Chapter 51, Care of the Patient with a Reproductive Disorder

A nurse is caring for a patient who reports that she has premenstrual syndrome (PMS). Which statement would be most useful to the patient?

"Some research suggests that a diet high in complex carbohydrates, moderate in protein, and low in refined sugar and sodium may help ease the symptoms." Research suggests that a diet high in complex carbohydrates, moderate in protein, and low in refined sugar and sodium may help ease the symptoms of PMS. In addition, a health care provider may prescribe supplements of vitamin B6, calcium, and magnesium. Telling the patient to try a hot water bottle suggests the nurse has confused PMS with dysmenorrhea, because this response is a common remedy that might be tried for the pain of dysmenorrhea. Telling the patient to count pads suggests the nurse has confused PMS with abnormal uterine bleeding. Tampon and pad counts are an important way of quantifying the amount of bleeding a woman is having with her menstrual period. Research suggests that alcohol, caffeine, chocolate, and smoking should be reduced or eliminated in women with PMS. In addition, adequate rest, sleep, and relaxation are helpful.

The student nurse is caring for a patient with prostatitis. Which statement made by the student nurse indicates the need for further teaching?

"You should sleep in the supine position." Prostatitis refers to an inflammation or infection in the prostate gland. The nurse should adjust the patient to whichever position is comfortable; however, the supine position is usually the most painful position. The nurse should encourage the patient to express feelings to reduce fear and increase their self-esteem. Analgesics are prescribed for pain, and should be regularly administered. The nurse should provide a diversional activity, such as listening to music, to help relax the patient.

A nurse is caring for a patient with toxic shock syndrome (TSS). She has a temperature of 102.5° F and complains of feeling "awful." Which nursing intervention should receive the highest priority?

Administering the antibiotics on time. Administering the antibiotics on time is the top priority nursing intervention of those listed. TSS is an acute bacterial infection caused by Staphylococcus aureus. It can be quite serious—even fatal. Therefore, administering antibiotics on time is of paramount importance to rid the body of the bacterial infection and achieve the best possible patient outcome. Bed rest is an important nursing intervention, and because of a fever, this patient will most likely not ask to get out of bed anyway; however, of the four interventions, it is not the highest priority. Teaching the patient to change tampons every 4 hours is an important nursing intervention; however, of the four interventions, it is not the highest priority. The patient with TSS is likely to be more receptive to patient teaching after the infection is under better control and she is feeling better. Providing a quiet, therapeutic environment is an important nursing intervention; however, from a physiologic standpoint, it is not the highest priority.

What instructions should the nurse give to a patient with vesicovaginal fistula? Select all that apply.

Change perineal pads frequently. Cleanse the perineum every 4 hours. The nurse's role in the management of a fistula is to keep the perineum clean and hygienic. Hence, perineal pads should be changed frequently, and the perineum should be cleansed every 4 hours. Chances of inflammation and edema are reduced if the perineum is kept clean. The patient should be encouraged to maintain an adequate fluid intake. Warm sitz baths should be given three times daily. Kegel exercises are done to strengthen the pelvic muscles and therefore, do not affect vesicovaginal fistula.

A patient with menorrhagia is concerned about the condition. When explaining menorrhagia to the patient to alleviate anxiety, what information should the nurse include? Select all that apply.

Daily menstrual bleeding is in excess of 80 mL for 3-5 days. Uterine fibroid and endometrial polyps are commonly associated with menorrhagia. Menstrual bleeding lasts for more than 7 days, and menstrual loss is less than 80 mL per day. Menorrhagia is either excessive menstrual blood loss, that is, more than 80 mL per day for 3-5 days or menstrual bleeding for more than 7 days with a menstrual loss of less than 80 mL per day. Uterine fibroids and endometrial polyps are commonly associated with menorrhagia. Anovulatory cycles are commonly associated with menorrhagia. Unopposed action of estrogen on the endometrium is responsible for menorrhagia.

The nurse is caring for a patient who underwent a hysterectomy. What nursing interventions should the nurse perform to prevent deep vein thrombosis (DVT) in this patient? Select all that apply.

Encourage leg exercises. Frequently change body position. Encouraging leg exercises keep the blood in constant motion and hence reduce the risk of DVT. Frequent changes in body posture prevent stasis and pooling of blood and diminish the risk of thrombosis. Absolute rest, pressure under the knee, and high Fowler's position increase risk of thrombosis by causing stasis and pooling of blood.

The primary health care provider prescribes a colposcopy for a patient. Which is the best nursing intervention?

Ensure that the patient abstains from intercourse 24 hours prior to the test. A colposcopy is a procedure that provides direct visualization of the cervix and the vagina. The nurse should ensure that the patient avoids intercourse 24 hours prior to the procedure; Intercourse reduces the amount of specimens available and may mask abnormal cells. The patient can void prior to the procedure, as this does not interfere with the test results. The patient should not be menstruating at the time of procedure, as it would interfere with the ability to obtain specimens. It is not necessary for the patient to drink large amounts of water prior to this diagnostic test.

The nurse is caring for a patient who has leukorrhea and irregular vaginal bleeding. The patient reports watery vaginal discharge with an offensive odor and severe pain in the back and thighs. Which nursing intervention would provide comfort to the patient?

Ensure that the patient is ambulated from bed. Leukorrhea and irregular vaginal bleeding indicates that the patient may be at risk for cervical cancer. It is characterized by a watery vaginal discharge with an offensive odor and severe pain in the back and thighs. The patient should be ambulated at frequent intervals and not restricted to the bed, which would promote perfusion. The knee-gatch position would reduce perfusion and increase pain and should therefore be avoided. Micturition should be promoted on catheter removal to remove any residual urine. Antiembolism stockings prevent blood clots and promote perfusion. Stockings should be checked at regular intervals.

A patient reports finding hardened areas in the breasts. The patient is scheduled for a fine needle biopsy. As the primary health care provider is aspirating fluid, the nurse observes brown, turbid, nonhemorrhagic fluid. Which condition should the nurse expect to be diagnosed in the patient?

Fibrocystic breast Fibrocystic breast disease is characterized by cyst formation, which is confirmed by biopsy. During the procedure, nonhemorrhagic fluid is observed. Chronic mastitis is characterized by inverted and cracked nipples, and difficulty in feeding. Breast cancer is a malignant condition which is characterized by the presence of lesions or tumors. Acute mastitis is an acute bacterial infection of the breast tissue, caused by streptococci or staphylococcus aureus.

The nurse is counseling a couple who are unable to bear children. What information should the nurse include? Select all that apply.

In certain cases, the cause for infertility may be unidentified. The cause for infertility may occur in either the male or the female. Assisted reproductive technologies (ARTs) can be used to bear children. In some cases, the exact cause for infertility may not be able to be identified. The cause for infertility may occur in either the male or the female; however, in a few cases, the cause for infertility may lie in both the male and the female. If the couple does not conceive in a natural way after trying all methods, the couple can opt for ARTs for conceiving. Tobacco and illicit drug use increase the risk of infertility. Cervicitis may be a cause of infertility; however, it can be treated with appropriate antibiotics.

A nurse is providing education to a patient newly diagnosed with endometriosis who has been prescribed leuprolide (Lupron). Which statement, if made by the patient, indicates an understanding of the treatment of endometriosis?

My symptoms will resume if treatment is stopped for any reason. Leuprolide (Lupron) is effective at treating the symptoms of endometriosis, but symptoms will resume if treatment is stopped. Lupron is not a cure for endometriosis. Although some women who get pregnant do not resume symptoms after pregnancy, this does not happen in every case. Total hysterectomy is not the next option of treatment after Lupron because the majority of symptoms occur as a result of transplanted endometrial tissue in other parts of the body.

When teaching a group of young women about pelvic inflammatory disease (PID), what information should the nurse include? Select all that apply.

PID is associated with a higher risk of ectopic pregnancy. Causative organisms reach the pelvic organs through the cervix in an ascending manner. PID can cause adhesions and strictures in the fallopian tubes to result in ectopic pregnancy. The organisms infecting the cervix ascend higher into the uterus, fallopian tubes, ovaries, and peritoneal cavity to cause PID. Causative organisms very rarely reach pelvic organs through the blood; in most cases, it is an ascending infection. Young age and multiple sex partners are risk factors for PID. PID is an infectious condition of the pelvic cavity that may involve the fallopian tubes (salpingitis), ovaries (oophoritis), and pelvic peritoneum (peritonitis).

A patient is scheduled to have a total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO). She has verbalized anxiety and has stated, "I won't be a woman anymore." In formulating a response, the nurse keeps in mind which facts about a TAH-BSO? Select all that apply.

This surgery will induce menopause. A TAH-BSO involves removal of the entire uterus, fallopian tubes, and ovaries. The incidence of urinary retention postoperatively is greater with a hysterectomy than with any other type of surgery. A TAH-BSO involves removal of the entire uterus (including the cervix), fallopian tubes, and ovaries. This is the most extensive surgery of the hysterectomies that can be performed. The incidence of urinary retention postoperatively is greater with a hysterectomy than with any other type of surgery, because trauma to the bladder unavoidably occurs. If the patient has a retention catheter, it must be kept patent and connected to gravity. If no catheter is present, the patient is checked frequently for bladder distention; accurate urinary output is recorded. A TAH-BSO will induce menopause because of removal of the ovaries. A total abdominal hysterectomy is completed through an incision in the abdomen. The patient is usually in the hospital for 3 to 4 days after the surgery.

. A 24-year-old woman arrives in the emergency department after 3 days of vomiting, diarrhea, muscle pain, and headache. The patient is found to be hypotensive and hyperthermic. The nurse notes a red macular rash on the palms of her hands. The patient's level of consciousness is decreased, but she is able to report that her last menstrual period began 3 days ago, she is not urinating as much as she usually does, and she has a sore throat. The nurse should anticipate beginning treatment for which condition?

Toxic shock syndrome Hypotension, hyperthermia, vomiting, diarrhea, palmar rash, and decreased urine output are among many symptoms of toxic shock syndrome, which is caused by an infection with Staphylococcus aureus. Endometriosis, bacterial vaginosis, and pelvic inflammatory disease do not cause such systemic symptoms.

The nurse is caring for a patient who is breastfeeding. The patient reports prolonged, heavy menstrual cycles. What medication should the nurse expect the primary health care provider to prescribe for the patient?

A progestin-only pill. A progestin-only pill is preferred in women who are breastfeeding, as it does not suppress milk production. However, the use of a progestin-only pill may cause severe bleeding and prolonged cycles. Implanon (Etanogestrel) is a thin, flexible rod containing ethonogestrel, which provides contraception for 3 years. It does not cause prolonged cycles or severe bleeding. The combination pill contains both estrogen and progesterone. It is does not cause prolonged cycles. The morning-after pill contains estradiol and causes hormone-related complications, such as weakness and abdominal pain.

A patient who has had a total hysterectomy has been prescribed estrogen therapy for hormone replacement. What should the nurse do first?

Administer the medication. The nurse should simply administer the medication. If the patient has retained all or part of her uterus, then the nurse should hold the medication and contact the provider, because the patient's hormone therapy should include progesterone to decrease the risk of endometrial cancer; however, this was a total hysterectomy. It would not be appropriate to hold the medication and contact the provider. Whenever a medication is held, the provider should be notified.

A 67-year-old postmenopausal woman comes to the clinic complaining of uterine bleeding. The nurse anticipates which test will be performed?

Endometrial biopsy Postmenopausal women who have abnormal uterine bleeding should have an endometrial biopsy performed to rule out endometrial cancer. Breast tissue biopsy, serum estrogen levels, and serum FSH levels are not necessary tests for this patient.

A nurse reviewing the chart of a patient in the clinic learns that the patient is taking clomiphene (Clomid). The nurse knows this patient has infertility as a result of which condition?

Impaired ovulation. Clomiphene (Clomid) is used to induce ovulation. Poor cervical mucus is treated by cauterization and estrogen therapy. Psychological stressors and uterine structure abnormalities are not treated with Clomid.

Which herb should the nurse expect to be used by the patient who reports using herbs to obtain an erection?

Yohimbine (Pausinystalia yohimbe) Yohimbine (Pausinystalia yohimbe) is the herb used for erectile dysfunction. Sage (Salvia officinalis) is the herb used to regulate the menstrual cycle. Chamomile (Matricaria recutita) is the drug used for treatment of menstrual cramps. Black cohosh (Cimicifuga racemosa) is used for premenstrual syndrome and menstrual irregularity.

The nurse is teaching a patient, who has had a modified radical mastectomy, about postoperative care. Which response made by the patient indicates a need for further teaching?

"I should not apply any lanolin cream to my skin." It is necessary to avoid chapped hands; therefore, lanolin cream should be used daily to retain moisture. An exercise regimen is necessary, but it should be performed after 2 weeks to reduce any risk of further infection. Heavy objects should not be lifted using the same arm, as it causes strain on the arm and increases pain. Venipunctures or any other needle sticks should be avoided because of the risk of infection due to lymph node removal during a modified radical mastectomy.

A school nurse is providing education to a group of high school students about gonorrhea. Which statement, if made by a student, indicates a need for further education about gonorrhea?

"If my partner has gonorrhea, I should avoid vaginal sex, but oral sex is safe." Gonorrhea can be passed through oral sex with an infected partner and should be avoided. A chlamydial infection often coexists with gonorrhea. Treatment is usually a single intramuscular injection of ceftriaxone (Rocephin). Gonorrhea is almost entirely transmitted through sexual contact.

A patient arrives at the clinic to report that she was exposed to genital herpes during unprotected sexual intercourse 7 days ago and wants to know if she is still at risk for a genital herpes infection. The nurse should base her response on the knowledge that an outbreak of herpes generally occurs up to how many days after exposure?

14 days In general, an outbreak of genital herpes can occur up to 14 days after exposure. The patient is still at risk for an outbreak. Less than 14 days is too soon to determine if the patient will not have an outbreak, and 90 days is longer than necessary

A nurse is caring for a 42-year-old woman being treated for infertility. She has a 5-year-old daughter, whom she and her husband conceived without medical intervention, and they would like another child. The woman is expressing frustration about not being able to conceive. Which statement accurately describes infertility and its treatment?

Approximately 50% of couples who undergo assessment of and treatment for infertility are able to conceive. Approximately 50% of couples who undergo assessment of and treatment for infertility are able to conceive. If this patient is expressing frustration, she may have the belief that the chances of conception are less than this; giving information may help alleviate her frustration. It is important to listen to the patient and support her feelings. The most fertile time of a woman's life is between the ages of 20 and 29. Fertility rates of women decrease dramatically with age; fertility rates of men do not change much with age. This patient has what is known as secondary infertility, because she was able to conceive a daughter in the past. Primary infertility refers to couples who have never conceived.

For symptomatic relief of various symptoms of premenstrual syndrome (PMS), which drug is the best for the nurse to suggest to the patient?

Buspirone (BuSpar) for anxiety. Buspirone (BuSpar) is an antianxiety drug taken in the luteal phase, which helps to alleviate symptoms associated with premenstrual syndrome. Vitamin B6 acts as a mood elevator. Spironolactone (Aldactone) is used in patients with fluid retention due to its diuretic action. Ibuprofen (Motrin, Advil) is used for painful conditions of premenstrual syndrome.

A nurse is preparing to care for a patient who has experienced surgical menopause. The nurse knows this patient has had surgery to remove which structure(s)?

Ovaries Surgical menopause occurs when bilateral ovaries are removed. Surgical menopause does not occur as a result of removal of the cervix, uterus, or adrenals.

A patient comes to the clinic complaining of vaginal itching and foul-smelling discharge. On pelvic examination the provider reports a thick, curdlike discharge on the vaginal walls. The nurse anticipates that a culture of the vaginal discharge will lead to a diagnosis of vaginitis caused by which organism?

Candida albicans. Vaginal itching and foul-smelling, curdlike discharge are consistent with an infection with C. albicans, a yeast. T. vaginalis, E. coli, and G. vaginalis do not cause a curdlike vaginal discharge.

What diagnostic test is useful for diagnosing cervical cancer and is recommended after a woman turns age 18?

Papanicolaou (Pap) test The diagnostic test that is useful for early detection of cervical cancer and is recommended after a woman turns age 18 is a Pap test, or Pap smear. This is a simple smear method of examining stained exfoliative peeling and sloughed off tissue or cells. The tissue sample is placed on a slide, sprayed with fixative, and sent to the laboratory for analysis. A colposcopy is a procedure that provides direct visualization of the cervix and vagina. Tissue is visualized for growths or other abnormalities or vascularity, and samples can be obtained for analysis. A culdoscopy is a procedure that provides direct visualization of the uterus and adnexa and is performed with use of local, spinal, or general anesthesia. The area is examined for tumors, cysts, and endometriosis; removal of eroded or infected tissue may also be performed. D&C is a procedure performed for a biopsy, to correct cervical stricture, and to treat dysmenorrhea. The cervix is dilated and the inside of the uterus is scraped with a curette.

Which nursing advice is appropriate for a patient with endometriosis?

Reassure the patient that this non-life threatening condition can be treated with a conservative or progressive treatment approach. Endometriosis is not a life-threatening condition, and its management progresses from conservative medical management to more invasive surgical management. There is no need for a hysterectomy for all patients suffering from endometriosis. Most of the patients with endometriosis respond to a medical line of management, and a few require minor surgical procedures. Weight management and exercises do not affect endometriosis; these are treatment components of polycystic ovary syndrome.

The primary health care provider has prescribed breast prosthesis to a patient who has undergone a modified radical mastectomy. What should the nurse teach the patient about the prosthesis?

"Ensure that the prosthesis fits snugly in the bottom of the bra cup." The prosthesis should fit snugly to hold the breasts in position. The prosthesis should not be placed right next to the remaining breast. There should be a space in between the prosthesis and the breast. Most prostheses are water proof and do not weigh down on the wearer, allowing them to be worn while swimming. Prostheses can be washed with water and mild detergents; the dry cleaning method is not necessarily used.

A nurse is providing education to a patient with syphilis who is 12 weeks pregnant. The patient indicates a need for further education by making which statement?

"Regardless of treatment, my baby will have syphilis from birth." With appropriate antibiotic treatment before 18 weeks' gestation, transmission of syphilis to the fetus is prevented. After 18 weeks' gestation, maternal antibiotic treatment will cure both the mother and child of syphilis. Antibiotic therapy in the second half of pregnancy increases the risk of preterm labor. An RPR test will be performed to determine the patient's infection status.

The nurse is teaching a patient about testicular self-examination. Which statement made by the patient indicates the need for further teaching?

"The testes should be smooth and hard to the touch." The testes should be firm to the touch, but not hard. If it is hard, it may indicate the presence of carcinoma. It is necessary to examine the scrotum every month for the presence of any masses. Self-examination should be performed after a shower, when the scrotum is warm and more relaxed. The epidydimis is found behind the testes and should feel like a soft tube.

The nurse is caring for a patient who has genital herpes. Which treatments should the nurse expect the primary health care provider to prescribe in order to provide comfort to the patient? Select all that apply.

Acyclovir (Zovirax) Lidocaine (Xylocaine) Acetaminophen (Tylenol) Acyclovir (Zovirax) is an antiviral drug prescribed for the treatment of genital herpes. It reduces the severity of the symptoms. Lidocaine (Xylocaine) is a local anesthetic prescribed to reduce pain. Systemic analgesic acetaminophen (Tylenol) can also be prescribed for pain. Nystatin (Mycostatin) is administered for the candidiasis infection. Ceftriaxone (Rocephin) is a penicillin-resistant cephalosporin used in the treatment of gonorrhea

A patient visits the clinic complaining of back and leg pain and foul-smelling dark bloody vaginal drainage. The nurse anticipates further examination will prompt which diagnosis?

Late-stage cervical cancer Late-stage cervical cancer is characterized by lower back and leg pain, as well as foul-smelling drainage that is dark and bloody. The drainage is caused by the tumor mass becoming necrotic and infected. Early-stage cervical and ovarian cancers are generally asymptomatic. Late-stage ovarian cancer manifests with increased abdominal girth and pain.

A patient visits the clinic with complaints of hot flashes caused by menopause. Which instruction should the nurse provide to help the patient relieve hot flashes?

Decrease caffeine intake from food and drinks. To relieve menopausal symptoms, the nurse should advise the patient to limit alcohol and caffeine intake, take 800 IU of vitamin E daily, and place cool cloths on flushed areas.

A patient has been prescribed sildenafil (Viagra) for erectile dysfunction. Which question should the nurse ask first?

Do you take nitroglycerin for chest pain? The nurse should first ask the patient if nitrates are taken for chest pain; this is a contraindication to the use of Viagra because it can cause severe hypotension. It is also important to explore the patient's understanding of safe sex practices and how to take the medication, but these questions can wait until after the nurse has determined whether or not the patient takes nitrates for chest pain.

A patient with a vaginal infection caused by Candida albicans has been prescribed a vaginal suppository. Which instruction would be most beneficial for curing the infection?

Insert the vaginal suppository at bedtime and lie horizontally for 30 minutes. The patient should insert the vaginal suppository around bedtime and remain recumbent for at least 30 minutes to promote absorption of the medication. An acidic, not alkaline, douche may be used before insertion. Although the patient should refrain from sexual activity during the course of treatment, this is to prevent infection of the partner. Oral antibiotics for the treatment of any infection should be taken for the full course of treatment, not stopped when the symptoms stop.

Which intervention should the nurse include in the plan of care for a patient who has had an abdominal hysterectomy?

Instruct the patient to take deep breaths after coughing every hour. The nurse should instruct the patient to take deep breaths after coughing to improve lung functioning. The nurse should instruct the patient to have bowel movements, as it is necessary to keep the colon empty to avoid postoperative distension. The nurse should assist the patient in movement every 2 hours. It is not necessary to maintain a prolonged bed rest. A low-residue diet is provided a few days prior to the surgery, but not postoperatively, as it reduces bowel movements.

A nurse is preparing a patient for a vaginal hysterectomy and should inform the patient she will be placed in which position?

Lithotomy The lithotomy position is used for a vaginal hysterectomy. The patient will not be placed in the prone, supine, or reverse Trendelenburg position.

A 23-year-old patient who experienced menarche at age 12 arrives at the clinic complaining of excessive uterine bleeding during her menstrual period. The nurse would correctly document this as which condition?

Menorrhagia Menorrhagia is excessive uterine bleeding at the time of menstruation. Amenorrhea is lack of uterine bleeding for longer than 6 months. Metrorrhagia is abnormal uterine bleeding between menstrual periods. Dysmenorrhea is painful menstrual periods.

The nurse caring for an infant observes darkened nail beds and milk-curd lesions on the mouth. What drug should the nurse expect the primary health care provider to prescribe for the patient?

Nystatin (Mycostatin) Darkened nail beds and milk-curd lesions on the mouth is indicative of a superficial candidiasis infection. Nystatin (Mycostatin) is the prescribed drug for the treatment of the candidiasis infection. Ceftriaxone (Rocephin) is a penicillin-resistant cephalosporin used in the treatment of gonorrhea. Metronidazole (Flagyl) is used in the trichomoniasis infection treatment, both in men and women. Azithromycin (Zithromax) is used in the treatment of chlamydia and is not safe for infants.

A patient presents with primary dysmenorrhea. Which clinical presentations during the physical examination the nurse is likely to find? Select all that apply.

Onset of pain 12-24 hours before menstruation Colicky lower abdominal pain radiating to the thighs Most severe pain on the first day that subsides within 2 days In primary dysmenorrhea, the pain starts 24 hours before the onset of menstruation. Pain will be localized to the lower abdomen and will be colicky in nature, radiating to the thighs. In primary dysmenorrhea, pain will be severe on the first day and rarely persist beyond the next 2 days. Unilateral pain and constant pain persisting for more than 2 days are features of secondary dysmenorrhea.

When collecting data from a menopausal patient, what symptoms is the nurse likely to observe? Select all that apply.

Osteoporosis Loss of skin elasticity Hot flashes and irregular menses Osteoporosis and loss of skin elasticity are the other associated features of menopause. Hot flashes and irregular menses are hallmarks of perimenopause. Constipation and vision changes may not occur as related to menopause but are age-related changes.

When educating a group of teenagers about premenstrual syndrome (PMS), what information should the nurse include? Select all that apply.

Premenstrual symptoms can be severe enough to impair interpersonal relationships. Premenstrual symptoms occur cyclically in the luteal phase just before menstruation. PMS may impair interpersonal relationships. PMS occur cyclically in the luteal phase before menstruation. PMS symptoms may vary from cycle to cycle. In a menstrual cycle, the follicular phase occurs after menstruation; thus, PMS is not experienced in this phase. For every woman, PMS presentation varies, and it may or may not be associated with breast discomfort.

What is a true statement regarding illness and sexuality?

Sexual dysfunction of a patient with diabetes mellitus can occur when the disease is not well controlled. Sexual dysfunction in a patient with diabetes mellitus can occur when the disease is not well controlled, but in general the dysfunction disappears when the lack of control is diagnosed and treated. Impotence is found in approximately half of men with diabetes mellitus and in general is related to poor control. The abuse of alcohol, which is a central nervous system depressant, leads to a decreased sex drive and inadequate sexual functioning. Patients (both men and women) who have had spinal cord injuries have reported experiencing orgasms, despite interruption of peripheral nerves and spinal cord reflexes. A mastectomy will usually affect a woman's sexual self-concept and intimate physical interactions. Two variables that can influence a woman's sexual function are (1) sufficient self-love and acceptance and (2) positive attitudes and feelings about sexuality.

The nurse is reviewing the results of a patient's Papanicolaou test (Pap smear) and finds that the cells are rated as a Class III. What should the nurse infer from this?

The cells have mild dysplasia, low-grade squamous epithelia, and need re-testing in 8 weeks. A patient who falls in Class III of the Papanicolaou test (Pap smear) test would have mild dysplasia, low-grade squamous epithelia, and may need re-testing in 8 weeks. If patient has severe dysplasia, high-grade squamous epithelia, and requires biopsy treatment, it indicates Class IV. If the patient has mild dysplasia and low-grade squamous epithelia, then it is Class III, but does not require biopsy treatment. If patient has severe dysplasia and high-grade squamous epithelia, it indicates Class IV severity. The patient does not require a repeat test; instead they would require treatment.

The nurse is collecting the data on a couple who are undergoing fertility treatment. What action made by the nurse may prevent open communication with the patient?

The nurse asks the patient's family to remain in the room. The nurse should request that the family leave the room, as the caregiver may not necessarily be an intimate partner and the patient may be uncomfortable answering personal questions in their presence. The nurse should always maintain privacy by closing the door, so that the patient is comfortable. A patient would be more comfortable answering questions by a nurse of the same gender, rather than a nurse of the opposite sex. The nurse should always maintain a non-judgmental approach, as this increases the patient's comfort and decreases their anxiety.

A patient arrives in the clinic with complaints of an enlarged scrotum. A mass is felt on examination. The test anticipates which test will be performed first?

Transillumination Transillumination is used to distinguish a hydrocele from a cancerous mass; light passes through a hydrocele but not a cancerous mass. A testicular ultrasound will be performed if the mass does not transilluminate. Testicular biopsy and needle aspiration of the mass are not the first tests to be performed.

The nurse is educating a patient about ways to prevent sexually transmitted diseases. Which patient behavior would increase the risk of a patient contracting a sexually transmitted disease?

Using an oil-based lubricant during sex. Water-based lubricants should be used, rather than oil-based lubricants. An oil-based lubricant may cause condom breakage. Voiding after intercourse reduces the occurrence of urinary tract infections, as it helps eliminate semen and any other bacteria that might have entered the vaginal area during intercourse. It is necessary to use barrier contraceptives to decrease the risk of sexually transmitted diseases. Hydrogen peroxide can be used as an antiseptic mouthwash in a 3:1 ratio with water; it reduces esophagopharyngeal sexually transmitted diseases. Topics

A patient comes to the clinic complaining of metrorrhagia. The nurse anticipates the patient will undergo tests to rule out which condition?

Uterine cancer Metrorrhagia, or abnormal bleeding between menstrual periods, can be a sign of uterine or ovarian cancer and must be investigated. Amenorrhea can be a sign of pregnancy and menopause. Breast tissue changes are a sign of breast cancer.

The nurse is caring for a patient who has yellowish-green discharge and pruritis. The primary health care provider has prescribed metronidazole (Flagyl). What instructions should the nurse give to the patient to prevent complications?

"Do not consume alcohol while taking this medication." Yellowish-green vaginal discharge and pruritis are the sign and symptoms of Trichomoniasis vaginalis; metronidazole (Flagyl) is used in its treatment. The patient should abstain from alcohol consumption, as it can cause reactions such as disorientation and headaches. Douching can increase the infection, and should not be suggested. Tight-fitting clothes trap moisture and may increase infection; loose-fitting clothes should be worn. Sitz baths would provide comfort in the perineal area and should be encouraged.

After a routine Pap smear, a patient is diagnosed with carcinoma in situ. Which statement, if made by the patient, indicates an understanding of the condition?

"I am so relieved to know that carcinoma in situ is curable." Because carcinoma in situ is a term used to describe a carcinoma that is diagnosed before it has invaded surrounding tissue, it is 100% curable without radical treatment. The patient does not need palliative care or a total hysterectomy or to be concerned about dying from the carcinoma in situ.

The nurse is discussing the use of the diaphragm with a patient as a method for birth control. Which statement made by the patient indicates the need for further teaching?

"I should remove the diaphragm immediately after sex." The diaphragm should not be removed until 8 hours after intercourse, to prevent sperm from getting in the cervix. Inserting the diaphragm prior to intercourse is the proper method of use. Deterioration in the diaphragm does not give proper protection, so it should not be used. Vaginal distension occurs after pregnancy, so the diaphragm should be refitted.

The nurse is educating a patient about the morning-after pill. Which statement made by the patient indicates effective learning?

"I should take 1 pill every 12 hours for a total of 2 pills within 72 hrs of intercourse. The morning-after pill contains ethinyl estradiol. It should be taken within 72 hours of intercourse, as it creates a hostile uterine lining and alters tubular transport. It should be taken in two doses at 12-hour intervals. The medication should be repeated if vomiting occurs; it is not contraindicated. The antibiotic ampicillin (Principen) decreases the contraceptive action of combination birth control pills. It has no effect on the morning-after pill. Menstruation usually occurs 2-3 weeks after taking the pill, not 2-3 days

A new mother diagnosed with acute mastitis asks the nurse whether or not she should continue breastfeeding her newborn child. What is the best response on the part of the nurse?

"You should continue to breastfeed your child throughout the infection and after your symptoms subside. " Breastfeeding allows for the emptying of inflamed ducts, which will reduce milk stasis and promote healing. It is not necessary to switch to formula, wait until symptoms subside before breastfeeding again, or "pump and dump" breast milk.

A 23-year-old patient in the clinic has been diagnosed with a chlamydial infection. The nurse knows which drug is the best option to promote treatment compliance?

Azithromycin Azithromycin therapy for chlamydia is given in a single injection. Ofloxacin and doxycycline are oral pills administered twice daily. Tetracycline is administered four times a day for at least 7 days. The single injection removes the uncertainty regarding treatment compliance.

A 55-year-old male patient has sudden-onset chills, fever, arthralgia, dysuria, nocturia, and weak stream. The provider performs a rectal examination and reports prostatic edema; the patient complains of pain during the examination. A culture and sensitivity test is performed on a swab from the urethra and bacteria are cultured. The nurse anticipates the provider will prescribe which medication?

Ciprofloxacin (Cipro) The patient is exhibiting signs of acute cystitis with a positive bacterial culture; therefore ciprofloxacin (Cipro), an antibiotic, would be the most appropriate therapy. Acyclovir is an antiviral medication. Tamsulosin (Flomax) is used for the treatment of benign prostatic hyperplasia. Although pain medication should be available, an opioid pain medication such as meperidine is not the first choice.

Which statement is correct with regard to menopause?

It is recommended that menopausal women take the lowest effective dose of hormone replacement therapy (HRT) for the shortest amount of time possible to relieve menopausal symptoms. It is recommended that menopausal women take the lowest effective dose of HRT for the shortest amount of time possible to relieve menopausal symptoms. Research has shown that long-term use of combination HRT with an estrogen-progestin combination heightens the risk of ischemic stroke, coronary heart disease, breast cancer, thromboembolism, and cognitive decline. Symptoms of menopause can last from a few months to several years before menstruation ceases permanently. Menopause is considered to be complete after a woman has had no menstrual periods for a period of 1 year. Approximately 25% of postmenopausal women develop osteoporosis. The average age for a woman to experience menopause is age 51, although it may begin anywhere between the ages of 35 and 60.

A nurse is caring for a patient who is 24 hours postoperative after a modified radical mastectomy of the left breast. Which nursing intervention is most appropriate for this patient?

Monitor the patient for signs of shock or hemorrhage. In caring for a postoperative patient who has undergone a modified radical mastectomy, it is important to monitor the patient for signs of shock or hemorrhage, because many large blood vessels are involved in the procedure. Drains may be placed in the axilla to facilitate drainage of the operative site. After a modified radical mastectomy, the patient should be placed in a 45° Fowler position to promote drainage, as long as vital signs are stable. The position should be changed frequently, and deep breathing and coughing are encouraged. After a modified radical mastectomy, no procedures should be performed on the operative side, including blood pressure measurement, venipuncture, injections, intravenous insertion, and fluid administration, because there is a risk of edema and infection. In caring for a postoperative patient who has undergone a modified radical mastectomy, the nurse should teach the patient not to lift heavy items with the affected arm for 6 to 8 weeks.

A newly married couple is interested in using a combined oral contraceptive containing both estrogen and progesterone. What information should the nurse include when explaining about combined oral contraceptives to this couple? Select all that apply.

Oral contraceptives increase the risk of breast cancer. Oral contraceptives increase blood pressure and serum cholesterol. Oral contraceptives increase the risk of breast cancer. The combined pill may elevate blood pressure and cholesterol. Oral contraceptives reduce the risk of ovarian cancer and increase the risk of liver cancer. Oral contraceptives need to be taken on a scheduled basis without any relation to sexual intercourse.

What is the most serious type of female reproductive infection?

Pelvic inflammatory disease (PID) PID is the most serious of the four disorders listed, because it can lead to adhesions or sterility of the woman. The definition of PID is any acute, subacute, recurrent, or chronic infection of the cervix, uterus, fallopian tubes, and ovaries that has extended to the connective tissues lying between the broad ligaments. Sexually active women with more than one partner are at increased risk of developing PID. Atrophic vaginitis is inflammation of the vagina that occurs in women after menopause and with aging. Low estrogen levels cause the vulva and vagina to atrophy and become susceptible to bacterial invasion. Senile vaginitis is another name for atrophic vaginitis. Simple vaginitis, inflammation of the vagina, is a common vaginal infection, often caused by Escherichia coli. Goals of treatment include cure of the infection, prevention of reinfection, prevention of complications, and prevention of infection of sexual partner(s).

A resident is sharing during an assessment with the RN and the LPN that he has been having trouble urinating over the last few months. When he asks why that is happening, the LPN can teach him that which anatomic part of the male reproductive system often hypertrophies with age?

Prostate gland The part of the male reproductive system that often hypertrophies with age, making voiding difficult, is the prostate gland. This is a doughnut-shaped gland that surrounds the neck of the bladder and the urethra. It contains muscular and glandular tissue. Cowper glands are two pea-sized glands under the male urethra. They provide lubrication during sexual intercourse. The epididymis is a tightly coiled tube structure that lies superior to the testes and extends posteriorly. With sexual stimulation, the walls of the epididymis contract and force the sperm along the seminiferous tubules of the testes into the vas deferens. The ductus deferens, also known as the vas deferens, is approximately 18 inches long and rises along the posterior wall of the testes. This, along with nerves and blood vessels, is enclosed in a connective tissue sheath called the spermatic cord.

A nurse is providing perineum care to a patient who has been diagnosed with a rectovaginal fistula. The patient covers her face and exclaims, "I am just so embarrassed to have my family know about my condition now." What is the most therapeutic response by the nurse?

"I can see you're upset. Can you tell me more about what is embarrassing to you?" The nurse should validate the patient's concerns and attempt to glean more information regarding the cause of the patient's embarrassment. The nurse should not presume to know about the patient's family situation without more information. Telling the patient she can now have the problem fixed so no one else has to know reinforces the patient's feelings of shame. Although it may be helpful for the patient to be reminded of the confidentiality laws, this does not validate the patient's concerns or elicit what is truly bothering the patient.

A patient with endometriosis visits the clinic complaining of pain during sex. The nurse knows to document this complaint as which condition?

Dyspareunia Pain during sex is called dyspareunia. Dysphagia is difficulty swallowing. Dysmenorrhea is painful menstruation. Amenorrhea is a lack of menstruation.

The nurse is caring for a pregnant patient infected with Chlamydia trachomatis. Which drug should the nurse expect to be prescribed for the patient?

Erythromycin (Erythrocin) Erythromycin (Erythrocin) is a drug of choice for pregnant patients being treated for the Chlamydia trachomatis infection. Nystatin (Mycostatin) is used as a treatment for the mild fungal infection candidiasis. Ceftriaxone (Rocephin) is a penicillin-resistant cephalosporin used in the treatment of neisseria gonorrhea. Metronidazole (Flagyl) is used in treating the Trichomoniasis vaginalis infection in both men and women.

A patient experiencing menopause confides in the nurse that she is most concerned about urge incontinence. Which instruction from the nurse would be most helpful to the patient to prevent urge incontinence?

Perform Kegel exercises several times a day. The nurse should instruct the patient to perform Kegel exercises several times per day to promote pelvic floor muscle strengthening, which will decrease urge incontinence. Thin panty liners can be recommended to the patient to help if urge incontinence occurs, but this is not the best instruction to prevent urge incontinence. The patient should not limit fluid intake because this can lead to health complications. Disposable underwear is not the best suggestion at this time.

What interventions are suitable for a patient with primary dysmenorrhea? Select all that apply.

Regular exercises Nonsteroidal anti-inflammatory drugs Application of heat to lower abdomen and back. Regular exercise reduces endometrial hyperplasia and hence prostaglandin production. Nonsteroidal anti-inflammatory drugs oppose the action of prostaglandins to relieve pain. Heat application causes vasodilation and helps to drain locally produced prostaglandins. Even though steroids are effective, due to their adverse effect, they are avoided. Since there is no other pelvic pathology, and patients respond better to drugs, there is no need for hysterectomy.

The nurse is caring for a patient who has a noticeable fluid accumulation in the scrotum, seen when using a transilluminator light. What should the nurse infer from these findings?

The patient has a hydrocele. A hydrocele is characterized by fluid accumulation between the two layers of the tunica vaginalis membranes covering the testes. This is noticeable when transillumination light passes through the swelling. Phimosis is a condition in which the prepuce (foreskin) is too small to allow it to be retracted over the penis. A varicocele occurs when veins in the scrotum become dilated due to internal spermatic vein reflux. If the transilluminating light does not pass through the swelling, it is a cancerous growth.

A couple who failed to conceive under infertility management has been asked to go for in vitro fertilization (IVF). When explaining the procedure, what information should the nurse include? Select all that apply.

This procedure is done for patients with tubal obstruction and diminished sperm count. The embryo develops outside the body and is later transplanted into the patient's uterus. IVF is transplantation of an embryo formed by the fusion of male and female gametes outside the body into the patient's uterus. This procedure is done for patients with fallopian tube obstruction, diminished sperm count, and unexplained infertility. This procedure takes 2-3 days. IVF is indicated in cases of low sperm count. It is a costly procedure and may require multiple attempts.