Question 1

A 49-yr-old patient tells the nurse that she is postmenopausal but has recently had occasional spotting. Which initial response by the nurse is appropriate?

Accepted Answer

In postmenopausal women,a common cause of spotting is hormone replacement therapy. Because breakthrough bleeding may be a sign of problems such as cancer or infection,the nurse would not imply that this is normal. The length of time since the last menstrual period is not relevant to the patient's symptoms. Although endometrial cancer may cause spotting,this information is not appropriate as an initial response.

Question 2

A 58-yr-old patient is on the medical-surgical unit after undergoing a radical vulvectomy for vulvar carcinoma. The greatest risk to the patient at this time is

Accepted Answer

Complex and meticulous wound care is needed to prevent infection and delayed wound healing. The patient may be at risk for other problems,but they are not the greatest concerns in the immediate postoperative time period.

Question 3

A patient who has a large cystocele was admitted 10 hours ago but has not yet voided. If the patient reports no urge to void,which action should the nurse take first?

Accepted Answer

Because urinary retention is common with a large cystocele,the nurse's first action should be to use an ultrasound bladder scanner to check for the presence of urine in the bladder. The other actions may be appropriate,depending on the findings with the bladder scanner.

Question 4

A 19-yr-old patient visits the health clinic for a routine checkup. Which question should the nurse ask to determine whether a Pap test is needed?

Accepted Answer

The current American Cancer Society recommendation is that a Pap test be done every 3 years,starting 3 years after the first sexual intercourse and no later than age 21 years. The information about menstrual periods and substance abuse will not help determine whether the patient requires a Pap test.

Question 5

A patient brought to the emergency department reports being sexually assaulted. The patient is confused about where she is and she has a laceration above the right eye. Which action should the nurse take first?

Accepted Answer

The first priority is to treat urgent medical problems associated with the sexual assault. The patient's head injury may be associated with a head trauma such as a skull fracture or subdural hematoma. Therefore her neurologic status should be assessed first. The other nursing actions are also appropriate,but they are not as high in priority as assessment and treatment for acute physiologic injury.

Question 6

Which nursing assessment finding in a patient who recently started taking hormone replacement therapy (HRT)requires discussion with the health care provider about a change in therapy?

Accepted Answer

Unilateral calf swelling may indicate deep vein thrombosis caused by the changes in coagulation associated with HRT and would indicate that the HRT should be discontinued. Breast tenderness,weight gain,and intermittent spotting are common side effects of HRT and do not indicate a need for a change in therapy.

Question 7

A patient is on the surgical unit after a radical abdominal hysterectomy. Which finding requires a report to the health care provider?

Accepted Answer

The decreased urine output indicates possible low blood volume and further assessment is needed to assess for possible internal bleeding. Decreased bowel sounds,minor drainage on the dressing,and abdominal pain with coughing are expected after this surgery.

Question 8

The nurse will plan to teach the female patient with genital warts about the

Accepted Answer

Genital warts are caused by the human papillomavirus (HPV)and increase the risk for cervical cancer. There is no indication that the patient needs teaching about PID,oral contraceptives,or endometrial cancer.

Question 9

The nurse will plan to teach a 34-yr-old patient diagnosed with stage 0 cervical cancer about

Accepted Answer

Because the carcinoma is in situ,conization can be used for treatment. Radical hysterectomy,chemotherapy,or radiation will not be needed.

Question 10

Which topic will the nurse include in the preoperative teaching for a patient admitted for an abdominal hysterectomy?

Accepted Answer

Venous thromboembolism is a potential complication after the surgery,and the nurse will instruct the patient about ways to prevent it. Vaginal sensation is decreased after a vaginal hysterectomy but not after abdominal hysterectomy. Most hysterectomies are not done for treatment of cancer. Unless the patient has cancer,chemotherapy and radiation will not be prescribed. Because the patient will still have her ovaries,her estrogen level will not decrease.

Question 11

A 31-yr-old patient who has been diagnosed with human papillomavirus (HPV)infection gives a health history that includes smoking tobacco,taking oral contraceptives,and having been treated twice for vaginal candidiasis. Which topic will the nurse include in patient teaching?

Accepted Answer

Because HPV infection and smoking are both associated with increased cervical cancer risk,the nurse should emphasize the importance of avoiding smoking. An HPV infection does not decrease vaginal lubrication,decrease the ability to conceive,or require the use of antifungal creams.

Question 12

A patient requests a prescription for birth control pills to control severe abdominal cramping and headaches during her menstrual periods. Which action should the nurse take first?

Accepted Answer

Oral contraceptives may be appropriate to control this patient's symptoms,but the patient's health history may indicate contraindications to oral contraceptive use. Because the patient is requesting contraceptives for management of dysmenorrhea,whether she is sexually active is irrelevant. Because the patient is asking for birth control pills,responding that she should try NSAIDs is nontherapeutic. The patient does not need teaching about oral contraceptive side effects at this time.

Question 13

A patient undergoes an anterior and posterior (A&P)colporrhaphy for repair of a cystocele and rectocele. Which nursing action will be included in the postoperative care plan?

Accepted Answer

The patient will have a retention catheter for several days after surgery to keep the bladder empty and decrease strain on the suture. A pessary will not be needed after the surgery. Vaginal wound packing is not usually used after an A&P repair. A low-residue diet will be ordered after posterior colporrhaphy.

Question 14

A 50-yr-old patient is diagnosed with uterine bleeding caused by a leiomyoma. Which information will the nurse include in the patient teaching plan?

Accepted Answer

Leiomyomas appear to depend on ovarian hormones and will atrophy after menopause,leading to a decrease in symptoms. Aspirin use is discouraged because the antiplatelet effects may lead to heavier uterine bleeding. The size of the tumor will shrink after menopause. Leiomyomas are benign tumors that do not undergo malignant changes.

Question 15

A patient in the emergency department reports that she has been sexually assaulted. Which action by the nurse will help to maintain the medicolegal chain of evidence?

Accepted Answer

The careful labeling of specimens and materials will assist in maintaining the chain of evidence. Assisting with paperwork,and discussing STIs and pregnancy prevention are interventions that might be appropriate after sexual assault,but they do not help maintain the legal chain of evidence.

Question 16

Which patient in the women's health clinic will the nurse expect to teach about an endometrial biopsy?

Accepted Answer

Patients with a personal or familial history of hereditary nonpolyposis colorectal cancer are at increased risk for endometrial cancer. Alcohol addiction does not increase this risk. Multiple pregnancies and oral contraceptive use offer protection from endometrial cancer.

Question 17

A patient has just been instructed in the treatment for a Chlamydia trachomatis vaginal infection. Which patient statement indicates that the nurse's teaching has been effective?

Accepted Answer

Chlamydia is a sexually transmitted bacterial infection that requires treatment of both partners with antibiotics for 7 days. The other statements are true for the treatment of Candida albicans infection.

Question 18

Which action should the nurse take when a 35-yr-old patient has a Pap test result of minor cellular changes?

Accepted Answer

Patients with minor changes on the Pap test can be followed with Pap tests every 4 to 6 months because these changes may revert to normal. Punch biopsy or colposcopy may be used if the Pap test shows more prominent changes. The HPV vaccine may reduce the risk for cervical cancer,but it is recommended only for ages 9 through 26 years.

Question 19

When caring for a patient who has a radium implant for treatment of cervical cancer,the nurse will

Accepted Answer

The nurse should spend minimal time in the patient's room to avoid exposure to radiation. The patient and nurse can have longer conversations by telephone between the patient room and nursing station. To prevent displacement of the implant,absolute bed rest is required. Wearing of gloves and gown when changing linens and flushing the toilet several times are not necessary because the isotope is confined to the implant.

Question 20

A nursing diagnosis that is likely to be appropriate for a 67-yr-old patient who has just been diagnosed with stage III ovarian cancer is

Accepted Answer

The patient with stage III ovarian cancer is likely to be anxious about the poor prognosis and about the need to make decisions about the multiple treatments that may be used. Decreased vaginal sensation does not occur with ovarian cancer. The patient may develop immune dysfunction when she receives chemotherapy,but she is not currently at risk. It is unlikely that the patient has delayed seeking medical care because the symptoms of ovarian cancer are vague and occur late in the course of the cancer.

Quiz 53: Female Reproductive and Genital Problems