Porth's Patho: Disorders of Female Reproductive, Chapter 45

A client diagnosed with endometriosis asks the nurse how it is that she did not know about this when she had it for so long. What is the nurse's best response? -"It is a rare disease." -"You needed to have surgery to diagnose it." -"Its symptoms mimic those of other disorders " -"There are no symptoms."

-"Its symptoms mimic those of other disorders Symptoms of endometriosis often mimic symptoms of other pelvic disorders and the severity of the symptoms does not always reflect the extent of the disease. There are no serum markers or non-invasive tests for the disease. It is not rare, and you do not need surgery to diagnose it; however, definitive diagnosis can be accomplished with laparoscopy and histological testing. Most cases are diagnosed on symptomatology.

What will the nurse assess in a client diagnosed with Paget disease as a cause of breast cancer? -Enlargement of all lymph nodes in the axilla -Increased menstruation -Vaginal discharge -A lesion of the nipple on the affected breast

-A lesion of the nipple on the affected breast Paget disease accounts for 1% of all breast cancer and presents as an eczematous lesion of the nipple and areola. When the lesion is limited to the nipple only, the rate of axillary metastasis is approximately 5%. The other findings are not typical of Paget disease.

In assessing a client with a fibroadenoma of the breast, what will the nurse find? -Extreme pain during menstruation -Hard masses -Firm, rubbery masses -Unmovable masses

-Firm, rubbery masses The nurse will find firm, rubbery masses in a client with fibroadenoma. The masses will be moveable and there is not extreme pain. They are usually asymptomatic.

What is the term for the condition that involves dyspareunia and widespread vaginal burning in the absence of bacterial presence? -Bartholin gland abscess -Vaginitis -Localized vulvodynia -Generalized vulvodynia

-Generalized vulvodynia The type of vulvodynia that is described is generalized vulvodynia, as opposed to localized, which is not as widespread. Vaginitis would have bacterial involvement. These are not the symptoms associated with a Bartholin gland abscess.

The nurse is caring for a client with lichen simplex chronicus. What assessment finding does the nurse expect? -Bleeding -Painful urination -Black patches of skin -Gray-white plaques with an irregular surface

-Gray-white plaques with an irregular surface Lichen simplex chronicus presents as thickened gray white plaques with an irregular surface. It is thought to be a response of the genital skin to some type of irritant. Bleeding, pain, and black patches are not seen with this disorder.

There are two types of vulvar cancer. One type is found in older women, and one type is found in younger women, generally less than 40 years of age. The type found in younger women is thought to be caused by: -Human papillomavirus (HPV) -Lichen sclerotic lesions -Nonsquamous cell lesions -Multiple sexual partners

-Human papillomavirus (HPV) One-third to one-half of vulvar intraepithelial neoplasia (VIN) cases appear to be caused by the cancer-promoting potential of certain strains (subtypes 16 and 18) of HPV that are sexually transmitted and are associated with the type of vulvar cancer found in younger women. The other answers are not thought to be associated with vulvar cancer in younger women.

A client is diagnosed with vulvar carcinoma, which appears as an inconspicuous thickening of the skin resembling eczema or dermatitis and may produce few symptoms other than pruritus, local discomfort, and exudation. The nurse understands that the cancer metastasizes readily through which mode? -Vaginal flora -Multiple lymph channels -Hair follicles -Pores that are close together

-Multiple lymph channels The malignant lesion gradually spreads superficially or as a deep furrow involving all of one labial side. Because there are many lymph channels around the vulva, the cancer metastasizes freely to the regional lymph nodes.

The nurse practitioner is reviewing risk factors for the development of pelvic inflammatory disease (PID) with a client. Which information is appropriate to include? Select all that apply. -Use of barrier contraception -Age older than 30 years -Previous diagnosis of sexually transmitted infection -Sexual intercourse before the age of 15 years -Multiple sex partners

-Previous diagnosis of sexually transmitted infection -Sexual intercourse before the age of 15 years -Multiple sex partners Factors that predispose women to the development of PID include an age younger than 25 years; young age at first intercourse (younger than 15 years); use of nonbarrier contraception, especially intrauterine device or oral contraception; history of new, multiple, or symptomatic sex partners; and previous history of PID or sexually transmitted infection.

The nurse working in a fertility clinic is assessing a client's risk for fallopian tube obstruction. Which disorder places the woman at greatest risk for fallopian tube obstruction? -Dysmenorrhea -Endometriosis -Uterine prolapse -Vaginitis

Endometriosis Tubal patency is required for fertilization and can be disrupted secondary to PID, ectopic pregnancy, large myomas, endometriosis, pelvic adhesions, and previous tubal ligation. The remaining options do not relate to the fallopian tubes.

Which factor in a client's history is most likely related to the diagnosis of cervical squamous dysplasia? -Bartholin cysts -Infertility -Human papillomavirus (HPV) infection -Endometriosis

Human papillomavirus (HPV) infection HPV is the most common cause of cell dysplasia, as the virus causes cell changes. Conditions that do not contribute to cell dysplasia include endometriosis, Bartholin cysts, and infertility. Bartholin cysts occur when the ducts from the Bartholin glands become blocked. Endometriosis occurs when the endometrial tissue is displaced in the body. Infertility is inability to conceive or maintain pregnancy.

A client with polycystic ovary syndrome (PCOS) visits a fertility clinic. Which intervention will best improve the chance for a successful pregnancy? -Clomiphene -Weight loss -Spironolactone -Metformin

Clomiphene Clomiphene is a hypothalamic-pituitary-stimulating drug that promotes ovulation. This is the agent of choice for improving successful pregnancy in clients with PCOS. Clients with PCOS are encouraged to lose weight because obesity is known to increase insulin resistance and promote androgen production, which leads to development of multiple immature follicles. Metformin is an insulin-sensitizing agent that helps control blood glucose, but it is not directly beneficial in promoting pregnancy. Spironolactone may be useful in suppressing hirsutism that results from excess androgen production, but it will not affect pregnancy.

Leiomyomas are smooth-muscle fibroid tumors that usually develop in which part of the reproductive system? -The corpus of the uterus -Fibrocystic breasts -Ovaries -Uterosacral ligaments

The corpus of the uterus Leiomyomas, also known as myomas or fibroids, are benign uterine neoplasms of smooth-muscle origin. They usually develop as submucosal, subserosal, or intramural tumors in the corpus of the uterus. The uterosacral and other ligaments maintain the uterus and other pelvic structures in proper position; ligaments weaken with age without forming fibrous tumors. Fibrocystic changes, formerly called fibrocystic breast disease, are benign irregular fibrous breast lesions. The ovaries may develop follicular or corpus luteum cysts, which are generally benign.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder. The nurse understands that about 50% of the women who are diagnosed with PCOS have which problem? -Obesity -Hyperprogesterone -Diabetes insipidus -Hypoandrogen

-Obesity About 50% of women who are diagnosed with PCOS are obese. Hyperinsulinemia and insulin resistance are thought to play a role in the pathogenesis of the disorder.

An asymptomatic client who is worried about developing breast cancer due to the fact that it runs in her family asks the nurse if she could have a mammogram to see if she has any lumps. The nurse informs the client that a tumor usually is undetectable until it has doubled 30 times and contains more than 1 billion cells. This means that at this point it measures approximately which size? -5 cm -4 cm -1 cm -3 cm

1 cm Using conventional radiographic methods, a tumor usually is undetectable until it has doubled 30 times and contains more than 1 billion cells. At this point it is approximately 1 cm in size. A tumor that measures anything over 1 cm including 3 cm, 4 cm, and 5 cm would definitely be detectable using radiography.

A nurse who works in a fertility clinic is conducting a program on options for various fertility issues. The nurse judges that the participants understand the education when they identify that donor eggs are the best option for which woman? -A 38-year-old -A 42-year-old -A 33-year-old -A 28-year-old

42 Donor eggs provide a much higher likelihood of success for women older than 40 years of age, when both egg numbers and egg quality decline.

There are many cancers of the female reproductive system. The nursing student knows that the most readily detected and most easily cured cancer—if detected early—is: -Cervical -Vulvar -Vaginal -Ovarian

Cervical Cervical cancer is readily detected and, if detected early, is the most easily cured of all the cancers of the female reproductive system.

There are many cancers of the female reproductive system. The nursing student knows that the most readily detected and most easily cured cancer—if detected early—is: -Vulvar -Cervical -Vaginal -Ovarian

Cervical Cervical cancer is readily detected and, if detected early, is the most easily cured of all the cancers of the female reproductive system.

A female client reports a grayish-green nipple discharge in one breast. Which additional manifestation corresponds with a diagnosis of ductal ectasia? -Multiple nodules in the breast -Firm, fixed, irregular nodule -Ductal inflammation with thickening -Tender, fluid-filled sac

Ductal inflammation with thickening Ductal ectasia occurs spontaneously in older women as a grayish-green discharge from one breast. Discharge increases with palpation and includes burning, itching, and a pulling sensation of the nipple. Inflammation and thickening occur in the involved duct.

A 29-year-old client had a Papanicolaou smear performed during her most recent visit to her primary care provider. This diagnostic procedure aims to identify: -Human papillomavirus (HPV) antibodies -Atypical cervix cellular changes -Lesions at the transformation zone -Cervical polyps

-Atypical cervix cellular changes The primary purpose of a Pap smear is to obtain cytology samples from the cervix to examine the cervical cells for atypical changes. These precancerous changes represent a continuum of morphologic changes with indistinct boundaries that may gradually progress to cancer in situ and then to invasive cancer. The performance of a Pap smear allows for visualization of the cervix, but the primary diagnostic purpose is not the identification of lesions and polyps. Cytology samples are not tested for HPV antibodies.

The nurse is teaching a client with polycystic ovary syndrome (PCOS) about the condition. Which statement by the client indicates a need for further instruction? -"I need to regulate my weight to help prevent complications." -"I may have inherited a tendency to this disorder." -"I may need medical intervention when I want to conceive." -"I developed this as a result of a sexually transmitted infection."

-"I developed this as a result of a sexually transmitted infection." PCOS is an endocrine disorder with a genetic link. Clients with PCOS can prevent diabetes and improve fertility by controlling obesity. Infertility may be an issue for clients with PCOS even if they control their weight. For those women, additional medication may be necessary to improve ovulatory cycles.

The nurse has taught a 30-year-old female client to perform breast self-evaluation (BSE). Which statement by the client indicates correct understanding? -"I will palpate my breasts for lumps a few days after my period." -"I will perform BSE on the first of every month during a shower." -"I will look in a mirror and call my doctor for breast asymmetry." -"I will let my partner examine my breasts on a monthly basis."

-"I will palpate my breasts for lumps a few days after my period." BSE should be performed monthly. Men and postmenopausal women should select a convenient date. Premenopausal women should time the exam for a few days after menses begins. This is when the breast tissue is less tender or enlarged in response to estrogens that build up before menses. BSE should examine the entire breast in a methodical manner, palpating for abnormalities with the pads of the fingers. Breasts are generally not completely symmetrical. Although obvious asymmetry is a reason to notify the primary healthcare provider, this response does not indicate that the client understands the importance of monthly exams in relation to the menstrual cycle.

A female client reports that her mother-in-law was just diagnosed with cervical cancer and asks the nurse about her own risk. Which response by the nurse is correct? -"Your risk is higher if you did not use oral contraception." -"If you have annual Papanicolaou (Pap) smears, you have a low risk." -"If you had the human papillomavirus (HPV) vaccine, your risk is greatly reduced." -"Your family history indicates you should have genetic testing."

-"If you had the human papillomavirus (HPV) vaccine, your risk is greatly reduced." HPV is implicated in cancer of the vulva, vagina, and cervix. The vaccine against HPV is estimated to reduce the risk of cervical cancer by 97%. The Papanicolaou (Pap) test helps to identify cell dysplasia in the transitional zone of the cervix; however, as many as 20% of women with intraepithelial lesions have normal Pap test results. Factors that increase risk of cervical cancer include use of oral contraceptive medications, cigarette smoking, early age of first sexual intercourse, multiple pregnancies, immunodeficiency, and family history of cervical cancer in first- or second-degree relatives.

What will the nurse teach the client who has a cervical polyp? -"You do not need to have this removed." -"Polyps are most often cancerous." -"Polyps typically are asymptomatic" -"Polyps cause extreme pain."

-"Polyps typically are asymptomatic" Polyps are the most common lesion of the cervix and are typically asymptomatic and benign. They do have to be removed and examined. They do not usually cause pain.

After an office visit with her primary health provider, a female client with an elevated CA-125 test result asks the nurse if that means she has ovarian cancer. What is the nurse's best response? -"You will need to ask your doctor to explain the test to you." -"The test is not specific for ovarian cancer but suggests further evaluation to find the cause of the elevation." -"The test is an accurate screening tool for early detection of ovarian cancer." -"Don't worry about it. The test is too general to cause you to be alarmed."

-"The test is not specific for ovarian cancer but suggests further evaluation to find the cause of the elevation." The CA-125 tumor marker is a cell surface antigen. The level may be elevated for a variety of reasons including inflammation, endometriosis, uterine fibroids, pregnancy, liver disease, and cancers of the cervix, fallopian tube, and pancreas. It is elevated in about 50% of cases with early stage ovarian cancer, but has more predictive value with postmenopausal women or women with more advanced stages of cancer. Therefore, the CA-125 test should not be used as an exclusive test to screen for ovarian cancer, but a client with an elevation should have further testing to determine the cause. It is appropriate for the nurse to provide basic education when a client has seen the health provider but still has questions.

Fibrocystic changes in the breast are not uncommon. How is the diagnosis of fibrocystic changes made? -Ultrasonography and mammography -Physical examination and client history -Mammography and galactography -Galactography and biopsy

-Ultrasonography and mammography Diagnosis of fibrocystic changes is made by physical examination, mammography, ultrasonography, and biopsy (i.e., aspiration of tissue sample). Client history and galactography are not used to diagnose fibrocystic changes in the breast.

A client asks the health care provider to, "Explain brachytherapy, which is recommended for my cervical cancer." Which response by the nurse is most accurate? -"You will go to the x-ray department where they will insert a device in your vagina until it touches the cervix and then turn on a laser." -"They will insert a radioactive device into your vagina and position it next to the cervix, so that curative levels of radiation are directly on the cancer site." -"The health care provider will take you to surgery, place your legs in the stirrups, and irrigate your entire vaginal cavity with radioactive water. Then the provider will pack your vagina with sterile packing." -"You will come to the radiation department daily for at least 4 weeks, where they will insert a device and shine a beam on your cervical cancer area, hoping for it to burn off the cancer."

-"They will insert a radioactive device into your vagina and position it next to the cervix, so that curative levels of radiation are directly on the cancer site." External-beam irradiation and intracavitary irradiation or brachytherapy (i.e., insertion of radioactive materials into the body) can be used in the treatment of cervical cancer. Intracavitary radiation provides direct access to the central lesion and increases the tolerance of the cervix and surrounding tissues, permitting curative levels of radiation to be used. None of the other answers describe this process. It usually is inserted in radiology, and then the client is transported to a private room until an allotted time frame passes.

A client with vulvodynia tells the nurse, "This is not getting better. I just can't live like this." What is the best response by the nurse? -"Has your partner complained about intimacy?" -"You may need an increase in your steroid dosage." -"Give the physical therapy a bit more time to help you." -"What bothers you the most about your condition?"

-"What bothers you the most about your condition?" Vulvodynia is a syndrome of unexplained "burning" vulvar pain along with hypersensitivity to touch. There are no obvious deformities, infections, or inflammations that might cause the sensations similar to neuropathic pain disorders. Treatment is primarily symptomatic and includes pelvic floor physical therapy, steroids, topical lubricants, and selective serotonin reuptake inhibitors. Psychosocial support is needed because of strain placed on sexual, family, and work relationships.

An older female client calls and reports, "Another cyst in my private area. I had this years ago, but after 15 years it has returned. What should I do?" Which advice should the health care provider give to this client? -"Try sitting in a warm bath to see if it helps." -"Are you allergic to any medication?" -"You should call and make an appointment. I would like to evaluate this further." -"I will call your pharmacy and order some antibiotic cream."

-"You should call and make an appointment. I would like to evaluate this further." Because the Bartholin glands usually shrink during menopause, a vulvar growth in postmenopausal women is suspicious and should be evaluated for malignancy. Antibiotics and creams may be appropriate after physical assessment of the site, but these should not be the first line of action. If this cyst is at the Bartholin gland, local application of moist heat may be an appropriate course of action as well, following physical examination.

A female client with uterine leiomyomas asks the nurse about her risk of uterine cancer. Which statement best answers the question? -"You are at low risk because you do not have diabetes mellitus or hypertension." -"Your risk of uterine cancer will decrease after age 65." -"Your leiomyomas may cause heavy periods but will not become cancerous." -"Your uterine cancer risk is decreased by taking oral contraceptives."

-"Your leiomyomas may cause heavy periods but will not become cancerous." Leiomyomas of the uterus, also called fibroids, are benign smooth muscle tumors which are commonly asymptomatic. Clients may experience excessive menstrual bleeding, anemia, urinary frequency, rectal pressure, and abdominal distention. Most tumors regress with menopause. The presence of leiomyomas does not increase the risk of uterine cancer.

Which sexually active woman most likely faces the highest risk of developing an ectopic pregnancy? -A 42-year-old who has decided to try to have one more child and has had her tubal ligation reversed -A 22-year-old who has a history of anorexia nervosa and who has a body mass index (BMI) of 12.0 (normal BMI = 18.5-24.9) -A 14-year-old who experienced menarche 2 years earlier -A 27-year-old who stopped using medroxyprogesterone contraceptive injection several months ago

-A 42-year-old who has decided to try to have one more child and has had her tubal ligation reversed Previous tubal ligation is an identified risk factor for ectopic pregnancy. Young age, use of injection contraception, and low BMI are not specifically associated with ectopic pregnancy.

The client has a Bartholin cyst that has developed into an abscess. The nurse explains to the client the plan of care, including which treatments? -A catheter may be inserted to drain the cyst for several weeks. -A hysterectomy will be required. -Application of dry heat. -Antifungal cream will be administered.

-A catheter may be inserted to drain the cyst for several weeks. The treatment of symptomatic Bartholin cysts consists of the administration of appropriate antibiotics, local application of moist heat, and incision and drainage. A Word catheter may be inserted to continue to drain the cyst for a few weeks.

What is a primary intervention for the nurse to implement for a client with pelvic inflammatory disease ? -Prepare the client for laparoscopy. -Prepare the client for a hysterectomy. -Administer antibiotic therapy. -Administer intravenous pain medication.

-Administer antibiotic therapy. While laparoscopy can provide definitive diagnosis, cases are usually diagnosed on symptomatology. Antibiotic therapy is usually sufficient for treatment. The client does not need a hysterectomy or IV pain medication.

A client has developed a 5-cm Bartholin cyst and is experiencing pain, tenderness, and dyspareunia. Which treatment regimen is commonly prescribed for this condition? Select all that apply. -Antibiotics -Antihistamines -Antianxiety medications -Moist heat applications -Drainage of cyst

-Antibiotics -Moist heat applications -Drainage of cyst The treatment of symptomatic Bartholin gland cysts consists of the administration of appropriate antibiotics, local application of moist heat, and incision and drainage. Cysts that frequently are abscessed or are large enough to cause blockage of the introitus may require surgical intervention (i.e., marsupialization, a procedure that involves removal of a wedge of vulvar skin and the cyst wall). The other medications are not used as treatments.

A female client is scheduled for a laparoscopic removal of an ectopic pregnancy. Which assessment finding would indicate the need for the nurse to prepare the client for a laparotomy? -BP 90/50 mmHg -Emotional distress -Abdominal pain -Slight rise in human chorionic gonadotropin (hCG) levels

-BP 90/50 mmHg Ectopic or tubal pregnancy occurs when the fertilized egg implants in the fallopian tube instead of the uterus. The embryo eventually outgrows the blood supply and space. The tube ruptures, or the pregnancy is interrupted. Symptoms include abdominal pain, spotting, and referred shoulder pain. A laparoscopy may be used to remove small, unruptured ectopic pregnancies, but a laparotomy may be needed if the pregnancy is large, the tube has ruptured, or the client is hemodynamically unstable. The hCG is a hormone secreted by the placenta; its rise is less than expected in ectopic pregnancy.

The sister of a 25-year-old female client has breast cancer, and genetic testing showed her to have the BRCA1 gene. The client asks the nurse how she can prevent developing breast cancer herself. Which prophylactic interventions might be considered in this situation? Select all that apply. -Bilateral oophorectomy -Low-dose methotrexate -Breast magnetic resonance imaging (MRI) -Hormone replacement -Bilateral mastectomy

-Bilateral oophorectomy -Breast magnetic resonance imaging (MRI) -Bilateral mastectomy If this client carries the BRCA1 gene like her sister, she has a 60% to 85% risk of developing breast cancer. Therefore, she should have a vigilant monitoring schedule for early breast cancer. MRI of the breast is preferred because of reduced radiation exposure and enhanced sensitivity. Prevention may also include bilateral mastectomy and/or bilateral oophorectomy to reduce hormones and the tissue that responds to them. The chemoprevention category that may be considered is aromatase inhibitors

A 59-year-old woman with a recent diagnosis of breast cancer has begun a course of hormone therapy. What is the goal of this pharmacologic treatment? -Blocking the entry of malignant cells into the axillary lymph nodes -Blocking the effects of progesterone on tumor growth -Blocking effects of estrogen on the growth of malignant cells -Increasing serum hormone levels to promote tumor cell lysis

-Blocking effects of estrogen on the growth of malignant cells Hormone therapy is used to block the effects of estrogen on the growth of breast cancer cells. Among the most common drugs used for hormone therapy is tamoxifen, a nonsteroidal antiestrogen that binds to estrogen receptors and blocks the effects of estrogens on the growth of malignant cells in the breast. Such drugs do not directly block axillary node involvement or induce tumor cell lysis.

What can a female client with a palpable breast lump expect as the next diagnostic step if the mass does not appear on mammography? -Mastectomy -Surgical excision -MRI of the breast -Breast ultrasound

-Breast ultrasound Approximately 40% of breast cancers can be detected by palpation but not mammography, and another 40% can be detected by mammography but not palpation. Further evaluation of any lump should occur. Ultrasound is noninvasive and helps differentiate between cysts and solid masses. Fine-needle aspiration and biopsy may be needed after ultrasound.

Which condition would the nurse expect a female client with human papillomavirus (HPV) to exhibit? -Lichen simplex chronicus -Cervical intraepithelial neoplasia -Adenomyosis -Infertility

-Cervical intraepithelial neoplasia The presence of HPV increases cell dysplasia in the cervical transition zone, called cervical intraepithelial neoplasia, and ranked into three levels. The most common cause of dysplasia is HPV infection. Lichen simplex chronicus is a condition of intense itching of the vulva. HPV does not cause infertility or adenomyosis, which occurs when endometrial tissue becomes interspersed between smooth muscle fibers.

The nurse is assessing a client with vulvodynia. What does the nurse expect to find when assessing the client? Select all that apply. -Accompanying diseases -An identifiable cause -Chronic pain -Vulvar irritation

-Chronic pain -Vulvar irritation This condition is characterized by vulvar irritation and rawness in the absence of any other relevant visible findings or any clinically identifiable neurologic disorder. There are no accompanying diseases or causes.

Which female client is exhibiting signs of untreated polycystic ovary syndrome (PCOS)? -Client age 34, states excess body hair and menstrual cycles are irregular -Client age 56, reports scant menstrual bleeding at increasing distant intervals -Client age 27, reports very painful periods with midcycle bleeding -Client age 42, has recent weight gain and heavy menstrual cycles for 10-14 days

-Client age 34, states excess body hair and menstrual cycles are irregular PCOS is an endocrine disorder affecting between 5% and 10% of women of childbearing age. Common manifestations include irregular infrequent menstrual periods, signs of hyperandrogenism such as acne and excess body hair, elevated testosterone levels, obesity, insulin resistance, and polycystic ovaries. Also characteristic of the disorder is an imbalance between LH and FSH where the luteinizing hormone (LH) levels are higher in proportion to follicle-stimulating hormone (FSH). This leads to anovulation and infertility. A client with excessive menstrual bleeding may be experiencing uterine tumors. A woman nearing menopause is likely to experience a decrease in menstrual flow and a greater time period between cycles. Endometriosis is a common cause of midcycle bleeding and dysmenorrhea.

An examination of the external genitalia of a female would concentrate on which structures? Select all that apply. -Cervix -Clitoris -Labia minora -Vagina

-Clitoris -Labia minora The external genitalia (labia majora, labia minora, clitoris, and vestibular glands) surround the openings of the urethra and vagina. The internal genitalia of the female reproductive system include the ovaries, fallopian tubes, uterus, cervix, and vagina.

The vulva area is especially prone to skin infections. The nurse knows that this occurs because of: -Constant exposure to secretions and moisture -Dryness -Shearing and friction -Type of clothing worn

-Constant exposure to secretions and moisture The vulva (composed of the mons pubis, labia majora and minora, clitoris, and vestibule) is particularly prone to skin infections because it is constantly exposed to secretions and moisture.

A 45-year-old client reports "needing to bear down with urination," frequency, and occasional loss of urine when coughing. Based on symptoms, which diagnosis is most appropriate for this client? -Enterocele -Rectocele -Cystocele -Spermatocele

-Cystocele The symptoms described are commonly found with cystocele, which is the herniation of the bladder into the vagina resulting in urinary symptoms. The bear-down sensation is common in this disorder and not found in the other disorders. Rectocele is the herniation of the rectum into the vagina. Enterocele can be asymptomatic or cause a dull, dragging sensation and occasionally low backache. Spermatocele is a male disorder.

A client who has been diagnosed with premenstrual syndrome (PMS) asks if there is anything to help alleviate the symptoms. The best response would be: -Increase intake of caffeine products during this period. -Eat a diet low in simple sugars and high in protein. -Limit activities and maintain bed rest as necessary. -Decrease intake of fluids to reduce fluid retention.

-Eat a diet low in simple sugars and high in protein. Treatment for PMS includes treating various symptoms. A diet low in sugar and high in protein and reduction in caffeine intake are recommended. Other suggestions include diuretics to reduce fluid retention, continue fluid intake as usual, regular exercise, and analgesics for pain.

The nurse in the ER is caring for a client with lower abdominal pain that is greater on the right side and who has light vaginal spotting. When the client's human chorionic gonadotropin (hCG) level is lower than normal, the nurse plans care for a client with: -Cervical cancer -Premenstrual syndrome -Appendicitis -Ectopic pregnancy

-Ectopic pregnancy The symptoms described, and the positive but low hCG, would be most indicative of an ectopic pregnancy. Appendicitis could be suspected with right lower abdominal pain, but would not have a positive hCG and spotting. Neither PMS nor cervical cancer would present with all the above symptomology.

A school nurse is providing an informational session about the prevention of cervical cancer in young girls and women. The most important information for the nurse to present would be: -Abstinence of sexual activity until in a monogamous relationship -Use of latex condom with each and every sexual encounter -Use of low-dose estrogen oral contraceptive pills or patches -HPV vaccine before becoming sexually active

-HPV vaccine before becoming sexually active Two types of HPV vaccines are currently available to prevent HPV infection: a quadrivalent vaccine to prevent infection by HPV subtypes 16, 18, 6, and 11 and a bivalent vaccine to prevent infection by subtypes 16 and 18. The quadrivalent vaccine has been approved for females and males between the ages of 9 and 26 years, optimally before initiation of sexual activity. Abstinence and condoms may help, but the vaccine is recommended.

A 38-year-old woman with proliferative breast changes of papilloma asks the nurse about her risk for breast cancer. Which statement of risk is correct? -Low unless other relatives have cancer -Lower as a result of your exercising -Higher because of your papilloma -High due to your increasing age

-Higher because of your papilloma Clients with proliferative lesions such as calcifications, hyperplasia, sclerosing adenosis, and intraductal papillomas should be evaluated regularly because if these lesions develop atypical cells, they are more likely to develop into cancerous growths. Cancer risk increases when a woman has several first-degree relatives with breast cancer, is obese, is older, has a history of benign breast disease, is childless or did not breast-feed, consumes more than one alcoholic beverage per day, and had early onset of menstruation or late menopause.

A female client with blocked fallopian tubes seeks assistance at a fertility clinic. Which assisted reproductive technology will bring the greatest chance for conception? -In vitro fertilization (IVF) -Zygote intrafallopian transfer (ZIFT) -Gamete intrafallopian transfer (GIFT) -Artificial insemination

-In vitro fertilization (IVF) When the fallopian tubes are blocked, the ovum released from the ovary will not be picked up or travel to the uterus to meet with sperm. IVF combines harvested ova with sperm in a laboratory. After 3 to 5 days, the successful embryos will be inserted into the uterus through an intracervical catheter. GIFT uses similar technology but implants the ovum and sperm in the fallopian tube. ZIFT inserts an embryo into the fallopian tube. Artificial insemination inserts sperm directly into the uterus, but this will not be successful if the fallopian tubes are blocked and the ovum never reaches the uterus.

The nurse performs a complete physical assessment on a client with polycystic ovary syndrome (PCOS). Which assessment findings support this diagnosis? Select all that apply. -Dysmenorrhea -Increased dark facial hair -Obesity -Decreased luteinizing hormone (LH) level -Elevated blood glucose

-Increased dark facial hair -Obesity -Elevated blood glucose PCOS is an endocrine disorder affecting between 5% and 10% of women of childbearing age. Common manifestations include irregular infrequent menstrual periods, signs of hyperandrogenism such as acne and excess body hair, elevated testosterone levels, obesity, insulin resistance, and polycystic ovaries. Also characteristic of the disorder is an imbalance between LH and FSH (follicle-stimulating hormone) where the LH levels are higher in proportion to FSH. This leads to anovulation and infertility.

An 18-year-old woman presents at the clinic complaining of new-onset breakthrough bleeding, even though she is taking contraceptives. What contraceptive use, along with new-onset breakthrough bleeding, has been associated with pelvic inflammatory disease? -Intrauterine device -Spermicidal foam -Depo-Provera -Diaphragm

-Intrauterine device

A client reporting low abdominal pain, purulent cervical discharge, and painful intercourse is diagnosed with pelvic inflammatory disease (PID). The provider educates the client about this disease mentioning which statement? -Caused by a ruptured tubal pregnancy -Associated with chronic endometriosis -Is a polymicrobial infection of the upper reproductive tract -Is associated with serous luteal ovarian cyst formation

-Is a polymicrobial infection of the upper reproductive tract Pelvic inflammatory disease (PID) is an inflammation and polymicrobial infection of the upper reproductive tract that involves the uterus (endometritis), fallopian tubes (salpingitis), or ovaries (oophoritis) associated with sexually transmitted and endogenous organisms. Endometriosis is the condition in which functional endometrial tissue is found in ectopic sites outside the uterus; the displaced endometrial tissue may cause localized inflammation. Ruptured tubal pregnancy causes salpingitis and inflammation unrelated to sexually transmitted infections (STIs). Benign ovarian epithelial tumors are almost always serous or mucinous. Serous (fluid-filled) luteal or follicular ovarian cysts are non-infective, are non-inflammatory, and frequently resolve spontaneously without treatment.

The parents of a 9-year-old child ask the nurse for information about quadrivalent human papillomavirus recombinant vaccine. Which instructions are appropriate for the nurse to provide? Select all that apply. -It should be given before the child is sexually active. -It prevents sexually transmitted infections. -It can be given to boys and girls. -It prevents a common cause of cervical cancer. -It produces short-term immunity.

-It should be given before the child is sexually active. -It can be given to boys and girls. -It prevents a common cause of cervical cancer. The quadrivalent human papillomavirus recombinant vaccine is given to boys and girls between the ages of 9 and 26 years before they begin sexual activity. The vaccine provides long-term immunity from HPV, which is a common cause of cervical cancer. It does not protect against other sexually transmitted diseases.

The health care provider suspects a diagnosis of endometriosis. Which procedure provides a definitive diagnosis? -Computed tomography (CT) scan -Loop electrosurgical excision procedure (LEEP) -Laparoscopy -Magnetic resonance imaging (MRI)

-Laparoscopy Endometriosis may be difficult to diagnose because its symptoms mimic those of other pelvic disorders. Definitive diagnosis can be accomplished only through laparoscopy and confirmed with histological testing. This minimally invasive surgery allows direct visualization of pelvic organs to determine the presence and extent of endometrial lesions. Imaging techniques, including ultrasonography and magnetic resonance imaging (MRI), can be useful tools in evaluating endometriomas and deep endometriosis.

A woman reports to the primary healthcare provider that she experiences monthly changes before her menstrual cycle. Which statement demonstrates understanding of premenstrual disorders? -Premenstrual dysphoric disorder (PMDD) in young women is managed with modification of dietary habits. -Many women report premenstrual emotional or physical changes. -Women with premenstrual molimina require initial hospitalization. -Premenstrual syndrome (PMS) is often the result of emotional instability in older women.

-Many women report premenstrual emotional or physical changes Premenstrual mood disorders fall into a continuum of severity of symptoms and dysfunction. Most women report some premenstrual changes. In premenstrual molimina the symptoms are mild. In PMS women present with at least one mild to moderate physical or psychological symptom that occurs between 3 and 14 days before the menstrual period and is relieved by onset of menses. In PMDD, the client experiences at least 5 of 11 characteristic symptoms and has severe dysfunction, which is often associated with mood disorders. Common symptoms include irritability and emotional lability, food cravings, change in bowel habits, edema, breast and pelvic congestion, incoordination, weight gain, and insomnia.

Polycystic ovary syndrome is an endocrine disorder and a common cause of chronic anovulation. In addition to the clinical manifestations of PCOS, long-term health problems, including cardiovascular disease and diabetes, have been linked to PCOS. What drug has emerged as an important part of PCOS treatment? -Methotrexate -DHEAS -Mineralocorticoids -Metformin

-Metformin Metformin, an insulin-sensitizing drug used with or without ovulation-inducing medications, is emerging as an important component of PCOS treatment. DHEAS is often found in the blood of women with PCOS. Methotrexate is used in ectopic pregnancies. Spironolactone, an anti-mineralocorticoid, is used in treating PCOS, not mineralocorticoids.

A woman diagnosed with fibrocystic breast disease asks, "What treatments are available?" The most important information to share about treating symptoms include which intervention? -Application of steroid creams -Daily antioxidants -Avoidance of simple carbohydrates in the diet -Mild analgesics like acetaminophen

-Mild analgesics like acetaminophen Treatment for fibrocystic changes is usually symptomatic. Mild analgesics (aspirin, acetaminophen, or NSAID), and local application of heat or cold may be used for pain relief. The other options will not help with the symptoms of fibrocystic changes.

A client has been diagnosed with acute cervicitis caused by Chlamydia trachomatis. Which clinical manifestation correlates to this diagnosis? -Persistent pruritic vulvitis -Abscess formation -Mucopurulent drainage -Thick, gray-white plaques

-Mucopurulent drainage With acute cervicitis, the cervix becomes reddened and edematous; irritation from the infection Chlamydia trachomatis results in copious mucopurulent drainage and leukorrhea. Bartholin gland obstruction causes a cyst to form, becomes purulent, and results in abscess formation. Lichen simplex chronicus lesions are labial thick, gray-white plaques. Squamous cell vulvar carcinoma is characterized by a recurrent, persistent, pruritic vulvitis, sometimes as the only report.

The nurse is teaching the client about risk factors for cervical cancer. What will be included in the plan of care? Select all that apply. -Multiple sexual partners -Smoking -History of sexually transmitted infections -Diabetes -First intercourse at an early age -Alcohol consumption

-Multiple sexual partners -Smoking -History of sexually transmitted infections -First intercourse at an early age Risk factors for cervical cancer include early age at first intercourse, multiple sexual partners, smoking, and a history of STIs. Diabetes and alcohol consumption are not risk factors.

A female client is being seen in the ED with complaints of lower abdominal pain, dyspareunia, back pain, purulent cervical discharge, and the presence of adnexal tenderness and painful cervix on bimanual pelvic examination. The nurse suspects the client has pelvic inflammatory disease (PID), and will assess the client for: -Use of oral contraceptives -Number of sexual partners -Dietary habits -Toileting habits

-Number of sexual partners PID is a polymicrobial infection of the upper reproductive tract (uterus, fallopian tubes, or ovaries) associated with the sexually transmitted organisms such as N. gonorrhoeae or C. trachomatis as well as endogenous organisms, including anaerobes, such as Haemophilus influenza, enteric gram-negative rods, and streptococci. Factors that predispose women to the development of PID include an age of 16 to 24 years, nulliparity, history of multiple sexual partners, and previous history of PID. The symptoms of PID include lower abdominal pain, which may start just after a menstrual period; dyspareunia; back pain; purulent cervical discharge; and the presence of adnexal tenderness and exquisitely painful cervix on bimanual pelvic examination.

The nurse is assessing a 24-year-old client who states that she has infrequent menstrual periods that are approximately 40 to 42 days apart. She also states, "My periods are really light. It's almost like I hardly even need to use a pad sometimes." The nurse should document which medical terms associated with this client's menstruation? Select all that apply. -Menometrorrhagia -Oligomenorrhea -Hypomenorrhea -Amenorrhea -Polymenorrhea

-Oligomenorrhea -Hypomenorrhea Dysfunctional cycles may take the form of amenorrhea (absence of menstruation), hypomenorrhea (scanty menstruation), oligomenorrhea (infrequent menstruation, periods more than 35 days apart), polymenorrhea (frequent menstruation, periods less than 21 days apart), menorrhagia (excessive menstruation), or metrorrhagia (bleeding between periods). Menometrorrhagia is heavy bleeding during and between menstrual periods. This client exhibits hypomenorrhea and oligomenorrhea.

A female client presents to her primary care physician with a report of very heavy bleeding during menstrual cycles. Tests indicate the condition is not from a hormone imbalance. Which intervention option is least invasive? -Vaginal hysterectomy -Endometrial ablation -Dilatation and curettage (D&C) -Oral contraceptives

-Oral contraceptives The least invasive treatment options for nonhormonal causes of excessive menstrual bleeding include oral contraceptives, cyclic progesterone therapy, or long-acting progesterone injection. Endometrial ablation is more invasive and eliminates the basement layer of the endometrium through use of heat, cold, microwaves, chemicals, or radiofrequency energy sources. D&C is a surgical scraping of the uterine lining. A hysterectomy, whether vaginal or abdominal, is the most invasive procedure to eliminate uterine bleeding.

The client is diagnosed with vaginitis. What will the nurse assess? Select all that apply. -Age over 60 -Pain with urination -Inflammation of the vagina -Postmenopausal -Vaginal discharge -Burning and itching

-Pain with urination -Inflammation of the vagina -Vaginal discharge -Burning and itching Vaginitis represents an inflammation of the vagina that is characterized by discharge, burning, itching, and pain with urination. It can occur at any age and is not restricted to postmenopausal women.

A client has been diagnosed with a Bartholin gland cyst. The nurse expects the client may experience which symptoms if this becomes infected? -Pain, erythema, and dystonia -Distention, hyperthermia, and dyspnea -Pain, dysphagia, and tenderness -Pain, tenderness, and dyspareunia

-Pain, tenderness, and dyspareunia A Bartholin gland cyst is a fluid-filled sac that results from occlusion of the duct system in the Bartholin gland. Acute symptoms are usually the result of infection and include pain, tenderness, and dyspareunia.

Endometriosis is characterized by painful hemorrhagic lesions in the pelvis, which may develop into which potential complication? -Candidiasis vaginitis -Pelvic adhesions -Bladder herniation -Endometrial cancer

-Pelvic adhesions Endometriosis is the condition in which functional endometrial tissue is found in ectopic sites outside the uterus. Endometriosis usually becomes apparent in the reproductive years when the lesions are stimulated by ovarian hormones in the same way as normal endometrium, becoming proliferative, then secretory, and finally undergoing menstrual breakdown. Bleeding into the surrounding structures can cause pain and the development of significant pelvic adhesions. Endometrial cancer often develops as a result of prolonged estrogenic stimulation and/or unopposed estrogen therapy with excessive growth (i.e., hyperplasia) of the endometrium inside the uterus. Candidiasis vaginitis is a common yeast infection unrelated to intrapelvic endometriosis. Bladder herniation (cystocele) happens when bladder muscle support weakens with age or multiple births.

A client has been diagnosed with endometriosis. What assessment finding does the nurse expect? Select all that apply. -Increased fertility -Pelvic pain -Premenstrual pain -Back pain -Referred chest pain

-Pelvic pain -Premenstrual pain -Back pain Endometriosis symptoms present with pelvic pain and back pain, and most pain occurs premenstrually, subsiding after cessation of menstruation. There is decreased fertility with this condition. Chest pain is not a reported symptom.

Which disorder of the female genitourinary system is most likely to result from a disruption in normal endocrine function? -Ovarian cancer -Cervicitis -Pelvic inflammatory disease (PID) -Polycystic ovary syndrome (PCOS)

-Polycystic ovary syndrome (PCOS) Women with PCOS typically have abnormal gonadotropin levels, a problem that is manifested by increased release of LH in relation to FSH release. This causes an increase in production of androstenedione and testosterone by the theca cells of the ovary. Ovarian cancer does not have an endocrine etiology, and both PID and cervicitis have infectious etiologies.

A female client has an ectopic pregnancy. Which factors in the client's history could contribute to the condition? Select all that apply. -Diabetes mellitus -Smokes one pack per day -Endometriosis -Obesity -Pelvic inflammatory disease (PID)

-Smokes one pack per day -Pelvic inflammatory disease (PID) Ectopic, or tubal, pregnancy occurs when the fertilized egg is implanted in the fallopian tube instead of the uterus. Causes of the condition include previous tubal surgery, tubal ligation or reversal, previous tubal pregnancy, PID, endometriosis, smoking, current use of an intrauterine device, and use of fertility drugs to induce ovulation.

A female client reports to the health care provider that she has noticed a release of urine when she laughs or sneezes. Which interventions should the provider implement first? -Provide information about the estrogen ring -Refer the client to a surgeon -Insert a Foley catheter to measure daily output -Teach the client to do pelvic floor exercises

-Teach the client to do pelvic floor exercises A female client who begins to experience unwanted release of urine when abdominal pressure increases (such as during coughing, sneezing, squatting, lifting, or laughing) may be experiencing a cystocele as a result of pelvic floor relaxation. Cystoceles can lead to difficulty in emptying the bladder and cystitis. The nurse should first determine if the condition is caused by cystitis. Although a mild cystocele can be controlled through pelvic floor strengthening exercises (Kegel exercises), and an estrogen ring may help strengthen the muscles, the nurse must assess first. Referral for surgical consult will occur after evaluation.

Which client does the nurse determine is most likely at risk for cancer of the vagina? -The client who underwent multiple procedures for infertility -The client who is 28 years of age -The client who is 61 years of age -The client with diabetes

-The client who is 61 years of age Primary cancers of the vagina are extremely rare, but are most prevalent in women 60 years of age and older. The other stated clients are not at high risk.

Ectopic pregnancies are true gynecologic emergencies and are considered the leading cause of maternal death in the first trimester. What diagnostic test would the nurse expect to have ordered for a suspected ectopic pregnancy? -Transvaginal ultrasound if pregnancy is less than 5 weeks gestation -Ultrasonography followed by serial hCG tests -Amniocentesis -Serial β-human chorionic gonadotropin (hCG) with higher than normal hCG production

-Ultrasonography followed by serial hCG tests Diagnostic tests for ectopic pregnancy include a urine pregnancy test, ultrasonography, and β-hCG (hormone produced by placental cells) levels. Serial β-hCG tests may detect lower than normal hCG production. Transvaginal ultrasound studies after 5 weeks' gestation may demonstrate an empty uterine cavity or presence of the gestational sac outside the uterus. In a comparison of various protocols for diagnosing ectopic pregnancy, ultrasound followed by serial hCG levels was found to yield the best results.

An adult client reports persistent vaginal irritation and recurrent infections. In her history the physician notices that she recently has been prescribed antibiotics for a respiratory infection and concludes that it has affected her normal flora by: -inhibiting the normal function of helper T cells. -causing the vaginal environment to be more alkaline than normal. -causing a loss of glycogen that provides energy to secretor cells of the vaginal wall. -inhibiting the normal inflammatory response in her vaginal epithelium.

-causing the vaginal environment to be more alkaline than normal. The bacteria that make up the normal flora metabolize glycogen and in the process produce the lactic acid that normally maintains the vaginal pH of 3.8 to 4.5. Disruptions in these normal environmental conditions—including increased pH—predispose to infection. There is no immune suppression or loss of glycogen.

When explaining polycystic ovary syndrome (PCOS) to a newly diagnosed client, the health care worker states, "This ovarian dysfunction is caused by: -absent FSH." -elevated LH." -insulin deficit." -low androgen."

-elevated LH. The underlying etiology of the disorder is unknown, although most women have altered gonadotropin levels. Most women with PCOS have elevated luteinizing hormone (LH) levels with normal estrogen and follicle-stimulating hormone (FSH) production. This altered LH/FSH ratio often is used as a diagnostic criterion for this condition. The elevated LH level also results in increased androgen production. Hyperinsulinemia may also lead to the excess androgen production; the overall goal of PCOS treatment is to suppress the insulin-facilitated, LH-driven androgen production.

A client has been diagnosed with breast cancer following a suspicious mammogram followed by biopsy. The nurse who is planning this client's care should recognize that her prognosis is primarily dependent on the: -extent to which lymph nodes are involved. -proportion of breast tissue that is involved. -client's prediagnosis health status. -specific location of the breast tissue that is involved.

-extent to which lymph nodes are involved. The prognosis for breast cancer is related more to the extent of nodal involvement than to the extent of breast involvement. Health status is important, or course, but lymph node involvement is the primary determinant of a client's prognosis.

A client is experiencing oligomenorrhea. The nurse interprets this as: -bleeding that occurs between menstrual cycles. -frequent menstruation with periods less than 21 days apart. -heavy bleeding between and during menstrual cycles. -infrequent menstruation with periods more than 35 days apart.

-infrequent menstruation with periods more than 35 days apart. Oligomenorrhea is infrequent menstruation, periods more than 35 days apart; polymenorrhea is frequent menstruation, periods less than 21 days apart; menorrhagia is excessive menstruation; metrorrhagia is bleeding between periods; amenorrhea is absence of menstruation; hypomenorrhea is scanty menstruation.