Female Reproductive Disorders

When caring for a 58-yr-old patient with persistent menorrhagia, the nurse will plan to monitor the a. complete blood count (CBC). b. estrogen level. c. gonadotropin-releasing hormone (GNRH) level. d. serial human chorionic gonadotropin (hCG) results.

A. Because anemia is a likely complication of menorrhagia, the nurse will need to check the CBC. Estrogen and GNRH levels are checked for patients with other problems, such as infertility. Serial hCG levels are monitored in patients who may be pregnant, which is not likely for this patient.

A patient has an induced abortion with suction curettage at an ambulatory surgical center. Which instructions will the nurse include when discharging the patient? a. "Abstain from sexual intercourse for the next 2 weeks." b. "Irregular menstrual periods are expected for a few months." c. "Avoid contraceptives until your reexamination." d. "Heavy vaginal bleeding is expected for 2 weeks."

A. Because infection is a possible complication of this procedure, the patient is advised to avoid intercourse until the reexamination in 2 weeks. Patients may be started on contraceptives on the day of the procedure. The patient should call the doctor if heavy vaginal bleeding occurs. No change in the regularity of the menstrual periods is expected.

A 58-yr-old patient is on the medical-surgical unit after undergoing a radical vulvectomy for vulvar carcinoma. The greatest risk to the patient at this time is a. wound infection. b. self-care deficit. c. inadequate nutrition. d. ineffective sexual pattern.

A. Complex and meticulous wound care is needed to prevent infection and delayed wound healing. The patient may be at risk for other problems, but they are not the greatest concerns in the immediate postoperative time period.

A 20-year-old patient is interested in protection from the human papilloma virus (HPV) since she may become sexually active. Which response from the nurse is the most accurate? a. "Either Gardasil or Cervarix can provide protection." b. "The most common side effect of the vaccine is itching at the injection site." c. "You are too old to receive an HPV vaccine." d. "You will need to have three injections over a span of 1 year."

A. Current HPV vaccines are Gardasil and Cervarix, which should be given before the first sexual contact to protect against the highest risk HPV types associated with cervical cancer. The patient is not too old since it is recommended that young women up to 26 years should receive an HPV vaccine. The entire series consists of three injections over 6 months, not 1 year. Local pain and redness surrounding the injection site are very common, but this does not include itching.

A patient is considering the use of combined estrogen-progesterone hormone replacement therapy (HRT) during menopause. Which information will the nurse include during their discussion? a. HRT decreases osteoporosis risk and increases the risk for cardiovascular disease and breast cancer. b. Use of HRT for up to 10 years to prevent symptoms such as hot flashes is generally considered safe. c. Increased risk of colon cancer in women taking HRT requires frequent colonoscopy. d. Use of estrogen-containing vaginal creams provides the same benefits as oral HRT.

A. Data from the Women's Health Initiative indicate an increased risk for cardiovascular disease and breast cancer in women taking combination HRT but a decrease in hip fractures. Vaginal creams decrease symptoms related to vaginal atrophy and dryness, but they do not offer the other benefits of HRT, such as decreased hot flashes. Most women who use HRT are placed on short-term treatment and are not treated for up to 10 years. The incidence of colon cancer decreases in women taking HRT.

The nurse will plan to teach the female patient with genital warts about the a. importance of regular Pap tests. b. increased risk for endometrial cancer. c. appropriate use of oral contraceptives. d. symptoms of pelvic inflammatory disease (PID).

A. Genital warts are caused by the human papillomavirus (HPV) and increase the risk for cervical cancer. There is no indication that the patient needs teaching about PID, oral contraceptives, or endometrial cancer.

A nurse is caring for four postoperative patients who each had a total abdominal hysterectomy. Which patient would the nurse assess first upon initial rounding? a. Patient who has had two saturated perineal pads in the last 2 hours b. Patient with a temperature of 99° F (37.2° C) and blood pressure of 115/73 mm Hg c. Patient who has pain of "4" on a scale of 0 to 10 d. Patient with a urinary catheter output of 150 mL in the last 3 hours

A. Normal vaginal bleeding should be less than one saturated perineal pad in 4 hours. Two saturated pads in such a short time could indicate hemorrhage, which is a priority. The other patients also have needs, but the patient with excessive bleeding would be assessed first.

A patient is on the surgical unit after a radical abdominal hysterectomy. Which finding requires a report to the health care provider? a. Urine output of 125 mL in the first 8 hours after surgery b. One-inch area of bloody drainage on the abdominal dressing c. Complaints of abdominal pain at the incision site with coughing d. Decreased bowel sounds in all four abdominal quadrants

A. The decreased urine output indicates possible low blood volume and further assessment is needed to assess for possible internal bleeding. Decreased bowel sounds, minor drainage on the dressing, and abdominal pain with coughing are expected after this surgery.

The nurse is caring for a patient with pelvic inflammatory disease (PID) requiring hospitalization. Which nursing intervention will be included in the plan of care? a. Elevate the head of the bed at least 30 degrees. b. Use cold packs PRN for pelvic pain. c. Monitor liver function tests. d. Teach the patient how to perform Kegel exercises.

A. The head of the bed should be elevated to at least 30 degrees to promote drainage of the pelvic cavity and prevent abscess formation higher in the abdomen. Although a possible complication of PID is acute perihepatitis, liver function test results will remain normal. There is no indication for increased fluid intake. Application of heat is used to reduce pain. Kegel exercises are not helpful in PID.

A patient with pelvic inflammatory disease (PID) is being treated with oral antibiotics as an outpatient. Which instruction will be included in patient teaching? a. Return for a follow-up appointment in 2 to 3 days. b. Instruct a male partner to use a condom during sexual intercourse for the next week. c. Nonsteroidal antiinflammatory drug (NSAID) use may prevent pelvic organ scarring d. Abdominal pain may persist for several weeks.

A. The patient is instructed to return for follow-up in 48 to 72 hours. The patient should abstain from intercourse for 3 weeks. Abdominal pain should subside with effective antibiotic therapy. Corticosteroids may help prevent inflammation and scarring, but NSAIDs will not decrease scarring.

A patient undergoes an anterior and posterior (A) colporrhaphy for repair of a cystocele and rectocele. Which nursing action will be included in the postoperative care plan? a. Perform urinary catheter care. b. Repack the vagina with gauze daily. c. Teach the patient to insert a pessary. d. Encourage a high-fiber diet.

A. The patient will have a retention catheter for several days after surgery to keep the bladder empty and decrease strain on the suture. A pessary will not be needed after the surgery. Vaginal wound packing is not usually used after an A repair. A low-residue diet will be ordered after posterior colporrhaphy.

The nurse in the women's health clinic has four patients who are waiting to be seen. Which patient should the nurse see first? a. A 19-yr-old patient with menorrhagia who has been using superabsorbent tampons and has fever with weakness b. A 42-yr-old patient with secondary amenorrhea who says that her last menstrual cycle was 3 months ago c. A 22-yr-old patient with persistent red-brown vaginal drainage 3 days after having balloon thermotherapy d. A 35-yr-old patient with heavy spotting after having a progestin-containing IUD (Mirena) inserted a month ago

A. The patient's history and clinical manifestations suggest possible toxic shock syndrome, which will require rapid intervention. The symptoms for the other patients are consistent with their diagnoses and do not indicate life-threatening complications.

A 34-yr-old patient who is discussing contraceptive options with the nurse says, "I want to have children but not for a few years." Which response by the nurse is accurate? a. "Women often have more difficulty becoming pregnant after about age 35." b. "If you do not become pregnant within the next few years, you never will." c. "You have many more years of fertility left, so there is no rush to have children." d. "Stop taking oral contraceptives several years before you want to have a child."

A. The probability of successfully becoming pregnant decreases after age 35 years, although some patients may have no difficulty in becoming pregnant. Oral contraceptives do not need to be withdrawn for several years for a woman to become pregnant. Although the patient may be fertile for many years, it would be inaccurate to indicate that there is no concern about fertility as she becomes older. Although the risk for infertility increases after age 35 years, not all patients have difficulty in conceiving.

The nurse in the infertility clinic is explaining in vitro fertilization (IVF) to a couple. The woman tells the nurse that they cannot afford IVF on her husband's salary. The man replies that if his wife worked outside the home, they would have enough money. Which nursing diagnosis is appropriate? a. Defensive coping related to anxiety about lack of conception b. Ineffective sexuality patterns related to psychological stress c. Decisional conflict related to inadequate financial resources d. Ineffective denial related to frustration about continued infertility

A. The statements made by the couple are consistent with the diagnosis of defensive coping. No data indicate that ineffective sexuality and ineffective denial are problems. Although the couple is quarreling about finances, the data do not provide information indicating that the finances are inadequate.

A patient has undergone a vaginal hysterectomy with a bilateral salpingo-oophorectomy. She is concerned about a loss of libido. What intervention by the nurse would be best? a. Teach that estrogen cream inserted vaginally may help. b. Reinforce that weight gain may be inevitable. c. Suggest increasing vitamins and supplements daily. d. Discuss the value of a balanced diet and exercise.

A. Use of vaginal estrogen cream and gentle dilation can help with vaginal changes and loss of libido. Weight gain and masculinization are misperceptions after a vaginal hysterectomy. Vitamins, supplements, a balanced diet, and exercise are helpful for healthy living, but are not necessarily going to increase libido.

A patient is scheduled for an induced abortion using instillation of hypertonic saline solution. Which information will the nurse plan to discuss with the patient before the procedure? a. The expulsion of the fetus may take 1 to 2 days. b. The procedure may be unsuccessful in terminating the pregnancy. c. There is a possibility that the patient may deliver a live fetus. d. The patient will require a general anesthetic.

A. Uterine contractions take 12 to 36 hours to begin after the hypertonic saline is instilled. Because the saline is feticidal, the nurse does not need to discuss any possibility of a live delivery or that the pregnancy termination will not be successful. General anesthesia is not needed for this procedure.

Which topic will the nurse include in the preoperative teaching for a patient admitted for an abdominal hysterectomy? a. Purpose of ambulation and leg exercises b. Adverse effects of systemic chemotherapy c. Symptoms caused by the drop in estrogen level d. Decrease in vaginal sensation after surgery

A. Venous thromboembolism is a potential complication after the surgery, and the nurse will instruct the patient about ways to prevent it. Vaginal sensation is decreased after a vaginal hysterectomy but not after abdominal hysterectomy. Most hysterectomies are not done for treatment of cancer. Unless the patient has cancer, chemotherapy and radiation will not be prescribed. Because the patient will still have her ovaries, her estrogen level will not decrease.

A patient who is scheduled for a routine gynecologic examination tells the nurse that she has had intercourse during the past year with several men. The nurse will plan to teach about the reason for a. antibiotic therapy. b. Chlamydia testing. c. pregnancy testing. d. contraceptive use.

B. Chlamydia testing is recommended annually for women with multiple sex partners. There is no indication that the patient needs teaching about contraceptives, pregnancy testing, or antibiotic therapy.

The patient is emotionally upset about the recent diagnosis of stage IV endometrial cancer. Which action by the nurse is best? a. Let the patient alone for a long period of reflection time. b. Create an atmosphere of acceptance and discussion. c. Ask friends and relatives to limit their visits. d. Tell the patient that an emotional response is unacceptable.

B. Discussion of a patient's concerns about the presence of cancer and the potential for recurrence will provide emotional support and allay fears. Coping behaviors are encouraged with the support of friends and relatives. An emotional response should be accepted.

A 55-year-old postmenopausal woman reports a history of dyspareunia, backache, pelvis pressure, urinary tract infections, and a frequent urinary urgency. Which condition does the nurse suspect? a. Ovarian cyst b. Cystocele c. Fibroid d. Rectocele

B. Dyspareunia, backache, pelvis pressure, urinary tract infections, and urinary urgency are all symptoms of a cystocele—a protrusion of the bladder through the vaginal wall. Ovarian cysts are rare after menopause. A rectocele is associated with constipation, hemorrhoids, and fecal impaction. Fibroids are associated with heavy bleeding.

A patient has scheduled brachytherapy sessions and states that she feels as though she is not safe around her family. What is the best response by the nurse? a. "To be totally safe, it is a good idea to sleep in a separate room." b. "You are only radioactive when the radioactive implant is in place." c. "You should use a separate bathroom from the rest of the family." d. "It is best to stay a safe distance from friends or family between treatments."

B. In brachytherapy, the surgeon inserts an applicator into the uterus. After placement is verified, the radioactive isotope is placed in the applicator for several minutes for a single treatment. There are no restrictions for the woman to stay away from her family or the public between treatments.

A 19-yr-old patient has been diagnosed with primary dysmenorrhea. How will the nurse suggest that the patient manage discomfort? a. Use cold packs on the abdomen and back for pain relief. b. Take nonsteroidal antiinflammatory drugs (NSAIDs) when her period starts. c. Avoid aerobic exercise during her menstrual period. d. Talk with her health care provider about beginning antidepressant therapy.

B. NSAIDs should be started as soon as the menstrual period begins and taken at regular intervals during the usual time frame when pain occurs. Aerobic exercise may help reduce symptoms. Heat therapy, such as warm packs, is recommended for relief of pain. Antidepressant therapy is not a typical treatment for dysmenorrhea.

A patient was recently diagnosed with polycystic ovary syndrome. It is most important for the nurse to teach the patient a. how to decrease facial hair growth. b. methods to maintain appropriate weight. c. ways to reduce the occurrence of acne. d. reasons for a total hysterectomy.

B. Obesity exacerbates the problems associated with polycystic ovary syndrome, such as insulin resistance and type 2 diabetes. The nurse should also address the problems of acne and hirsutism, but these symptoms are lower priority because they do not have long-term health consequences. Although some patients do require total hysterectomy, it is usually performed only after other therapies have been unsuccessful.

Which patient in the women's health clinic will the nurse expect to teach about an endometrial biopsy? a. A 55-yr-old patient who has 3 to 4 alcoholic drinks each day b. A 25-yr-old patient who has a family history of hereditary nonpolyposis colorectal cancer c. A 35-yr-old patient who has used oral contraceptives for 15 years d. A 45-yr-old patient who has had six previous full-term pregnancies and two spontaneous abortions

B. Patients with a personal or familial history of hereditary nonpolyposis colorectal cancer are at increased risk for endometrial cancer. Alcohol addiction does not increase this risk. Multiple pregnancies and oral contraceptive use offer protection from endometrial cancer.

To prevent pregnancy in a patient who has been sexually assaulted, the nurse in the emergency department will plan to teach the patient about the use of a. methotrexate with misoprostol. b. levonorgestrel (Plan-B One-Step). c. dilation and evacuation. d. mifepristone .

B. Plan B One-Step reduces the risk of pregnancy when taken within 72 hours of intercourse. The other methods are used for therapeutic abortion but not for pregnancy prevention after unprotected intercourse.

A patient in the emergency department reports that she has been sexually assaulted. Which action by the nurse will help to maintain the medicolegal chain of evidence? a. Discussing the availability of the "morning-after pill" for pregnancy prevention b. Labeling all specimens and other materials obtained from the patient c. Assisting the patient in filling out the application for financial compensation d. Educating the patient about baseline sexually transmitted infection (STI) testing

B. The careful labeling of specimens and materials will assist in maintaining the chain of evidence. Assisting with paperwork, and discussing STIs and pregnancy prevention are interventions that might be appropriate after sexual assault, but they do not help maintain the legal chain of evidence.

A 19-yr-old patient visits the health clinic for a routine checkup. Which question should the nurse ask to determine whether a Pap test is needed? a. "Do you have cramping with your periods?" b. "Have you had sexual intercourse?" c. "Do you use any illegal substances?" d. "At what age did your menstrual periods start?"

B. The current American Cancer Society recommendation is that a Pap test be done every 3 years, starting 3 years after the first sexual intercourse and no later than age 21 years. The information about menstrual periods and substance abuse will not help determine whether the patient requires a Pap test.

A patient who was admitted to the emergency department with severe abdominal pain is diagnosed with an ectopic pregnancy. The patient begins to cry and asks the nurse to leave her alone to grieve. Which action should the nurse take next? a. Stay with the patient and encourage her to discuss her feelings. b. Provide teaching about options for termination of the pregnancy. c. Explain the reason for taking vital signs every 15 to 30 minutes. d. Close the door to the patient's room and minimize disturbances.

C. Because the patient is at risk for rupture of the fallopian tube and hemorrhage, frequent monitoring of vital signs is needed. The patient has asked to be left alone, so staying with her and encouraging her to discuss her feelings are inappropriate actions. Minimizing contact with her and closing the door of the room is unsafe because of the risk for hemorrhage. Because the patient has requested time to grieve, it would be inappropriate to provide teaching about options for pregnancy termination.

A patient has just been instructed in the treatment for a Chlamydia trachomatis vaginal infection. Which patient statement indicates that the nurse's teaching has been effective? a. "The symptoms are due to the overgrowth of normal vaginal bacteria." b. "I can purchase an over-the-counter medication to treat this infection." c. "Both my partner and I will need to take the medication for a full week." d. "The medication will need to be inserted once daily with an applicator."

C. Chlamydia is a sexually transmitted bacterial infection that requires treatment of both partners with antibiotics for 7 days. The other statements are true for the treatment of Candida albicans infection.

A 49-yr-old patient tells the nurse that she is postmenopausal but has recently had occasional spotting. Which initial response by the nurse is appropriate? a. "Breakthrough bleeding is not unusual in women your age." b. "A frequent cause of spotting is endometrial cancer." c. "Are you using prescription hormone replacement therapy?" d. "How long has it been since your last menstrual period?"

C. In postmenopausal women, a common cause of spotting is hormone replacement therapy. Because breakthrough bleeding may be a sign of problems such as cancer or infection, the nurse would not imply that this is normal. The length of time since the last menstrual period is not relevant to the patient's symptoms. Although endometrial cancer may cause spotting, this information is not appropriate as an initial response.

A 50-yr-old patient is diagnosed with uterine bleeding caused by a leiomyoma. Which information will the nurse include in the patient teaching plan? a. The patient will need frequent monitoring to detect any malignant changes. b. The tumor size is likely to increase throughout the patient's lifetime. c. The symptoms may decrease after the patient undergoes menopause. d. Aspirin or acetaminophen may be used to control mild to moderate pain.

C. Leiomyomas appear to depend on ovarian hormones and will atrophy after menopause, leading to a decrease in symptoms. Aspirin use is discouraged because the antiplatelet effects may lead to heavier uterine bleeding. The size of the tumor will shrink after menopause. Leiomyomas are benign tumors that do not undergo malignant changes.

A patient with endometriosis asks why she is being treated with medroxyprogesterone, a medication that she thought was a contraceptive. The nurse explains that this therapy a. prevents a pregnancy that could worsen the menstrual bleeding. b. relieves symptoms such as vaginal atrophy and hot flashes. c. suppresses the menstrual cycle by mimicking pregnancy. d. leads to permanent suppression of abnormal endometrial tissues.

C. Medroxyprogesterone induces a pseudopregnancy, which suppresses ovulation and causes shrinkage of endometrial tissue. Menstrual bleeding does not occur during pregnancy. Vaginal atrophy and hot flashes are caused by synthetic androgens such as danazol or gonadotropin-releasing hormone agonists such as leuprolide. Although hormonal therapies will control endometriosis while the therapy is used, endometriosis will recur once the menstrual cycle is reestablished.

A patient tells the nurse that she would like a prescription for oral contraceptives to control her premenstrual dysphoric disorder (PMD-D) symptoms. Which patient information that contraindicates oral contraceptives should be communicated to the health care provider? a. Bilateral breast tenderness b. Previous spontaneous abortion c. History of migraine headaches d. Frequent abdominal bloating

C. Oral contraceptives are contraindicated in patients with a history of migraine headaches. The other patient information would not prevent the patient from receiving oral contraceptives.

A young patient who is trying to become pregnant asks the nurse how to determine when she is most likely to conceive. The nurse explains that a. she will need to bring a specimen of cervical mucus to the clinic for testing. b. ovulation is unpredictable unless there are regular menstrual periods. c. ovulation prediction kits can provide accurate information about ovulation. d. she should take her body temperature daily and have intercourse when it drops.

C. Ovulation prediction kits indicate when luteinizing hormone (LH) levels first rise. Ovulation occurs about 28 to 36 hours after the first rise of LH. This information can be used to determine the best time for intercourse. Body temperature rises at ovulation. Postcoital cervical smears are used in infertility testing, but they do not predict the best time for conceiving and are not obtained by the patient. Determination of the time of ovulation can be predicted by basal body temperature charts or ovulation prediction kits and is not dependent on regular menstrual periods.

A patient has recently been diagnosed with stage III endometrial cancer and asks the nurse for an explanation. What response by the nurse is correct about the staging of the cancer? a. "The cancer has spread to the mucosa of the bowel and bladder." b. "It is contained in the endometrium of the cervix." c. "It has reached the vagina or lymph nodes." d. "The cancer now involves the cervix."

C. Stage III of endometrial cancer reaches the vagina or lymph nodes. Stage I is confined to the endometrium. Stage II involves the cervix, and stage IV spreads to the bowel or bladder mucosa and/or beyond the pelvis.

The nurse is educating a patient on the prevention of toxic shock syndrome (TSS). Which statement by the patient indicates a lack of understanding? a. "It is best if I wash my hands before inserting the tampon." b. "If I don't use tampons, I should not get TSS." c. "I need to change my tampon every 8 hours during the day." d. "At night, I should use a feminine pad rather than a tampon."

C. Tampons need to be changed every 3 to 6 hours to avoid infection by such organisms as Staphylococcus aureus. All of the other responses are correct: use of feminine pads at night, not using tampons at all, and washing hands before tampon insertion are all strategies to prevent TSS.

A 47-yr-old patient asks whether she is going into menopause if she has not had a menstrual period for 3 months. Which response by the nurse is appropriate? a. "Have you thought about using hormone replacement therapy?" b. "Most women feel a little depressed about entering menopause." c. "What was your menstrual pattern before your periods stopped?" d. "Because you are in your mid-40s, it is likely that you are menopausal."

C. The initial response by the nurse should be to assess the patient's baseline menstrual pattern. Although many women do enter menopause in the mid-40s, more information about this patient is needed before telling her that it is likely she is menopausal. Although hormone therapy may be prescribed, further assessment of the patient is needed before discussing therapies for menopause. Because the response to menopause is very individual, the nurse should not assume that the patient is experiencing any adverse emotional reactions.

The nurse has just received change-of-shift report about the following four patients. Which patient should be assessed first? a. A patient who is complaining of 5/10 pain after an abdominal hysterectomy b. A patient in the fifteenth week of gestation who has uterine cramping and spotting c. A patient with a possible ectopic pregnancy who is complaining of shoulder pain d. A patient with a cervical radium implant in place who is crying in her room

C. The patient with the ectopic pregnancy has symptoms consistent with rupture and needs immediate assessment for signs of hemorrhage and possible transfer to surgery. The other patients should also be assessed as quickly as possible but do not have symptoms of life-threatening complications.

A female patient tells the nurse that she has been having nightmares and acute anxiety around men since being sexually assaulted 3 months ago. The most appropriate nursing diagnosis for the patient is a. ineffective coping related to inability to resolve incident. b. sleep deprivation related to frightening dreams. c. rape-trauma syndrome related to rape experience. d. anxiety related to effects of being raped.

C. The patient's symptoms are most consistent with the nursing diagnosis of rape-trauma syndrome. The nursing diagnoses of sleep deprivation, ineffective coping, and anxiety address some aspects of the patient's symptoms but do not address the problem as completely as the rape-trauma syndrome diagnosis.

A 28-yr-old patient reports anxiety, headaches with dizziness, and abdominal bloating occurring before her menstrual periods. Which action is best for the nurse to take at this time? a. Suggest that the patient try aerobic exercise to decrease her symptoms. b. Teach the patient about appropriate lifestyle changes to reduce premenstrual syndrome (PMS) symptoms. c. Ask the patient to keep track of her symptoms in a diary for 3 months. d. Advise the patient to use nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen to control symptoms.

C. The patient's symptoms indicate possible PMS, but they also may be associated with other diagnoses. Having the patient keep a symptom diary for 2 or 3 months will help in confirming a diagnosis of PMS. The nurse should not implement interventions for PMS until a diagnosis is made.

A patient is admitted to the emergency department with toxic shock syndrome. Which action by the nurse is the most important? a. Transfuse the patient to manage low blood count. b. Collect a blood specimen for culture and sensitivity. c. Remove the tampon as the source of infection. d. Administer IV fluids to maintain fluid and electrolyte balance.

C. The source of infection should be removed first. All of the other answers are possible interventions depending on the patient's symptoms and vital signs, but removing the tampon is the priority.

Which action would the nurse teach to help the patient prevent vulvovaginitis? a. Use feminine hygiene sprays to avoid odor. b. Cleanse the inner labial mucosa with soap and water. c. Wear loose cotton underwear. d. Wipe back to front after urination.

C. To prevent vulvovaginitis, the patient should wear cotton underwear. The patient should wipe front to back after urination, not back to front. The patient should cleanse the inner labial mucosa with water only, and avoid using feminine hygiene sprays.

The nurse will plan to teach a 34-yr-old patient diagnosed with stage 0 cervical cancer about a. radical hysterectomy. b. chemotherapy. c. conization. d. radiation.

C. Because the carcinoma is in situ, conization can be used for treatment. Radical hysterectomy, chemotherapy, or radiation will not be needed.

A 56-yr-old patient is concerned about having a moderate amount of vaginal bleeding after 5 years of menopause. The nurse will anticipate teaching the patient about a. dilation and curettage (D). b. uterine balloon therapy. c. endometrial ablation. d. endometrial biopsy.

D. A postmenopausal woman with vaginal bleeding should be evaluated for endometrial cancer, and endometrial biopsy is the primary test for endometrial cancer. D will be needed only if the biopsy does not provide sufficient information to make a diagnosis. Endometrial ablation and balloon therapy are used to treat menorrhagia, which is unlikely in this patient.

A 31-yr-old patient who has been diagnosed with human papillomavirus (HPV) infection gives a health history that includes smoking tobacco, taking oral contraceptives, and having been treated twice for vaginal candidiasis. Which topic will the nurse include in patient teaching? a. Antifungal cream administration b. Use of water-soluble lubricants c. Possible difficulties with conception d. Risk factors for cervical cancer

D. Because HPV infection and smoking are both associated with increased cervical cancer risk, the nurse should emphasize the importance of avoiding smoking. An HPV infection does not decrease vaginal lubrication, decrease the ability to conceive, or require the use of antifungal creams.

A patient who has a large cystocele was admitted 10 hours ago but has not yet voided. If the patient reports no urge to void, which action should the nurse take first? a. Insert a straight catheter per the PRN order. b. Notify the health care provider of the inability to void. c. Encourage the patient to increase oral fluids. d. Use an ultrasound scanner to check for urinary retention.

D. Because urinary retention is common with a large cystocele, the nurse's first action should be to use an ultrasound bladder scanner to check for the presence of urine in the bladder. The other actions may be appropriate, depending on the findings with the bladder scanner.

Which statement by the patient indicates that the nurse's teaching about treating vaginal candidiasis was effective? a. "I will tell my partner that we cannot have intercourse for a month." b. "I will insert the antifungal cream right before I get up in the morning." c. "I can douche with warm water if the itching continues to bother me." d. "I should clean carefully after each urination and bowel movement."

D. Cleaning of the perineal area will decrease itching caused by contact of the irritated tissues with urine and reduce the chance of further infection of irritated tissues by bacteria in the stool. Sexual intercourse should be avoided for 1 week. Douching will disrupt normal protective mechanisms in the vagina. The cream should be used at night so that it will remain in the vagina for longer periods of time.

A patient requests a prescription for birth control pills to control severe abdominal cramping and headaches during her menstrual periods. Which action should the nurse take first? a. Teach about the side effects of oral contraceptives. b. Suggest nonsteroidal antiinflammatory drugs (NSAIDs). c. Determine whether the patient is sexually active. d. Take the patient's personal and family health history.

D. Oral contraceptives may be appropriate to control this patient's symptoms, but the patient's health history may indicate contraindications to oral contraceptive use. Because the patient is requesting contraceptives for management of dysmenorrhea, whether she is sexually active is irrelevant. Because the patient is asking for birth control pills, responding that she should try NSAIDs is nontherapeutic. The patient does not need teaching about oral contraceptive side effects at this time.

Which action should the nurse take when a 35-yr-old patient has a Pap test result of minor cellular changes? a. Teach the patient about punch biopsy. b. Administer human papillomavirus (HPV) vaccine. c. Teach the patient about colposcopy. d. Schedule another Pap test in 4 months.

D. Patients with minor changes on the Pap test can be followed with Pap tests every 4 to 6 months because these changes may revert to normal. Punch biopsy or colposcopy may be used if the Pap test shows more prominent changes. The HPV vaccine may reduce the risk for cervical cancer, but it is recommended only for ages 9 through 26 years.

A patient has just returned from a total abdominal hysterectomy and needs postoperative nursing care. What action can the nurse delegate to the unlicensed assistive personnel (UAP)? a. Evaluate the dressing for drainage. b. Assess heart, lung, and bowel sounds. c. Check the hemoglobin and hematocrit levels. d. Empty the urine from the urinary catheter bag.

D. The UAP is able to empty the urinary output from the catheter. The nurse would assess the heart, lung, and bowel sounds; check the hemoglobin and hematocrit levels; and evaluate the drainage on the dressing.

The nurse is caring for a postoperative patient following an anterior colporrhaphy. What action can be delegated to the unlicensed assistive personnel (UAP)? a. Teaching the patient to avoid lifting her 4-year-old grandson b. Reviewing the hematocrit and hemoglobin results c. Assessing the level of pain and any drainage d. Drawing a shallow hot bath for comfort measures

D. The UAP is able to provide comfort through a bath. The registered nurse would review any laboratory results, complete any teaching, and assess pain and discharge.

A patient brought to the emergency department reports being sexually assaulted. The patient is confused about where she is and she has a laceration above the right eye. Which action should the nurse take first? a. Ask the patient to describe what occurred during the assault. b. Assist the patient to remove her clothing. c. Ask the sexual assault nurse examiner (SANE) to assess the patient. d. Assess the patient's neurologic status.

D. The first priority is to treat urgent medical problems associated with the sexual assault. The patient's head injury may be associated with a head trauma such as a skull fracture or subdural hematoma. Therefore her neurologic status should be assessed first. The other nursing actions are also appropriate, but they are not as high in priority as assessment and treatment for acute physiologic injury.

When caring for a patient who has a radium implant for treatment of cervical cancer, the nurse will assist the patient to a. ambulate every 2 to 3 hours. b. flush the toilet several times right after the patient voids. c. use gloves and gown when changing the patient's bed. d. encourage the patient to discuss any concerns by telephone.

D. The nurse should spend minimal time in the patient's room to avoid exposure to radiation. The patient and nurse can have longer conversations by telephone between the patient room and nursing station. To prevent displacement of the implant, absolute bed rest is required. Wearing of gloves and gown when changing linens and flushing the toilet several times are not necessary because the isotope is confined to the implant.

A nursing diagnosis that is likely to be appropriate for a 67-yr-old patient who has just been diagnosed with stage III ovarian cancer is sexual dysfunction related to a. loss of vaginal sensation. b. risk for infection related to impaired immune function. c. situational low self-esteem related to guilt about delaying medical care. d. anxiety related to cancer diagnosis and need for treatment decisions.

D. The patient with stage III ovarian cancer is likely to be anxious about the poor prognosis and about the need to make decisions about the multiple treatments that may be used. Decreased vaginal sensation does not occur with ovarian cancer. The patient may develop immune dysfunction when she receives chemotherapy, but she is not currently at risk. It is unlikely that the patient has delayed seeking medical care because the symptoms of ovarian cancer are vague and occur late in the course of the cancer.

Which nursing assessment finding in a patient who recently started taking hormone replacement therapy (HRT) requires discussion with the health care provider about a change in therapy? a. Breast tenderness b. Intermittent spotting c. Weight gain of 3 lb d. Left calf swelling

D. Unilateral calf swelling may indicate deep vein thrombosis caused by the changes in coagulation associated with HRT and would indicate that the HRT should be discontinued. Breast tenderness, weight gain, and intermittent spotting are common side effects of HRT and do not indicate a need for a change in therapy.

A 32-yr-old patient has oral contraceptives prescribed for endometriosis. The nurse will teach the patient to a. take calcium supplements to prevent developing osteoporosis during therapy. b. use a second method of contraception to ensure that she will not become pregnant. c. expect to experience side effects such as facial hair. d. take the medication every day for the next 9 months.

D. When oral contraceptives are prescribed to treat endometriosis, the patient should take the medications continuously for 9 months. Facial hair is a side effect of synthetic androgens. The patient does not need to use additional contraceptive methods. The hormones in oral contraceptives will protect against osteoporosis.

A healthy 24-yr-old patient who has been vaccinated against human papillomavirus (HPV) has a normal Pap test result. Which information will the nurse include in patient teaching when calling the patient with the results of the Pap test? a. No further Pap testing is needed until you decide to become pregnant. b. Yearly Pap testing is suggested for women with multiple sexual partners. c. You can wait until after age 30 before having another Pap test. d. Pap testing is recommended every 3 years for women your age.

D. Women ages 21 to 29 years should get a Pap test every 3 years.

A 22-yr-old patient tells the nurse that she has not had a menstrual period for the past 3 months. Which action is most important for the nurse to take? a. Ask about any recent stressful lifestyle changes. b. Measure the patient's current height and weight. c. Question the patient about prescribed medications. d. Obtain a urine specimen for a pregnancy test.

D. Pregnancy should always be considered a possible cause of amenorrhea in women of childbearing age. The other actions are also appropriate, but it is important to check for pregnancy in this patient because pregnancy will require rapid implementation of actions to promote normal fetal development such as changes in lifestyle, folic acid intake, and so on.