PrepU Sexuality

Monitor for increased adverse effects and toxicity of medications.

A 70-year-old transgender client is taking exogenous sex hormone therapy. What will the nurse include in the care plan for the client?

Vulvar pruritus.

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:

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.

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?

FSH increases during the premenstrual phase. Estrogen decreases, along with LH and progesterone.

Which hormone increases during the premenstrual phase?

Bleeding

Which of the following is the most immediate danger after prostate surgery?

"An antibiotic injection is the best treatment since the lesion has just occurred." An untreated chancre will usually resolve within 2 months, but a generalized infection will occur as the microorganisms spread from the original site. A rash will occur in 2 to 8 weeks after the chancre. A single dose of penicillin G benzathine is the medication of choice for early syphilis.

A 28-year-old sexually active male presented to a clinic because he was concerned about a round, painless sore on the shaft of his penis that had appeared 2 days prior to his visit. The nurse practitioner recognized the lesion as a "chancre," an indicator of primary syphilis. The nurse should tell the patient:

Urethral strictures are more frequent for TURP than for nontransurethral procedures. Urethral strictures are more frequent for TURP than with nontransurethral procedures. TURP rarely causes erectile dysfunction. It requires an overnight stay. There is danger of retrograde ejaculation.

A client is to undergo a TURP for BPH. Which statement is accurate with regard to a TURP?

Genital warts or condylomata are caused by the human papilloma virus (HPV). Herpes virus causes genital herpes. Treponema pallidum is the cause of syphilis. Hemophilus ducreyi bacillus is the cause of chancroid.

A group of students are reviewing class material on sexually transmitted infections in preparation for a test. The students demonstrate understanding of the material when they identify which of the following as the cause of condylomata?

Cryptorchidism Structural abnormalities include cryptorchidism, torsion of the spermatic cord, phimosis, paraphimosis, hydrocele, spermatocele, and varicocele. Erectile dysfunction and priapism are erection disorders. Prostatitis is an infectious disorder.

After teaching a group of student about structural abnormalities of the male reproductive system, the instructor determines that the teaching was successful when the students identify which of the following as an example?

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.

Culture of client's vaginal discharge reveals Gardnerella vaginalis. Which of the following would the nurse expect to assess?

"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.

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?

Hormone therapy decreases the risk of hot flashes. It increases the risk of stroke, heart attack, and blood clots.

Hormone therapy decreases the risk of

Progesterone by the corpus luteum beginning to decrease

In the menstrual cycle, every month the female reproductive system generates an ovum. When the ovum is not fertilized, production of which of the following leads to menstruation?

Use another form of birth control until further notice. It may take up to 10 ejaculations to clear sperm and prevent impregnation. The client should be instructed to use another form of reliable birth control until a sperm count proves sterility has occurred. Use of Tylenol, scrotal support, and rest are all helpful during the initial recovery period.

Following a vasectomy, which is the most important instruction to provide to the client?

"These are normal, manageable symptoms of menopause."

A client reports loss of interest in sexual relations and discomfort during intercourse. Which is the best response by the nurse?

Soy milk Alternative treatments such as natural estrogens found in soy products may be effective in treating hot flashes associated with menopause. Ginkgo biloba is an herbal remedy that may help to treat blood disorders and improve memory. The benefits of drinking bitter gourd tea include possible blood glucose regulation, cancer prevention, and antioxidant protection. Turmeric is used in the treatment of digestive and liver problems.

A 55-year-old client has hypertension. She admits to her physician that she stopped taking her regular medications about 3 months ago and started an alternative, new-age therapy. When the client asks about herbal remedies to treat her hot flashes, which natural estrogen is the physician likely to recommend?

Pap testing every 2 to 3 years After an initial screening, a woman should undergo a Pap test with conventional cervical cytology smears annually with conventional cervical cytology or biennially with liquid-based cytology. At or after age 30, those women who have had three consecutive normal screening tests may be screened every 2 to 3 years unless they have high risk factors for developing cervical cancer.

A 32-year-old woman has had three consecutive normal Pap tests. Which of the following recommendations for screening would be appropriate?

Ibuprofen Prostaglandin inhibitors such as aspirin, ibuprofen, naproxen, and mefenamic acid would be recommended. Acetaminophen (Tylenol) would be the least likely choice. Calcium is a supplement for bone health. Cholecalciferol is a vitamin D supplement used for bone health.

A client comes to the clinic reporting dysmenorrhea and is diagnosed with primary dysmenorrhea. Which medication would the nurse most likely suggest for pain relief?

Do not douche before the procedure

A client is scheduled to undergo a Papanicolaou test. The nurse should advise the client of which preparation?

cryptorchidism Cryptorchidism (failure of one or both testes to descend into the scrotum) appears to play a role in testicular cancer, even when corrected surgically. Other significant history findings for testicular cancer include mumps orchitis, inguinal hernia during childhood, and maternal use of diethylstilbestrol or other estrogen-progestin combinations during pregnancy. Testosterone therapy during childhood, sexually transmitted disease, and early onset of puberty aren't risk factors for testicular cancer.

A client is undergoing a diagnostic workup for suspected testicular cancer. When obtaining the client's history, the nurse checks for known risk factors for this type of cancer. Testicular cancer has been linked to:

"Who is the gestational parent?" The nurse should use inclusive language when completing the home visit with the clients and their newborn. The nurse should ask who the gestational parent is instead of asking who the newborn's mother is. It is important that the nurse use inclusive terms such as grandparents, instead of grandmother or grandfather. Chestfeeding, nursing, or lactation is preferred to the term breastfeeding.

A community health nurse is caring for a lesbian couple with a 3-day-old newborn. When completing a home visit, which question demonstrates the nurse's ability to promote an inclusive environment?

Vagina The vagina is considered an internal female reproductive system structure. The vulva, labia majora, and mons pubis are external structures.

A group of students are reviewing the female reproductive system in preparation for a test. Which of the following if identified by the students as an internal structure indicates successful learning?

Lupron

A health care provider prescribed a luteinizing hormone-releasing hormone (LHRH) agonist to suppress testicular androgen and treat prostate cancer. Which medication is the primary drug of choice?

Hypertension may be a contributing factor because some types of antihypertensive agents can reduce a male's ability to achieve or sustain an erection. A history of lower back pain, sinus infections, or asthma is unrelated to erectile dysfunction.

A nurse is reviewing the history of a client who is experiencing difficulty sustaining an erection. Which of the following might the nurse suspect as a possible contributing factor?

Chronic pelvic pain. Chronic pelvic pain is the most frequent symptom of endometriosis. Low back pain, dyspareunia, dysuria, dyschezia, dysmenorrhea, and menorrhagia are among the common complaints. The level of pain associated with endometriosis is not necessarily correlated with the stage of endometriosis.

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:

fluid retention, low back pain, headache

A patient informs the nurse that she believes she has premenstrual syndrome and is having physical symptoms as well as moodiness. What physical symptoms does the nurse recognize are consistent with PMS? Select all that apply.

For postmenopausal women experiencing dyspareunia (painful intercourse) due to vaginal dryness, the nurse should recommend a water-soluble lubricant (e.g., K-Y Jelly, Astroglide, Replens), hormone cream, or contraceptive foam. Petroleum jelly is not water-soluble. An analgesic, such as ibuprofen or aspirin, would not address the primary problem, which is vaginal dryness.

A postmenopausal patient is experiencing dyspareunia. What methods can the nurse recommend she use to diminish the discomfort?

tissue biopsy A needle biopsy of prostatic tissue is obtained to diagnose a definitive cancer of the prostate. The PSA assay is a blood test that, when elevated, may correspond with prostate cancer. However, an elevated PSA does not always indicate a malignancy; it may indicate benign disease or other factors such as an enlarged prostate gland, older age, prostatitis, recent ejaculation, and other innocuous causes. Cystoscopy involves a cystoscope inserted into the urinary meatus to inspect the bladder, prostate, and urethra. This aids in evaluating the degree of encroachment by the prostate on the urethra. A digital rectal examination is performed to assess the prostate for size as well as evidence of tumor.

A urologist suspects that a client might have prostate cancer. Which test would be used to make a diagnosis of cancer?

Erectile dysfunction may be due to testosterone insufficiency. Common causes of erectile dysfunction include neurologic disorder like spinal cord injury, perineal trauma, testosterone insufficiency, side effects of drug therapy such as antihypertensives or antidepressants, atherosclerosis, hypertension, and complications of diabetes mellitus. Erectile dysfunction may be related to anxiety or depression. It is not a normal aspect of aging.

After teaching a group of students about erectile dysfunction, the instructor determines that the teaching was successful when the students identify which of the following as true?

Trichomonas A Trichomonas species infection is typically malodorous and presents with a copious, often frothy yellow-green appearance. Candida species infections are characterized by either a yeast odor or none, along with a thin to thick, curd-like, white appearance. Eschar and Escherichia coli bacteria are not associated with vaginal discharges.

During an internal vaginal examination, the nurse practitioner notes a frothy and malodorous discharge. What bacteria does the practitioner suspect is causing this disorder?

Luteal In the luteal phase, which begins after ovulation, progesterone is secreted by the corpus luteum. In the proliferative phase, FSH output increases, stimulating estrogen secretion. The secretory phase is near the middle of the cycle, and LH output increases. Premenstrual phase is the phase before menstruation.

During which phase of the menstrual cycle is progesterone secreted by the corpus luteum?

Progesterone by the corpus luteum beginning to decrease If the ovum is not fertilized, the production of progesterone by the corpus luteum begins to decrease and it changes from a yellow to a white spot on the ovary (corpus albicans). Without the high level of progesterone, the endometrium degenerates and sheds, a process referred to as menstruation. The corpus luteum does not produce estrogen. The production of another ovum is not the factor that causes endometrium degeneration. Production of follicle stimulating hormone by the anterior pituitary initiates ovulation.

In the menstrual cycle, every month the female reproductive system generates an ovum. When the ovum is not fertilized, production of which of the following leads to menstruation?

Wound infection with MRSA Gonorrhea and chlamydia are reportable communicable diseases. In any healthcare facility, a mechanism should be in place to ensure that all diagnosed patients are reported to the local public health department to ensure follow-up of the patient. The public health department also is responsible for interviewing the patient to identify sexual contacts so that contact notification and screening can be initiated.

The nurse has received several laboratory studies back at the clinic. Which of these results should be reported to the local health department?

7:00 AM and 8:00 AM The best time of day for the total large corticosteroid dose is in the early morning, between 7:00 AM and 8:00 AM, when the adrenal gland is most active. Therefore, dosage at this time of day will result in the maximum suppression of the adrenal gland.

The nurse is aware that the best time of day for the total large corticosteroid dose is between:

Metrorrhagia Metrorrhagia is vaginal bleeding at a time other than a menstrual period. The amount of blood is not important; the fact that it occurs unexpectedly is significant. Oligomenorrhea is infrequent menses. Menorrhagia is excessive bleeding at the time of normal menstruation. Dysmenorrhea is painful menstruation.

The nurse is gathering data about a client's menstruation. The client reports that she has been experiencing some bleeding that occurs suddenly and without a regular pattern in between her normal menstrual periods. The nurse documents this finding as which of the following?

Vaginal bleeding

The nurse is interviewing a postmenopausal client during an annual gynecologic exam. Which assessment finding presents the greatest concern in the care of this client?

Dyspareunia (difficult or painful intercourse) can be superficial, deep, primary, or secondary and may occur at the beginning of, during, or after intercourse.

The nurse is preparing a patient for a gynecologic examination when the patient says, "I hope the exam doesn't hurt as much as intercourse with my husband does." What should the nurse document this finding as?

Palpate each testicle separately, following a warm shower. It is best to examine and palpate each testicle following a warm shower, when the testes are relaxed and not retracted. Because one testicle is normally larger and hangs lower, comparing the two sides is not indicated. Both testes should be oval in shape, smooth, and firm without masses or tenderness. Most tumors are located on the lateral aspect of the testicles.

The nurse is providing instruction for testicular self-examination to a group of young adolescents. Which is the most correct examination technique?

Mumps at age 15 years Viral mumps infection that occurs after puberty can be the cause of orchitis, which may result in testicular atrophy and sterility. Uncircumcised penis, UTIs, and number of sex partners are not indicated with sterility.

Which of the following nursing assessment findings would be most significant in determining sterility in a male client?

Using a reliable method of contraception for several weeks. It may take several weeks or more after surgery before the ejaculatory fluid is free of sperm, and the client is informed to use a reliable method of contraception until sperm no longer are present. The client should apply ice packs to the scrotum to reduce swelling and use a mild analgesic such as aspirin or acetaminophen for pain relief. The client typically can resume sexual activity when comfortable, usually in 1 week.

Which of the following would be most important to include in a teaching plan for a client who has had a vasectomy?

Escherichia coli Prostatitis is an inflammation of the prostate gland and is most often caused by microorganisms that reach the prostate by way of the urethra. Escherichia coli and microbes that cause sexually transmitted infections often are responsible. Staphylococcus and Streptococcus are not typically a cause of prostatitis. Paramyxovirus is the cause of mumps.

A client who comes to the clinic reporting perineal pain, dysuria, and fever is diagnosed with prostatitis. The nurse understands that which of the following organisms would be the most likely cause?

"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.

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?

Trichomonas vaginalis Bartholinitis, and infection of the greater vestibular gland, may be caused by the following infections: Escherichia coli, Trichomonas vaginalis, Staphylococcus, Streptococcus, and Gonococcus. It is not associated with Candida albicans (which causes candidiasis), Chlamydia, or Gardnerella vaginalis.

A patient is diagnosed with Bartholinitis. What organism does the nurse recognize the patient is most likely infected with?

It grows within the wall of the uterine muscle.

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?

"Many people infected with gonorrhea are infected with chlamydia as well." Treatment for gonorrhea includes the antibiotic ceftriaxone. Because many people with gonorrhea have a coexisting chlamydial infection, doxycycline or azithromycin (Zithromax) is also ordered. There has been an increase in the number of resistant strains of gonorrhea, but that isn't the reason for this dual therapy. This combination of antibiotics doesn't reduce the risk of reinfection or provide a faster cure.

A nurse is caring for a male client with gonorrhea who's receiving ceftriaxone (Rocephin) and doxycycline (Vibramycin). The client asks the nurse why he's receiving two antibiotics. How should the nurse respond?

Use of nitrates PDE5 inhibitors facilitate penile erection by producing smooth muscle relaxation in the corpora cavernosa via vasodilation of the blood vessels. If a client is using nitrates (which also exhibit vasodilation) hypotension is likely to occur. History of hypertension and diabetes does not interfere with the administration of PDE5 inhibitors. Use of diuretics is not significant.

The nurse is reviewing a client's medication and health history. Which assessment finding would cause the nurse to question the client's new prescription for the phosphodiesterase inhibitor sildenafil?

Asking the client's permission to discuss sexuality The PLISSIT model of sexual assessment begins with permission and subsequently includes limited information, specific suggestions, and intensive therapy.

The nurse is utilizing the PLISSIT model of sexual health assessment during an interaction with a new client. According to this model, the nurse should begin with what action?

Prevention of wound complications

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?

"I feel like I have more respect and support since the surgery." A client with enhanced human dignity will verbalize feelings of satisfaction related to the level of respect given to them. The client demonstrates reduced anxiety by engaging in social spaces, such as public restrooms, and connecting to larger social networks. The client shows evidence of promoting hope by voicing positive feelings about the future.

The nurse is evaluating expected outcomes for a client with gender dysphoria who recently had a successful phalloplasty. Which statement indicates the client is experiencing feelings of enhanced dignity following the surgery?

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.

Which client has the highest risk of ovarian cancer?

Gonorrhea Gonorrhea must be reported to the public health department. Bacterial vaginitis, genital herpes, and HPV aren't reportable diseases.

A client comes to the outpatient department complaining of vaginal discharge, dysuria, and genital irritation. Suspecting a sexually transmitted disease (STD), the physician orders diagnostic testing of the vaginal discharge. Which STD must be reported to the public health department?

"Is your family supportive of your gender identity?" Depression and anxiety stem from stigma or lack of social support in adolescents with gender dysphoria. The nurse begins by assessing the client's family support and home environment. If it is a source of concern, the family can be referred to a mental health professional to help the family accept and nurture their child. Assessing other forms of social support and referral to a support group is beneficial after assessing the adolescent's home environment. Hormone therapy would not be recommended as a strategy to address the potential sources for the client's depression.

An adolescent presents with signs of depression to a local clinic. On assessment, the nurse finds the client is diagnosed with gender dysphoria. Which question will the nurse ask first?

assess the client's gender identity Health care professionals should never assume a person's sexual orientation or gender identity based on physical characteristics, mannerisms, communication style, voice, clothing, or hairstyle. The nurse has failed to assess the client's gender identity and should ask the client directly. The nurse should assess for the client's use of preferred pronouns after assessing for gender identity. Assessing for sexual orientation involves asking the client regarding romantic, emotional, or sexual attraction to persons of the opposite gender, the same gender, or to both or more than one gender. Assessing the client's sex includes physical and biological characteristics that distinguish men and women such as chromosomes, genitals, and hormones.

A client is admitted to the emergency room. The nurse completing the client's health history looks at the client and indicates that the client is "female" on the chart. What has the nurse failed to do in this situation?

The nurse is most accurate to prepare for a cesarean section because the mother has an active lesion and does not want to transmit the virus to the newborn. Antibiotic therapy, at this time, does not prevent the transmission of the infection. A full assessment is always completed on the newborn and is not an adjustment in the plan of care. Antibacterial ointment is not placed on the mother's lesions.

The nurse is working in the labor and delivery suite when a client with active herpes simplex virus type 2 (HSV-2) appears in active labor. Which adjustment in the plan of care will the nurse prepare for?

The client will have areolar mounds. There are five stages to breast development according to the Tanner staging system. Stage 4 results in areolar mounds in the breast area. Stage 1 is prepubertal (no development), stage 2 is a breast bud, stage 3 is breast elevation, stage 4 results in an areolar mound, and stage 5 demonstrates an adult contour of the breast.

The nurse notes that the health care provider has staged a client's breast development at stage 4 of the Tanner's staging system for a female transgender client taking estrogen therapy. What should the nurse expect to find on assessment of the client?

Ovulation

A nurse is conducting a health education class for a group of 12- to 14-year-old girls and describing the events of secretory phase. Which of the following would the nurse include?

You will have the dilator in situ for 5 days after the surgery. The vaginal dilator stays in situ for the first 5 postoperative days, while the client receives low-molecular-weight heparin. The client is taught to postoperatively dilate and cleanse the neovaginal cavity for a period of 3 to 6 months. If the client is having regular penile-vaginal intercourse, the client can stop using the vaginal dilator once the client is 6 months postoperative. The client will continue to use the vaginal dilator regularly, if the client is not having penile-vaginal intercourse.

The nurse is teaching a client how to use a vaginal dilator after a vaginoplasty. What teaching will the nurse provide?

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.

A client who had intracavity radiation treatment for cervical cancer 1 month earlier reports small amounts of vaginal bleeding. This finding most likely represents:

Progesterone Without a high level of progesterone, the endometrium (uterine lining) degenerates and shreds. Estrogen is a hormone that is essential for menstruation and prepares the uterus for pregnancy. Women produce testosterone, which maintains muscle mass, bone strength, and sex drive. Prolactin is produced by the pituitary gland and stimulates lactation.

A client presents with symptoms of menstrual difficulties and infertility. Which hormone is essential in the maintenance of the endometrium?

Increased labial thickness

Nursing students are reviewing information about the age-related changes in the reproductive system and their effects. The students demonstrate a need for additional study when they identify which of the following as an expected change?

After exposure during delivery Mother-to-child transmission of HIV-1 may occur in utero or through breastfeeding, but most perinatal infections are thought to occur after exposure during delivery.

When do most perinatal HIV infections occur?

Medication use Certain medications such as antihypertensive drugs, antidepressants, narcotics, etc. can cause sexual dysfunction in men. Impotence is not a normal part of aging. Undescended testicle is not indicative of ED. Sexual history is not indicative of ED.

Which nursing assessment finding is most significant in determining the plan of care in a client with erectile dysfunction?

Luteinizing hormone.

The menstrual cycle is dependent on the interplay among a number of hormones. The hormone(s) responsible for stimulation of progesterone is (are):

Spirochetes Direct identification of the spirochete bacteria obtained from the chancre lesion of primary syphilis is used for a positive diagnosis.

To confirm a diagnosis of syphilis, the nurse would identify the gram-negative bacteria, Treponema palladium, on the laboratory report. The nurse knows that this bacteria is classified among:

"Keep your scrotum elevated on a folded towel until the swelling goes down." The scrotum is elevated with a folded towel, four tail bandage, or adhesive tape across the upper thighs to relieve pain by lessening the weight of the testes. Ice is applied under the scrotum not on top or leaning against it. Sexual intercourse is to be avoided until symptoms are relieved. Antibiotics are typically prescribed as part of the initial treatment, not when the client develops a fever.

A client diagnosed with epididymitis is being discharged from the emergency department. Which of the following would be most important for the nurse to include as part of the client's discharge teaching?

placement of small amounts of collagen in urethral walls to aid the closing pressure. Periurethral bulking is the placement of small amounts of collagen in urethral walls to aid the closing pressure. Bladder augmentation is a procedure that increases storage capacity of the bladder. Implantation of an artificial sphincter that can be inflated to prevent urine loss and deflated to allow urination is one type of surgery done to improve urinary control. Anterior repair is a procedure that increases support to the bladder by tightening the vaginal wall under the urethra.

A client is going to have a surgical procedure called a periurethral bulking to improve urinary control. Periurethral bulking is:

It can take 2 to 6 months for your menses to stop. Cessation of menses should occur within 2 to 6 months for a client taking masculinizing hormone therapy. Androgen therapy will suppress menses even if the client has ovaries and a uterus. Androgen therapy will cause vaginal atrophy and cessation of menses. It takes 2 to 6 months, not 3 weeks, for menses to cease during masculinizing hormone therapy.

A client is taking masculinizing hormone therapy. What education will the nurse provide regarding masculinizing hormone therapy and the cessation of menses?

Prepare to administer subcutaneous epinephrine and corticosteroids. The use of accessory muscles to maximize airflow is often manifested by retractions in the neck during inspiration and is an ominous sign of impending respiratory distress. The client's obstruction is caused by edema resulting from an allergic reaction, and treatment should include immediate administration of subcutaneous epinephrine and a corticosteroid. The other interventions may be indicated for a client with a laryngeal obstruction; however, in this instance the most appropriate intervention to treat the client's laryngeal edema is the administration of the medications.

A client presents to the ED with a suspected allergic reaction. The client is experiencing laryngeal edema, which is causing obstruction, and is demonstrating retractions in the neck during inspiration. Which is the nurse's priority intervention?

"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 reports loss of interest in sexual relations and discomfort during intercourse. Which is the best response by the nurse?

Offer information on human immunodeficiency virus (HIV) testing. In women, gynecologic problems may be the focus of the chief complaint for clients who are HIV positive but not yet diagnosed. Abnormal results of Papanicolaou tests, genital warts, pelvic inflammatory disease, and persistent vaginitis may also correlate with HIV infection. Based on this information, the priority nursing action is to offer information on HIV testing to the client. Although recommending abstinence or safer-sex practices, providing a prescribed topical antifungal agent to treat the client's vaginal infection, and referring to a support group may be appropriate, the priority is to determine the source of the client's symptoms.

A female client comes to the clinic and tells the nurse, "I think I have another vaginal infection and I also have some wart-like lesions on my vagina. This is happening quite often." Which nursing action is the priority for this client?

"How do you describe your sexual orientation?" Clients will not reveal their sexual orientation if they perceive criticism, fear or disgust on the part of care providers. It is important for the nurse to take a sexual history in a nonjudgmental manner and ask open-ended questions. Asking a client to describe their sexual orientation is an open-ended question that avoids placing sexuality in binary categories (such as being attracted to men or women). When the nurse is questioning about the client's sexual health and sexual orientation, it is better to ask an open-ended question than to ask about the client's relationship status as the starting point. The nurse should first assess the client's sexual orientation and behavior before asking specific questions regarding HIV or sexually transmitted infections.

A nurse is a completing health history for a transgender man. Which question is appropriate to ask the client first?

"I should do this exam at least once a week." Testicular self-examination is performed monthly, preferably when warm, such as in the shower. The client should place his thumb on top and his middle and index fingers under the testis. It is normal for one testis to be larger than the other.

A nurse is instructing a client in testicular self-examination. Which client statement indicates the need for additional teaching?

Age of first ejaculate would most likely not be asked. Premature ejaculation or other concerns of a sexual nature, pain during sexual intercourse, and contraceptive practices would most likely be included in the health history.

A nurse is obtaining a male client's health history before performing a physical examination. Which information would most likely not be obtained?

Sexual desire typically becomes progressively less.

A nurse is preparing a health promotion class for a group of seniors at a local community center. As one part of the presentation, the nurse is planning to address sexuality and sexual function. Which statement would be least appropriate to include?

The risk of acquiring HIV through the transfusion of blood products is almost nonexistent. The amount of HIV contained in body fluids on exposure is associated with the risk for infection. HIV can be found in seminal fluid, vaginal secretions, and breast milk. Sharing of infected equipment used to inject drugs increases the risk for infection.

A nurse is preparing a presentation about human immunodeficiency virus (HIV) for a local community group. What would the nurse include in the presentation about HIV transmission? Select all that apply.

Testicular cancer is more common in older men.

A nurse is teaching a male client to perform monthly testicular self-examinations. Which point is appropriate to make?

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 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:

Trichomonas vaginalis The most effective treatment for trichomoniasis is metronidazole or tinidazole (Tindamax). Both partners receive a one-time loading dose or a smaller dose three times a day for 1 week (CDC, 2010a).

A patient has been diagnosed with a vaginal infection and received a prescription for metronidazole (Flagyl). The nurse knows that this is the recommended treatment for a vaginal infection caused by what organism?

Prostate biopsy If prostate cancer is detected early, the likelihood of cure is high (Eggert, 2010). It can be diagnosed through an abnormal finding with the digital rectal examination (DRE), serum prostate-specific antigen (PSA), and ultrasound-guided transrectal ultrasound (TRUS) with biopsy. Detection is more likely with the use of combined diagnostic procedures. The diagnosis of prostate cancer is confirmed by a histologic examination of tissue removed surgically by transurethral resection of the prostate (TURP), open prostatectomy, or ultrasound-guided transrectal needle biopsy.

A patient is suspected to have prostate cancer related to observed clinical symptoms. What definitive test can the nurse assist with to confirm a diagnosis of prostate cancer?

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 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?

In retroflexion, the uterus bends posteriorly, as shown in option B. In retroversion, the uterus turns posteriorly as a whole unit, as shown in option A. In anteversion, the uterus tilts forward as a whole unit, as shown in option C. In anteflexion, the uterus bends anteriorly, as shown in option D.

A pelvic examination reveals that a woman's uterus is retroflexed. Which of the following best depicts this position?

Pelvic infection Pain on gentle movement of the cervix is called a positive chandelier sign or positive cervical motion tenderness and usually indicates a pelvic infection.

A positive chandelier sign is indicative of which of the following?

Gynecologic problems In women with HIV, gynecologic problems, such as abnormal results of Papanicolaou tests, genital warts, pelvic inflammatory disease, and persistent vaginitis may be the focus of a majority of complaints. Acute retroviral syndrome (viremia) may be the chief complaint in one third to more than one half of those infected, not necessarily women. Its manifestations include rashes, muscle and joint pain, and weight loss.

A woman infected with HIV comes into the clinic. What symptoms may be the focus of a medical complaint in women infected with HIV?

Bartholin glands. The Bartholin glands are two bean-sized glands on either side of the entrance to the vagina that secrete fluid into the vaginal area. They can become blocked (cyst formation) or infected (abscess formation). Treatment is different for each, but pain is common with both. Pain can interfere with sitting and walking. A culture is necessary to diagnose the bacteria causing an abscess.

A woman visits her primary health care provider with a complaint of pain and swelling in the vaginal area. The pain is present when she sits and walks; intercourse is painful. The nurse prepares the patient for an examination. The nurse and health care provider suspect that the patient may have an inflammation or infection of the:

Keep the client NPO. With torsion of the spermatic cord, immediate surgery is necessary to prevent atrophy of the cord and preserve fertility. The client should be placed on NPO status in preparation for surgery. Elevating the scrotum intensifies the pain by increasing the degree of twist. Analgesics are prescribed preoperatively to control pain. Cardiac changes are not indicated unless client history warrants assessment.

A young client is admitted with torsion of the spermatic cord. Which is the most appropriate action to be taken by the nurse?

"I will avoid having sexual relations until I see the doctor again." Cone biopsy is a procedure done to remove abnormal cervical tissue. The nurse or primary provider provides guidelines regarding postoperative sexual activity, bathing, and other activities. Because open tissue may be potentially exposed to HIV and other pathogens, the client is cautioned to avoid intercourse until healing is complete and verified at follow-up. Routine repeat cone biopsy is not normally indicated. Perineorrhaphy refers to sutural repair of perineal lacerations; sutures are not required with a cone biopsy. Cryotherapy refers to destruction of tissue by freezing; no freezing is involved with a cone biopsy.

Cone biopsy describes a procedure in which cervical tissue is removed as result of detection of abnormal cells. Which statements by the client demonstrates that the client undergoing a cone biopsy understands the discharge instructions?

Candida Trichomonas bacteria cause a copious and often frothy yellow-green colored discharge that is malodorous. A yeast infection doesn't have an odor but bacterial vaginosis is fishy in smell. Refer to Table 32-5 in the text.

During an internal vaginal examination, the nurse practitioner notes a frothy and malodorous discharge. The nurse suspects the odor is caused by which bacteria?

Progesterone The corpus luteum produces progesterone for 12 to 16 days during the cycle. If fertilization happens, progesterone will continue to be secreted.

Ovulation occurs midway between days 17 and 22 (usually at day 14) in a normal 28-day menstrual cycle. Conception occurs during ovulation. If an egg is fertilized, this hormone will continue to be produced to protect the egg until the placenta takes over. Which of the following is the correct hormone?

Syphilis is manifested by a painless chancres or ulcerated lesions. Psoriasis is exhibited by plaques with scales. Kaposi sarcoma are cutaneous lesions that are blue-red or dark brown in color. Urticaria is wheals or hives due to infection or allergic reactions.

Painless chancres or ulcerated lesions are associated with which systemic disease?

Family history of breast cancer

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?

Finasteride (Proscar)

The client with benign prostatic hyperplasia (BPH) is considering use of medication in the management of symptoms. Which of the following drugs reduces the size of the prostate without lowering circulating levels of testosterone?

Consistently uses condoms with sexual activity Consistent use of condoms for sexual activity indicates that the client has knowledge of the disorder and its transmission, thereby taking steps to reduce the risk of transmission. This action supports achievement of the outcome. Sexual activity even when lesions are not present can still lead to transmission of the infection. Lesions should be cleaned with mild soap and water and patted dry; occlusive ointments, powders, or dressings should be avoided because they do not allow the lesions to dry.

The following outcome appears on the plan of care for a client with genital herpes: "Client demonstrates knowledge about measures to reduce the risk of transmission and recurrences." Which of the following, if reported by the client, would support achievement of this outcome?

Luteinizing hormone. The female pituitary gland releases follicle-stimulating (FSH) and luteinizing hormone (LH). Progesterone production and the release of mature eggs is dependent on luteinizing hormone.

The menstrual cycle is dependent on the interplay among a number of hormones. The hormone(s) responsible for stimulation of progesterone is (are):

Leukorrhea 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.

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?

"After the surgery you will be on bed rest for 5 days, and in hospital for 2 weeks." Anticipatory guidance helps the client to understand what to expect during the surgery and postoperatively. An example would include outlining periods for bed rest and overall hospital stay. The purpose of this approach is to ensure that client understands each step of the process in advance. Affirming health data (e.g., taking hormone therapy), providing vague statements (e.g., expecting significant changes to their life after surgery), and reflecting on readiness for the surgery are not related to the nursing skill of providing anticipatory guidance prior to a surgical procedure.

The nurse is completing anticipatory guidance for a transgender female client preparing for a vaginoplasty. Which statement reflects this approach?

"Your partner could have been asymptomatic at that time." The nurse is most correct to support the client and provide information on how the infection could have been spread. It is true that the client's partner could have been asymptomatic during their sexual contact. The nurse should not be judgmental or accusing in nature as in the other responses.

The nurse is counseling a client who has been diagnosed with two sexually transmitted infections. The client is shocked and states not knowing how this has happened. Which of the following statements is most appropriate by the nurse?

A condom does not need to be used during sexual activity if the disease is dormant.

The nurse is instructing a client with herpes simplex virus type 2 (HSV-2) about self-care and precautions. Which instruction would not be included in this client education session?

Every 4 to 6 hours

The nurse is providing teaching to a group of older adolescent girls about menstruation and the use of tampons. The nurse would instruct the girls to change tampons at which frequency?

The effect of the vaccination is optimized if it is administered before the child becomes sexually active. The nurse should advise the parents that the vaccination should ideally be administered before the onset of sexual activity, to prevent genital warts. The vaccination is available and effective when administered to both men and women. The HPV vaccination does not preclude women from having regular cervical cancer screening in the future. A Pap smear prior to the administration of the vaccination is not required, particularly for those woman who are not yet sexually active.

The school health nurse is conducting a teaching session for parents to provide information about the human papillomavirus (HPV) vaccination. What prevention information should the nurse include in the session?

intersex The term intersex is used to describe a person who is born with biological traits that do not fit into male or female characterizations of sex characteristics. Cisgender is a term for people who identify with the gender that matches the sex assigned to them at birth. Transgender is an umbrella term used to describe the full range of people whose gender identity does not match with the sex assigned to them at birth. Queer identifies people who are romantically, emotionally, or sexually attracted to numerous genders or people who identify as nonheterosexual but do not want to use labels, such as gay, lesbian, or bisexual.

Which term is used to describe a person who is born with biological traits that are not characterized as either male or female?