OB Practice: Chapter 7 Benign Disorders of the Female Reproductive Tract

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. The client needs to understand that a Foley catheter will be in place for up to 1 week and that she might not be able to urinate due to the swelling after the catheter has been removed. The client should cleanse the perineal area daily with mild soap and water, especially around where the catheter enters the urinary meatus. If the woman is provided with a leg bag to be worn during waking hours, instruct her to empty it frequently and keep it below the level of the bladder to prevent backflow. The same principles are applied to the primary Foley bag when emptying it.

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 Foley catheter will be left in place for up to one week to allow the surgical site time to heal properly. The client may also experience some dysuria once it is removed due to the swelling that can occur. The client will need instructions on how to properly care for a leg bag, the importance of pelvic rest to allow for proper healing, and using stool softeners to avoid straining or stressing the pelvic region.

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." Typically, with hormonal therapy, fibroids regrow when the medication is stopped. A myomectomy preserves the uterus. Uterine artery embolization is frequently painful. Laser surgery can cause scarring and adhesions which could impact future fertility

A client with pelvic organ prolapse (POP) is asked by her nurse if she has ever had any problem with constipation. She looks puzzled and asks the nurse, "What does my stool have to do with my POP?" Which would be the best response by the nurse?

"The straining to pass hard stool increases intra-abdominal pressure, which over time can cause pelvic prolapse." The best response would be to explain to the client that the straining seen in constipation increases intra-abdominal pressure, which over time causes pelvic organs to prolapse. Telling the client that it is part of a questionnaire and that it is part of the medical history is not therapeutic and does not offer any type of explanation to the client. Even though the primary care provider would want to know, this response is not appropriate and offers the client no explanation.

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." The purpose of pelvic floor exercises is to increase the muscle volume, which will result in a stronger muscular contraction. The exercises do not move the pelvic floor upward, increase blood supply, or establish regular elimination patterns.

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 dietary fiber increase and an increase in fluids will help avoid constipation, which puts a strain on the intra-abdominal cavity and pelvic organs. An increase in fiber will help to stimulate peristalsis. The recommended amount of fiber is 25 mg daily. Avoiding caffeine will not change symptoms. The client should avoid high-impact exercise because it increases intra-abdominal pressure.

The nurse is providing postoperative care for a woman who underwent an abdominal hysterectomy for uterine fibroids. Which nursing interventions are included in the postoperative care? Select all that apply.

Administer analgesics promptly or use a prescribed PCA pump. Change the client's linen and gown often to promote hygiene. Administer antiemetic to control nausea and vomiting per prescription. Nursing postoperative care for a client who has had a hysterectomy includes giving analgesics and a PCA pump, promoting hygiene by keeping linens/gowns clean, giving an antiemetic to control nausea and vomiting, and changing client position often to provide comfort and support. Carbonated drinks do not affect postoperative care.

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 Although the cause of fibroids is not known, several predisposing factors have been identified: age (late reproductive years), with peak incidence occurring around age 45; African American ethnicity; hypertension; nulliparity; and obesity.

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. Hormone replacement therapy may improve the tone and vascularity of the supporting tissue in perimenopausal and menopausal women by increasing 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 Kegel exercises strengthen the pelvic floor muscles to support the inner organs and prevent further prolapse; they might limit the progression of mild prolapse and alleviate some symptoms. They will not, however, help severe uterine prolapse. Surgery is for more severe cases. Doing nothing is not an option, and the colpexin sphere would be used in a case that had more pronounced symptoms.

A nurse is caring for a 45-year-old client using a pessary to help decrease leakage of urine and support a prolapsed vagina. Which recommendation is most commonly provided to a client regarding pessary care?

Remove the pessary twice weekly, and clean it with soap and water. The most common recommendation for pessary care is removing the pessary twice weekly and cleaning it with soap and water. In addition, douching with diluted vinegar or hydrogen peroxide helps to reduce urinary tract infections and odor, which are side effects of using a pessary. Estrogen cream is applied to make the vaginal mucosa more resistant to erosion and strengthen the vaginal walls. Removing the pessary before sleeping or intercourse is not part of the instructions for pessary care.

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. The nurse should instruct the client to undergo ultrasound examination every 3 to 6 months to monitor the cysts. The other testing is not important for this condition

The mother of four small children comes to the clinic reporting a bulge between her vagina and her rectum. It is painless and has not gotten any larger since the woman noticed it two weeks ago. After examining the woman, the care provider says the woman will be referred to a surgeon. After the care provider leaves the room, the woman asks the nurse to explain what she has. What would the nurse tell her?

She has an enterocele because her small intestine and peritoneum are jutting downward between the uterus and the rectum. The names of pelvic support disorders correspond to the affected organs. Cystocele occurs when the bladder bulges into the front wall of the vagina. Rectocele occurs when the rectum protrudes into the back wall of the vagina. Enterocele occurs when the small intestine and peritoneum jut downward between the uterus and rectum. Uterine prolapse occurs when the uterus drops down into the vagina.

Structural disorders that cause prolapse of reproductive organs in women can be aided by the practice of Kegel exercises. When the nurse is explaining Kegel exercises to a client, which information is most important to include?

These exercises will relieve mild prolapse symptoms. Kegel exercises can alleviate mild prolapse symptoms and may even aid in stopping the progression of prolapse. Symptoms that may be decreased include pelvic pressure and low back pain. These exercises may be done after surgery; they do not increase blood pressure and are not affected by food.

The nurse would expect which client to be at a high risk for developing a pelvic support disorder?

a 60-year-old mother with four children Women may experience pelvic support disorders related to pelvic relaxation or urinary continence. These disorders usually develop after years of wear and tear on the muscles and tissues that support the pelvic floor, such as what occurs with childbearing, chronic coughing, straining, surgery, or simply aging

The nursing instructor is teaching about Bartholin cysts and informs the students that Bartholin cysts are the most common cystic growth in the vulva. She describes this type of cyst as being:

a swollen, fluid-filled, sac-like structure. A Bartholin cyst is a swollen, fluid-filled, sac-like structure that results when one of the ducts of the Bartholin's gland becomes blocked. A uterine fibroid is a benign proliferation composed of smooth muscle and fibrous connective tissue in the uterus. A fistual is a abnormal opening between a genital tract organ and another organ. A polyp is a small benign growth.

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

abnormal uterine bleeding Fibroids are dependent on estrogen and grow rapidly during the childbearing years unless menopause occurs. Abnormal uterine bleeding is a clinical manifestation. Diarrhea is not a factor; constipation and abdominal pain can occur if fibroids are getting larger.

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

bulging of the bladder into the vagina. A cystocele is the bulging of the bladder into the vagina. A rectocele is a herniation of the rectum into the vagina. An enterocele is a protrusion of the intestinal wall into the vagina. A uterovaginal prolapse is the downward displacement of the cervix anywhere from low in the vagina to outside the vagina.

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 Cystocele occurs when the posterior bladder wall protrudes downward through the anterior vaginal wall. Rectocele occurs when the rectum sags and pushes against or into the posterior vaginal wall. Enterocele occurs when the small intestine bulges through the posterior vaginal wall (especially common when straining). Uterine prolapse occurs when the uterus descends through the pelvic floor and into the vaginal canal.

The nurse is teaching women in a community clinic about urinary incontinence. The nurse knows that women who have weak pelvic floor muscles may have stress incontinence. Which intervention would be least effective in relieving urinary incontinence?

decreasing oral intake of fluids to less than 1 L/day The least effective intervention would be to decrease fluids to less than 1.5 L/day. This could put the woman at risk for dehydration and urinary infection. All other choices are effective in managing urinary incontinence

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 risk for recurrent prolapse after surgery documented morbid obesity documented chronic obstructive pulmonary disease Women who are at too high a risk and therefore are not surgery candidates include those who are morbidly obese, have chronic obstructive pulmonary disease, and are at risk for recurrent prolapse. Most pelvic disorders manifest with symptoms of low back pain and pelvic pressure. A client with severe pelvic prolapse may very well be a surgery prospect.

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 Mifepristone is a progestin antagonist used to treat uterine fibroids. Leuprolide, nafarelin, and goserelin are gonadotropin-releasing hormone antagonists.

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. Polycystic ovary syndrome (PCOS) involves the presence of multiple inactive follicle cysts within the ovary that interfere with ovarian function. It is the most common cause of medically treatable infertility and is responsible for 70% of cases of anovulatory subfertility and up to 20% of couples' infertility cases.

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 Informing the client about factors in her lifestyle that might be modified to reduce her risk of developing POP would be an exmaple of primary prevention.

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 rectocele occurs when the rectum sags and pushes into or against the posterior vaginal wall. A cystocele occurs when the posterior bladder wall protrudes downward through the anterior vaginal wall. An enterocele occurs when the small intestine bulges through the posterior vaginal wall. Uterine prolapse occurs when the uterus descends through the pelvic floor and into the vaginal canal.

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. Today, almost all pessaries are made of medical-grade silicone. They are pliable and have a long shelf life, lack odor and secretion absorption, are biologically inert, and nonallergenic and noncarcinogenic. They can also be boiled or autoclaved for sterilization.

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 extent of uterine prolapse is classified in terms of stages: stage 0: no descent of pelvic structure during straining; stage I: prolapsed descending organ is >1 cm above the hymenal ring; stage II: the prolapsed organ extends approximately 1 cm below the hymenal ring; stage III: prolapse extends to 2 cm to 3 cm below the hymenal ring; and stage IV: vagina is completely everted or prolapsed organ is >3 cm below the hymenal ring.

A client comes to the genitourinary clinic reporting accidental leakage of urine. She says it happens whenever she coughs, laughs, or sneezes. It also happens sometimes when she exercises. Which condition should the nurse expect?

stress incontinence Accidental leakage of urine that occurs with increased pressure on the bladder from coughing, sneezing, laughing, or physical exertion is labeled stress incontinence. Urge incontinence is characterized by precipitous loss of urine preceded by a strong urge to void with increased bladder pressure and detrusor contraction. Mixed incontinence is a combination of the two.

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 Follicular cysts typically appear in women of reproductive age. They can occur at any age but are rare after menopause. All other statements are true

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. The majority of genital fistulas are the result of obstetric trauma. When labor is obstructed or prolonged, this unrelieved compression causes ischemia, which causes pressure necrosis and subsequent fistula formation. A urethrovaginal fistula is formed between the urethra and vagina. Vesicovaginal fistulas occur between the bladder and genital tract. A rectovaginal fistula would occur between the rectum or sigmoid colon and vagina. Urge incontinence would result with the urine leaking from the urethra, not vagina.

A client is seen in the clinic with symptoms of "dragging" and feeling like something is "coming down." During her assessment, the nurse should look at which risk factors for a prolapse? Select all that apply.

vaginal birth advanced age increased body mass index The cause of prolpase is multifactorial with vaginal birth, advancing age, and increasing body mass index as the most consistent risk factors. Diabetes and frequent UTIs are not risk factors for a prolapse.

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 Side effects of GnRH include hot flashes, vaginal dryness, headaches, mood changes, depression, bone loss, and musculoskeletal malaise. Other side effects require use of a pessary, a hard plastic or rubber device placed in the vagina for support.

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

vaginal hysterectomy Surgical interventions might include anterior or posterior colporrhaphy (to repair a cystocele or rectocele) and vaginal hysterectomy (for uterine prolapse). A vaginal hysterectomy is the treatment of choice for uterine prolapse because it removes the prolapsed organ that is bringing down the bladder and rectum with it. It can be combined with an anterior and posterior repair if a cystocele or rectocele is present. An abdominal hysterectomy would not be used typically.