Chapter 53: Caring for Clients with Disorders of the Female Reproductive System

A client undergoing treatment for vaginosis is also counseled about measures to prevent its recurrence. Which statement by the client best indicates effective counseling?

"I will avoid douching after my period." Vaginitis is a condition in which the vagina is inflamed. Frequent douching predisposes the client to vaginitis. Treatment of a client' partners does not seem to be effective, but use of condoms may be helpful. Antiprotozoal vaginal suppositories should be used at regular intervals rather than only after intercourse. Voiding will not prevent the recurrence of vaginitis.

A client reports stress incontinence, pelvic pain, and a feeling like "something is dropping out of my vagina." The client is diagnosed as having a pelvic organ prolapse and the treatment plan includes using a pessary. Which instructions will the nurse include in client education?

Apply a sterile lubricant to the pessary before it is reinserted. A pessary should be lubricated before insertion. Bedrest and alterations to voiding are not necessary to use the device safely and effectively.

A client is postoperative day 1 following a vaginal hysterectomy. The nurse notes an increase in the client's abdominal girth and the client complains of "bloating." What is the nurse's most appropriate action?

Apply warm compresses to the client's lower abdomen. If the client has abdominal distention or flatus, a rectal tube and application of heat to the abdomen may be prescribed. Ice and carbonated beverages are not recommended and prone positioning would be uncomfortable.

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?

Candidiasis Candidiasis is a fungal or yeast infection caused by strains of Candida. Miconazole (Monistat) is an antifungal medication used in the treatment of candidiasis. This agent is inserted into the vagina with an applicator at bedtime and may be applied to the vulvar area for pruritus. HPV, bacterial vaginosis, and TSS are not treated by Monistat.

A client who underwent an anterior colporrhaphy 6 hours ago has not voided. She reports some discomfort in her suprapubic area. Which of the following would the nurse expect to do?

Catheterize the client. After repair of a cystocele (anterior colporrhaphy), the client is encouraged to void within a few hours. If the client does not void within this period and reports discomfort or pain in the bladder region after 6 hours, the client should be catheterized to prevent pressure on the suture line. Stool softeners may be appropriate after a posterior colporrhaphy (repair of a rectocele) or repair of a complete perineal laceration. Ice can be applied locally after an external perineal repair. Because the client is post surgery, analgesics most likely would have been ordered already. In this situation, the pain is from bladder distention; relief of this distention through catheterization would subsequently relieve the client's pain.

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?

Cervical cancer 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 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?

Count and inspect each perineal pad that the client uses. To detect bleeding, the nurse counts the perineal pads used or checks the incision site, assesses the extent of saturation with blood, and monitors vital signs. The perineum is not swabbed and there is no reason to prohibit the use of the toilet. Absorbent pads are applied to the perineum; it is not open to air.

Which condition is a downward displacement of the bladder toward the vaginal orifice?

Cystocele 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 client has returned to the postsurgical unit after vulvar surgery. What intervention should the nurse prioritize during the initial postoperative period?

Monitoring the integrity of the surgical site An important intervention for the client who has undergone vulvar surgery is to monitor closely for signs of infection in the surgical site, such as redness, purulent drainage, and fever. The client should be placed in low Fowler position to reduce pain by relieving tension on the incision. Sitz baths are discouraged after of wide excision of the vulva because of the risk of infection. Analgesics should be administered preventively on a scheduled basis to relieve pain and increase the client's comfort level.

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 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.

A nurse providing prenatal care to a pregnant woman is addressing measures to reduce her postpartum risk of cystocele, rectocele, and uterine prolapse. What action should the nurse recommend?

Performance of pelvic muscle exercises Some disorders related to "relaxed" pelvic muscles (cystocele, rectocele, and uterine prolapse) may be prevented. During pregnancy, early visits to the primary provider permit early detection of problems. During the postpartum period, the woman can be taught to perform pelvic muscle exercises, commonly known as Kegel exercises, to increase muscle mass and strengthen the muscles that support the uterus and then to continue them as a preventive action. Fluid intake, prevention of constipation, and hygiene do not reduce this risk.

While caring for a client who is being treated for severe pelvic inflammatory disease (PID), which nursing action minimizes transmission of infection?

Performing hand hygiene when entering the room 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.

A 27-year-old female client is diagnosed with invasive cervical cancer and is told she needs to have a hysterectomy. One of the nursing diagnoses for this client is "disturbed body image related to perception of femininity." What intervention would be most appropriate for this client?

Reassure the client that she will still be able to have intercourse with sexual satisfaction and orgasm. The client needs reassurance that she will still have a vagina and that she can experience sexual intercourse after temporary postoperative abstinence while tissues heal. Information that sexual satisfaction and orgasm arise from clitoral stimulation rather than from the uterus reassures many women. Most women note some change in sexual feelings after hysterectomy, but they vary in intensity. In some cases, the vagina is shortened by surgery, and this may affect sensitivity or comfort. It would be inappropriate to reassure the client that she will still be able to have children; there is no reason to reassure the client about not being able to have sex. There is no way you can know how the client is feeling and it would be inappropriate to say so.

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?

"My partner will not need any treatment." 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 recurrence. Which client statement tells the nurse that the client effectively understands the prevention protocol?

"My sexual partner will also need to be treated." 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 nurse practitioner is examining a client who presented at the free clinic with vulvar pruritus. For which assessment finding would the practitioner look that may indicate the client has an infection caused by Candida albicans?

Cottage cheese-like discharge The symptoms of C. albicans include itching and a scant white discharge that has the consistency of cottage cheese. Yellow-green discharge is a sign of T. vaginalis. Gray-white discharge and a fishy odor are signs of G. vaginalis.

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, cheese-like vaginal discharge. Which condition is the client most likely experiencing?

Vulvovaginal candidiasis 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, cheese-like 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.

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 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.

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?

"This testing is offered to every adolescent and adult regardless of their lifestyle, appearance or history." Because clients may be reluctant to discuss risk-taking behavior, routine screening should be offered to all women between the ages of 13 to 64 years in all health care settings. Assuring a woman that the offer of testing is not related to a heightened risk may alleviate her anxiety. Middle-aged women are not the prime demographic for HIV infection. The nurse should avoid causing fear by immediately discussing treatment or the fact that many clients are unaware of their diagnosis.

A client has been diagnosed with cancer of the cervix. In what age group would the nurse expect the client to be?

35 to 50 years Cancer of the cervix has its peak incidence among women between 35 and 50 years of 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 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.

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?

Avoid commercial feminine hygiene products, such as sprays. Instead of tight-fitting synthetic, nonabsorbent, heat-retaining underwear, cotton underwear is recommended to prevent vaginal infections. Douching is generally discouraged, as is the use of feminine hygiene products. Daily bathing is not restricted.

A client has been diagnosed with endometriosis. When planning this client's care, the nurse should prioritize what nursing diagnosis?

Acute pain related to misplaced endometrial tissue Symptoms of endometriosis vary but include dysmenorrhea, dyspareunia, and pelvic discomfort or pain. Dyschezia (pain with bowel movements) and radiation of pain to the back or leg may occur. Ineffective tissue perfusion is not associated with endometriosis and there is no plausible risk of fluid overload. Endometriosis is not transmittable.

The history of a female patient reveals the following:First coitus at age 16 yearsFirst pregnancy at age 28 yearsSexual intercourse with circumcised partnerWeight appropriate for heightWhich of the following would alert the nurse to a possible risk factor for developing cervical cancer?

Age at first coitus Risk factors for developing cervical cancer include an early age with first coitus, early childbearing, overweight status, and sexual intercourse with uncircumcised males.

A client with challenging menopausal symptoms has discussed treatment options with the physician and now has some questions for the nurse. The client asks, "What are the potential risks of hormone replacement therapy?" What is the best answer?

All options are correct. In using hormonal replacement therapy, the risks of breast cancer and the seriousness of future myocardial infarction and stroke may outweigh the potential benefit of alleviating symptoms associated with menopause. The Women's Health Initiative study revealed an increase in breast cancer, blood clots, stroke, and heart disease in postmenopausal women taking HRT.

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 IV drug use 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.

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

Headache Fluid retention Low back pain Major symptoms of PMS include physical symptoms such as headache, fatigue, low back pain, painful breasts, and a feeling of abdominal fullness, caused by fluid retention. Fever and hypotension are not typical symptoms of PMS.

When teaching clients about the risk factors of cervical cancer, what would the nurse identify as the most important risk factor?

Human papillomavirus (HPV) HPV is the most salient risk factor for cervical cancer, exceeding the risks posed by smoking, late childbearing, and postmenopausal bleeding.

The nurse is providing education regarding sexually transmitted infections. Which statement regarding herpes virus 2 (herpes genitalis) is accurate?

In pregnant women with active herpes, babies delivered vaginally may become infected with the virus. A cesarean birth may be performed if the virus recurs near the time of delivery. Asexual transmission by contact with wet surfaces or self-transmission (i.e., touching a cold sore and then touching the genital area) can occur. Transmission is possible even when the carrier does not have symptoms.

A patient is diagnosed with the most common type of uterine fibroid, an intramural fibroid. The nurse includes which information in teaching the patient about this type of fibroid?

It grows within the wall of the uterine muscle.

Which is the main cause of anemia in a client with active uterine leiomyoma?

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

Which of the following should be a nurse's priority in considering causes for amenorrhea?

Pregnancy Pregnancy should always be excluded first when determining causes of amenorrhea.

A client with advanced vaginal cancer asks the nurse, "What is the usual treatment for this type of cancer?" Which treatment should the nurse name?

Radiation The usual treatment for advanced vaginal cancer is radiation. Chemotherapy typically is ordered only if vaginal cancer is diagnosed in an early stage, which is rare. Rarely, surgery may be combined with radiation. Immunotherapy isn't used to treat vaginal cancer.

A perimenopausal woman informs the nurse that she is having irregular vaginal bleeding. What should the nurse encourage the patient to do?

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

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?

The bladder must be emptied prior to surgery and a catheter may be placed during surgery. The intestinal tract and the bladder need to be empty before the client is taken to the OR to prevent contamination and injury to the bladder or intestinal tract. The client is informed that her periods are now over, but she may have a slightly bloody discharge for a few days. The client is instructed to avoid straining, lifting, or driving until her surgeon permits her to resume these activities. The client's hormonal balance is upset, which usually occurs in reproductive system disturbances. The client may experience depression and heightened emotional sensitivity to people and situations.

A 34-year-old client has been diagnosed with endometriosis. What topic should the nurse emphasize during health education?

The importance of reporting a possible pregnancy as soon as it occurs Clients with endometriosis need to report pregnancies as soon as possible so that relevant treatment can be provided. The disease is noninfectious, so there is no need to have the partner tested or to be prescribed antibiotics.

A female client has just been diagnosed with condylomata acuminata (genital warts). What information is most appropriate for the nurse to tell this client?

The warts may require surgical removal or cryotherapy Options for treatment of external genital warts by a primary provider include topical application of trichloroacetic acid, podophyllin (Podofin, Podocon), cryotherapy, as well as surgical removal. Because condylomata acuminata is a virus, there is no permanent cure. Because condylomata acuminata can occur on the vulva, a condom will not protect sexual partners. HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx.

When a female client reports a frothy, yellow-green vaginal discharge, the nurse suspects the client has a vaginal infection caused by which organism?

Trichomonas vaginalis Trichomonas vaginalis causes a frothy yellow-white or yellow-green vaginal discharge. Candidiasis causes a white, cheese-like 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 using a diagram to educate a client with a pelvic organ prolapse. Which condition would the client have based on the illustration?

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

Which is the earliest and the most common symptom of endometrial cancer?

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