Question 1

A 22-year-old woman is being seen at the clinic for problems with vulvar pain,dysuria,and fever.On physical examination,the nurse notices clusters of small,shallow vesicles with surrounding erythema on the labia.There is also inguinal lymphadenopathy present.The most likely cause of these lesions is:

Accepted Answer

Herpes simplex virus type 2 presents with clusters of small,shallow vesicles with surrounding erythema that erupt on the genital areas.There is also the presence of inguinal lymphadenopathy.The individual reports local pain,dysuria,and fever.See Table 26-2 for more information and descriptions of the other conditions.

Question 2

When assessing a newborn infant's genitalia,the nurse notices that the genitalia are somewhat engorged.The labia majora are swollen,the clitoris looks large,and the hymen is thick.The vaginal opening is difficult to visualize.The infant's mother states that she is worried about the labia being swollen.The nurse should reply:

Accepted Answer

It is normal for a newborn's genitalia to be somewhat engorged.A sanguineous vaginal discharge or leukorrhea is normal during the first few weeks because of the maternal estrogen effect.During the early weeks,the genital engorgement resolves,and the labia minora atrophy and remain small until puberty.

Question 3

The nurse is palpating a female patient's adnexa.The findings include a firm,smooth uterine wall;the ovaries are palpable and feel smooth and firm.The fallopian tube is firm and pulsating.The nurse's most appropriate course of action would be to:

Accepted Answer

Normally the uterine wall feels firm and smooth,with the contour of the fundus rounded.Ovaries are not often palpable,but when they are,they normally feel smooth,firm,and almond shaped and are highly movable,sliding through the fingers.The fallopian tube is not palpable normally.No other mass or pulsation should be felt.Pulsation or palpable fallopian tube suggests ectopic pregnancy,which warrants immediate referral.

Question 4

When performing an external genitalia examination of a 10-year-old girl,the nurse notices that there is no pubic hair,and the mons and the labia are covered with fine vellus hair.These findings are consistent with stage _____ of sexual maturity,according to the Sexual Maturity Rating scale.

Accepted Answer

Sexual Maturity Rating stage 1 is the preadolescent stage.There is no pubic hair.The mons and labia are covered with fine,vellus hair as on the abdomen.See Table 26-1.

Question 5

A patient calls the clinic for instructions before having a Papanicolaou (Pap)smear.The most appropriate instructions from the nurse are:

Accepted Answer

When instructing a patient before a Papanicolaou (Pap)smear is obtained,the nurse should follow these guidelines: Do not obtain during the woman's menses or if a heavy infectious discharge is present.Instruct the woman not to douche,have intercourse,or put anything into the vagina within 24 hours before collecting the specimens.Any specimens will be obtained during the visit,not beforehand.

Question 6

During the examination portion of a patient's visit,she will be in lithotomy position.Which statement below reflects some things that the nurse can do to make this more comfortable for her?

Accepted Answer

The nurse should elevate her head and shoulders to maintain eye contact.The patient's arms should be placed at her sides or across the chest,not behind the head,because this position only tightens the abdominal muscles.The feet should be placed into the stirrups,knees apart,and buttocks at the edge of the examining table.Place the stirrups so the legs are not abducted too far.

Question 7

A nurse is assessing a patient's risk of contracting a sexually transmitted infection (STI).An appropriate question to ask would be:

Accepted Answer

In reviewing a patient's risk for sexually transmitted infections,the nurse should ask,in a nonconfrontational manner,whether condoms are used at each episode of sexual intercourse.Asking a person whether he or she has an infection does not address the risk.

Question 8

The nurse is examining a 35-year-old female patient.During the history,the nurse notices that she has had two term pregnancies,and both babies were delivered vaginally.During the internal examination the nurse observes that the cervical os is a horizontal slit with some healed lacerations and that the cervix has some nabothian cysts that are small,smooth,and yellow.In addition,the nurse notices that the cervical surface is granular and red,especially around the os.Finally,the nurse notices the presence of stringy,opaque,odorless secretions.Which of these findings are abnormal?

Accepted Answer

Normal findings: Nabothian cysts may be present on the cervix after childbirth.The cervical os is a horizontal,irregular slit in the parous woman.Secretions vary according to the day of the menstrual cycle,and may be clear and thin or thick,opaque,and stringy.The surface is normally smooth,but cervical eversion,or ectropion may occur where the endocervical canal is "rolled out." Abnormal finding: The cervical surface should not be reddened or granular,which may indicate a lesion.

Question 9

During a vaginal examination of a 38-year-old woman,the nurse notices that the vulva and vagina are erythematous and edematous with thick,white,curdlike discharge adhering to the vaginal walls.The woman reports intense pruritus and thick white discharge from her vagina.The nurse knows that these history and physical examination findings are most consistent with which of these conditions?

Accepted Answer

The woman with candidiasis often reports intense pruritus and thick white discharge.The vulva and vagina are erythematous and edematous.The discharge is usually thick,white,and curdlike.Infection with trichomoniasis causes a profuse,watery,gray-green,and frothy discharge.Bacterial vaginosis causes a profuse discharge that has a "foul,fishy,rotten" odor.Atrophic vaginitis may have a mucoid discharge.See Table 26-5 for complete descriptions of each option.

Question 10

The nurse is preparing to interview a postmenopausal woman.Which of these statements is true with regard to the history of a postmenopausal woman?

Accepted Answer

Postmenopausal bleeding warrants further workup and referral.The other statements are not true.

Question 11

A 65-year-old woman is in the office for routine gynecologic care.She had a complete hysterectomy 3 months ago after cervical cancer was detected.The nurse knows that which of these statements is true with regard to this visit?

Accepted Answer

In the aging adult woman,natural lubrication is decreased;to avoid a painful examination,the nurse should take care to lubricate instruments and the examining hand adequately.Menopause,with the resulting decrease in estrogen production,shows numerous physical changes.The cervix shrinks and looks pale and glistening.With the bimanual examination,the uterus feels smaller and firmer and the ovaries are not palpable normally.Women should continue cervical cancer screening up to age 70 years if they have an intact cervix and are in good health.Women who have had a total hysterectomy for benign gynecologic disease do not need cervical cancer screening,but if the hysterectomy was done for cervical cancer,then Pap tests should continue until the patient has a 10-year history of no abnormal results.

Question 12

During an examination,which tests will the nurse collect to screen for cervical cancer?

Accepted Answer

Laboratories may vary in method,but usually the test consists of three specimens: endocervical specimen,cervical scrape,and vaginal pool.The other tests (acetic acid wash,KOH preparation,and saline mount)are used to test for sexually transmitted infections.

Question 13

During an internal examination of a woman's genitalia,the nurse will use which technique for proper insertion of the speculum?

Accepted Answer

The examiner should instruct the woman to bear down,turn the width of the blades horizontally,and insert the speculum at a 45-degree angle downward toward the small of the woman's back.See the text under "Speculum Examination" for more detail.

Question 14

When the nurse is interviewing a preadolescent girl,which opening statement would be least threatening?

Accepted Answer

Try the open-ended,"When did you … ?" rather than "Do you … ?" This is less threatening because it implies that the topic is normal and unexceptional.

Question 15

The nurse is preparing to examine the external genitalia of a school-age girl.Which of these positions would be most appropriate in this situation?

Accepted Answer

For school-age children it is best to place them on the examining table in a frog-leg position.With toddlers and preschoolers,it is best to have the child on the parent's lap in a frog-leg position.

Question 16

When the nurse is discussing sexuality and sexual issues with adolescents,a permission statement helps to convey that it is normal to think or feel a certain way.Which of these is the best example of a permission statement?

Accepted Answer

Start with a permission statement,"Often girls your age experience ...." This conveys that it is normal to think or feel a certain way,and it is important to relay that the topic is normal and unexceptional.

Question 17

The nurse is preparing for an internal genitalia examination of a woman.Which order of the examination is correct?

Accepted Answer

The correct sequence is speculum examination,then bimanual examination after removing the speculum,and then rectovaginal examination.The examiner should change gloves before performing the rectovaginal examination to avoid spreading any possible infection.

Question 18

When performing the bimanual examination,the nurse notices that the cervix feels smooth and firm,is round,and is fixed in place (does not move).When cervical palpation is performed,the patient complains of some pain.The nurse's interpretation of these results should be which of these?

Accepted Answer

Normally the cervix feels smooth and firm,as the consistency of the tip of the nose.It softens and feels velvety at 5 to 6 weeks of pregnancy (Goodell's sign).The cervix should be evenly rounded.With a finger on either side,the examiner should be able to move the cervix gently from side to side,and doing so should produce no pain for the patient.Hardness of the cervix may occur with malignancy.Immobility may occur with malignancy,and pain may occur with inflammation or ectopic pregnancy.

Question 19

The nurse has just completed an inspection of a nulliparous woman's external genitalia.Which of these would be a description of a finding within normal limits?

Accepted Answer

There should be no lesions,except for occasional sebaceous cysts.These are yellowish 1-cm nodules that are firm,nontender,and often multiple.The labia majora are dark pink,moist,and symmetrical;redness indicates inflammation or lesions.Discharge that is sticky and yellow-green may indicate infection.In the nulliparous woman,the labia majora meet in the midline,are symmetric and plump.

Question 20

An 18-year-old patient is having her first pelvic examination.Which action by the nurse is appropriate?

Accepted Answer

Use the techniques of the educational or mirror pelvic examination.This is a routine examination with some modifications in attitude,position,and communication.First,the woman is considered an active participant,one who is interested in learning and in sharing decisions about her own health care.The woman props herself up on one elbow,or the head of the table is raised.Her other hand holds a mirror between her legs,above the examiner's hands.The woman can see all that the examiner is doing and has a full view of her genitalia.The mirror works well for teaching normal anatomy and its relationship to sexual behavior.You can ask her if she would like to have a family member,friend,or chaperone present for the examination.The drape should be pushed down between the woman's legs so that the nurse can see her face.

Quiz 26: Female Genitourinary System