Question 1

A client is admitted to the emergency department with toxic shock syndrome.Which action by the nurse is the most important?

Accepted Answer

The source of infection should be removed first.All of the other answers are possible interventions depending on the client's symptoms and vital signs,but removing the tampon is the priority.

Question 2

The nurse is caring for a postoperative client following an anterior colporrhaphy.What action can be delegated to the unlicensed assistive personnel (UAP)?

Accepted Answer

The UAP is able to provide comfort through a bath.The registered nurse should review any laboratory results,complete any teaching,and assess pain and discharge.

Question 3

A 28-year-old client is diagnosed with endometriosis and is experiencing severe symptoms.Which actions by the nurse are the most appropriate at this time? (Select all that apply.)

Accepted Answer

With endometriosis,pain is the predominant symptom,with anxiety occurring because of the diagnosis.Interventions should be directed to pain and anxiety relief,such as low-level heat,relaxation techniques,and education about the pathophysiology and possible treatment of endometriosis.The nurse could suggest resources to give more information about the diagnosis.Discussion of the possibility of infertility and side effects of laparoscopic surgery is premature and may increase the anxiety.

Question 4

The nurse is teaching a client who is undergoing brachytherapy about what to immediately report to her health care provider.Which signs and symptoms would be included in this teaching? (Select all that apply.)

Accepted Answer

Health teaching for a client having brachytherapy should emphasize reporting abdominal pain,visible blood in the urine,and heavy vaginal bleeding.Severe diarrhea (not constipation),urethral burning,extreme fatigue,and a fever over 100° F should also be reported.

Question 5

The nurse is educating a client on the prevention of toxic shock syndrome (TSS).Which statement by the client indicates a lack of understanding?

Accepted Answer

Tampons need to be changed every 3 to 6 hours to avoid infection by such organisms as Staphylococcus aureus.All of the other responses are correct: use of feminine pads at night,not using tampons at all,and washing hands before tampon insertion are all strategies to prevent TSS.

Question 6

A nurse is caring for four postoperative clients who each had a total abdominal hysterectomy.Which client should the nurse assess first upon initial rounding?

Accepted Answer

Normal vaginal bleeding should be less than one saturated perineal pad in 4 hours.Two saturated pads in such a short time could indicate hemorrhage,which is a priority.The other clients also have needs,but the client with excessive bleeding should be assessed first.

Question 7

A client has undergone a vaginal hysterectomy with a bilateral salpingo-oophorectomy.She is concerned about a loss of libido.What intervention by the nurse would be best?

Accepted Answer

Use of vaginal estrogen cream and gentle dilation can help with vaginal changes and loss of libido.Weight gain and masculinization are misperceptions after a vaginal hysterectomy.Vitamins,supplements,a balanced diet,and exercise are helpful for healthy living,but are not necessarily going to increase libido.

Question 8

A client has scheduled brachytherapy sessions and states that she feels as though she is not safe around her family.What is the best response by the nurse?

Accepted Answer

In brachytherapy,the surgeon inserts an applicator into the uterus.After placement is verified,the radioactive isotope is placed in the applicator for several minutes for a single treatment.There are no restrictions for the woman to stay away from her family or the public between treatments.

Question 9

The client is emotionally upset about the recent diagnosis of stage IV endometrial cancer.Which action by the nurse is best?

Accepted Answer

Discussion of a client's concerns about the presence of cancer and the potential for recurrence will provide emotional support and allay fears.Coping behaviors are encouraged with the support of friends and relatives.An emotional response should be accepted.

Question 10

The nurse is doing preoperative teaching for a client who is scheduled for removal of cervical polyps in the office.Which statement by the client indicates a correct understanding of the procedure?

Accepted Answer

Polyp removal is a simple office procedure with the client feeling no pain.The other responses are incorrect.Cervical polyps are the most common benign growth of the cervix.Cautery is used to stop any bleeding,and there is no evidence that cervical polyps have a relationship to childbearing.

Question 11

A 20-year-old client is interested in protection from the human papilloma virus (HPV)since she may become sexually active.Which response from the nurse is the most accurate?

Accepted Answer

Current HPV vaccines are Gardasil and Cervarix,which should be given before the first sexual contact to protect against the highest risk HPV types associated with cervical cancer.The client is not too old since it is recommended that young women up to 26 years should receive an HPV vaccine.The entire series consists of three injections over 6 months,not 1 year.Local pain and redness surrounding the injection site are very common,but this does not include itching.

Question 12

A 55-year-old post-menopausal woman is assessed by the nurse with a history of dyspareunia,backache,pelvis pressure,urinary tract infections,and a frequent urinary urgency.Which condition does the nurse suspect?

Accepted Answer

Dyspareunia,backache,pelvis pressure,urinary tract infections,and urinary urgency are all symptoms of a cystocele-a protrusion of the bladder through the vaginal wall.Ovarian cysts are rare after menopause.A rectocele is associated with constipation,hemorrhoids,and fecal impaction.Fibroids are associated with heavy bleeding.

Question 13

A postmenopausal client is experiencing low back and pelvic pain,fatigue,and bloody vaginal discharge.What laboratory tests would the nurse expect to see ordered for this client if endometrial cancer is suspected? (Select all that apply.)

Accepted Answer

Serum tumor markers such as CA-125 assess for metastasis,especially if elevated.H&H would evaluate the possibility of anemia,a common finding with postmenopausal bleeding with endometrial cancer.WBC count is not indicated since there are no signs of infection.The INR and PT are coagulation tests to measure the time it takes for a fibrin clot to form.They are used to evaluate the extrinsic pathway of coagulation in clients receiving oral warfarin.

Question 14

The nurse is taking the history of a 24-year-old client diagnosed with cervical cancer.What possible risk factors would the nurse assess? (Select all that apply.)

Accepted Answer

Smoking,multiple sexual partners,poor diet,and age less than 18 for first intercourse are all risk factors for cervical cancer.Nulliparity is a risk factor for endometrial cancer.

Question 15

A client is scheduled to start external beam radiation therapy (EBRT)for her endometrial cancer.Which teaching by the nurse is accurate? (Select all that apply.)

Accepted Answer

EBRT is usually performed in ambulatory care and does not require hospitalization.The client needs to know to evaluate the skin,especially in the perineal area,for any breakdown,and avoid sunbathing.The technician does not apply new site markings,so the client needs to avoid washing off the markings that indicate the treatment site.

Question 16

A client has recently been diagnosed with stage III endometrial cancer and asks the nurse for an explanation.What response by the nurse is correct about the staging of the cancer?

Accepted Answer

Stage III of endometrial cancer reaches the vagina or lymph nodes.Stage I is confined to the endometrium.Stage II involves the cervix,and stage IV spreads to the bowel or bladder mucosa and/or beyond the pelvis.

Question 17

The nurse is giving discharge instructions to a client who had a total abdominal hysterectomy.Which statements by the client indicate a need for further teaching? (Select all that apply.)

Accepted Answer

Driving and sitting for extended periods of time should be avoided until the surgeon gives permission.For 2 to 6 weeks,exercise participation should also be avoided.All of the other responses demonstrate adequate knowledge for discharge.The client should not lift anything heavier than 10 pounds,should limit stair climbing,and should refrain from sexual intercourse.

Question 18

Which action would the nurse teach to help the client prevent vulvovaginitis?

Accepted Answer

To prevent vulvovaginitis,the client should wear cotton underwear.The client should wipe front to back after urination,not back to front.The client should cleanse the inner labial mucosa with water only,and avoid using feminine hygiene sprays.

Question 19

A client has a recurrent Bartholin cyst.What is the nurse's priority action?

Accepted Answer

A major cause of an obstructed duct forming a cyst is infection.The laboratory specimen is a priority since a culture is needed in order to prescribe sensitive antibiotics.Comfort measures can then be used,such as ice packs and moist heat.

Question 20

A client has just returned from a total abdominal hysterectomy and needs postoperative nursing care.What action can the nurse delegate to the unlicensed assistive personnel (UAP)?

Accepted Answer

The UAP is able to empty the urinary output from the catheter.The nurse would assess the heart,lung,and bowel sounds; check the hemoglobin and hematocrit levels; and evaluate the drainage on the dressing.

Quiz 71: Care of Patients with Gynecologic Problems