Chapter 51: Management of Patients with Female Reproductive Disorders

A client comes to the free clinic reporting a gray-white discharge that clings to the external vulva and vaginal walls. A nurse practitioner assesses the client and diagnoses Gardnerella vaginalis. What would be the most appropriate nursing action at this time? A. Advise the client that this is an overgrowth of normal vaginal flora. B. Discuss the effect of this diagnosis on the client's fertility. C. Document the vaginal discharge as normal. D. Administer acyclovir as ordered.

A. Advise the client that this is an overgrowth of normal vaginal flora.

A female client is being admitted postoperatively to the surgical floor after a radical vulvectomy. What minimum equipment and interventions should the nurse anticipate and prepare for? Select all that apply. A. An intravenous infusion pump for antibiotics B. A Bair hugger warming blanket to prevent hypothermia C. A private or single room for neutropenic isolation D. Portable suction for postoperative nausea and vomiting E. Sequential compression devices to reduce the risk of venous thromboembolism

A. An intravenous infusion pump for antibiotics E. Sequential compression devices to reduce the risk of venous thromboembolism

A nurse is caring for a pregnant client with active herpes. The teaching plan for this client should include which of the following? A. Babies delivered vaginally may become infected with the virus. B. Recommended treatment is excision of the herpes lesions. C. Pain generally does not occur with a herpes outbreak during pregnancy. D. Pregnancy may exacerbate the pregnant client's symptoms, but poses no risk to the infant.

A. Babies delivered vaginally may become infected with the virus.

A client with trichomoniasis comes to the walk-in clinic. In developing a care plan for this client the nurse would know to include what as an important aspect of treating this client? A. Both partners will be treated with metronidazole. B. Constipation and menstrual difficulties may occur. C. The client should perform Kegel exercises 30 to 80 times daily. D. Care will involve hormone therapy to control the pain.

A. Both partners will be treated with metronidazole.

The nurse is caring for a 63-year-old client with ovarian cancer. The client is to receive chemotherapy consisting of paclitaxel and carboplatin. For what adverse effect of this treatment should the nurse monitor the client? A. Leukopenia B. Metabolic acidosis C. Hyperphosphatemia D. Respiratory alkalosis

A. Leukopenia

A female client has just been diagnosed with condylomata acuminata (genital warts). What information is most appropriate for the nurse to tell this client? A. The warts may require surgical removal or cryotherapy B. The most common treatment is metronidazole, which should eradicate the problem within 7 to 10 days. C. The potential for transmission to the sexual partner will be eliminated if condoms are used every time they have sexual intercourse. D. The human papillomavirus (HPV), which causes condylomata acuminata, cannot be transmitted during oral sex.

A. The warts may require surgical removal or cryotherapy

The nurse is caring for a client who has been diagnosed with genital herpes. When preparing a teaching plan for this client, what general guidelines should be taught? A. Thorough handwashing is essential. B. Exposure to ultraviolet light assists in eradicating the virus. C. Lesions should be gently massaged with ointment. D. Self-infection cannot occur from touching lesions during a breakout.

A. Thorough handwashing is essential.

A female client tells the nurse that they think they have a vaginal infection because the client has noted inflammation of the vulva and the presence of a frothy, yellow-green discharge. The nurse recognizes that the clinical manifestations described are typical of what vaginal infection? A. Trichomonas vaginalis B. Candidiasis C. Gardnerella D. Gonorrhea

A. Trichomonas vaginalis

Following a recent history of dyspareunia and lower abdominal pain, a client has received a diagnosis of pelvic inflammatory disease (PID). When providing health education related to self-care, the nurse should address what topics? Select all that apply. A. Use of condoms to prevent infecting others B. Appropriate use of antibiotics C. Taking measures to prevent pregnancy D. The need for a Pap smear every 3 months E. The importance of weight loss in preventing symptoms

A. Use of condoms to prevent infecting others B. Appropriate use of antibiotics

3. When teaching clients about the risk factors of cervical cancer, what would the nurse identify as the most important risk factor? A. Late childbearing B. Human papillomavirus (HPV) C. Postmenopausal bleeding D. Tobacco use

B. Human papillomavirus (HPV)

A middle-aged female client has been offered testing for HIV/AIDS upon admission to the hospital for an unrelated health problem. The nurse observes that the client is visibly surprised and embarrassed by this offer. How should the nurse best respond? A. "Most women with HIV don't know they have the disease. If you have it, it's important we catch it early." B. "This testing is offered to every adolescent and adult regardless of their lifestyle, appearance or history." C. "The rationale for this testing is so that you can begin treatment as soon as testing comes back, if it's positive." D. "You're being offered this testing because you are actually in the prime demographic for HIV infection."

B. "This testing is offered to every adolescent and adult regardless of their lifestyle, appearance or history."

A client has been diagnosed with endometriosis. When planning this client's care, the nurse should prioritize what nursing diagnosis? A. Anxiety related to risk of transmission B. Acute pain related to misplaced endometrial tissue C. Ineffective tissue perfusion related to hemorrhage D. Excess fluid volume related to abdominal distention

B. Acute pain related to misplaced endometrial tissue

A female client with diabetes and heart failure is taking an antibiotic, loop diuretic, corticosteroid, and an antipyretic medication. What medicines and conditions would likely increase the client's risk of developing the infection Candida albicans? Select all that apply. A. Heart failure B. Antibiotics C. Corticosteroid D. Antipyretics E. Diabetes F. Diuretics

B. Antibiotics C. Corticosteroid E. Diabetes

A client is postoperative day 1 following a vaginal hysterectomy. The nurse notes an increase in the client's abdominal girth and the client reports "bloating." What is the nurse's most appropriate action? A. Provide the client with an unsweetened, carbonated beverage. B. Apply warm compresses to the client's lower abdomen. C. Provide an ice pack to apply to the perineum and suprapubic region. D. Assist the client into a prone position.

B. Apply warm compresses to the client's lower abdomen.

A 31-year-old client has returned to the postsurgical unit following a hysterectomy. The client's care plan addresses the risk of hemorrhage. How should the nurse best monitor the client's postoperative blood loss? A. Have the client void and have bowel movements using a commode rather than toilet. B. Count and inspect each perineal pad that the client uses. C. Swab the client's perineum for the presence of blood at least once per shift. D. Leave the client's perineum open to air to facilitate inspection.

B. Count and inspect each perineal pad that the client uses.

A 36-year-old female client is being evaluated for fibroids with accompanying symptoms of menorrhagia, chronic constipation, abdominal pain and pressure. The client is a very busy lawyer who wants children and requests that any treatments be accomplished on an outpatient basis. What is the best treatment option for this client? A. Magnetic resonance-guided focused ultrasound surgery. B. Hysteroscopic resection of myomas C. Abdominal myomectomy D. Uterine artery embolization

B. Hysteroscopic resection of myomas

10. A client with ovarian cancer is admitted to the hospital for surgery and the nurse is completing the client's health history. What clinical manifestation would the nurse expect to assess? Select all that apply. A. Fish-like vaginal odor B. Increased abdominal girth C. Fever and chills D. Lower abdominal pelvic pain E. Pleuritic chest pain

B. Increased abdominal girth, D. Lower abdominal pelvic pain

A recent colposcopy revealed precursor lesions for a female client. A procedure was recommended to evaluate and remove any abnormal cells in the cervix. The client is most likely scheduled for what outpatient procedure? A. Cryotherapy B. Loop electrocautery excision procedure C. Cone biopsy D. Pelvic exenteration

B. Loop electrocautery excision procedure

The nurse is caring for a client with a diagnosis of vulvar cancer who has returned from the PACU after undergoing a wide excision of the vulva. How should this client's analgesic regimen be best managed? A. Analgesia should be withheld unless the client's pain becomes unbearable. B. Scheduled analgesia should be administered around-the-clock to prevent pain. C. All analgesics should be given on a PRN, rather than scheduled, basis. D. Opioid analgesics should be avoided and NSAIDs exclusively provided.

B. Scheduled analgesia should be administered around-the-clock to prevent pain.

A client comes to the clinic reporting a tender, inflamed vulva. Testing does not reveal the presence of any known causative microorganism. What aspect of this client's current health status may account for the client's symptoms of vulvitis? A. The client is morbidly obese. B. The client has type 1 diabetes. C. The client has chronic kidney disease. D. The client's mother had similar problems in mid-adulthood.

B. The client has type 1 diabetes.

A teenage girl is brought to the clinic by a parent. The parent explains to the nurse that the daughter has just started using tampons, but is not yet sexually active. The parent states, "I am very concerned because my daughter is having a lot of stabbing pain and burning." Assessment reveals no signs of infection, so the nurse should suspect what health problem? A. Vulvitis B. Vulvodynia C. Vaginitis D. Bartholin cyst

B. Vulvodynia

A student nurse is caring for a client who has undergone a wide excision of the vulva. What action is contraindicated in the immediate postoperative period? A. Placing client in low Fowler position B. Application of compression stockings C. Ambulation to a chair D. Provision of a low-residue diet

C. Ambulation to a chair

The nurse is planning health education for a client who has experienced a vaginal infection. What guidelines should the nurse include in this program regarding prevention? A. Wear tight-fitting synthetic underwear. B. Douche weekly to eradicate perineal bacteria. C. Avoid commercial feminine hygiene products, such as sprays. D. Restrict daily washing.

C. Avoid commercial feminine hygiene products, such as sprays.

A 45-year-old client has just undergone a radical hysterectomy for invasive cervical cancer. Prior to the surgery the health care provider explained to the client that after the surgery a source of radiation would be placed near the tumor site to aid in reducing recurrence. What is the placement of the source of radiation called? A. Internal beam radiation B. Trachelectomy C. Brachytherapy D. External radiation

C. Brachytherapy

1. While taking a health history on a 20-year-old female client, the nurse learns that the client is taking miconazole. The nurse is justified in presuming that this client has what medical condition? A. Bacterial vaginosis B. Human papillomavirus (HPV) C. Candidiasis D. Toxic shock syndrome (TSS)

C. Candidiasis

A female client is being evaluated due to increased menstrual bleeding and dysmenorrhea. A history and physical suggest the diagnosis of endometriosis rather than uterine fibroids. What finding would support the diagnosis of endometriosis? A. Genetic predisposition B. Menstrual cycle longer than 35 days C. Familial predisposition D. Having multiple children at a younger age.

C. Familial predisposition

When reviewing the electronic health record of a female client, the nurse reads that the client has a history of adenomyosis. The nurse should be aware that this client experiences symptoms resulting from what pathophysiologic process? A. Loss of muscle tone in the vaginal wall B. Excessive synthesis and release of unopposed estrogen C. Invasion of the uterine wall by endometrial tissue D. Proliferation of tumors in the uterine wall

C. Invasion of the uterine wall by endometrial tissue

A client comes to the free clinic reporting a gray-white discharge that clings to the external vulva and vaginal walls. A nurse practitioner assesses the client and diagnoses Gardnerella vaginalis. What would be the most appropriate nursing action at this time? A. Advise the client that this is an overgrowth of normal vaginal flora. B. Discuss the effect of this diagnosis on the client's fertility. C. Document the vaginal discharge as normal. D. Administer acyclovir as ordered.

C. Monitoring the integrity of the surgical site

A client diagnosed with cervical cancer will soon begin a round of radiation therapy. When planning the client's subsequent care, the nurse should prioritize actions with what goal? A. Preventing hemorrhage B. Ensuring the client knows the treatment is palliative, not curative C. Protecting the safety of the client, family, and staff D. Ensuring that the client adheres to dietary restrictions during treatment

C. Protecting the safety of the client, family, and staff

A female client is being evaluated at the gynecologist's office for painful urination, and dark and foul-smelling vaginal discharge after intercourse. Recently the client has noticed a small amount of blood coming from the rectum after bowel movements and increased leg pain after work. The client is most likely experiencing what stage of cervical cancer? A. Stage I B. Stage III C. Stage IV D. Stage II

C. Stage IV

A female client with large uterine fibroids is scheduled for a hysterectomy next month and is started on leuprolide. The client requests information about the medication's route, duration of treatment and any side effects. What is the nurse's best response? A. This medical regimen will consist of weekly subcutaneous injections. B. This is a medication that works best if taken consistently over a long period of time. C. The medication induces a temporary menopause-like environment in the body. D. The medication may temporarily increase vaginal secretions creating an environment for bacterial growth.

C. The medication induces a temporary menopause-like environment in the body.

A client is being discharged home after a hysterectomy. When providing discharge education for this client, the nurse has cautioned the client against sitting for long periods. This advice addresses the client's risk of what surgical complication? A. Pudendal nerve damage B. Fatigue C. Venous thromboembolism D. Hemorrhage

C. Venous thromboembolism

A client has been diagnosed with polycystic ovary syndrome (PCOS). The nurse should encourage what health promotion activity to address the client's hormone imbalance and infertility? A. Kegel exercises B. Increased fluid intake C. Weight loss D. Topical antibiotics as prescribed

C. Weight loss

A 25-year-old client diagnosed with invasive cervical cancer expresses a desire to have children. What procedure might the care team offer as treatment? A. Radical hysterectomy B. Radical cystectomy C. Modified radical hysterectomy D. Radical trachelectomy

D. Radical trachelectomy

A client with genital herpes is having an acute exacerbation. What medication would the nurse expect to be ordered to suppress the symptoms and shorten the course of the infection? A. Clotrimazole B. Metronidazole C. Podophyllin D. Acyclovir

D. Acyclovir

8. The nurse is teaching a client preventative measures regarding vaginal infections. The nurse should include which factor as an important risk? A. High estrogen levels B. Late menarche C. White ethnicity D. Frequent douching

D. Frequent douching

A nurse providing prenatal care to a pregnant client is addressing measures to reduce postpartum risk of cystocele, rectocele, and uterine prolapse. What action should the nurse recommend? A. Maintenance of good perineal hygiene B. Prevention of constipation C. Increased fluid intake for 2 weeks' postpartum D. Performance of pelvic muscle exercises

D. Performance of pelvic muscle exercises

The nurse is providing preoperative education for a client diagnosed with endometriosis. A hysterectomy has been scheduled. What education topic should the nurse be sure to include for this client? A. Menstrual periods will continue to occur for several months, some of them heavy. B. Normal activity will be permitted within 48 hours following surgery. C. After a hysterectomy, hormone levels remain largely unaffected. D. The bladder must be emptied prior to surgery and a catheter may be placed during surgery.

D. The bladder must be emptied prior to surgery and a catheter may be placed during surgery.

A client has herpes simplex 2 viral infection (HSV-2). The nurse recognizes that which of the following should be included in teaching the client? A. The virus also causes "cold sores" of the lips. B. The virus may be cured with topical antibiotics. C. The client's family history is an important part of assessment. D. Treatment is aimed at relieving symptoms.

D. Treatment is aimed at relieving symptoms.