procedure.

2. Pelvic rest means nothing is placed in the vagina. The client does not need a tampon at this time, but sexual intercourse should be avoided until the vaginal area has healed.

36. The nurse is caring for a client diagnosed with uterine cancer who has been receiving systemic therapy for six (6) months. Which intervention should the nurse implement first? 1. Determine which antineoplastic medication the client has received. 2. Ask the client if she has had any problems with mouth ulcers at home. 3. Administer the biologic response modifier filgrastim (Neupogen). 4. Encourage the client to discuss feelings about having cancer.

2. The systemic side effects of chemotherapy are not always apparent, and the development of stomatitis can be extremely distressing for the client. The nurse should assess the client's tolerance to treatments.

20. Which nursing task could be delegated to the unlicensed assistive personnel (UAP) for the client who had a total vaginal hysterectomy? 1. Observe the color and amount of drainage on the client's perineal pad. 2. Maintain a current intake and output for the client each shift. 3. Provide the client with a plan of pharmacological pain management. 4. Prepare the client for her discharge scheduled for the next day.

2. This nursing task can be delegated, but evaluation is the responsibility of the nurse.

11. The nurse is caring for a client diagnosed with uterine cancer who has received afterload intracavitary radiation. Which precaution should the nurse implement? 1. Wear rubber gloves to protect the nurse from all exposure. 2. Allow any visitor the client wishes to see. 3. Minimize the amount of time spent with the client. 4. Encourage the client to ambulate in the hallway.

3. Afterload intracavitary radiation therapy treatments are completed in the client's room after prepared applicators are placed in surgery. This minimizes exposure of the health-care workers to radiation. The nurse should plan care to minimize exposure to the client and the radiation.

35. The nurse and an unlicensed assistive personnel (UAP) are caring for clients on a gynecology surgery floor. Which intervention cannot be delegated to the UAP? 1. Empty the indwelling catheter on the three (3)-hour postoperative client. 2. Assist the client who is two (2) days post-hysterectomy to the bathroom. 3. Monitor the peri-pad count on a client diagnosed with fibroid tumors. 4. Encourage the client who is refusing to get out of bed to walk in the hall.

3. Monitoring a peri-pad count is done to determine if the client is bleeding excessively; the nurse should do this as part of the assessment.

24. The nurse is discussing pelvic floor exercises with a client. Which information should the nurse teach? 1. Perform the exercises four (4) times per day. 2. The exercises will prevent stress incontinence. 3. Contract the perineal muscles and hold for 10 seconds. 4. Contract the abdominal and buttock muscles to increase strength.

3. Perineal muscles should be contracted and held for 10 seconds followed by 10 seconds of rest.

16. What intervention should the nurse implement for a client diagnosed with a rectocele? 1. Limit oral intake to decrease voiding. 2. Encourage a low-residue diet. 3. Administer a stool softener daily. 4. Arrange for the client to take sitz baths.

3. Stool softeners and laxatives are used to prevent and treat constipation, which is common with a rectocele. Because of the positioning of the rectum, stool can stay in the rectal pouch, causing constipation.

46. The client has had a total abdominal hysterectomy for cancer of the ovary. Which diet should the nurse discuss when providing discharge instructions? 1. A low-residue diet without seeds. 2. A low-sodium, low-fat diet with skim milk. 3. A regular diet with fruits and vegetables. 4. A full liquid-only diet with milk shake supplements.

3. The client is not placed on a specific diet, but it is always a good recommendation to include fruits and vegetables in the diet.

32. The client diagnosed with endometriosis experiences pain rated a "5" on a 1-to-10 pain scale during her menses. Which intervention should the nurse teach the client? 1. Teach the client to take a stool softener when taking morphine, a narcotic. 2. Instruct the client to soak in a tepid bath for 30 to 45 minutes when the pain occurs. 3. Explain the need to take the nonsteroidal anti-inflammatory drugs with food. 4. Discuss the possibility of a hysterectomy to help relieve the pain.

3. The medication of choice for mild to moderate dysmenorrhea is an NSAID. NSAIDs cause gastrointestinal upset and should be taken with food.

42. The nurse writes a problem of "anticipatory grieving" for a client diagnosed with ovarian cancer. Which nursing intervention is priority for this client? 1. Request the HCP to order an antidepressant medication. 2. Refer the client to a CanSurmount volunteer for counseling. 3. Encourage the client to verbalize feelings about having cancer. 4. Give the client an advance directive form to fill out.

3. The nurse should plan to spend time with the client and allow the client to discuss the feelings of having cancer, dying, fear of the treatments, and any other concerns.

44. The client diagnosed with ovarian cancer is prescribed radiation therapy for regional control of the disease. Which statement indicates the client requires further teaching? 1. "I will not wash the marks off my abdomen." 2. "I will have a treatment every day for six (6) weeks." 3. "Nausea caused by radiation therapy cannot be controlled." 4. "I need to drink a nutritional shake if I don't feel like eating."

3. There are many medications prescribed for cancer or treatmentinduced nausea. The client should notify the HCP if adequate relief is not obtained.

25. The nurse is caring for a 30-year-old nulliparous client who is complaining of severe dysmenorrhea. Which diagnostic test should the nurse prepare the client to undergo to determine a diagnosis? 1. A bimanual vaginal exam. 2. A pregnancy test. 3. An exploratory laparoscopy. 4. An ovarian biopsy.

3. There is a high incidence of endometriosis among women who have never had children (nulliparity) and those who have children later in life. The most common way to diagnose this condition is through an exploratory laparoscopy.

40. The client has had an exploratory laparotomy to remove an ovarian tumor. The pathology report classifies the tumor as a "low malignancy potential" (LMP) tumor. Which statement explains the scientific rationale for this pathology report? 1. The client does not have cancer but will need adjuvant therapy. 2. The client would have developed cancer if the tumor had not been removed. 3. These borderline tumors resemble ovarian cancer but have better outcomes. 4. The client has a very poor prognosis and has less than six (6) months to live.

3. These tumors are low-grade cancers with fewer propensities for metastasis than most ovarian cancers.

43. The client diagnosed with ovarian cancer has had eight (8) courses of chemotherapy. Which laboratory data warrant immediate intervention by the nurse? 1. Absolute neutrophil count of 3,500. 2. Platelet count of 150 × 103. 3. Red blood cell count of 5.0 × 106. 4. Urinalysis report of 100 WBCs.

4. A normal urinalysis contains one (1) to two (2) WBCs. A report of 100 WBCs indicates the presence of an infection. A clean voided specimen should be obtained and a urine culture should be done. This client should be prescribed antibiotics immediately.

34. The HCP has prescribed two (2) IV antibiotics for the female client diagnosed with diabetes and pneumonia. Which order should the nurse request from the HCP? 1. Request written information on antibiotic-caused vaginal infections. 2. Request yogurt to be served on the client's meal trays. 3. Request a change of one of the antibiotics to an oral route. 4. Request L. acidophilus, a yeast preparation, three (3) times a day.

4. Female clients on antibiotics are at risk for killing the good bacteria, which keep yeast infections in check. This is especially true in clients diagnosed with diabetes. Lactobacillus acidophilus is a yeast replacement medication.

6. The nurse in the gynecology clinic is assessing the 50-year-old client who has had four (4) children and is complaining of having lower abdominal pressure and fatigue along with some urinary incontinence. Which instruction should the nurse teach the client? 1. Wear a peri-pad to keep from having an accident. 2. Try not to laugh or sneeze unless at home. 3. Discuss the pros and cons of a vaginal hysterectomy. 4. Instruct to perform Kegel exercises.

4. Kegel exercises help to strengthen the pelvic muscles. They are recommended for all women and should be performed 30 to 80 times per day.

37. The 24-year-old female client presents to the clinic with lower abdominal pain on the left side she rates as a "9" on a 1-to-10 scale. Which diagnostic procedure should the nurse prepare the client for? 1. A computed tomography scan. 2. A lumbar puncture. 3. An appendectomy. 4. A pelvic sonogram.

4. Ovarian cysts are fluid-filled sacs located on the surface of the ovary. A lower pelvic sonogram is the preferred diagnostic tool. It is not invasive and usually not painful.

22. The nurse is teaching the client diagnosed with uterine prolapse. Which information should the nurse include in the discussion? 1. Increase fluids and daily exercise to prevent constipation. 2. Explain there is only one acceptable treatment for uterine prolapse. 3. Instruct the client to visually check the uterine prolapse daily. 4. Discuss limiting coughing and lifting heavy objects.

4. Symptoms can be aggravated by coughing, sneezing, lifting heavy objects, standing for prolonged periods, and climbing stairs.

13. The nurse is discharging a client diagnosed with pelvic inflammatory disease (PID). Which statement by the client indicates an understanding of the discharge instructions? 1. "I should expect pelvic pain after intercourse." 2. "I need to douche every day to prevent PID." 3. "I will have a vaginal exam every two (2) years." 4. "My partner should use a condom if he is infectious."

4. The client and partner should consistently use a condom if there is any chance of transmission of any organism.

14. Which intervention should the nurse include when teaching the client who is having an anterior colporrhaphy to repair a cystocele? 1. Discuss the need to perform perineal care every four (4) hours. 2. Discuss the care of an indwelling catheter for at least one (1) month. 3. Instruct the client how to care for the pessary inserted in surgery. 4. Teach the client how to perform Kegel exercises.

4. The client should be taught how to perform Kegel exercises to strengthen the muscles.

29. The postmenopausal client reveals it has been several years since her last gynecological examination and states, "Oh, I don't need exams anymore. I am beyond having children." Which statement should be the nurse's response? 1. "As long as you are not sexually active, you don't have to worry." 2. "You should be taking hormone replacement therapy now." 3. "You are beyond bearing children. How does that make you feel?" 4. "There are situations other than pregnancy that should be checked."

4. The client should have a yearly clinical examination of the breasts and pelvic area for the detection of cancer.

10. The nurse is teaching a class to older women concerning cancer of the uterus. Which situation is a risk factor for developing endometrial cancer? 1. Age 40 years or younger. 2. Perimenopausal bleeding. 3. Progesterone given with estrogen. 4. Truncal obesity.

4. Truncal obesity is one of the risk factors for developing endometrial cancer, although it has not been determined how this occurs.

45. The female client has a mother who died from ovarian cancer and a sister diagnosed with ovarian cancer. Which recommendations should the nurse make regarding early detection of ovarian cancer? 1. The client should consider having a prophylactic bilateral oophorectomy. 2. The client should have a transvaginal ultrasound and a CA-125 laboratory test every six (6) months. 3. The client should have yearly magnetic resonance imaging (MRI) scans. 4. The client should have a biannual gynecological examination with flexible sigmoidoscopy.

A transvaginal ultrasound is a sonogram in which the sonogram probe is inserted into the vagina and sound waves are directed toward the ovaries. The CA-125 tumor marker is elevated in several cancers. It is nonspecific but, coupled with the sonogram, can provide information about ovarian cancer for early diagnosis.

12. Which manifestations of menopause are related to estrogen deficiency (select all that apply)? a. Cessation of menses b. Breast engorgement c. Vasomotor instability d. Reduction of bone fractures e. Decreased cardiovascular risk

a, c. The lack of estrogen in menopause contributes to many of the signs of aging, including cessation of menses, vasomotor instability (hot flashes), atrophic changes of vaginal and external genitalia and breast tissue, increased risks for coronary artery disease and osteoporosis, redistribution of fat, muscle and joint pain, loss of skin elasticity, and atrophic lower urinary tract changes.

15. The patient calls the office and says that she thinks she has a "yeast infection." What signs or symptoms should the nurse expect in this patient (select all that apply)? a. Intense itching and dysuria b. Hemorrhagic cervix and vagina c. Pruritic, frothy greenish or gray discharge d. Thick, white, cottage cheese-like discharge e. Mucopurulent discharge and postcoital spotting

a, d. "Yeast infection" or vulvovaginal candidiasis has intense itching and dysuria from urine coming in contact with fissures or irritated areas in the vulva. The discharge is thick, white, and curdlike. Hemorrhagic cervix and vagina occur with trichomoniasis and produce a pruritic, frothy greenish or gray discharge. Mucopurulent discharge and postcoital spotting from cervical inflammation is seen with cervicitis.

28. During assessment of the patient with vulvar cancer, what should the nurse expect to find? a. Soreness and itching of the vulva b. Labial lesions with purulent exudate c. Severe excoriation of the labia and perineum d. Painless, firm nodules embedded in the labia

a. Early signs of cancer of the vulva include pruritus, soreness of the vulva, unusual odor, and discharge or bleeding of the vulva, with edema of the vulva and lymphadenopathy occurring as the disease progresses. Labial lesions and excoriation more commonly occur with infections and nodules are more often cysts or lipomas.

16. A patient is diagnosed and treated for a Gardnerella vaginalis infection at a clinic. For her treatment to be effective, what does the nurse tell the patient? a. Her sexual partner should also be examined and treated. b. Her sexual partner must use a condom during intercourse. c. She should wear minipads to prevent reinfection as long as she has vaginal drainage. d. The vaginal suppository should be used in the morning so it will be fighting the infection all day.

a. Gardnerella vaginalis infection is a bacterial vaginosis that may be sexually transmitted and both partners may be infected. Treatment of the condition includes vaginal treatment with metronidazole (Flagyl) or clindamycin (Cleocin) or treatment via the oral route. Sexual activity is avoided until both partners are infection free. Minipads may be used to contain vaginal secretions but they do not prevent reinfection. Vaginal suppositories and creams are used at bedtime so that the medication remains in the vagina for a long period of time.

24. A woman who has been postmenopausal for 10 years calls the clinic because of vaginal bleeding. The nurse schedules a visit for the patient and informs her to expect to have which diagnostic procedure? a. An endometrial biopsy b. Abdominal radiography c. A laser treatment to the cervix d. Only a routine pelvic examination and Pap test

a. Postmenopausal vaginal bleeding is the first sign of endometrial cancer. When it occurs, a sample of endometrial tissue must be taken to exclude cancer. An endometrial biopsy can be done as an office procedure and is indicated in this case. Abdominal x-rays and Pap tests are not reliable tests for endometrial cancer. Laser treatment of the cervix is indicated only for cervical dysplasia.

37. Priority Decision: To prepare a woman who has been raped for physical examination, what should the nurse do first? a. Ensure that a signed informed consent is obtained from the patient. b. Provide a private place for the patient to talk about what happened to her. c. Instruct the patient not to wash, eat, drink, or urinate before the examination. d. Administer prophylaxis for sexually transmitted infections (STIs) and tetanus.

a. Specific informed consent must be obtained from the rape victim before any examination can be made or rape data collected. Following consent, the patient is advised not to wash, eat, drink, or urinate before the examination so that evidence can be collected for medicolegal use. Prophylaxis for STIs, hepatitis B, and tetanus is administered following examination and follow-up testing for pregnancy and human immunodeficiency virus (HIV) is done in several weeks.

1. A couple seeks assistance from an infertility specialist for evaluation of their infertility. What does the nurse inform the couple they can expect during the initial visit? a. Physical and psychosocial functioning examinations b. Assessment of tubal patency with a hysterosalpingogram c. Pelvic ultrasound for the woman and semen analysis for the man d. Postcoital testing to evaluate sperm numbers and motility in cervical and vaginal secretions

a. The initial visit of a couple seeking assistance with infertility includes a history and physical for both partners, testing for medical problems and sexually transmitted infections (STIs), a cervical Papanicolaou (Pap) test, possible semen analysis, and instruction for at-home ovulation testing. A discussion of possible future testing options and cost is also done. If the couple decides to continue with treatment, further visits will include more intensive evaluation, including postcoital testing, a hysterosalpingogram, pelvic ultrasound, and midluteal progesterone and prolactin levels.

32. When teaching a patient with problems of pelvic support to perform Kegel exercises, what should the nurse tell the patient to do? a. Contract her muscles as if trying to stop the flow of urine. b. Tighten the lower abdominal muscles over the bladder area. c. Squeeze all of the perineal muscles as if trying to close the vagina. d. Lie on the floor and do leg lifts to strengthen the abdominal muscles.

a. The muscles that should be exercised are those affected by trying to stop a flow of urine. Kegel exercises help to strengthen muscular support of the perineum, pelvic floor, and bladder and are also beneficial for problems with pelvic support and stress incontinence.

26. Which cancer is associated with intrauterine exposure to diethylstilbestrol (DES) or metastasis from another gynecologic cancer? a. Vaginal b. Ovarian c. Cervical d. Endometrial

a. Vaginal cancer is usually related to metastases of other cancers or intrauterine exposure to diethylstilbestrol (DES).

22. A patient with a stage 0 cervical cancer identified from a Papanicolaou (Pap) test asks the nurse what this finding means. The nurse's response should include which information? a. Malignant cells have extended beyond the cervix to the upper vagina. b. Abnormal cells are present but are confined to the epithelial layer of the cervix. c. Atypical cells characteristic of inflammation but not necessarily malignancy are present. d. This is a common finding on Pap testing and she will be examined frequently to see whether the abnormal cells spread beyond the cervix.

b. A stage 0 cervical cancer indicates cancer in situ that is confined to the epithelial layer of the cervix and requires treatment. Stage 0 is the least invasive. Stage I is confined to the cervix. Stage II has spread beyond the cervix to the upper two thirds of the vagina but not the tissues around the uterus. Stage III involves the pelvic wall, lower third of the vagina, and/or kidney problems. Stage IV indicates spread to distant organs.

18. What should the nurse include when implementing care for the patient with acute PID? a. Perform vaginal irrigations every 4 hours. b. Promote bed rest in semi-Fowler's position. c. Instruct the patient to use tampons to control vaginal drainage. d. Ambulate the patient frequently to promote drainage of exudate.

b. Bed rest in semi-Fowler's position promotes drainage of the pelvic cavity by gravity and may prevent the development of abscesses high in the abdomen. Coitus, douching, and tampon use should be avoided to prevent spreading infection upward from the vagina, although frequent perineal care should be performed to remove infectious drainage.

11. Priority Decision: A patient with abdominal pain and irregular vaginal bleeding is admitted to the hospital with a suspected ectopic pregnancy. Before actual diagnosis, what is the most appropriate action by the nurse? a. Provide analgesics for pain relief. b. Monitor vital signs, pain, and bleeding frequently. c. Explain the need for frequent blood samples for β-human chorionic gonadotropin monitoring. d. Offer support for the patient's emotional response to the loss of the pregnancy.

b. Ectopic pregnancy is a life-threatening condition. If the fallopian tube ruptures, profuse bleeding can lead to hypovolemic shock. All of the interventions are indicated but the priority is monitoring the vital signs and pain for evidence of bleeding.

3. A patient with a 10-week pregnancy is admitted to the emergency department with vaginal bleeding and abdominal cramping. What does the nurse recognize about this situation? a. The patient will recover quickly when the bleeding stops. b. The patient is most likely experiencing a spontaneous abortion. c. The patient will be scheduled for an immediate dilation and curettage (D&C). d. Treatment of the patient with bed rest is usually successful in preventing further bleeding.

b. In the presence of a confirmed pregnancy, uterine cramping with vaginal bleeding is the most important sign of spontaneous abortion. Other conditions causing vaginal bleeding, such as an incompetent cervix, do not usually cause cramping. There is no evidence that any medical treatment improves the outcome for spontaneous abortion. Blood loss can be significant and the loss of the pregnancy may cause long-term grieving. Dilation and curettage (D&C) (if needed) is performed after the abortion to minimize blood loss and reduce the chance of infection.

6. When teaching a patient with PMS about management of the disorder, the nurse includes the need to a. supplement the diet with vitamins C and E. b. limit dietary intake of caffeine and refined sugar. c. use estrogen supplements during the luteal phase. d. limit exercise and physical activity when symptoms are present.

b. Limitation of refined sugar and caffeine in the diet has been shown to decrease the PMS symptoms of abdominal bloating, increased appetite, and irritability. Exercise is encouraged because it increases the release of endorphins, which elevates the mood, and also has a tranquilizing effect on muscle tension. Estrogen is not used during the luteal phase but progesterone may be tried. Vitamin B6 and foods high in tryptophan may promote serotonin production, which improves symptoms.

17. A young woman is admitted to the hospital with acute pelvic inflammatory disease (PID). During the nursing history, the nurse notes which risk factor as being significant for this patient? a. Lack of any method of birth control b. Sexual activity with multiple partners c. Use of a vaginal sponge for contraception d. Recent antibiotic-induced monilial vaginitis

b. Sexual activity with multiple partners increases the risk for pelvic inflammatory disease (PID) and there is often a history of an acute infection of the lower genital tract caused by gonococcal or chlamydial microorganisms. The only significant contraceptive issue related to PID is that condom use will help to prevent STIs that may lead to PID.

36. Priority Decision: On admission of a victim of sexual assault to the emergency department, what should be the first priority of the nurse? a. Contact a rape support person for the patient. b. Assess the patient for urgent medical problems. c. Question the patient about the details of the assault. d. Inform the patient what procedures and treatments will be performed.

b. Sexual assault is an act of violence and the first priority of care for the patient should be assessment and treatment of serious injuries involving extragenital areas, such as fractures, subdural hematomas, cerebral concussions, and intraabdominal injuries. All of the other options are appropriate treatments but treatment for shock and urgent medical injuries is the first priority.

13. A patient is 51 years old and suffered a wrist fracture when she slipped on the ice. She has her uterus and is interested in starting hormone therapy (HT), as she is also experiencing menopause symptoms. What should the nurse include when discussing the risks and benefits of HT with this patient? a. Taking only progestin is suggested for a woman with a uterus. b. Taking both estrogen and progestin may decrease her bone loss. c. The risk of breast cancer and cardiovascular disease is decreased with HT. d. Taking estrogen and progestin will increase the risk of endometrial cancer.

b. Taking combination hormone therapy (HT) increases bone marrow density and decreases fractures. Both progestin and estrogen are recommended for a menopausal woman with a uterus. The risk for breast cancer, cardiovascular disease, and stroke are increased and the risk for endometrial cancer is decreased with combination HT.

25. A patient has been diagnosed with cancer of the ovary. In planning care for the patient, what does the nurse recognize that treatment of the patient depends on? a. Results of a direct-needle biopsy of the ovary b. Results of a laparoscopy with multiple biopsies c. Whether the patient desires to maintain fertility d. The findings of metastasis by ultrasound or computed tomography (CT) scan

b. Treatment of ovarian cancer is determined by staging from the results of laparoscopy with multiple biopsies of the ovaries and other tissue throughout the pelvis and lower abdomen. The patient's desire for fertility is not a consideration because of the high mortality rate associated with ovarian cancer. Although diagnosis of ovarian tumors may be made by transvaginal ultrasound or computed tomography (CT) scan, the treatment of ovarian cancer depends on the staging of the tumor.

30. A disturbed body image needing nursing interventions to assist the patient and family to cope may be seen in any patient undergoing gynecologic surgery. With which surgery will this most likely be expected to occur? a. Vaginectomy b. Hemivulvectomy c. Pelvic exenteration d. Radical hysterectomy

c. A pelvic exenteration is the most radical gynecologic surgery and results in removal of the uterus, ovaries, fallopian tubes, vagina, bladder, urethra, and pelvic lymph nodes and, in some situations, also the descending colon, rectum, and anal canal. There are urinary and fecal diversions on the abdominal wall, the absence of a vagina, and the onset of menopausal symptoms, all of which result in severe altered body structure and changes in body image. The patient and family will need much understanding and support during the long recovery period, including verbalization of feelings.

29. A 44-year-old woman undergoing a total abdominal hysterectomy asks whether she will need to take estrogen until she reaches the age of menopause. What is the best response by the nurse? a. "Yes, it will help to prevent the more intense symptoms caused by surgically induced menopause." b. "You are close enough to normal menopause that you probably won't need additional estrogen." c. "Because your ovaries won't be removed, they will continue to secrete estrogen until your normal menopause." d. "There are so many risks associated with estrogen replacement therapy that it is best to begin menopause now."

c. A total hysterectomy involves the removal of the uterus and possibly the cervix but the fallopian tubes and ovaries are left intact. Although menstruation is terminated, normal ovarian production of estrogen continues. When the tubes and ovaries are removed, it is called a bilateral salpingooophorectomy. A panhysterectomy is the procedure in which the uterus and cervix as well as the tubes and ovaries are removed.

14. The patient arrives at the urgent care facility worried about the fishy smell of her vaginal discharge. What does the nurse suspect will be diagnosed? a. Cervicitis b. Trichomoniasis c. Bacterial vaginosis d. Vulvovaginal candidiasis

c. Bacterial vaginosis is characterized by watery vaginal discharge with a fishy odor. Cervicitis displays mucopurulent discharge and postcoital spotting. Trichomoniasis has frothy greenish or gray discharge. Vulvovaginal candidiasis has thick, white, curdy discharge.

23. Fertility and normal reproductive function can be maintained when a cancer of the cervix is successfully treated with which therapy? a. External radiation therapy b. Internal radiation implants c. Conization or laser surgery d. Cryotherapy or subtotal hysterectomy

c. Conization (an excision of a cone-shaped section of the cervix) and laser treatment both are effective to locally remove or destroy malignant cells of the cervix and preserve fertility. Radiation treatments frequently impair ovarian and uterine function and lead to sterility. A subtotal hysterectomy would be contraindicated in the treatment of cervical cancer because the cervix would be left intact in this procedure.

2. An infertile couple has used at-home ovulation testing using basal body temperature without conceiving. The nurse understands that what will be used first to treat this infertile couple? a. Surgery to reduce endometriosis b. Intrauterine insemination with sperm from the husband c. Selective estrogen receptor modulator (clomiphene [Clomid]) d. Assisted reproductive technologies (e.g., in vitro fertilization [IVF])

c. Drug therapy will be used before more invasive treatments. Drugs may include selective estrogen receptor modulators, menotropin (human menopausal gonadotropin), follicle-stimulating hormone agonists, gonadotropin-releasing hormone (GnRH) antagonists, GnRH agonists, or human chorionic gonadotropin (hCG). If the husband's reproductive system is functioning, intrauterine insemination with his sperm will be done. The assisted reproductive technologies may be used if this is not successful. The surgery for endometriosis could be done if this was diagnosed but that is not included in this question.

7. What is the rationale for the regular use of nonsteroidal antiinflammatory drugs (NSAIDs) during the first several days of the menstrual period for women who have primary dysmenorrhea? a. They suppress ovulation and the production of prostaglandins that occur with ovulation. b. They cause uterine relaxation and small vessel constriction, preventing cramping and abdominal congestion. c. They inhibit the production of prostaglandins believed to be responsible for menstrual pain and associated symptoms. d. They block the release of luteinizing hormone, preventing the increase in progesterone associated with maturation of the corpus luteum.

c. The release of excess prostaglandin F2α (PGF2α) from the endometrium at the time of menstruation or increased sensitivity to the prostaglandin is responsible for symptoms of primary dysmenorrhea and drugs that inhibit prostaglandin production and release, such as nonsteroidal antiinflammatory drugs (NSAIDs), are effective in many patients with primary dysmenorrhea. Oral contraceptives may be used for primary dysmenorrhea by reducing endometrial hyperplasia.

19. A 20-year-old patient with PID is crying and tells the nurse that she is afraid she will not be able to have children as a result of the infection. What is the nurse's best response to the patient? a. "I would not worry about that right now. Our immediate concern is to cure the infection you have." b. "Sterility following PID is possible but not common and it is too soon to know what the effects will be." c. "The possibility of infertility following PID is increased. Would you like to talk about what it means to you?" d. "The infection can cause more serious complications, such as abscesses and shock, that you should be more concerned about."

c. The risk for infertility following PID is high and the nurse should allow time for the patient to express her feelings, clarify her concerns, and begin problem solving with regard to the outcomes of the disease. Responses that do not allow for discussion of feelings and concerns or that tell the patient how she should feel or what she should worry about are not therapeutic.

20. The patient is suspected of having endometriosis and/or uterine leiomyoma. What best describes what is found with these conditions? a. Endometriosis and uterine leiomyoma are two gynecologic conditions that increase with the onset of menopause. b. Danazol (Danacrine) and Lupron (GnRH analog) are used to treat endometriosis and leiomyomas to create a pseudopregnancy. c. Treatment of endometriosis and leiomyomas depends on the severity of symptoms and the woman's desire to maintain fertility. d. The presence of ectopic uterine tissue that bleeds and causes pelvic and abdominal adhesions, cysts, and pain is known as uterine leiomyoma.

c. The treatment of endometriosis and leiomyomas is surgical when the patient does not tolerate the symptoms, with the type of surgery for endometriosis dependent on the desire for pregnancy. Endometriosis and leiomyomas subside with the onset of menopause. Therefore the medications to treat them create a pseudomenopause. The ectopic uterine tissue is endometriosis, while leiomyomas are fibrous smooth muscle tumors.

9. A young woman who runs vigorously as a form of exercise has not had a menstrual period in more than 6 months. What should the nurse teach her? a. Normal periods will return when she stops running. b. Uterine balloon therapy may be necessary to promote uterine sloughing of the overgrown endometrium. c. Progesterone or birth control pills should be used to prevent persistent overgrowth of the endometrium. d. Unopposed progesterone production causes an overgrowth of the endometrium that increases her risk for endometrial cancer.

c. When ovulation does not occur, estrogen continues to be unopposed by progesterone and excessive buildup of the endometrium occurs. To prevent the risk of endometrial cancer by the buildup of the endometrium or to prevent menorrhagia from an unstable endometrium, progesterone or birth control pills are prescribed to ensure that the patient's endometrial lining will be shed at least four to six times a year. Balloon therapy to treat menorrhagia is contraindicated in women who desire future fertility.

8. A 20-year-old woman is a college softball player who participates in strenuous practices and a heavy class schedule. She is describing an absence of menses. What could be contributing to her amenorrhea? a. Decreased sexual activity b. Excess prostaglandin production c. Strenuous exercise or lack of calories d. Endometrial cancer or uterine fibroids

c. Young female athletes may experience amenorrhea related to excessive exercise, low body weight, or severe dieting as well as stress. If she had increased sexual activity, she would be assessed for pregnancy but decreased sexual activity will not affect her menses. Excess prostaglandin production leads to dysmenorrhea. Metrorrhagia is associated with endometrial cancer or uterine fibroids.

5. Premenstrual syndrome (PMS) is most likely to be diagnosed in a woman with which occurrence? a. Symptoms can be controlled with the use of progesterone. b. The woman has symptoms only when oral contraceptives are used. c. Symptoms can be correlated with altered serum levels of estrogen and progesterone. d. The woman has the same symptom pattern following ovulation for two or three consecutive menstrual cycles.

d. Premenstrual syndrome (PMS) is diagnosed when other possible causes for symptoms have been eliminated. A diagnosis is based on a symptom diary that indicates the same symptoms during the luteal phase, approximately 1 week before menses, for two or three consecutive menstrual cycles. Oral contraceptives may be used to control the symptoms of PMS by suppressing ovulation and although progesterone may also relieve the symptoms of PMS, its effectiveness is not associated with the diagnosis of PMS. There are no laboratory findings that account for the premenstrual symptoms.

4. The patient is a perimenopausal woman who has an unexpected and unwanted pregnancy. She wants an abortion. What should the nurse teach her about the effects of an abortion? a. D&C will be needed. b. She will feel much better afterwards. c. The products of conception will pass immediately. d. She will need someone to support her through her loss.

d. There is physical and emotional pain and grieving after an abortion that puts the patient in need of support. D&C is needed only if the products of conception do not pass completely or bleeding becomes excessive. The time it takes for the products of conception to pass depends on the type of abortion being done and is immediate with surgical abortion and slower with medical abortion.

31. What occurs during treatment of the patient with an intrauterine radioactive implant? a. All care should be provided by the same nurse. b. The patient may ambulate in the room as desired. c. There can be unlimited number and duration of visitors. d. The patient is restricted to bed rest with turning from side to side.

d. To prevent displacement of the intrauterine implant, the patient is maintained on absolute bed rest with turning from side to side. Bowel elimination is discouraged during the treatment by cleaning the colon before implantation and urinary elimination is maintained by an indwelling catheter. Because the patient is radioactive, no individual nurse should spend more than 30 minutes daily with the patient and visitors are restricted to less than 3 hours each day at a minimum of 6 feet from the patient.

31. The client diagnosed with uterine cancer is complaining of lower back pain and unilateral leg edema. Which statement best explains the scientific rationale for these signs/symptoms? 1. This is expected pain for this type of cancer. 2. This means the cancer has spread to other areas of the pelvis. 3. The pain is a result of the treatment of uterine cancer. 4. Radiation treatment always causes some type of pain in the region.

2. This pain indicates the cancer is in the retroperitoneal region and the prognosis is poor.

5. Which of the following is a finding that is most often associated with endometrial cancer? (a) Thickened endometrial lining on ultrasound. (b) Irregular periods. (c) Young age. (d) Dyspareunia.

b

6. Symptoms of an ectopic pregnancy include: (a) hematuria, pelvic pain, and dizziness. (b) amenorrhea, pelvic pain, and vaginal spotting. (c) constipation, nausea, and fainting. (d) fallopian pain, nausea, and breast enlargement.

b

27. The nurse is admitting a client diagnosed with Stage Ia cancer of the cervix to an outpatient surgery center for a conization. Which data would the client most likely report? 1. Diffuse watery discharge. 2. No symptoms. 3. Dyspareunia. 4. Intense itching.

2. At this stage the client is asymptomatic and the cancer has been determined by a Pap smear.

21. The nurse is formulating a care plan for a client post an abdominal hysterectomy. Which nursing diagnosis is appropriate for the client who has developed a complication? 1. Potential for urinary retention. 2. Potential for nerve damage. 3. Potential for intestinal obstruction. 4. Potential for fluid imbalance.

3. Clients who have had a total abdominal hysterectomy are at risk for intestinal obstruction.

18. Which specific complication should the nurse assess for in the client with a uterine prolapse recovering from an anterior and posterior repair? 1. Orthostatic hypotension. 2. Atelectasis 3. Allen sign. 4. Deep vein thrombosis.

4. Assessing for deep vein thrombosis (DVT) is performed on all clients having a vaginal hysterectomy. After any surgery requiring the client to be placed in the lithotomy position, the cllient should be assessed for DVT. These clients are at a higher risk for this complication.

17. Which statement indicates further instruction is needed for the client with a cystocele? 1. "I need to have a sonogram to diagnose this problem." 2. "I need to practice Kegel exercises to help strengthen my muscles." 3. "I lose my urine when I sneeze because of my cystocele." 4. "I can never have sexual intercourse again."

4. Clients with cystoceles may have sexual intercourse unless contraindicated by another medical reason.

2. Which disorder is characterized by pain in the lower abdomen, vagina, posterior pelvis, and back that lasts for 2 to 3 days and occurs 5 to 7 days before menses? A. Ovarian cyst B. Endometriosis C. PID D. Uterine leiomyomas

B. The classic symptom of endometriosis, acquired dysmenorrhea, may produce the findings listed above.

3. Which statement isn't true about PID? A. Risk factors include more than one sexual partner and a history of STD. B. Up to 25% of patients may become infertile after one episode of PID. C. Untreated PID may be fatal. D. The patient's sexual partners don't need to be examined and treated for infection.

D. It's necessary for the patient's sexual partners to be examined and treated for infection.

8. Symptoms indicative of cervical cancer include: (a) irregular vaginal bleeding. (b) bloating. (c) weight gain and nausea. (d) dyspareunia.

a

9. The most important lab value to monitor in a patient with heavy bleeding due to fibroids is: (a) hemoglobin. (b) luteinizing hormone. (c) white blood cell count. (d) potassium.

a

27. Which factors are associated with endometrial cancer (select all that apply)? a. Obesity b. Smoking c. Family history d. Early sexual activity e. Early menarche and late menopause f. Unopposed estrogen-only replacement therapy

a, b, f. Endometrial cancer is at higher risk in obese patients because adipose cells store estrogen, which is the major risk factor, especially unopposed estrogen. Smoking is a risk factor for endometrial and cervical cancer. Early sexual activity is a risk factor for cervical cancer. Family history and early menarche and late menopause causing increased menstrual cycles are risk factors for ovarian cancer.

35. What is an appropriate outcome for a patient who undergoes an anterior colporrhaphy? a. Maintain normal bowel patterns b. Adjust to temporary ileal conduit c. Urinate within 8 hours postoperatively d. Experience healing of excoriated vaginal and vulvar tissue

a. An anterior colporrhaphy involves repair of a cystocele and an indwelling urinary catheter is left in place for several days postoperatively while healing occurs. Bowel function should not be altered and is maintained with a low-residue diet and a stool softener if necessary to avoid straining and pressure on the incision.

33. The patient is describing a feeling of something coming down her vagina and having a backache. What is most likely the cause of this discomfort? a. Cystocele b. Dysmenorrhea c. Uterine prolapse d. Abdominal distention

c. A uterine prolapse occurs when the uterus is displaced through the vagina, causing the feeling of something coming down her vagina, a backache, dyspareunia, or a heavy feeling in the pelvis.

21. An 18-year-old patient with irregular menstrual periods, hirsutism, and obesity has been diagnosed with polycystic ovary syndrome (PCOS). What is an accurate rationale for the expected treatment? a. Hirsutism may be treated with leuprolide to decrease an altered body image. b. The medication used will cure the hormonal abnormality of excess testosterone. c. The loss of weight will improve all of the symptoms, so this will be the first treatment tried. d. The progression of PCOS leads to cardiovascular disease and possibly to type 2 diabetes mellitus if untreated.

d. Left untreated, polycystic ovary syndrome (PCOS) may lead to cardiovascular disease and abnormal insulin resistance with type 2 diabetes mellitus. Hirsutism may be treated with spironolactone. Leuprolide is used to treat hyperandrogenism but PCOS cannot be cured. Severity of symptoms is associated with obesity but the hormone abnormalities will be treated along with the obesity to prevent complications. If this treatment is not successful, a hysterectomy with bilateral salpingectomy and oophorectomy may be performed.

10. A 29-year-old woman is at the clinic with menorrhagia. What finding would the nurse expect in this patient's assessment? a. Pain with each menstrual period b. Excessive bleeding at irregular intervals c. Bleeding or spotting between menstrual periods d. Increased duration or amount of menstrual bleeding

d. Menorrhagia is increased duration or amount of bleeding with menses. Pain with menses is called dysmenorrhea. Metrorrhagia is excessive bleeding at irregular intervals or spotting between menstrual periods.

34. Priority Decision: The patient's diagnosis is a large rectocele requiring surgery. What nursing interventions will be the priority postoperatively? a. An ice pack to relieve swelling b. An enema each day to relieve constipation c. Administration of a stool softener each night d. Perineal care after each urination or defecation

d. The primary goal of care is to prevent wound infection and pressure on the vaginal incision, which requires perineal cleansing at least twice daily and after each urination and defecation. An ice pack and stool softener will be used but they are not the priority. The enema would have been done preoperatively.