Ch. 57: Mgmt of Pts w/ Female Reproductive Disorders

The nurse is obtaining the history from a client who is suspected of having pelvic inflammatory disease (PID). Which client statement would help support the suspicion of PID? "My partner and I use condoms during sexual intercourse." "I was 15 years old when I first had sex." "I've never had any sexually transmitted infection." "I haven't had sex with anyone else except my current partner."

"I was 15 years old when I first had sex." Explanation: Risk factors for PID include early age at first intercourse, mutliple sexual partners, frequent intercourse, intercourse without condoms, sex with a partner with a sexually transmitted infection, and a history of sexually transmitted infections or previous pelvic infections. Therefore, the statement about being 15 years old when the client first had sex suggest the presence of a risk factor that would support the suspicion of PID.

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

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

During a routine sports physical examination, the nurse practitioner recommends HPV vaccination for an 11-year-old girl. Which statements by the client's mother demonstrates understanding of HPV vaccinations? "This vaccination is not indicated for my son, since boys cannot receive the HPV vaccine." "If my daughter is immunized against HPV, she can delay her first scheduled Pap test." "I will track follow-up appointments in my smartphone so she receives all three injections." "It's nice that she can take this vaccination intranasally, to avoid repeated injections."

"I will track follow-up appointments in my smartphone so she receives all three injections." Explanation: The Centers for Disease Control and Prevention recommends routine vaccination of boys and girls 11-12 years of age, before they become sexually active. The vaccination is administered in three intramuscular doses, with the initial dose followed by a second dose in 2 months and a third dose 6 months after the first dose. Completion of all three doses of the vaccine is important for immunity to develop; it does not replace other strategies important in the prevention of HPV. Women still need recommended cervical cancer screening.

A client is admitted for intracavitary radiation as treatment for her reproductive tract cancer. Which client statement demonstrates to the nurse that the client understands the planned procedure? "I'm going to have a catheter inserted to drain my urine so I don't need to get out of bed to go to the bathroom." "I can sit at the side of my bed but I can't get out of the bed to walk around." "I'll be taken to a special x-ray room where a machine will direct the radiation to my abdomen." "While I'm in surgery, the doctors will focus the radiation directly on the area to kill the cells."

"I'm going to have a catheter inserted to drain my urine so I don't need to get out of bed to go to the bathroom." Explanation: Intracavitary irradiation involves the insertion of specially prepared applicators that are loaded with radioactive material into the endometrial cavity and vagina. The client must be isolated in a private room and remain in bed. A urinary catheter is inserted to allow for urinary elimination. External radiation therapy involves a machine that directs radiation to the specified area. Intraoperative radiation involves radiation applied directly to the affected area during surgery.

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

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

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

"My partner will not need any treatment." Explanation: Trichomoniasis is treated with metronidazole. Both partners are treated and receive a one-time loading dose or smaller dose three times a day for a week. The client may experience a transient metallic taste when taking the drug. Client are strongly advised to abstain from alcohol when taking metronidazole because of a possible disulfiram-like reaction.

A client undergoing treatment for vaginitis is also counseled about measures to prevent its recurrence. Which statement by the client best indicates effective counseling? "My sexual partner will also need to be treated." "I will insert a vaginal suppository after intercourse." "I will void immediately after intercourse." "I will always douche immediately after intercourse."

"My sexual partner will also need to be treated." Explanation: Vaginitis is a condition in which the vagina is inflamed. If not already infected, the sexual partner may contract the infection from the client. If both are not treated simultaneously, the infection will pass back and forth. Antiprotozoal vaginal suppositories should be used at regular intervals, rather than only after intercourse. Voiding will not prevent the recurrence of vaginitis. Frequent douching predisposes the client to vaginitis.

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? "Symptoms of endometriosis are increased during normal menstrual cycle." "Contraceptives will allow blood to be diverted to the peritoneal cavity." "Trapping blood causes less pain or discomfort for clients with endometriosis." "Endometriosis is usually cured with surgical menopause."

"Symptoms of endometriosis are increased during normal menstrual cycle." Explanation: 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.

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

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

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

"These are normal, manageable symptoms of menopause." Explanation: 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.

Which statement by the nurse demonstrates effective communication techniques when initiating a discussion about sex with a 25-year-old female client? "Have you had sex with more than one partner?" "Why didn't you start receiving annual Pap tests at an earlier age?" "Do you know how to properly apply a male condom?" "What questions do you have related to your sexual health?"

"What questions do you have related to your sexual health?" Explanation: Therapeutic communication techniques include a nonjudgmental attitude, use of open-ended questions, and allowing the client to lead the discussion. Educational counseling and role playing may be helpful. "Why" statements immediately place the client in a defensive position that may block communication.

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

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

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

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

A client is being seen at the local community-based clinic where you practice nursing. Her healthcare provider has diagnosed the client with candidiasis and prescribed clotrimazole cream once daily for 7 days. You are providing education on how to administer the prescribed treatment. Which of the following techniques will the client use to administer this medication? Administer cream at bedtime high into vaginal canal. Administer cream in the morning or after daily shower at the opening of vaginal canal. Administer cream outside of vagina once daily at bedtime. Administer cream three times daily high into vaginal canal.

Administer cream at bedtime high into vaginal canal. Explanation: Administer cream or vaginal tablets high into vaginal canal; instruct client to remain recumbent for 10 to 15 minutes or administer at bedtime. Vaginal cream is administered high into vaginal canal; instruct client to remain recumbent for 10 to 15 minutes or administer at bedtime.

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

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

During consultations with the oncologist, a client with cervical cancer is informed that radioactive materials will be inserted in the area of the tumor. She has to undergo these sessions over a period of 3 weeks. Which method of cancer treatment is being described? Antineoplastic therapy Chemotherapy Brachytherapy Needle aspiration biopsy

Brachytherapy Explanation: Internal radiation, or brachytherapy, delivers a dose of radiation to a localized area inside the body through the use of an implant. The implant may be applied by a needle, seed, bead, or catheter, or can be given orally. Antineoplastic agents used in chemotherapy interfere with the cellular function of the cancer cells and cause cell death. Needle aspiration biopsy involves aspirating tissue fragments through a needle guided into the cancer cells.

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

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

Over the past 2 months, a client has been receiving treatment for multiple ear infections and tonsillitis. The client reports a curdy white vaginal discharge and burning with urination. What is the most likely cause of these symptoms? Candida albicans Trichomonas vaginalis Gardnerella vaginalis None of the options is correct.

Candida albicans Explanation: Candida albicans presents with a thick, curdy white discharge, accompanied by a strong odor and burning with urination. Trichomonas vaginalis presents with a foamy, yellow-white discharge, accompanied by a foul odor and severe itching. Gardnerella vaginalis presents with a watery, gray-white discharge, accompanied by a fishy odor and more discharge after intercourse.

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

Candidiasis Explanation: The discharge of candidiasis may be watery or thick, but has a white, cheeselike appearance. The other disorders do not have a cheeselike appearance.

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

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

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

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

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: Dysuria. Low back pain. Chronic pelvic pain. Dyspareunia.

Chronic pelvic pain. Explanation: 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.

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

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

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

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

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

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

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

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

Which assessment finding will most likely influence the treatment regimen selected by a client with endometriosis? Presence of pain Family planning Dysmenorrhea Presence of chocolate cyst

Family planning Explanation: Selection of a more conservative option may be indicated to preserve the possibility for future childbearing. Pain, dysmenorrhea, and chocolate cysts are all symptoms associated with endometriosis and can influence decision for treatment.

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

Fishy smelling watery discharge Explanation: 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.

A client, age 42, visits the gynecologist. After examining the client, the physician suspects cervical cancer. The nurse reviews the client's history for risk factors for this disease. Which history finding is a risk factor for cervical cancer? Onset of sporadic sexual activity at age 17 Spontaneous abortion at age 19 Pregnancy complicated with eclampsia at age 27 Human papillomavirus infection at age 32

Human papillomavirus infection at age 32 Explanation: Like other viral and bacterial venereal infections, human papillomavirus is a risk factor for cervical cancer. Other risk factors for this disease include frequent sexual intercourse before age 20, multiple sex partners, and multiple pregnancies. A spontaneous abortion and pregnancy complicated by eclampsia aren't risk factors for cervical cancer.

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? Chronic pelvic inflammatory disease Infertility Pelvic pain Ascending infection

Infertility Explanation: 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 patient is taking oral danazol (Danocrine), 800 mg/day, for 9 months for the treatment of endometriosis. How does the nurse describe this medication to the patient? It is a gonadotropin that decreases ovarian and pituitary stimulations. It is an antigonadotropin that increases pituitary stimulation and decreases ovarian stimulation. It is a gonadotropin that decreases pituitary stimulation and increases ovarian stimulation. It is an antigonadotropin that decreases pituitary and ovarian stimulations.

It is an antigonadotropin that decreases pituitary and ovarian stimulations. Explanation: A synthetic androgen, danazol (Danocrine), causes atrophy of the endometrium and subsequent amenorrhea. The medication inhibits the release of gonadotropin with minimal overt sex hormone stimulation.

A woman comes to the emergency department reporting vaginal discharge and pelvic pain that increases with urination. The client also reports nausea and vomiting, headache, and anorexia. A pelvic examination reveals cervical motion tenderness. The client is diagnosed with acute pelvic inflammatory disease (PID) and is admitted. Which of the following would be most appropriate to include in this client's plan of care? Applying cool compresses to the abdomen Instituting airborne infection control precautions Maintaining bedrest in the semi-Fowler's position Inserting an indwelling urinary (Foley) catheter

Maintaining bedrest in the semi-Fowler's position Explanation: The hospitalized client with pelvic inflammatory disease (PID) is maintained on bed rest and is placed in the semi-Fowler's position to facilitate dependent drainage. Heat may be applied to the abdomen to provide comfort and pain relief. Standard precuations are followed to minimize the risk of infection transmission. PID most commonly results from sexual transmission. An indwelling urinary catheter typically is not necessary unless the client's infection is severe and urinary output must be monitored closely and frequently.

On a visit to the gynecologist, a client complains of urinary frequency, pelvic discomfort, and weight loss. After a complete physical examination, blood studies, and a pelvic examination with a Papanicolaou test, the physician diagnoses stage IV ovarian cancer. The nurse expects to prepare the client for which initial treatment? Radiation therapy Major surgery Chemotherapy None (At this advanced stage, ovarian cancer isn't treatable.)

Major surgery Explanation: Ovarian cancer usually requires aggressive treatment — initially, surgery. The client will require a total abdominal hysterectomy and bilateral salpingo-oophorectomy with tumor resection, omentectomy, appendectomy, and lymphadenectomy. Radiation therapy is palliative for a client in this advanced stage of the disease. Chemotherapy also is largely palliative during this stage; however, prolonged remissions have been achieved in some clients.

Typical clinical manifestations of bacterial vaginosis (BV) include which of the following? Malodorous, gray vaginal discharge Frothy, white vaginal discharge Thick, white adherent discharge Yellow vaginal discharge

Malodorous, gray vaginal discharge Explanation: BV has a characteristic gray vaginal discharge with a "fishy" odor.

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

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

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

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

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

Metronidazole Explanation: The most effective treatment for trichomoniasis is metronidazole. Miconazole, clindamycin, and clotrimazole are not the most effective treatment for trichomoniasis.

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

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

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

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

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? Relieving edema to lower extremities Alterations for sexual function Prevention of wound complications Care of colostomy site

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

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

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

A patient has had a pessary inserted for long-term treatment of a prolapsed uterus. As part of the teaching plan, what should the nurse advise the patient to do? See her gynecologist to remove and clean the pessary at regular intervals. Keep the insertion site clean and dry. Avoid sexual intercourse. Avoid climbing stairs as much as possible.

See her gynecologist to remove and clean the pessary at regular intervals. Explanation: A pessary can be used to avoid surgery (Lone, Thakar, Sultan, et al., 2011). This device is inserted into the vagina and positioned to keep an organ, such as the bladder, uterus, or intestine, properly aligned when a cystocele, rectocele, or prolapse has occurred. Pessaries are usually ring- or doughnut shaped and are made of various materials, such as rubber or plastic (Fig. 57-4). Rubber pessaries must be avoided in women with latex allergy. The size and type of pessary are selected and fitted by a gynecologic health care provider. The patient should have the pessary removed, examined, and cleaned by her health care provider at prescribed intervals.

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

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

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

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

Which of the following is an expected outcome for a client 24 hours after an abdominal hysterectomy? Bowel sounds will be heard on auscultation. The perineal pad will have a minimal amount of serous drainage. The client will express feelings of a positive body image. The client will perform leg exercises hourly.

The client will perform leg exercises hourly. Explanation: During the first 24 hours after an abdominal hysterectomy, the client is at risk for development of thrombophlebitis because of potential interference with pelvic and leg circulation. Leg exercises are essential to promote circulation and prevent a thrombus. Bowel sounds may not be heard immediately after surgery. It may take up to 48 hours for peristalsis to return. Perineal pads are used after a vaginal hysterectomy, not an abdominal hysterectomy. In the early phases of recovery, the client will be more likely to focus on expressing feelings of discomfort rather than a positive body image.

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

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

A patient diagnosed with endometriosis asks for an explanation of the disease. What should the nurse explain to the patient? She has developed an infection in the lining of her uterus. Tissue from the lining of the uterus has implanted in areas outside the uterus. The lining of the uterus is thicker than usual, causing heavy bleeding and cramping. The lining of the uterus is too thin because endometrial tissue has implanted outside the uterus.

Tissue from the lining of the uterus has implanted in areas outside the uterus. Explanation: Endometriosis is a chronic disease affecting between 6% and 10% of women of reproductive age (Falcone & Lebovic, 2011) and consisting of a benign lesion or lesions that contain endometrial tissue (similar to that lining the uterus) found in the pelvic cavity outside the uterus.

A patient who is diagnosed as having endometriosis asks for an explanation of the disease. What is the nurse's best response? She has developed an infection in the lining of her uterus. Tissue similar to the lining of the uterus has implanted in areas outside the uterus. The lining of the uterus is thicker than usual, causing heavy bleeding and cramping. The lining of the uterus is too thin because endometrial tissue has implanted outside the uterus.

Tissue similar to the lining of the uterus has implanted in areas outside the uterus. Explanation: A benign lesion with cells similar to those lining the uterus grows aberrantly anywhere in the pelvic cavity outside the uterus.

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

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

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

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

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

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

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

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

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

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

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

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

Over the past 2 months, a client has been receiving treatment for multiple ear infections and tonsillitis. The client reports vaginal discharge and itching. What is likely the cause of the client's vaginitis? antibiotics infrequent douching regulated diabetes increased estrogen

antibiotics Explanation: When antibiotics are taken for a long time or repeated courses of antibiotic therapy are necessary, an overgrowth of yeastlike fungi that usually exists in small numbers in the vagina can occur, resulting in vaginitis. Antibiotics or frequent douching eliminate the bacilli that promote an acidic vaginal environment, which can lead to vaginitis. Unregulated diabetes causes an excess of glycogen in vaginal mucus, which supports the growth of microorganisms, which can lead to vaginitis. Decreased estrogen at menopause reduces the thick, moist consistency of vaginal tissue which can lead to vaginitis.

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

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

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

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

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

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

A 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: see her gynecologist to remove and clean the pessary at regular intervals. keep the insertion site clean and dry. avoid sexual intercourse. avoid climbing stairs as much as possible.

see her gynecologist to remove and clean the pessary at regular intervals. Explanation: 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.