OB nursing concepts 3
A woman has preinvasive cancer of the cervix. In discussing available treatments, the nurse includes what?
cryosurgery . Cryosurgery, laser surgery, and the loop electrosurgical excision procedure (LEEP) are several techniques used to treat preinvasive lesions. Colposcopy is the examination of the cervix with a stereoscopic binocular microscope that magnifies the view of the cervix. This already would have been done as part of the diagnosis of preinvasive cancer of the cervix. A hysterectomy is performed if the cancer has extended beyond the cervix. Women with positive pelvic nodes (indicating invasive cancer) usually receive whole-pelvis irradiation.
After having a discussion with a client, the nurse finds that the client has regular menstrual cycles every 28 days. What instructions should the nurse give to the client to prevent conception?
The couple should abstain from sexual intercourse from days 10 through 17. The client has regular menstrual cycles of 28 days. The beginning of the fertile period is estimated by subtracting 18 days from the length of the shortest cycle. The end of the fertile period is determined by subtracting 11 days from the length of the longest cycle. Therefore, according to the formula, the fertile days are from day 10 through day 17 (shortest cycle, 28 - 18 = day 10, and longest cycle, 38 - 11= day 17). Therefore, the nurse should advise the client to abstain from sexual intercourse between days 10 and 17. If the woman has a shortest cycle of 24 days and a longest cycle of 30 days, then the couple should abstain from sexual intercourse from days 6 through 19. As per the calculation, women who have regular cycles of 28 days should not have unprotected sexual intercourse between days 11 and 17, because it is a fertile period.
The nurse is instructing a client on self-care after embolization of the uterine artery. Which statements should be included? Select all that apply.
"Eat a diet rich in fluid and fiber." "Avoid vaginal intercourse for up to 4 weeks." Uterine artery embolization is performed to cut off blood supply to fibroids, thereby reducing or eliminating them. After this procedure, clients are advised to eat a diet rich in fluids and fiber. Vaginal intercourse should be avoided until the uterus is healed, which may take about 4 weeks. Tampons should not be used, because they may aggravate the pain. A vaginal dilator is suggested for vaginal stenosis, which is a side effect of radiation therapy. Douching is not recommended after uterine artery embolization.
A client is worried about pregnancy after unprotected sex. Within how many hours can the client use emergency contraception to prevent pregnancy?
3 days . The client should take emergency contraception within 72 hours of unprotected sex to prevent pregnancy. The client may be already pregnant 10, 12 or 21 days after unprotected sex. Therefore, the use of emergency contraception is ineffective, because the pill does not affect an implanted pregnancy.
Which client should the nurse know should not use the spermicide nonoxynol-9 (N-9) as, or with, her contraceptive method?
A client at risk for human immunodeficiency virus (HIV. The use of N-9 spermicides with the contraceptive diaphragm is not effective in protecting against sexually transmitted infections such as HIV. Instead, the frequent use of N-9 spermicides increases the risk for HIV. Spermicides do not affect the client with iron deficiency. Using spermicides with a contraceptive diaphragm increases its contraceptive effectiveness. Spermicides are used with a male condom to increase contraceptive effectiveness.
Which nursing interventions are beneficial for a client preparing for uterine polyps removal? Select all that apply.
Advise the client to perform relaxation exercises. Provide psychologic support to the client during the removal procedure. Advise the client to avoid sexual intercourse for up to 1 week after surgery Uterine polyps may be removed via surgery. Nursing care includes preparing the woman for what to expect during the removal procedure. The nurse should encourage relaxation and breathing exercises to decrease stress in the client. The client may be anxious, and providing psychologic support is helpful. After the procedure, the woman is advised to avoid sexual intercourse for up to 1 week. Using tampons and douching should be avoided for up to 1 week or until the site is healed.
What are common types of uterine displacement? Select all that apply.
Anteflexion, retroflexion, and retroversion are types of uterine displacement. Dorsiflexion and plantar flexion are movements of the foot.
A woman was treated recently for toxic shock syndrome (TSS). She has intercourse occasionally and uses protection. Based on her history, what contraceptive method should she and her partner avoid?
Cervical cap. Women with a history of TSS should not use a cervical cap. The condom, vaginal film, and vaginal sheath are not contraindicated for a woman with a history of TSS.
A client is diagnosed with neoplasia in the lower two-thirds of the epithelium of the cervix. Which type of cervical cancer is associated with this condition?
Cervical intraepithelial neoplasia (CIN) 2. Cancer of the cervix begins as neoplastic changes in the cervical epithelium. CIN 2 involves the lower two-thirds of the epithelium and may progress to carcinoma in situ. Carcinoma in situ (CIS) is diagnosed when the full thickness of epithelium is replaced with abnormal cells. CIN 1 refers to abnormal cellular proliferation in the lower third of the epithelium. CIN 3 involves the full thickness of the epithelium and often progresses to carcinoma in situ.
A client is diagnosed with polycystic ovaries following laparoscopy. The client is diagnosed to have anovulation. What strategies included in the treatment would help the client conceive? Select all that apply.
Clomiphene (Clomid) and metformin (Glucophage) Clomiphene (Clomid) and dexamethasone (Decadron). Anovulation, excess androgenic hormones, and insulin resistance are the most common symptoms of polycystic ovarian syndrome. Clomiphene (Clomid) is a selective estrogen receptor modulator, which is used as an ovarian stimulant. Insulin sensitizers like metformin (Glucophage) and dexamethasone (Decadron) potentiate the effects of clomiphene (Clomid) when given to women with anovulation and polycystic ovarian syndrome. Antioxidants like vitamins E and C and herbal medications like ginseng are beneficial in cases of male infertility. Thyroid-stimulating hormone (Synthroid) is useful to treat hypothyroidism and is not associated with polycystic ovarian disease.
In using a two-client model for a cancer client who is pregnant, which emphasis would be used for clinical ethical decision-making?
Consideration would focus on promotion of fetal well being. In a two-client model, the focus would be on fetal well-being. A one-client model would focus on the maternal-fetal unit.
Self-care instructions for a woman following a modified radical mastectomy include that she:
Expect a decrease in sensation or tingling in her affected arm as her body heals. Empty surgical drains once a day or every other day A decrease in sensation and tingling in the affected arm and in the incision are expected for weeks to months after the surgery. Loose clothing should be worn because tight clothing could impede circulation in the affected arm. The axilla of the affected arm should not be shaved nor should depilatory creams or strong deodorants be used. Drains should be emptied at least twice a day and more often if necessary.
When using the basal body temperature method of family planning, the woman should know that:
Her temperature will increase about 0.4° to 0.8° F after ovulation. The basal body temperature will increase about 0.4° to 0.8° F when ovulation occurs. The woman is fertile for up to 18 days. She should take her temperature upon rising in the morning. A woman's temperature is usually higher in the second half of her cycle.
What are the common manifestations of benign breast masses of ectasia? Select all that apply.
Mass behind the nipple Not well delineated Thick, sticky nipple discharge Benign breast masses of ectasia manifest as masses behind the nipples that are not well delineated and thick, sticky nipple discharge. They are nonmobile, unlike fibroadenoma. The breasts are irregular, not round and smooth as with fibrocystic changes.
Which condition in a client who is using a copper-bearing intrauterine device indicates a need for removal of the device?
Rashes. Rashes indicate that the client is allergic to copper. A severe allergic reaction can also cause anaphylaxis in the client. So, the copper-bearing intrauterine device needs to be removed immediately. Nausea is not a side effect of the copper-bearing intrauterine device. Bleeding and cramping are the side effects of the device. However, the client can take nonsteroidal antiinflammatory drugs to reduce the pain.
the presence of pedunculated leiomyomas indicates that the client has risk of tumor cell necrosis.
The leiomyomas or fibroid tumors that have a stalk are known as pedunculated leiomyomas, and may twist and become necrotic, resulting in severe pain. Therefore, the presence of pedunculated leiomyomas indicates that the client has risk of tumor cell necrosis. Label A represents the subserous leiomyomas that develop under the peritoneal surface of the uterus. They protrude out of the surface of the uterus. They do not twist and result in tumor necrosis. Label B represents intramural leiomyomas. They develop within the walls of the uterus. Label D represents submucosal leiomyomas, which develop in the endometrium and protrude into the uterine cavity. They do not have a stalk, do not twist, and might not result in necrosis
A client's medical history shows that she has undergone a uterine artery embolization. Which question does the nurse ask to assess for complications following this procedure?
"Do you get regular periods? Uterine artery embolization helps to treat uterine fibroids by reducing the blood supply to the uterine body. The procedure can induce early menopause in the client, so the nurse should ask if the client has regular menstrual cycles to screen for this complication. Uterine artery embolization does not affect the blood supply to the liver or pancreas, however, so the nurse does not need to ask about symptoms of fatty liver, including bloating after meals, or of type 2 diabetes, such as excessive hunger, thirst, and urination. . Excessive body hair is a symptom of Stein-Leventhal syndrome, but this is caused by an increase in testosterone levels and not an obstruction of blood flow to the uterus body.
The nurse is teaching hygienic measures to a client with vulvodynia. Which statement by the client indicates a need for further teaching?
"I should wear silk or rayon underwear." Vulvodynia is a chronic pain disorder of the vulvar area. The causes of vulvar pain include the use of oral contraceptives; the presence of candidiasis or human papillomavirus; wearing tight-fitting underwear and pants, especially synthetic materials; sexual activity; and tampon use. Hygienic measures for clients with vulvodynia include wearing white cotton underwear, because it does not have synthetic chemicals that may irritate the perineal area. The client should not wear tight clothing, because it may cause discomfort. Using 100% cotton menstrual pads helps prevent skin irritation. The client should avoid using lubricants that contain propylene glycol, because these lubricants neither relieve the pain nor aid in healing.
A married couple is discussing male and female sterilization with the nurse. Which statement is most appropriate for the nurse to make?
"Major complications after sterilization are rare." Sterilization procedures can be safely done on an outpatient basis. Complications are uncommon and usually not serious. The average failure rate for female sterilization is 0.5%. The average failure rate for male sterilization is 0.15%. A vasectomy has no effect on potency or volume of ejaculate. Sterilization reversal is costly, difficult, and uncertain.
A male patient asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). What is the nurse's most appropriate response?
"Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; also it has been linked to an increase in the transmission of human immunodeficiency virus (HIV) and can cause genital lesions.".
A nursing instructor is teaching student nurses about discharge planning and teaching for premenopausal women after hysterectomy. Which statement by the student nurses indicates a need for additional teaching?
"Teach the client the pros and cons of hormonal replacement." Hormonal replacement therapy is not necessary in premenopausal women after hysterectomy, because the ovaries are not removed. The client has to avoid vigorous exercise for 6 weeks, because it may cause pain in the pelvis. The first followup visit is very important for a client after hysterectomy in order to assess associated complications such as vaginal bleeding and urinary retention. After hysterectomy, clients are advised to use water-soluble lubricants during vaginal intercourse to decrease discomfort.
The nurse is teaching a client about the cervical mucus ovulation detection method to prevent pregnancy. What does the nurse tell the client?
"The mucus should be free from semen for accurate assessment." The cervical mucus ovulation-detection method requires the client to check the quantity and character of mucus on the vulva or introitus. Observing the changes in mucus characteristics helps the client understand whether or not she is experiencing ovulation. Mucus characteristics may change if there is semen in the mucus, and the client may not be able to assess it accurately. Antihistamines dry the mucus and may hinder accurate assessment. Wet, clear, and slippery mucus indicates ovulation, and the couple should engage in unprotected intercourse during this time only if they desire pregnancy. Vaginal infections may change the mucus characteristics, and therefore would interfere with accuracy.
Which of the following clinical presentations is consistent with the physical finding of carcinoma in situ (CIS)?
Abnormal cells noted in the full thickness of the epithelium. CIS is defined as abnormal cells noted in the full thickness of the epithelium. Abnormal cells located in the uterine fundus indicate dysplasia but do not define CIS. Abnormal cells located in the lower one third of the epithelium indicate CIN 1. Endometriosis is the inflammation of the endometrial lining of the uterus.
Which medication is useful in the treatment of luteal-phase inadequacy? Select all that apply.
Clomiphene citrate (Clomid) Progesterone (Prometrium) vaginal gel. Clomiphene citrate (Clomid) and progesterone (Prometrium) vaginal gel (8%) are used to treat luteal phase inadequacy. Metformin (Glucophage) is useful to restore cyclic ovulation and menses in women with polycystic ovarian syndrome (PCOS). Ganirelix acetate (Ganirelix) is indicated for controlled ovarian stimulation as an infertility treatment. Human chorionic gonadotropin (HCG) is useful for ovulation induction.
Nurses, certified nurse-midwives, and other advanced practice nurses have the knowledge and expertise to assist women in making informed choices regarding contraception. A multidisciplinary approach should ensure that the woman's social, cultural, and interpersonal needs are met. Which action should the nurse take first when meeting with a new client to discuss contraception?
Determination of the woman's level of knowledge regarding contraception and her commitment to a method is the primary step of this nursing assessment and necessary before completing the process and moving on to a nursing diagnosis. Once the client's level of knowledge is determined, the nurse can interact with the woman to compare options, reliability, cost, comfort level, protection from sexually transmitted infections (STIs), and a partner's willingness to participate. Although important, obtaining data about the frequency of coitus is not the first action that the nurse should undertake when completing an assessment. Data should include not only the frequency of coitus but also the number of sexual partners, level of contraceptive involvement, and the partner's objections. A woman's willingness to touch her genitals and cervical mucus is a key factor for the nurse to discuss should the client express interest in using one of the fertility awareness methods of contraception, but is not the first action taken by the nurse. The nurse must be aware of whether the client is attempting to prevent conception, delay conception, or attempting to conceive.
A nulliparous woman has a history of cancer therapy, which had an adverse effect on her pituitary gland. What risk does the nurse expect in the client?
Difficulty conceiving. Cancer therapy may have severely adverse effects on the body. If the therapy affects the pituitary gland, women may resume their menstrual cycles but are still at risk of having difficulty conceiving. Neurologic impairment is not directly related to the pituitary gland. Risk of recurrence is associated with many types of cancers. Cancer therapy also causes hepatotoxicity.
A client wants to have an abortion during the 18th week of pregnancy. What abortion technique should the nurse suggest to the patient?
Dilation and evacuation. The client is in her second trimester of pregnancy. Therefore, the nurse should suggest the dilation and evacuation method of abortion. This method is safe and can be used until 20 weeks of gestation. Surgical (aspiration) methods and use of medications such as methotrexate (Trexal), mifepristone (Mifeprex), and misoprostol (Cytotec) are effective for abortion during the first trimester of pregnancy. These methods are not suitable, because the patient is in the 18th week of pregnancy.
Which interventions could be implemented by the nurse in the care of a client who is experiencing altered taste sensation because of radiation therapy? Select all that apply.
Eat chicken or fish in the diet rather than red meat. Eat tart foods. Eating chicken or fish in the diet rather than red meat may help to alleviate altered taste sensation. Eating tart foods may help to stimulate the taste buds. Drinking clear liquids and avoiding carbonated liquids are interventions for a client who is suffering from nausea and vomiting. Avoiding alcoholic beverages and extreme food temperatures would be an intervention for a client who has stomat
When obtaining a health history, the nurse should be aware that the most common malignancy of the reproductive system is what?
Endometrial cancer
Your client has just returned from a uterine artery embolization (UAE Procedure). Prior to her discharge, it is very important to discuss symptoms that require a call to the health care provider. Which of the following would require contacting the physician? Select all that apply.
Fever of 39° C Swelling or hematoma at the puncture site Abnormal vaginal discharge. Fever of 39° C or greater may indicate an infection, and the physician should be notified. A slight fever or pain may be experienced because of acute fibroid degradations. Swelling or hematoma at the puncture site may be an indication of bleeding into the groin. The client should not experience any abnormal vaginal discharge (foul odor, brown color or tissue). The physician should be notified if the client is experiencing urinary retention. Urinary frequency is not a complication of UAE. Mild pain can be expected with any procedure and is not a reason for concern.
On interacting with a client, the nurse finds that the client uses lubricants that contain nonoxynol-9 (N-9) at least twice a day. The nurse instructs the client to not use N-9. What is the reason for giving such advice to the client?
Frequent use raises the client's risk of sexually transmitted infections. Nonoxynol-9 is a surfactant and is used as a lubricant. This chemical has spermicidal properties and reduces the mobility of sperm. This chemical attacks the flagella and body of the sperm, thereby preventing the sperm from reaching the cervical os. Frequent use of nonoxynol-9 places the client at a higher risk for sexually transmitted infections, because it decreases immunity and can cause lesions in the anus. Nonoxynol-9 does not decrease libido and does not increase progesterone or estrogen levels. Nonoxynol-9 does not decrease bone mineral density. Depot medroxyprogesterone acetate, used as a contraceptive, decreases bone mineral density in women and increases the risk of osteoporosis.
A client is planning to use the calendar rhythm method for contraception. On assessment, the nurse finds that the client has regular menstrual cycles of 28 days each. When should the couple abstain from sexual activity to avoid pregnancy?
From days 10 through 17. In the calendar rhythm method, the client is taught to subtract 18 days from the length of the shortest cycle to determine the beginning of the fertile period. The client is instructed to subtract 11 days from the length of the longest cycle to determine the end of the fertile period. Accordingly in this case, the couple will have to abstain from sexual activity from day 10 through day 17, because ovulation occurs on day 14 plus or minus 2 days. The client may become pregnant if she engages in sexual activity after the 10th day.
A client is prescribed griseofulvin (Fulvicin P/G) for the treatment of ringworm. After reviewing the medical history of the client, the nurse finds that the client is taking oral contraceptives. What advice should the nurse gives to the client?
Griseofulvin (Fulvicin P/G) reduces the efficacy of oral contraceptives. Therefore, to prevent pregnancy, the nurse should advise the client to use other contraceptive methods while taking griseofulvin (Fulvicin P/G). The client should not take a double dose of oral contraceptives, because it may cause drug overdose and may cause adverse effects in the client. Lowering the dose of griseofulvin (Fulvicin P/G) may not eliminate the ringworm infection. Griseofulvin (Fulvicin P/G) diminishes the action of oral contraceptives. Therefore, the client should not take oral contraceptives and griseofulvin (Fulvicin P/G) simultaneously.
A postpartum client with mild uterine prolapse is treated with a vaginal pessary. After interacting with the client during the follow-up visit, which statement by the client would require intervention by the nurse?
I'm exercising 45 to 60 minutes daily." A client with uterine prolapse may have pelvic relaxation and low backache, so the client should avoid prolonged standing and physical activities that can cause back pain and worsen the client's condition. The client with uterine prolapse should do Kegel exercises regularly because they help to improve uterine muscle tone. The client should douche with vinegar solution to maintain vaginal pH and to remove excess vaginal secretions. The client should remove the pessary at night, clean it, and replace it in the morning in order to prevent infection and discomfort.
A client with uterine prolapse is advised to use a pessary. What instruction should the nurse give the client if the client decides to leave the pessary placed in the vagina?
Instruct the client to perform regular douching. Uterine prolapse can be caused by congenital or acquired weakness of the pelvic support structures (often called pelvic relaxation). Pessaries can be useful in cases of mild prolapse and are used by many primary health care providers as the first line management of uterine prolapse. If the pessary is not replaced frequently, regular douching with commercially prepared solutions or weak vinegar solutions should be advised. These solutions are used to remove excessive secretions. Performing Kegel exercises may not help in maintaining hygiene when the pessary is left in place The knee-chest position is advised for a client with a mildly retroverted uterus. The nurse should teach all the clients who decide to use the pessary about the method of removal and replacement. It is not specific only to clients who decide to leave the pessary in the vagina
A client reports having a "bearing-down" sensation and increased frequency of urination. The pelvic examination reveals a bulged anterior vaginal wall. Which treatment strategies should be included in the client's care plan to resolve the symptoms? Select all that apply.
Kegel exercises Colporrhaphy Vaginal hysterectomy The client's signs and symptoms, along with the pelvic examination, indicate cystocele, which is the protrusion of the bladder downwards into the vagina. Kegel exercises help to strengthen the pelvic floor muscles and to reduce the bulge caused by the pressure exerted by the cystocele. Colporrhaphy is a surgical procedure that helps to repair the vaginal wall. During this surgery, the health care provider shortens the client's pelvic muscles in order to provide better support to the bladder. Vaginal hysterectomy is a surgical procedure that involves removal of the cervix or uterus in order to reduce the symptoms of cystocele. Electrical stimulation and serotonin-norepinephrine reuptake inhibitors help to alleviate the symptoms of urinary incontinence.
The nurse is assessing a client with fibroids on the outer wall of the uterus. Which treatment strategy would be most beneficial if the client wants to conceive in the future?
Myomectomy. Myomectomy is a surgical procedure that helps to remove fibroids while leaving the uterine muscle walls intact. It does not affect a woman's fertility. Hysterectomy is a surgical procedure that involves the complete removal of the uterus and thus renders a client infertile. Laser surgery involves scarring in the uterine cavity and affects the client's childbearing potential. Estrogen therapy can increase the estrogen levels in the client, which may enhance tumor growth. Therefore, estrogen therapy is not beneficial for the client.
In providing health promotion education to reduce the likelihood of transmission of sexually transmitted diseases, which actions would still have a low increased risk? Select all that apply.
Oral sex with female or male wearing condom Vaginal intercourse with condom. Blood contact during sexual act due to menses Oral sex while wearing a condom and vaginal intercourse with a condom are sexual practices with low but potential risk. Erotic conversation would be considered to be a safe risk reduction practice. Oral-anal contact and blood contact during a sexual act due to menses would be considered high risk practices.
Group B streptococci (GBS) are part of the normal vaginal flora in 20% to 30% of healthy pregnant women. GBS has been associated with poor pregnancy outcomes and is an important factor in neonatal morbidity and mortality. Which of the following would not be considered a risk factor for neonatal GBS infection
Premature rupture of membranes less than 18 hours Premature rupture of the membranes of 18 hours or more, not 18 hours or less, increases the risk for neonatal GBS infection, so this is not a risk factor. A positive prenatal culture is a risk factor for neonatal GBS infection. Preterm birth at less than 37 weeks remains a risk factor for neonatal GBS infection. Maternal fever of 38° C or greater is also a risk factor for neonatal GBS infection.
Following a hysterectomy for endometrial cancer, a client presents with acute pain and impaired tissue integrity at the site of surgery. Which intervention does the nurse add to the care plan to reduce the risk of infection?
Providing fruits rich in vitamin C to the client. Vitamin C helps in maintaining tissue integrity, promotes wound healing, and reduces the risk of infection, so the nurse can provide foods rich in vitamin C to reduce the risk of infection while the client recovers. Analgesics help to relieve pain, but they do not promote wound healing and or reduce risk of infection. A warm compress provides muscle relaxation and alleviates pain, but does not reduce risk of infection. Changing position frequently promotes blood flow and decreases the perception of pain.
Although remarkable developments have occurred in reproductive medicine, assisted reproductive therapies are associated with a number of legal and ethical issues. Nurses can provide accurate information about the risks and benefits of treatment alternatives so couples can make informed decisions about their choice of treatment. Which issues would need to be addressed by an infertile couple before treatment? Select all that apply.
Risk of multiple gestation. Whether or how to disclose the facts of conception to offspring. Freezing embryos for later use. Financial ability to cover the cost of treatment. Stress management techniques and couple counseling. Multiple gestation is indeed a risk of treatment of which the couple needs to be aware. To minimize the chance of multiple gestation, generally only three or fewer embryos are transferred. The couple should be informed that there may be a need for multifetal reduction. Nurses can provide anticipatory guidance on this matter. Depending on the therapy chosen, there may be a need for donor oocytes, sperm, embryos, or a surrogate mother. Couples who have excess embryos frozen for later transfer must be fully informed before consenting to the procedure. A decision must be made regarding the disposal of embryos in the event of death or divorce or if the couple no longer want the embryos at a future time. Stress management techniques and couple counseling should be addressed before treatment. Although the method of payment is important, obtaining this information is not the nurse's responsibility. It is also of note that 14 states have mandated some form of insurance to assist couples with coverage for infertility.
What information will the nurse include in planning for the care of a woman who has had a vaginal hysterectomy?
The woman should expect no changes in her hormone levels. Unless the ovaries also were removed, hormonal levels should not change. Menses will cease, but the hypothalamic-pituitary-ovarian axis remains intact. The woman should expect to have vaginal discharge for 4 to 6 weeks. Full recovery varies from woman to woman, depending on risk factors and individual healing. Surgical menopause occurs only if the ovaries are also removed. The client should avoid tub baths, intercourse, and douching until after the follow-up exam
A pregnant client has ovarian cysts and reports a feeling of pelvic fullness. Which type of functional ovarian cysts could this client have, given the description of symptoms?
Theca-lutein cysts Theca-lutein cysts are associated with hydatidiform mole and may occur if the woman has taken ovulation-inducing drugs. These cysts may also be seen in a pregnant woman with a large placenta. The pregnant woman also experiences a feeling of fullness around the pelvic region due to these cysts and the growing fetus. Follicular cysts develop most commonly in normal ovaries of young women, and they cause severe pelvic pain. Clinical manifestations associated with a corpus luteum cyst include pain, tenderness over the ovary, delayed menses, and irregular or prolonged menstrual flow. Clinical manifestations of PCOS include obesity, hirsutism, irregular menses or amenorrhea, and infertility.
A female client informs the nurse that she conceived in the first month after discontinuing oral contraceptives (COCs). The client is worried about the effect of possible COC use on this pregnancy. What does the nurse tell the client?
There is no evidence that there will be fetal or maternal harm if the client conceives in the first month after discontinuing oral contraceptives. The child will not have any birth defects because of this, and conception is safe even in the first month after discontinuing the pills. Iron deficiency anemia occurs in the fetus if the fetal iron supply is decreased and is not related to maternal COC use.
A client diagnosed with polycystic ovary syndrome (PCOS) is prescribed spironolactone (Aldactone). What is the reason for prescribing this medication?
To suppress the production of androgens. Polycystic ovary syndrome (PCOS) occurs due to an imbalance in hormone production. This syndrome is associated with androgen-producing tumors. Spironolactone (Aldactone) is an anti-androgen prescribed to the client with PCOS to suppress the production of androgens. Ovulation-inducing drugs are given to clients with PCOS who are planning for pregnancy. Spironolactone (Aldactone) is a diuretic and may promote fluid loss, however, fluid loss is not a treatment goal in PCOS. Spironolactone (Aldactone) does not have any effect on the production of estrogen.
A client is diagnosed with submucosal leiomyomas. Which statement should the nurse use to explain this to the client?
Tumors have developed in the endometrium and protrude into the uterine cavity. Leiomyomas are classified according to the location in the uterine wall. Submucosal leiomyomas are the least common tumors and cause severe symptoms. These tumors develop in the endometrium and protrude into the uterine cavity. Intramural leiomyomas are tumors that develop within the wall of the uterus. Subserous leiomyomas develop beneath the peritoneal surface of the uterus and appear as small or large masses that protrude from the outer uterine surface.
A client complains about a foul-smelling vaginal discharge despite careful hygiene habits. On assessment the nurse notices the presence of fecal matter in the vagina. What suggestion should the nurse provide to prevent oozing of fecal matter in the vagina?
Use an enema before leaving the house. Feces oozing into the vagina is a symptom of a rectovaginal fistula. Using an enema before leaving the house provides temporary relief from the oozing of fecal material into the vagina, and may make the client more comfortable. Avoiding soap, using deodorizing douches, and using protective pads may ensure hygiene but may not stop the oozing of fecal material into the vagina. The client should be instructed to wash her genitalia thoroughly to decrease her discomfort, and mild soaps will be safe for this purpose. Commercial deodorizing douches are used by clients with genital fistulas to reduce the unpleasant odor. However, these interventions may not stop the leakage of fecal material into the vagina. The protective pads suggested for clients with genital fistulas are used throughout the day, but these will not stop the oozing.
A woman is using the basal body temperature (BBT) method of contraception. She calls the clinic and tells the nurse, "My period is due in a few days, and my temperature has not gone up." The nurse's most appropriate response is what?
You probably didn't ovulate during this cycle." Pregnancy cannot occur without ovulation (which is being measured using the BBT method). Dismissing the woman's concerns is not appropriate. Illness would most likely cause an increase in BBT. The absence of a temperature increase most likely is the result of lack of ovulation.
What does the nurse teach a client about the use of FemCap?
You should leave the FemCap in place for at least 6 hours after intercourse." FemCap is a cervical cap, which should be left in place for at least six hours after intercourse. This is because the spermicides inside the cap act as a chemical barrier and the seal provides a physical barrier to sperm. The client need not use a condom, because FemCap is an effective contraceptive device. The client should use spermicides only once before insertion, not for every additional act of intercourse. TSS is a side effect that occurs with the use of cervical caps and not because the client avoids spermicides.
The standard mammogram film of a client reveals the presence of microcalcifications that are clustered together and have irregular edges. Which diagnostic intervention would help to confirm the cause of the client's condition?
biopsy . The client's mammogram reveals the presence of microcalcifications that are clustered together and have irregular edges. This can be a sign of ductal carcinoma in situ. This can be confirmed by a biopsy of the calcified tissue. Digital mammogram will also reveal the presence of microcalcifications in the breast. It will not confirm ductal carcinoma. Magnetic resonance imaging is used to determine the size of tumors. Positron emission tomography is used to determine whether a breast tumor has metastasized. Topics
A client who had stimulated ovulation is given hormonal therapy to maintain the uterine lining. The client, however, has a spontaneous abortion while resting at home. What could be the probable reason for the spontaneous abortion?
he client was administered exogenous progesterone as the main therapy. Progesterone is a hormone released by the ovaries. Progesterone plays a vital role in the implantation of the fertilized egg and in the maintenance of the pregnancy. Exogenous progesterone, when administered alone, cannot maintain the uterine lining, and, because of this, may result in abortion. In the case of stimulated ovulation, exogenous progesterone is effective in maintaining the uterine lining only if used as adjunct therapy. Exogenous estrogen is used to treat menopausal symptoms and osteopeorosis. It is unrelated to the maintenance of the uterine lining in stimulated ovulation. Therefore, exogenous estrogen is not beneficial as either the main therapy or as adjunct therapy.
A pregnant woman is infected with human immunodeficiency virus (HIV), with a viral load of more than 400 copies/ml. It is therefore recommended that she have a caesarean birth at 38 weeks of gestation. On assessment at 36 weeks, the nurse finds that the patient has a viral load of 800 copies/ml and ruptured membranes, and the labor is progressing rapidly. What is the primary health care provider likely to order?
immediate vaginal birth. Ruptured membranes and a rapidly progressing labor indicate that the client is ready for vaginal birth. If the viral load in the client is less than 1000 copies/ml at 36 weeks, the patient can be prepared for a vaginal birth. Scalp pH sampling is avoided, because it may result in inoculation of the virus into the fetus. If the viral load is more than 1000 copies/ml, it is recommended that the client have a caesarean birth. The use of a fetal scalp electrode is avoided, because it increases the risk of transmission of infection to the fetus.
The breast cancer risk assessment screening report of a 30-year-old woman indicates that the client is at high risk of developing malignant breast cancer. Which strategy should be added to the treatment plan to prevent breast cancer in the client?
tamoxifen. The client is 30 years old and likely has not reached menopause. Tamoxifen (Nolvadex) is the drug of choice for prophylaxis of breast cancer for pre- and postmenopausal women. Having the first child after 40 years of age significantly raises the risk of developing breast cancer. Regular breast examination and mammography may help to detect the cancer in the early stages, but may not prevent it from occurring. Raloxifene hydrochloride (Evista) is the drug of choiceg for prophylaxis of breast cancer for postmenopausal women.
