Chapter 71: Care of Patients with Gynecologic Problems

Question 1

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

Answer 1

Wear loose cotton underwear

To prevent vulvovaginitis, the client should wear cotton underwear.

Question 2

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

Answer 2

I need to change my tampon every 8 hours during the day

Tampons need to be changed every 3 to 6 hours to avoid infection by such organisms as Staphylococcus aureus.

Question 3

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

Answer 3

Remove the tampon as the source of infection

The source of infection should be removed first

Question 4

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?

Answer 4

Cystocele

Dyspareunia, backache, pelvis pressure, urinary tract infections, and urinary urgency are all symptoms of a cystocelea protrusion of the bladder through the vaginal wall

Question 5

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

Answer 5

Drawing a shallow hot bath for comfort measures

The UAP is able to provide comfort through a bath.

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?

a. Client who has had two saturated perineal pads in the last 2 hours
b. Client with a temperature of 99 F and blood pressure of 115/73 mm Hg
c. Client who has pain of 4 on a scale of 0 to 10
d. Client with a urinary catheter output of 150 mL in the last 3 hours

Answer 6

Client who has had two saturated perineal pads in the last 2 hours

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.

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?

Answer 7

Teach that estrogen cream inserted vaginally may help.

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.

Question 8

A client has a recurrent Bartholin cyst. What is the nurses priority action?

Answer 8

Obtain a fluid sample for laboratory analysis.

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

Question 9

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?

Answer 9

There should be little or no discomfort during the procedure

Polyp removal is a simple office procedure with the client feeling no pain.

Question 10

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?

Answer 10

It has reached the vagina or lymph nodes

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

Question 11

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

Answer 11

Create an atmosphere of acceptance and discussion.

Discussion of a clients 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 12

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?

Answer 12

You are only reactive when the radioactive implant is in place

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.

Question 13

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)?

a. Assess heart, lung, and bowel sounds.
b. Check the hemoglobin and hematocrit levels.
c. Evaluate the dressing for drainage.
d. Empty the urine from the urinary catheter bag.

Answer 13

Empty the urine from the urinary catheter bag.

The UAP is able to empty the urinary output from the catheter.

Question 14

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?

Answer 14

Either Gardasil or Cervarix can provide protection.

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

Question 15

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.)

Answer 15

Reduce the pain by low-level heat.
Relieve anxiety by relaxation techniques and education.
Suggest resources such as the Endometriosis Association.

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.

Question 16

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.)

Answer 16

I should not have any problems driving to see my mother, who lives 3 hours away.
Now that I have time off from work, I can return to my exercise routine next week.

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.

Question 17

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.)

Answer 17

Smoking
Multiple sexual partners
Poor diet
Younger than 18 at first intercourse
Infections with HPV

Smoking, multiple sexual partners, multiple birth, poor diet, and age less than 18 for first intercourse, infection with HPV are all risk factors for cervical cancer.

Question 18

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.)

Answer 18

Your skin needs to be inspected daily for any breakdown.
It is not wise to stay out in the sun for long periods of time.
The perineal area may become damaged with the radiation
“You will not be radioactive or pose any danger to anyone else.”

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.

Question 19

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.)

Answer 19

Abdominal pain
Visible blood in the urine
Heavy vaginal bleeding

Health teaching for a client having brachytherapy should emphasize reporting abdominal pain, visible blood in the urine, and heavy vaginal bleeding

Question 20

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.)

Answer 20

Cancer antigen-125 (CA-125)
Hemoglobin and hematocrit (H&H)

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.

Question 21

A nurse is caring for a woman who had hysteroscopic surgery for uterine leiomyomas. On initial assessment, the nurse notes the following: pulse: 114 beats/min, respiratory rate: 20 breaths/minute, crackles in bilateral lung bases. What action by the nurse takes priority?

Answer 21

Call the Rapid Response Team.

The fluid that is used during this procedure to distend the uterine cavity can be absorbed, leading to fluid overload. This client has signs of fluid overload which can be critical. The nurse would notify the Rapid Response Team first, then perform the other actions.

Question 22

A client has recently been diagnosed with type II endometrial cancer and will be treated with brachytherapy. What statement by the client indicates a need for further education on this treatment?

Answer 22

“I have to be alone in the room during treatment so I don’t expose others.”

Type II endometrial cancer is likely to invade the uterine wall and metastasize. Treatment with brachytherapy is intended to prevent recurrence. During the treatment, which lasts 20 to 30 minutes each, the woman must remain on bedrest to avoid dislodging the radioactive source. The source emits radiation while it is in place, so the woman is in the treatment room by herself. Once it is removed, she has no restrictions on being around others. She would need to report any heavy vaginal bleeding or severe diarrhea.

Question 23

The outpatient clinic nurse has assessed a woman who reports a month-long history of feeling
full, urinary frequency, and bloating. What action by the nurse is best?

Answer 23

Teach the woman about CA-125 test.

Evidence shows that women with ovarian cancer often have recognizable, early signs such as abdominal bloating, urinary frequency or urgency, feeling full or difficulty eating, and pelvic pain. The nurse should “think ovarian” and facilitate the client having a CA-125 blood test, which is a cancer antigen test.

Question 24

The nurse has educated a community group of risk factors for ovarian cancer. Which
statement by a participant shows the need for reviewing the information?

Answer 24

“This is a disease of young women.”

Ovarian cancer usually strikes women who are middle age or older

Question 25

A nurse has taken an informed consent to a woman who is having a transvaginal repair of a
prolapsed uterus. What client statement indicates a need for more information?

Answer 25

“The mesh they use may become infected.”

Mesh is not used in the transvaginal approach as it has been discontinued in this country.

Question 26

A 25-year-old woman is concerned about contracting HPV. What information by the nurse is
most appropriate?

Answer 26

“We can provide HPV testing along with your Pap smear.”

HPV DNA testing can be done at the same time as the pap smear. Most women have HPV
infection during their lives; however, it is not always benign. Two types, 16 and 18 are responsible for about 70% of cervical cancers. The vaccination with Gardasil 9 can be given up to age 45.

Question 27

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

Answer 27

Teach nonpharmacologic comfort measures.
Relieve anxiety by relaxation techniques and education.
Review complete blood count for possible iron deficiency anemia

With uterine leiomyomas or fibroids, heavy bleeding is the predominant symptom, with anxiety occurring because of fears of cancer or infertility. Interventions would be directed to the heavy bleeding and anxiety relief, such as relaxation techniques and education about the
pathophysiology and possible treatment of the fibroids. While many women do not experience
pain with this condition

Question 28

A client has recurrent vulvovaginitis. Which statements by the client indicate a need for further teaching? (Select all that apply.

Answer 28

“I can take a long, hot bath to relieve itching.”
“I need to take all of my antibiotics as prescribed.”
“I should use antibacterial soap to clean the area.”

Clients should avoid hot water baths as they may increase the itching and infection. They may take warm or tepid sitz baths for 30 minutes several times a day to relieve itching.

Question 29

The nurse is doing home care teaching for a client who has undergone cryotherapy. Which statements by the client indicate a correct understanding of the instructions? (Select all that apply.)

Answer 29

“I should not use tampons, douche, or have sexual activity.”
“I should shower rather than take a tub bath.”
“There should be little or no discomfort.”

Cryotherapy involves freezing of cervical cancer cells and is often painless. Clients are restricted from heavy lifting. They may have a heavy watery discharge for several weeks, but should report any heavy bleeding, foul-smelling drainage, or a fever.