Chapter 53 Disorders of the Female Repro System

After teaching a client about the use of a pessary, which statement by the client indicates the need for additional instruction? A) "A white or yellow vaginal discharge is expected and normal." B) "I need to apply a sterile lubricant to the pessary before reinserting it." C) "After removal, I should wash the pessary with warm soapy water, rinse, and dry it." D) "I should call the physician if I notice any discomfort with the pessary."

Ans: A Feedback: A white or yellow discharge from the vagina is not a normal finding and should be reported to the physician because it may indicate an infection. A sterile lubricant is applied to the pessary before it is reinserted. After removal, the pessary should be washed thoroughly with warm soapy water, followed by rinsing and drying. Discomfort may indicate that a pessary has been inserted incorrectly, it has moved, or that it is causing irritation. These problems should be reported to the physician.

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? A) "I will remove and clean it every day." B) "I will report any signs of irritation or bleeding." C) "I should have greater ease of emptying my bladder." D) "I should report any foul odor or drainage."

Ans: A Feedback: 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.

Which of the following is an early symptom of vulvar cancer? A) Pruritus with genital burning B) Fever accompanied by chills C) Severe abdominal pain D) Dyspareunia

Ans: A Feedback: 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.

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? A) "Symptoms of endometriosis are increased during normal menstrual cycle." B) "Contraceptives will allow blood to be diverted to the peritoneal cavity." C) "Trapping blood causes less pain or discomfort for clients with endometriosis." D) "Endometriosis is usually cured with surgical menopause."

Ans: A Feedback: The use of estrogen-progestin contraceptives keeps the client in a nonbleeding phase of the menstrual cycle, therefore decreasing ectopic tissue from shedding and causing extrauterine 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.

Which of the following nursing instructions is essential in the care of a postmenopausal client who is prescribed ibandronate (Boniva)? A) Take with 8 oz of water. B) Take calcium supplements. C) Milk helps with absorption. D) Take at bedtime.

Ans: A Feedback: These drugs are best absorbed when given with 8 oz of water on arising in the morning. Avoid lying down for at least 30 minutes to prevent dyspepsia and esophageal irritation. Do not take with milk or calcium supplements because calcium inhibits absorption of the drug.

The nurse is providing an educational presentation on toxic shock syndrome to a group of adolescents. Which preventative measure is a primary focus for this group? A) If using tampons, change frequently. B) Do not use vaginal devices for birth control. C) Toxin is associated with multiple sex partners. D) Use good personal hygiene.

Ans: A Feedback: Toxic shock syndrome is often associated with the use of superabsorbent tampons that are not changed frequently. The infection can also be introduced through unclean vaginal devices or keeping the device in place too long after use. Good personal hygiene and safe sexual practices should also be addressed although not specific to TSS.

Because ovarian cancer has nonspecific symptoms and can result in lethal outcome, diagnostic testing may be indicated for some women. Which risk factors support the need for screening? Select all that apply. A) Carrying genetic mutation for the disease B) Being nulliparous C) Family history of lung cancer D) Breastfeeding E) Use of oral contraceptives for 5 years or more F) Multiple full-term pregnancies

Ans: A, B Feedback: Woman who are nulliparous, have a family history of ovarian cancer, and or carry a genetic mutation tend to develop ovarian cancer more often than others. Preventative measures recommended to lower the risk of ovarian cancer include having at least 2 full-term pregnancies, breastfeeding after pregnancies, and using oral contraceptives for 5 years or more. History of lung cancer is not a risk factor.

When caring for a client with polycystic ovarian syndrome, the nurse will focus teaching needs in the management of which associated problems? Select all that apply. A) Hypertension B) Hyperlipidemia C) Infertility D) Absence of body hair E) Weight loss F) Decreased Insulin

Ans: A, B, C Feedback: Polycystic ovarian syndrome is associated with multiple endocrine abnormalities such as abnormal lipid levels, hypertension, and difficulty with conceiving due to interference of ovulation. Other symptoms include excessive body hair, weight gain, and overproduction and inefficient use of insulin.

Following a laparoscopic-assisted vaginal hysterectomy, which client assessment finding would warrant nursing intervention? Select all that apply. A) Dorsal recumbent positioning with knee bend B) Early ambulation C) Peri-pad changed every shift D) Catheter tube secured to leg E) TED stockings removed and reapplied twice daily F) High-fiber diet

Ans: A, C Feedback: Following abdominal surgery, positioning of the legs with sharp bends can interfere with blood flow and should be avoided. Peri-pad should be changed at least once every 4 hours to observe for bleeding and prevent infection. Early ambulation and application of TED hose promote circulation and decrease risk for thrombophlebitis and embolus formation. Securing the catheter prevents pulling on the bladder neck. High-fiber diet prevents constipation and straining.

While collecting data on reproductive history, the client discloses early menarche, early sexual engagement, chlamydia infection, and treatment for gonorrhea. The nurse knows that this client is at highest risk for the development of which of the following? A) Sexually Transmitted Infections B) Breast cancer C) Fibroid tumor or myoma D) Cervical cancer

Ans: A, D Feedback: Cervical cancer is the second most frequent malignancy of the female reproductive system and is associated with risk factors such as becoming sexually active at an early age, acquiring genital infections, or STIs. Breast cancer and fibroid tumors are not indicated with the history presented.

A female client is diagnosed with carcinoma in situ of the endometrium. The nurse interprets this as which of the following? A) Cancer is confined to the body of the uterus. B) The malignancy is localized. C) Cancer extends outside the uterus. D) The malignancy involves the uterine body and cervix.

Ans: B Feedback: 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 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? A) Chronic pelvic inflammatory disease B) Infertility C) Pelvic pain D) Ascending infection

Ans: B Feedback: 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 prescribed androgen therapy. Which of the following would the nurse explain as a possible adverse effect? A) Severe bleeding from the vagina B) Weight gain C) Decreased libido D) Areolar pigmentation

Ans: B Feedback: Androgen therapy causes decalcification of bone, and the client has an increased appetite and gains weight. It may also cause fluid retention, increased libido, and symptoms of virilization. Pigmentation of the nipple and areola are the adverse effects of estrogen therapy, whereas severe bleeding is not an adverse effect of either androgen or estrogen therapy.

The nurse is collecting assessment data on a client who is reporting a vaginal discharge that is cottage cheese-like in appearance. Which pathogen is the most likely cause for this symptom? A) Gonococci B) Candida albicans C) Trichomonas vaginalis D) Gardnerella vaginalis

Ans: B Feedback: Candida albicans is a yeast infection that presents with a thick, curdy white discharge. Gonococcus is the organism that causes gonorrhea and presents with a yellow, mucopurulent discharge. Trichomonas vaginalis presents with a foamy, white, foul-smelling discharge and Gardnerella vaginalis is a watery, fishy-smelling discharge.

30. 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? A) "I will not need any further treatment." B) "The cancer has not spread." C) "I will need surgery and chemotherapy to increase my odds for survival." D) "I can wait until I have finished having babies to seek treatment."

Ans: B Feedback: 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 client is struggling with symptoms of irritability and "feeling crazy" at times. Which assessment data would provide the most important information needed in the development of a treatment plan for this client? A) Reproductive history B) Menstrual diary C) Vital signs D) Dietary assessment

Ans: B Feedback: Diagnosis of premenstrual disorder and/or premenstrual dysphoric disorder is based on data recorded in a menstrual diary over the time period lasting at least 2 months or more. Symptoms are absent during the period between onset of menstruation and ovulation as recorded in the diary. Reproductive history, vital signs, and dietary assessment are not significant in the diagnosis of the PMS or PMDD.

A client reports loss of interest in sexual relations and discomfort during intercourse. Which is the best response by the nurse? A) "Don't worry, every woman goes through this." B) "These are normal, manageable symptoms of menopause." C) "You need to discuss this with your spouse." D) "Hormone replacement therapy can resolve your symptoms."

Ans: B Feedback: 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.

A postmenopausal client is receiving alendronate. Which of the following would the nurse include when teaching the client about this drug? A) "Take the drug with milk or milk products to enhance absorption." B) "Drink at least 8 oz of water when you take this drug." C) "Be sure to take the drug just before going to bed at night." D) "Lie down for at least 30 minutes after you've taken the drug."

Ans: B Feedback: Medications, such as alendronate, which help to prevent bone loss in postmenopausal women, should be given with 8 oz of water on arising in the morning to maximize absorption. They should not be given with milk or milk products because calcium inhibits absorption of the drug. The client should avoid lying down and remain upright for at least 30 minutes after taking the drug to prevent dyspepsia and esophageal irritation.

Which assessment finding will most likely influence the treatment regime selected by a client with endometriosis? A) Presence of pain B) Family planning C) Dysmenorrhea D) Presence of chocolate cyst

Ans: B Feedback: Selection of a more conservative option may be indicated to preserve the possibility for future childbearing. Pain, dysmenorrhea, and chocolate cysts are all symptoms associated with endometriosis and can influence decision for treatment.

A young, single client reports excessive menstrual flow with menses lasting 10 days each month. Which treatment option will provide symptomatic relief for this client with the least risk? A) Dilation and curettage (D and C) B) Hormonal contraceptives C) Endometrial ablation D) Uterine balloon therapy

Ans: B Feedback: When combination hormonal contraceptives are administered, they produce a light menstrual period and are helpful in the management of menorrhagia. D and C can provide symptomatic relief; however, the effectiveness is limited. Endometrial ablation and uterine balloon therapy cause the endometrium to slough and are cost-effective but are only used after childbearing has completed.

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? A) Vulvar cancer B) Breast cancer C) Cervical cancer D) Endometrial cancer

Ans: C Feedback: 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 client is admitted to the hospital with the diagnosis of sepsis secondary to pelvic inflammatory disease. Which transmission-based precaution will be initiated by the nurse? A) Standard precautions B) Protective precautions C) Contact precautions D) Droplet precautions

Ans: C Feedback: Contact isolation is a category of transmission-based precautions for controlling the spread of infectious microorganisms found in body fluids. Standard precautions are used in the care of all clients in the prevention of HIV and Hepatitis. Protective precautions are instituted when a client is immune compromised and needs protected from others. Droplet precautions are not indicated with PID.

Culture of client's vaginal discharge reveals Gardnerella vaginalis. Which of the following would the nurse expect to assess? A) Foul foamy discharge B) Thick curdy white discharge C) Fishy smelling watery discharge D) Yellowish white discharge

Ans: C Feedback: 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.

Following a radical vulvectomy, the nurse is preparing the client for discharge to home. Which care intervention would be considered the priority for this client? A) Relieving edema to lower extremities B) Alterations for sexual function C) Prevention of wound complications D) Care of colostomy site

Ans: C Feedback: Prevention of complications and infection is paramount due to the location of the wound. The perineal area provides a warm, dark environment that supports the growth of mircroorganisms that can be introduced into the wound. With a radical vulvectomy, it is likely to find surgical drains and urinary catheter that can also interfere with the maintenance of the wound. Relieving edema to the lower extremities may be a necessary part of care if the lymph nodes and blood vessels are disturbed. The client may have a colostomy and care instructions should be provided. Alteration in sexual function needs to be addressed but not a priority for the initial stage of healing.

A client with vaginitis complains of itching and burning of the perineum. Which suggestion would be most appropriate to relieve the client's symptoms? A) Use a pure vinegar douche daily. B) Use skin protectants containing zinc oxide. C) Take sitz baths frequently. D) Avoid yogurt with active lactobacilli cultures.

Ans: C Feedback: 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. A vinegar (1 to 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.

A client with extensive endometriosis is scheduled for a panhysterectomy. Which statement by the client indicates a need for further teaching? A) "I will be having my uterus, tubes, and ovaries removed." B) "I am finished having children." C) "I will not have to deal with symptoms of menopause." D) "I will now have a greater risk for stroke and heart disease."

Ans: C Feedback: Surgical menopause causes a sudden drop in estrogen and progesterone levels resulting in varied symptoms in clients. The risks of heart disease and stroke increase with estrogen reduction. A panhysterectomy is the removal of the uterus, both tubes and ovaries and will result in the inability to conceive children.

Which of the following would be most important to determine when assessing a client being admitted for suspected toxic shock syndrome (TSS)? A) Existence of menorrhagia B) Psychological trauma C) Use of superabsorbent tampons D) Use of oral contraceptives

Ans: C Feedback: 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.

A client has just been diagnosed with endometriosis. Which of the following would be most appropriate to provide the client with support and guidance about treatment options? A) "Treatment is essential, so you really need to make a decision pretty quickly." B) "If it was me, I would probably choose the medication options." C) "It might help to include your partner in any of the discussions about options." D) "The test results are clear and another physician would tell you the same thing."

Ans: C Feedback: The nurse assists the client through the decision-making process as it applies to family planning and medical or surgical treatment. Suggesting that the client include her partner or significant other in the discussion of options would be most helpful and therapeutic. The client does not need to make a decision immediately. The nurse should not give advice or offer his or her own opinions to influence the client's choice. The nurse should support the client's option of seeking a second opinion.

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? A) Presence of kyphosis B) Symptoms of hot flashes C) Family history of breast cancer D) History of osteoporosis

Ans: C Feedback: 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.

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? A) Positive for human papillomavirus (HPV) B) Use of pessary C) Vaginal bleeding D) Urinary stress incontinence

Ans: C Feedback: 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.

A young client has just completed the 6-month series of Gardasil vaccine. Which comment by the client would alert the nurse that further teaching is needed? A) "This vaccine lowers my risk for cervical cancer." B) "I will still need to have routine screening for cervical cancer." C) "I am at lower risk for developing cervical warts." D) "This vaccine will prevent human papilloma virus (HPV) from occurring."

Ans: D Feedback: Gardasil is a vaccine that protects against four types of HPV, which cause 70% of cervical cancers and 90% of cervical warts but does not protect against other strains of HPV and prevaccination infections. Routine cervical cancer screening is recommended regardless of vaccine use.

A client is ordered a vaginal cream for the treatment of a yeast infection. As the nurse provides instruction, which step for inserting vaginal medications should be highlighted? A) Do not use once menses begins. B) Eat yogurt daily. C) Lie down for 1 hour after insertion. D) Wash applicator after each use.

Ans: D Feedback: Reinfection can occur if the applicator is not washed after each use. The vaginal medication should be continued as prescribed and used through the 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 10 to 15 minutes after insertion to provide adequate time for direct contact with the medication instilled.

A client is to be scheduled for a vesicovaginal fistula repair. Which nursing intervention is focused on preventing complications that may delay the procedure? A) Deodorizing douches as needed B) Use of stool softeners C) Daily perineal care D) Encourage fluid intake

Ans: D Feedback: Surgery may be delayed if infection or inflammation occurs. Fluid intake is encouraged to keep urine free of infection. Deodorizing douches will assist with control of urine odor but not significant in preventing complications of infection. Use of stool softeners would be indicated in the management of rectovaginal fistulas. Perineal care should be done every 4 hours and as needed throughout the day.

A client who is diagnosed with premenstrual syndrome is ordered a gonadotropin-releasing hormone (GnRH). Which is a priority teaching item in the use of this drug? A) Maintain a menstrual diary B) Reduce sugar intake C) Eat 6 small meals daily D) Increase calcium and vitamin D intake

Ans: D Feedback: The client who takes a GnRH analog may experience loss of bone density similar to osteoporosis and should increase calcium and vitamin D intake by eating calcium rich foods or by taking supplements. A menstrual diary is helpful in diagnosing PMS and determining effectiveness of treatment. Reduction of sugar intake and eating 6 small meals daily are helpful in the management of PMS but not significant with GnRH treatment.

Which is the primary assessment finding in identifying the possible cause of repeated episodes of vaginitis in a female client? A) Tub baths preferred over shower B) Healthy sex life C) Occasional use of vinegar douches D) Type 2 diabetes mellitus

Ans: D Feedback: Unregulated blood sugars can result in alteration of the vaginal environment and promote the presence of glycogen in vaginal mucus, which supports the growth of microorganisms. Monitoring and controlling blood sugars would be key in a client with diabetes. Tub baths and participation in a healthy sex life are not associated with vaginitis. Frequent douching should be avoided.