Chapter 71
A 51-year-old female who is perimenopausal broke her arm after a fall in her home. She also reports progressive fatigue, insomnia, and hot flashes. What priority assessment question should the nurse ask to collect more data regarding the patient's health history? A."Do you engage in exercise?" B."Can you tell me about your diet?" C."What medications are you currently taking?" D."Do you have a family history of heart disease?"
A
A patient had a pelvic examination and needs an additional diagnostic test for possible uterine leiomyomas. The nurse prepares the patient for which diagnostic test? A. Transvaginal ultrasound B. Laparoscopy C. Hysteroscopy D. Endometrial biopsy
A
A patient had loop electrosurgical excision procedure for treatment and diagnosis of cervical cancer. In the discharge instructions what does the nurse tell the patient to expect after the procedure? A. Spotting B. Menses-like vaginal bleeding C. Cramps lasting 24 hours D. Watery discharge
A
A patient has had a posterior colporrhaphy. What is included in the nurse care of this patient? A. Give pain medication before a bowel movement B. Obtain an order for prn laxatives C. Resume regular activities after discharge D. Promote a high-fiber diet
A
A patient reports the sensation of feeling as if "something is falling out" along with painful intercourse, backache and a feeling of heaviness or pressure in the pelvis. Which question does the nurse ask to assess for a cystocele? A. "Are you having urinary frequency or urgency?" B. "Do you feel constipated?" C. "Have you had a problem with hemorrhoids?" D. "Have you had any heavy vaginal bleeding?"
A
A patient with a fever, myalgia, sore throat and sunburn-like rash is admitted with the diagnosis of toxic shock syndrome. What additional clinical manifestations should the nurse assess for? A. Hypotension B. Vaginal bleeding C. Bradycardia D. Polyuria
A
A young woman had minimally invasive surgery for the removal of uterine fibroids. The nurse emphasizes that this information should be included when giving health history; however for which future scenario is the history most essential? A. Becomes pregnant and is looking forward to a home delivery with midwife assistance B. Potentially needs a hysterosalpinogram for evaluation of fallopian tube patency C. Develops recurrent and frequent episodes of vulvovaginitis related to Candida albicans D. Plans to take oral contraceptives for several years to delay pregnancy
A
The home health nurse is reviewing the patient's medication list and sees that the patient was given doxorubicin at the hospital. What gynecologic diagnosis would the nurse expect to see as part of the patient's history? A. Endometrial cancer B. Cervical polyps C. Endometriosis D. Dysfunctional uterine bleeding
A
The nurse is caring for a patient who had a posterior colporrhaphy. Which task is most appropriate to delegate to unlicensed assistive personnel? A. Assist the patient with a sitz bath to relieve discomfort B. Assist the patient to select menu items that are low residue C. Change the bed linens every 4 hours or more as needed D. Supervise and teach the patient to turn every 2 hours
A
The nurse is caring for a patient who had hysteroscopic surgery. The patient reports severe lower abdominal pain, appears pale, and has trouble focusing on the nurse's questions about the pain. Vital signs show T: 98.6, P: 120/min, R: 24/min, BP: 103/60. Which complications does the nurse suspect? A. Hemorrhage B. Embolism C. Fluid overload D. Incomplete suppression of menstruation
A
The nurse is caring for a patient with a radioactive implant in the uterus. Which instruction will the nurse give to unlicensed assistive personnel? A. Patient is on bedrest and excessive movement is restricted B. Assist the patient to ambulate in the hall at least three times per shift C. Assist the patient to get up to the toilet or the commode chair D. Linens and patient gown should be frequently changed for drainage
A
The nurse is preparing patient teaching for several young women who will undergo surgical procedures for gynecologic problems. Which surgical procedure is most likely to induce menopausal symptoms? A. Bilateral salpingo-oophorectomy B. Radioblation C. Uterine artery embolization D. Hysteroscopic myomectomy
A
The nurse is teaching a class about laparoscopic hysteroscopic myomectomy. Which patient should be invited to attend the teaching session? A. 23-year-old woman with uterine fibroids who would like to have children in the future B. 65-year-old woman who was diagnosed with uterine cancer but also has a bleeding disorder C. 43-year-old African American woman with early diagnosed endometrial cancer D. 73-year-old woman with urinary incontinence secondary to a cystocele
A
The nurse understands that which physical change may be expected by the patient who has undergone a total abdominal hysterectomy?A.The patient will no longer have a period. B.Vaginal drainage may be bloody for the first month. C.Nutritional education to avoid weight gain is necessary. D.Although the ovaries were removed, no menopausal symptoms will be experienced.
A
The patient needs a diagnostic testing to determine the presence of endometrial thickening and possible cancer. Which brochure will the nurse prepare for the patient? A. "How Transvaginal Ultrasound and Endometrial Biopsy Are Used in Cancer Diagnosis" B. "The Role of Abdominal Ultrasound and Magnetic Resonance Imaging in Cancer Diagnosis" C. "Advances in the Diagnosis of Cancer Using Computed Tomography and Cystography" D. "What the Presence of BRCA1 or BRCA2 Gene Mutations Means in the Diagnosis of Cancer"
A
What information would the nurse give to a sexually active 35-year-old woman about conventional Papanicolaou (Pap) smear and human papillomavirus (HPV) testing? A. Every 5 years is sufficient B. Annual screening is reccommended C. Testing can stop after three normal pap smears D. If there are no risk factors testing is not necessary
A
Which patient has the greatest need for evaluation of possible endometrial cancer? A. 63-year-old woman who is having painless vaginal bleeding B. 33-year-old woman who reports a past history of multiple sex partners C. 23-year-old woman who has not had a menstural period for 3 months D. 52-year-old woman who is having irregular menses for 3 months
A
Which therapies would the nurse expect to use for a patient who is being treated for a rectocele? A. High-fiber diet, stool softeners, and laxatives B. Intravaginal estrogen and a pessary C. Oral contraceptives and antibiotics D. Doxorubicin and cisplatin
A
The patient reports itching, change in vaginal discharge, and an odor. The nurse suspects that the patient has vulvovaginitis. Based on vulvovaginitis which questions would the nurse ask? SATA A. "Have you recently been taking antibiotics?" B. "Have you been swimming in a lake or pond?" C. "Do you consistently wipe from front to back?" D. "Do you use tampons?" E. "Do you douche or use vaginal sprays?" F. "Have you had a problem with vaginal yeast infections?"
A,C,D,E,F
The nurse is teaching a patient who is being discharged after having a total abdominal hysterectomy. Which conditions does the nurse tell the patient to immediately report to the surgeon? SATA A. Vaginal drainage that becomes thicker and foul-smelling B. Hot flashes and night sweats C. Temperature over 100 D. Burning during urination E. Feeling more tired and sleeping longer F. Pain, tenderness, redness, or swelling in calves
A,C,D,F
The surgical procedure for stage 1 disease of endometrial cancer involves removal of which components? SATA A. Uterus B. Vagina C. Fallopian tubes D. Rectum E. Ovaires F. Peritoneum fluid for cytologic examination
A,C,E,F
Following a uterine embolization using a vascular closure device what patient care would the nurse provide? SATA A. Assist the patient to ambulate 2 hours after the procedure B. Keep the patient on bedrest with the leg immobilized for 4 hours before ambulating C. Encourage the patient to drink a lot of fluids D. Assess for constipation and administer laxatives as needed E. Raise the head of the bed F. Assess pain level and provide analgesics as needed
A,E,F
Endometrial (Uterine) Cancer
Adenocarcinoma is most common type Postmenopausal bleeding is main symptom Diagnostic assessment CA-125 tumor marker Transvaginal ultrasound Endometrial biopsy
A patient had an anterior colporrhaphy and is returning to the clinic for follow-up appointment. Which patient statement indicates that the procedure has achieved the desired therapeutic outcome? A. "The abdominal pain is almost gone" B. "I have good control over my urination" C. "That constipated feeling has resolved" D. "My vaginal bleeding has resolved"
B
A patient has undergone a total hysterectomy with vaginal repair. Which over-the-counter product will the nurse recommend to decrease sexual discomfort related to intercourse? A. Hydrocortisone cream B. Water-based lubricants C. Petroleum jelly D. Vitamin A and D ointment
B
A patient is admitted with toxic shock syndrome. What organism is frequently associated with this syndrome when it occurs as a menstrual-related infection? A. Escherichia coli B. Staphylococcus aureus C. Haemopholus influenzae D. Beta-hemolytic streptococcus
B
A patient is diagnosed with uterine leiomyomas. What does the nurse expect to see in the documentation as the patient's chief presenting symptom? A. Foul-smelling vaginal discharge B. Heavy vaginal bleeding C. Intermittent abdominal pain D. Urinary intcontinence
B
A patient receiving chemotherapy treatments reports fatigue, loss of energy, and experiencing an "emotional crisis every day and my hair is falling out." What does the nurse do first to help the patient adapt to the body changes? A. Suggest participation in self-management B. Encourage the patient to ventilate feelings C. Help the patient to select a wig or scarf D. Encourage the patient to talk to her family
B
A patient with uterine leiomyomas reports a feeling of pelvic pressure constipation and urinary retention. She says "I can't button my pants anymore." What does the nurse do to further evaluate the patient's condition? A. Check the lower extremities for fluid retention B. Assess the abdomen for distension or enlargement C. Measure the fluid intake and urine output D. Palpate the urinary meatus for inflammation
B
The nurse encourages a teenage patient to receive the human papillomavirus (HPV) vaccine because it protects against which type of cancer? A. Endometrial cancer B. Cervical cancer C. Ovarian cancer D. Uterine cancer
B
The nurse is caring for a patient who is one day post-op for a total abdominal hysterectomy. Which assessment finding is cause for greatest concern? A. Urinary catheter is in place with a moderate amount of dark amber urine B. Patient reports saturating one pad in an hour with dark red blood C. Patient reports difficulty with bowels and asks for a stool softener D. Incision is intact but appears more inflamed than previously
B
The nurse is giving discharge teaching to a patient who had a transvaginal reapid for pelvic organ prolapse using a surgical mesh. What does the nurse include? A. Avoid cigarette smoking for at least 1 month B. Abstain from sexual intercourse for 6 weeks C. Reduce calories to lose 2 pounds a month D. Avoid tub baths to prevent soaking the mesh
B
The nurse is teaching self-care management to a 39-year-old woman who had an abdominal hysterectomy. Which point would be emphasized to avoid complications of this surgery? A. Bathe and douche daily to prevent infection B. Take temperature twice a day for 3 days after surgery C. Resume typical exercise routines as soon as possible D. Gently massage calves if tenderness of swelling occurs
B
The nurse reads in the patient's chart that the patient is experiencing surgical menopause after having a total hysterectomy and bilateral salpino-oophorectomy. What expected sign symptom does the nurse anticipate that the patient will report? A. Masculinization B. Vaginal changes C. Rejection by partner D. Weight gain
B
The nurse understands that which female reproductive cancer claims the most lives? A.Breast B.Ovarian C.Cervical D.Endometrial
B
Three years after the patient was diagnosed and treated for endometrial cancer the patient and family are told that the cancer is recurring. Which intervention is the nurse most likely to use? A. Arrange for the patient to speak to other patients with recurring cancer B. Assess for readiness to explore palliative care and hospice C. Assist the patient to identify complementary therapies for palliation D. Teach about radical hysertectomy followed by brachytherapy
B
Which laboratory result indicates that the primary goal of treatment of the patient's uterine fibroids has been successful? A. Vaginal smears show no bacterial growth B. Red blood cell count is within normal limits C. Human chorionic gonadotropin is negative D. White blood cell count is within normal limits
B
Young women who have intercourse as teenagers and or have multiple sex partners are at high risk for which disease/disorder? A. Edomentriosis B. Cervical cancer C. Amenorrhea D. Ovarian cancer/
B
The nurse is caring for a patient who had hysteroscopic surgery. The nurse is vigilant to assess for signs and symptoms of which potential complications? SATA A. Postembolectomy syndrome B. Fluid overload C. Embolism D. Perforation of uterus E. Hemorrhage F. Ureter injury
B,C,D,E,F
A patient who had a total abdominal hysterectomy is anxious to resume her activities because she has young children at home. What postprocedure information does the nurse provide to the patient? SATA A. Climb stairs to build strength and endurance B. Avoid sitting for prolonged periods C. Do not lift anything heavier than 5-10 lbs D. Walk or job at least 1-2 miles every day E. When sitting do not cross legs F. Resume regular household chores and activities
B,C,E
A 36-year-old patient is diagnosed with dysfunctional uterine bleeding. During the pelvic exam the health care provider determines that the bleeding is acute. What is the nurse's priority action? A. Prepare the patient for transfer to the operating room B. Prepare to assist with a dilation and curettage C. Anticipate an order for oral contraceptive therapy D. Obtain an order for injectable medroxyprogesterone acetate
C
A patient had a total abdominal hysterectomy. Which patient behavior is the best indicator that she is coping and adapting successfully? A. Refuses to look at the wound but encourages the nursing students to look B. Sits quietly and passively while the nurse performs wound care C. Asks questions about the wound care but seems reluctant to do self-care D. Frequently stares at the wound site but refuses to touch the area
C
A patient is receiving external radiation therapy for treatment of endometrial cancer. What task does the nurse delegate to the unlicensed assistive personnel? A. Gently wash the markings outlining the treatment site B. Monitor for signs of skin breakdown especially in the perineal area C. Assist the patient to ambulate if she feels fatigue or tiredness D. Clean the urinary catheter and meatus with mild soap and water
C
The nurse is caring for four female patients. Which patient does the nurse anticipate may need a referral for hospice services? A.29-year-old with painful periods B.44-year-old with fibrous uterine leiomyoma C.60-year-old with ovarian cancer D.71-year-old with uterine prolapse
C
The nurse is caring for several patients who had total abdominal hysterectomies. All patients are coming to the clinic for their 6-week follow-up appointment. Which patient demeanor is the strongest indicator that there is a need for psychological referral? A. Quiet and withdrawn but asks appropriate questions B. Tense and impatient but answers questions correctly C. Disheveled and lackluster and displays a lack of interest in questions D. Cheerful and distractible and answers questions with excessive detail
C
The nurse is giving discharge teaching to a woman who had local cervical ablation. What information would be included? A. Sexual activity may be resumed usually in 1 week B. Change tampons every 4 hours C. Report heavy vaginal bleeding or foul-smelling drainage D. Avoid lifting heavy objects for several days
C
The nurse is giving instructions to a patient who is undergoing brachytherapy for cervical cancer. What information does the nurse include? A. "Limit interactions with others between treatments for their protection' B. "We will give you pain medication prior to every treatment" C. "Report any blood in the urine or severe diarrhea immediately" D. "Expect heavy vaginal bleeding during this time"
C
The nurse is interviewing a young woman who is considering the option of uterine artery embolization for the treatment of uterine fibroids. Which question would the nurse ask to assist the patient in making a decision? A. "How has the uterine fibroid condition been affecting your lifestyle?" B. "Do you have a family history of breast or uterine cancer?" C. "What did the health care provider tell you about the procedure?" D. "Would you like a brochure about planning future pregnancies?"
C
The nurse is teaching a group of women about prevention of toxic shock syndrome. What preventive measures does the nurse include? A. "Use super-absorbent tampons" B. "Use sanitary napkins on heavy flow days" C. "Change your tampon every 3-6 hours" D. "Void immediately after intercourse"
C
The nurse sees that a patient has been advised by the health care provider to apply lindane to the affected area. What is a self-care measure for this patient to ensure that the symptoms do not return after using this medication? A. Wash the area daily with hydrogen peroxide B. Take a sitz bath for 30 minutes several times a day C. Wash clothes and linens and disinfect the home environment D. Remove any irritants or allergens (i.e. change detergents)
C
What is the primary factor for the low survival rates for patients who are diagnosed with ovarian cancer? A. Ovarian cancer develops in patient with underlying immunosuppression and poor health B. Ovarian cancer does not respond well to conventional radiation and chemotherapy treatments C. Symptoms are mild and vague; therefore the cancer is often not detected until its late stage D. There are no specific diagnostic tests that can confirm or rule out ovarian cancer
C
What is the priority preoperative and postoperative nursing care for a patient with leiomyomas? A. Preventing infection B. Managing severe pain C. Monitoring for bleeding D. Assessing for and managing anxiety
C
Which classic symptom is indicative of invasive gynecologic cancer? A. Swelling of the lymph nodes in groin area B. Dark and foul-smelling vaginal discharge C. Painless vaginal bleeding unrelated to menses D. Flank pain with dysuria and dark urine
C
A 20-year-old woman is being evaluate for possible toxic shock syndrome. What question would the nurse ask? A. "How many pads do you use on heavy flow days?" B. "Have you ever used intravaginal estrogen therapy?" C. "Do you have a history of multiple sexual partners?" D. "Do you use internal contraceptives?"
D
An obese 59-year-old patient describes excessive menstrual bleeding that occurs approximately every 10 days. Which question should the nurse ask first? A. "Have you noticed fever or signs of infection?" B. "Did you ever use oral contraceptives?" C. "When was the last time you had intercourse?" D." How many pads (or tampons) do you use each day?"
D
In recalling dietary intake for a recent 24-hour period a female patient describes eating eggs, whole milk, and bacon for breakfast; fried chicken and french fries for lunch; three-cheese pizza and ice cream for dinner. This type of diet places her at increased risk for which disorder? A. Dysfunctional uterine bleeding B. Dysparenuia C. Early menopause D. Cancer of the ovaries
D
The nurse is taking a history on a patient with probable gynecologic cancer. Which clinical manifestation is a sign of metastasis? A. Watery vaginal discharge B. Constipation C. Dysparenuia D. Dysuria
D
What self-management strategy would the nurse recommend to a patient to prevent vulvovaginitis? A. Wear lightweight nylon underwear B. Cleanse inner labial mucosa with antiseptic soap C. Apply antiseptic cream daily to perineal area D. Wear breathable fabrics, such as cotton
D
Which disorder is strongly associated with prolonged exposure to estrogen without the protective effects of progesterone? A. Endometriosis B. Uterine cancer C. Leiomyomas D. Endometrial cancer
D
Which patient is most likely to be accepting of surgery and demonstrate better coping behaviors? A. 62-year-old woman with an active social and work life has an abdominal hysterectomy for advanced ovarian cancer B. 23-year-old woman with BRCA1 and BRCA2 genes elects to have a prophylactic bilateral salpingo-oophorectomy C. 58-year-old woman with one supportive adult child has ovarian cancer which was treated with cytoreduction D. 44-year-old woman with two children and supportive partner had an abdominal hysterectomy for uterine fibroids
D
Which woman is at greatest risk for pelvic orang prolapse? A. 16-year-old adolescent caring for her first child B. 25-year-old who became sexually active at age 15 C. 34-year-old who has a history of endometriosis D. 48-year-old obese mother of four children
D
HPV Vaccine
HPV vaccine available for girls and young women (ages 9-26) HPV can cause cancer of the cervix, vagina, vulva, penis, anus, and back of throat (CDC, 2019) 90% of HPV cancers can be prevented with vaccination (CDC, 2019)
Ovarian Cancer
Leading cause of death from female reproductive cancers (but not most common) Vague abdominal and GI symptoms Treatment usually involves surgery and chemotherapy
Bartholin Cyst
Obstruction of the duct of the Bartholin gland Caused by infection, thickened mucus near ductal opening, or trauma (lacerations) May be asymptomatic May need simply incision and drainage (I&D)
Benign Neoplasms
Ovarian cyst Uterine leiomyoma (fibroids or myomas) May not need treatment if asymptomatic Nonsurgical management Surgical management
Cervical Polyp
Pedunculated tumors that arise from the mucosa that extends through the opening of the cervical os May be asymptomatic If symptomatic: Bleeding, leukorrhea Usually removed during an office visit via clamp and cautery
What should the patient be taught about brachytherapy?
This therapy will require a hospital stay. Its purpose is to prevent recurrence of the disease You will be isolated in a private room while the isotope is in place.
What tests are most likely to be ordered for a 51 year old with vaginal bleeding?
Transvaginal ultrasound and endometrial biopsy
Toxic Shock Syndrome (TSS)
Usually results from menstruation and tampon use; can be fatal Staphylococcus aureus Develops within 5 days after onset of menstruation Fever, rash, myalgias, sore throat, edema, hypotension Treatment focuses on removal of infection source Educate client about frequent tampon changes (3-6 hrs), washing hands before changing tampon, & using pads instead of tampons
Pelvic Organ Prolapse (POP)
Uterine, cystocele, rectocele Patients often report feeling of "something falling out" Dyspareunia, backache, heaviness or pressure in pelvis, bowel or bladder problems Treatment focuses on the degree of POP Conservative treatment is preferred over surgical treatment when possible Kegel exercises, pessaires, intravaginal estrogen therapy
