Chapter 7

A nurse is providing care to a client with uterine fibroids who is prescribed a progestin antagonist. Which medication would the nurse most likely expect the client to receive?

mifepristone

A client diagnosed with uterine prolapse is to undergo surgery. The nurse would prepare a preoperative teaching plan for which surgery?

vaginal hysterectomy

Assessment of a client reveals evidence of a cystocele. The nurse interprets this as:

bulging of the bladder into the vagina.

A woman is diagnosed with polycystic ovarian syndrome (PCOS). Which treatment would the nurse not explain to the client?

estrogen replacement therapy

Which finding would the nurse most likely expect in a woman with endometrial polyps?

metrorrhagia

A diabetic client who also suffers from urinary incontinence knows the importance of maintaining her blood glucose levels. This is doubly important for this type of client in regards to her incontinence because of which factor?

Abnormal glucose levels can cause polyuria.

A woman with uterine prolapse has undergone a vaginal hysterectomy and is being discharged home with an indwelling urinary catheter in place. The client will be using a leg bag during the day. Which instructions would the nurse most likely include in the client's discharge teaching plan? Select all that apply.

"Clean your perineal area each day with a mild soap and water." "Be sure to empty your leg bag frequently throughout the day."

A nurse is teaching a client how to use a pessary. The nurse determines that the teaching was successful based on which statement?

"I need to clean the pessary with soap and water."

A client is to have a vaginal hysterectomy to repair her stage IV uterine prolapse. The nurse realizes she needs more education when she states:

"I'm not going home with a Foley catheter in place."

A client diagnosed with pelvic organ prolapse is being taught how to perform pelvic floor muscle exercises. During the teaching session, the client asks the nurse, "How do these exercises help?" Which response by the nurse would be most appropriate?

"They help to increase the volume of your muscles which leads to stronger muscle contraction."

A nurse is reviewing the various treatment options with a client diagnosed with uterine fibroids. The nurse determines that the teaching was successful based on which statement?

"If I use hormone therapy, my fibroids may grow back when I stop the medication."

A nurse is conducting a presentation for a local women's group about urinary incontinence. During the presentation, several of the women voice statements about their beliefs related to this condition. Which statements would the nurse identify as misconceptions that need to be corrected? Select all that apply.

"It is an inevitable part of aging." "It is an acceptable part of being a woman." "It is a condition that cannot be prevented."

The nurse is conducting a presentation about urinary incontinence for a local women's group. During the presentation, which statement by a member of the group would the nurse need to clarify?

"It's normal for a woman to develop incontinence as she ages."

The nursing instructor is teaching a student about urinary incontinence and realizes that the student needs further instruction when she makes which statement?

"Urinary incontinence is an inevitable problem of aging."

The nurse is teaching a female client about early-stage pelvic organ prolapse. Which statement that centers on dietary and lifestyle changes will promote pelvic relaxation and decrease chronic problems later in life?

"You will need to increase fiber in your diet."

A nurse is caring for a client with pelvic organ prolapse. As part of the client's workup, the nurse obtains a postvoid residual urine specimen via catheterization. Which specimen amount would lead the nurse to suspect that additional testing will be needed?

120 mL

A nurse is teaching a client how to perform Kegel exercises. During the teaching session, the client asks, "How many times a day should I do these?" The nurse would instruct the client to perform the exercises at least how many times per day?

5

A nurse is reviewing the medical record of a woman diagnosed with a uterine fibroid. The nurse would identify which factors as predisposing the client to this condition? Select all that apply.

African American ethnicity history of hypertension

The nurse is giving instructions on pessary usage for a client diagnosed with uterine prolapse. Which instruction is important for the nurse to provide?

Call the health care provider if you experience painful urination.

A nurse is caring for a female client with urinary incontinence. Which instructions should the nurse include in the client's teaching plan to reduce the incidence or severity of incontinence? Select all that apply.

Continue pelvic floor exercises. Increase fiber in the diet. Control blood glucose levels.

A nurse is preparing a presentation for a group of women which will cover various dietary and lifestyle changes to help avoid future pelvic structure changes. Which key point should the nurse point out in this presentation to the women?

Drink plenty of fluids each day.

A nurse is caring for a client for whom estrogen replacement therapy has been recommended for pelvic organ prolapse. Which nursing intervention is the most appropriate for the nurse to implement before the start of the therapy?

Evaluate the client to validate her risk for complications.

Myomectomy is recommended to a client for removal of uterine fibroids. The client is concerned about the surgery and wants to know if there are any associated disadvantages. Which is a disadvantage of myomectomy?

Fibroids may grow back.

The mother of four small children comes to the clinic and has just been diagnosed with an enterocele. What should the nurse teach the client about her diagnosis?

Her small intestine and peritoneum are jutting downward between the uterus and the rectum.

The primary care provider has prescribed estrogen replacement therapy (ERT) for a menopausal woman who has been diagnosed with pelvic organ prolapse (POP). The client asks the nurse why she needs to be on hormones. Which would be the nurse's best response?

Hormone replacement will increase blood perfusion and the elasticity of the vaginal wall.

A client comes to the genitourinary clinic with very mild symptoms of pelvic organ prolapse (POP) that has just started in the last several days. What would be the treatment of choice for this client?

Kegel exercises

A 58-year-old woman is diagnosed with uterine prolapse. Which nonsurgical treatments are available for this disorder? Select all that apply.

Pessaries Estrogen replacement therapy Kegel exercises

The nurse is educating a 48-year-old woman on pessary care following a diagnosis of prolapsed vagina. Which instruction would be most important to include?

Remove the pessary device twice a week and clean with soap and water.

A nurse is caring for a 32-year-old client for whom pessary usage is recommended for uterine prolapse. Which instruction should the nurse include in the teaching plan for the client concerning the pessary?

Report any discomfort with urination and defecation.

A nurse is educating a woman diagnosed with small ovarian cysts on follow-up care. Which instruction would be appropriate?

Schedule ultrasound every 3 to 6 months.

A nurse is providing discharge teaching to a client who needs Kegel exercises to strengthen the pelvic floor muscles. Which guideline would be appropriate to teach the client?

Squeeze the muscles in your rectum as when you are trying to prevent passing flatus.

After teaching a woman how to perform Kegel exercises, the woman states the steps. Which steps would the nurse determine as reflecting the correct components of Kegel exercises? Select all that apply.

Squeeze the rectal muscles as if trying to prevent the passage of flatus. Stop and start urinary flow to identify pubococcygeus muscle. Tighten the pubococcygeus muscle for a count of three, then relax. Contract and relax the pubococcygeus muscle rapidly 10 times.

A client with large uterine fibroids is scheduled to undergo a hysterectomy. Which intervention should the nurse perform as a part of the preoperative care for the client?

Teach turning, deep breathing, and coughing.

A nurse needs to provide preoperative care to a woman who is undergoing a scheduled hysterectomy. Her diagnosis is uterine fibroids. Which preoperative instruction should the nurse provide?

The client should turn, cough, and deep-breathe.

Kegel exercises are recommended for a client with pelvic organ prolapse. Which information about the exercises should the nurse give the client?

They alleviate mild prolapse symptoms.

A 36-year-old was diagnosed with uterine fibroids (leiomyomas). The nurse teaches the client to expect which clinical manifestation?

abnormal uterine bleeding

A client has presented to the clinic reporting "things not feeling right down there." After discussing the situation with her, the nurse has identified which factors that suggest the woman has a high risk for pelvic organ prolapse? Select all that apply.

birth trauma straining with chronic constipation obesity

A client with pelvic organ prolapse is using lifestyle modifications and working to lose weight. The client asks the nurse, "Which type of exercise would be best?" The nurse would most likely suggest which exercise?

brisk walking

A nurse is assisting with the pelvic exam of a woman who has come to the clinic with reports of abnormal vaginal bleeding. The client is diagnosed with an endocervical polyp. The nurse understands that the pelvic exam most likely revealed a polyp appearing as:

cherry red.

The nurse is instructing a client who suffers from urinary incontinence about certain types of foods that have been proven to be bladder irritants and precipitate urgency. Which foods should the nurse tell the client to avoid? Select all that apply.

chocolate caffeine soda alcohol spicy foods orange juice

The nurse correctly recognizes that which clients are likely not candidates for corrective surgery for pelvic organ prolapse? Select all that apply.

client at high risk of recurrent prolapse after surgery client who is morbidly obese before surgery client who has chronic obstructive pulmonary disease

The pessary is often used to treat marked prolapse. Although it may support a prolapsed pelvic organ, it does not allow for concomitant strengthening of pelvic floor muscles and does not reduce urine leakage. What newer device can both support the pelvic floor muscle and facilitate rehabilitation of the pelvic floor muscles?

colpexin sphere

A nurse is reviewing the physical exam findings of a woman who has come to the clinic with reports of feeling a dragging sensation in her vagina. The exam reveals the posterior bladder wall protruding into the anterior vaginal wall. The nurse interprets this finding as indicative of which condition?

cystocele

The nursing instructor is teaching the students about pelvic organ prolapse (POP). The nurse understands that teaching has been successful when the students identify which different types of POP? Select all that apply.

cystocele rectocele enterocele uterine prolapse

A client who stands all day at her job has been diagnosed with pelvic organ prolapse. The client is asking the nurse in the office about whether she will be a candidate for surgery. The nurse knows that which documented findings will make the client ineligible for surgery? Select all that apply.

documented chronic obstructive pulmonary disease documented morbid obesity documented risk for recurrent prolapse after surgery

A nurse working in the OB clinic is talking to a client who asks the nurse why her primary care provider has not prescribed estrogen replacement therapy (ERT) to treat her pelvic organ prolapse (POP). The nurse informs the client that ERT is not for everyone and should not be given to clients who are at risk for developing which conditions? Select all that apply.

endometrial cancer myocardial infarction (MI) stroke breast cancer deep vein thrombosis (DVT) pulmonary emboli (PE)

The nursing instructor is teaching about urinary incontinence and informs the students that dysfunction of either the bladder, the urethra, or the levator muscle can cause incontinence. She also lists which contributing factors for incontinence? Select all that apply.

fluids such as alcohol and caffeinated and carbonated drinks constipation habitual "preventive" emptying advancing age pregnancy and birth obesity

A nurse is assessing a client who comes to the clinic reporting urinary incontinence. The nurse suspects that the client may be experiencing urge incontinence based on which findings? Select all that apply.

frequency nocturia

A nurse is conducting a health promotion program, encouraging lifestyle changes to help clients prevent various benign and treatable conditions. Which suggestions would the nurse most likely include? Select all that apply.

low-fat diet regular exercise high vegetable-fruit diet adequate fluid intake

The surgeon is recommending surgery to remove the fibroids from a client's uterus; however, the client and her husband still desire children. The nurse would most likely provide information on which procedure that will help the client preserve her fertility?

myomectomy

The nurse is taking a history on a woman suspected of having uterine fibroids. Which findings in her history would the nurse recognize as predisposing factors? Select all that apply.

obesity age nulliparity

A 40-year-old client arrives at the community health center experiencing a strange, dragging feeling in the vagina. She stated that "at times it feels as if there is a lump" there as well. Which condition do these symptoms indicate?

pelvic organ prolapse

The nurse is admitting a 42-year-old client to the women's medical floor. During the history, the chief report from the client is "I feel like there is a lump in my vagina, and it feels like it is sometimes dragging." Which disorder does the nurse suspect?

pelvic organ prolapse

The nurse working in the genitourinary clinic understands that the most common cause for women suffering from urinary incontinence is:

pelvic organ prolapse (POP).

A young couple have presented to the office with concerns of possible infertility. A physical examination and complete history of the woman reveals type 2 diabetes mellitus, obesity, sleep apnea, and hypertension. The nurse would suspect:

polycystic ovary syndrome.

A nurse is preparing a presentation for a local women's group about pelvic floor disorders. When describing these disorders, the nurse would address which factors as placing the woman at increased risk? Select all that apply.

pregnancy straining on defecation estrogen deficiency chronic smoker's cough

A client has presented to the clinic for diagnostic studies to evaluate her for polycystic ovary syndrome. Which test should be included?

pregnancy test

A client has presented to the clinic for testing to evaluate her for an ovarian cyst. Which test would the nurse anticipate being done first?

pregnancy test

The nurse is teaching a premenopausal client about dietary and lifestyle modifications that can reduce the risk factors for developing pelvic organ prolapse (POP). The nurse is describing which type of prevention?

primary

A nurse is conducting a presentation for a local women's group about pelvic organ prolapse. When describing the different types, which information would the nurse incorporate into the description of a cystocele?

protrusion of the bladder wall through the anterior vaginal wall

When assessing a client, a nurse determines that the client has a rectocele based on which finding?

sagging of the rectum, which pushes against or into the posterior vaginal wall

A nurse is explaining to a client that pessaries have been used through the ages as a nonsurgical means of treating pelvic organ prolapse. The nurse describes the pessaries of today as being primarily constructed of:

silicone.

The nurse is working with a client who has been diagnosed with urge incontinence related to detrusor muscle contractions. Part of the educational material suggesting lifestyle changes should include information that which situation increases muscular contractions?

smoking

When assessing a woman with pelvic organ prolapse, the nurse notes the uterus is approximately 1 cm below the hymenal ring. The nurse documents this finding as which stage of prolapse?

stage II

The nursing instructor is teaching about urinary incontinence. She lists the three most common types to be urge, stress, and mixed incontinence. Which of these is caused by inadequate urinary sphincter function?

stress

A nurse is presenting a class about benign female reproductive conditions to a group of women at the local community center. When describing genital fistulas, which condition would the nurse identify as a cause of the majority of fistulas? Select all that apply.

trauma during labor and birth female genital cutting

The nurse is reviewing with a new client the diagnosis of polycystic ovarian syndrome (PCOS). Which long-term health problems would the nurse review as a risk with this syndrome?

type 2 diabetes

A nurse is caring for a 25-year-old woman suspected of having follicular cysts. Which finding is not a clinical manifestation?

typically occur after menopause

A client was in labor for more than 36 hours and now reports urine leaking from her vagina. On examination the nurse would be inspecting for:

urethrovaginal fistula.

A nurse is caring for a woman who has just been diagnosed with uterine prolapse. Which symptoms may interfere with her daily activities? Select all that apply.

urinary frequency low back pain pelvic pressure

The nursing student exhibits an understanding of pelvic organ prolapse (POP) when she correctly identifies which factors as contributing to its development? Select all that apply.

vaginal birth obesity lifting chronic cough estrogen deficiency

A nurse is caring for a client who has been prescribed gonadotropin-releasing hormone (GnRH) medication for uterine fibroids. For which side effect of GnRH medications should the nurse monitor the client?

vaginal dryness

A woman has been given the diagnosis of uterine fibroids. Prescribed treatment consists of gonadotropin-releasing hormone (GnRH). The nurse is teaching her client about the side effects of this medication. Which side effect would be important to include in the explanation?

vaginal dryness