med-surg quiz 5 reprod
Which laboratory result indicates that the primary goal of treatment of the patient's uterine fibroids has been successful?
b. Red blood cell count is within normal limits.
What is the priority preoperative and postoperative nursing care for a patient with leiomyomas?
c. Monitoring for bleeding
The nurse is interviewing a young woman who is considering the option of uterine artery embolization for the treatment of uterine fibroids. Which question would the nurse ask to assist the patient making a decision?
c. What did the HCP tell you about the procedure?
Which pt is most likely to be accepting of surgery and demonstrate better coping behaviors?
d. 44-year-old woman with two children and supportive partner had an abdominal hysterectomy for uterine fibroids.
Which woman is at greatest risk for pelvic pain prolapse?
d. 48-year-old obese mother of four children
In recalling dietary intake for a recent 24-hour period, a female pt describes eating eggs, whole milk, and bacon for breakfast; fried chicken and French fries for lunch; three-cheese pizza and ice cream for dinner. This type of diet places her at increased risk for which disorder?
d. Cancer of the ovaries
A 20-year-old woman is being evaluated for possible toxic shock syndrome. What question would the nurse ask?
d. Do you use internal contraceptives?
The nurse is taking a history on a patient with probable gynecologic cancer. Which clinical manifestation is a sign of metastasis?
d. Dysuria
Which disorder is strongly associated with prolonged exposure to estrogen without the protective effects of progesterone?
d. Endometrial cancer
A pt reports the sensation of feeling as if "something is falling out" along with painful intercourse, backache, and a feeling of heaviness or pressure in the pelvis. Which question does the nurse ask to assess for a cystocele?
a. Are you having urinary frequency or urgency?
Following a uterine embolization using a vascular closure device, what pt care would the nurse provide? SATA
a. Assist the patient to ambulate 2 hours after the procedure e. Raise the head of the bed f. Assess pain level and provide analgesics as needed
The nurse is caring for a patient who had a posterior colporrhaphy. Which task is most appropriate to delegate to unlicensed assistive personnel?
a. Assist the patient with a sitz bath to relieve discomfort
The home health nurse is reviewing the patient's medication list and sees that the pt was given doxorbucin at the hospital. What gynecologic diagnosis would the nurse expect to see as part of the patient's history?
a. Endometrial cancer
What information would the nurse give to a sexually active 35-year-old woman about conventional Papanicolaou (Pap) smear and human papillomavirus (HPV) testing?
a. Every 5 year is sufficient
A patient has had a posterior colporrhaphy. What is included in the nursing care of this pt?
a. Give pain medication before a bowel movement
The patient reports itching, change in vaginal discharge, and an odor. The nurse suspects that the pt has vulvovaginitis. Based on knowledge about the common causes of vulvovaginitis, which questions would the nurse ask? SATA
a. Have you recently been taking antibiotics? b. Do you consistently wipe from front to back? d. Do you use tampons? e. Do you douche or use vaginal sprays? f. Have you had problems with vaginal yeast infections?
The nurse is caring for a pt who had hysteroscopic surgery. The pt reports severe lower abdominal pain, appears pale, and has trouble focusing on the nurse's questions about the pain. Vital signs show T 98.6; P 120/min; R 24/min; BP 103/60. Which complication does the nurse suspect?
a. Hemorrhage
Which therapies would the nurse expect to use for a patient who is being treated for a rectocele?
a. High-fiber diet, stool softeners, and laxatives
The patient needs diagnostic testing to determine the presence of endometrial thickening and possible cancer. Which brochure will the nurse prepare for the patient?
a. How Transvaginal Ultrasound and Endometrial Biopsy are Used in Cancer Diagnosis
A pt with a fever, myalgia, sore throat, and sunburn-like rash is admitted with the diagnosis of toxic shock syndrome. What additional clinical manifestation should the nurse assess for?
a. Hypotension
The nurse is caring for a patient with a radioactive implant in the uterus. Which instruction will the nurse give to UAP?
a. Pt is on bedrest and excessive movement is restricted.
A pt had loop electrosurgical excision procedure for tx and dx of cervical cancer. In the d/c instructions, what does the nurse tell the pt to expect after the procedure?
a. Spotting
A patient had a pelvic examination and needs an additional diagnostic test for possible uterine leiomyomas. The nurse prepares the patient for which diagnostic test?
a. Transvaginal ultrasound
The surgical procedure for stage I disease of endometrial cancer involves removal of which components? SATA
a. Uterus c. Fallopian tubes e. Ovaries f. Peritoneum fluid for cytologic examination
A patient is diagnosed with uterine leiomyomas. What does the nurse expect to see in the documentation as the patient's chief presenting symptom?
b. Heavy vaginal bleeding
A young woman had minimally invasive surgery for the removal of uterine fibroids. The nurse emphasizes that this information should be included when giving health history; however for which future scenario is the history most essential?
a. Becomes pregnant and is looking forward to a home delivery with midwife assistance
The nurse is preparing pt teaching for several young women who will undergo surgical procedures for gynecologic pb. Which procedure most likely to induce menopausal symptoms?
a. Bilateral salpingo-oophorectomy
A nurse is assessing a client who is being admitted for surgical repair of a rectocele. What signs or symptoms does the nurse expect the client to report? SATA
1. Painful intercourse 3. Bearing-down sensations
A client who has a diagnosis of endometriosis is concerned about the side effect of hot flashes from her prescribed medication. She tells the nurse that her mother found them very uncomfortable during her menopause. Which medication causes this side effect?
2. Leuprolide (Lupron)
The nurse is teaching a class about laparoscopic or hysteroscopic myomectomy. Which patient should be invited to attend the teaching session?
a. 23-year-old woman with uterine fibroids who would like to have children in the future
A client has an anterior and posterior surgical repair of a cystocele and rectocele and returns from the PACU with an indwelling catheter in place. What should the nurse tell the client about the primary reasons for the catheter? SATA
1. Discomfort is minimized 3. Urinary retention is prevented 4. Pressure on the suture line is relieved
The nurse is working in the emergency department when a client with possible toxic shock syndrome is admitted. Which prescribed intervention will the nurse implement first? 1. Remove the client's tampon. 2. Obtain blood specimens for culture. 3. Give acetaminophen 650 mg 4. Infuse nafcillin 1000 mg IV.
1. Remove the client's tampon. Rationale: Because the most likely source of the bacteria causing the toxic shock syndrome is the client's tampon, it is essential to remove it first. The other actions should be implemented in the following order: obtain blood culture samples (best done before initiating antibiotic therapy to ensure accurate culture and sensitivity results), infuse nafcillin (rapid initiation of antibiotic therapy will decrease bacterial release of toxins), and administer acetaminophen (fever reduction may be necessary, but treating the infection has the highest priority).
After an abdominal hysterectomy, the client returns to the unit with an indwelling catheter. The nurse identifies that the urine in the client's collection bag has become increasingly sanguinous. What complication does a nurse suspect?`
1. An incisional nick in the bladder
Which patient has the greatest need for evaluation of endometrial cancer?
a. 63-year-old woman who is having painless vaginal bleeding
A client who had an abdominal hysterectomy 3 days ago reports burning with urination. Her urine output during the previous shift was 210 mL, and her temperature is 101.3°F (38.5°C). Which of these actions prescribed by the health care provider will the nurse implement first?
1.Insert a straight catheter as needed (PRN) for output of less than 300 mL/8 hr.
When assessing a client with cervical cancer who had a total abdominal hysterectomy yesterday, the nurse obtains the following data. Which information has the most immediate implications for planning of the client's care? 1. Fine crackles are audible at the lung bases. 2. The client's right calf is swollen, and she reports mild calf tenderness. 3. The client uses the patient-controlled analgesia device every 30 minutes. 4. Urine in the collection bag is amber and clear.
2 The client's right calf is swollen, and she reports mild calf tenderness. Right calf swelling and tenderness indicate the possible presence of deep vein thrombosis. This will change the plan of care because the client may be placed on bed rest and will require diagnostic testing and possible anticoagulant therapy. The other data indicate the need for common postoperative nursing actions such as having the client cough, assessing her pain, and increasing her fluid intake.
Three days after undergoing a pelvic exenteration procedure, a client reports dizziness after experiencing a sudden "giving" sensation along her abdominal incision. The nurse finds that the wound edges are open, and loops of intestine are protruding. Which action should the nurse take first?
2. Cover the wound with saline-soaked dressings.
A 15 Y.O adolescent tells a school nurse, " I have persistent pain during my periods". What should the nurse encourage her to do?
2. Having a gynecologic examination
An 86 Y.O woman had an anterior and posterior colporrhaphy (A &P repair) several days ago. Her retention catheter was removed 8 hours ago. Which assessment finding requires that the nurse acts most rapidly?
2. Her abdomen is firm and tender to palpation above the symphysis pubis
The nurse is supervising a student nurse who is caring for a client who has an intracavitary radioactive implant in place to treat cervical cancer. Which action by the student requires that the nurse intervene immediately? . Standing next to the client for 5 minutes while assisting with her bath 2. Asking the client how she feels about losing her childbearing ability 3. Assisting the client to the bedside commode for a bowel movement 4. Offering to get the client whatever she would like to eat or drink
3. Assisting the client to the bedside commode for a bowel movement
A client with a third-degree uterine prolapse is scheduled for a vaginoplasty. What should the nurse anticipate the surgeon will order?
3. Apply moist compresses to the uterus
A client at the women's health clinic tells the nurse she has endometriosis. What factors associated with endometriosis does the nurse anticipate the client will report? SATA
3. Rectal pressure 4. Abdominal pain
The nurse is working in the postanesthesia care unit caring for a 32-year-old client who has just arrived after undergoing dilation and curettage to evaluate infertility. Which assessment finding should be immediately communicated to the surgeon? 1. Blood pressure of 162/90 mm Hg 2. Saturation of the perineal pad after the first 30 minutes 3. Oxygen saturation of 91% to 95 4. Sharp, continuous, level 8 abdominal pain (on a scale of 0 to 10)
4. Sharp, continuous, level 8 abdominal pain (on a scale of 0 to 10) Rationale: Cramping or aching abdominal pain is common after dilation and curettage; however, sharp, continuous pain may indicate uterine perforation, which would require rapid intervention by the surgeon. The other data indicate a need for ongoing assessment or interventions. Transient blood pressure elevation may occur because of the stress response after surgery. Bleeding after the procedure is expected but should decrease over the first 2 hours. Although the oxygen saturation is not at an unsafe level, interventions to improve the saturation should be carried out.
What does a nurse expect to be the priority concern of a 28-year-old woman who is to undergo a laparascopic bilateral salpingo-oophorectomy?
4. Loss of childbearing potential
A client is dx with uterine fibroids, and the HCP advises a hysterectomy. The client expresses concern about having a hysterectomy at age 45 because she has heard from friends that she will undergo severe symptoms of menopause after sx. What is the nurse's most appropriate response?
4. Some women may experience symptoms of menopause if their ovaries are removed with their uterus.
When taking the health history of a client who is admitted for repair of a cystocele and rectocele, the nurse should expect the client to report the occurence of:
4. Stress incontinence and low abdominal pressure
When potential complication does a nurse anticipate when admitting a client with the diagnosis of severe procidentia (prolapse of the uterus)?
4. Ulcerations
After a hysterosalpingo-oophorectomy, a client wants to know whether it would be wise for her to take hormones right away to prevent symptoms of menopause. What is the nurse's most appropriate response? A) "It is best to wait because you may not have any symptoms." B) "It is comforting to know that hormones are available if you should ever need them." C) "You have to wait until symptoms are severe; otherwise, hormones will have no effect." D) "Discuss this with your HCP, because it is important to know your concerns."
D) "Discuss this with your HCP, because it is important to know your concerns."
The nurse is teaching a pt who is being d/c after having a total abdominal hysterectomy. Which conditions does the nurse tell the pt to immediately report to the surgeon? SATA
a. Vaginal drainage that becomes thicker or foul-smelling c. Temperature over 100F (38C) d. Burning during urination f. Pain, tenderness, redness, or swelling in calves
The nurse is giving discharge teaching to a patient who had a transvaginal repair for pelvic organ prolapse using a surgical mesh. What does the nurse include?
b. Abstain from sexual intercourse for 6 weeks.
Three years after the pt was diagnosed and treated for endometrial cancer, the pt and family are told that the cancer is recurring. Which intervention is the nurse most likely to use?
b. Assess for readiness to explore palliative care and hospice.
A pt with uterine leiomyamas reports a feeling of pelvic pressure, constipation, and urinary retention. She says, "I can't button my pants anymore." What does the nurse do to further evaluate the patient's condition?
b. Assess the abdomen for distention or enlargement.
A pt who had a total abdominal hysterectomy is anxious to resume her activities because she has young children at home. What postprocedure information does the nurse provide to the patient? SATA
b. Avoid sitting for prolonged periods. c. Do not lift anything heavier than 5-10lbs. e. When sitting, do not cross the legs.
The nurse encourages a teenage patient to receive the human papillomavirus (HPV) vaccine because it protects against which type of cancer?
b. Cervical cancer
Young women who have intercourse as teenagers and/or have multiple sex partners are at high risk for which disease/ disorder?
b. Cervical cancer
A patient receiving chemotherapy treatments reports fatigue, loss of energy, and experiencing an "emotional crisis every day and my hair is falling out". What does the nurse do first to help the patient adapt to body changes?
b. Encourage the patient to ventilate feelings.
The nurse is caring for a patient who had hysteroscopic surgery. The nurse is vigilant to assess for signs and symptoms of which potential complications? SATA
b. Fluid overload c. Embolism d. Perforation of uterus e. Hemorrhage f. Ureter injury
A pt had an anterior colporrhaphy and is returning to the clinic for the follow-up appointment. Which pt statement indicates that the procedure has achieved the desired therapeutic outcome?
b. I have good control ove my urination
The nurse is caring for a patient who is one day post-op for a total abdominal hysterectomy. Which assessment finding is cause for greatest concern?
b. Patient reports saturating one pad in an hour with dark red blood
A patient is admitted with toxic shock syndrome. What organism is frequently associated with this syndrome when it occurs as a menstrual-related infection?
b. Staphylococcus aureus
The nurse is teaching self-care management to a 39-year-old woman who had an abdominal hysterectomy. Which point would be emphasized to avoid complications of this surgery?
b. Take temperature twice a day for 3 days after surgery
The nurse reads in the pt's chart that the pt is experiencing surgical menopause after having a total hysterectomy and bilateral salpingo-oophorectomy. What expected sign/symptom does the nurse anticipate that the patient will report?
b. Vaginal changes
A patient has undergone a total hysterectomy with vaginal repair. Which over-the-counter product will the nurse recommend to decrease sexual discomfort related to intercourse?
b. water-based lubricants
A 36-year-old pt is diagnosed with dysfunctional uterine bleeding. During the pelvic exam, the HCP determines that the bleeding is acute. What is the nurse's priority action?
c. Anticipate an order for oral contraceptive therapy
A pt had a total abdominal hysterectomy. Which pt behavior is the best indicator that she is coping and adapting successfully?
c. Ask questions about the wound but seems reluctant to do self-care.
A patient is receiving external radiation therapy for treatment of endometrial cancer. What task does the nurse delegate to unlicensed assistive personnel?
c. Assist the patient to ambulate if she feels fatigue or tiredness
The nurse is teaching a group of women about prevention of toxic shock syndrome. What preventive measure does the nurse include?
c. Change your tampons every 3-6 hours
The nurse is caring for several patients who had total abdominal hysterectomies. All patients are coming to the clinic for their 6-week follow-up appointment. Which patient demeanor is the strongest indicator that there is a need for psychological referral?
c. Disheveled and lackluster and displays a lack of interest in questions
Which classic symptom is indicative of invasive gynecologic cancer?
c. Painless vaginal bleeding unrelated to menses
The nurse is giving instructions to a pt who is undergoing brachytherapy for cervical cancer. What information does the nurse include?
c. Report any blood in the urine or severe diarrhea immediately
The nurse is giving discharge teaching to a woman who had local cervical ablation. What information would be included?
c. Report heavy vaginal bleeding or foul-smelling drainage.
What is the primary factor for the low survival rates for pt's who are diagnosed with ovarian cancer?
c. Symptoms are mild and vague; therefore, the cancer is often not detected until its late stage.
The nurse sees that a pt has been advised by the HCP to apply lindane to the affected area. What is a self-care measure for this pt to ensure that the symptoms do not return after using the medication?
c. Wash clothes and linens, and disinfect the home environment.
An obese 59-year-old pt describes excessive menstrual bleeding that occurs approximately every 10 days. Which question should the nurse ask first?
d. How many pads (or tampons) do you use each day?
What self-management strategy would the nurse recommend to a patient to prevent vulvovaginitis?
d. Wear breathable fabrics, such as cotton.