Chapter 64 - Reproductive System

The nurse is conducting a reproductive assessment of a young adult client. What assessment question will the nurse ask? (Select all that apply.)

"Have you had any sexually transmitted infections?" "If you engage in sexual activities, do you practice 'safe' sex?" "Are you currently experiencing any reproductive concerns?" "When did you first start menstruating?" Asking the client about a history of sexually transmitted infections is a question included in the health perception/health management pattern for performing a reproductive assessment. If the answer is "yes," the nurse continues with "When?" and "What type?" The nurse will ask if the client has any current reproductive concerns that should be noted. It is important to assess, if the client is sexually active, that he or she practices (and understands) "safe" sex. This might include the use of condoms, being tested for human immunodeficiency virus, and other measures to keep from acquiring sexually transmitted infections. Although the nurse might inquire whether a client has experienced changes in his or her body appearance or function, asking about changes the client might want to see is not important in doing a reproductive assessment.

The nurse is educating a 22-year-old female about the Papanicolaou (Pap) test. Which client statement indicates that further teaching is needed? (Select all that apply.)

"I can have sexual intercourse the night before the test." "I will douche the morning before I have the Pap test performed." The client must not have sexual intercourse, douche, or use vaginal medications or deodorants for at least 24 hours before the test. These all may interfere with test interpretation; therefore, these misconceptions require further nursing teaching.The other client statements are accurate, and do not require further nursing teaching. Annual screening is recommended to 30 years of age with the conventional Pap test. The Pap smear is a cytologic study that is effective in detecting precancerous and cancerous cells in the cervix. The specimen-containing slides from a Pap smear are sent to a laboratory for evaluation.

An older adult client reports uncomfortable sexual intercourse associated with vaginal dryness. Which nursing response is appropriate?

"Products such as water-soluble lubricants may be helpful." Information about vaginal estrogen therapy and water-soluble lubricants need to be provided to the older adult client with vaginal dryness. There is no need to inform the primary health care provider because vaginal dryness is a normal change associated with aging. Additional pelvic examinations are not indicated for this client. Kegel exercises are used for clients with incontinence.

The health care provider has completed a cervical biopsy on a client. Which postprocedure teaching will the nurse provide?

"Use the antiseptic solution rinses to clean your perineum." The client must keep the perineum clean and dry by using antiseptic solution rinses as directed by the primary health care provider, and needs to change pads frequently. The client is told not have intercourse or lift heavy objects for about 2 weeks after the procedure. The client also needs to rest for 24 hours after the procedure.

What teaching does the nurse provide to a client prior to a mammogram?

"You must not wear deodorant the day of your mammogram." Remind the client not to use creams, lotions, powders, or deodorant on the breasts or underarms before the mammogram, because these products may be visible on the mammogram and lead to misdiagnosis. Mammography is an x-ray of the soft tissue of the breast. Dietary restrictions are not necessary before a mammogram. The client may experience some temporary discomfort when the breast is compressed during positioning and the test itself.

The human papilloma virus (HPV) test may be collected at the same time as the Papanicolaou (Pap) test for screening. Which finding indicates the highest risk for development of cervical cancer?

Abnormal Pap results and positive HPV test If not treated, women with an abnormal Pap results and a positive HPV test have the highest risk for developing cervical cancer. Women who have normal Pap test results and no HPV infection are at the lowest risk for developing cervical cancer.

Which statement does the nurse identify as accurate regarding the prostate-specific antigen (PSA) test?

African-American men may benefit from starting PSA screening at age 40. Health care providers may interpret the results of the PSA test differently. The PSA test can be used to monitor the disease course after treatment. Although elevated PSA levels may be associated with prostate cancer, there is variance among health care providers in interpretation of results. Levels less than 2.5 to 4.0 ng/mL may be considered normal depending on the resource used. The PSA test can be used to screen for prostate cancer, as well as to monitor the disease after treatment.Certain factors such as digital rectal examination (DRE), prostatitis, acute urinary retention, and ejaculation can cause transient rises in PSA. African-American men are 1.6 times as likely to develop prostate cancer and twice as likely to die from it compared to white men. For this reason, teach African-American male patients to begin prostate cancer screening at age 40.

A client scheduled for a hysterosalpingogram is interviewed by the nurse. What interview information is critical for the nurse to report to the primary health care provider before the procedure?

Allergy to shellfish The contrast medium used during hysterosalpingography is iodine-based, so the primary health care provider will need to know if the client is allergic to shellfish. Obstetric history, menstrual history, and recent medications are communicated to the primary health care provider but do not require any change in the procedure. Two months between an abortion and this procedure is adequate. This test is done just at the completion of menses so that it would not interrupt a pregnancy in the uterus or the fallopian tube.

The nurse is teaching a group of young women. Which factor does the nurse teach increases a women's risk for development of cervical cancer?

Having sexual intercourse at a very early age Having intercourse at a very early age and/or multiple sex partners places a woman at high risk for the development of cervical cancer. Eating a diet that is high in fat content, the number of pregnancies, and using a diaphragm have not been identified as increasing the risk for cervical cancer.

The nurse is obtaining a personal health history on a 21-year-old male. How does the nurse approach questions about his sexual practices?

Respect the client's choice to answer or not answer questions about sexual practices. Respecting the client's choice to answer or not answer questions about sexual practices is an important part of the process of taking the sexual history of any client. Deferring questions about sexual practices to the primary health care provider or skipping questions is inappropriate, as important health information may be missed. All adult clients should be offered the opportunity to discuss sexual practices as these relate to patient-centered care.

A client with pelvic pain is admitted to the same-day surgery unit for a laparoscopic procedure. Which nursing action will the RN delegate to assistive personnel (AP)?

Taking admission blood pressure and heart rate Although most of the admission assessment and history will be completed by the RN, the admission vital signs can be delegated to a AP. Client education and teaching is a higher-level skill and must be done by the RN. Catheter insertion is also a higher-level skill and would be done by the RN.

A 68-year-old client has recently undergone a prostate biopsy. Which assessment finding will the nurse report to the health care provider?

Temperature of 101.6° F (38.7° C) Rarely, sepsis can develop after a prostate biopsy. However, clients need to be told to contact their primary health care provider immediately if they experience fever, pain when urinating, or penile discharge. Expected findings after a prostate biopsy may include slight soreness, light rectal bleeding, and blood in the urine or stools for a few days. Semen may be red or rust-colored for several weeks.

The nurse is reviewing a laboratory report that indicates a decrease in a client's estradiol level. How does the nurse interpret this information?

The client may be in menopause. Decreased levels of estradiol in a client may indicate menopause, hypopituitarism, anorexia nervosa, or a possible pregnancy concern. This laboratory finding does not indicate a normal pregnancy, pregnancy with twins, or the presence of a malignant tumor.