Reproductive: endometriosis - hysterectomy
During a routine sports physical examination, the nurse practitioner recommends HPV vaccination for an 11-year-old girl. Which statements by the client's mother demonstrates understanding of HPV vaccinations? A. "I will track follow-up appointments in my smartphone so she receives all three injections." B. "If my daughter is immunized against HPV, she can delay her first scheduled Pap test." C. "This vaccination is not indicated for my son, since boys cannot receive the HPV vaccine." D. "It's nice that she can take this vaccination intranasally, to avoid repeated injections."
A ("I will track follow-up appointments in my smartphone so she receives all three injections." The Centers for Disease Control and Prevention recommends routine vaccination of boys and girls 11-12 years of age, before they become sexually active. The vaccination is administered in three intramuscular doses, with the initial dose followed by a second dose in 2 months and a third dose 6 months after the first dose. Completion of all three doses of the vaccine is important for immunity to develop; it does not replace other strategies important in the prevention of HPV. Women still need recommended cervical cancer screening.)
A 32-year-old client has been diagnosed with an ovarian cyst and asks the nurse, "Should I be worried about cancer?" Which response by the nurse would be most appropriate? A. "Most cysts are benign in younger women, but it's good to have it checked out." B. "Ovarian cysts can be malignant but this is a rare occurrence." C. "Ovarian cysts are just that, cysts and not a cause for concern." D. "Since you don't have any symptoms, the chances of having cancer are really remote."
A ("Most cysts are benign in younger women, but it's good to have it checked out." The risk of malignancy in postmenopausal women is much greater than in premenopausal women, with almost all pelvic masses in premenopausal women being benign. However, although typically benign, the cyst should be evaluated to exclude ovarian cancer. The most appropriate response would be to provide this information to the client but also reinforce her actions to have the cyst evaluated. Telling the client that the cyst is no cause for concern or that ovarian cysts are rarely malignant ignores the client's feelings and does not address the client's concern. The absence of symptoms does not eliminate the possibility of a malignancy. Often, ovarian cancer is difficult to detect and signs and symptoms are vague and nonspecific.)
A client is diagnosed with polycystic ovarian syndrome. Which of the following findings would the nurse expect to assess? Select all that apply. A. Impaired glucose tolerance B. Emaciated appearance C. Sleep apnea D. Menorrhagia E. Hirsutism
A, C, E (- Hirsutism - Impaired glucose tolerance - Sleep apnea Polycystic ovarian syndrome is associated with obesity, insulin resistance, impaired glucose tolerance, dyslipidemia, sleep apnea, and infertlity. In addition, menstrual periods may be irregular. Menorrhagia (excessive bleeding) is more commonly associated with fibroids.)
A client is in the clinic for an annual examination and questions the need for a pelvic examination and Pap smear because she had a hysterectomy many years ago. Which response by the nurse is most appropriate? a. "Do you still have your cervix?" b. "Are you sexually active?" c. "We can skip it if you like." d. "Let's see what the doctor says."
ANS: A Women who still have their cervix after hysterectomy still need a Pap smear according to the guidelines established for other women. Sexual activity is not relevant. Simply stating that it can be skipped does not help the woman protect her health. Asking the provider does not help the nurse further assess the client.
The client in the gynecology clinic asks the nurse, "What are the risk factors for developing cancer of the cervix?" Which statement is the nurse's best response? a. "The earlier age of sexual activity and the more partner, the greater the risk." b. "Eating fast food high in fat and taking birth control pills are risk factors" c. "A chlamydia infection can cause cancer of the cervix." d. "Having early pap smears will protect you from developing cancer
ANS: A Risk factors for cancer of the cervix include sexual activity before the age of 20 years; multiple sexual partner; early childbearing; exposure to HPV; HIV infection; smoking; and nutritional deficits of folates, beta carotene and vitamin C
Which question is most important for the nurse to ask the client with a cystocele who is schedule to have a pessary inserted? a. "Do you know if you are allergic to latex?" b. "When did you started having incontinence?: c. 'When was your last bowel movement?" d. "Are you experiencing any pelvic pressure?"
ANS: A The client should be assessed for allergies to latex as a result of the composition of the pessary
The nurse is caring for a client who is day 1 post-op hysterectomy for cancer of the ovary. Which nursing intervention should the nurse implement? Select all the apply. a. Assess for calf enlargement and tenderness b. TCDB every 6 hours c. Assess pain on a 1 to 10 pain scale d. Apply sequential compression devices to legs e. Assess bowel sounds every 4 hours.
ANS: A, C, D, E All client who had surgery are at risk for developing deep vein thrombosis and an enlarged, tender calf is a sign of DVT. Clients who have had surgery should be assessed for pain on a pain scale and by observing for physiological markers indicating pain. Sequential compression hose are used prophylactically to prevent deep vein thrombosis. The client should be assess for the return of bowel sounds.
The client is diagnosed with benign uterine fibroid tumors. Which question should the nurse ask to determine if the client is experiencing a complication? a. "How many period have you missed?" b. "Do you get short of breath easily?" c. "How many times have you been pregnant?" d. "Where is the location of the pain you are having?
ANS: B Many women delay surgery until anemia has occured from the heavy menstrual flow. A symptom of anemia is shortness of breath
A 68-year-old female client presents to the gynecology clinic with complaints of painless vaginal bleeding. The nurse anticipates that the client will be tested for which condition? A) Ovarian cyst B) Cervical or uterine cancer C) Polycystic Ovarian syndrome D) Endometriosis
ANS: B Painless vaginal bleeding is often the only symptom of cervical or uterine cancer
The nurse is caring for a client diagnosed with uterine cancer who has been receiving systemic therapy for 6 months. Which intervention should the nurse implement first? a. Determine which antineoplastic medication the client has received. b. Ask the client if she has had any problems with mouth ulcers at home. c. Administer the biologic response modifier filgrastim (Neupogen) d. Encourage the client to discuss feeling about having cancer.
ANS: B The systemic side effects of chemotherapy are not always apparent and the development of stomatitis can be extremely distressing for the client. The nurse should assess the client's tolerance to treatments.
The 50 year old female client complains of bloating and indigestion and tells the nurse she has gained two inches in her waist recently. Which question should the nurse ask the client? a. "What do you have before you feel bloated?" b. "Have you had your ovaries removed?" c. "Are you stools darker in color lately? d. " Is the indigestion worse when you lie down?"
ANS: B Ovarian cancer has vague symptoms of abdominal discomfort, but increasing abdominal girth is the most common symptom. If the client has had the ovaries removed, then the nurse would assess for another cause.
The female client has a mother with ovarian cancer. Which recommendations should the nurse make regarding early detection of ovarian cancer? a. The client should consider having a prophylactic bilateral oophorectomy. b. The client should have a transvaginal ultrasound and a CA-125 laboratory test every 6 months. c. The client should have yearly magnetic resonance imaging (MRI) scans d. The client should have a biannual gynecological examination with flexible sigmoidoscopy.
ANS: B The transvaginal ultrasound is a sonogram in which the sonogram probe is inserted into the vagina and sound waves are directed toward the ovaries. The CA-125 tumor marker is elevated in several cancers. It is nonspecific but, coupled with the sonogram, can provide information about ovarian cancer for early diagnosis.
While the nurse is preparing a client for a Pap test, the client asks why the Pap test needs to be done. Which reasons should the nurse include in a response? Select all that apply. A) Diagnose uterine cancer B) Detect the presence of STIs C) Detect abnormal cells in the cervix D) Diagnose cause of PMS E) Detect hormonal changes
ANS: B, C, E
A client has just had a Pap test to help confirm a diagnosis. The nurse completes the laboratory requisition that the client had which possible diagnosis? A) Vulvitis B) Endometriosis C) HPV infection D) AIDS
ANS: C
The nurse is formulating a care place for a client post-abdominal hysterectomy. Which nursing diagnosis is appropriate for the client who has developed a complication? a. Potential for urinary retention. b. Potential for nerve damage c. Potential for intestinal obstruction d. Potential for fluid imbalance
ANS: C Clients who have has a total abdominal hysterectomy are at risk for intestinal obstruction
What intervention should the nurse implement for a client diagnosed with rectocele? a. Limit oral intake to decrease voiding. b. Encourage a low-residue diet c. Administer a stool softener daily. d. Arrange for the client to take sitz baths
ANS: C Stool softeners are laxatives are used to prevent and treat constipation, which is common with rectocele. BEcause of the position of the rectum, stool can stay in the rectal pouch, causing constipation
The client diagnosed with endometriosis experience pain rated a 5 on a 1 to 10 pain scale during her menses. Which intervention should the nurse teach the client? a. Teach the client to take a stool softener when taking morphine b. Instruct the client to soak in a tepid bath for 30-45 minutes when the pain occurs. c. Explain the needs to take nonsteroidal anti-inflammatory rugs with food. d. Discuss the possibility of a hysterectomy to help relieve the pain
ANS: C The medication of choice for mild to moderate dysmenorrhea is an NSAID. NSAIDS cause GI upset and should be taken with food.
A client is scheduled for an ultrasound to evaluate for possible uterine fibroids. Which instruction by the nurse is most appropriate? a. "Do not eat or drink anything after midnight." b. "Take these laxatives the morning of the test." c. "Do not urinate an hour before the test; a full bladder will give best results." d. "Have a designated driver because you will be sleepy from the anesthesia."
ANS: C The scan is noninvasive and painless. The abdominal and pelvic organs are better visualized with the bladder full during the scan. The other statements are inaccurate
The client has had a total abdominal hysterectomy for cancer of the ovary. Which diet should the nurse discuss when providing discharge instructions? a. A low residue diet without seeds b. A low sodium, low fat diet with skim milk c. A regular diet with fruits and vegetables. d. A full liquid-only diet with mild shake supplements.
ANS: C: The client is not placed on a specific diet, but it is always a good to recommendation to include fruits and vegetables in the diet
When examining an adult female client, the nurse observes tissue protruding from the vaginal opening. The nurse reviews the medical record for a documented history of what disorder? A) Enodometriosis B) Leiomyoma C) Pelvic infection D) Uterine prolapse
ANS: D
What specific complication should the nurse assess for in the client with uterine prolapse recovering from a anterior and posterior repair? a. Orthostatic Hypertension b. Atelectasis c. Allen sign d. Deep vein thrombosis.
ANS: D Assessing for deep vein thrombosis (DVT) is performed on all client having a vaginal hysterectomy. After any surgery requiring the client to be placed in the lithotomy position, the client should be assessed for DVT. These clients are at a higher risk for this complication.
Which states indicates further instruction is needed for the client with cystocele? a. "I need to have a sonogram to diagnosed this problem" b. "I need to practice Kegel exercises to help strengthen my muscles." c. "I lose my urine when I sneeze because of my cystocele." d. "I can never have sexual intercourse again."
ANS: D Clients with cystoceles may have seuxal intercourse unless contraindicated by another medical reason
Which intervention should the nurse include when teaching the client who is having an anterior colporrhaphy to repair a cystocele? a. Discuss the need to perform perineal care every 4 hours b. Discuss the care of an indwelling catheter for at least one month c. Instruct the client how to care for the pessary inserted in surgery d. Teach the client how to perform Kegel exercises.
ANS: D The client should be taught how to perform kegel exercises to strengthen the muscles.
The postmenopausal client reveals it has been several years since her last gynecological examination and states, "Oh I don't need exams anymore. I am beyond having children" Which statement should be the nurse's response? a. "As long as you are not sexually active, you don't have to worry." b. "You should be taking hormone replacement therapy now." c. "You are beyond bearing children. How does that make you feel?" d. "There are situations other than pregnancy that should be checked"
ANS: D The client should have a yearly clinical examination of the breast and pelvic area for the detection of cancer.
The nurse is teaching the client diagnosed with uterine prolapse. Which information should the nurse include in the discussion? a. Increase fluid and daily exercise to prevent constipation. b. Explain there is only one acceptable treatment for uterine prolapse. c. Instruct the client to visually check the uterine prolapse daily. d. Discuss limiting coughing and lifting heavy objects
ANS: D Symptoms can be aggravated by coughing, sneezing, lifting heavy objects, standing for prolonged periods and climbing stairs.
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. An enterocele B. A urinary tract infection C. A cystocele D. A rectocele
C (A cystocele 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 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: A. Dyspareunia. B. Low back pain. C. Chronic pelvic pain. D. Dysuria.
C (Chronic pelvic pain is the most frequent symptom of endometriosis. Low back pain, dyspareunia, dysuria, dyschezia, dysmenorrhea, and menorrhagia are among the common complaints. The level of pain associated with endometriosis is not necessarily correlated with the stage of endometriosis.)
A client, age 42, visits the gynecologist. After examining the client, the physician suspects cervical cancer. The nurse reviews the client's history for risk factors for this disease. Which history finding is a risk factor for cervical cancer? A. Onset of sporadic sexual activity at age 17. B. Pregnancy complicated with eclampsia at age 27. C. Human papillomavirus infection at age 32.
C (Human papillomavirus infection at age 32. Like other viral and bacterial venereal infections, human papillomavirus is a risk factor for cervical cancer. Other risk factors for this disease include frequent sexual intercourse before age 20, multiple sex partners, and multiple pregnancies. A spontaneous abortion and pregnancy complicated by eclampsia aren't risk factors for cervical cancer.)
A client who wishes to preserve childbearing asks the nurse to explain how taking oral contraceptives will work in the management of endometriosis. Which is the best response by the nurse? A. "Trapping blood causes less pain or discomfort for clients with endometriosis." B. "Endometriosis is usually cured with surgical menopause." C. "Contraceptives will allow blood to be diverted to the peritoneal cavity." D. "Symptoms of endometriosis are increased during normal menstrual cycle."
D ("Symptoms of endometriosis are increased during normal menstrual cycle." The use of estrogen-progestin contraceptives keeps the client in a non bleeding phase of the menstrual cycle, therefore decreasing ectopic tissue from shedding and causing extra uterine bleeding. Blood that is trapped in the peritoneal cavity causes more pain as adhesions form. Endometriosis is cured by natural or surgical menopause but can be medically managed for periods of time with the use of oral contraceptives.)
A client has undergone a total abdominal hysterectomy and bilateral salpingo-oopherectomy as treatment for endometrial cancer. When providing postoperative care to this client the nurse would be alert for signs and symptoms of which of the following? A. Neurotoxicity B. Clotting deficiencies C. Leukopenia D. Bladder dysfunction
D (Bladder dysfunction After a total abdominal hysterectomy and bilateral salpingo-oopherectomy, the client is at risk for several complications, especially bladder dysfunction because the surgical site is close to the bladder. Leukopenia and neurotoxicity are adverse effects of chemotherapy agents such as paclitaxel and carboplatin used to treat ovarian cancer. Deep vein thrombosis, not clotting deficiencies are a potential complication after this type of surgery.)
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? A. Hodgkin disease B. Colorectal cancer C. Cancer of the urinary tract D. Cervical cancer
D (Cervical cancer The client's symptoms are those of cervical cancer. Symptoms of cervical cancer include abnormal vaginal bleeding and persistent yellowish, blood-tinged, or 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.)
Which of the following is the descent of the small intestine into the vaginal vault? A. Cystocele B. Uterine prolapse C. Rectocele D. Enterocele
D (Enterocele The descent of the small intestine into the vaginal vault is termed enterocele. A rectocele is the extrusion of the rectum into the posterior vagina. A cystocele is the herniation of the bladder into the anterior vagina. A uterine prolapsed is the downward descent of the uterus into the vagina.)
A patient is receiving chemotherapy with paclitaxel as treatment for ovarian cancer. The patient arrives at the facility for laboratory testing prior to her next dose of chemotherapy. The results are as follows: A. Hemoglobin: 12.9 gm/dL B. White blood cell count: 2,200 /cu mm C. Platelets: 250,000 /cu mm D. Red blood cell count: 4,400,00/cu mm Which result would be a cause for concern?
D (The patient's white blood cell count is low, revealing leukopenia and placing the patient at an increased risk for infection. The other results are within normal parameters and would not be a cause for concern.)
