Reproductive Disorders

A perimenopausal woman informs the nurse that she is having irregular vaginal bleeding. What should the nurse encourage the patient to do?

- See her gynecologist as soon as possible. Explanation: All women should be encouraged to have annual checkups, including a gynecologic examination. Any woman who is experiencing irregular bleeding should be evaluated promptly.

The nurse is encouraging a patient to have a cervical examination and Pap smear. It has been many years since the patient's last exam, and she was diagnosed with HPV 6 years ago. The patient states, "I am not having any trouble down there, so it is best to leave things alone." What is the best response by the nurse?

- "Early cervical cancer rarely produces any symptoms." Explanation: Early cervical cancer rarely produces symptoms. If symptoms are present, they may go unnoticed as a thin, watery vaginal discharge often noticed after intercourse or douching. When symptoms such as discharge, irregular bleeding, or pain or bleeding after sexual intercourse occur, the disease may be advanced.

A client is being discharged home after a hysterectomy. When providing discharge education for this client, the nurse has cautioned the client against sitting for long periods. This advice addresses the client's risk of what surgical complication?

- Venous thromboembolism Explanation: The client should resume activities gradually. This does not mean sitting for long periods, because doing so may cause blood to pool in the pelvis, increasing the risk of thromboembolism. Sitting for long periods after a hysterectomy does not cause postoperative nerve damage; it does not increase the fatigue factor after surgery or the risk of hemorrhage.

Which is the earliest and the most common symptom of endometrial cancer?

- bleeding Explanation: Bleeding is the earliest and the most common sign of endometrial cancer.

A client is experiencing symptoms associated with menopause. What is a likely recommendation to increase the client's interest in sexual activity?

- low-dose androgens Explanation: Low-dose androgens are added to the hormone replacement regimen to restore an interest in sexual activity.

A patient is diagnosed with the most common type of uterine fibroid, an intramural fibroid. The nurse includes which information in teaching the patient about this type of fibroid?

- It grows within the wall of the uterine muscle.

Which drug is the most effective treatment for trichomoniasis?

- Metronidazole Explanation: The most effective treatment for trichomoniasis is metronidazole.

An elderly client, who can void only while standing and pushing upward on the vagina, is ordered a pessary. Which comment from the client indicates a need for further teaching about this device?

- "I will remove and clean it every day." Explanation: Pessaries should be removed, cleaned, and replaced periodically (at least every 2 months). If the client is unable to manage the pessary, then follow-up appointments should be made with the practitioner. Ill-fitting pessaries can cause irritation and erosion of tissue resulting in irritation, bleeding, or infection. The placement of the pessary should support the uterus in the pelvis and lessen urinary and pelvic symptoms.

A middle-aged female client has been offered testing for HIV/AIDS upon admission to the hospital for an unrelated health problem. The nurse observes that the client is visibly surprised and embarrassed by this offer. How should the nurse best respond?

- "This testing is offered to every adolescent and adult regardless of their lifestyle, appearance or history." Explanation: Because clients may be reluctant to discuss risk-taking behavior, routine screening should be offered to all women between the ages of 13 and 64 years in all health care settings. Assuring a client that the offer of testing is not related to a heightened risk may alleviate the anxiety. Middle-aged women are not the prime demographic for HIV infection.

Which client has the highest risk of ovarian cancer?

- 45-year-old woman who has never been pregnant Explanation: The incidence of ovarian cancer increases in women who have never been pregnant, are older than age 40, are infertile, or have menstrual irregularities. Other risk factors include a family history of breast, bowel, or endometrial cancer. The risk of ovarian cancer is reduced in women who have taken hormonal contraceptives, have had multiple births, or have had a first child at a young age.

A patient reports to the nurse that she has a sense of pelvic pressure and urinary problems such as incontinence, frequency, and urgency. The problem has gotten much worse since the birth of her third child. What does the nurse suspect the patient is experiencing?

- A cystocele Explanation: Cystocele is a downward displacement of the bladder toward the vaginal orifice (Fig. 57-3) from damage to the anterior vaginal support structures. It usually results from injury and strain during childbirth. Because a cystocele causes the anterior vaginal wall to bulge downward, the patient may report a sense of pelvic pressure and urinary problems such as incontinence, frequency, and urgency. Back pain and pelvic pain may occur as well. The symptoms of rectocele resemble those of cystocele, with one exception: Instead of urinary symptoms, patients may experience rectal pressure. Constipation, uncontrollable gas, and fecal incontinence may occur in patients with complete tears.

A client has been diagnosed with endometriosis. When planning this client's care, the nurse should prioritize what nursing diagnosis?

- Acute pain related to misplaced endometrial tissue Explanation: Symptoms of endometriosis vary but include: - dysmenorrhea - dyspareunia - pelvic discomfort or pain. - Dyschezia (pain with bowel movements) and radiation of pain to the back or leg may occur. Ineffective tissue perfusion is not associated with endometriosis and there is no plausible risk of fluid overload. Endometriosis is not transmittable.

The history of a female patient reveals the following:First coitus at age 16 yearsFirst pregnancy at age 28 yearsSexual intercourse with circumcised partnerWeight appropriate for heightWhich of the following would alert the nurse to a possible risk factor for developing cervical cancer?

- Age at first coitus Explanation: Risk factors for developing cervical cancer include: - an early age with first coitus - early childbearing - overweight status - sexual intercourse with uncircumcised males

A client reports stress incontinence, pelvic pain, and a feeling like "something is dropping out of my vagina." The client is diagnosed as having a pelvic organ prolapse and the treatment plan includes using a pessary. Which instructions will the nurse include in client education?

- Apply a sterile lubricant to the pessary before it is reinserted. Explanation: A pessary should be lubricated before insertion. Bedrest and alterations to voiding are not necessary to use the device safely and effectively.

A client is postoperative day 1 following a vaginal hysterectomy. The nurse notes an increase in the client's abdominal girth and the client reports "bloating." What is the nurse's most appropriate action?

- Apply warm compresses to the client's lower abdomen. Explanation: If the client has abdominal distention or flatus, a rectal tube and application of heat to the abdomen may be prescribed. Ice and carbonated beverages are not recommended, and prone positioning would be uncomfortable.

A woman's current health reports are suggestive of a diagnosis of premenstrual dysphoric disorder (PMDD). Which should the nurse do first?

- Assess the client for risk of suicide. Explanation: If the client has severe symptoms of PMS or PMDD, the nurse assesses her for suicidal, uncontrollable, and violent behavior. The problem can escalate and is not necessarily self-limiting. HT is not a relevant intervention and the nurse should not recommend herbal supplements without input from the primary provider.

The nurse is planning health education for a client who has experienced a vaginal infection. What guidelines should the nurse include in this program regarding prevention?

- Avoid commercial feminine hygiene products, such as sprays. Explanation: Instead of tight-fitting synthetic, nonabsorbent, heat-retaining underwear, cotton underwear is recommended to prevent vaginal infections. Daily washing is not restricted. Douching is generally discouraged, as is the use of feminine hygiene products. Some studies have found that submersion in particularly hot baths and/or adding salts or fragrances disrupts the vaginal PH (potential hydrogen) and may contribute to vaginal infections.

A client has been diagnosed with genital herpes. Knowing that education is an essential part of nursing care of the client with a genital herpes infection, the nurse plans to include which method(s) to minimize HIV transmission? Select all that apply. - Avoiding unprotected sexual intercourse - Avoiding multiple sexual partners - Avoiding physical contact with others in crowded places - Avoiding IV drug use - Avoiding HPV vaccinations

- Avoiding unprotected sexual intercourse - Avoiding multiple sexual partners - Avoiding IV drug use Explanation: Intravenous drug use and risky sexual behaviors, which include multiple partners and unprotected sex, are factors that can put anybody at risk for HIV. Thus, the correct way to minimize HIV transmission would be to avoid these factors. HIV is not transmitted through simple physical contact. Open lesions related to HPV increase the likelihood that HIV can be transmitted; prevention includes administration of the HPV vaccine.

A client with trichomoniasis comes to the walk-in clinic. In developing a care plan for this client the nurse would know to include what as an important aspect of treating this client?

- Both partners will be treated with metronidazole. Explanation: The most effective treatment for trichomoniasis is metronidazole. Both partners receive a one-time loading dose or a smaller dose three times a day for 1 week. In pelvic inflammatory disease, menstrual difficulties and constipation may occur. Kegel exercises are prescribed to help strengthen weakened muscles associated with cystocele and other structural deficits.

During consultations with the oncologist, a client with cervical cancer is informed that radioactive materials will be inserted in the area of the tumor. She has to undergo these sessions over a period of 3 weeks. Which method of cancer treatment is being described?

- Brachytherapy Explanation: Internal radiation, or brachytherapy, delivers a dose of radiation to a localized area inside the body through the use of an implant. The implant may be applied by a needle, seed, bead, or catheter, or can be given orally. Antineoplastic agents used in chemotherapy interfere with the cellular function of the cancer cells and cause cell death. Needle aspiration biopsy involves aspirating tissue fragments through a needle guided into the cancer cells.

Over the past 2 months, a client has been receiving treatment for multiple ear infections and tonsillitis. The client reports a curdy white vaginal discharge and burning with urination. What is the most likely cause of these symptoms?

- Candida albicans Explanation: Candida albicans: - thick, curdy white discharge - strong odor and burning with urination Trichomonas vaginalis: - foamy, yellow-white discharge - foul odor and severe itching Gardnerella vaginalis: - watery, gray-white discharge - fishy odor - more discharge after intercourse

A client has vaginitis identified through tests as caused by a fungus. The nurse recognizes that the likely causative organism is which of the following?

- Candida albicans Explanation: The pathogenic microorganisms frequently associated with vaginitis are: - bacterium Gardnerella vaginalis - protozoan Trichomonas vaginalis - yeast-like fungus Candida albicans. L. acidophilus: a probiotic used to treat Candida infections

A client who underwent an anterior colporrhaphy 6 hours ago has not voided. She reports some discomfort in her suprapubic area. Which of the following would the nurse expect to do?

- Catheterize the client. Explanation: After repair of a cystocele (anterior colporrhaphy), the client is encouraged to void within a few hours. If the client does not void within this period and reports discomfort or pain in the bladder region after 6 hours, the client should be catheterized to prevent pressure on the suture line. Stool softeners may be appropriate after a posterior colporrhaphy (repair of a rectocele) or repair of a complete perineal laceration. Ice can be applied locally after an external perineal repair. Because the client is post surgery, analgesics most likely would have been ordered already. In this situation, the pain is from bladder distention; relief of this distention through catheterization would subsequently relieve the client's pain.

A woman in her late 30s has been having unusually heavy menstrual periods combined with occasional urine and stool leakage over the past few weeks. Upon further enquiry, she reveals that she also has postcoital pain and bleeding. To which diagnosis will the investigation most likely lead?

- Cervical cancer Explanation: The client's symptoms are those of cervical cancer. Symptoms of cervical cancer include: - abnormal vaginal bleeding - persistent yellowish, blood-tinged - foul-smelling discharge. Clients may complain of postcoital pain and bleeding, bleeding between menstrual periods, and unusually heavy menstrual periods. If the cancer has progressed into the pelvic wall, the Clients may experience pain in the flank regions of the body.

A nurse practitioner examines a patient suspected of having endometriosis. The nurse knows that although a definitive diagnosis could not be made without diagnostic treatment (transvaginal ultrasound), the most frequent symptom is:

- Chronic pelvic pain. Explanation: Chronic pelvic pain is the most frequent symptom of endometriosis along with: - Low back pain - dyspareunia - dysuria - dyschezia - dysmenorrhea - menorrhagia

A female client severely reduced her body fat through extreme caloric restriction and exercise. Which reproductive abnormalities could she acquire as a result of the reduction in body fat?

- Delay or cessation of menstruation Explanation: She could acquire reproductive abnormalities, such as delay or cessation of menstruation. A cause of infertility in women is polycystic ovarian syndrome a complex endocrine disorder linked to insulin resistance. High caffeine consumption may also put a client at risk for fibrocystic breast disease.

When a female client reports profuse purulent discharge, dysuria, and bleeding, the advance practice nurse is most likely to prescribe which medication to treat this condition?

- Doxycycline for 1 week Explanation: Chlamydia causes a profuse purulent discharge and may be accompanied by dysuria and bleeding. The Centers for Disease Control and Prevention recommends treating chlamydia with doxycycline for 1 week or a single dose of azithromycin. Trichomonas vaginalis causes a frothy yellow-white or yellow-green vaginal discharge. Treatment for Trichomonas vaginalis is metronidazole or tinidazole. Both partners receive a one-time loading dose. Candidiasis causes a white, cheese-like discharge clinging to the vaginal epithelium. Terconazole cream inserted into the vagina with an applicator at bedtime and is the appropriate treatment for Candidiasis. Gardnerella vaginalis causes a gray-white to yellow-white discharge clinging to the external vulva and vaginal walls. Metronidazole is taken orally twice a day for 1 week to treat Gardnerella vaginalis.

A nurse is caring for a client who had a vulvectomy. Included in the client's care plan are interventions to reduce the risk for infection. Which intervention would not be included in the nursing care plan?

- Empty surgical drains and catheter drainage bag with clean techniques. Explanation: A drain or catheter provides a portal through which microorganisms can enter the client's body. Principles of asepsis should be maintained. Using aseptic principles and universal precautions reduces the potential for transmitting pathogens. Hand hygiene is the best method for preventing the transmission of microorganisms; gloves are one type of universal precautions that act as a barrier to prevent contact with blood and infectious microorganisms. Stool contains pathogens that can be introduced into the wound.

Which of the following is the descent of the small intestine into the vaginal vault?

- Enterocele Explanation: - Enterocele: Small intestine into the vaginal vault - Rectocele: Extrusion of the rectum into the posterior vagina - Cystocele: herniation of the bladder into the anterior vagina. - Uterine prolapse: downward descent of uterus into vagina.

A patient informs the nurse that she believes she has premenstrual syndrome and is having physical symptoms as well as moodiness. What physical symptoms does the nurse recognize are consistent with PMS? Select all that apply. - Fluid retention - Low back pain - Fever - Headache - Hypotension

- Fluid retention - Low back pain - Headache Explanation: Major symptoms of PMS include physical symptoms such as: - headache - fatigue - low back pain - painful breasts - feeling of abdominal fullness, caused by fluid retention. Fever and hypotension are not typical symptoms of PMS.

A young client presenting at the health clinic with fever and mucopurulent vaginal drainage is diagnosed with acute pelvic inflammatory disease (PID). Which long-term affect is of greatest concern in the care of this client?

- Infertility Explanation: About one third of all women who are infertile have lost the ability to conceive due to PID. Early treatment of PID prevents the infection from ascending up the reproductive tract and/or from becoming chronic. Pelvic pain is a common symptom associated with PID.

A client has a routine Papanicolaou (Pap) test during a yearly gynecologic examination. The result reveals a class V finding. What should the nurse tell the client about this finding?

- It calls for a biopsy as soon as possible. Explanation: A class V finding in a Pap test suggests probable cervical cancer; the client should have a biopsy as soon as possible. Class I: normal, no action needed Class II: inflammation, repeat Pap in 3 months Class III: mild/moderate dysplasia, repeat Pap 6 wks - 3 mnths Class V: probable cervical cancer; biopsy asap Class IV: possible cervical cancer; biopsy asap

The nurse is caring for a 63-year-old client with ovarian cancer. The client is to receive chemotherapy consisting of paclitaxel and carboplatin. For what adverse effect of this treatment should the nurse monitor the client?

- Leukopenia Explanation: Chemotherapy is usually administered IV on an outpatient basis using a combination of platinum and taxane agents. Paclitaxel (Taxol) plus carboplatin (Paraplatin) are most often used because of their excellent clinical benefits and manageable toxicity. Leukopenia, neurotoxicity, and fever may occur. Acid-base imbalances and elevated phosphate levels are not anticipated.

The nurse in the gynecology clinic is interviewing a patient who informs the nurse that her mother and aunt had carcinoma of the cervix. What does the nurse recognize are two chief symptoms of early carcinoma that the patient should be questioned about?

- Leukorrhea and irregular vaginal bleeding or spotting Explanation: Early cervical cancer rarely produces symptoms. If symptoms are present, they may go unnoticed as a thin, watery vaginal discharge often noticed after intercourse or douching. When symptoms such as discharge, irregular bleeding, or pain or bleeding after sexual intercourse occur, the disease may be advanced.

Which of the following is a term used to describe excessive menstrual bleeding?

- Menorrhagia Explanation: Menorrhagia is excessive menstrual bleeding. Amenorrhea is the absence of menses. Dysmenorrhea is painful menses. Metrorrhagia is excessive and prolonged menstrual bleeding.

Which is the main cause of anemia in a client with active uterine leiomyoma?

- Menorrhagia Explanation: Uterine leiomyomas or fibroids cause menorrhagia, which in turn can cause anemia. Poor dietary intake of iron does not cause anemia but aggravates the problem. Though there can be a feeling of pressure in the pelvic region, this does not cause anemia.

A client has returned to the postsurgical unit after vulvar surgery. What intervention should the nurse prioritize during the initial postoperative period?

- Monitoring the integrity of the surgical site Explanation: An important intervention for the client who has undergone vulvar surgery is to monitor closely for signs of infection in the surgical site: - redness - purulent drainage - fever The client should be placed in low Fowler position to reduce pain by relieving tension on the incision. Sitz baths are discouraged after of wide excision of the vulva because of the risk of infection. Analgesics should be administered preventively on a scheduled basis to relieve pain and increase the client's comfort level.

A client has a history of dysmenorrhea. During monthly menses, the client experiences incapacitating cramping and passes large clots. The client's primary care physician initiates conservative treatment. What interventions would the physician to recommend?

- NSAIDs Explanation: Dysmenorrhea is treated with mild non-narcotic analgesics and by treating the underlying cause if one is identified. Symptomatic relief is accomplished with NSAIDs, which reduce prostaglandins. Prostaglandins are biologic chemicals that exist in endometrial tissue, where they exert a stimulating effect on the uterus, producing cramping and pain.

A nurse providing prenatal care to a pregnant client is addressing measures to reduce postpartum risk of cystocele, rectocele, and uterine prolapse. What action should the nurse recommend?

- Performance of pelvic muscle exercises Explanation: Some disorders related to "relaxed" pelvic muscles (cystocele, rectocele, and uterine prolapse) may be prevented. During pregnancy, early visits to the primary care provider permit early detection of problems. During the postpartum period, the client can be taught to perform pelvic muscle exercises, commonly known as Kegel exercises, to increase muscle mass and strengthen the muscles that support the uterus and then to continue them as a preventive action. Fluid intake, prevention of constipation, and hygiene do not reduce this risk.

A client is admitted to the health care center with abdominal pain, nausea, and vomiting. The client has a body mass index (BMI) of 30 and reports irregular menstrual cycles and feeling tired all the time. The nurse suspects the client's symptoms to indicate which condition?

- Polycystic ovary syndrome (PCOS) Explanation: Features of PCOS includes: - obesity - sleep apnea - irregular menstrual periods. Bacterial vaginosis can occur throughout the menstrual cycle and does not produce local discomfort or pain. Symptoms such as discharge, irregular bleeding, or pain or bleeding after sexual intercourse are consistent with cancer of the cervix. Symptoms of endometriosis vary but include: - dysmenorrhea - dyspareunia - pelvic discomfort or pain - Dyschezia (pain with bowel movements) and radiation of pain to the back or leg may occur

A client diagnosed with cervical cancer will soon begin a round of radiation therapy. When planning the client's subsequent care, the nurse should prioritize actions with what goal?

- Protecting the safety of the client, family, and staff Explanation: Care must be taken to protect the safety of clients, family members, and staff during radiation therapy. Hemorrhage is not a common complication of radiation therapy and the treatment can be curative. Dietary restrictions are not normally necessary during treatment.

Most cervical cancers, if not detected and treated, spread to which area?

- Regional pelvic lymph nodes Explanation: Most cervical cancers, if not detected and treated, spread to regional pelvic lymph nodes.

Upon examination, the nurse practitioner notes a backward positioning of the client's uterus. How would the nurse document this finding?

- Retroversion Explanation: - Retroversion: Uterus turns posteriorly as a whole unit - Anteversion: Uterus tilts forward as a whole unit - Retroflexion: Fundus bends posteriorly - Anteflexion: Uterus bends anteriorly

Which position occurs when the uterus turns posteriorly as a whole unit?

- Retroversion Explanation: In retroversion, the uterus turns posteriorly as a whole unit. In anteversion, the uterus tilts forward as a whole unit. In retroflexion, the fundus bends posteriorly. In anteflexion, the uterus bends anteriorly.

The nurse is caring for a client with a diagnosis of vulvar cancer who has returned from the PACU after undergoing a wide excision of the vulva. How should this client's analgesic regimen be best managed?

- Scheduled analgesia should be administered around-the-clock to prevent pain. Explanation: Because of the wide excision, the client may experience severe pain and discomfort even with minimal movement. Therefore, analgesic agents are administered preventively (i.e., around the clock at designated times) to: - relieve pain - increase the client's comfort level - allow mobility - Opioids are usually required.

The nurse is providing preoperative education for a client diagnosed with endometriosis. A hysterectomy has been scheduled. What education topic should the nurse be sure to include for this client?

- The bladder must be emptied prior to surgery and a catheter may be placed during surgery. Explanation: The intestinal tract and the bladder need to be empty before the client is taken to the OR to prevent contamination and injury to the bladder or intestinal tract. The client is informed that their periods are now over, but the client may have a slightly bloody discharge for a few days. The client is instructed to avoid: - straining - lifting - driving until the surgeon permits the client to resume these activities. The client's hormonal balance is upset, which usually occurs in reproductive system disturbances. The client may experience depression and heightened emotional sensitivity to people and situations.

A 34-year-old client has been diagnosed with endometriosis. What topic should the nurse emphasize during health education?

- The importance of reporting a possible pregnancy as soon as it occurs Explanation: Clients with endometriosis need to report pregnancies as soon as possible so that relevant treatment can be provided. The disease is noninfectious, so there is no need to have the partner tested or to be prescribed antibiotics.

A client has herpes simplex 2 viral infection (HSV-2). The nurse recognizes that which of the following should be included in teaching the client?

- Treatment is aimed at relieving symptoms. Explanation: HSV-2 (genital herpes) and is known to ascend the peripheral sensory nerves and remain inactive after infection, becoming active in times of stress. The virus is not curable, but treatment is aimed at controlling symptoms. HSV-1 (cold sores) and varicella zoster causes shingles. Family history is not relevant because the infection is viral.

A female client tells the nurse that they think they have a vaginal infection because the client has noted inflammation of the vulva and the presence of a frothy, yellow-green discharge. The nurse recognizes that the clinical manifestations described are typical of what vaginal infection?

- Trichomonas vaginalis Explanation: The clinical manifestations indicate T. vaginalis, which is treated with metronidazole in the form of oral tablets. Candidiasis produces a white, cheese-like discharge. Gardnerella is characterized by gray-white to yellow-white discharge clinging to external vulva and vaginal walls. Gonorrhea often produces no symptoms.

A nurse is teaching a client about why ovarian cancer is largely considered to be a lethal cancer of the female reproductive system. What should the nurse include in the teaching? Select all that apply. - Tumors are typically far advanced and inoperable by the time of diagnosis. - Ovarian cancer's vague symptoms are often ignored. - Tumors present with nonspecific symptoms. - There is no effective screening test. - Tumor-specific antigens are helpful in screening.

- Tumors are typically far advanced and inoperable by the time of diagnosis. - Ovarian cancer's vague symptoms are often ignored. - Tumors present with nonspecific symptoms. - There is no effective screening test. Explanation: Although other types of female reproductive system cancers occur with greater incidence, ovarian tumors are the leading cause of death from gynecologic malignancies. Tumors of the ovary have been lethal largely because they present with nonspecific symptoms, which are often ignored. There is no effective screening test; tumors frequently are far advanced and inoperable by the time the tumors are diagnosed. Tumor-specific antigens are used after diagnosis of ovarian cancer.

A client with HIV has recently completed a 7-day regimen of antibiotics. She reports vaginal itching and irritation. In addition, the client has a white, cheese-like vaginal discharge. Which condition is the client most likely experiencing?

- Vulvovaginal candidiasis Explanation: Use of antibiotics decreases bacteria, thereby altering the natural protective organisms usually present in the vagina, which can lead to candidiasis overgrowth. Clinical manifestations include a vaginal discharge that causes pruritus; the discharge may be watery or thick but usually has a white, cheese-like appearance. Bacterial vaginosis does not produce local discomfort or pain. Discharge, if noticed, is heavier than normal and is gray to yellowish white. Most HPV infections are self-limiting and without symptoms.

What is the main cause of anemia in a client with active uterine leiomyoma?

- menorrhagia Explanation: Uterine leiomyomas or fibroids cause menorrhagia, which in turn causes anemia. A poor dietary intake of iron does not cause anemia but aggravates the problem. Though there can be a feeling of pressure in the pelvic region, this does not cause anemia.

A patient had a pessary inserted for long-term treatment of a prolapsed uterus. As part of a teaching plan, the nurse would advise the patient to:

- see her gynecologist to remove and clean the pessary at regular intervals. Explanation: A pessary should be removed, examined, and cleaned by a health care provider at prescribed intervals. At this time, the vaginal wall should be examined for pressure points or signs of irritation.