CH 27: Common Gynecologic Conditions

A nurse is reviewing the history, physical exam, and diagnostic test findings for a woman diagnosed with endometrial cancer. The findings reveal that the cancer has spread to the cervix and other parts of the uterus and to nearby lymph nodes. The nurse interprets these findings as suggestive of which stage? A) I B) II C) III D) IV

C) III In stage I, the tumor is confined to the corpus uteri. In stage II, it has spread to the cervix, but not outside the uterus. In stage III, it has spread locally (to other parts of the uterus) and regionally (to nearby lymph nodes). In stage IV, it has invaded the bladder mucosa, bowel with distant metastases to the lungs, liver, and bone.

A woman with ovarian cancer has been told that she is in stage III of the cancer. The nurse is reviewing the information with her. Which statement would help in the woman's understanding of stage III ovarian cancer? A) The cancer is limited to the ovaries. B) The growth involves one or both ovaries. C) The growth has spread to the lymph nodes and other areas/organs in the abdominal cavity. D) The cancer has spread to distant sites.

C) The growth has spread to the lymph nodes and other areas/organs in the abdominal cavity. The staging and diagnosis is performed by a laparoscopy. The staging is I to IV. Stage III means the cancer has spread to the lymph nodes and other areas in the abdominal cavity. A five-year survival rate for this stage is 30% to 60%.

Polys are benign tumors of the_______?

Cervix or endometrium

A client asks a nurse to review the process of menopause and the physical changes that accompany it. The client wants to know if others will know she is going through menopause. What are external indicators of menopause that the nurse should share with the client? 1. Tendency to gain weight 2. Thinning of hair 3. Loss of eyebrows 4. Dry itchy skin A) 1, 2, 3 B) 1, 2, 4 C) 1, 3, 4 D) 2, 3, 4

D) 2, 3, 4 External indicators of menopause include a tendency to gain weight, thinning of hair, growth of hair on the upper lip and chin, and dry, itchy skin.

stage 0 pelvic organ prolapse

No descent of pelvic structure during straining

what is the number one cause of infertility?

PCOS

stage 3 pelvic organ prolapse

Prolapse extends 2 to 3 cm below the hymenal ring

enterocele

Prolapse of the small bowel into the vagina.

stage 1 pelvic organ prolapse

Prolapsed descending organ is >1 cm above the hymenal ring

stage 4 pelvic organ prolapse

The vagina is completely everted or the prolapsed organ is >3 cm below the hymenal ring

Leiomyomas are benign tumors of the_______?

Uterus

vesicovaginal fistula

abnormal opening between the bladder and the vagina

rectovaginal fistula

abnormal opening between the vagina and rectum

Postcoital bleeding

bleeding after intercourse

metrorrhagia

bleeding between periods

vulvodynia

chronic pain in the vulvar area without a known cause

nulliparity

having borne no children

olgiomenorrhea

infrequent menstrual periods

Primary amenorrhea

lack of any period by the age of 15

myometrium

muscle layer of the uterus

No diagnostic test for _______ cancer.

ovarian

dysmenorrhea

painful menstruation

Dyschezia

painful or difficult bowel movement

cystocele

prolapsed bladder

rectocele

prolapsed rectum

What is an early symptom of vulvar cancer?

pruritus with genital burning

Secondary amenorrhea

the cessation of menstruation at some time after menarche. No menses for 3 months.

stage 2 pelvic organ prolapse

vThe prolapsed organ extends 1 cm below the hymenal ring

PALM-COEIN

-Polyp, adenomyosis, leiomyoma, malignancy and hyperplasia -Coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, Not yet classified

Menopause typically occurs at what age?

51-52

A client is to have a vaginal hysterectomy to repair her stage IV uterine prolapse. The nurse realizes she needs more education when she states: A) "I'm not going home with a Foley catheter in place." B) "The leg bag will be covered by my clothes, once I am home." C) "My husband is not crazy about the six weeks of pelvic rest." D) "I have already picked up the stool softeners."

A) "I'm not going home with a Foley catheter in place." A Foley catheter will be left in place for up to one week to allow the surgical site time to heal properly. The client may also experience some dysuria once it is removed due to the swelling that can occur. The client will need instructions on how to properly care for a leg bag, the importance of pelvic rest to allow for proper healing, and using stool softeners to avoid straining or stressing the pelvic region.

Vulvar cancer is suspected in a client. When reviewing the client's history which report would the nurse most likely find? Select all that apply. A) dyspareunia B) persistent vulvar itching C) history of herpes simplex D) lesion on the cervix E) abnormal Papanicolau test result

A) dyspareunia B) persistent vulvar itching C) history of herpes simplex

When assessing a woman with pelvic organ prolapse, the nurse notes the uterus is approximately 1 cm below the hymenal ring. The nurse documents this finding as which stage of prolapse? A) stage II B) stage 0 C) stage I D) stage III

A) stage II The extent of uterine prolapse is classified in terms of stages: stage 0: no descent of pelvic structure during straining; stage I: prolapsed descending organ is >1 cm above the hymenal ring; stage II: the prolapsed organ extends approximately 1 cm below the hymenal ring; stage III: prolapse extends to 2 cm to 3 cm below the hymenal ring; and stage IV: vagina is completely everted or prolapsed organ is >3 cm below the hymenal ring.

A nurse is conducting an in-service program for a group of staff nurses. After teaching the group about ovarian cysts, the nurse determines that the teaching was successful when the group identifies which type of cyst as being associated with hydatidiform mole? A) theca-lutein cyst B) corpus luteum cyst C) follicular cyst D) polycystic ovarian syndrome

A) theca-lutein cyst Although rare, theca-lutein cysts, which develop from prolonged abnormally high levels of human chorionic gonadotropin, are associated with hydatiform mole, choriocarcinoma, polycystic ovarian syndrome, and clomiphene therapy. Corpus luteum cysts form when the corpus luteum becomes cystic or hemorrhagic and fails to degenerate after 14 days. Follicular cysts are caused by the failure of the ovarian follicle to rupture at the time of ovulation. Both types typically require no treatment. Polycystic ovarian syndrome (PCOS) involves the presence of multiple inactive follicle cysts within the ovary that interfere with ovarian function.

A postmenopausal client is told at her routine gynecological exam that the primary care provider has found a cyst on her right ovary. The nurse notices that this does not cause worry for this client. What should the nurse and/or care provider tell this client? A) "You are correct not to be concerned; after all, it is only a cyst." B) "After menopause a mass on an ovary is not a cyst and should be considered cancerous until proven otherwise." C) "We will keep a eye on it and recheck it at your next yearly appointment." D) "You may get a second opinion if you would like."

B) "After menopause a mass on an ovary is not a cyst and should be considered cancerous until proven otherwise." After menopause, a mass on an ovary is not a cyst; physiologic cysts can arise only from a follicle that has not ruptured or from the cystic degeneration of the corpus luteum. Brushing it off is not responsible, and waiting a full year would put the client at serious risk from dying from the cancer. Suggesting a second opinion instead of explaining the seriousness of it to the client would not be responsible or ethical.

A nursing student correctly identifies that a person's outward appearance or expression of genes is referred to as the: A) allele. B) phenotype. C) genotype. D) genome.

B) phenotype. Alleles are two like genes. Phenotype refers to a person's outward appearance or the expression of genes. Genotype refers to his or her actual gene composition. Genome is the complete set of genes present in a person.

A nurse is assessing a client with polycystic ovary syndrome for metabolic syndrome. Which findings would the nurse assess? Select all that apply. A) waist circumference 32 inches B) triglyceride level 175 mg/dL C) HDL 60 mg/dL D) elevated C-reactive protein E) hypotension

B) triglyceride level 175 mg/dL D) elevated C-reactive protein

Which statement would be most appropriate when explaining endometriosis as a cause of a woman's infertility? A) "Ovulation does take place; however, the misplaced endometrial tissue interferes with transport of the ovum." B) "Your uterine cervix fails to close because it is engorged with tissue." C) "Menstrual sloughing does not occur, so there is never a new base for embryo growth." D) You do not ovulate because of endometrial implants on the ovaries."

A) "Ovulation does take place; however, the misplaced endometrial tissue interferes with transport of the ovum." With endometriosis, endometrial tissue migrates into the fallopian tubes and peritoneum or other sites outside of the uterus. Ovulation occurs, but the egg may be trapped by the misplaced tissue.

A nurse is caring for a female client with urinary incontinence. Which instructions should the nurse include in the client's teaching plan to reduce the incidence or severity of incontinence? Select all that apply. A) Continue pelvic floor exercises. B) Increase fiber in the diet. C) Increase intake of orange juice. D) Control blood glucose levels. E) Wipe from back to front.

A) Continue pelvic floor exercises. B) Increase fiber in the diet. D) Control blood glucose levels.

The mother of four small children comes to the clinic and has just been diagnosed with an enterocele. What should the nurse teach the client about her diagnosis? A) Her small intestine and peritoneum are jutting downward between the uterus and the rectum. B) Her rectum is protruding into the back wall of the vagina. C) Her uterus has prolapsed and is causing this bulge. D) Her bladder is bulging into the front wall of the vagina.

A) Her small intestine and peritoneum are jutting downward between the uterus and the rectum. The names of pelvic support disorders correspond to the affected organs. Enterocele occurs when the small intestine and peritoneum jut downward between the uterus and rectum. Cystocele occurs when the bladder bulges into the front wall of the vagina. Rectocele occurs when the rectum protrudes into the back wall of the vagina. Uterine prolapse occurs when the uterus drops down into the vagina.

A nurse is preparing a discussion for a group of women at the clinic. When describing vaginal cancer, the nurse would most likely integrate which statement into the discussion? A) Pulmonary metastasis is common with adenocarcinomas of the vagina. B) Adenocarcinomas are the most common cell type. C) Squamous cell cancers develop rapidly and spread late. D) Squamous cell carcinomas are more common in women in their 40s.

A) Pulmonary metastasis is common with adenocarcinomas of the vagina. Adenocarcinomas demonstrate an increase in pulmonary metastases and supraclavicular and pelvic node involvement. Squamous cell carcinomas are the most common cell type associated with vaginal cancer. Squamous cell cancers develop slowly and spread early. Squamous cell carcinomas of the vagina usually occur in women over the age of 50.

A nurse is assisting with the pelvic exam of a woman who has come to the clinic with reports of abnormal vaginal bleeding. The client is diagnosed with an endocervical polyp. The nurse understands that the pelvic exam most likely revealed a polyp appearing as: A) cherry red. B) grayish-white. C) purplish-blue. D) pinkish-gray.

A) cherry red. Most endocervical polyps are cherry red; most cervical polyps are grayish-white.

A nurse is reviewing the history and physical examination of a client diagnosed with secondary dysmenorrhea for possible associated causes. Which etiology would the nurse need to keep in mind as being the most common? A) endometriosis B) multigravida status C) hormonal imbalance D) perimenopause

A) endometriosis Secondary dysmenorrhea is painful menstruation due to pelvic or uterine pathology. Endometriosis is the most common cause of secondary dysmenorrhea. Other recognized causes include adenomyosis, fibroids, pelvic infection, an intrauterine device, cervical stenosis, or congenital uterine or vaginal abnormalities.

A nurse is providing teaching about lifestyle modifications to address a client's pelvic organ prolapse. The nurse understand that the majority of these changes focus on: A) reducing intra-abdominal pressure. B) increasing muscle tone. C) providing mechanical support. D) preventing incontinence.

A) reducing intra-abdominal pressure. The majority of lifestyle changes, such as losing weight, avoiding heavy lifting and high-impact exercises, avoiding straining on defecation, and stopping smoking help to reduce the risk of increasing intra-abdominal pressure. Pessaries provide mechanical support. Kegel exercises improve muscle tone. The overall goal is reduce the symptoms, such as incontinence.

A nurse is caring for a client for whom estrogen replacement therapy has been recommended for pelvic organ prolapse. Which nursing intervention is the most appropriate for the nurse to implement before the start of the therapy? A) Discuss the effective dose of estrogen required to treat the client. B) Evaluate the client to validate her risk for complications. C) Discuss the dietary modifications following therapy. D) Discuss the cost of estrogen replacement therapy.

B) Evaluate the client to validate her risk for complications. Before starting estrogen replacement therapy, each woman must be evaluated on the basis of a thorough medical history to validate her risk for complications such as endometrial cancer, myocardial infarction, stroke, breast cancer, pulmonary emboli, or deep vein thrombosis. The effective dose of estrogen required, the dietary modifications, and the cost of estrogen replacement therapy can be discussed at a later stage when the client understands the risks associated with estrogen replacement therapy and decides to use hormone therapy.

A nurse is caring for a 45-year-old client using a pessary to help decrease leakage of urine and support a prolapsed vagina. Which recommendation is most commonly provided to a client regarding pessary care? A) Douche the vaginal area with diluted vinegar or hydrogen peroxide. B) Remove the pessary twice weekly, and clean it with soap and water. C) Use estrogen cream to make the vaginal mucosa more resistant to erosion. D) Remove the pessary before sleeping or intercourse.

B) Remove the pessary twice weekly, and clean it with soap and water. The most common recommendation for pessary care is removing the pessary twice weekly and cleaning it with soap and water. In addition, douching with diluted vinegar or hydrogen peroxide helps to reduce urinary tract infections and odor, which are side effects of using a pessary. Estrogen cream is applied to make the vaginal mucosa more resistant to erosion and strengthen the vaginal walls. Removing the pessary before sleeping or intercourse is not part of the instructions for pessary care.

A nurse is assessing a 45-year-old client. The client asks for information regarding the changes that are most likely to occur with menopause. Which should the nurse tell the client? A) The uterus tilts backward. B) The uterus shrinks and gradually atrophies. C) Cervical muscle content increases. D) The outer layer of the cervix becomes rough.

B) The uterus shrinks and gradually atrophies. After menopause, the uterus shrinks and gradually atrophies. A full bladder, not menopause, causes the uterus to tilt backward. Cervical muscle content does not increase during menopause. Menopause has no significant effect on the outer layer of the cervix.

The nurse reviews the medical record of a woman diagnosed with ovarian cancer, stage II. The nurse interprets this information, understanding that the disease: A) is limited to the ovary. B) involves one or both ovaries and extends into the pelvis. C) has spread to the lymph nodes and other organs within the abdomen. D) has metastasized to distant sites.

B) involves one or both ovaries and extends into the pelvis. Stage II ovarian cancer involves one or both ovaries, with pelvic extension. Disease limited to the ovary characterizes stage I ovarian cancer. Stage III ovarian cancer has spread to the lymph nodes and other organs and structures inside the abdominal cavity. Stage IV disease typically involves metastasis to distant sites.

A 47-year-old woman is being seen at the local clinic reporting irregular menstrual cycles. The nurse would explain to the client that the irregularity is most likely due to: A) pregnancy. B) menopause. C) hormonal fluctuations. D) an underlying endocrine problem.

B) menopause. As a woman's reproductive capabilities end, her menstrual cycles will become irregular and finally cease. The average age for menopause is 47 to 55 years. This client meets these criteria. Pregnancy would cause absence of menstrual cycles. Hormonal fluctuations and underlying endocrine problems would not be the anticipated causality.

After undergoing diagnostic testing, a woman is diagnosed with a corpus luteum cyst. The nurse anticipates that the woman will require: A) biopsy. B) no treatment. C) oral contraceptives. D) metformin.

B) no treatment. Corpus luteum cysts form when the corpus luteum becomes cystic or hemorrhagic and fails to degenerate after 14 days. Typically these cysts appear after ovulation and resolve without intervention. Biopsy would be indicated if a malignancy was suspected. Oral contraceptives and metformin would be used to treat polycystic ovarian syndrome.

The nurse notes that a patient has a history of "fibroids" and is aware that this term refers to a benign tumor of the uterus. What is a more appropriate term for a fibroid? A) Bartholin's cyst B) Dermoid cyst C) Hydatidiform mole D) Leiomyoma

D) Leiomyoma A leiomyoma is a usually benign tumor of the uterus, commonly referred to as a "fibroid." A Bartholin's cyst is a cyst in a paired vestibular band in the vulva, while a dermoid cyst is a benign tumor that is thought to arise from parts of the ovum and normally

A client is suspected of having endometrial cancer. The nurse would most likely prepare the client for which procedure to confirm the diagnosis? A) Trasvaginal ultrasound B) colposcopy C) Papanicolau test D) endometrial biopsy

D) endometrial biopsy An endometrial biopsy is the procedure of choice to make the diagnosis of endometrial cancer. A transvaginal ultrasound may be used to evaluate the endometrial cavity and measure the endometrial thickness to detect endometrial hyperplasia, but it does not confirm the diagnosis. Colposcopy is used to diagnose cervical cancer. A Papanicolau test screens for abnormal cervical cells.

The nurse is providing care to a client with abnormal uterine bleeding. Treatment with medications has been unsuccessful, and surgical intervention is being considered. The nurse identifies which technique as being the last resort? A) endometrial ablation B) dilation and curretage C) uterine artery embolization D) hysterectomy

D) hysterectomy If the client does not respond to medical therapy, surgical intervention might include dilation and curettage (D&C;), endometrial ablation, uterine artery embolization, or hysterectomy. Of these, hysterectomy is considered a last resort.

A nurse is assessing a female client and suspects that the client may have endometrial polyps based on which clinical manifestation? A) bleeding after intercourse B) vaginal discharge C) bleeding between menses D) irregular, acyclic bleeding

D) irregular, acyclic bleeding The most common clinical manifestation of endometrial polyps is irregular, acyclic uterine bleeding. Cervical and endocervical polyps are often asymptomatic, but they can produce mild symptoms such as abnormal vaginal bleeding (after intercourse or douching, between menses) or discharge.

urethrovaginal fistula

abnormal opening between the vagina and the urethra