Chapter 8
After teaching a local woman's community group about cervical cancer, the nurse understands that teaching has been successful when the group identifies which condition as a risk factor for cervical cancer? chronic vulvitis vulvar dermatosis genital herpes obesity and menopausegenital herpes
Genital Herpes Explanation: Genital herpes increases the risk for cervical cancer. Chronic vulvitis and vulvar dermatosis are risk factors for vulvar cancer. Obesity and menopause are risk factors for pelvic relaxation alteration.
A postmenopausal client is told at her routine gynecological exam that the primary care provider has found a cyst on her right ovary. The nurse notices that this does not cause worry for this client. What should the nurse and/or care provider tell this client? "You are correct not to be concerned; after all, it is only a cyst." "After menopause a mass on an ovary is not a cyst and should be considered cancerous until proven otherwise." "We will keep a eye on it and recheck it at your next yearly appointment." "You may get a second opinion if you would like."
"After menopause a mass on an ovary is not a cyst and should be considered cancerous until proven otherwise." Explanation: After menopause, a mass on an ovary is not a cyst; physiologic cysts can arise only from a follicle that has not ruptured or from the cystic degeneration of the corpus luteum. Brushing it off is not responsible, and waiting a full year would put the client at serious risk from dying from the cancer. Suggesting a second opinion instead of explaining the seriousness of it to the client would not be responsible or ethical.
A nurse is reviewing the history, physical exam, and diagnostic test findings for a woman diagnosed with endometrial cancer. The findings reveal that the cancer has spread to the cervix and other parts of the uterus and to nearby lymph nodes. The nurse interprets these findings as suggestive of which stage? I II III IV
III Explanation: In stage I, the tumor is confined to the corpus uteri. In stage II, it has spread to the cervix, but not outside the uterus. In stage III, it has spread locally (to other parts of the uterus) and regionally (to nearby lymph nodes). In stage IV, it has invaded the bladder mucosa, bowel with distant metastases to the lungs, liver, and bone.
A nurse is educating a 25-year-old client with a family history of cervical cancer. Which test should the nurse inform the client about to detect cervical cancer at an early stage? transvaginal ultrasound CA-125 blood test Papanicolaou test blood tests for mutations in the BRCA genes
Papanicolaou test Explanation: The client should have Papanicolaou tests regularly to detect cervical cancer during the early stages. Blood tests for mutations in the BRCA genes indicate the lifetime risk of the client of developing breast or ovarian cancer. CA-125 is a biologic tumor marker associated with ovarian cancer, but it is not currently sensitive enough to serve as a screening tool. The transvaginal ultrasound can be used to detect endometrial abnormalities.
A 55-year-old client presents to the clinic with persistent vulvar pruritus, burning, and a lump. She states she has had the symptoms for 5 months and has been trying to treat them with over-the-counter creams. She has a history of multiple sexual partners and HPV and is a smoker. What should the nurse do next? Prepare the client for a biopsy of the lesion. Determine what creams the client has used. Assess how much the client smokes daily. Schedule the client for cryosurgery.
Prepare the client for a biopsy of the lesion. Explanation: The client has classic symptoms of vulvar cancer. All clients with vulvar lumps should be biopsied even if they are asymptomatic. Cryosurgery may be scheduled if the biopsy confirms the diagnosis of vulvar cancer. It is not important to know what creams the client has used or how much she smokes at this time.
A nurse working in the Family Birthing Center is answering the nurse hotline phone. A client calls in to schedule her annual Papanicolaou test. How could the nurse best educate the client before her procedure to make sure the results are not affected? Make sure the appointment is 5 days after the last menses. Refrain from sexual intercourse 48 hours before testing to ensure clear results. It is safe to use tampons 72 hours before testing. The client may douche at least 48 hours before testing.
Refrain from sexual intercourse 48 hours before testing to ensure clear results. Explanation: Nurses should use teaching guidelines with clients to optimize the Papanicolaou test results. Strategies to educate would include no douche, no tampons, no jellies, no spermicides, no intercourse. The optimal time for testing is 2 weeks after the first day of your last menses.
A 28-year-old woman had a Papanicolaou test 4 weeks ago. The results of the test are classified as ASC-US as per the Bethesda System. Which therapeutic management intervention should the nurse expect the health care provider to prescribe? Repeat the Papanicolaou test in 4 to 6 months, or refer for a colposcopy. Refer for a colposcopy with human papillomavirus (HPV) testing. Send for an immediate colposcopy, with follow up based on results. Discontinue any further Papanicolaou tests.
Repeat the Papanicolaou test in 4 to 6 months, or refer for a colposcopy. Explanation: A result of ASC-US for Papanicolaou testing is classified by the Bethesda System. This system gives a uniform diagnostic term to Papanicolaou test results. This means the health care provider should repeat the test in 4 to 6 months or refer for a colposcopy. Results of AGC or AIS indicate the need for an immediate colposcopy and follow up based on results. A colposcopy with HPV testing is the treatment when results are ASC-H.
A client is waiting for the results of an endometrial biopsy for suspected endometrial cancer. She wants to know more about endometrial cancer and asks the nurse about the available treatment options. Which treatment information should the nurse give the client? Surgery involves removal of the uterus, fallopian tubes, and ovaries; adjuvant therapy is used if relevant. Surgery involves removal of the uterus only. Follow-up care after the relevant treatment should last for at least 6 months after the treatment. In advanced cancers, radiation and chemotherapy are used instead of surgery.
Surgery involves removal of the uterus, fallopian tubes, and ovaries; adjuvant therapy is used if relevant. Explanation: The nurse should inform the client that surgery most often involves removal of the uterus (hysterectomy) and the fallopian tubes and ovaries (salpingo-oophorectomy). Removal of the tubes and ovaries, not just the uterus, is recommended because tumor cells spread early to the ovaries, and any dormant cancer cells could be stimulated to grow by ovarian estrogen. In advanced cancers, radiation and chemotherapy are used as adjuvant therapies to surgery. Routine surveillance intervals for follow-up care are typically every 3 to 4 months for the first 2 years.
A woman with ovarian cancer has been told that she is in stage III of the cancer. The nurse is reviewing the information with her. Which statement would help in the woman's understanding of stage III ovarian cancer? The growth has spread to the lymph nodes and other areas/organs in the abdominal cavity. The growth involves one or both ovaries. The cancer has spread to distant sites. The cancer is limited to the ovaries.
The growth has spread to the lymph nodes and other areas/organs in the abdominal cavity. Explanation: The staging and diagnosis is performed by a laparoscopy. The staging is I to IV. Stage III means the cancer has spread to the lymph nodes and other areas in the abdominal cavity. A five-year survival rate for this stage is 30% to 60%.
A woman with ovarian cancer has been told that she is in stage III of the cancer. The nurse is reviewing the information with her. Which statement would help in the woman's understanding of stage III ovarian cancer? The cancer is limited to the ovaries. The growth involves one or both ovaries. The growth has spread to the lymph nodes and other areas/organs in the abdominal cavity. The cancer has spread to distant sites.
The growth has spread to the lymph nodes and other areas/organs in the abdominal cavity. Explanation: The staging and diagnosis is performed by a laparoscopy. The staging is I to IV. Stage III means the cancer has spread to the lymph nodes and other areas in the abdominal cavity. A five-year survival rate for this stage is 30% to 60%.
A young woman has been referred for a colposcopy by the health care provider. The nurse is educating the woman on the procedure. Which information about the colposcopy should the nurse provide? The procedure may be painful. The results of the Papanicolaou test were abnormal; therefore, this procedure must be done. Sexual intercourse should be avoided for 2 weeks. There may be some pain while urinating for up to 1 week after the test.
The results of the Papanicolaou test were abnormal; therefore, this procedure must be done. Explanation: A colposcopy is performed when results of a Papanicolaou test are abnormal. This is a painless procedure with no aftereffects, so urinating afterwards is not a problem, and sexual intercourse need not be avoided.
A client has been referred for a colposcopy by the primary care provider. The client wants to know more about the examination. Which information regarding a colposcopy should the nurse give to the client? Client may feel pain in the vaginal area during the examination. The test is conducted because of abnormal results in a Papanicolaou test. Intercourse should be avoided for at least 1 week afterward. Client may experience pain during urination for a week following the test.
The test is conducted because of abnormal results in a Papanicolaou test. Explanation: The nurse should explain to the client that the colposcopy is done because the care provider has observed abnormalities in the Papanicolaou test results. The nurse should also explain to the client that the procedure is painless and there are no adverse effects, such as pain during urination. There is no need to avoid intercourse for a week after the colposcopy.
Which risk factors are associated with vaginal cancer? Select all that apply. advancing age HIV infection persistent ovulation over time smoking hormone replacement therapy for more than 10 years
advancing age HIV infection smoking Although direct risk factors for the initial development of vaginal cancer have not been identified, associated risk factors include advancing age (greater than 60 years old), human immunodeficiency virus (HIV) infection, smoking, previous pelvic radiation, exposure to diethylstilbestrol (DES) in utero, vaginal trauma, history of genital warts (human papillomavirus infection), cervical cancer, chronic vaginal discharge, and low socioeconomic level. Persistent ovulation over time and hormone replacement therapy for more than 10 years are risk factors associated with ovarian cancer.
A nurse will be speaking at a local high school about women's health. The nurse is planning to talk about sexually transmitted infections (STIs) as well as routine checks, along with guidelines for Papanicolaou testing. What should the nurse include in the Papanicolaou test guidelines about when to have a first test? at the age of 18 or within 2 years of first sexual intercourse 2 years after first sexual intercourse at the age of 16 at the age of 21 or within 3 years of first sexual intercourse
at the age of 21 or within 3 years of first sexual intercourse Explanation: American Cancer Society guidelines for Papanicolaou testing recommend that the first Papanicolaou test is done at age 21 or within 3 years of first sexual intercourse. Other guidelines state that the tests should be done yearly until age 30 using the glass slide method and every 2 years using liquid-based method. At age 30 to 70, the tests should be done every 2 to 3 years if the previous three Papanicolaou tests were normal. They may be discontinued after age 70 if the previous three Papanicolaou tests were normal and no Papanicolaou tests in the previous 10 years were abnormal.
A nurse is caring for a 30-year-old woman who was just diagnosed with cervical cancer. Which psychosocial need would be the priority for the nurse with her client? clear information on the disease, management, and treatment touching the client's hand for comfort remaining cheerful through all of the interactions offering words of hope to the client
clear information on the disease, management, and treatment Explanation: Women diagnosed with cancer of the reproduction tract need to understand their disease, prognosis, and what treatment options they have. The nurse's role is to educate with effective and clear communication techniques. The nurse should be sincere and may provide realistic hope, but her role as educator is primary.
The nurse is caring for a client being treated for vaginal cancer. Which finding will the nurse report immediately to the primary health care provider? vaginal bleeding after intercourse a feeling of heaviness in the vagina foul-smelling urine watery vaginal discharge
foul-smelling urine Explanation: The nurse would immediately report foul-smelling urine. This is an indication of a urinary tract infection, not vaginal cancer. Abnormal vaginal bleeding such as after intercourse or menopause, vaginal heaviness (from a lump or tumor), watery discharge, constipation, pelvic pain, vaginal mass, and urinary frequency are expected findings of vaginal cancer.
x After teaching a local woman's community group about cervical cancer, the nurse understands that teaching has been successful when the group identifies which condition as a risk factor for cervical cancer? chronic vulvitis vulvar dermatosis genital herpes obesity and menopause
genital herpes Explanation: Genital herpes increases the risk for cervical cancer. Chronic vulvitis and vulvar dermatosis are risk factors for vulvar cancer. Obesity and menopause are risk factors for pelvic relaxation alteration.
The nurse is evaluating a female client who reports irregular vaginal bleeding, recent weight loss, and dyspareunia. Which finding will the nurse highlight for the health care provider to review first? history of human papillomavirus (HPV) previous spontaneous abortion (miscarriage) report of multiple past sexual partners no previous Papanicolaou (Pap) test
history of human papillomavirus (HPV) Explanation: The client's symptoms indicate cervical cancer, which is caused by HPV. History of HPV along with the client's symptoms would help the health care provider determine what action to take next for this client. Taking diethylstilbestrol (DES) to prevent a spontaneous abortion (miscarriage) is a risk factor; however, a miscarriage alone is not. A report of multiple sexual partners is concerning because this could indicate exposure to sexually transmitted infections. However, this information is not a priority over knowing actual exposure. Not having a previous Pap test provides no information for the health care provider.
The nurse reviews the medical record of a woman diagnosed with ovarian cancer, stage II. The nurse interprets this information, understanding that the disease: is limited to the ovary. involves one or both ovaries and extends into the pelvis. has spread to the lymph nodes and other organs within the abdomen. has metastasized to distant sites.
involves one or both ovaries and extends into the pelvis. Explanation: Stage II ovarian cancer involves one or both ovaries, with pelvic extension. Disease limited to the ovary characterizes stage I ovarian cancer. Stage III ovarian cancer has spread to the lymph nodes and other organs and structures inside the abdominal cavity. Stage IV disease typically involves metastasis to distant sites.
A client presents for a routine checkup at a local health care center. One of the client's distant relatives died of ovarian cancer, and the client wants to know about measures that can reduce the risk of ovarian cancer. The nurse informs the client about which measure to reduce the risk of ovarian cancer? maintaining a healthy weight avoiding the use of oral contraceptive pills (OCPs) not breastfeeding using perineal talc or hygiene sprays
maintaining a healthy weight Explanation: The nurse should instruct the client about the importance of healthy lifestyles and stress the importance of maintaining a healthy weight to reduce the risk. Another factor associated with a reduced risk of ovarian cancer is the use of oral contraceptive pills. Breastfeeding should be encouraged as a risk-reducing strategy. The nurse should instruct the client to avoid using perineal talc or hygiene sprays.
Which symptom is an early symptom of vulvar cancer? pruritus with genital burning fever accompanied by chills severe abdominal pain headache
pruritus with genital burning Explanation: Pruritus and genital burning are the most frequent early symptoms of vulvar cancer, followed by a bloody discharge from the vagina. Abdominal pain can be a result of a surgery related to ovary, such as salpingo-oophorectomy, or formation of cysts in the ovary. Headache and fever accompanied by chills are not the early symptoms of vulvar cancer.
A nurse is speaking to a local women's group about the various types of cancer affecting the female reproductive tract. The nurse explains that ovarian cancer is the leading cause of death from gynecologic malignancies based on the understanding that this type of cancer: spreads more easily than other female reproductive cancers. arises from extremely rare types of cells that are resistant to treatment. typically manifests with vague symptoms resulting in late diagnosis. is closely associated with highly resistant sexually transmitted infections.
typically manifests with vague symptoms resulting in late diagnosis. Explanation: Tumors of the ovary have been lethal largely because they present with nonspecific symptoms and therefore frequently are far advanced and inoperable by the time they are diagnosed. Ease of spread and types of cells involved are not reasons underlying the fatal nature of this type of cancer. Ovarian cancer is not associated with sexually transmitted infections. Cervical cancer is linked to human papillomavirus infection.
When reviewing the history of a woman diagnosed with endometrial cancer, the nurse would identify which factor as increasing the woman's risk? menopause at age 47 years menarche at age 14 years vaginal birth of 4 children use of tamoxifen
use of tamoxifen Explanation: Use of tamoxifen is a risk factor for the development of endometrial cancer, as are nulliparity, early menarche (before the age of 12), and late onset of menopause (after age 52 years).
