Chapter 57: Management of Patients With Female Reproductive Disorders

Which type of yeast infection is manifested by white, cheese-like discharge? Cervicitis Trichomoniasis Candidiasis Bacterial vaginosis

Candidiasis The discharge of candidiasis may be watery or thick, but has a white, cheese-like appearance. The other disorders do not have a cheese-like appearance.

Which is the earliest and the most common symptom of endometrial cancer? bleeding loss of weight pressure on the bladder pain

bleeding Bleeding is the earliest and the most common sign of endometrial cancer.

Which of the following is the descent of the small intestine into the vaginal vault? Uterine prolapse Enterocele Rectocele Cystocele

Enterocele The descent of the small intestine into the vaginal vault is termed enterocele. A rectocele is the extrusion of the rectum into the posterior vagina. A cystocele is the herniation of the bladder into the anterior vagina. A uterine prolapsed is the downward descent of the uterus into the vagina.

A client is experiencing symptoms associated with menopause. What is a likely recommendation to increase the client's interest in sexual activity? antidepressants herbal aphrodisiacs low-dose androgens bisphosphates

low-dose androgens Low-dose androgens are added to the hormone replacement regimen to restore an interest in sexual activity.

A client is being treated for trichomoniasis. The client has received instructions about the prescribed drug therapy. The nurse determines that the client needs additional teaching when she states which of the following? "My partner will not need any treatment." "I might notice a metallic taste in my mouth while I'm taking the drug." "I need to take the medication three times a day for a week." "I need to avoid drinking any alcohol with this drug."

"My partner will not need any treatment." Trichomoniasis is treated with metronidazole. Both partners are treated and receive a one-time loading dose or smaller dose three times a day for a week. The client may experience a transient metallic taste when taking the drug. Client are strongly advised to abstain from alcohol when taking metronidazole because of a possible disulfiram-like reaction (.A known adverse effect of metronidazole (Flagyl) is a drug-drug reaction that occurs when metronidazole and alcohol are taken together. Symptoms of this disulfiram-like reaction include severe nausea and vomiting. In this case, the exposure may have occurred in the hospital)

A client who wishes to preserve childbearing asks the nurse to explain how taking oral contraceptives will work in the management of endometriosis. Which is the best response by the nurse? "Endometriosis is usually cured with surgical menopause." "Symptoms of endometriosis are increased during normal menstrual cycle." "Contraceptives will allow blood to be diverted to the peritoneal cavity." "Trapping blood causes less pain or discomfort for clients with endometriosis."

"Symptoms of endometriosis are increased during normal menstrual cycle." The use of estrogen-progestin contraceptives keeps the client in a non bleeding phase of the menstrual cycle, therefore decreasing ectopic tissue from shedding and causing extra uterine bleeding. Blood that is trapped in the peritoneal cavity causes more pain as adhesions form. Endometriosis is cured by natural or surgical menopause but can be medically managed for periods of time with the use of oral contraceptives.

While obtaining the history, a client reports that her mother was treated with diethylstilbestrol (DES) during her pregnancy. The nurse determines that this client is at risk for which of the following? Endometrial cancer Breast cancer Vulvar cancer Cervical cancer

Cervical cancer Cervical cancer affects the lowest portion of the uterus and is associated with the risk factor of being born to mothers treated with DES during their pregnancy. DES is not a risk factor associated with vulvar or breast cancers. Endometrial cancer occurs in women who take estrogens without the addition of progesterone for 5 or more years during and after menopause.

A nurse is preparing a teaching plan for a client with a vulvovaginal infection. Which teaching would not be appropriate for the nurse to include? Douche with a dilute vinegar solution twice a day. Refrain from unprotected sexual intercourse with partners. Maintain a reclining position for 30 minutes after inserting vaginal medication. Wear cotton underwear that is loose-fitting and allows for air flow.

Douche with a dilute vinegar solution twice a day. Research has shown that douching provides no benefit in the prevention or care of vulvovaginal infections. Douching usually is unnecessary because daily baths or showers and proper hygiene after voiding and defecation keep the perineal area clean. In addition, douching tends to eliminate normal flora, reducing the body's ability to ward off infection. Repeated douching may result in vaginal epithelial breakdown and chemical irritation. The client should recline for approximately 30 minutes after inserting any vaginal medication to prevent the medication from escaping from the vagina. Loose-fitting cotton underwear is advised rather than tight-fitting synthetic, nonabsorbent, heat-retaining underwear. Unprotected sexual intercourse is associated with risks and should be avoided.

The client is asking if there is a pill that can be ordered to control the symptoms of menopause. Which assessment finding is most important in determining nursing care in association with hormone replacement therapy? Family history of breast cancer Symptoms of hot flashes History of osteoporosis Presence of kyphosis

Family history of breast cancer The risk of endometrial or breast cancer in women prescribed HRT may outweigh the benefits of relieving symptoms of menopause and preventing kyphosis or hip fractures associated with osteoporosis.

Culture of client's vaginal discharge reveals Gardnerella vaginalis. Which of the following would the nurse expect to assess? Thick, curdy, white discharge Yellowish-white discharge Fishy-smelling watery discharge Foul, foamy discharge

Fishy-smelling watery discharge Gardnerella vaginalis is associated with a gray-white, watery, fishy smelling vaginal discharge. The discharge associated with a candida infection is curdy white, thick and strong. Discharge due to Trichomonas vaginalis is yellow-white, foamy, and foul.

The nurse is providing education regarding sexually transmitted infections. Which statement regarding herpes virus 2 (herpes genitalis) is accurate? The virus is very difficult to kill. In pregnant women with active herpes, babies delivered vaginally may become infected with the virus. Usually, the virus is killed at room temperature by drying. Transmission of the virus requires sexual contact.

In pregnant women with active herpes, babies delivered vaginally may become infected with the virus. A cesarean birth may be performed if the virus recurs near the time of delivery. Asexual transmission by contact with wet surfaces or self-transmission (i.e., touching a cold sore and then touching the genital area) can occur. Transmission is possible even when the carrier does not have symptoms.

A young client presenting at the health clinic with fever and mucopurulent vaginal drainage is diagnosed with acute pelvic inflammatory disease (PID). Which long-term affect is of greatest concern in the care of this client? Pelvic pain Chronic pelvic inflammatory disease Infertility Ascending infection

Infertility About one third of all women who are infertile have lost the ability to conceive due to PID. Early treatment of PID prevents the infection from ascending up the reproductive tract and/or from becoming chronic. Pelvic pain is a common symptom associated with PID.

The nurse in the gynecology clinic is interviewing a patient who informs the nurse that her mother and aunt had carcinoma of the cervix. What does the nurse recognize are two chief symptoms of early carcinoma that the patient should be questioned about? Leukoplakia and metrorrhagia Dyspareunia and foul-smelling vaginal discharge Leukorrhea and irregular vaginal bleeding or spotting "Strawberry" spots and menorrhagia

Leukorrhea (mild, odorless discharge from the vagina that is clear or milky in color) and irregular vaginal bleeding or spotting Early cervical cancer rarely produces symptoms. If symptoms are present, they may go unnoticed as a thin, watery vaginal discharge often noticed after intercourse or douching. When symptoms such as discharge, irregular bleeding, or pain or bleeding after sexual intercourse occur, the disease may be advanced.

Which of the following is a term used to describe excessive menstrual bleeding? Amenorrhea Dysmenorrhea Menorrhagia Metrorrhagia

Menorrhagia Menorrhagia is excessive menstrual bleeding. Amenorrhea is the absence of menses. Dysmenorrhea is painful menses. Metrorrhagia is excessive and prolonged menstrual bleeding.

Which is the main cause of anemia in a client with active uterine leiomyoma? Hemolysis Pressure of the fibroid on the pelvic veins Poor intake of foods containing iron Menorrhagia

Menorrhagia Uterine leiomyomas or fibroids cause menorrhagia, which in turn can cause anemia. Poor dietary intake of iron does not cause anemia but aggravates the problem. Though there can be a feeling of pressure in the pelvic region, this does not cause anemia.

Which drug is the most effective treatment for trichomoniasis? Clindamycin Clotrimazole Metronidazole Miconazole

Metronidazole The most effective treatment for trichomoniasis is metronidazole.

While caring for a client who is being treated for severe pelvic inflammatory disease (PID), which nursing action minimizes transmission of infection? Implementing reverse isolation precautions Keeping the client in a sitting position Strictly adhering to the no visitation policy Performing hand hygiene when entering the room

Performing hand hygiene when entering the room While caring for a client hospitalized with PID, the nurse has to reduce the risk of the spread of pathogenic microorganisms. Meticulous hand hygiene minimizes the transmission of infection. There is no reason to restrict visitors in this situation; however, visitors need to be educated in proper hand hygiene. Reverse isolation is not indicated for this client. A sitting position will not aid in preventing nosocomial infections.

A client is admitted to the health care center with abdominal pain, nausea, and vomiting. The client has a body mass index (BMI) of 30 and reports irregular menstrual cycles and feeling tired all the time. The nurse suspects the client's symptoms to indicate which condition? Endometriosis Bacterial vaginosis Cancer of the cervix Polycystic ovary syndrome (PCOS)

Polycystic ovary syndrome (PCOS) Features of PCOS includes obesity, sleep apnea, and irregular menstrual periods. Bacterial vaginosis can occur throughout the menstrual cycle and does not produce local discomfort or pain. Symptoms such as discharge, irregular bleeding, or pain or bleeding after sexual intercourse are consistent with cancer of the cervix. Symptoms of endometriosis vary but include dysmenorrhea, dyspareunia, and pelvic discomfort or pain. Dyschezia (pain with bowel movements) and radiation of pain to the back or leg may occur.

A perimenopausal woman informs the nurse that she is having irregular vaginal bleeding. What should the nurse encourage the patient to do? Disregard this phenomenon because it is common during this life stage. See her gynecologist as soon as possible. Stop taking her Premarin (hormonal therapy). Mention it to her physician during her next annual examination.

See her gynecologist as soon as possible. All women should be encouraged to have annual checkups, including a gynecologic examination. Any woman who is experiencing irregular bleeding should be evaluated promptly.

A client with vaginitis complains of itching and burning of the perineum. Which suggestion would be most appropriate to relieve the client's symptoms? Avoid yogurt with active lactobacilli cultures. Take sitz baths frequently Use a pure vinegar douche daily. Use skin protectants containing zinc oxide.

Take sitz baths frequently Sitz baths are recommended to relieve the client's itching and burning, as well as relieve swelling of the vulva and perineum. Skin protectants containing zinc oxide promote healing. Using a vinegar (1to 2 tablespoons) and water (1 pint) douche daily may be used to combat the vaginitis when the client is symptomatic. Taking Lactobacillus acidophilus in capsule form or eating yogurt containing active cultures of lactobacilli can help restore normal vaginal microorganisms.

A nurse is speaking to a local women's group about the various types of cancer affecting the female reproductive tract. The nurse explains that ovarian cancer is the leading cause of death from gynecologic malignancies based on the understanding that this type of cancer does which of the following? Arises from extremely rare types of cells that are resistant to treatment Spreads more easily than other female reproductive cancers Typically manifests with vague symptoms resulting in late diagnosis Is closely associated with highly resistant sexually transmitted infections

Typically manifests with vague symptoms resulting in late diagnosis Tumors of the ovary have been lethal largely because they present with nonspecific symptoms and therefore, frequently are far advanced and inoperable by the time they are diagnosed. Ease of spread and types of cells involved are not reasons underlying the fatal nature of this type of cancer. Ovarian cancer is not associated with sexually transmitted infections. Cervical cancer is linked to human papilloma virus infection.

Which term describes an opening between the bladder and the vagina? Cystocele Rectocele Vesicovaginal fistula Rectovaginal fistula

Vesicovaginal fistula A vesicovaginal fistula may occur because of tissue injury sustained during surgery, vaginal birth, or a disease process. A cystocele is a downward displacement of the bladder toward the vaginal orifice. A rectocele is a bulging of the rectum into the vagina. A rectovaginal fistula is an opening between the rectum and the vagina.

A nurse who works in a gynecologist's office frequently cares for patients who are diagnosed with vulvovaginal candidiasis. The nurse should teach the patients how to manage and treat the most common symptom of: Dysuria. Dyspareunia. Vulvar pruritus. Vaginal pain.

Vulvar pruritus. Vulvar pruritus is the chief complaint of those diagnosed with candidiasis.

A client with HIV has recently completed a 7-day regimen of antibiotics. She reports vaginal itching and irritation. In addition, the client has a white, cheese-like vaginal discharge. Which condition is the client most likely experiencing? Trichomonas vaginalis vaginitis Vulvovaginal candidiasis Bacterial vaginosis Human papillomavirus

Vulvovaginal candidiasis Use of antibiotics decreases bacteria, thereby altering the natural protective organisms usually present in the vagina, which can lead to candidiasis overgrowth. Clinical manifestations include a vaginal discharge that causes pruritus; the discharge may be watery or thick but usually has a white, cheese-like appearance. Bacterial vaginosis does not produce local discomfort or pain. Discharge, if noticed, is heavier than normal and is gray to yellowish white. Most HPV infections are self-limiting and without symptoms.

A client is prescribed androgen therapy. Which of the following would the nurse explain as a possible adverse effect? Weight gain Decreased libido Areolar pigmentation Severe bleeding from the vagina

Weight gain Androgen therapy causes recalcification of bone and the client has an increased appetite and gains weight. It may also cause fluid retention, increased libido, and symptoms of virilization. Pigmentation of the nipple and areola are the adverse effects of estrogen therapy, while severe bleeding is not an adverse effect of either androgen or estrogen therapy.

A client who had intracavity radiation treatment for cervical cancer 1 month earlier reports small amounts of vaginal bleeding. This finding most likely represents: an expected effect of the radiation therapy. recurrence of the carcinoma. development of a rectovaginal fistula. infection secondary to a change in vaginal flora.

an expected effect of the radiation therapy. After intracavity radiation, some vaginal bleeding occurs for 1 to 3 months. Intermittent, painless vaginal bleeding is a classic symptom of cervical cancer, but given the client's history, bleeding in more likely a result of the radiation. The passage of feces through the vagina, not vaginal bleeding, is a sign of rectovaginal fistula. Vaginal infections are indicated by various types of vaginal discharge, not vaginal bleeding.

Which abnormality is not considered a structural abnormality? pelvic organ prolapse endometriosis pelvic inflammatory disease vaginal fistulas

pelvic inflammatory disease Pelvic inflammatory disease is an infection of the pelvic organs other than the uterus. These include the ovaries, fallopian tubes, pelvic vascular system, and pelvic supporting structures. Endometriosis is a condition in which tissue with a cellular structure and function resembling that of the endometrium is found outside the uterus. The atypical locations for endometrial tissue include the ovaries, the pelvic cavity, and occasionally the abdominal cavity. A fistula is an unnatural opening between two structures. The opening may be between a ureter and the vagina, between the bladder and the vagina, or between the rectum and the vagina. The term prolapse indicates a structural protrusion. Women experience any number of problems of this nature in the vagina. They include cystocele, rectocele, enterocele, and uterine prolapse.

A 32-year-old client has been diagnosed with an ovarian cyst and asks the nurse, "Should I be worried about cancer?" Which response by the nurse would be most appropriate? "Ovarian cysts are just that, cysts and not a cause for concern." "Ovarian cysts can be malignant but this is a rare occurrence." "Since you don't have any symptoms, the chances of having cancer are really remote." "Most cysts are benign in younger women, but it's good to have it checked out."

"Most cysts are benign in younger women, but it's good to have it checked out." The risk of malignancy in postmenopausal women is much greater than in premenopausal women, with almost all pelvic masses in premenopausal women being benign. However, although typically benign, the cyst should be evaluated to exclude ovarian cancer. The most appropriate response would be to provide this information to the client but also reinforce her actions to have the cyst evaluated. Telling the client that the cyst is no cause for concern or that ovarian cysts are rarely malignant ignores the client's feelings and does not address the client's concern. The absence of symptoms does not eliminate the possibility of a malignancy. Often, ovarian cancer is difficult to detect and signs and symptoms are vague and nonspecific.

When a female client reports a frothy, yellow-green vaginal discharge, the nurse suspects the client has a vaginal infection caused by which organism? Gardnerella vaginalis Trichomonas vaginalis Candida albicans Chlamydia

Trichomonas vaginalis Trichomonas vaginalis causes a frothy yellow-white or yellow-green vaginal discharge. Candidiasis causes a white, cheese-like discharge clinging to the vaginal epithelium. Gardnerella vaginalis causes a gray-white to yellow-white discharge clinging to the external vulva and vaginal walls. Chlamydia causes a profuse purulent discharge.

While caring for a client who is being treated for severe pelvic inflammatory disease (PID), the nurse insists on keeping the client in a semi-sitting position. The nurse advises this in order to: facilitate pelvic drainage and minimize the upward extension of the infection. facilitate easy distraction of the client. prevent nosocomial infections to other clients. prevent movement that may increase pain.

facilitate pelvic drainage and minimize the upward extension of the infection. While caring for a client hospitalized with PID, the nurse has to reduce the risk of the systemic spread of pathogenic microorganisms. The client must be advised to keep the upper body elevated; this facilitates pelvic drainage and minimizes the upward extension of infection.

A patient had a pessary inserted for long-term treatment of a prolapsed uterus. As part of a teaching plan, the nurse would advise the patient to: avoid climbing stairs as much as possible. see her gynecologist to remove and clean the pessary at regular intervals. avoid sexual intercourse. keep the insertion site clean and dry.

see her gynecologist to remove and clean the pessary at regular intervals. A pessary should be removed, examined, and cleaned by a health care provider at prescribed intervals. At this time, the vaginal wall should be examined for pressure points or signs of irritation.

A nurse is providing care for a patient who was diagnosed with a rectocele. Which illustration best depicts this condition?

(4th quiz five questions) Option B shows a rectocele, in which there is an upward pouching of the rectum that pushes the posterior vaginal wall forward. cystocele occurs when there is a downward displacement of the bladder toward the vaginal wall. An enterocoele is a protrusion of the intestinal wall into the vagina.

A nurse practitioner examines a patient suspected of having endometriosis. The nurse knows that although a definitive diagnosis could not be made without diagnostic treatment (transvaginal ultrasound), the most frequent symptom is: Chronic pelvic pain. Low back pain. Dysuria. Dyspareunia.

Chronic pelvic pain. Chronic pelvic pain is the most frequent symptom of endometriosis. Low back pain, dyspareunia, dysuria, dyschezia (excessive straining with stools), dysmenorrhea, and menorrhagia (abnormally heavy or prolonged bleeding) are among the common complaints. The level of pain associated with endometriosis is not necessarily correlated with the stage of endometriosis.

Which is a risk factor for cervical cancer? Exposure to the human papilloma virus (HPV) Late childbearing Underweight status Sex with circumcised males

Exposure to the human papilloma virus (HPV) Risk factors for cervical cancer include exposure to HPV, sex with uncircumcised males, overweight, and early childbearing.

While caring for a patient who is treated for severe pelvic inflammatory disease (PID), the nurse insists on keeping her in a semisitting position. Which of the following is correct rationale for this positioning? Prevention of nosocomial infections to other patients Prevention movement as it increases pain Facilitation of pelvic drainage and minimize the upward extension of infection Facilitation of easy distraction of the patient

Facilitation of pelvic drainage and minimize the upward extension of infection While caring for a patient hospitalized with PID, the nurse has to reduce the risk of the systemic spread of pathogenic microorganisms. The nurse also has to monitor the symptoms to detect, manage, and to minimize sepsis if it occurs. The patient must also be advised to keep her upper body elevated. This facilitates pelvic drainage and minimizes the upward extension of infection. This position will not aid in the prevention of nosocomial infections, decrease the pain, nor easily distract the patient.

A client has a history of dysmenorrhea. During monthly menses, the client experiences incapacitating cramping and passes large clots. The client's primary care physician initiates conservative treatment. What interventions would the physician to recommend? corticosteroids NSAIDs ultrasonography oral hypoglycemia agents

NSAIDs Dysmenorrhea is treated with mild non-narcotic analgesics and by treating the underlying cause if one is identified. Symptomatic relief is accomplished with NSAIDs, which reduce prostaglandins. Prostaglandins are biologic chemicals that exist in endometrial tissue, where they exert a stimulating effect on the uterus, producing cramping and pain.

A nurse is reviewing a client's medical history. Which factor indicates the client is at risk for candidiasis? Nulliparity Use of corticosteroids Menopause Use of spermicidal jelly

Use of corticosteroids A small quantity of the fungus Candida albicans commonly exists in the vagina. Because corticosteroids decrease host defense, they increase the risk of candidiasis. Candidiasis is rare before menarche and after menopause. Using hormonal contraceptives, not spermicidal jelly, and pregnancy, not nulliparity, increase the risk of candidiasis.

The nurse is encouraging a patient to have a cervical examination and Pap smear. It has been many years since the patient's last exam, and she was diagnosed with HPV 6 years ago. The patient states, "I am not having any trouble down there, so it is best to leave things alone." What is the best response by the nurse? "If you are not having any problems, then there is no reason to have one." "If your insurance is paying for it, you should have an exam." "Early cervical cancer rarely produces any symptoms." "You could have another type of sexually transmitted infection."

"Early cervical cancer rarely produces any symptoms." Early cervical cancer rarely produces symptoms. If symptoms are present, they may go unnoticed as a thin, watery vaginal discharge often noticed after intercourse or douching. When symptoms such as discharge, irregular bleeding, or pain or bleeding after sexual intercourse occur, the disease may be advanced.

A client has just been diagnosed with endometriosis. Which of the following would be most appropriate to provide the client with support and guidance about treatment options? "Treatment is essential, so you really need to make a decision pretty quickly." "If it was me, I would probably choose the medication options." "It might help to include your partner in any of the discussions about options." "The test results are clear and another physician would tell you the same thing."

"It might help to include your partner in any of the discussions about options." The nurse assists the client through the decision-making process as it applies to family planning and medical or surgical treatment. Suggesting that the client include her partner or significant other in the discussion of options would be most helpful and therapeutic. The client does not need to make a decision immediately. The nurse should not give advice or offer his or her own opinions to influence the client's choice. The nurse should support the client's option of seeking a second opinion.

Which condition is a downward displacement of the bladder toward the vaginal orifice? Rectocele Cystocele Fistula Vulvodynia

Cystocele A cystocele results from damage to the anterior vaginal support structures. A rectocele is a bulging of the rectum into the vagina. Vulvodynia is a painful condition that affects the vulva. A fistula is an abnormal opening between two organs or sites.

Which client has the highest risk of ovarian cancer? 45-year-old woman who has never been pregnant 40-year-old woman with three children 36-year-old woman who had her first child at age 22 30-year-old woman taking hormonal contraceptives

45-year-old woman who has never been pregnant The incidence of ovarian cancer increases in women who have never been pregnant, are older than age 40, are infertile, or have menstrual irregularities. Other risk factors include a family history of breast, bowel, or endometrial cancer. The risk of ovarian cancer is reduced in women who have taken hormonal contraceptives, have had multiple births, or have had a first child at a young age.

A patient reports to the nurse that she has a sense of pelvic pressure and urinary problems such as incontinence, frequency, and urgency. The problem has gotten much worse since the birth of her third child. What does the nurse suspect the patient is experiencing? A urinary tract infection A rectocele An enterocele A cystocele

A cystocele Cystocele is a downward displacement of the bladder toward the vaginal orifice (Fig. 57-3) from damage to the anterior vaginal support structures. It usually results from injury and strain during childbirth. Because a cystocele causes the anterior vaginal wall to bulge downward, the patient may report a sense of pelvic pressure and urinary problems such as incontinence, frequency, and urgency. Back pain and pelvic pain may occur as well. The symptoms of rectocele resemble those of cystocele, with one exception: Instead of urinary symptoms, patients may experience rectal pressure. Constipation, uncontrollable gas, and fecal incontinence may occur in patients with complete tears.

A client is diagnosed with vaginitis due to trichomoniasis. Which of the following agents would the nurse expect the physician to prescribe? Miconazole Clotrimazole Sulfisoxazole Metronidazole

Metronidazole Metronidazole (Flagyl) is an antiprotozoal agent used to treat vaginitis due to trichomonas vaginalis. Miconazole and clotrimazole are antifungal agents used to treat candidiasis. Sulfisoxazole (Gantrisin) is used to treat vaginitis due to chlamydia.

Which of the following is the preferred medication for bacterial vaginosis? Monistat Metronidazole Terazol Gyne-Lotrimin

Metronidazole The preferred medication for treatment of bacterial vaginosis is metronidazole 500 mg twice daily for seven days. Monistat, Gyne-Lotrimin, and Terazol are used in the management of candidiasis.

A client has undergone a total abdominal hysterectomy and bilateral salpingo-oophorectomy as treatment for endometrial cancer. When providing postoperative care to this client the nurse would be alert for signs and symptoms of which of the following? Clotting deficiencies Bladder dysfunction Leukopenia Neurotoxicity

Bladder dysfunction After a total abdominal hysterectomy and bilateral salpingo-oophorectomy, the client is at risk for several complications, especially bladder dysfunction because the surgical site is close to the bladder. Leukopenia and neurotoxicity are adverse effects of chemotherapy agents such as paclitaxel and carboplatin used to treat ovarian cancer. Deep vein thrombosis, not clotting deficiencies are a potential complication after this type of surgery.

Assessment of a client reveals evidence of a cystocele. The nurse interprets this as which of the following? Protrusion of intestinal wall into the vagina Herniation of the rectum into the vagina Bulging of the bladder into the vagina Downward displacement of the cervix

Bulging of the bladder into the vagina A cystocele is the bulging of the bladder into the vagina. A rectocele is a herniation of the rectum into the vagina. An enterocele is a protrusion of the intestinal wall into the vagina. An uterovaginal prolapse is the downward displacement of the cervix anywhere from low in the vagina to outside the vagina.

The nurse is collecting assessment data on a client who is reporting a vaginal discharge that is cottage cheese-like in appearance. Which pathogen is the most likely cause for this symptom? Trichomonas vaginalis Gardnerella vaginalis Candida albicans Gonococci

Candida albicans Candida albicans is a yeast infection that presents with a thick, curdy white discharge. Gonococcus is the organism that causes gonorrhea and presents with a yellow, mucopurulent discharge. Trichomonas vaginalis presents with a foamy, white, foul-smelling discharge and Gardnerella vaginalis is a watery, fishy-smelling discharge.

Which type of yeast infection is manifested by white, cheese-like discharge? Candidiasis Bacterial vaginosis Trichomoniasis Cervicitis

Candidiasis The discharge of candidiasis may be watery or thick, but has a white, cheese-like appearance. The other disorders do not have a cheese-like appearance.

A client who underwent an anterior colporrhaphy 6 hours ago has not voided. She reports some discomfort in her suprapubic area. Which of the following would the nurse expect to do? Apply ice to the area. Catheterize the client. Obtain an order for an analgesic. Administer a stool softener.

Catheterize the client. After repair of a cystocele (anterior colporrhaphy), the client is encouraged to void within a few hours. If the client does not void within this period and reports discomfort or pain in the bladder region after 6 hours, the client should be catheterized to prevent pressure on the suture line. Stool softeners may be appropriate after a posterior colporrhaphy (repair of a rectocele) or repair of a complete perineal laceration. Ice can be applied locally after an external perineal repair. Because the client is post surgery, analgesics most likely would have been ordered already. In this situation, the pain is from bladder distention; relief of this distention through catheterization would subsequently relieve the client's pain.

In which group is it most important for the client to understand the importance of an annual Papanicolaou test? Clients infected with the human papillomavirus (HPV) Clients with a long history of hormonal contraceptive use Clients with a pregnancy before age 20 Clients with a history of recurrent candidiasis

Clients infected with the human papillomavirus (HPV) HPV causes genital warts, which are associated with an increased incidence of cervical cancer. Recurrent candidiasis, pregnancy before age 20, and use of hormonal contraceptives don't increase the risk of cervical cancer.

The nurse is providing education regarding sexually transmitted diseases. Which statement regarding herpes virus 2 (herpes genitalis) is accurate? Transmission of the virus requires sexual contact. Usually, the virus is killed at room temperature by drying. The virus is very difficult to kill. In pregnant women with active herpes, babies delivered vaginally may become infected with the virus.

In pregnant women with active herpes, babies delivered vaginally may become infected with the virus. A cesarean birth may be performed if the virus recurs near the time of delivery. Asexual transmission by contact with wet surfaces or self-transmission (i.e., touching a cold sore and then touching the genital area) can occur. Transmission is possible even when the carrier does not have symptoms.

A patient is diagnosed with the most common type of uterine fibroid, an intramural fibroid. The nurse includes which information in teaching the patient about this type of fibroid? It lies underneath the outermost layer of the uterus. It arises from inside or outside the surface of the uterine muscle. It grows within the wall of the uterine muscle. It grows below the inner uterine surface.

It grows within the wall of the uterine muscle.

Following a radical vulvectomy, the nurse is preparing the client for discharge to home. Which care intervention would be considered the priority for this client? Prevention of wound complications Care of colostomy site Alterations for sexual function Relieving edema to lower extremities

Prevention of wound complications Prevention of complications and infection is paramount due to the location of the wound. The perineal area provides a warm, dark environment that supports the growth of microorganisms that can be introduced into the wound. With a radical vulvectomy, it is likely to find surgical drains and urinary catheter that can also interfere with the maintenance of the wound. Relieving edema to the lower extremities may be a necessary part of care if the lymph nodes and blood vessels are disturbed. The client may have a colostomy and care instructions should be provided. Alteration in sexual function needs to be addressed but not a priority for the initial stage of healing.

Which of the following is an early symptom of vulvar cancer? Dyspareunia Fever accompanied by chills Pruritus with genital burning Severe abdominal pain

Pruritus with genital burning Pruritus and genital burning are the most frequent early symptoms of vulvar cancer, followed by a bloody discharge from the vagina. Abdominal pain can be a result of a surgery related to ovary, such as salpingo-oophorectomy, or formation of cysts in the ovary. Dyspareunia and fever accompanied by chills are not the early symptoms of vulvar cancer.

A female client comes to the clinic complaining of intense vulvar pruritus and irritation accompanied by a vaginal discharge. A specimen of the discharge is examined to determine the cause. Which of the following would the nurse interpret as indicative of candidiasis? Evidence of clue cells Absence of lactobacilli pH greater than 4.5 Spores and hyphae

Spores and hyphae Candidiasis is detected by the microscopic identification of spores and hyphae. A pH greater than 4.5 is suggestive of trichomoniasis. Clue cells and absence of lactobacilli indicate bacterial vaginosis.

Which STD seems to accelerate in HIV-positive clients? Trichomoniasis Gonorrhea Herpes Syphilis

Syphilis Syphilis seems to accelerate in HIV-positive clients and proceeds directly from primary to tertiary disease in some clients. Chlamydia is associated with a high risk of HIV.

A female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client? The potential for transmission to her sexual partner will be eliminated if condoms are used every time she and her partner have sexual intercourse. The human papillomavirus (HPV), which causes condylomata acuminata, can't be transmitted during oral sex. This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually. The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days.

This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually. Women with condylomata acuminata are at risk for cancer of the cervix and vulva. Yearly Pap smears are very important for early detection. Because condylomata acuminata is a virus, there is no permanent cure. Because condylomata acuminata can occur on the vulva, a condom won't protect sexual partners. HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx.

Following a colposcopy, the confirmation of in situ carcinoma of the cervix has been determined. Which comment by the client indicates an appropriate understanding of the diagnosis? "I can wait until I have finished having babies to seek treatment." "The cancer has not spread." "I will not need any further treatment." "I will need surgery and chemotherapy to increase my odds for survival."

"The cancer has not spread." Carcinoma in situ means the cancer has not left the original site and therefore has not invaded other tissues. Further treatment is required, which usually consists of cryosurgery or hysterectomy. Surgery with adjuvant chemotherapy is usually reserved for cancers that are more advanced. Even though cervical cancers tend to be slower growing, treatment should not be delayed.

A client reports loss of interest in sexual relations and discomfort during intercourse. Which is the best response by the nurse? "These are normal, manageable symptoms of menopause." "Don't worry, every woman goes through this." "Hormone replacement therapy can resolve your symptoms." "You need to discuss this with your spouse."

"These are normal, manageable symptoms of menopause." Diminished libido and/or dyspareunia are common symptoms associated with perimenopause. Explaining that this can be a normal finding may help to alleviate worries for the client and provide hope for management of the symptoms. The nurse should avoid telling a client "not to worry" or "talk to someone else" because these can negate client feelings and shut down communication. HRT may not be recommended for this client.

A client has been diagnosed with genital herpes. Knowing that education is an essential part of nursing care of the client with a genital herpes infection, the nurse plans to include which method(s) to minimize HIV transmission? Select all that apply. Avoiding unprotected sexual intercourse Avoiding physical contact with others in crowded places Avoiding multiple sexual partners Avoiding HPV vaccinations Avoiding IV drug use

Avoiding unprotected sexual intercourse Avoiding multiple sexual partners Avoiding IV drug use Intravenous drug use and risky sexual behaviors, which include multiple partners and unprotected sex, are factors that can put anybody at risk for HIV. Thus, the correct way to minimize HIV transmission would be to avoid these factors. HIV is not transmitted through simple physical contact. Open lesions related to HPV increase the likelihood that HIV can be transmitted; prevention includes administration of the HPV vaccine.

A woman in her late 30s has been having unusually heavy menstrual periods combined with occasional urine and stool leakage over the past few weeks. Upon further enquiry, she reveals that she also has postcoital pain and bleeding. To which diagnosis will the investigation most likely lead? Colorectal cancer Hodgkin disease Cancer of the urinary tract Cervical cancer

Cervical cancer The client's symptoms are those of cervical cancer. Symptoms of cervical cancer include abnormal vaginal bleeding and persistent yellowish, blood-tinged, or foul-smelling discharge. Clients may complain of postcoital pain and bleeding, bleeding between menstrual periods, and unusually heavy menstrual periods. If the cancer has progressed into the pelvic wall, the Clients may experience pain in the flank regions of the body.

The nurse documents the following history obtained from a female patient:No known allergiesDouching 2 to 3 times per weekUse of barrier methods for contraceptionRecent viral upper respiratory infectionEstrogen levels within acceptable parametersWhich of the following would the nurse identify as a risk factor for the patient developing a vulvovaginal infection? Douching Viral upper respiratory infection Barrier contraception Normal estrogen levels

Douching Risk factors for vulvovaginal infections include frequent douching, allergies, oral contraceptive use, use of broad-spectrum antibiotics (for bacterial infections), and low estrogen levels.

A patient is receiving chemotherapy with paclitaxel as treatment for ovarian cancer. The patient arrives at the facility for laboratory testing prior to her next dose of chemotherapy. The results are as follows: Hemoglobin: 12.9 gm/dL White blood cell count: 2,200 /cu mm Platelets: 250,000 /cu mm Red blood cell count: 4,400,00/cu mm Which result would be a cause for concern? White blood cell count Platelet count Hemoglobin level Red blood cell count

White blood cell count The patient's white blood cell count is low, revealing leukopenia and placing the patient at an increased risk for infection. The other results are within normal parameters and would not be a cause for concern.

An elderly client, who can void only while standing and pushing upward on the vagina, is ordered a pessary. Which comment from the client indicates a need for further teaching about this device? "I should have greater ease of emptying my bladder." "I will report any signs of irritation or bleeding." "I will remove and clean it every day." "I should report any foul odor or drainage."

"I will remove and clean it every day." Pessaries should be removed, cleaned, and replaced periodically (at least every 2 months). If the client is unable to manage the pessary, then follow-up appointments should be made with the practitioner. Ill-fitting pessaries can cause irritation and erosion of tissue resulting in irritation, bleeding, or infection. The placement of the pessary should support the uterus in the pelvis and lessen urinary and pelvic symptoms.