303 Hinkle PrepU Chapter 57: Management of Patients With Female Reproductive Disorders

Which client has the highest risk of ovarian cancer?

45 year old woman that has never been pregnant The incidence of ovarian cancer increases in women who have never been pregnant, are older than age 40, are infertile, or have menstrual irregularities. Other risk factors include a family history of breast, bowel, or endometrial cancer. The risk of ovarian cancer is reduced in women who have taken hormonal contraceptives, have had multiple births, or have had a first child at a young age.

A client has been diagnosed with genital herpes. Knowing that education is an essential part of nursing care of the client with a genital herpes infection, the nurse plans to include which method(s) to minimize HIV transmission? Select all that apply.

Avoiding unprotected sexual intercourse Avoiding multiple sexual partners Avoiding IV drug use Intravenous drug use and risky sexual behaviors, which include multiple partners and unprotected sex, are factors that can put anybody at risk for HIV. Thus, the correct way to minimize HIV transmission would be to avoid these factors. HIV is not transmitted through simple physical contact. Open lesions related to HPV increase the likelihood that HIV can be transmitted; prevention includes administration of the HPV vaccine.

A patient reports to the nurse that she has a sense of pelvic pressure and urinary problems such as incontinence, frequency, and urgency. The problem has gotten much worse since the birth of her third child. What does the nurse suspect the patient is experiencing?

a cystocele Cystocele is a downward displacement of the bladder toward the vaginal orifice (Fig. 57-3) from damage to the anterior vaginal support structures. It usually results from injury and strain during childbirth. Because a cystocele causes the anterior vaginal wall to bulge downward, the patient may report a sense of pelvic pressure and urinary problems such as incontinence, frequency, and urgency. Back pain and pelvic pain may occur as well. The symptoms of rectocele resemble those of cystocele, with one exception: Instead of urinary symptoms, patients may experience rectal pressure. Constipation, uncontrollable gas, and fecal incontinence may occur in patients with complete tears.

A client who had intracavity radiation treatment for cervical cancer 1 month earlier reports small amounts of vaginal bleeding. This finding most likely represents:

an expected effect of the radiation therapy After intracavity radiation, some vaginal bleeding occurs for 1 to 3 months. Intermittent, painless vaginal bleeding is a classic symptom of cervical cancer, but given the client's history, bleeding in more likely a result of the radiation. The passage of feces through the vagina, not vaginal bleeding, is a sign of rectovaginal fistula. Vaginal infections are indicated by various types of vaginal discharge, not vaginal bleeding.

Assessment of a client reveals evidence of a cystocele. The nurse interprets this as which of the following?

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

Which is a risk factor for cervical cancer?

exposure to HPV Risk factors for cervical cancer include exposure to HPV, sex with uncircumcised males, overweight, and early childbearing.

Most cervical cancers, if not detected and treated, spread to which area?

regional pelvic lymph nodes Most cervical cancers, if not detected and treated, spread to regional pelvic lymph nodes.

A nurse who works in a gynecologist's office frequently cares for patients who are diagnosed with vulvovaginal candidiasis. The nurse should teach the patients how to manage and treat the most common symptom of:

vulvar pruritis Vulvar pruritus is the chief complaint of those diagnosed with candidiasis.

A nurse is preparing a teaching plan for a client with a vulvovaginal infection. Which teaching would not be appropriate for the nurse to include?

douche with a dilute vinegar solution twice daily Research has shown that douching provides no benefit in the prevention or care of vulvovaginal infections. Douching usually is unnecessary because daily baths or showers and proper hygiene after voiding and defecation keep the perineal area clean. In addition, douching tends to eliminate normal flora, reducing the body's ability to ward off infection. Repeated douching may result in vaginal epithelial breakdown and chemical irritation. The client should recline for approximately 30 minutes after inserting any vaginal medication to prevent the medication from escaping from the vagina. Loose-fitting cotton underwear is advised rather than tight-fitting synthetic, nonabsorbent, heat-retaining underwear. Unprotected sexual intercourse is associated with risks and should be avoided.

While caring for a patient who is treated for severe pelvic inflammatory disease (PID), the nurse insists on keeping her in a semisitting position. Which of the following is correct rationale for this positioning?

facilitate pelvic drainage and minimize the upward extension of the infection While caring for a patient hospitalized with PID, the nurse has to reduce the risk of the systemic spread of pathogenic microorganisms. The nurse also has to monitor the symptoms to detect, manage, and to minimize sepsis if it occurs. The patient must also be advised to keep her upper body elevated. This facilitates pelvic drainage and minimizes the upward extension of infection. This position will not aid in the prevention of nosocomial infections, decrease the pain, nor easily distract the patient.

Culture of client's vaginal discharge reveals Gardnerella vaginalis. Which of the following would the nurse expect to assess?

fishy smelling watery discharge Gardnerella vaginalis is associated with a gray white, watery, fishy smelling vaginal discharge. The discharge associated with a Candida infection is curdy white, thick, and strong. Discharge due to trichomonas vaginalis is yellow white, foamy, and foul.

A client, age 42, visits the gynecologist. After examining the client, the physician suspects cervical cancer. The nurse reviews the client's history for risk factors for this disease. Which history finding is a risk factor for cervical cancer?

human papillomavirus infection at age 32 Like other viral and bacterial venereal infections, human papillomavirus is a risk factor for cervical cancer. Other risk factors for this disease include frequent sexual intercourse before age 20, multiple sex partners, and multiple pregnancies. A spontaneous abortion and pregnancy complicated by eclampsia aren't risk factors for cervical cancer.

A young client presenting at the health clinic with fever and mucopurulent vaginal drainage is diagnosed with acute pelvic inflammatory disease (PID). Which long-term affect is of greatest concern in the care of this client?

infertility About one third of all women who are infertile have lost the ability to conceive due to PID. Early treatment of PID prevents the infection from ascending up the reproductive tract and/or from becoming chronic. Pelvic pain is a common symptom associated with PID.

A client is ordered a vaginal cream for the treatment of a yeast infection. What teaching should the nurse include for inserting the vaginal medication?

insert the medication into the vagina using an applicator Vaginal medication is inserted with an applicator. The vaginal medication should be continued as prescribed and not discontinued because of menses. Although eating yogurt containing active cultures of lactobacilli can be helpful to replenish normal vaginal flora, this is not specific to insertion of vaginal medications. The client should be instructed to remain recumbent for at least 30 minutes after medication insertion to provide adequate time for direct contact with vaginal tissues.

Which statement is true regarding endometriosis?

it affects women of reproductive age Endometriosis affects women of reproductive age. It is a benign lesion or lesions with cells similar to those lining the uterus. Extensive endometriosis causes few symptoms. Causation has been linked to infertility.

A client is in isolation after receiving an internal radioactive implant to treat cancer. Two hours later, the nurse discovers the implant in the bed linens. What should the nurse do first?

leave the room and notify the radiation therapy department immediately If a radioactive implant becomes dislodged, the nurse should immediately leave the room and notify the radiation therapy department. The nurse shouldn't attempt to handle the implant or remain in the room with the implant.

A client is experiencing symptoms associated with menopause. What is a likely recommendation to increase the client's interest in sexual activity?

low-dose androgens Low-dose androgens are added to the hormone replacement regimen to restore an interest in sexual activity.

A woman comes to the emergency department reporting vaginal discharge and pelvic pain that increases with urination. The client also reports nausea and vomiting, headache, and anorexia. A pelvic examination reveals cervical motion tenderness. The client is diagnosed with acute pelvic inflammatory disease (PID) and is admitted. Which of the following would be most appropriate to include in this client's plan of care?

maintaining bedrest in a semi fowlers position The hospitalized client with pelvic inflammatory disease (PID) is maintained on bed rest and is placed in the semi-Fowler's position to facilitate dependent drainage. Heat may be applied to the abdomen to provide comfort and pain relief. Standard precautions are followed to minimize the risk of infection transmission. PID most commonly results from sexual transmission. An indwelling urinary catheter typically is not necessary unless the client's infection is severe and urinary output must be monitored closely and frequently.

Which of the following is a term used to describe excessive menstrual bleeding?

menorrhagia Menorrhagia is excessive menstrual bleeding. Amenorrhea is the absence of menses. Dysmenorrhea is painful menses. Metrorrhagia is excessive and prolonged menstrual bleeding.

Which drug is the most effective treatment for trichomoniasis?

metronidazole The most effective treatment for trichomoniasis is metronidazole. Miconazole, clindamycin, and clotrimazole are not the most effective treatment for trichomoniasis.

The nurse is reviewing the medical record of a client diagnosed with uterine cancer. Which of the following, if noted, would the nurse identify as a risk factor?

nulliparity Risk factors for uterine cancer include age of 55 years or more, obesity, unopposed estrogen therapy, nulliparity, truncal obesity, late menopause (after age 52 years), and use of tamoxifen. Early age at first sexual intercourse, exposure to diethylstilbestrol, and vitamin deficiencies are risk factors associated with cervical cancer.

Which abnormality is not considered a structural abnormality?

pelvic inflammatory disease Pelvic inflammatory disease is an infection of the pelvic organs other than the uterus. These include the ovaries, fallopian tubes, pelvic vascular system, and pelvic supporting structures. Endometriosis is a condition in which tissue with a cellular structure and function resembling that of the endometrium is found outside the uterus. The atypical locations for endometrial tissue include the ovaries, the pelvic cavity, and occasionally the abdominal cavity. A fistula is an unnatural opening between two structures. The opening may be between a ureter and the vagina, between the bladder and the vagina, or between the rectum and the vagina. The term prolapse indicates a structural protrusion. Women experience any number of problems of this nature in the vagina. They include cystocele, rectocele, enterocele, and uterine prolapse.

While caring for a client who is being treated for severe pelvic inflammatory disease (PID), which nursing action minimizes transmission of infection?

performing hand hygiene when entering the room While caring for a client hospitalized with PID, the nurse has to reduce the risk of the spread of pathogenic microorganisms. Meticulous hand hygiene minimizes the transmission of infection. There is no reason to restrict visitors in this situation; however, visitors need to be educated in proper hand hygiene. Reverse isolation is not indicated for this client. A sitting position will not aid in preventing nosocomial infections.

A client is admitted to the health care center with abdominal pain, nausea, and vomiting. The client has a body mass index (BMI) of 30 and reports irregular menstrual cycles and feeling tired all the time. The nurse suspects the client's symptoms to indicate which condition?

polycystic ovarian syndrome Features of PCOS includes obesity, sleep apnea, and irregular menstrual periods. Bacterial vaginosis can occur throughout the menstrual cycle and does not produce local discomfort or pain. Symptoms such as discharge, irregular bleeding, or pain or bleeding after sexual intercourse are consistent with cancer of the cervix. Symptoms of endometriosis vary but include dysmenorrhea, dyspareunia, and pelvic discomfort or pain. Dyschezia (pain with bowel movements) and radiation of pain to the back or leg may occur.

Which of the following is an early symptom of vulvar cancer?

pruritis with genital burning Pruritus and genital burning are the most frequent early symptoms of vulvar cancer, followed by a bloody discharge from the vagina. Abdominal pain can be a result of a surgery related to ovary, such as salpingo-oophorectomy, or formation of cysts in the ovary. Dyspareunia and fever accompanied by chills are not the early symptoms of vulvar cancer.

Pelvic infection is most commonly caused by which of the following?

sexual transmission Pelvic infection is most commonly caused by sexual transmission but can also occur with invasive procedures such as endometrial biopsy, surgical abortion, hysteroscopy, or insertion of an intrauterine device.

A client with vaginitis complains of itching and burning of the perineum. Which suggestion would be most appropriate to relieve the client's symptoms?

take sitz baths frequently Sitz baths are recommended to relieve the client's itching and burning, as well as relieve swelling of the vulva and perineum. Skin protectants containing zinc oxide promote healing. Using a vinegar (1to 2 tablespoons) and water (1 pint) douche daily may be used to combat the vaginitis when the client is symptomatic. Taking Lactobacillus acidophilus in capsule form or eating yogurt containing active cultures of lactobacilli can help restore normal vaginal microorganisms.

During a routine sports physical examination, the nurse practitioner recommends HPV vaccination for an 11-year-old girl. Which statements by the client's mother demonstrates understanding of HPV vaccinations?

"I will track follow up appointments in my smart phone so she receives all three injections" The Centers for Disease Control and Prevention recommends routine vaccination of boys and girls 11-12 years of age, before they become sexually active. The vaccination is administered in three intramuscular doses, with the *initial dose followed by a second dose in 2 months and a third dose 6 months after the first dose*. Completion of all three doses of the vaccine is important for immunity to develop; it does not replace other strategies important in the prevention of HPV. Women still need recommended cervical cancer screening.

A nurse is teaching personal hygiene care techniques to a client with genital herpes. Which statement by the client indicates the teaching has been effective?

"I will wear loose cotton underwear" Wearing loose cotton underwear promotes drying and helps avoid irritation of the lesions. The use of lubricants is contraindicated because they can prolong healing time and increase the risk of secondary infection. Lesions shouldn't be rubbed or scratched because of the risk of tissue damage and additional infection. Cool, wet compresses can be used to soothe the itch. The use of moisturizer on lesions isn't recommended.

A client is admitted for intracavitary radiation as treatment for her reproductive tract cancer. Which client statement demonstrates to the nurse that the client understands the planned procedure?

"I'm going to have a catheter inserted to drain my urine so I don't need to get out of bed to go to the bathroom." Intracavitary irradiation involves the insertion of specially prepared applicators that are loaded with radioactive material into the endometrial cavity and vagina. The client must be isolated in a private room and remain in bed. A urinary catheter is inserted to allow for urinary elimination. External radiation therapy involves a machine that directs radiation to the specified area. Intraoperative radiation involves radiation applied directly to the affected area during surgery.

A 32-year-old client has been diagnosed with an ovarian cyst and asks the nurse, "Should I be worried about cancer?" Which response by the nurse would be most appropriate?

"Most cysts are benign in younger women, but it is good to have it checked out". The risk of malignancy in postmenopausal women is much greater than in premenopausal women, with almost all pelvic masses in premenopausal women being benign. However, although typically benign, the cyst should be evaluated to exclude ovarian cancer. The most appropriate response would be to provide this information to the client but also reinforce her actions to have the cyst evaluated. Telling the client that the cyst is no cause for concern or that ovarian cysts are rarely malignant ignores the client's feelings and does not address the client's concern. The absence of symptoms does not eliminate the possibility of a malignancy. Often, ovarian cancer is difficult to detect and signs and symptoms are vague and nonspecific.

Following a colposcopy, the confirmation of in situ carcinoma of the cervix has been determined. Which comment by the client indicates an appropriate understanding of the diagnosis?

"the cancer has not spread". Carcinoma in situ means the cancer has not left the original site and therefore has not invaded other tissues. Further treatment is required, which usually consists of cryosurgery or hysterectomy. Surgery with adjuvant chemotherapy is usually reserved for cancers that are more advanced. Even though cervical cancers tend to be slower growing, treatment should not be delayed.

A nurse is providing care for a patient who was diagnosed with a rectocele. Which illustration best depicts this condition?

Option B shows a rectocele, in which there is an upward pouching of the rectum that pushes the posterior vaginal wall forward. A cystocele (Option A) occurs when there is a downward displacement of the bladder toward the vaginal wall. An enterocele (Option C) is a protrusion of the intestinal wall into the vagina. Option D shows the most common position for the uterus detected on palpation.

A patient has had a pessary inserted for long-term treatment of a prolapsed uterus. As part of the teaching plan, what should the nurse advise the patient to do?

See her gynecologist to remove and clean the pessary at regular intervals. A pessary can be used to avoid surgery (Lone, Thakar, Sultan, et al., 2011). This device is inserted into the vagina and positioned to keep an organ, such as the bladder, uterus, or intestine, properly aligned when a cystocele, rectocele, or prolapse has occurred. Pessaries are usually ring- or doughnut shaped and are made of various materials, such as rubber or plastic (Fig. 57-4). Rubber pessaries must be avoided in women with latex allergy. The size and type of pessary are selected and fitted by a gynecologic health care provider. The patient should have the pessary removed, examined, and cleaned by her health care provider at prescribed intervals.

A patient diagnosed with endometriosis asks for an explanation of the disease. What should the nurse explain to the patient?

Tissue from the lining of the uterus has implanted in areas outside the uterus. Endometriosis is a chronic disease affecting between 6% and 10% of women of reproductive age (Falcone & Lebovic, 2011) and consisting of a benign lesion or lesions that contain endometrial tissue (similar to that lining the uterus) found in the pelvic cavity outside the uterus.

A nurse is teaching a client about why ovarian cancer is largely considered to be a lethal cancer of the female reproductive system. What should the nurse include in the teaching? Select all that apply.

Tumors are typically far advanced and inoperable by the time of diagnosis. Ovarian cancer's vague symptoms are often ignored. Tumors present with nonspecific symptoms. There is no effective screening test. Although other types of female reproductive system cancers occur with greater incidence, ovarian tumors are the leading cause of death from gynecologic malignancies. Tumors of the ovary have been lethal largely because they present with nonspecific symptoms, which are often ignored. There is no effective screening test; tumors frequently are far advanced and inoperable by the time the tumors are diagnosed. Tumor-specific antigens are used after diagnosis of ovarian cancer.

A client is being seen at the local community-based clinic where you practice nursing. Her healthcare provider has diagnosed the client with candidiasis and prescribed clotrimazole cream once daily for 7 days. You are providing education on how to administer the prescribed treatment. Which of the following techniques will the client use to administer this medication?

administer cream at bedtime high into vaginal canal Administer cream or vaginal tablets high into vaginal canal; instruct client to remain recumbent for 10 to 15 minutes or administer at bedtime. Vaginal cream is administered high into vaginal canal; instruct client to remain recumbent for 10 to 15 minutes or administer at bedtime.

Over the past 2 months, a client has been receiving treatment for multiple ear infections and tonsillitis. The client reports vaginal discharge and itching. What is likely the cause of the client's vaginitis?

antibiotics When antibiotics are taken for a long time or repeated courses of antibiotic therapy are necessary, an overgrowth of yeast-like fungi that usually exists in small numbers in the vagina can occur, resulting in vaginitis. Antibiotics or frequent douching eliminate the bacilli that promote an acidic vaginal environment, which can lead to vaginitis. Unregulated diabetes causes an excess of glycogen in vaginal mucus, which supports the growth of microorganisms, which can lead to vaginitis. Decreased estrogen at menopause reduces the thick, moist consistency of vaginal tissue which can lead to vaginitis.

A client has undergone a total abdominal hysterectomy and bilateral salpingo-oophorectomy as treatment for endometrial cancer. When providing postoperative care to this client the nurse would be alert for signs and symptoms of which of the following?

bladder dysfunction After a total abdominal hysterectomy and bilateral salpingo-oophorectomy, the client is at risk for several complications, especially bladder dysfunction because the surgical site is close to the bladder. Leukopenia and neurotoxicity are adverse effects of chemotherapy agents such as paclitaxel and carboplatin used to treat ovarian cancer. Deep vein thrombosis, not clotting deficiencies are a potential complication after this type of surgery.

Which is the earliest and the most common symptom of endometrial cancer?

bleeding Bleeding is the earliest and the most common sign of endometrial cancer.

During consultations with the oncologist, a client with cervical cancer is informed that radioactive materials will be inserted in the area of the tumor. She has to undergo these sessions over a period of 3 weeks. Which method of cancer treatment is being described?

brachytherapy Internal radiation, or brachytherapy, delivers a dose of radiation to a localized area inside the body through the use of an implant. The implant may be applied by a needle, seed, bead, or catheter, or can be given orally. Antineoplastic agents used in chemotherapy interfere with the cellular function of the cancer cells and cause cell death. Needle aspiration biopsy involves aspirating tissue fragments through a needle guided into the cancer cells.

Over the past 2 months, a client has been receiving treatment for multiple ear infections and tonsillitis. The client reports a curdy white vaginal discharge and burning with urination. What is the most likely cause of these symptoms?

candida albicans Candida albicans presents with a thick, curdy white discharge, accompanied by a strong odor and burning with urination. Trichomonas vaginalis presents with a foamy, yellow-white discharge, accompanied by a foul odor and severe itching. Gardnerella vaginalis presents with a watery, gray-white discharge, accompanied by a fishy odor and more discharge after intercourse.

While obtaining the history, a client reports that her mother was treated with diethylstilbestrol (DES) during her pregnancy. The nurse determines that this client is at risk for which of the following?

cervical cancer Cervical cancer affects the lowest portion of the uterus and is associated with the risk factor of being born to mothers treated with DES during their pregnancy. DES is not a risk factor associated with vulvar or breast cancers. Endometrial cancer occurs in women who take estrogens without the addition of progesterone for 5 or more years during and after menopause.

A woman in her late 30s has been having unusually heavy menstrual periods combined with occasional urine and stool leakage over the past few weeks. Upon further enquiry, she reveals that she also has postcoital pain and bleeding. To which diagnosis will the investigation most likely lead?

cervical cancer The client's symptoms are those of cervical cancer. Symptoms of cervical cancer include abnormal vaginal bleeding and persistent yellowish, blood-tinged, or foul-smelling discharge. *Clients may complain of postcoital pain and bleeding, bleeding between menstrual periods, and unusually heavy menstrual periods*. If the cancer has progressed into the pelvic wall, the Clients may experience pain in the flank regions of the body.

A nurse practitioner examines a patient suspected of having endometriosis. The nurse knows that although a definitive diagnosis could not be made without diagnostic treatment (transvaginal ultrasound), the most frequent symptom is:

chronic pelvic pain Chronic pelvic pain is the most frequent symptom of endometriosis. Low back pain, dyspareunia, dysuria, dyschezia, dysmenorrhea, and menorrhagia are among the common complaints. The level of pain associated with endometriosis is not necessarily correlated with the stage of endometriosis.

Upon examination, the nurse practitioner notes a backward positioning of the client's uterus. How would the nurse document this finding?

retroversion In retroversion, the uterus turns posteriorly as a whole unit. In anteversion, the uterus tilts forward as a whole unit. In retroflexion, the fundus bends posteriorly. In anteflexion, the uterus bends anteriorly.

Which position occurs when the uterus turns posteriorly as a whole unit?

retroversion In retroversion, the uterus turns posteriorly as a whole unit. In anteversion, the uterus tilts forward as a whole unit. In retroflexion, the fundus bends posteriorly. In anteflexion, the uterus bends anteriorly.

A perimenopausal woman informs the nurse that she is having irregular vaginal bleeding. What should the nurse encourage the patient to do?

see her gynecologist as soon as possible All women should be encouraged to have annual checkups, including a gynecologic examination. Any woman who is experiencing irregular bleeding should be evaluated promptly.

Which of the following is the preferred medication for bacterial vaginosis?

metronidazole The preferred medication for treatment of bacterial vaginosis is metronidazole 500 mg twice daily for seven days. Monistat, Gyne-Lotrimin, and Terazol are used in the management of candidiasis.

A client with HIV has recently completed a 7-day regimen of antibiotics. She reports vaginal itching and irritation. In addition, the client has a white, cheese-like vaginal discharge. Which condition is the client most likely experiencing?

vulvovaginal candidiasis Use of antibiotics decreases bacteria, thereby altering the natural protective organisms usually present in the vagina, which can lead to candidiasis overgrowth. Clinical manifestations include a vaginal discharge that causes pruritus; the discharge may be watery or thick but usually has a white, cheese-like appearance. Bacterial vaginosis does not produce local discomfort or pain. Discharge, if noticed, is heavier than normal and is gray to yellowish white. Most HPV infections are self-limiting and without symptoms.

A patient is receiving chemotherapy with paclitaxel as treatment for ovarian cancer. The patient arrives at the facility for laboratory testing prior to her next dose of chemotherapy. The results are as follows:Hemoglobin: 12.9 gm/dLWhite blood cell count: 2,200 /cu mmPlatelets: 250,000 /cu mmRed blood cell count: 4,400,00/cu mmWhich result would be a cause for concern?

white blood cell count The patient's white blood cell count is low, revealing leukopenia and placing the patient at an increased risk for infection. The other results are within normal parameters and would not be a cause for concern.

A patient has been diagnosed with an invasive vulvar malignancy. What primary treatment for invasive vulvar malignancy will the nurse prepare the patient for?

wide excision Vulvar intraepithelial lesions are preinvasive and are also called vulvar carcinoma in situ. They may be treated by local excision, laser ablation, application of chemotherapeutic creams, or cryosurgery. When invasive vulvar carcinoma exists, treatment may include wide excision or removal of the vulva (vulvectomy). An effort is made to individualize treatment, depending on the extent of the disease. A wide excision is performed only if lymph nodes are normal. More pervasive lesions require vulvectomy with deep pelvic node dissection.

Which type of yeast infection is manifested by white, cheese-like discharge?

candidiasis The discharge of candidiasis may be watery or thick, but has a white, cheese-like appearance. The other disorders do not have a cheese-like appearance.

A 24-year-old client births a healthy female infant. Incidentally, the client was given diethylstilbestrol (DES) during her pregnancy. It is important that the nurse stresses frequent gynecological examinations of client's daughter when she reaches a certain age because of which concern?

to prevent the onset of vaginal carcinoma in the client's daughter Studies have shown a relation between taking DES during an early pregnancy and the development of vaginal carcinoma, not vulvar cancer, in the (young) female offspring. Therefore, DES is no longer used to treat problems associated with pregnancy. To prevent the onset of vaginal carcinoma in the client's daughter, the nurse should instruct the client to have her daughter receive complete gynecologic examinations regularly. Gynecologic examinations of the client's daughter will not ensure regular menstruation cycles or a complication-free pregnancy.

A patient has been diagnosed with a vaginal infection and received a prescription for metronidazole (Flagyl). The nurse knows that this is the recommended treatment for a vaginal infection caused by what organism?

trichomonas vaginalis The most effective treatment for trichomoniasis is metronidazole or tinidazole (Tindamax). Both partners receive a one-time loading dose or a smaller dose three times a day for 1 week (CDC, 2010a).

When a female client reports a frothy, yellow-green vaginal discharge, the nurse suspects the client has a vaginal infection caused by which organism?

trichomonas vaginalis Trichomonas vaginalis causes a frothy yellow-white or yellow-green vaginal discharge. Candidiasis causes a white, cheese-like discharge clinging to the vaginal epithelium. Gardnerella vaginalis causes a gray-white to yellow-white discharge clinging to the external vulva and vaginal walls. Chlamydia causes a profuse purulent discharge.

A client undergoing treatment for vaginosis is also counseled about measures to prevent its recurrence. Which statement by the client best indicates effective counseling?

"I will avoid douching after my period" Vaginitis is a condition in which the vagina is inflamed. Frequent douching predisposes the client to vaginitis. Treatment of a client' partners does not seem to be effective, but use of condoms may be helpful. Antiprotozoal vaginal suppositories should be used at regular intervals rather than only after intercourse. Voiding will not prevent the recurrence of vaginitis.

An elderly client, who can void only while standing and pushing upward on the vagina, is ordered a pessary. Which comment from the client indicates a need for further teaching about this device?

"I will remove and clean it every day" Pessaries should be removed, cleaned, and replaced periodically (at least every 2 months). If the client is unable to manage the pessary, then follow-up appointments should be made with the practitioner. Ill-fitting pessaries can cause irritation and erosion of tissue resulting in irritation, bleeding, or infection. The placement of the pessary should support the uterus in the pelvis and lessen urinary and pelvic symptoms.

A client who wishes to preserve childbearing asks the nurse to explain how taking oral contraceptives will work in the management of endometriosis. Which is the best response by the nurse?

"Symptoms of endometriosis are increased during normal menstrual cycle." The use of estrogen-progestin contraceptives keeps the client in a non bleeding phase of the menstrual cycle, therefore decreasing ectopic tissue from shedding and causing extra uterine bleeding. Blood that is trapped in the peritoneal cavity causes more pain as adhesions form. Endometriosis is cured by natural or surgical menopause but can be medically managed for periods of time with the use of oral contraceptives.

A client reports loss of interest in sexual relations and discomfort during intercourse. Which is the best response by the nurse?

"These are normal, manageable symptoms of menopause" Diminished libido and/or dyspareunia are common symptoms associated with perimenopause. Explaining that this can be a normal finding may help to alleviate worries for the client and provide hope for management of the symptoms. The nurse should avoid telling a client "not to worry" or "talk to someone else" because these can negate client feelings and shut down communication. HRT may not be recommended for this client.

The nurse is caring for a patient postoperatively who had a simple vulvectomy. What nursing interventions should be provided to this patient? Select all that apply.

Cleansing the wound daily Offering a low-residue diet Positioning the patient with pillows The wound is usually cleansed daily with warm, normal saline irrigations or other antiseptic solutions as prescribed, or a transparent dressing may be in place over the wound to minimize exposure to the air and subsequent pain. A low-residue diet prevents straining on defecation and wound contamination. Positioning the patient on her side, with pillows between her legs and against the lumbar region, provides comfort and reduces tension on the surgical wound. After the dressings are removed, a bed cradle may be used to keep the bed linens away from the surgical site. Antibiotic ointment should not be applied to the site.

A client has a history of dysmenorrhea. During monthly menses, the client experiences incapacitating cramping and passes large clots. The client's primary care physician initiates conservative treatment. What interventions would the physician to recommend?

NSAIDs Dysmenorrhea is treated with mild non-narcotic analgesics and by treating the underlying cause if one is identified. Symptomatic relief is accomplished with NSAIDs, which reduce prostaglandins. Prostaglandins are biologic chemicals that exist in endometrial tissue, where they exert a stimulating effect on the uterus, producing cramping and pain.

What interventions for the relief of pain and discomfort can the nurse educate the patient with a vulvovaginal infection about using? Select all that apply.

Warm perineal irrigations Sitz baths Cornstarch for chafed inner thighs Warm perineal irrigations promote healing. Sitz baths may be occasionally recommended and may provide temporary relief of symptoms. Meticulous skin care is necessary to prevent excoriation. Applying bland creams or lightly dusting with cornstarch may be soothing. Douching tends to eliminate normal flora, reducing the body's ability to ward off infection. In addition, repeated douching may result in vaginal epithelial breakdown and chemical irritation and has been associated with other pelvic disorders.

The client is asking if there is a pill that can be ordered to control the symptoms of menopause. Which assessment finding is most important in determining nursing care in association with hormone replacement therapy?

family history of breast cancer The risk of endometrial or breast cancer in women prescribed HRT may outweigh the benefits of relieving symptoms of menopause and preventing kyphosis or hip fractures associated with osteoporosis.

A 34-year-old client has been diagnosed with endometriosis. What topic should the nurse emphasize during health education?

the importance of reporting a possible pregnacy as soon as it occurs Clients with endometriosis need to report pregnancies as soon as possible so that relevant treatment can be provided. The disease is noninfectious, so there is no need to have the partner tested or to be prescribed antibiotics.

A female client is diagnosed with carcinoma in situ of the endometrium. The nurse interprets this as which of the following?

the malignancy is localized A localized malignancy is referred to as carcinoma in situ. Stage I endometrial cancer is confined to the body (corpus) of the uterus, stage II involves the corpus and cervix, and stage III extends outside the uterus but not the true pelvis.

A nurse is reviewing a client's medical history. Which factor indicates the client is at risk for candidiasis?

use of corticosteroids A small quantity of the fungus Candida albicans commonly exists in the vagina. Because corticosteroids decrease host defense, they increase the risk of candidiasis. Candidiasis is rare before menarche and after menopause. Using hormonal contraceptives, not spermicidal jelly, and pregnancy, not nulliparity, increase the risk of candidiasis.

Which of the following would be most important to determine when assessing a client being admitted for suspected toxic shock syndrome (TSS)?

use of superabsorbent tampons TSS is commonly associated with the use of superabsorbent tampons that are not changed frequently and internal contraceptives that remain in place longer than necessary. Assessing the use of oral contraceptives, psychological trauma, or menorrhagia is not required for diagnosing the cause of TSS.

The nurse is interviewing a postmenopausal client during an annual gynecologic exam. Which assessment finding presents the greatest concern in the care of this client?

vaginal bleeding Vaginal bleeding in a client after menopause is abnormal and a predominant symptom for vaginal cancers. The incidence of vaginal cancer is higher among woman infected with HPV and those who use a pessary but neglect to remove and clean it. Urinary stress incontinence is not a significant concern.

Which term describes an opening between the bladder and the vagina?

vesicovaginal fistula A vesicovaginal fistula may occur because of tissue injury sustained during surgery, vaginal birth, or a disease process. A cystocele is a downward displacement of the bladder toward the vaginal orifice. A rectocele is a bulging of the rectum into the vagina. A rectovaginal fistula is an opening between the rectum and the vagina.