Chapter 7 -- Benign Disorders of the Female Reproductive Tract

A nurse is teaching a client how to perform Kegel exercises. Which of the following would the nurse include? (Select all that apply.) A) "Squeeze your rectal muscles as if you are trying to avoid passing flatus." B) "Tighten your pubococcygeal muscle for a count of 10." C) "Contract and relax your pubococcygeal muscle rapidly 10 times." D) "Try bearing down for about 10 seconds for no more than 5 times." E) "Do these exercises at least 5 times every hour."

A C

A client presents to the office reporting severe lower abdominal pain. Ultrasound reveals an ovarian cyst. The client asks, "Is the cyst benign?" The nurse responds, explaining that ovarian cysts are benign approximately how often? 90% of the time 70% of the time 50% of the time 30% of the time

90% of the time Ovarian cyst are very common growths that are benign 90% of the time. They are also asymptomatic in many women. When the cysts grow large and exert pressure on surrounding structures, women often seek medical treatment.

To assist the woman in regaining control of the urinary sphincter for urinary incontinence, the nurse should teach the client to do which of the following? A) Perform Kegel exercises daily. B) Void every hour while awake. C) Limit her intake of fluid. D) Take a laxative every night.

A

When preparing the discharge teaching plan for the woman who had surgery to correct pelvic organ prolapse, which of the following would the nurse include? A) Care of the indwelling catheter at home B) Emphasis on coughing to prevent complications C) Return to usual activity level in a few days D) Daily douching with dilute vinegar solution

A

Which of the following would the nurse include when teaching women about preventing pelvic support disorders? A) Performing Kegel isometric exercises B) Consuming low-fiber diets C) Using hormone replacement D) Voiding every 2 hours

A

A woman with uterine prolapse has undergone a vaginal hysterectomy and is being discharged home with an indwelling urinary catheter in place. The client will be using a leg bag during the day. Which instructions would the nurse most likely include in the client's discharge teaching plan? Select all that apply. "Clean your perineal area each day with a mild soap and water." "Keep the leg bag anchored on your abdomen, above your bladder." "Be sure to empty your leg bag frequently throughout the day." "You shouldn't have any problems urinating after the catheter is removed." "Avoid cleaning around the area where the catheter is inserted."

"Clean your perineal area each day with a mild soap and water." "Be sure to empty your leg bag frequently throughout the day." The client needs to understand that a Foley catheter will be in place for up to 1 week and that she might not be able to urinate due to the swelling after the catheter has been removed. The client should cleanse the perineal area daily with mild soap and water, especially around where the catheter enters the urinary meatus. If the woman is provided with a leg bag to be worn during waking hours, instruct her to empty it frequently and keep it below the level of the bladder to prevent backflow. The same principles are applied to the primary Foley bag when emptying it.

A nurse is preparing a client for discharge following an abdominal hysterectomy for fibroids. After providing discharge teaching, the nurse determines that the teaching was successful based on which client statement? "I can resume using tampons in about 3 weeks." "I don't have any restrictions on what I can lift or carry." "I should shower rather than take a tub bath." "I should limit my intake of foods that are high in fiber for about 2 weeks."

"I should shower rather than take a tub bath." Following an abdominal hysterectomy, the client should not insert anything in her vagina for about 6 weeks (pelvic rest), should avoid heavy lifting or straining for about 6 weeks, shower rather than take tub baths, and increase her intake of high-fiber foods to promote bowel elimination and prevent straining.

A client is to have a vaginal hysterectomy to repair her stage IV uterine prolapse. The nurse realizes she needs more education when she states: "I'm not going home with a Foley catheter in place." "The leg bag will be covered by my clothes, once I am home." "My husband is not crazy about the six weeks of pelvic rest." "I have already picked up the stool softeners."

"I'm not going home with a Foley catheter in place." A Foley catheter will be left in place for up to one week to allow the surgical site time to heal properly. The client may also experience some dysuria once it is removed due to the swelling that can occur. The client will need instructions on how to properly care for a leg bag, the importance of pelvic rest to allow for proper healing, and using stool softeners to avoid straining or stressing the pelvic region.

A nurse is reviewing the various treatment options with a client diagnosed with uterine fibroids. The nurse determines that the teaching was successful based on which statement? "If I use hormone therapy, my fibroids may grow back when I stop the medication." "A myomectomy will not allow me to keep my uterus." "Uterine artery embolization is associated with minimal pain." "Laser surgery won't affect my ability to have children."

"If I use hormone therapy, my fibroids may grow back when I stop the medication." Typically, with hormonal therapy, fibroids regrow when the medication is stopped. A myomectomy preserves the uterus. Uterine artery embolization is frequently painful. Laser surgery can cause scarring and adhesions which could impact future fertility.

The nurse is conducting a presentation about urinary incontinence for a local women's group. During the presentation, which statement by a member of the group would the nurse need to clarify? "It's normal for a woman to develop incontinence as she ages." "There are ways to prevent urinary incontinence." "Urinary incontinence is a treatable condition." "Incontinence can be cured in some cases."

"It's normal for a woman to develop incontinence as she ages." A common misconception is that incontinence is an age-related change. It is not a normal part of aging. Urinary incontinence is preventable, treatable, and often curable.

A client diagnosed with pelvic organ prolapse is being taught how to perform pelvic floor muscle exercises. During the teaching session, the client asks the nurse, "How do these exercises help?" Which response by the nurse would be most appropriate? "They help to increase the volume of your muscles which leads to stronger muscle contraction." "They help to move the pelvic floor upward so that your symptoms eventually decrease." "The exercises increase the amount of blood that your muscles receive making them less relaxed." "The exercises help you to establish regular bowel elimination patterns so you don't strain so much."

"They help to increase the volume of your muscles which leads to stronger muscle contraction." The purpose of pelvic floor exercises is to increase the muscle volume, which will result in a stronger muscular contraction. The exercises do not move the pelvic floor upward, increase blood supply, or establish regular elimination patterns.

The nursing instructor is teaching a student about urinary incontinence and realizes that the student needs further instruction when she makes which statement? "For many women with urge incontinence simple reassurance and lifestyle interventions might help." "Urinary incontinence is an inevitable problem of aging." "There are many effective treatments for urinary incontinence." "Urinary incontinence is not an inevitable problem of aging."

"Urinary incontinence is an inevitable problem of aging." There is a widespread belief that urinary incontinence is an inevitable problem of getting older and that little or nothing can be done to relieve symptoms or reverse it. This is not true. For many women with urge incontinence simple reassurance and lifestyle changes might help. If they do not, numerous effective treatments are available.

The nurse is teaching a female client about early-stage pelvic organ prolapse. Which statement that centers on dietary and lifestyle changes will promote pelvic relaxation and decrease chronic problems later in life? "You will need to increase fiber in your diet." "You will need to avoid products that contain caffeine." "You will want to avoid increasing your fluid intake." "You will want to add high-impact exercise to your routine or increase time spent on it."

"You will need to increase fiber in your diet." A dietary fiber increase and an increase in fluids will help avoid constipation, which puts a strain on the intra-abdominal cavity and pelvic organs. An increase in fiber will help to stimulate peristalsis. The recommended amount of fiber is 25 mg daily. Avoiding caffeine will not change symptoms. The client should avoid high-impact exercise because it increases intra-abdominal pressure.

A nurse is reviewing the medical record of a client. Which of the following would lead the nurse to suspect that the client is experiencing polycystic ovary syndrome? (Select all that apply.) A) Decreased androgen levels B) Elevated blood insulin levels C) Anovulation D) Waist circumference of 32 inches E) Triglyceride level of 175 mg/dL F) High-density lipoprotein level of 40 mg/dL

BCE

A client with polycystic ovary syndrome (PCOS) is receiving oral contraceptives as part of her treatment plan. The nurse understands that the rationale for this therapy is to: A) Restore menstrual regularity B) Induce ovulation C) Improve insulin uptake D) Alleviate hirsutism

A

A woman is scheduled for an anterior and posterior colporrhaphy as treatment for a cystocele. When the nurse is explaining this treatment to the client, which of the following descriptions would be most appropriate to include? A) "This procedure helps to tighten the vaginal wall in the front and back so that your bladder and urethra are in the proper position." B) "Your uterus will be removed through your vagina, helping to relieve the organ that is putting the pressure on your bladder." C) "This is a series of exercises that you will learn to do so that you can strengthen your bladder muscles." D) "These are plastic devices that your physician will insert into your vagina to provide support to the uterus and keep it in the proper position."

A

A woman with polycystic ovary syndrome tells the nurse, "I hate this disease. Just look at me! I have no hair on the front of my head but I've got hair on my chin and upper lip. I don't feel like a woman anymore." Further assessment reveals breast atrophy and increased muscle mass. Which nursing diagnosis would most likely be a priority? A) Situational low self-esteem related to masculinization effects of the disease B) Social isolation related to feelings about appearance C) Risk for suicide related to effects of condition and fluctuating hormone levels D) Ineffective peripheral tissue perfusion related to effects of disease on vasculature

A

After teaching a group of students about ovarian cysts, the instructor determines that the teaching was successful when the students identify which type of cyst as being associated with hydatiform mole? A) Theca-lutein cyst B) Corpus luteum cyst C) Follicular cyst D) Polycystic ovary syndrome

A

A nurse is reading a journal article about care of the woman with pelvic organ prolapse. The nurse would expect to find information related to which of the following? (Select all that apply.) A) Rectocele B) Fecal incontinence C) Cystocele D) Urinary incontinence E) Enterocele

A, C, E

Conservative treatment options available for women with pelvic organ prolapse are: a. Pessaries and PFM exercises b. External pelvic fixation devices c. Weight gain and yoga d. Firm panty-and-girdle garments

A. Both pessaries and Kegel exercises help hold up and strengthen the pelvic floor to restore the pelvic organs to their correct anatomic position.

Which of the following dietary and lifestyle modifications might the nurse recommend to help prevent pelvic relaxation as women age? a. Eat a high-fiber diet to avoid constipation and straining. b. Avoid sitting for long periods; get up and walk around frequently. c. Limit the amount of exercise to prevent overdeveloping muscles. d. Space children a year apart to reduce wear and tear on the uterus.

A. Preventing constipation and straining with defecation would lessen the strain on pelvic organs. *B is incorrect: sitting for long periods will not affect pelvic organ movement. Gravity will create a downward pull on all organs regardless of the position, sitting or standing.

A diabetic client who also suffers from urinary incontinence knows the importance of maintaining her blood glucose levels. This is doubly important for this type of client in regards to her incontinence because of which factor? Abnormal glucose levels can cause polyuria. Abnormal glucose levels can cause polyphagia. Abnormal glucose levels can cause polydipsia. all of the above

Abnormal glucose levels can cause polyuria. Managing urinary incontinence is extremely important for a diabetic. Abnormal blood glucose levels (such as seen in hypergylcemia) can cause polyuria, which will add to the incontinence problem. The others might also be present when a client suffers from hyperglycemia, but they do not affect the incontinence the client is suffering from.

A nurse is reviewing the medical record of a woman diagnosed with a uterine fibroid. The nurse would identify which factors as predisposing the client to this condition? Select all that apply. age of 38 African American ethnicity history of hypertension multiparity underweight

African American ethnicity history of hypertension Although the cause of fibroids is not known, several predisposing factors have been identified: age (late reproductive years), with peak incidence occurring around age 45; African American ethnicity; hypertension; nulliparity; and obesity.

After teaching a woman with pelvic organ prolapse about dietary and lifestyle measures, which of the following statements would indicate the need for additional teaching? A) "If I wear a girdle, it will help support the muscles in the area." B) "I should take up jogging to make sure I exercise enough." C) "I will try to drink at least 64 oz of fluid each day." D) "I need to increase the amount of fiber I eat every day.

B

The nurse would be least likely to find which of the following in a client with uterine fibroids? A) Regularly shaped, shrunken uterus B) Acute pelvic pain C) Menorrhagia D) Complaints of bloating

B

When developing the plan of care for a woman who has had an abdominal hysterectomy, which of the following would be contraindicated? A) Ambulating the client B) Massaging the client's legs C) Applying elasticized stockings D) Encouraging range-of-motion exercises

B

After undergoing diagnostic testing, a woman is diagnosed with a corpus luteum cyst. The nurse anticipates that the woman will require: A) Biopsy B) No treatment C) Oral contraceptives D) Glucophage

B Corpus luteum cysts form when the corpus luteum becomes cystic or hemorrhagic and fails to degenerate after 14 days. Typically, these cysts appear after ovulation and resolve without intervention. Biopsy would be indicated if a malignancy was suspected. Oral contraceptives and metformin would be used to treat polycystic ovarian syndrome.

The primary care provider has prescribed estrogen replacement therapy (ERT) for a menopausal woman who has been diagnosed with pelvic organ prolapse (POP). The client asks the nurse why she needs to be on hormones. Which would be the nurse's best response? A. Hormone replacement will decrease blood perfusion and the elasticity of the vaginal wall. B. Hormone replacement will increase blood perfusion and the elasticity of the vaginal wall. C. Hormone replacement will increase the blood perfusion and decrease the elasticity of the vaginal wall. D. Hormone replacement will decrease blood perfusion and increase the elasticity of the vaginal wall.

B. Hormone replacement will increase blood perfusion and the elasticity of the vaginal wall. Hormone replacement therapy may improve the tone and vascularity of the supporting tissue in perimenopausal and menopausal women by increasing blood perfusion and the elasticity of the vaginal wall.

A client is diagnosed with an enterocele. The nurse interprets this condition as: A) Protrusion of the posterior bladder wall downward through the anterior vaginal wall B) Sagging of the rectum with pressure exerted against the posterior vaginal wall C) Bulging of the small intestine through the posterior vaginal wall D) Descent of the uterus through the pelvic floor into the vagina

C

A nurse is providing care to a female client receiving treatment for a Bartholin's cyst. The client has had a small loop of plastic tubing secured in place to allow for drainage. The nurse instructs the client that she will have a follow-up appointment for removal of the plastic tubing at which time? A) 1 week B) 2 weeks C) 3 weeks D) 4 weeks

C

After teaching a group of students about genital fistulas, the instructor determines that the teaching was successful when the students identify which of the following as a major cause? A) Radiation therapy B) Congenital anomaly C) Female genital cutting D) Bartholin's gland abscess

C

When teaching a woman how to perform Kegel exercises, the nurse explains that these exercises are designed to strengthen which muscles? A) Gluteus B) Lower abdominal C) Pelvic floor D) Diaphragmatic

C

Women with polycystic ovarian syndrome (PCOS) are at increased risk for developing which of the following long-term health problems? a. Osteoporosis b. Lupus Type c. 2 diabetes d. Migraine headaches

C. Insulin resistance is characterized by failure of insulin to enter cells appropriately, resulting in hyperinsulinemia, a characteristic of PCOS. Factors that contribute to this include obesity, physical inactivity, and poor dietary habits. This person is at risk for developing type 2 diabetes secondary to insulin resistance.

When you are interviewing a client with uterine fibroids, what subjective data would you expect to find in her history? a. Cyclic migraine headaches b. Urinary tract infections c. Chronic pelvic pain d. Chronic constipation

C. Pressure against adjacent structures and stretching of the uterine muscle with increasing growth of the fibroid creates pain

A nurse is caring for a female client with urinary incontinence. Which instructions should the nurse include in the client's teaching plan to reduce the incidence or severity of incontinence? Select all that apply. Continue pelvic floor exercises. Increase fiber in the diet. Increase intake of orange juice. Control blood glucose levels. Wipe from back to front.

Continue pelvic floor exercises. Increase fiber in the diet. Control blood glucose levels. The teaching guidelines include continuing pelvic floor (Kegel) exercises, increasing fiber in the diet to reduce constipation, and controlling blood glucose levels to prevent polyuria. The nurse should instruct the client to reduce the intake of fluids and foods that are bladder irritants, such as orange juice, soda, and caffeine, and the client should wipe from front to back to prevent urinary tract infections.

A group of students are preparing a class presentation about polyps. Which of the following would the students most likely include in the presentation? A) Polyps are rarely the result of an infection. B) Endocervical polyps commonly appear after menarche. C) Cervical polyps are more common than endocervical polyps. D) Endocervical polyps are most common in women in their 50s.

D

A nurse is assessing a female client and suspects that the client may have endometrial polyps based on which of the following? A) Bleeding after intercourse B) Vaginal discharge C) Bleeding between menses D) Metrorrhagia

D

A postmenopausal woman with uterine prolapse is being fitted with a pessary. The nurse would be most alert for which side effect? A) Increased vaginal discharge B) Urinary tract infection C) Vaginitis D) Vaginal ulceration

D

A woman is admitted for repair of cystocele and rectocele. She has nine living children. In taking her health history, which of the following would the nurse expect to find? A) Sporadic vaginal bleeding accompanied by chronic pelvic pain B) Heavy leukorrhea with vulvar pruritus C) Menstrual irregularities and hirsutism on the chin D) Stress incontinence with feeling of low abdominal pressure

D

A woman is being evaluated for pelvic organ prolapse. A postvoid residual urine specimen is obtained via a catheter. Which residual volume finding would lead the nurse to suspect the need for further testing? A) 50 mL B) 75 mL C) 100 mL D) 120 mL

D

After teaching a group of students about pelvic organ prolapse, the instructor determines that the teaching was successful when the group identifies leiomyomas as which of the following? A) Cysts B) Pelvic organ prolapse C) Fistula D) Fibroid

D

After teaching a local woman's group about incontinence, the nurse determines that the teaching was successful when the group identifies which of the following as characteristic of stress incontinence? A) Feeling a strong need to void B) Passing a large amount of urine C) Most common in women after childbirth D) Sneezing may be an initiating stimulus

D

Side effects experienced by women taking gonadotropin-releasing hormone (GnRH) agonists for the treatment of fibroids closely resemble those of: a. Anorexia nervosa b. Osteoarthritis c. Depression d. Menopause

D. GnRH agonists block the production of estrogen, which produces menopausal symptoms.

A nurse is preparing a presentation for a group of women which will cover various dietary and lifestyle changes to help avoid future pelvic structure changes. Which key point should the nurse point out in this presentation to the women? Limit fiber intake to less than 25 grams daily. Eat more refined, processed foods. Drink plenty of fluids each day. Engage in vigorous exercise.

Drink plenty of fluids each day. All women should drink at least eight 8-ounce glasses of fluid a day. Fiber intake needs to be increased; the recommended daily intake of fiber for women is 25 grams. Refined, processed, low-fiber foods need to be replaced with high-fiber foods. The women should be encouraged to perform Kegel exercises to help increase the strength of the pelvic floor muscles. Other exercising should also be encouraged but the Kegel exercises are specific to the affected area which will lead to pelvic floor prolapse. Depending on the type of vigorous exercise, some will actually result in pelvic floor prolapse, if it puts lots of strain on the pelvic floor.

A nurse is caring for a client for whom estrogen replacement therapy has been recommended for pelvic organ prolapse. Which nursing intervention is the most appropriate for the nurse to implement before the start of the therapy? Discuss the effective dose of estrogen required to treat the client. Evaluate the client to validate her risk for complications. Discuss the dietary modifications following therapy. Discuss the cost of estrogen replacement therapy.

Evaluate the client to validate her risk for complications. Before starting estrogen replacement therapy, each woman must be evaluated on the basis of a thorough medical history to validate her risk for complications such as endometrial cancer, myocardial infarction, stroke, breast cancer, pulmonary emboli, or deep vein thrombosis. The effective dose of estrogen required, the dietary modifications, and the cost of estrogen replacement therapy can be discussed at a later stage when the client understands the risks associated with estrogen replacement therapy and decides to use hormone therapy.

The mother of four small children comes to the clinic and has just been diagnosed with an enterocele. What should the nurse teach the client about her diagnosis? Her small intestine and peritoneum are jutting downward between the uterus and the rectum. Her rectum is protruding into the back wall of the vagina. Her uterus has prolapsed and is causing this bulge. Her bladder is bulging into the front wall of the vagina.

Her small intestine and peritoneum are jutting downward between the uterus and the rectum. The names of pelvic support disorders correspond to the affected organs. Enterocele occurs when the small intestine and peritoneum jut downward between the uterus and rectum. Cystocele occurs when the bladder bulges into the front wall of the vagina. Rectocele occurs when the rectum protrudes into the back wall of the vagina. Uterine prolapse occurs when the uterus drops down into the vagina.

A client comes to the genitourinary clinic with very mild symptoms of pelvic organ prolapse (POP) that has just started in the last several days. What would be the treatment of choice for this client? a. surgery b. Kegel exercises c. nothing d. colpexin sphere

Kegel exercises strengthen the pelvic floor muscles to support the inner organs and prevent further prolapse; they might limit the progression of mild prolapse and alleviate some symptoms. They will not, however, help severe uterine prolapse. Surgery is for more severe cases. Doing nothing is not an option, and the colpexin sphere would be used in a case that had more pronounced symptoms.

a client who reported changes in her normal voiding pattern and altered bowel habits is diagnosed with polycystic ovarian syndrome. Which instructions is most appropriate for the nurse to provide the client to help alleviate her condition? a. adhere to follow-up-care b. increase intake of fiber c. increase fluid intake d. perform Kegel exercises

a. the nurse should stress follow-up-care so that the client does not overlook this benign disorder.

A nurse is caring for a 45-year-old client using a pessary to help decrease leakage of urine and support a prolapsed vagina. Which recommendation is most commonly provided to a client regarding pessary care? Douche the vaginal area with diluted vinegar or hydrogen peroxide. Remove the pessary twice weekly, and clean it with soap and water. Use estrogen cream to make the vaginal mucosa more resistant to erosion. Remove the pessary before sleeping or intercourse.

Remove the pessary twice weekly, and clean it with soap and water. The most common recommendation for pessary care is removing the pessary twice weekly and cleaning it with soap and water. In addition, douching with diluted vinegar or hydrogen peroxide helps to reduce urinary tract infections and odor, which are side effects of using a pessary. Estrogen cream is applied to make the vaginal mucosa more resistant to erosion and strengthen the vaginal walls. Removing the pessary before sleeping or intercourse is not part of the instructions for pessary care.

During a routine physical examination, the client is noted to have a Bartholin's cyst abcess. The nurse recognizes the need to obtain testing to rule out: STI. cancer. fungal infection. UTI.

STI. Cultures of the purulent abscess fluid and of the cervix should be obtained for Neisseria gonorrhea and Chlamydia trachomatis to rule out sexually transmitted infection. A careful history should include questions concerning the woman's sexual practices and protective measures used.

A client with abnormal uterine bleeding is diagnosed with small ovarian cysts. The nurse has to educate the client on the importance of routine check-ups. Which assessment is most appropriate for this client's condition? Monitor gonadotropin level every month. Monitor blood sugar level every 15 days. Schedule periodic Pap smears. Schedule an ultrasound every 3 to 6 months.

Schedule an ultrasound every 3 to 6 months. The nurse should monitor the client with ultrasound scans every 3 to 6 months. Monitoring gonadotropin level and blood sugar level and scheduling periodic Pap smears are not important assessments for the client with small ovarian cysts.

A nurse is providing discharge teaching to a client who needs Kegel exercises to strengthen the pelvic floor muscles. Which guideline would be appropriate to teach the client? Repeat Kegel exercises once a week. Try to bring up the entire pelvic floor and bear down 3 times. Squeeze the muscles in your rectum as when you are trying to prevent passing flatus. Contract and relax the pubococcygeus muscle rapidly 2 times.

Squeeze the muscles in your rectum as when you are trying to prevent passing flatus. Teaching guidelines for teaching clients about Kegel exercises include the following: Exercises should be repeated 5 times a week; the pelvic floor should be raised followed by bearing down 10 times. Contraction and relaxation of the pubococcygeus muscle should be done 10 times quickly. The only correct guideline listed here is to squeeze the muscles in your rectum as when you are trying to prevent passing flatus.

A 36-year-old was diagnosed with uterine fibroids (leiomyomas). The nurse teaches the client to expect which clinical manifestation? decrease in fibroid size if pregnancy occurs diarrhea acute abdominal pain abnormal uterine bleeding

abnormal uterine bleeding Fibroids are dependent on estrogen and grow rapidly during the childbearing years unless menopause occurs. Abnormal uterine bleeding is a clinical manifestation. Diarrhea is not a factor; constipation and abdominal pain can occur if fibroids are getting larger.

A client with large uterine fibroids is scheduled to undergo a hysterectomy. Which intervention should the nurse perform as a part of the preoperative care for the client? Teach turning, deep breathing, and coughing. Instruct the client to reduce activity level. Educate the client on the need for pelvic rest. Instruct the client to avoid a high-fat diet.

Teach turning, deep breathing, and coughing. The nurse should teach the client turning, deep breathing, and coughing prior to the surgery to prevent atelectasis and respiratory complications such as pneumonia. Reducing activity level and the need for pelvic rest are instructions related to discharge planning after the client has undergone a hysterectomy. A high fat diet need not be avoided before undergoing hysterectomy; avoiding a high-fat diet is required for clients with pelvic organ prolapse to reduce constipation.

A nurse needs to provide preoperative care to a woman who is undergoing a scheduled hysterectomy. Her diagnosis is uterine fibroids. Which preoperative instruction should the nurse provide? The client should reduce her activity. The client should turn, cough, and deep-breathe. The client should avoid a high-calorie diet. The client should rest the pelvic area.

The client should turn, cough, and deep-breathe. The client should learn to turn, cough, and deep-breathe to prevent postoperative respiratory issues such as atelectasis and pneumonia. Discharge planning after surgery is completed will include instructions on resting the pelvis and decreasing activity. Regular surgery does not require a reduction in calories.

In securing a health history of a 65-year-old woman, which clinical manifestation described by the client would the nurse suspect is related to pelvic organ prolapse? a. Chronic abdominal pain b. Heavy feeling or dragging in vagina c. Uterine cramping and backache d. Weight gain and edema of ankles

The correct response is "B" because when pelvic organs prolapse into the vaginal area, most women will experience a feeling of dragging, a lump in the vagina, or something coming down. Their symptoms are related to the site and type of prolapse. Responses "A," "C," and "D" are incorrect since none of them are directly related to pelvic organ prolapse.

Structural disorders that cause prolapse of reproductive organs in women can be aided by the practice of Kegel exercises. When the nurse is explaining Kegel exercises to a client, which information is most important to include? These exercises should be done after a meal. These exercises will relieve mild prolapse symptoms. These exercises are not to be performed after surgery. These exercises will increase blood pressure.

These exercises will relieve mild prolapse symptoms. Kegel exercises can alleviate mild prolapse symptoms and may even aid in stopping the progression of prolapse. Symptoms that may be decreased include pelvic pressure and low back pain. These exercises may be done after surgery; they do not increase blood pressure and are not affected by food.

The nurse would expect which client to be at a high risk for developing a pelvic support disorder? an 18-year-old college freshman a 29-year-old mother of one son a 60-year-old mother with four children a 30-year-old who just gave birth to twin girls

a 60-year-old mother with four children Women may experience pelvic support disorders related to pelvic relaxation or urinary continence. These disorders usually develop after years of wear and tear on the muscles and tissues that support the pelvic floor, such as what occurs with childbearing, chronic coughing, straining, surgery, or simply aging.

The nursing instructor is teaching about Bartholin cysts and informs the students that Bartholin cysts are the most common cystic growth in the vulva. She describes this type of cyst as being: a benign proliferation composed of smooth muscle and fibrous connective tissue in the uterus. a swollen, fluid-filled, sac-like structure. a small growth that is benign. an abnormal opening between a genital tract organ and and another organ.

a swollen, fluid-filled, sac-like structure. A Bartholin cyst is a swollen, fluid-filled, sac-like structure that results when one of the ducts of the Bartholin's gland becomes blocked. A uterine fibroid is a benign proliferation composed of smooth muscle and fibrous connective tissue in the uterus. A fistual is a abnormal opening between a genital tract organ and another organ. A polyp is a small benign growth

a 40- year-old client reports low back pain after standing for a long time. The primary care provider has diagnosed the client with pelvic organ prolapse. The nurse correctly recognizes which client are likely not candidates for corrective surgery for pelvic organ prolapse? select all that apply a. client with low back pain and pelvic pressure b. client at high risk of recurrent prolapse after surgery c. client who is morbidly obese before surgery d. client who has severe organ prolapse e. client has chronic obstructive pulmonary disease

b,c,e

Kegel exercises are recommended for a client with pelvic organ prolapse. Which information about the exercises should the nurse give the client? a. they should be performed after food intake b. they alleviate mild prolapse symptoms c. not recommended after surgery D. increase BP

b. it may limit progression of mild prolapse and alleviate mild prolapse symptoms, including low back pain and pelvic pressure. They do not t cause increase in BP

A client has presented to the clinic reporting "things not feeling right down there." After discussing the situation with her, the nurse has identified which factors that suggest the woman has a high risk for pelvic organ prolapse? Select all that apply. birth trauma straining with chronic constipation obesity older age for first birth infant birth weight less than 4,500 grams

birth trauma straining with chronic constipation obesity Factors associated with pelvic organ prolapse include birth trauma, young age at first birth, increased abdominal pressure secondary to straining with chronic constipation, obesity, and infant birth weight above 4,500 grams.

Assessment of a client reveals evidence of a cystocele. The nurse interprets this as: herniation of the rectum into the vagina. protrusion of intestinal wall into the vagina. downward displacement of the cervix. bulging of the bladder into the vagina.

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

A nurse is caring for a female client with symptoms of first-degree pelvic organ prolapse. Which instruction related to dietary and lifestyle modifications should the nurse provide to the client to help prevent pelvic relaxation and chronic problems later in life? a. Avoid caffeine products. b. Avoid excess intake of fluids. c. Increase dietary fiber. d. Increase high-impact aerobics.

c. to prevent constipation

A nurse is caring for a 32-year-old client for whom pessary usage is recommended for uterine prolapse. Which instruction should the nurse include in the teaching plan for the client concerning the pessary? a. Avoid jogging and jumping. b. Wear a girdle or abdominal support. c. Report any discomfort with urination and defecation. d. Avoid lifting heavy objects.

c. Report any discomfort with urination and defecation. The nurse should instruct the client using a pessary to report any discomfort or difficulty with urination or defecation. Avoiding high-impact aerobics, jogging, jumping, and lifting heavy objects, as well as wearing a girdle or abdominal support, are recommended for a client with prolapse as part of lifestyle modifications and may not be necessary for a client using a pessary.

A nurse is assisting with the pelvic exam of a woman who has come to the clinic with reports of abnormal vaginal bleeding. The client is diagnosed with an endocervical polyp. The nurse understands that the pelvic exam most likely revealed a polyp appearing as: cherry red. grayish-white. purplish-blue. pinkish-gray.

cherry red. Most endocervical polyps are cherry red; most cervical polyps are grayish-white.

A client who stands all day at her job has been diagnosed with pelvic organ prolapse. The client is asking the nurse in the office about whether she will be a candidate for surgery. The nurse knows that which documented findings will make the client ineligible for surgery? Select all that apply. documented low back pain and pelvic pressure documented risk for recurrent prolapse after surgery documented morbid obesity documented severe pelvic organ prolapse documented chronic obstructive pulmonary disease

documented risk for recurrent prolapse after surgery documented morbid obesity documented chronic obstructive pulmonary disease Women who are at too high a risk and therefore are not surgery candidates include those who are morbidly obese, have chronic obstructive pulmonary disease, and are at risk for recurrent prolapse. Most pelvic disorders manifest with symptoms of low back pain and pelvic pressure. A client with severe pelvic prolapse may very well be a surgery prospect.

A nurse is assessing a client who comes to the clinic reporting urinary incontinence. The nurse suspects that the client may be experiencing urge incontinence based on which findings? Select all that apply. frequency pain on urination nocturia small volume of urine leakage burning when urinating

frequency nocturia Urge incontinence is characterized by urgency, frequency, nocturia, and a large amount of urine loss. There is no pain or burning.

The client who has a uterine prolapse has been given a pessary. When teaching the client about the use of this device, the nurse should teach the client to monitor which common side effects? Select all that apply. increased vaginal discharge decrease in urinary output UTI vaginitis odor

increased vaginal discharge UTI vaginitis odor When educating the client about the use of a pessary the nurse should also include side effects. Because this is a foreign body in the vagina, the most common side effects are increased vaginal discharge, UTIs, vaginitis and odor. Decreased output is not associated with using a pessary.

A nurse is conducting a health promotion program, encouraging lifestyle changes to help clients prevent various benign and treatable conditions. Which suggestions would the nurse most likely include? Select all that apply. low-fat diet regular exercise high-impact aerobics high vegetable-fruit diet adequate fluid intake

low-fat diet regular exercise high vegetable-fruit diet adequate fluid intake Many of the conditions can be improved and/or prevented by following a low-fat, high vegetable-fruit diet, and getting regular exercise. High-impact aerobics should be avoided because of the excessive downward pressure placed on organs. Educating your clients will help improve their lives and possibly prevent many disorders.

A nurse is providing care to a client with uterine fibroids who is prescribed a progestin antagonist. Which medication would the nurse most likely expect the client to receive? leuprolide nafarelin goserelin mifepristone

mifepristone Mifepristone is a progestin antagonist used to treat uterine fibroids. Leuprolide, nafarelin, and goserelin are gonadotropin-releasing hormone antagonists.

The nurse is admitting a 42-year-old client to the women's medical floor. During the history, the chief report from the client is "I feel like there is a lump in my vagina, and it feels like it is sometimes dragging." Which disorder does the nurse suspect? urinary incontinence endocervical polyps pelvic organ prolapse uterine fibroids

pelvic organ prolapse In pelvic organ prolapse, the pelvic floor muscles are weak, and this results in a feeling of "dragging," or that some sort of "lump" is present in the vagina. Symptoms of pelvic organ prolapse do not include urinary incontinence. Endocervical polyps manifest with abnormal vaginal bleeding. With uterine fibroids, the uterus is large and has an odd shape.

A 40-year-old client arrives at the community health center experiencing a strange, dragging feeling in the vagina. She stated that "at times it feels as if there is a lump" there as well. Which condition do these symptoms indicate? urinary incontinence endocervical polyps pelvic organ prolapse uterine fibroids

pelvic organ prolapse Weakening of the pelvic-floor muscles causes a feeling of dragging and a "lump" in the vagina; these are symptoms of pelvic organ prolapse. These symptoms do not indicate urinary incontinence, endocervical polyps, or uterine fibroids. Urinary incontinence is the involuntary loss of urine. The symptoms of endocervical polyps are abnormal vaginal bleeding or discharge. In cases of uterine fibroids, the uterus is enlarged and irregularly shaped.

A young couple have presented to the office with concerns of possible infertility. A physical examination and complete history of the woman reveals type 2 diabetes mellitus, obesity, sleep apnea, and hypertension. The nurse would suspect: polycystic ovary syndrome. irregular menses. leiomyomas. hormonal imbalance.

polycystic ovary syndrome. Polycystic ovary syndrome (PCOS) involves the presence of multiple inactive follicle cysts within the ovary that interfere with ovarian function. It is the most common cause of medically treatable infertility and is responsible for 70% of cases of anovulatory subfertility and up to 20% of couples' infertility cases.

A client has presented to the clinic for diagnostic studies to evaluate her for polycystic ovary syndrome. Which test should be included? pregnancy test CBC with PT, PTT lipid panel hormone levels

pregnancy test Diagnostic tests will include a pregnancy test to rule out ectopic pregnancy. A CBC with PT, PTT, lipid panel, and hormone levels may also be ordered based on the client's complaints and evaluation.

The nurse is teaching a premenopausal client about dietary and lifestyle modifications that can reduce the risk factors for developing pelvic organ prolapse (POP). The nurse is describing which type of prevention? primary secondary tertiary none of the above

primary Informing the client about factors in her lifestyle that might be modified to reduce her risk of developing POP would be an exmaple of primary prevention.

A nurse is conducting a presentation for a local women's group about pelvic organ prolapse. When describing the different types, which information would the nurse incorporate into the description of a cystocele? sagging of the rectum, pushing against or into the posterior vaginal wall protrusion of the bladder wall through the anterior vaginal wall bulging of the small intestine through the posterior vaginal wall downward movement of the uterus through the pelvic floor and into the vagina

protrusion of the bladder wall through the anterior vaginal wall A cystocele occurs when the posterior bladder wall protrudes downward through the anterior vaginal wall. A rectocele occurs when the rectum sags and pushes into or against the posterior vaginal wall. An enterocele occurs when the small intestine bulges through the posterior vaginal wall. Uterine prolapse occurs when the uterus descends through the pelvic floor and into the vaginal canal.

A nurse is explaining to a client that pessaries have been used through the ages as a nonsurgical means of treating pelvic organ prolapse. The nurse describes the pessaries of today as being primarily constructed of: silicone. rubber. porcelain. metal.

silicone. Today, almost all pessaries are made of medical-grade silicone. They are pliable and have a long shelf life, lack odor and secretion absorption, are biologically inert, and nonallergenic and noncarcinogenic. They can also be boiled or autoclaved for sterilization.

disadvantages of myomectomy?

that the fibroids may grow back in the future

The nurse is reviewing with a new client the diagnosis of polycystic ovarian syndrome (PCOS). Which long-term health problems would the nurse review as a risk with this syndrome? migraine celiac disease type 2 diabetes cellulitis

type 2 diabetes With PCOS, the client is at risk for long-term health issues such as reproductive cancers, cardiovascular disease, hypertension, type 2 diabetes, and dyslipidemia. Migraines can be caused by many unknown factors and appear in numerous disorders. Celiac disease is not associated with PCOS. Cellulitis is an acute infection, not a long-term health issue.

A nurse is caring for a 25-year-old woman suspected of having follicular cysts. Which finding is not a clinical manifestation? typically occur after menopause grow less than 5 cm in diameter are detected by vaginal ultrasound usually shrink and do not require treatment

typically occur after menopause Follicular cysts typically appear in women of reproductive age. They can occur at any age but are rare after menopause. All other statements are true.

A client was in labor for more than 36 hours and now reports urine leaking from her vagina. On examination the nurse would be inspecting for: urethrovaginal fistula. vesicovaginal fistula. urge incontinence fistula. rectovaginal fistula.

urethrovaginal fistula. The majority of genital fistulas are the result of obstetric trauma. When labor is obstructed or prolonged, this unrelieved compression causes ischemia, which causes pressure necrosis and subsequent fistula formation. A urethrovaginal fistula is formed between the urethra and vagina. Vesicovaginal fistulas occur between the bladder and genital tract. A rectovaginal fistula would occur between the rectum or sigmoid colon and vagina. Urge incontinence would result with the urine leaking from the urethra, not vagina.

A nurse is caring for a woman who has just been diagnosed with uterine prolapse. Which symptoms may interfere with her daily activities? Select all that apply. urinary frequency low back pain pelvic pressure sinus pressure diarrhea

urinary frequency low back pain pelvic pressure Symptoms of pelvic organ prolapse that can interfere with daily living and activities include urinary, constipation, sexual, and low back pain; pelvic pressure; vaginal heaviness; and abdominal pressure. Sinus pressure and diarrhea are not a symptoms.

A woman has been given the diagnosis of uterine fibroids. Prescribed treatment consists of gonadotropin-releasing hormone (GnRH). The nurse is teaching her client about the side effects of this medication. Which side effect would be important to include in the explanation? increased vaginal discharge vaginal dryness urinary tract infection vaginitis

vaginal dryness Side effects of GnRH include hot flashes, vaginal dryness, headaches, mood changes, depression, bone loss, and musculoskeletal malaise. Other side effects require use of a pessary, a hard plastic or rubber device placed in the vagina for support

A nurse is caring for a client who has been prescribed gonadotropin-releasing hormone (GnRH) medication for uterine fibroids. For which side effect of GnRH medications should the nurse monitor the client? increased vaginal discharge vaginal dryness urinary tract infections vaginitis

vaginal dryness Vaginal dryness is one of the side effects of GnRH medications. The other side effects of GnRH medications are hot flashes, headaches, mood changes, musculoskeletal malaise, bone loss, and depression. Increased vaginal discharge, urinary tract infections, and vaginitis are side effects of a pessary, not GnRH medications.

A nurse is educating a group of students in the community clinic about pelvic organ prolapse. What can be a cause of this disorder? facial surgery employment that requires no lifting history of trouble gaining weight weakening of pelvic support related to birth trauma

weakening of pelvic support related to birth trauma Pelvic organ prolapse can be caused by downward gravity from being an erect human, atrophy of muscles with aging and decreasing hormones, obesity, lifting heavy objects, reproductive surgery, and weak pelvic support due to birth trauma. The other choices do not cause pelvic organ prolapse.