Chapter 56: Assessment and Management of Patients with Female Physiologic Processes
The nurse is relating health education to male students when asked where sperm is actually made. Which location is most correct?
In the testes within the scrotum Explanation: Health instruction should be clear, specific, and factual. The specific location for sperm production is in the testes, which lie in the scrotum. More general information is that the sperm are produced in the male reproductive system and immature spermatozoa are formed in the seminiferous tubules. Sperm are not present from birth.
The nurse is scheduling an appointment for Pap test with a client. What information should the nurse provide to the client to ensure the test is accurate? Select all that apply.
"Avoid sexual intercourse for at least 2 days prior to the test." "Use a sanitary pad instead of tampon 2 to 3 days prior to the test." Explanation: It is important for the nurse to remind the client not to have sexual intercourse for at least 2 days before the test. The nurse should also remind the client not to use tampons; birth-control foams or jellies; other vaginal creams, moisturizers, or lubricants; or vaginal medicines for 2 to 3 days before the test. A sanitary pad is permitted and would not interfere with the results of the Pap test. The nurse should remind the client to try not to schedule an appointment for a time during the menstrual period. The best time to conduct the Pap test is at least 5 days after the menstrual period stops.
Because of a client's reluctance to begin hormone therapy, the advance nurse practitioner prescribes venlafaxine to decrease the risk of
hot flashes. Explanation: Problematic hot flashes have been treated with low-dose venlafaxine as an alternative to hormone therapy. Hormone therapy decreases the risk of hot flashes, but it increases the risk of stroke, heart attack, and blood clots.
The nurse educator is teaching a group of nursing students in a reproductive health class. The students are correct in identifying that a woman is most likely to be unable to become pregnant at what age?
49 years old Explanation: Menopause marks the end of a woman's reproductive capacity, which typically occurs between 45 and 52 years of age. The alternate options are ages that are under the typical age of onset for menopause.
During physical examination of the male reproductive system, which method would best provide the nurse information about the prostate's size as well as evidence of tumor?
digital rectal examination Explanation: A digital rectal examination (DRE) is performed to assess the prostate for size as well as evidence of tumor.
Which structure is referred to as the vulva?
external female genitalia Explanation: The major external structures include the mons pubis, vaginal orifice (opening), labia majora, labia minora, and clitoris. These structures are also referred to as the vulva (collective term for external genitalia).
Within the female internal reproductive structures, where is the egg most commonly fertilized?
fallopian tubes Explanation: One or the other fallopian tube receives an extruded ovum every month and serves as the place where the ovum is most commonly fertilized.
Hormone therapy decreases the risk of
hot flashes. Explanation: Hormone therapy decreases the risk of hot flashes. It increases the risk of stroke, heart attack, and blood clots.
Which patient in the ED should the advance nurse practitioner treat first?
A 21-year-old woman reporting sharp colicky abdominal pain, menstrual spotting, and dizziness Explanation: The client with sharp, colicky abdominal pain, menstrual spotting, and dizziness has clinical manifestations of an ectopic pregnancy and should be treated first. If untreated, a ruptured ectopic pregnancy can be life threatening. Bloating, headache, and depression are consistent with premenstrual syndrome (PMS) and do not indicate the priority client at this time. Irregular menses, breast tenderness, and sweating are expected premenopausal symptoms. Vaginal irritation, copious malodorous and frothy/yellow-green discharge is consistent with a Trichomonas species infection and is not the priority.
A woman visits her primary health care provider with a complaint of pain and swelling in the vaginal area. The pain is present when she sits and walks; intercourse is painful. The nurse prepares the patient for an examination. The nurse and health care provider suspect that the patient may have an inflammation or infection of the:
Bartholin glands. Explanation: The Bartholin glands are two bean-sized glands on either side of the entrance to the vagina that secrete fluid into the vaginal area. They can become blocked (cyst formation) or infected (abscess formation). Treatment is different for each, but pain is common with both. Pain can interfere with sitting and walking. A culture is necessary to diagnose the bacteria causing an abscess.
The nurse is discussing nutritional needs for a postmenopausal patient. What dietary increase should the nurse recommend to the patient?
Calcium Explanation: Postmenopausal women should be encouraged to observe recommended calcium and vitamin D intake, including calcium supplements, if indicated, to slow the process of osteoporosis. Iron and vitamin K need not be increased unless there are signs of deficiency. Salt should be eaten in moderation, not increased, to prevent hypertension.
A woman comes to the clinic complaining of vaginal itching and a discharge. Inspection reveals a thick curd-like white discharge. The nurse suspects which of the following?
Candida infection Explanation: Complaints of vaginal itching with a thin to thick, curd-like white vaginal discharge suggests a Candida (yeast) infection. Bacterial vaginosis would be manifested by a discharge that is thin and grayish or yellow with a fishy odor. Trichomonas infection is manifested by a malodorous, copious, often frothy yellow-green vaginal discharge. Atrophic vaginitis is manifested by vulvar or vaginal dryness with a scant, often mucoid, but possibly blood-tinged vaginal discharge.
A 35-year-old African American woman who smokes regularly and had diabetes visits the health care unit with sustained elevated blood levels and is diagnosed with essential hypertension. Which contraceptive method is best for this client?
Cervical cap Explanation: Women who smoke and are 35 years of age or older should not take oral contraceptives because of an increased risk of cardiovascular disease. Mechanical barriers like cervical caps do not use hormonal therapy and are appropriate in this case. Menotropins, a combination of follicle-stimulating hormone and luteinizing hormone, may be used to stimulate the ovaries to produce eggs. An etonogestrel/ethinyl estradiol vaginal ring is a combination hormonal contraceptive that releases estrogen and progestin and is contraindicated for this client.
A client has decided to use a transdermal contraceptive patch. The nurse instructs her that she can apply the patch to which area? Select all that apply.
Chest Torso Arms Thighs Explanation: A transdermal contraceptive patch can be applied to the torso, chest, arms, or thighs. It should not be applied to the breasts.
Which of the following is an age-related functional change of the female reproductive system?
Decreased ovulation Explanation: Functional changes of the female reproductive system include decreased ovulation, onset of menopause, hormonal fluctuations, decreased bone formation, decreased vaginal lubrication, and increased pH of the vagina.
A nurse practitioner is conducting a history and physical on a 42-year-old woman. One of the questions asked of someone in this age group is the type of medications that the patient's mother took during her pregnancy. The nurse is assessing for a past history of ______ use.
Diethylstilbestrol Explanation: Diethylstilbestrol (DES) is a nonsteroidal estrogen that was given to pregnant women (1940-1970) to prevent pregnancy complications. After 30 years, it was found to cause vaginal cancer in daughters exposed to the drug in utero. The incidence of occurrence can be as high as 40%.
Which diagnostic test is indicated for postmenopausal bleeding?
Endometrial biopsy Explanation: For postmenopausal bleeding, an endometrial biopsy or D&C is indicated.
Menopause marks the end of a woman's reproductive capacity. Which of the following is a common complaint that may be due to a cystocele?
Dyspareunia Explanation: A cystocele can cause dyspareunia and incontinence. See Table 32-2 in the text for a complete list of both structural and functional age-related changes.
When instructing clients at a prenatal class, the nurse is most correct to state which medical name as being removed during circumcision?
The prepuce Explanation: The prepuce or foreskin is removed during circumcision. The prepuce covers the glans. The shaft is tubular and composed of erectile tissue. The corpora cavernosa is a column of erectile tissue.
The nurse practitioner performing a physical assessment on an 80-year-old woman is looking for which of the following functional changes in the reproductive system? Select all that apply.
Thickening and stiffness of the vaginal wall Uterine prolapse Vulvar dystrophy Vaginal dryness Explanation: In the elderly woman, the vaginal walls tend to thicken and become stiff. Uterine prolapse and vulvar dystrophy can occur. The best preventative is Kegel exercises. Decreased vaginal lubrication is common.
During an internal vaginal examination, the nurse practitioner notes a frothy and malodorous discharge. The nurse suspects the odor is caused by which bacteria?
Trichomonas Explanation: Trichomonas bacteria cause a copious and often frothy yellow-green colored discharge that is malodorous. A yeast infection doesn't have an odor but bacterial vaginosis is fishy in smell. Refer to Table 32-5 in the text.
While examining the introitus, the nurse practitioner asks the client to "bear down." The nursing student observing the examination knows that the nurse practitioner is assessing the client for which condition?
Uterine prolapse Explanation: The introitus is the vaginal orifice. Uterine prolapse occurs when the cervix and uterus descend under pressure through the vaginal canal and can be seen at the introitus. To identify such protrusions, the examiner asks the client to "bear down." Examinations for colorectal cancer or female genital mutilation do not improve when the client bears down. A Pap test reveals atypical cells; the liquid method allows for human papillomavirus testing. This procedure does not require the client to bear down.
A group of students are reviewing the female reproductive system in preparation for a test. Which of the following if identified by the students as an internal structure indicates successful learning?
Vagina Explanation: The vagina is considered an internal female reproductive system structure. The vulva, labia majora, and mons pubis are external structures.
A patient has been diagnosed with a Trichomoniasis vaginal infection. The nurse would expect which color of discharge?
Yellow-green Explanation: Vaginal discharge associated with Trichomoniasis vaginal infection is copious and often frothy/yellow-green. Candida infection is associated with thin to thick, curd-like, white discharge. White discharge is associated with a normal discharge. Bacterial vaginosis is associated with thin and grayish or yellow discharge.
The nurse is preparing a client for a pelvic examination. The client asks the nurse, "Why do I need to urinate and empty my bladder?" Which response by the nurse would be most appropriate?
"It helps make you more comfortable and the exam easier." Explanation: The client empties her bladder before the examination to ensure her comfort and ease the examination. A full bladder can make palpation of the pelvic organs uncomfortable for the client and difficult for the examiner. Although a urine specimen may be used for testing and it can help identify a possible infection, these are not the primary reasons for a client to empty her bladder. A full bladder does not interfere with obtaining a specimen for a Pap smear, however, a full bladder could make the examination more uncomfortable for the client.
Which term describes a procedure in which cervical tissue is removed because abnormal cells are detected?
Cone biopsy (conization) Explanation: Cone biopsy is a procedure done to remove abnormal cervical tissue. Colporrhaphy refers to repair of the vagina. Cryotherapy refers to destruction of tissue by freezing. Perineorrhaphy refers to sutural repair of perineal lacerations.
A client reports experiencing vulvar pruritus. Which assessment factor may indicate that the client has an infection caused by Candida albicans?
Cottage cheese-like discharge Explanation: The symptoms of C. albicans include itching and a scant white discharge that has the consistency of cottage cheese. Yellow-green discharge is a sign of Trichomonas vaginalis. Gray-white discharge and a fishy odor are signs of Gardnerella vaginalis.
The nurse is preparing a patient for a gynecologic examination when the patient says, "I hope the exam doesn't hurt as much as intercourse with my husband does." What should the nurse document this finding as?
Dyspareunia Explanation: Dyspareunia (difficult or painful intercourse) can be superficial, deep, primary, or secondary and may occur at the beginning of, during, or after intercourse.
Which term refers to difficult or painful sexual intercourse?
Dyspareunia Explanation: Dyspareunia is a common problem in older women. Amenorrhea refers to the absence of menstrual flow. Dysmenorrhea refers to painful menstruation. Endometriosis is a condition in which endometrial tissue seeds in other areas of the pelvis
A 20-year-old client comes to the clinic for a routine examination. The client reports that she has just started having sexual intercourse. The nurse would recommend that the client have a Pap smear at which frequency?
Every 3 years Explanation: For women between 19 to 39 years old, Pap smears are recommended every 3 years after beginning to have sexual intercourse.
A nurse is reviewing the medical record of a client who has come to the clinic for contraception. What condition would hormonal contraceptives be contraindicated for in a client?
History of thrombophlebitis Explanation: Absolute contraindications to the use of hormonal contraceptives include a history of thrombophlebitis because of the increased risk for emboli formation. Hypertension, if controlled in an otherwise healthy young nonsmoker, is not a contraindication for the use of combination agents. However, the client would require a low dose and careful monitoring. Hormonal contraceptives may decrease acne in some situations and help to establish a regular bleeding cycle. An irregular menstrual cycle is not a contraindication.
Which test is an x-ray study of the uterus and the fallopian tubes after injection of a contrast agent?
Hysterosalpingography Explanation: Hysterosalpingography is an x-ray study of the uterus and the fallopian tubes after injection of a contrast agent. Laparoscopy allows the pelvic structures to be visualized. A hysteroscopy allows direct visualization of all parts of the uterine cavity be means of a lighted optical instrument. Endometrial ablation is the destruction of the uterine lining.
A client comes to the clinic reporting dysmenorrhea and is diagnosed with primary dysmenorrhea. Which medication would the nurse most likely suggest for pain relief?
Ibuprofen Explanation: Prostaglandin inhibitors such as aspirin, ibuprofen, naproxen, and mefenamic acid would be recommended. Acetaminophen (Tylenol) would be the least likely choice. Calcium is a supplement for bone health. Cholecalciferol is a vitamin D supplement used for bone health.
A 27-year-old client is a regular smoker and has diabetes. She has been diagnosed with hypertension and says she finds it cumbersome and time-consuming to visit the doctor regularly just to check her blood pressure. Her vital signs are temperature 98.8°F, pulse 72, respirations 12, BP 112/72 mm Hg. In addition, laboratory reports show a hemoglobin A1C level of 5%. The client is requesting contraceptive therapy. Which aspects of client teaching would the nurse recommend? Select all that apply.
Purchasing a self-monitoring cuff Discussing methods for stress reduction Advising a smoking cessation program Prescribing a combination oral contraceptive pill Explanation: Because this client finds it time-consuming to visit the doctor just for a blood pressure (BP) reading, the nurse can suggest the use of an automatic cuff at a local pharmacy, or purchasing a self-monitoring cuff. Discussing methods to reduce stress and advising smoking cessation would constitute client education in managing hypertension. Controlled hypertension in otherwise healthy young nonsmokers is generally not a contraindication to the use of combination agents, but it does require a low dose and careful BP monitoring. Hemoglobin A1C levels are within acceptable levels; administering glycemic control is not indicated at this time.
Cone biopsy describes a procedure in which cervical tissue is removed as result of detection of abnormal cells. Which statements by the client demonstrates that the client undergoing a cone biopsy understands the discharge instructions?
"I will avoid having sexual relations until I see the doctor again." Explanation: Cone biopsy is a procedure done to remove abnormal cervical tissue. The nurse or primary provider provides guidelines regarding postoperative sexual activity, bathing, and other activities. Because open tissue may be potentially exposed to HIV and other pathogens, the client is cautioned to avoid intercourse until healing is complete and verified at follow-up. Routine repeat cone biopsy is not normally indicated. Perineorrhaphy refers to sutural repair of perineal lacerations; sutures are not required with a cone biopsy. Cryotherapy refers to destruction of tissue by freezing; no freezing is involved with a cone biopsy
The nurse is providing information at the local YMCA about screenings for breast and cervical cancer. The nurse should inform young women that they should begin their screenings at what time?
Annual breast and pelvic examinations are important for all women 21 years of age or older and for those who are sexually active, regardless of age. Explanation: Annual breast and pelvic examinations are important for all women 21 years or older and for those who are sexually active, regardless of age.
The nurse is obtaining a history from a male client who states having difficulty achieving and sustaining an erection. When reviewing the medication history, which medication classification does the nurse anticipate?
Antihypertensives Explanation: Due to the therapeutic effect of antihypertensive medications decreasing blood pressure, the nurse is correct to anticipate a side effect of a male client having difficulty achieving or sustaining an erection. The other medication classifications do not typically have an effect on the male reproductive system.
The nurse instructs a female client about contraceptive options. The nurse explains that the intrauterine device (IUD) is a good contraceptive option for women who:
Are in a monogamous relationship. Explanation: The IUD is suitable for clients who desire long-term contraceptive use and are in a monogamous relationship. Because of the increased risk of infection with an IUD if an STD occurs, the device is not appropriate for women with multiple partners or a history of STDs. Previous ectopic pregnancy is also a contraindication for an IUD because the incidence of ectopic implantation is slightly higher.
The nurse is caring for a client who has been admitted to hospital for uterine bleeding after incomplete miscarriage. The nurse knows what will be included in this client's treatment?
Dilation and curettage Explanation: Dilation and curettage (D&C) can be used as a diagnostic or therapeutic tool. The cervical canal is dilated and the endometrium is scraped. D&C can be used to gather endometrial tissue for cytologic examination, control abnormal uterine bleeding, and as a therapeutic measure for incomplete miscarriage. In this case, D&C is being used as a therapeutic intervention to control bleeding from the incomplete passage of residual tissue in the uterus. Endometrial ablation is performed in cases of severe bleeding not responsive to other therapies. Performed in an outpatient setting under general, regional, or local anesthesia, the uterus is distended with a fluid infusion. Ultrasonography is useful adjunct to the physical examination for patients with abnormal pelvic findings but is not useful as a therapeutic treatment of uterine bleeding. A hysteroscopy allows direct visualization of all parts of the uterine cavity by means of a lighted optical instrument. It is used as a diagnostic tool, not a treatment for bleeding.
A woman who is 10 weeks pregnant arrives at the emergency department reporting vaginal bleeding and cramping. She states, "I've passed some small clots." Inspection of the perineal pad reveals moderate bleeding and some tissue. The client's cervix is dilated. The nurse interprets these findings as indicative of which of the following?
Incomplete abortion Explanation: The client is most likely experiencing an incomplete abortion as evidenced by the cramping, passage of tissue, vaginal bleeding, and cervical dilation. Cervical dilation would be absent in a threatened abortion. An inevitable abortion is indicated by the continued signs and symptoms of an abortion despite measures to prevent it. Habitual abortion involves successive, repeated, spontaneous abortions of unknown cause.
Nursing students are reviewing information about the age-related changes in the reproductive system and their effects. The students demonstrate a need for additional study when they identify which of the following as an expected change?
Increased labial thickness Explanation: Age-related changes include a thinning of the labia, decreased bone formation, increased vaginal pH, and decreased vaginal lubrication.
The examiner is preparing to perform a pelvic examination. Which of the following would be done first?
Inspection of the external genitalia Explanation: The pelvic examination begins with inspection of the external genitalia. This is followed by a speculum examination in which the cervix is inspected and then specimens for Pap smear and other testing are obtained. As the speculum is removed, the vagina is inspected. A bimanual examination follows.
A patient asks the nurse if there are any available nonsurgical options to terminate a pregnancy if she is only 2 weeks pregnant. What information should the nurse provide to the patient about a medication that blocks progesterone?
Mifepristone (RU-486, Mifeprex) is used only in early pregnancy to terminate a pregnancy nonsurgically. Explanation: Mifepristone (Mifeprex), formerly known as RU-486, is a medication used only in early pregnancy (up to 49 days from the last menstrual period) to induce abortion. It works by blocking
A 32-year-old woman has had three consecutive normal Pap tests. Which of the following recommendations for screening would be appropriate?
Pap testing every 2 to 3 years Explanation: After an initial screening, a woman should undergo a Pap test with conventional cervical cytology smears annually with conventional cervical cytology or biennially with liquid-based cytology. At or after age 30, those women who have had three consecutive normal screening tests may be screened every 2 to 3 years unless they have high risk factors for developing cervical cancer.
A positive chandelier sign is indicative of which of the following?
Pelvic infection Explanation: Pain on gentle movement of the cervix is called a positive chandelier sign or positive cervical motion tenderness and usually indicates a pelvic infection.
A client is diagnosed with hypertension. The client also reports skin discoloration, weight gain, and nausea. Which contraceptive preparations would the nurse practitioner recommend for this client?
Progestin-only Explanation: Progestin-only preparations are useful for women who have experienced estrogen-related side effects (e.g., headaches, hypertension, leg pain, chloasma or skin discoloration, weight gain, or nausea) when taking combination pills. Combined preparations can be monophasic, biphasic, and or triphasic. Monophasic preparations supply the same dose of estrogen and progestin for 21 days. Biphasic preparations and triphasic pills vary the amount of hormonal components during the cycle.
A postmenopausal patient is experiencing dyspareunia. What methods can the nurse recommend she use to diminish the discomfort?
Water-based lubricant Explanation: For postmenopausal women experiencing dyspareunia (painful intercourse) due to vaginal dryness, the nurse should recommend a water-soluble lubricant (e.g., K-Y Jelly, Astroglide, Replens), hormone cream, or contraceptive foam. Petroleum jelly is not water-soluble. An analgesic, such as ibuprofen or aspirin, would not address the primary problem, which is vaginal dryness.
An older female client reports pain during intercourse, disrupting the intimacy that she and her husband are accustomed to sharing. What might be the cause of her pain?
atrophy of Bartholin glands Explanation: The female genitalia change during the aging process. Changes include thinning of pubic hair; decrease in the size of the labia majora and minora; shortening and narrowing of the vagina; and atrophy of Bartholin's glands, which results in less lubrication.
A nurse is preparing a presentation about contraception for a young adult community group. Which of the following would the nurse expect to address as the most effective means of contraception?
Abstinence Explanation: Abstinence is the only completely effective means of contraception. It is followed by sterilization. Hormonal contraceptives and barrier methods are effective but they must be used consistently to be effective.
Which of the following terms is used to describe destruction of tissue by freezing?
Cryotherapy Explanation: Cryotherapy refers to destruction of tissue by freezing. The procedure is also called a cone biopsy. Colporrhaphy refers to repair of the vagina. Perineorrhaphy refers to structural repair of perineal lacerations.
A client is scheduled to undergo a Papanicolaou test. The nurse should advise the client of which preparation?
Do not douche before the procedure Explanation: To avoid washing away cellular material, the client should be instructed not to douche before having a Pap test. A Pap test should be performed when a client is not menstruating because blood usually interferes with interpretation. Consuming food that contains iodine is not contraindicated for a Papanicolaou test. The client should be instructed to avoid intercourse for 2 days prior to having the Pap test.
Which hormone is absent during menstruation?
Progesterone Explanation: During menstruation, progesterone is absent. Estrogen is low, FSH is increased, and LH is low during menstruation.
Which nursing question is essential when caring for a client prior to a pelvic examination?
"Would you like to void at this time?" Explanation: Prior to a pelvic examination, the nurse offers the client the use of the restroom to void. It is most important for the client to empty her bladder so that the physician can feel pelvic structures more clearly and also for the comfort of the client. Asking client history questions is completed at the beginning of the appointment. It is important to offer assistance to those who may need help in assuming the lithotomy position.
The nurse is conducting a health history when a middle-aged client states that her last menstrual period was 6 months ago. Upon further questioning, the client also states that symptoms of hot flashes and mood fluctuations. Which question should the nurse ask next?
"Are you taking any hormone replacement therapy?" Explanation: To ensure a thorough health history, a client who exhibits symptoms of perimenopause should be assessed for the use of hormone replacement therapy to alleviate the symptoms. This information adds to the data reported by the client. Asking if the client feels like hurting herself may be extreme with the report of mood fluctuations. Asking if the client is finished having children produces little additional data. Asking the first menstrual period is part of the health history but not the best question to ask after the client's statement.
The nurse is completing community education when asked by a client without health insurance why a mammogram is needed if the women are completing breast self-examinations at home. The nurse is most correct to respond stating which of the following?
"Mammograms can detect cysts or tumors too small to palpate." Explanation: During community instruction, it is most important to relay facts in a clear, factual, and nonjudgmental way. Stating the need for mammograms to detect small cysts or tumors is clear and factual. Stating the mammograms are "better" is vague and provides no better understanding. Although a mammogram does provide a baseline and reassurance of breast health, the most clear and factual reason why the mammogram is completed is its ability to detect cancerous tumors at an early stage.
The nurse is providing client education to a 45-year-old female who asks how she can be certain that she has reached menopause. How should the nurse respond?
"Menopause is likely if you have not menstruated for 12 months." Explanation: Menopause is defined retrospectively by 12 months of amenorrhea and loss of ovarian follicular activity. Estrogen levels decline leading up to menopause, not increase. Although a retrospective reporting of perimenopausal symptoms can take place up to 8 years or more before the final menstrual period, 8 years of menstrual irregularity does not necessarily confirm menopause. Other underlying causes should also be investigated in this case. Hallmark symptoms of perimenopause include hot flashes and night sweats. With the onset of menopause, these symptoms should decline or cease entirely.
A 52-year-old client asks the nurse how she is to remember when to schedule her clinical breast examination. Which response by the nurse is most correct?
"The clinical breast evaluation will be completed with annual gynecologic examination." Explanation: A clinical breast examination is completed by a physician, nurse, or physician's assistant as part of the gynecologic examination, an annual examination, or before a mammogram. Unless there is an abnormality, a clinical breast examination does not need to be completed more than annually as the client is completing the monthly self-breast examinations. The examination is typically performed in the physician's office and not a diagnostic center unless the client happens to be also scheduled for a mammogram.
An 56-year-old menopausal client comes to the clinic reporting painful intercourse. Her pelvic examination reveals vaginal dryness. Which suggestion would be most appropriate?
"Try using a water-soluble lubricant before intercourse." Explanation: Dyspareunia (painful intercourse) in a menopausal woman is most likely from vaginal dryness. Use of a water-soluble lubricant can be helpful in adding moisture to the area and relieving the pain of intercourse. Kegel exercises would be helpful to combat problems related to bladder control. Calcium supplements would be helpful to prevent osteoporosis. Drinking 6 to 8 glasses of water daily helps reduce the woman's risk for urinary tract infections.
A patient who is scheduled for a gynecologic examination and Pap smear informs the nurse that she just began her menstrual cycle. What is the best response by the nurse?
"We will reschedule your examination when you have finished menstruating." Explanation: The nurse should not obtain a Papanicolaou (Pap) smear if the woman is menstruating or has other frank bleeding; the examination should be rescheduled to after her menstruation.
The nurse is about to begin conducting a pelvic examination of a client. The client reports having lower back and hip pain anytime she has to lie on her back. What is the best way for the nurse to proceed with the examination?
Ask the client to lie on her left side with the right leg bent Explanation: For a client who experiences pain in the supine lithotomy position, Sims' position (client on left side with her right leg bent at a 90-degree angle) may be used instead. Promoting client comfort is an important part of the pelvic examination. Although the supine lithotomy position is ideal for conducting a pelvic examination, other positions are possible and the client should be accommodated for her disability. Although the supine lithotomy position is best suited for conducting the bimanual examination, it can be done with the client in the alternate position as well. The nurse can inform the client it may take longer or feel differently than it would if she was lying on her back. The presence of a disability does not justify skipping any part or all of the pelvic examination, which is included in the physical assessment. Having the client in the clinic is an opportune time to complete the examination; therefore, the nurse should adjust the exam, using accommodation to meet the client's needs during this visit.
Which of the following diagnostic tests is used as a therapeutic measure for incomplete miscarriage?
Dilation and curettage (D & C) Explanation: A D & C is used as a therapeutic measure for incomplete miscarriage. Laparoscopy involves inserting a laparoscope into the peritoneal cavity through small incision below the umbilicus to allow visualization of the pelvic structures. Endometrial ablation is performed in cases of severe bleeding not responsive to other therapies. An endometrial biopsy is a method of obtaining endometrial tissue by placing a flexible suction tube through the cervix into the uterus.
Which of the following instructions would be appropriate to include when preparing a woman for an abdominal ultrasound?
Drink at least 1 quart of water an hour before the test. Explanation: Drinking at least 1 quart of water 45 minutes to 1 hour before the test and no voiding until after the test ensures a full bladder and facilitates transmission of the ultrasound waves. It also elevates the bowel away from the other pelvic organs. The client should restrict solid food intake for 6 to 8 hours before the test to avoid having images of her test obscured by gas and intestinal contents. There is no restriction on douching for this test. A full bladder, not an empty one, facilitates this test.
An adolescent patient comes to the clinic with complaints of "terrible pain" during menstruation. What should the nurse document this subjective data as?
Dysmenorrhea Explanation: Primary dysmenorrhea is painful menstruation, with no identifiable pelvic pathology. It occurs at the time of menarche or shortly thereafter. It is characterized by crampy pain that begins before or shortly after the onset of menstrual flow and continues for 48 to 72 hours. Amenorrhea is the absence of menstruation. Menorrhagia is prolonged or excessive bleeding at the time of the regular menstrual flow. Metrorrhagia is vaginal bleeding between regular menstrual periods.
The nurse, who is conducting a Papanicolaou (Pap) smear, performs which actions to promote client comfort during the procedure? Select all that apply.
Ensure warming of the speculum Lubricate the blades of the speculum Explain to the client that some discomfort is normal Explanation: Warming the speculum prior to insertion can be more comfortable for the client. Lubrication of the outer superior and inferior blade of the plastic vaginal speculum with a small amount of a water-soluble lubricant gel decreases the pain associated with insertion and opening of the vaginal speculum in both premenopausal and postmenopausal women, without affecting the quality of the cytology results during the collection of Pap test specimens. The nurse should share education about the pelvic examination with the client to proceed more smoothly and ensure the client knows what to expect. Along with other important information about the procedure, the nurse should tell the client it is normal to feel uncomfortable and apprehensive. During the pelvic examination, when the speculum is positioned properly, it should be opened slowly, not using a quick motion, to visualize the cervix as this would be uncomfortable to the client. If there is purulent drainage at the cervical os, this is an indication there could be an infection present. The nurse should obtain a culture of the drainage with a sterile applicator, not flushing the drainage away.
A client is scheduled for an abdominal ultrasound as a follow up to her pelvic examination. Which action by the nurse would be most appropriate?
Ensuring that the client has a full bladder Explanation: An abdominal ultrasound is a simple procedure that requires no specific preparation other than ensuring that the client has a full bladder to enhance visualization of abdominal area. A mild sedative, laxatives, and an enema would be used prior to a hysterosalpingography. A hysteroscopy should be done about 5 days after menstruation ceases.
A nurse is conducting a health promotion class about the female reproductive system and menstrual cycle for a group of young adult women. The nurse determines that the teaching was successful when the group identifies which of the following?
Estradiol is the most potent ovarian estrogen. Explanation: The ovarian follicle produces several different estrogens, the most potent being estradiol. Ovulation occurs usually 2 weeks prior to the next menstrual period. Progesterone secretion is highest in the luteal phase, which begins after ovulation. If an ovum is fertilized, estrogen and progesterone levels remain high.
The nurse is providing teaching to a group of older adolescent girls about menstruation and the use of tampons. The nurse would instruct the girls to change tampons at which frequency?
Every 4 to 6 hours Explanation: Tampons should not be used for more than 4 to 6 hours to reduce the risk of infection and possible toxic shock syndrome.
A 13-year-old who started her menstrual cycle at age 12 asks the nurse practitioner how frequently her "period" should come. The nurse takes a calendar and has the girl circle the date of her last period, which started on January 7. The nurse then circles when her next period should start based on the average number of days in a normal cycle. What date did the nurse circle?
February 4 Explanation: February 5 is 28 days from the start of the last cycle, based on the average number of days in a normal cycle. However, cycles can vary from 21 to 42 days, depending on a variety of factors.
A patient informs the nurse that she believes she has premenstrual syndrome and is having physical symptoms as well as moodiness. What physical symptoms does the nurse recognize are consistent with PMS? Select all that apply.
Fluid retention Low back pain Headache Explanation: Major symptoms of PMS include physical symptoms such as headache, fatigue, low back pain, painful breasts, and a feeling of abdominal fullness, caused by fluid retention. Fever and hypotension are not typical symptoms of PMS.
A client has a routine Papanicolaou (Pap) test during a yearly gynecologic examination. The result reveals a class V finding. What should the nurse tell the client about this finding?
It calls for a biopsy as soon as possible. Explanation: A class V finding in a Pap test suggests probable cervical cancer; the client should have a biopsy as soon as possible. Only a class I finding, which is normal, requires no action. A class II finding, which indicates inflammation, calls for a repeat Pap test in 3 months. A class III finding, which indicates mild to moderate dysplasia, calls for a repeat Pap test in 6 weeks to 3 months. A class IV finding indicates possible cervical cancer; like a class V finding, it warrants a biopsy as soon as possible.
Which statement is true regarding hormonal contraception?
It increases the risk for venous thromboembolism. Explanation: Clients taking hormonal contraception have an increased risk for venous thromboembolism, but their risk for benign breast cancer and uterine cancer is decreased. Fetal anomalies are not a concern.
The expert nurse is assisting a novice nurse insert a Foley catheter. The novice nurse has tried unsuccessfully to insert the catheter, and the expert nurse is providing verbal guidance while spreading which area to reveal the urethral opening?
Labia majora and minora Explanation: The labia majora and minora are a portion of the external genitalia and when parted reveals the urethral opening. The meatus refers to an opening or passage. The clitoris is sensitive erectile tissue considered the site of sexual pleasure. The fourchette is the area beneath the vaginal opening at the base of the labia majora.
The menstrual cycle is dependent on the interplay among a number of hormones. The hormone(s) responsible for stimulation of progesterone is (are):
Luteinizing hormone. Explanation: The female pituitary gland releases follicle-stimulating (FSH) and luteinizing hormone (LH). Progesterone production and the release of mature eggs is dependent on luteinizing hormone.
In educating a patient with PMS about changing her dietary practices, what would the nurse recommend that she increase her intake of?
Magnesium Explanation: PMS is a cluster of physical, emotional, and behavioral symptoms that are usually related to the luteal phase of the menstrual cycle. Alternative therapies that have been used include vitamins B6 (pyridoxine) and E, calcium, magnesium, and oil of primrose capsules (Hawkins et al., 2012).
A nurse is providing care to a client who was just admitted with a diagnosis of ectopic pregnancy. When reviewing the client's history, which of the following would the nurse identify as a major risk factor for this client?
Pelvic inflammatory disease (PID) Explanation: PID is a major risk factor for ectopic pregnancy. Other risk factors include salpingitis, peritubal adhesions, structural abnormalities of the tube, previous ectopic pregnancy, previous tubal surgery, multiple previous induced abortions, tumors that distort the tube, and IUD and progestin-only contraceptives. Combined hormonal contraceptive use, in vitro fertilization, and habitual abortions are not risk factors for ectopic pregnancy.
Which of the following is the period of transition from normal periods to the complete cessation of menses for 1 year?
Perimenopause Explanation: Perimenopause is the period of transition from normal periods to the complete cessation of menses for 1 year. Menopause marks the end of a woman's reproductive capacity and generally occurs between 45 and 52 years of age. Menstruation is the cyclic shedding of the uterine lining that occurs when pregnancy has not been established. Menarche is the first menstrual cycle.
A client is prescribed a combination hormonal contraceptive. What condition would the nurse instruct the client to report to the healthcare provider immediately?
Pregnancy Explanation: A client taking combined hormonal contraceptives should immediately report thrombophlebitis or known or suspected pregnancy because of serious complications like pulmonary emboli or miscarriage. Although nausea and mood changes are bothersome adverse effects, they do not need to be reported immediately. Difficulty hearing is not associated with combined hormonal contraceptive use.
A client presents with symptoms of menstrual difficulties and infertility. Which hormone is essential in the maintenance of the endometrium?
Progesterone Explanation: Without a high level of progesterone, the endometrium (uterine lining) degenerates and shreds. Estrogen is a hormone that is essential for menstruation and prepares the uterus for pregnancy. Women produce testosterone, which maintains muscle mass, bone strength, and sex drive. Prolactin is produced by the pituitary gland and stimulates lactation.
In the menstrual cycle, every month the female reproductive system generates an ovum. When the ovum is not fertilized, production of which of the following leads to menstruation?
Progesterone by the corpus luteum beginning to decrease Explanation: If the ovum is not fertilized, the production of progesterone by the corpus luteum begins to decrease and it changes from a yellow to a white spot on the ovary (corpus albicans). Without the high level of progesterone, the endometrium degenerates and sheds, a process referred to as menstruation. The corpus luteum does not produce estrogen. The production of another ovum is not the factor that causes endometrium degeneration. Production of follicle stimulating hormone by the anterior pituitary initiates ovulation.
A nurse is employed by a fertility clinic. Diagnostic testing is being completed to determine the source of the male not producing viable sperm to enable ovum fertilization. Which male structures does the nurse consider if the problem is narrowed to sperm survivability?
Prostate gland Explanation: The accessory structure of the prostate gland contains secretory cells that produce alkaline fluid. The prostatic fluid mixes with sperm. The alkalinity of the prostatic fluid neutralizes the acidic metabolic wastes released by the sperm and counteracts the acid pH within the vagina to ensure mass survival of the sperm. The Cowper's glands add lubrication for penetration of the vagina.
When the nurse places the patient in the stirrups for a pelvic exam she observes a bulge caused by rectal cavity protrusion. What does the nurse know this protrusion is called?
Rectocele Explanation: Childbirth trauma may have affected the posterior vaginal wall, producing a bulge caused by rectal cavity protrusion (rectocele). Trauma to the anterior vaginal wall during childbirth may have resulted in incompetency of the musculature, and a bulge caused by the bladder protruding into the submucosa of the anterior vaginal wall (cystocele) may be seen. The cervix and uterus may descend under pressure through the vaginal canal and be seen at the introitus (uterine prolapse). Hemorrhoids would not cause a bulge in the pelvic region.
A nurse is obtaining health history from a young adult woman. Which of the following would alert the nurse to a possible problem?
Reports of dyspareunia Explanation: Dyspareunia, or pain with intercourse, is an abnormal finding associated with numerous potential problems. Onset of menarche is usually between 12 to 14 years but could be as early as age 10 or 11 years. The menstrual cycle typically averages 28 days but it can vary from 21 to 42 days. A mucus-like vaginal discharge is normal.
The nurse is caring for a client who states having an irregular menstrual period. Which diagnostic test provides information of the body's ability to ovulate?
Serum follicle-stimulating hormone Explanation: The anterior pituitary hormone known a follicle-stimulating hormone (FSH) initiates ovulation monthly. Monitoring the FSH level provides information about the timing of ovulation. Thyroid level, estrogen level, and serum luteinizing hormone do not give information about the ability to ovulate
Which of the following positions may be utilized for a patient who is unable to maintain the supine lithotomy position?
Sims' Explanation: Although several positions may be used for the pelvic examination, the supine lithotomy position is used most commonly. Sims' position may be used with a patient who is unable to maintain the supine lithotomy position due to acute illness or disability. The prone, semi-Fowler's, and Trendelenburg position would not be used.
Nursing students are reviewing information about natural family planning methods in preparation for a quiz the next day. The students demonstrate a need for additional study when they identify which of the following as an example?
Spermicide Explanation: Spermicides are considered a barrier method of contraception. Natural family planning methods include the calendar, basal body temperature, symptothermal, and ovulation methods.