Chapter 27-Assessing Female Genitalia & Rectum

The nurse is separating the labia of a female patient during a reproductive physical examination. The structures that the nurse will inspect include: (Select all that apply.)

-Clitoris -Urethral meatus -Vaginal opening -Labia minora

The nurse notes a white curd-like discharge when inspecting a female client's labia. What should the nurse suspect this client is experiencing?

candida vaginitis

The outermost layer of the vaginal wall is composed of

pink squamous epithelium and connective tissue.

A nurse assesses a 30-year-old client who has never had a Pap test. Which factors should the nurse explain to the client are a risk for cervical cancer? Select all that apply.

-Diet low in fruits -Multiple pregnancies -History of Chlamydia infection

What care should a nurse take when using a speculum to assess a client's cervix? Select all that apply.

-Encourage the client to take deep breaths and keep her feet in the stirrups -Choose the instrument that is the correct size for the client -Insert the speculum at a 45-degree angle downward

A 35-year-old client tells the nurse that she is concerned that she may be already starting menopause. The nurse should explain that the normal range of years for menopause to occur is which of the following?

40 to 58 years old

The nurse suspects a client weighing 161 pounds may be exhibiting signs of sepsis. Which urinary output value indicates acute oliguria?

50 mL in past 2 hours

When examining the genitalia of a client, a nurse observes a yellowish discharge from the external os. The nurse recognizes this finding as indicative of what condition?

Mucopurulent cervicitis

Which statement by a client in regards to her ability to conceive should prompt a nurse to ask additional questions about infertility?

My husband and I have had unprotected intercourse for over a year

The nurse is reviewing the functions of the ovaries, uterus, clitoris and vagina with a group of high school students. Based on this information, what would be the best response by the high school student about the function of the clitoris?

Small erectile structure that responds to sexual stimulation.

A 57-year-old woman has come to the OB/GYN clinic for her annual physical. She tells the nurse that it has been 14 months since her last period. What should the nurse further assess?

The patient is postmenopausal.

When assessing a pregnant female, the nurse documents Gravida 3, Para 2 regarding obstetrical history in the health record. Which situation correctly corresponds to the obstetrical history of the woman?

The woman has been pregnant three times and has delivered two live children.

During the examination of the external genitalia, the nurse notices drainage from the urethra. The nurse should prepare to assess this client for which condition?

Urethritis

The nurse is caring for a 17-year-old girl who is 16 weeks pregnant. The patient's history shows infection with multiple STIs. What should the nurse do?

Verify that prior STIs were treated according to protocol.

Which client should the nurse assess for possible primary amenorrhea?

an 18-year-old who has never started menses

A client visits the clinic and tells the nurse that her stools have been pale for the past 2 days and her skin has been itching. The nurse should refer the client to a physician for possible

biliary disease

While assessing the anus of an adult client, the nurse detects the presence of small nodules. The nurse should refer the client to a physician for possible

polyps

What information should a nurse give a client who reports a routine of frequent douching?

predisposes the vagina to yeast infections

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

Retroversion

Which of the following is a downward displacement of the bladder toward the vaginal orifice?

Cystocele

A client reports the new onset of mucus in the stool. How should the nurse document this in the client's history?

Steatorrhea

A client asks the nurse when a colonoscopy is recommended. Which advice provided by the nurse is most appropriate?

"A flexible sigmoidoscopy should be done every five years starting at age 50."

A female client tells the nurse that she may be experiencing premenstrual syndrome. An appropriate question for the nurse to ask the client is

"Do you experience mood swings or bloating?"

The nurse is performing a genitourinary assessment on a 42-year-old client and has explained to her that the assessment will require rectovaginal palpation. The client winces and asks, "Is that really necessary?" Which of the nurse's responses would provide the best rationale for rectovaginal palpation?

"I know this is probably unpleasant, but it's important for me to determine if your uterus is where it's expected."

A 57-year-old woman calls the clinic reporting painful intercourse followed by spotting. She tells the nurse that she hasn't had a period in 2 years. What should the nurse tell her?

"These findings are common in postmenopausal women."

A 29-year-old woman with a longstanding diagnosis of genital herpes has presented to the clinic because of a recent "flare-up." What should the nurse expect during inspection of this recurrence of herpes?

A local patch of small, painful lesions on the client's vulva

While inspecting the labia minora, a nurse notices that they are asymmetric. Which of the following does this finding most likely point to?

Abcess

A female client presents to the clinic with chills and fever for 3 days. She also complains of sores in her genital region. The nurse should prepare to give which instructions to this client?

Abstinence should be practiced while sores are weeping.

A female client with a history of endometriosis tests positive with a urine pregnancy test. She complains of right lower quadrant pain and nausea. During an ultrasound, an empty gestational sac is seen. What is the nurse's priority action?

Advise client to seek treatment right away.

During a gynecologic examination, the nurse observes that the client has a yellow-green frothy vaginal discharge. The nurse should plan to test the client for possible

Trichomonas vaginalis infection.

A 27-year-old female client complains of amenorrhea and severe right-sided pelvic pain. What is the nurse's priority action?

Assess the client's vital signs.

A client has been ordered a physical examination of the genitalia. Which information should a nurse give a client scheduled for her first Pap test to improve the accuracy of the test?

Avoid douching 48 hours before the examination.

When collecting a specimen from the cervix for cytology, the nurse does which of the following?

Labels glass slides and treats them immediately with fixative

An adult woman presents at the clinic with a grayish vaginal discharge. What should the nurse suspect?

Bacterial vaginosis

A 24-year-old travel agent comes to your clinic complaining of pain and swelling in her vulvar area. She states that 2 days before she could feel a small tender spot on the left side of her vagina but now it is larger and extremely tender. Her last period was 1 year ago; she is sexually active. She uses the Depo-Provera shot for contraception. She denies any nausea, vomiting, constipation, diarrhea, pain with urination, or fever. Her past medical history is significant for ankle surgery. Her mother is healthy, and her father has type 2 diabetes. On examination she appears her stated age and is standing up. She states she cannot sit down without excruciating pain. Her blood pressure, temperature, and pulse are unremarkable. On visualization of her perineum a large, red, tense swelling is seen to the left of her introitus. Palpation of the mass causes a great deal of pain. What disorder of the vulva is most likely causing her problems?

Bartholin's gland infection

The nurse is planning to inspect the anal area of an adult female client. To assess for any bulges or lesions, the nurse should ask the client to

Bear down

A nurse is teaching a sex education class at the local university. In a prelecture quiz, the nurse asks what the two small folds that extend from the clitoral hood to the posterior fourchette of the vagina are called. What would be the correct answer?

Labia minora

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

Candidiasis

When examining the genitalia of a client, a nurse observes cauliflower-like growth on the client's cervix. The nurse recognizes this finding as indicative of what condition?

Cervical cancer

A 35-year-old client has a Pap test with a normal test result. The client has had two previous tests with normal results. Which information is correct for the nurse tell this client with regard to future screening for cervical cancer?

Continue exams every 2-3 years

A Nurse Practitioner is examining a patient who presented at the free clinic with vulvar pruritus. Which assessment factor would the practitioner look for that may indicate that the patient has an infection caused by Candida albicans?

Cottage cheese-like discharge

A young adult woman presents at the clinic stating, "I think I have a yeast infection." The nurse notes this is the third time in the past 90 days that this client has been to the clinic for yeast infections. What should the nurse consider as a comorbidity with this client?

Diabetes

The nurse is present during a pelvic examination of a female client. The healthcare provider states that the multiparous client has several small nodules at the cervix that look like yellow pustules. The nurse should prepare for which action?

Document the findings.

The nurse selects the diagram shown to use when teaching a female client. What health problem is the nurse reviewing with this client?

Fibroids

A female client has been diagnosed with menorrhagia. What information should the nurse provide the client concerning menses flow?

Flow may include clots.

A nurse assesses a 22-year-old client who has never had a Pap test. Which factor should the nurse explain to the client as being a risk for cervical cancer?

Having multiple sexual partners

A 17-year-old client has expressed concern over having a vaginal discharge just before her menses begins. What response should the nurse provide the client to best address her concerns?

If there are no other signs or symptoms, it is likely a result of normal ovulation."

A nurse inspects the genitalia of an elderly client and notices the mucosa is dry and atrophied. The nurse should educate the client about her increased risk of what condition?

Infection

An adolescent is brought to the clinic by her mother because of abnormal uterine bleeding. What should the nurse explain about this bleeding?

It is common in adolescents and woman approaching menopause.

Which position is it most logical for the nurse to place the female client in for the anus and rectum examination?

Lithotomy

The nurse is working with an anorexic client who complains that sexual intercourse with her partner is painful. The nurse suspects that the client may lack the fat pad that is typically located over the pubic bone in women and that functions to absorb force and protect the pubic bone. Which of the following is the name of this structure?

Mons pubis

A nurse observes a few small, yellow colored nodules on the cervix of a client during the speculum exam. They are not painful, nonodorous, and thin clear discharge is present. The nurse recognizes these are most indicative of what type of condition?

Nabothian cysts

A nurse practitioner documents as follows: "Client reports pain and tenderness over area of right ovary and a history of irregular menses." With which of the following diagnoses are these findings consistent?

Ovarian cyst

When doing a bimanual examination of the ovaries, the nurse practitioner palpates quickly and gently. Why should this part of the examination be brief?

Ovaries are similar to gonads in their sensitivity

A 35-year-old woman visits her family doctor and reports mood swings, swelling of her breasts, acne, bloating, and weight gain every month, starting about 2 weeks prior to her period. What disorder is this patient describing?

PMS

A nurse inspects the cervix of a 52-year-old client during a routine assessment. Which coloration of the cervix may indicate that the woman is postmenopausal?

Pale

The nurse is present during a pelvic examination of an adolescent female client. Which action should the nurse prepare for first?

Pap smear specimen collection

During a comprehensive assessment, a female client complains of intense external genital itching. The nurse should carefully assess for which condition that commonly presents with this symptom?

Pediculosis pubis

An 18-year-old college freshman comes to the clinic complaining of severe left-sided lower abdominal pain and a foul yellow discharge. The pain began last night while she was having intercourse with her boyfriend. Afterwards the pain became more severe and the discharge started. By this morning she had a fever of 38.3°C and walking was making the pain worse. Only lying very still makes the pain better. She has tried ibuprofen and acetaminophen without any improvement. She denies any nausea, vomiting, diarrhea, or constipation. Her past medical history is unremarkable. She has had two past sexual partners. She uses the birth control patch instead of condoms. She smokes a half pack of cigarettes a day and drinks four to five beers per weekend night. She denies any illegal drug use. Her parents are both healthy. Examination shows a young woman who appears ill. Her temperature is 38.9°C and her pulse is elevated at 110. She is tender in the left lower quadrant but has no guarding or rebound. Speculum examination reveals yellow purulent drainage from the os. On palpation there is cervical motion tenderness and the left adnexa is swollen and tender. A urine analysis is unremarkable and the urine pregnancy test is pending. What is the best choice of diagnosis for this adnexal swelling?

Pelvic Inflammatory Disease

Which of the following is the most important risk factor for cervical cancer?

Persistent HPV infection

A nurse inspects the cervix of a 33-year-old, nonpregnant client during a routine assessment. Which coloration of the cervix would indicate normal health in this client?

Pink

The skin folds of the labia majora and the labia minora form a boat-shaped area termed the

vestibule

The nurse is reviewing the functions of the ovaries, uterus, clitoris and vagina with a group of nursing students. Based on this information, what would be the best response by a nursing student about the function of the uterus?

Receives the fertilized ovum and provides housing and nourishment for a fetus.

Which finding in a female client's history would alert the nurse to assess for signs of diabetes mellitus?

Recurrent candidiasis infections

A nurse inspects the cervix of a 28-year-old, nonpregnant client during a routine assessment. Which coloration of the cervix may indicate inflammation?

Red

What intervention should a nurse follow when obtaining the specimen for a gonorrhea culture?

Spread specimen in a "Z" pattern onto a special culture plate.

When palpating the internal female genitalia, the nurse separates the client's labia and asks her to strain down to assess which of the following?

Support of vaginal walls

During a physical examination of a female patient's reproductive system, the nurse detects a thick white discharge from the labia. The patient's vulva appears inflamed. How should the nurse document this finding?

Symptoms of candidal vaginitis

A 24-year-old delivers a healthy female infant. Incidentally, the patient had used diethylstilbestrol (DES) during her pregnancy. It is important that the nurse stress frequent gynecological examinations of patient's daughter when she reaches a certain age due to which of the following?

To prevent the onset of vaginal carcinoma in the patient's daughter.

A nurse is preparing a client for a Pap smear. The nurse knows that the area where 90% of the neoplasms of the lower genital track originate and the area from which cells will be obtained for the Pap smear is which of the following?

Transformational Zone

A female patient tells the nurse that she thinks she has a vaginal infection because she has noted inflammation of her vulva and a yellowish green discharge. The nurse recognizes that the clinical manifestations described are typical of what vaginal infections?

Trichomonas vaginalis

When the female patient reports a frothy yellow-green or brown vaginal discharge, the nurse suspects the patient has a vaginal infection caused by which of the following?

Trichomonas vaginalis

A 28-year-old married clothing sales clerk comes to the clinic for her annual examination. She requests a refill on her birth control pills. Her only complaint is painless bleeding after intercourse. She denies any other symptoms. Her past medical history consists of two spontaneous vaginal births. Her past six Pap smears have all been normal. She is married with two children. Her mother is in good health, and her father has high blood pressure. Examination shows a young woman appearing healthy and relaxed. Her vital signs are unremarkable, and her head, eyes, ears, throat, neck, cardiac, lung, and abdominal examinations are normal. Visualization of the perineum shows no lesions or masses. Speculum examination shows a red mass at the os. On taking a Pap smear the mass bleeds easily. Bimanual examination shows no cervical motion tenderness. Both ovaries are palpated and nontender. What is the most likely diagnosis related to the abnormality of her cervix?

cervical polyp

The nurse is assessing the genitalia of a female client and detects a bulging anterior wall in the vagina. The nurse should plan to refer the client to a physician for

cystocele.

An older adult client visits the clinic complaining of urinary incontinence. The nurse should explain to the client that this is often due to

decreased urethral elasticity.

A client visits the clinic because she has missed one period and suspects she is pregnant. While assessing the client, the nurse detects a solid, mobile, tender, unilateral adnexal mass. The client's cervix is soft. The nurse suspects that the client may be experiencing

ectopic pregnancy

The outer layer of the vaginal wall is under the direct influence of

estrogen.

The visible portion of the clitoris is termed the

glans

During assessment of the vaginal area of an adult client, the client tells the nurse that she has had pain in her vaginal area. The nurse should further assess the client for

infection

While assessing the cervix of an adult client, the nurse observes a yellowish discharge from the cervix. The nurse should further assess the client for a/an

infection

When examining the uterus, a nurse finds that the cervix and the body of the uterus are tilted backward. How should the nurse document this uterine finding?

retroverted

While inspecting a client's vagina, the nurse notes transverse folds in the outer layer of pink squamous epithelium. These folds are known as which of the following?

rugae

To best secure accurate assessment information, the nurse should complete which part of the reproductive history last?

sexual

During the inspection of a patient's reproductive system, the nurse identifies small lacerations and bruises of the labia majora and minora. What does this finding suggest to the nurse?

sexual abuse

A female client tells the nurse that she has pain while urinating. Besides obtaining a urinalysis, the nurse should assess the client for

sexually transmitted disease.