Question 1

Select the congenital anomaly that best reflects indications for fetal surgery.

Accepted Answer

Conditions treated by fetal surgery include congenital diaphragmatic hernia, congenital cystic adenomatoid malformation, bronchopulmonary sequestration, obstructive uropathy, sacrococcygeal teratomas , twin-to-twin transfusion syndrome, thoracic lesions, twin reversed arterial perfusion syndrome, monochorionic twins, discordant twins, and myelomeningocele . Fetal surgery may be accomplished by way of laparotomy and hysterotomy or, in some instances, with endoscopic techniques.

Question 2

Sally Hargraves is a 72-year-old patient with multicentric carcinoma in situ (CIS) of the vulva, without evidence of leukoplakia and pruritus. She has a history of prior papillomavirus infection. Select the most appropriate surgical option.

Accepted Answer

Simple vulvectomy is removal of the labia majora and labia minora, possibly (but not preferably) the glans clitoris, and occasionally tissue from the perianal area. A simple vulvectomy is usually performed to treat carcinoma in situ of the vulva when it is multicentric. Occasionally, a vulvectomy is necessary for the treatment of either leukoplakia or intractable pruritus, especially when a skinning procedure is impractical or has failed.

Question 3

Miranda Cox returned to her gynecologist's office for a second Pap smear when her routine exam showed dysplastic cells in her cervical cytology test. Miranda has a family history of cervical cancer and had laser ablation within the last 2 years for vulvar condylomata. She can expect her gynecologist to perform another Pap smear and:

Accepted Answer

A colposcopy, with colpomicroscopy, is often performed in the physician's office. This examination is indicated for the patient with an abnormal Papanicolaou (Pap) smear suggestive of dysplasia. It identifies cellular abnormalities that may involve the vulva, vagina, or cervix and helps identify areas of dysplasia and carcinoma in situ. Endocervical curette samples may be obtained during the colposcopic procedure to rule out invasive carcinoma or to detect early adenocarcinoma.

Question 4

From the list below, select the statement that is true about fallopian tube cancer.

Accepted Answer

Fallopian tube cancer is very rare, with an incidence of less than 1%. It is seen primarily as a metastasis from ovarian and endometrial cancers. Gynecologic cancers commonly occur in the endometrium, the cervix, the ovaries, or the vagina. Less common sites are the vulva and fallopian tubes. Risk factors associated with the development of these cancers are noted in Table 5-2.

Question 5

Ova travel through the fallopian tubes toward the uterus by which type of action?

Accepted Answer

The Greek word salpinx, meaning "trumpet" or "tube," is used to

Question 6

When catheterizing the female patient, the urethra must be located. The correct order of the external organs of the vulva listed anterior to posterior is:

Accepted Answer

The external organs, referred to collectively as the vulva, include the mons pubis, the labia majora and labia minora, the clitoris, the vestibular glands, the vaginal vestibule, the vaginal opening, and the urethral opening .

Question 7

During the skin preparation for a gynecologic procedure that requires both an abdominal and a vaginal prep, the circulator must ensure that cross-contamination does not occur. Select two principles of aseptic technique that support cross-contamination prevention.

Accepted Answer

Care must be taken not to cross-contaminate when prepping multiple areas, such as for an abdominal hysterectomy. The circulator always preps the abdomen before beginning the vaginal prep, using the principle "clean to dirty." Two separate prep trays should be used and the prep setups should be kept separate. The circulator should take care when performing vaginal preps on patients who have been experiencing vaginal bleeding and may have clots in the vaginal vault. The clots and any gross blood on the thighs or vulva should be removed before beginning the prep to allow full contact of the prepping solution.

Question 8

What classification of drugs are GYN/obstetric-related medications that require monitoring of blood pressure, assessment for continued bleeding, and monitoring of fundal response to the drug?

Accepted Answer

Oxytocics are medications that increase motor activity within the uterus by hormonal stimulation or by direct stimulation on the smooth muscles, usually resulting in uterine contractions. They may be used intraoperatively and postoperatively. The following are some nursing considerations after their administration: monitor blood pressure, assess for continued bleeding, and monitor fundal response to the drug.

Question 9

The surgical team gently abducted Matilda's arms into position on padded armboards at less than 90 degrees with palms facing up. Extra padding was placed under her elbows and an armboard strap was secured over her forearm. The armboards were locked into place to prevent inadvertent abduction. This important maneuver is designed as a risk reduction strategy to prevent:

Accepted Answer

Whenever possible the circulator positions the patient's arms on padded armboards with the palms up and fingers extended. Armboards are maintained at less than a 90-degree angle to prevent stretching of the brachial plexus. Care should be taken to protect all patients from integumentary, musculoskeletal, and nerve injury while ensuring adequate circulatory, renal, and respiratory functions.

Question 10

Marla Moriarity, a 32-year-old recently unemployed and uninsured college professor, is diagnosed with an early ectopic pregnancy. Her obstetrician has given her the option of surgical or medical therapy. She is well-informed about the details of each medical and surgical option, but her primary concern about her condition is that her decision will be based upon her strong cultural belief system that will not sanction the destruction of the fetus. Marla's treatment decision will most likely be:

Accepted Answer

Ectopic pregnancy, a devastating complication that affects up to 2% of all pregnancies, may be treated medically with methotrexate or surgically through salpingostomy, segmental resection, fimbrial expression, and salpingectomy. Methotrexate destroys rapidly dividing cells and is often administered in conjunction with the surgical procedure to destroy any residual trophoblastic cells that might remain. Laparoscopic and/or ultrasound-guided application of methotrexate to the extrauterine gestational sac may also be used as an alternative therapy. The more cost-effective medical treatment for ectopic pregnancy is considered a front-line therapy in many major medical centers. Ruptured ectopic pregnancy is considered a surgical emergency and is associated with severe abdominal pain, tachycardia, and hypotension.

Question 11

Matilda Gunderson, a 55-year-old woman with uterine cancer, is scheduled for an open panhysterectomy. She is positioned in low lithotomy with her legs symmetrically arranged in padded cradle stirrups. After the incision is made and primary dissection accomplished, she will be positioned in Trendelenburg position to facilitate exposure of the lower pelvis and displacement of the small bowel from the operative area. Matilda is at risk for compromise and injury related to prolonged Trendelenburg tilt, which promotes:

Accepted Answer

Patients placed in Trendelenburg position for prolonged gynecologic procedures are at increased cardiovascular risk because of decreased pulmonary compliance and functional residual capacity (FRC).

Question 12

Margie Donaldson's examination has revealed a family history of endometrial cancer. She has never been pregnant and has been taking hormone replacement therapy for 4 years. Her physician has scheduled her for a surgical procedure to obtain visual and pathologic information and provide treatment as indicated. Margie was sure that she would have to have a D&C (dilatation and curettage). Margie's surgery, on the operative schedule, would most probably be written as:

Accepted Answer

D&C is done either for diagnostic purposes or as a form of therapy for a variety of pelvic conditions, such as abnormal uterine bleeding or primary dysmenorrhea . D&C may also be performed when carcinoma of the endometrium is suspected. Indications for LAVH may be absence of genital prolapse, required adnexectomy, history of abdominopelvic surgery, salpingitis or endometriosis, lymphadenectomy, and endometrial cancer.

Question 13

An example of perineal glands that secrete mucus is:

Accepted Answer

Bartholin's glands and ducts are located on each side of the lower end of the vagina. These narrow ducts open into the vaginal orifice on the inner aspects of the labia minora. The glands secrete mucus and can become infected or inflamed.

Quiz 5: Gynecologic and Obstetric Surgery