Female Reproductive Disorders
Which palpable breast lump is most characteristic of breast cancer? 1. A single painless lump in the upper, outer quadrant of one breast. 2. A firm, painful lump that feels oval shaped and is freely moveable. 3. Bilateral multiple small lumps that are tender just before menstruation. 4. Soft, painless, symmetric lumps in the lower outer quadrant of both breasts.
Answer: 1 Rationale: Characteristic breast cancer lumps are usually singular and unilateral (affecting only one breast), and they can be found in any part of the breast. However, nearly one half of all malignant breast tumors are located in the upper outer quadrant, and nearly one fourth are located in the nipple-areolar complex. Most malignant lumps are painless and are palpated as firm, irregularly shaped, and fixed to underlying structures or skin. Fibrocystic breast changes are an exaggerated response to hormonal influences. Excess fibrous tissue develops, accompanied by overgrowth of the lining of the mammary ducts, proliferation of mammary ducts, and the formation of cysts. Fibrocystic nodules do not "become cancerous," but their presence may make it more difficult to detect malignant tumors by palpation. They are firm, painful lumps that usually affect both breasts. Smooth round lumps that are freely movable may be felt. Sometimes milky yellow or green discharge from the nipple is seen. Symptoms commonly are most apparent during the premenstrual phase of the menstrual cycle and typically improve after the menstrual period.
A patient who has been diagnosed with endometriosis is in need of drug therapy. Which drug is used most often in the treatment of endometriosis? 1. Danazol (Danocrine) 2. Progestin (Micronor) 3. Urofollitropin (Metrodin) 4. Clomiphene citrate (Clomid)
Answer: 1 Rationale: Danazol (Danocrine) is used to treat endometriosis. Progestin (Micronor) is used to prevent pregnancy by suppressing ovulation and altering the endometrium and cervical mucus. Urofollitropin (Metrodin) is used to stimulate ovarian follicular growth and to treat patients who have not responded to clomiphene citrate (Clomid). Clomiphene citrate (Clomid) is used to stimulate or mimic the actions of natural pituitary gonadotropins.REF: pp. 1101, 1112
The nurse is providing care for a 14-year-old patient with menorrhagia. The nursing diagnosis of anxiety had been added to her plan of care. Which intervention by the nurse is priority for the nursing diagnosis of anxiety? 1. Encourage the patient to express her feelings. 2. Teach the patient her role in the treatment process. 3. Assess the number of sexual partners the patient has encountered. 4. Instruct the patient to change perineal pads frequently during menses.
Answer: 1 Rationale: Menorrhagia is excessive bleeding during menstruation. Anxiety can develop because of the excessive bleeding and not knowing the cause. Supportive measures such as encouraging the patient to express her feelings, use of touch, and listening convey concern to the patient. Teaching the patient her role in the treatment process addresses knowledge deficit. Assessing the number of sexual partners should be part of the health history and could increase the patient's anxiety. Instructing the patient to change the perineal pad frequently is practicing good perineal hygiene.REF: p. 1105
A young woman has come to the physician's office for a routine pelvic examination. During the health history, she tells you that her mother says douching is an essential part of feminine hygiene. What is your best response? 1. "Your body has normal processes to cleanse the vagina, so douching is unnecessary." 2. "Douching is not really necessary, but it is a harmless procedure." 3. "No medically appropriate reasons exist for douching." 4. "Douching is safe if sterile solution is used."
Answer: 1 Rationale: The nurse's best advice to a patient about douching is "Your body has normal processes to cleanse the vagina, so douching is not necessary." It does not need to be done unless ordered by a physician or nurse practitioner. Douching is not harmless but potentially dangerous, because it may force tissue and microorganisms up into the uterus. In addition, cleansing and perfumed agents may cause allergic or irritant reactions. Contrary to common belief, douching is not an effective contraceptive practice. The vagina is not a sterile area, so sterile solution is not used.
Which question collects data about the patient's menarche? 1. "At what age did you begin menstruating?" 2. "Would you describe your menstrual flow as light or heavy?" 3. "What was your age when you first experienced hot flashes?" 4. "Do you usually have any changes in mood before your menstrual pain?"
Answer: 1 Rationale: When collecting data about a patient's menarche, the question to ask is "At what age did you begin menstruating?" Menarche is the first menstrual cycle, or first menstrual bleeding, in female humans. Age at menarche, if 11 years or younger, is an established risk factor for breast cancer. Age at menarche is not related to the patient's menstrual flow, age when first experienced a "hot flush," or mood changes before menstrual periods.
You are teaching a class on BSE to women of various ages. Which of the following should you tell women who no longer menstruate about BSE? Select all that apply. 1. "BSE is not a substitute for professional examinations." 2. "Perform BSE on the same day of each month." 3. "Older women should perform BSE every day." 4. "Mammograms are needed only if you discover a lump." 5. "Palpate the axilla as well as the breasts."
Answer: 1, 2, 5 Rationale: When teaching a class on breast self-examination (BSE), the primary role of the nurse is to instruct the class in BSE and to encourage scheduled professional examinations. BSE is not a substitute for periodic professional breast examinations. The BSE should be done at the same time each month and at the end of the menstrual period for menstruating women or on the same date each month for women who have ceased menstruating. Bilateral axillae need to be palpated with each arm only slightly (not fully) raised. Older women should do a BSE on the same date each month and not every day. The American Cancer Society recommends that mammograms be obtained in women at the age of 40 years and subsequent testing should be done annually thereafter and continued as long as they are otherwise in good health (ACS, 2013). In 2009, the U.S. Preventive Services Task Force issued new recommendations that mammography should begin at age 50. Mammograms are not done only if a lump has been discovered.
Which of the following statements are appropriate to prepare a patient for culdoscopy? Select all that apply. 1. "You will need to be in a knee-chest or lithotomy position." 2. "You will have no restrictions after the procedure." 3. "You will need to return in 1 week to have your sutures removed." 4. "You may have shoulder pain caused by air entering the pelvic cavity." 5. "You will be given general anesthesia for this procedure."
Answer: 1, 4 Rationale: Appropriate statements before a culdoscopy include: "You will need to be in a knee-chest or lithotomy position." This position can be physically uncomfortable, embarrassing, and humiliating, so assure the patient that she will be draped throughout the procedure. When completed, help the patient get out of the knee-chest position without exposure. Another appropriate statement is, "You may have shoulder pain caused by air entering the pelvic cavity." Shoulder pain with this procedure is a common complaint. After the procedure, restrictions include nothing inserted in the vagina (e.g., no vaginal intercourse, douching, or tampons) for the period of time the physician specifies. There are not sutures to remove. A small incision in the posterior vagina is made but will close and heal without sutures. General anesthesia is not given. The procedure is usually performed with light sedation and local anesthetic on an outpatient basis.
Which organism is most associated with mastitis? 1. Candida albicans 2. Staphylococcus aureus 3. Mycoplasma hominis 4. Chlamydia trachomatis
Answer: 2 Rationale: Staphylococcus aureus is the organism identified as the cause of mastitis. Candida albicans is the organism identified as a cause of vaginitis. Mycoplasma hominis and Chlamydia trachomatis are sexually transmitted organisms most associated with pelvic inflammatory infection.REF: p. 1107
A patient has just undergone a culdoscopic procedure. The nurse is educating the patient on postprocedure self-care. Which statement made by the patient indicates a need for further teaching? 1. "I may experience shoulder pain." 2. "I can engage in sexual intercourse at any time." 3. "I did not need stitches, and it will heal on its own." 4. "I should not insert anything into my vagina unless released to do so by my health care provider."
Answer: 2 Rationale: The patient should not insert anything into the vagina that may interfere with healing. This includes vaginal intercourse, douching, or using tampons unless released by the health care provider. The patient may experience shoulder pain related to the induction of air entering the pelvic cavity during the procedure. The incision will close and heal without sutures.REF: p. 1113
A patient tells the nurse that she has never performed breast self-examination because her doctor always examines her breasts at her yearly physical appointment. The nurse would tell the patient that breast self-examination is important and would provide which information? Select all that apply. 1. The breast self-examination should be done on the first day of every month. 2. Every woman needs to know the correct way to perform breast self-examination. 3. As long as you also have annual mammogram, then there is no need to perform breast self-examination. 4. Breast self-examination helps a woman find any changes in her breasts if they occur between medical appointments. 5. I can show you how to do breast self-examination. Then you can demonstrate how to do breast self-examination so I know you understand all of the steps and are comfortable with the process.
Answer: 2, 4, 5 Rationale: Breast self-examination is a self-care step enabling women to detect changes in their breasts as they occur. Every woman who has begun to menstruate should know the correct way to perform breast self-examination. The nurse needs to educate the patient on the steps of breast self-examination and validate the patient's ability to adequately perform the self-examination. Self-breast examinations should be performed monthly. Annual mammograms and annual physical examinations may not detect changes early enough.REF: p. 1097
Which statement made by the patient indicates a physiological result of a reproductive tract infection? 1. "I feel so ashamed." 2. "People will judge me now." 3. "I can be infertile because of this infection." 4. "I cannot trust my sexual partner ever again."
Answer: 3 Rationale: A physical result of a reproductive tract infection could be pain, discomfort, scarring of the fallopian tube, or infertility. Psychological effects might be changes in relationships, feelings of distrust toward partners, shame, embarrassment, and diminished self-esteem. The nurse needs to assess which effects are going on to help the patient cope effectively.REF: p. 1105
Fertilization occurs in which site? 1. Uterus 2. Ovary 3. Fallopian tube 4. Vagina
Answer: 3 Rationale: Fertilization, the union of sperm and ovum, takes place in the fallopian tubes. There are two fallopian tubes. They are thin, hollow, cilia-lined, tubular structures that extend from the uterine fundus. The fallopian tubes have funnel-shaped ends that partially surround the ovaries and that receive the ovum from the ovary. The fallopian tubes serve as passages for ova from the ovaries and for sperm that travel through the vagina and into the tubes. Fertilization does not occur in the uterus, ovary, or vagina.
A patient completed a 6-month course of danazol (Danocrine) for treatment of endometriosis. She would like to become pregnant. Which of the following is it important for her to understand? 1. She will begin menstrual bleeding within 1 week after stopping the danazol. 2. Her best chances of pregnancy are in the first month after completing danazol therapy. 3. She should not become pregnant for 1 month because danazol can cause birth defects. 4. She is unlikely to become pregnant for at least 1 year after taking danazol.
Answer: 3 Rationale: If a patient has been taking danazol (Danocrine) for 6 months and wants to get pregnant, she needs to wait 1 month because danazol can cause birth defects. Danazol is a synthetic androgenic steroid that inhibits gonadotropin excretion, resulting in amenorrhea and atrophy of intrauterine and ectopic endometrial tissue. It is also contraindicated during pregnancy, so the patient should know to use a barrier contraceptive during and for 1 to 3 months after the first normal menstrual period after therapy. The patient will not begin menstrual bleeding within 1 week after stopping the drug. She should not get pregnant in the first month after stopping the drug because of the risk of birth defects. She may try to get pregnant after 3 months of stopping the drug; she does not have to wait 1 year.
A 30-year old women who reports menarche at age 12, first sexual intercourse at age 14, and a history of treatment for HPV infection at age 15 is at increased risk for which of the following? 1. Breast cancer 2. Uterine prolapse 3. Cervical cancer 4. Fibroid tumors
Answer: 3 Rationale: The risk for cervical cancer is increased in women who had their initial sexual intercourse in early adolescence, or have been infected with the human papillomavirus (HPV), or human immunodeficiency virus (HIV). Additional factors associated with cervical cancer are cigarette smoking, a compromised immune system, and multiple sexual partners. Cervical cancer was formerly thought to be linked to sexual intercourse with uncircumcised males, but current research does not support this speculation. Age at menarche, if 11 years or younger, is an established risk factor for breast cancer. Uterine prolapse and fibroid tumors are not related to the risk factors for cervical cancer.
There are several types of diagnostic biopsies used. Which biopsy is a surgical procedure used to remove cancerous tissue? 1. Colposcopy 2. Endometrial biopsy 3. Cervical biopsy 4. Cone biopsy
Answer: 4 Rationale: A cone biopsy is used when a large amount of cervical tissue needs to be removed, most often when removing cancerous tissue rather than diagnosing cancer. General anesthesia is necessary to ensure comfort and minimize pain during the procedure. Colposcopy, endometrial biopsy, and cervical biopsy may be used to collect smaller specimens for assessment of the endometrium, to diagnose uterine bleeding patterns, and to diagnose cancer.REF: p. 1095
An older woman with uterine prolapse is being fitted with a pessary. What information should be included in the teaching plan? 1. The pessary permanently corrects the uterine prolapse. 2. Once the pessary is in place, no further care is needed. 3. No complications are associated with pessaries. 4. The position of the pessary must be checked in 24 hours.
Answer: 4 Rationale: After placement of a pessary, advise the patient to return within 24 hours for the physician to assess placement, effectiveness, and problems related to pressure on surrounding structures. A pessary is a device that is inserted into the vagina to apply pressure on the vaginal wall, thereby supporting the uterus in the pelvis. For women who are poor surgical risks or who refuse surgical treatment, pessaries are an option but they do not correct the uterine prolapse. Pessaries must be removed, cleaned, and replaced periodically. Although some primary health care providers prefer to remove, clean, and replace pessaries, capable patients can be taught to do this themselves. If they are not maintained or are fitted improperly, then they may act as irritants and cause tissue erosion, malignant tissue changes, or both. The patient's pessary must be documented so that it will not be forgotten and neglected.
Which organism is not commonly associated with PID? 1. Neisseria gonorrhoeae 2. Chlamydia trachomatis 3. Mycoplasma hominis 4. Escherichia coli
Answer: 4 Rationale: Escherichia coli is not associated with pelvic inflammatory disease (PID). Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma hominis are recognized as the organisms most associated with PID. Chlamydia infection is thought to be the most commonly occurring sexually transmitted infection and the one most often responsible for PID. As such, it is often implicated in infection of the fallopian tubes (salpingitis) and is considered to be the primary cause of ectopic pregnancy and infertility associated with tubal obstruction.
A patient has been prescribed Clomid (clomiphene citrate) 50 mg PO every day for 5 days on day 5 of the menstrual cycle. The nurse has just completed patient education on the medication. Which statement made by the patient indicates effective teaching? 1. "This medication does not affect my liver function." 2. "This medication does not affect my reproductive function." 3. "I do not need to avoid sexual intercourse if my ovaries are enlarged." 4. "I should discontinue the medication and contact my health care provider if I experience visual disturbances."
Answer: 4 Rationale: Visual disturbances are a major side effect. The patient should discontinue the medication and should report the symptom to the health care provider as soon as possible. Liver dysfunction is a contraindication for this medication. The medication is prescribed to help treat a reproductive disorder. Sexual intercourse should be avoided with ovarian enlargement to prevent rupture.REF: p. 1102
A patient describes symptoms of intermittent and irregular spotting. Which uterine bleeding disorder most likely matches the patient's symptoms? 1. Salpingitis 2. Amenorrhea 3. Menorrhagia 4. Metrorrhagia
Answer: 4 Rationale: Metrorrhagia is characterized by regular or intermittent spotting at various times in the menstrual cycle. Salpingitis is infection of the fallopian tubes. Amenorrhea is the absence of menstruation. Menorrhagia by definition is profuse or prolonged bleeding during menstruation.REF: pp. 1103, 1104
