OB Chapter 8 Practice Questions

6. A client is scheduled for cryosurgery to remove some abnormal tissue on the cervix. The nurse teaches the client about this treatment, explaining that the tissue will be removed by which method? A) Freezing B) Cutting C) Burning D) Irradiating

A Cryotherapy—destroys abnormal cervical tissue by freezing with liquid nitrogen, Freon, or nitrous oxide. Studies show a 90% cure rate (NCI, 2015g). Healing takes up to 6 weeks, and the client may experience a profuse, watery vaginal discharge for 3 to 4 weeks.

14.When preparing a woman with suspected vulvar cancer for a biopsy, the nurse expects that the lesion would most likely be located at which area? A) Labia majora B) Labia minora C) Clitoris D) Prepuce

A The diagnosis of vulvar cancer is made by a biopsy of the suspicious lesion, which is usually found on the labia majora.

23.A nurse is conducting a class for a local woman's group about recommendations for a Pap smear. One of the participants asks, At what age should a woman have her first Pap smear? The nurse responds by stating that a woman should have her first Pap smear at which age? A) 18 B) 21 C) 25 D) 28

B

5. Which finding obtained during a client history would the nurse identify as increasing a clients risk for ovarian cancer? A)Multiple sexual partners B) Consumption of a high-fat diet C) Underweight D)Grand multiparity (more than five children)

B

13. A woman is diagnosed with adenocarcinoma of the endometrium in situ. The nurse interprets this as indicating which of the following about the cancer? A) Spread to the uterine muscle wall B) Found on the endometrial surface C) Spread to the cervix D) Invaded the bladder

B Adenocarcinoma of the endometrium is typically preceded by hyperplasia. Carcinoma in situ is found only on the endometrial surface.

9. Which of the following descriptions would the nurse include when teaching a client about her scheduled colposcopy? A)A gel will be applied to your abdomen and a microphone-like device will be moved over the area to identify problem areas. B) A solution will be wiped on your cervix to identify any abnormal cells, which will be visualized with a magnifying instrument. C) Scrapings of tissue will be obtained and placed on slides to be examined under the microscope. D)After you receive anesthesia, a small device will be inserted into your abdomen near your belly button to obtain tissue samples.

B Colposcopy is a microscopic examination of the lower genital tract using a magnifying instrument called a colposcope. Specific patterns of cells that correlate well with certain histologic findings can be visualized. The woman is placed in the lithotomy position and her cervix is cleansed with acetic acid solution. Acetic acid makes abnormal cells appear white, which is referred to as acetowhite. These white areas are then biopsied and sent to the pathologist for assessment.

3. A woman comes to the clinic for a routine checkup. A history of exposure to which of the following would alert the nurse that she is at increased risk for cervical cancer? A) Hepatitis B) Human papillomavirus C) Cytomegalovirus D) Epstein-Barr virus

B HPV infection must be present for cervical cancer to occur. HPV infections occur in a high percentage of sexually active women,

15.When describing the various types of reproductive tract cancers to a local women's group, which of the following would the nurse identify as the least common type? A) Vulvar B) Vaginal C) Endometrial D) Ovarian

B Vaginal cancer is a rare malignant tissue growth arising in the vagina. Only about 1 of every 1,100 women will develop vaginal cancer in her lifetime. Vulvar cancer accounts for approximately 5% of all female genital malignancies. In the United States, women have a 1 in 333 chance of developing vulvar cancer at some point in their lifetime. It is the fourth most common gynecologic cancer. Endometrial cancer is the fourth most common gynecologic malignancy and accounts for 6% of all cancers in women in the United States or 1 in 37 women. Cervical cancer is the third most common genital malignancy in women in the United States. Ovarian cancer is the ninth most common cancer among women and the fifth most common cause of cancer deaths for women in the United States.

16. When assessing a female client for the possibility of vulvar cancer, which of the following would the nurse most likely expect the client to report? (Select all that apply.) A) Abnormal vaginal bleeding B) Persistent vulvar itching C) History of herpes simplex D) Lesion on the cervix E) Abnormal Pap smear

B, C In most cases, the woman reports persistent vulvar itching, burning, and edema that do not improve with the use of creams or ointments. A history of condyloma, gonorrhea, and herpes simplex are some of the factors for greater risk for VIN.

25. A client has an abnormal Pap smear that is classified as ASC-US. Based on the nurses understanding of this classification, the nurse would expect which of the following? A) Immediate colposcopy B) Testing for HPV C) Repeat Pap smear in 4 to 6 months D) Cone biopsy

C ASC-US: Repeat the Pap smear in 4 to 6 months or refer for colposcopy. ASC-H: Refer for colposcopy with HPV testing. Atypical glandular cells (AGC) and adenocarcinoma in situ (AIS): Immediate colposcopy; follow-up is based on the findings.

24. An instructor is describing the development of cervical cancer to a group of students. The instructor determines that the teaching was successful when the students identify which area as most commonly involved? A) Internal cervical os B) Junction of the cervix and fundus C) Squamous-columnar junction D) External cervical os

C Cervical cancer starts with abnormal changes in the cellular lining or surface of the cervix. Typically, these changes occur in the squamous-columnar junction of the cervix. Here, cylindrical secretory epithelial cells (columnar) meet the protective flat epithelial cells (squamous) from the outer cervix and vagina in what is termed the transformation zone. The continuous replacement of columnar epithelial cells by squamous epithelial cells in this area makes these cells vulnerable to taking up foreign or abnormal genetic material

When describing ovarian cancer to a local women's group, the nurse states that ovarian cancer often is not diagnosed early because: A) The disease progresses very slowly. B) The early stages produce very vague symptoms. C) The disease usually is diagnosed only at autopsy. D) Clients do not follow up on acute pelvic pain.

The correct answer is B. Typically there are no glaring features of ovarian cancer. Many of the symptoms are nonspecific and can easily be explained away and rationalized as changes related to the aging process. A is incorrect: ovarian cancer is aggressive and spreads early. C is incorrect: women do not have to die to be diagnosed with ovarian cancer. D is incorrect: most women with acute pain bring it to the attention of their health care provider, but acute pain is a late symptom of cancer.

19. The plan of care for a woman diagnosed with a suspected reproductive cancer includes a nursing diagnosis of disturbed body image related to suspected reproductive tract cancer and impact on sexuality as evidenced by the clients statement that she is worried that she won't be the same. Which of the following would be an appropriate outcome for this client? A) Client will verbalize positive statements about self and sexuality. B) Client will demonstrate understanding of the condition and associated treatment. C) Client will exhibit positive coping strategies related to diagnosis. D) Client will identify misconceptions related to her diagnosis.

A NURSING DIAGNOSIS: Disturbed body image related to suspected reproductive tract cancer and impact on client's sexuality and sense of self as evidenced by statement of being worried about not being the same Outcome Identification and Evaluation: The client will verbalize or demonstrate a positive self-esteem in relation to body image as evidenced by positive statements about self, sexuality, and participation in activities with others. Interventions: Promoting Healthy Body Image -Assess client's use of self-criticism to determine client's current state of coping and adjustment. -Determine if the client's change in body image has contributed to social isolation to provide a direction for care. -Provide opportunities for client to explore her feelings related to issues of sexuality, including past behaviors that may have placed her at risk, to minimize feelings of guilt about her condition. -Acknowledge the client's feelings about possible changes in her body and sexuality and her illness to foster trust and allow client to ventilate feelings and concerns. -Facilitate contact with other clients with the same type of cancer to promote sharing of feelings and decrease feelings of isolation. -Initiate referrals for counseling and community support groups as necessary to assist client in gaining a positive image of herself.

11. The daughter of a woman who has been diagnosed with ovarian cancer asks the nurse about screening for this cancer. Which response by the nurse would be most appropriate? A) Currently there is no reliable screening test for ovarian cancer. B) A Pap smear is almost always helpful in identifying this type of cancer. C) Theres a blood test for a marker, CA-125, that if elevated indicates cancer. D) A genetic test for two genes, if positive, will identify the ovarian cancer.

A Women with ovarian cancer are typically diagnosed at a late stage, when the cancer has spread into the peritoneal cavity and complete surgical removal is challenging. Seventy-five percent of ovarian cancers are not diagnosed until the cancer has advanced to stage III or IV, primarily because there is still no adequate screening test. However, women with increased risk related to BRCA ½ mutations or a family history of ovarian cancer should be considered for genetic counseling to further evaluate their risk

1. The nurse would refer a client, age 54, for follow-up for suspected endometrial carcinoma if she reports which of the following? A)Use of oral contraceptives between ages 18 and 25 B) Onset of painless, red postmenopausal bleeding C) Menopause occurring at age 46 D)Use of intrauterine device for 3 years

B Most commonly, the major initial symptom of endometrial cancer is abnormal and painless vaginal bleeding. Obtain a menstrual history and inquire if the woman is taking any hormones. Also ascertain if she has a personal or family history of breast, ovarian, or colon cancer. These key pieces of information will assist in identifying the woman at high risk for endometrial cancer.

22.A woman is scheduled for diagnostic testing to evaluate for endometrial cancer. The nurse would expect to prepare the woman for which of the following? A) CA-125 testing B) Transvaginal ultrasound C) Pap smear D) Mammography

B There is no specific screening test currently available to detect endometrial cancer. Screening for endometrial cancer is not routinely done because it is not practical or cost effective. A pelvic examination is frequently normal in the early stages of the disease. Changes in the size, shape, or consistency of the uterus or its surrounding support structures may exist when the disease is more advanced. Transvaginal ultrasound can be used to evaluate the endometrial cavity and measure the thickness of the endometrial lining. It can be used to detect endometrial hyperplasia. If the endometrium measures less than 4 mm, then the client is at low risk for malignancy. Large prospective studies have shown that an endometrial thickness of ≤4 mm on transvaginal ultrasound in postmenopausal women with bleeding has a low risk of malignancy. Thus, in postmenopausal clients with bleeding, biopsy is not indicted when endometrial thickness is ≤4 mm, thereby avoiding invasive diagnostics

20. During a routine health check-up, a young adult woman asks the nurse about ways to prevent endometrial cancer. Which of the following would the nurse most likely include? (Select all that apply.) A) Eating a high-fat diet B) Having regular pelvic exams C) Engaging in daily exercise D) Becoming pregnant E) Using estrogen contraceptives

B, C, D -Schedule regular pelvic examinations after the age of 21. -Visit health care practitioner for early evaluation of any abnormal bleeding after menopause. -Maintain a low-fat diet throughout life. -Exercise daily. -Manage weight to discourage hyperestrogenic states, which predispose to endometrial hyperplasia. -Pregnancy serves as a protective factor by reducing estrogen. -Ask your doctor about the use of combination estrogen and progestin pills. -When combination oral contraceptives are taken to facilitate the regular shedding of the uterine lining, take risk reduction measures. -Be aware of risk factors for endometrial cancer and make modifications as needed. -Report any of the following symptoms immediately: --Bleeding or spotting after sexual intercourse --Bleeding that lasts longer than a week --Reappearance of bleeding after 6 months or more of no menses --After cancer therapy, schedule follow-up appointments for the next few years. --After cancer therapy, frequently communicate with your health care provider concerning your status. --After surgery, maintain a healthy weight.

17. A nurse is reviewing the medical record of a woman diagnosed with vulvar cancer. Which of the following would the nurse identify as a risk factor for this cancer? (Select all that apply.) A) Age under 40 years B) HPV 16 exposure C) Monogamous sexual partner D) Hypertension E) Diabetes

B, D, E Risk factors for vulvar cancer include: Exposure to HPV type 16 Age over 50 years HIV infection VIN Lichen sclerosus (a patchy skin disorder) Melanoma or atypical moles Exposure to HSV type 2 Multiple sex partners Smoking Herpes simplex History of breast cancer Immune suppression Hypertension Diabetes mellitus Obesity

10. The nurse is preparing a presentation for a local women's group about ways to reduce the risk of reproductive tract cancers. Which of the following would the nurse include? A) Blood pressure evaluation every 6 months B) Yearly Pap smears starting at age 40 C) Yearly cholesterol screening starting at age 45 D) Consumption of two to three glasses of red wine per day

C -Do not smoke; smoking is linked to lung cancer development. -Drink alcohol only in moderation (no more than one drink daily). -Be physically active daily. -Eat a healthy diet. -Stay current with immunizations. -Use a condom with every sexual encounter. -Reach and maintain a healthy weight. -Take preventive medicines if needed. -Get recommended screening tests: --Body mass index (BMI) to identify obesity --Mammogram every 1 to 2 years starting at age 40 --Pap smear every 1 to 3 years if sexually active, between the ages of 21 and 65 --Cholesterol checked annually starting at age 45 --Blood pressure checked at least every 2 years --Diabetes test if hypertensive or hypercholesterolemia --Check for STIs if sexually active

18. A nurse is assisting with the collection of a Pap smear. When collecting the specimen, which of the following is done first? A) Insertion of the speculum B) Swabbing of the endocervix C) Spreading of the labia D) Insertion of the cytobrush

C 1. Explain procedure to the client 2. Instruct client to empty her bladder. 3. Wash hands thoroughly. 4. Assemble equipment, maintaining sterility of equipment 5. Position client on stirrups or foot pedals so that her knees fall outward. 6. Drape client with a sheet for privacy, covering the abdomen but leaving the perineal area exposed. 7. Open packages as needed. 8. Encourage client to relax. 9. Provide support to client as the practitioner obtains a sample by spreading the labia; inserting the speculum; inserting the cytobrush and swabbing the endocervix; and inserting the plastic spatula and swabbing the cervix 10. Transfer specimen to a container or a slide. If a slide is used, spray the fixative on the slide holding the spray container about 12 inches away from the slide 11. Place sterile lubricant on the practitioner's fingertip when indicated for the bimanual examination. 12. Wash hands thoroughly. 13. Label specimen according to facility policy. 14. Rinse reusable instruments and dispose of waste appropriately 15. Wash hands thoroughly. 16. Assist the client up after the exam is completed.

4. A client is scheduled to have a Pap smear. After the nurse teaches the client about the Pap smear, which of the following client statements indicates successful teaching? A)I need to douche the night before with a mild vinegar solution. B) I will take a bath first thing that morning to make sure I'm clean. C) I will not engage in sexual intercourse for 48 hours before the test. D) I will get a clean urine specimen when I first wake up the morning of the test.

C STRATEGIES TO OPTIMIZE PAP SMEAR RESULTS -Schedule your Pap smear appointment about 2 weeks (10 to 18 days) after the first day of your last menses to increase the chance of getting the best sample of cervical cells without menses. -Refrain from intercourse for 48 hours before the test because additional matter such as sperm can obscure the specimen. -Do not douche within 48 hours before the test to prevent washing away cervical cells that might be abnormal. -Do not use tampons, birth control foams, jellies, vaginal creams, or vaginal medications for 72 hours before the test, because they could cover up or obscure the cervical cell sample. -Cancel your Pap appointment if vaginal bleeding occurs, because the presence of blood cells interferes with visual evaluation of the sample.

12. Which of the following would the nurse be least likely to suggest when teaching a group of young women how to reduce their risk for ovarian cancer? A) Pregnancy B) Oral contraceptives C) Feminine hygiene sprays D) Breast-feeding

C Teach the woman about risk reduction strategies; for instance, pregnancy, use of oral contraceptives, and breastfeeding reduce the risk of ovarian cancer. Instruct women to avoid using talc and hygiene sprays on their genitals. Review the lifetime risks related to BRCA1 and BRCA2 genes and options available should the woman test positive for these genes. Help to promote community awareness of ovarian cancer by educating the public about risk-reducing behaviors.

21. After teaching a group of students about cervical cancer, the instructor determines that the teaching was successful when the students identify which of the following as the area included with a cone biopsy? A) Clitoris B) Uterine fundus C) Ovarian follicle D) Transformation zone

D Cone biopsy or conization—removes a cone-shaped section of cervical tissue. The base of the cone is formed by the ectocervix (outer part of the cervix) and the point or apex of the cone is from the endocervical canal. The transformation zone is contained within the cone sample. The cone biopsy is also a treatment and can be used to completely remove any precancers and very early cancers. Two methods are commonly used for cone biopsies:

8. A client is suspected of having endometrial cancer. The nurse would most likely prepare the client for which procedure to confirm the diagnosis? A)Transvaginal ultrasound B) Colposcopy C) Pap smear D)Endometrial biopsy

D Endometrial biopsy is an office procedure that is also one of the first steps in the diagnosis of endometrial cancer in a woman with postmenopausal bleeding. Transvaginal ultrasound can be used to evaluate the endometrial cavity and measure the thickness of the endometrial lining.

2. Which of the following instructions would the nurse include when preparing a woman for a Pap smear? A) Refrain from sexual intercourse for 1 week before the test. B) Wear cotton panties on the day of the test. C) Avoid taking any medications for 24 hours. D) Do not douche for 48 hours before the test.

D STRATEGIES TO OPTIMIZE PAP SMEAR RESULTS -Schedule your Pap smear appointment about 2 weeks (10 to 18 days) after the first day of your last menses to increase the chance of getting the best sample of cervical cells without menses. -Refrain from intercourse for 48 hours before the test because additional matter such as sperm can obscure the specimen. -Do not douche within 48 hours before the test to prevent washing away cervical cells that might be abnormal. -Do not use tampons, birth control foams, jellies, vaginal creams, or vaginal medications for 72 hours before the test, because they could cover up or obscure the cervical cell sample. -Cancel your Pap appointment if vaginal bleeding occurs, because the presence of blood cells interferes with visual evaluation of the sample.

Which of the following statements best indicates that a client has taken self-care measures to reduce her risk for cervical cancer? A) I've really cut down on the amount of caffeine I drink every day. B) I've thrown out all my bubble baths and just use soap and water now. C) Every time I have sexual intercourse, I douche. D) My partner always uses a condom when we have sexual intercourse.

D The nurse should focus primary prevention education on the following:-Identify high-risk behaviors in clients and teach them how to reduce such behaviors -Take steps to prevent STIs. -Avoid early sexual activity. -Faithfully use barrier methods of contraception. -Avoid smoking and drinking. -Receive the HPV vaccine. -Instruct women on the importance of screening for cervical cancer by having annual Pap smears. -Outline the proper preparation before having a Pap smear -Reinforce specific guidelines for screening. -Interferes with visual evaluation of the sample

Which of the following is considered a risk factor for vulvar cancer? A) Vitamin B12 deficiency B) Epstein-Barr virus C) Human papillomavirus D) Adenovirus

The correct response is "C" because HPV isn't just associated with cervical cancer, but also a major risk factor for the development of vulvar cancer. Response "A" is incorrect because a vitamin B deficiency is not a risk factor for the development of vulvar cancer, but may manifest in neuropathy, diarrhea, and dementia. Choice "B" is incorrect because this virus is associated with mononucleosis, hepatitis, and an increased risk of lymphomas in the transplant client. Choice "D" is incorrect because adenovirus is the cause of pharyngitis and conjunctivitis, not vulvar cancer.

The nurse is attempting to reassure her obese female client about the discovery of an ovarian cyst after her pelvic exam. Which of the following statements is true concerning ovarian cysts? They are: A) Frequently seen in polycystic kidney disease B) Always painful and need to be removed surgically C) A precursor to ovarian carcinoma D) Part of a syndrome that includes hypertension and diabetes

The correct response is "D" because ovarian cysts are frequently seen with polycystic ovarian syndrome (PCOS), which is characterized by hypertension and diabetes as well as amenorrhea, obesity, and hyperlipidemia. They are not associated with polycystic kidney disease, making choice "A" incorrect. Choice "B" is incorrect since the majority of ovarian cysts are painless. Choice "C" is incorrect since cysts are not a precursor to ovarian carcinoma.

Which of the following would the nurse identify as the priority psychosocial need for a women diagnosed with reproductive cancer? A) Research findings B) Hand-holding C) Cheerfulness D) Offering of hope

The correct response is A. Women need clear information to make informed choices about treatment and aftercare. This information will help reduce her anxiety and chose the best course of action for her. B is incorrect: hand-holding is important if used appropriately, but having clear information about what to expect and treatment options will go a longer way to meet her psychosocial needs. C is incorrect: cheerfulness is not necessarily therapeutic in the face of a grave prognosis. D is incorrect: instilling hope is important, but giving clear information would be more of a priority.

After teaching a group of students about reproductive tract cancers, the nursing instructor determines that the teaching was successful when the students identify which of the following as the deadliest type of female reproductive cancer? A) Vulvar B) Ovarian C) Endometrial D) Cervical

The correct response is B. Typically ovarian cancer is not diagnosed until it is in advanced stages, when the prognosis and survival rates are poor. A is incorrect: vulvar cancer is usually recognized earlier and when treated in its early stages is curable. C is incorrect: endometrial cancer can usually be detected secondary to postmenopausal bleeding and can be treated if detected early by surgery to remove the uterus or source of cancer. D is incorrect: cervical cancer, if detected early and treated, can be eliminated. With early treatment, it does not carry a high mortality rate.

When teaching a group of women about screening and early detection of cervical cancer, the nurse would include which of the following as most effective? A) Fecal occult blood test B) CA-125 blood test C) Pap smear and HPV test D) Sigmoidoscopy

The correct response is C. Pap smears are done specifically to detect abnormal cells of the cervix that might be cancerous. A is incorrect: a fecal occult blood test would be useful in detecting blood in the gastrointestinal tract and might be diagnostic of colorectal cancer, not cervical cancer. B is incorrect: this glycoprotein is not specific for cervical cancer, but levels may rise in pancreatic, liver, colon, breast, and lung cancers. D is incorrect: a sigmoidoscopy is used to visualize the sigmoid colon to identify cancer, polyps, or blockages. It is not diagnostic of cervical cancer.

A postmenopausal woman reports that she has started spotting again. Which of the following would the nurse do? A) Instruct the client to keep a menstrual diary for the next few months. B) Tell her not to worry, since this a common but not serious event. C) Have her start warm-water douches to promote healing. D) Anticipate that the doctor will assess her endometrium thickness.

The correct response is D. Any postmenopausal bleeding is suspicious for endometrial cancer. This event warrants immediate evaluation, which would include an endometrial biopsy. A is incorrect: postmenopausal women do not have menstrual periods unless they are taking hormone replacement therapy. B is incorrect: any postmenopausal bleeding is abnormal and needs evaluation to determine its cause. The exception would be for a woman taking hormone replacement therapy and still experiencing monthly cycles. C is incorrect: warm-water douches would not be advised for a woman experiencing postmenopausal bleeding, since it would not be therapeutic or warranted. Determining the etiology of the spotting or bleeding is imperative.