Question 1

Which information will the nurse include when developing a patient teaching plan for a 48-year-old patient with uterine bleeding caused by a leiomyoma?

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 2

A patient who is seen in the health clinic is diagnosed with genital warts. The nurse will plan to teach the patient about

Accepted Answer

Genital warts are caused by the human papilloma virus (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 3

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

Accepted Answer

To prevent displacement of the implant, absolute bed rest is required. Wearing of gloves when changing linens is not necessary because the isotope is confined to the implant. The patient will not get out of bed to void. The nurse will spend minimal time in the patient's room to avoid exposure to radiation.

Question 4

A patient's Pap test reveals cervical cells characteristic of adenocarcinoma of the cervix. Information obtained during the patient's health history and identified as a major risk factor for cervical cancer is

Accepted Answer

Smoking and HPV infection are both associated with increased cervical cancer risk. Estrogen therapy, oral contraceptive use, and multiple pregnancies do not increase risk.

Question 5

A 56-year-old woman tells the nurse that she is postmenopausal but has occasional spotting. Which response by the nurse is most appropriate?

Accepted Answer

In postmenopausal women, a common cause of spotting is hormone replacement therapy (HRT). Because breakthrough bleeding may be a sign of problems such as cancer or infection, the nurse should not tell the patient that it 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 6

When assessing a patient on her return to the surgical unit following a total abdominal hysterectomy, the nurse would expect to find

Accepted Answer

Abdominal pain after this surgery is expected. A urine output of at least 30 to 60 ml/hr is expected. A pressure dressing is not needed after a total abdominal hysterectomy. Moderate sanguineous drainage on the abdominal dressing may indicate postoperative hemorrhage.

Question 7

During assessment of a patient with suspected endometrial cancer, the nurse identifies an important risk factor for cancer of the endometrium when the patient's history includes

Accepted Answer

Because adipose cells store estrogen, obesity is a risk factor for endometrial cancer. Alcohol addiction does not increase this risk. Multiple pregnancies offer protection from endometrial cancer. Early sexual activity is associated with increased cervical cancer risk, but it does not increase risk for endometrial cancer.

Question 8

A patient with endometriosis is treated with medroxyprogesterone (Depo-Provera). The nurse explains that this therapy

Accepted Answer

Depo-Provera induces a pseudopregnancy, which suppresses ovulation and causes shrinkage of endometrial tissue. Vaginal atrophy and hot flashes are caused by synthetic androgens such as danazol or gonadotropin-releasing hormone agonists (GNRH) such as leuprolide. Although hormonal therapies will control endometriosis while the therapy is used, endometriosis will recur once the menstrual cycle is reestablished. Depo-Provera use is not associated with bone loss.

Question 9

A patient who has undergone a vaginal hysterectomy has not voided for 8 hours following surgery and is complaining of bladder distention. The most appropriate action by the nurse is to

Accepted Answer

After hysterectomy, the patient may experience urinary retention caused by temporary bladder atony; catheterization is needed if the patient has not voided for 8 hours. Increasing the patient's fluid is not appropriate when the bladder is distended. There is an order to catheterize the patient, so the nurse does not need to notify the health care provider. Ambulation will be uncomfortable for the patient with a full bladder.

Question 10

A 62-year-old patient with stage 0 carcinoma of the cervix that was determined by cervical conization has been told by her health care provider she needs no further treatment at this time. She asks the nurse why the doctor has not discussed other treatment options with her. The most appropriate response by the nurse is,

Accepted Answer

Because conization involves excision of the abnormal area of the cervix, it can be used for both diagnosis and treatment. Although the patient's age is considered when choosing treatment for cervical cancer, the staging for this patient indicates that no further treatment is needed. The second statement indicates that there is still cervical cancer present, which is not the case with stage 0 cervical cancer. HPV infection does increase the risk for cervical cancer, but it does not impact whether further treatment is needed for this patient.

Question 11

When a patient has oral contraceptives prescribed for endometriosis, the nurse will teach the patient to

Accepted Answer

When oral contraceptives are prescribed to treat endometriosis, the patient should take the medications continuously for 9 months. Facial hair is a side effect of synthetic androgens. The patient does not need to use additional contraceptive methods. The hormones in oral contraceptives will protect against osteoporosis.

Question 12

The nurse obtains all these data when assessing a patient who returned to the surgical unit after having a total abdominal hysterectomy and bilateral salpingo-oophorectomy 5 hours ago. Which information is most important to communicate to the surgeon?

Accepted Answer

The low urine output may indicate that a ureter has been ligated during the surgery, and the patient may need to return to surgery. Another possibility is that she is hypovolemic secondary to blood loss. The other data are not unusual after surgery and require nursing interventions such as ongoing monitoring and administration of pain medications but do not require rapid action by the health care provider.

Question 13

The nurse has just received change-of-shift report about these four patients. Which patient should be assessed first?

Accepted Answer

The patient with the ectopic pregnancy has symptoms consistent with rupture and needs immediate assessment for signs of hemorrhage and possible transfer to surgery. The other patients also should be assessed as quickly as possible but do not have symptoms of life-threatening complications.

Question 14

A patient who has undergone a radical vulvectomy for vulvar carcinoma returns to the medical-surgical unit after the surgery. In planning care for the patient, the nurse identifies a priority nursing diagnosis of

Accepted Answer

Complex and meticulous wound care is needed to prevent infection and delayed wound healing. The other nursing diagnoses may also be appropriate for the patient but are not the highest priority immediately after surgery.

Question 15

An 18-year-old visits the health clinic for a routine check-up. To determine whether a Pap test is needed, which question should the nurse ask?

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. The information about menstrual periods and substance abuse will not help to determine whether the patient requires a Pap test.

Question 16

A 56-year-old woman 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.

Question 17

An abdominal hysterectomy is scheduled for a 40-year-old patient with multiple uterine leiomyomas. Before the surgery, the nurse will teach the patient about

Accepted Answer

Deep vein thrombosis (DVT) is a potential complication after the surgery, and the nurse will instruct the patient about ways to prevent DVT. Vaginal sensation is decreased after a vaginal hysterectomy but not after abdominal hysterectomy. The patient will have an incision rather than an open wound. Because the patient will still have her ovaries, the estrogen level will not decrease.

Question 18

Stage III ovarian cancer is diagnosed in a 63-year-old woman. A nursing diagnosis that is likely to be appropriate 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.

Question 19

A 58-year-old woman calls the health clinic when she has a moderate amount of vaginal bleeding after 6 years of menopause. The nurse will anticipate scheduling the patient for

Accepted Answer

A postmenopausal woman with vaginal bleeding should be evaluated for endometrial cancer, and endometrial biopsy is the primary test for endometrial cancer. D&C will be needed only if the biopsy does not provide sufficient information to make a diagnosis. Endometrial ablation and balloon therapy are used to treat menorrhagia, which is unlikely in this patient.

Question 20

When caring for a patient recently diagnosed with polycystic ovary syndrome, it is most important for the nurse to teach the patient

Accepted Answer

Obesity exacerbates the problems associated with polycystic ovary syndrome, such as insulin resistance and type 2 diabetes. The nurse will also address the problems of acne and hirsutism, but these symptoms are lower priority because they do not have long-term health consequences. Although some patients do require total hysterectomy, this is usually performed only after other therapies have been unsuccessful.

Quiz 54: Nursing Management: Female Reproductive Problems