LACHARITY 17- Reproductive Problems Flashcards
A client who is being treated as an outpatient for pelvic inflammatory disease
(PID) with oral antibiotics returns to the clinic after 3 days of treatment.
Which finding by the nurse is of highest concern?
1. Client reports nausea after taking the antibiotics.
2. Client’s abdominal rebound pain is unchanged.
3. Client says she feels ashamed to have the infection.
4. Client’s cervical culture report shows gonorrhea.
Ans: 2 Because clinical manifestations of PID should be improving with 3
days of effective antibiotic treatment, the client’s ongoing pain indicates a
need for actions such as hospitalization for intravenous antibiotic therapy.
Nausea is an adverse effect of many antibiotics, but the client will be
instructed to continue the medications. The client’s feeling of shame should
be addressed by the nurse but is not the most important finding. Because
Neisseria gonorrhoeae is a common cause of PID, all drug regimens that are
used will be effective in treating gonorrhea (and Chlamydia trachomatis).
Focus: Prioritization.
The nurse obtains the health history of a 37-year-old woman who is
requesting contraceptive therapy. Which information about the client will
have the most impact on the choice of contraceptive?
1. History of uterine fibroids
2. Blood pressure of 136/80 mm Hg
3. Cigarette smoking of a pack/day
4. Planning outpatient oral surgery
Ans: 3 The most commonly prescribed oral contraceptives are combination
estrogen-progestin medications, but estrogen-containing oral contraceptives
are contraindicated for women who are older than 35 years and who smoke
because of the increased risk for thromboembolism. A progestin-only oral
contraceptive or an intrauterine device (IUD) may be prescribed for this
client. Estrogen-containing contraceptives may stimulate fibroid growth and
elevate blood pressure, but these are relative contraindications. It is
recommended that estrogen-containing contraceptives be discontinued a few
weeks before surgeries that might impair mobility and increase venous
thromboembolism risk, but oral surgery will not affect mobility. Focus:
Prioritization.
A postmenopausal woman who is taking raloxifene for osteoporosis calls the
clinic nurse with these concerns. Which information indicates a need for
immediate further evaluation?
1. Experiences hot flashes several times weekly
2. Describes family history of coronary artery disease
3. Reports nasal stuffiness and runny nose
4. Notices swelling and tenderness in left calf
Ans: 4 Raloxifene increases the risk for deep vein thrombosis and pulmonary
embolism, and the client should be evaluated further with an examination,
possible venous ultrasonography, and coagulation studies. Hot flashes and
nasal congestion are common side effects of raloxifene but are not reasons to
discontinue the medication. Raloxifene lowers myocardial infarction risk in
women at high risk. Focus: Prioritization.
The nurse is assessing a long-term-care client with a history of benign
prostatic hyperplasia. Which information will require the most immediate
action?
1. The client states that he always has trouble starting his urinary stream.
2. The chart shows an elevated level of prostate-specific antigen.
3. The bladder is palpable above the symphysis pubis, and the client is
restless.
4. The client says he has not voided since having a glass of juice 4 hours ago.
Ans: 3 A palpable bladder and restlessness are indicators of urinary retention,
which would require action (e.g., insertion of a catheter) to empty the
bladder. The other data would be consistent with the client’s diagnosis of
benign prostatic hyperplasia. More detailed assessment may be indicated, but
no immediate action is required. Focus: Prioritization.
While performing a breast examination on a 22-year-old client, the nurse
obtains these data. Which finding is of most concern?
1. Both breasts have many nodules in the upper outer quadrants.
2. The client reports bilateral breast tenderness with palpation.
3. The breast on the right side is slightly larger than the left breast.
4. An irregularly shaped, nontender lump is palpable in the left breast.
Ans: 4 Irregularly shaped and nontender lumps are consistent with a
diagnosis of breast cancer, so this client needs immediate referral for
diagnostic tests such as mammography or ultrasonography. The other
information is not unusual and does not indicate the need for immediate
action. Focus: Prioritization; Test Taking Tip: Remember to investigate
further when a client has a nontender lump or swelling because lumps that
are not painful are a common clinical manifestation of cancer in areas such as
the breasts or lymph tissues. Pain is rarely an early manifestation of cancer
but occurs as tumors grow and place pressure on other organs or tissues.
After undergoing a modified radical mastectomy, a client is transferred to the
317postanesthesia care unit. Which nursing action is best to assign to an
experienced LPN/LVN?
1. Monitoring the client’s dressing for any signs of bleeding
2. Documenting the initial assessment on the client’s chart
3. Communicating the client’s status report to the charge nurse on the surgical
unit
4. Teaching the client about the importance of using pain medication as
needed
Ans: 1 An LPN/LVN working in a postanesthesia care unit would be
expected to check dressings for bleeding and alert RN staff members if
bleeding occurs. The other tasks are more appropriate for nursing staff with
RN-level education and licensure. Focus: Assignment.
The nurse is working with an unlicensed assistive personnel (UAP) to care for
a client who has had a right breast lumpectomy and axillary lymph node
dissection. Which nursing action can be delegated to the UAP?
1. Teaching the client why blood pressure measurements are taken on the left
arm
2. Elevating the client’s arm on two pillows to promote lymphatic drainage
3. Assessing the client’s right arm for lymphedema
4. Reinforcing the dressing if it becomes saturated
Ans: 2 Positioning the client’s arm is a task within the scope of practice for
UAP working on a surgical unit. Client teaching and assessment are RN-level
skills. The RN should reinforce dressings as necessary because this requires
assessment of the surgical site and possible communication with the surgeon.
Focus: Delegation.
The nurse obtains the following assessment data about a client who has had a
transurethral resection of the prostate (TURP) and has continuous bladder
irrigation. Which finding indicates the most immediate need for nursing
intervention?
1. The client states that he feels a continuous urge to void.
2. The catheter drainage is light pink with occasional clots.
3. The catheter is taped to the client’s thigh.
4. The client reports painful bladder spasms.
Ans: 4 The bladder spasms may indicate that blood clots are obstructing the
catheter, which would indicate the need for irrigation of the catheter with 30
to 50 mL of normal saline using a piston syringe. The other data would all be
normal after a TURP, but the client may need some teaching about the usual
post-TURP symptoms and care. Focus: Prioritization.
A client with benign prostatic hyperplasia has a new prescription for
tamsulosin. Which statement about tamsulosin is most important to include
when teaching this client?
1. “This medication will improve your symptoms by shrinking the prostate.”
2. “The force of your urinary stream will probably increase.”
3. “Your blood pressure might decrease as a result of taking this medication.”
4. “You should avoid sitting up or standing up too quickly.”
Ans: 4 Because tamsulosin blocks alpha receptors in the peripheral arterial
system, the most significant side effects are orthostatic hypotension and
dizziness. To avoid falls, it is important that the client change positions
slowly. The other information is also accurate and may be included in client
teaching but is not as important as decreasing the risk for falls. Focus:
Prioritization; Test Taking Tip: When any medication might lower blood
pressure, be aware that safety is a priority. Avoid risk for falls by teaching
clients to change position slowly.
The nurse is caring for a client who has just returned to the surgical unit
after a transurethral resection of the prostate (TURP). Which assessment
finding will require the most immediate action?
1. Blood pressure reading of 153/88 mm Hg
2. Catheter that is draining deep red blood
3. Client not wearing antiembolism hose
4. Client report of abdominal cramping
Ans: 2 Hemorrhage is a major complication after TURP and should be
reported to the surgeon immediately. The other assessment data also indicate
a need for nursing action but not as urgently. Focus: Prioritization.
After a radical prostatectomy, a client is ready to be discharged. Which
nursing action included in the discharge plan should be assigned to an
318experienced LPN/LVN?
1. Reinforcing the client’s need to check his temperature daily
2. Teaching the client how to care for his retention catheter
3. Documenting a discharge assessment in the client’s chart
4. Instructing the client about the prescribed narcotic analgesic
Ans: 1 Reinforcement of previous teaching is an expected role of the
LPN/LVN. Planning and implementing client initial teaching and
documentation of a client’s discharge assessment should be performed by
experienced RN staff members. Focus: Assignment.
The day after a radical prostatectomy, a client has blood clots in the urinary
catheter and reports bladder spasms. The client says that his right calf is sore
and that he feels short of breath. Which action will the nurse take first?
1. Irrigate the catheter with 50 mL of sterile saline.
2. Administer oxybutynin 5 mg orally.
3. Apply warm packs to the right calf.
4. Measure oxygen saturation using pulse oximetry.
Ans: 4 It is important to assess oxygenation because the client’s calf
tenderness and shortness of breath suggest a possible venous
thromboembolism and pulmonary embolus, serious complications of
transurethral resection of the prostate. The other activities are appropriate but
are not as high a priority as ensuring that oxygenation is adequate. Focus:
Prioritization; Test Taking Tip: You should rapidly investigate any client
report of shortness of breath because oxygenation is the most basic
physiologic need.
The emergency department nurse receives change-of-shift report about four
clients. Which one should be assessed first?
1. A 19-year-old client with scrotal swelling and severe pain that has not
decreased with elevation of the scrotum
2. A 25-year-old client who has a painless indurated lesion on the glans penis
3. A 44-year-old client with an elevated temperature, chills, and back pain
associated with recurrent prostatitis
4. A 77-year-old client with abdominal pain and acute bladder distention
Ans: 1 This client has symptoms of testicular torsion, an emergency that
needs immediate assessment and intervention because it can lead to testicular
ischemia and necrosis within a few hours. The other clients also have
symptoms of acute problems (primary syphilis, acute bacterial prostatitis,
and prostatic hyperplasia with urinary retention), which need rapid
assessment and intervention, but these are not as urgent as the possible
326testicular torsion. Focus: Prioritization
The nurse obtains this information when taking the health history of a 56-
year-old postmenopausal woman. Which information is most important to
report to the health care provider (HCP)?
1. Sagging of breasts bilaterally
2. Vaginal dryness and painful intercourse
3. Hot flashes occurring during the night
4. Occasional painless vaginal bleeding
Ans: 4 Painless vaginal bleeding in postmenopausal women may indicate
endometrial or cervical cancer and will require diagnostic testing such as
endometrial biopsy. Breast atrophy, vaginal dryness and painful intercourse,
and hot flashes are common after menopause, although these symptoms
should also be discussed with the HCP and may need treatment. Focus:
Prioritization.
The nurse is interviewing a woman who is in the clinic for a well woman
exam, and the woman requests a screening test for ovarian cancer. Which
response by the nurse is best?
1. “Only a small number of ovarian cancers are diagnosed at an early stage.”
2. “There is no effective screening test for ovarian cancer in low-risk women.”
3. “Benefits of ovarian cancer screening will depend on your medical history.”
4. “Ovarian cancer screening will probably not be covered by your
insurance.”
Ans: 3 Current guidelines state that there is no effective screening tool for
low-risk women, but women who are high risk because of family history or
the BRCA genes may be screened with transvaginal ultrasonography and
serum marker CA-125 levels. The other statements are accurate but do not
respond as well to the client’s concern. Focus: Prioritization.
A client who has just returned to the surgical unit after a transurethral
resection of the prostate (TURP) reports acute bladder spasms. In which
order will the nurse perform these prescribed actions?
1. Administer acetaminophen/oxycodone 325 mg/5 mg.
3192. Irrigate the retention catheter with 30 to 50 mL of sterile normal saline.
3. Infuse 500 mL of 5% dextrose in lactated Ringer’s solution over 2 hours.
4. Offer the client oral fluids to at least 2500 to 3000 mL/day.
Ans: 2, 1, 3, 4 Bladder spasms after a TURP are usually caused by the
presence of clots that obstruct the catheter, so irrigation should be the first
action taken. Administration of analgesics may help to reduce spasm.
Administration of a bolus of IV fluids is commonly used in the immediate
postoperative period to help maintain fluid intake and increase urinary flow.
Oral fluid intake should be encouraged when the nurse is sure that the client
is not nauseated and has adequate bowel tone. Focus: Prioritization.
A 68-year-old client who is ready for discharge from the emergency
department has a new prescription for nitroglycerin 0.4 mg sublingual as
needed for angina. Which client information has the most immediate
implications for teaching?
1. The client has prostatic hyperplasia with some urinary hesitancy.
2. The client’s father and two brothers all have had myocardial infarctions.
3. The client uses sildenafil several times weekly for erectile dysfunction.
4. The client is unable to remember when he first experienced chest pain.
Ans: 3 Sildenafil is a potent vasodilator and has caused cardiac arrest in
clients who were also taking nitrates such as nitroglycerin. The other client
data indicate the need for further assessment or teaching, but it is essential for
the client who uses nitrates to avoid concurrent use of sildenafil. Focus:
Prioritization.
The nurse is caring for a 21-year-old client who had a left orchiectomy for
testicular cancer on the previous day. Which nursing activity will be best to
assign to an LPN/LVN?
1. Educating the client about post-orchiectomy chemotherapy and radiation
2. Administering the prescribed “as needed” (PRN) oxycodone to the client
3. Teaching the client how to do testicular self-examination on the remaining
testicle
4. Assessing the client’s knowledge level about post-orchiectomy fertility
Ans: 2 Administration of narcotics and the associated client monitoring are
included in LPN/LVN education and scope of practice. Assessments and
teaching are more complex skills that require RN-level education and are best
accomplished by an RN with experience in caring for clients with this
diagnosis. Focus: Assignment.
Which client is best for the oncology unit charge nurse to assign to an RN
who has floated from the emergency department?
1. Client who needs doxorubicin chemotherapy to treat metastatic breast
cancer
2. Client who needs discharge teaching after surgery for stage II ovarian
cancer
3. Client with metastatic prostate cancer who requires frequent assessment
and treatment for breakthrough pain
4. Client with testicular cancer who requires preoperative teaching about
orchiectomy and lymph node resection
Ans: 3 An RN from the emergency department would be experienced in
assessment and management of pain. Because of their diagnoses and
treatments, the other clients should be assigned to RNs who are experienced
in caring for clients with cancer. Focus: Assignment; Test Taking Tip: When
making assignments for nurses who have floated to a specialty area, it is best
to assign the float nurse to clients who require actions that are commonly
used in many areas of nursing, such as administration of analgesics, dressing
changes, and fluid infusions.
After receiving the change-of-shift report, in which order will the nurse
assess these assigned clients?
1. A 22-year-old client who has questions about how to care for the drains
placed in her breast reconstruction incision
2. An anxious 44-year-old client who is scheduled to be discharged today
after undergoing a total vaginal hysterectomy
3. A 69-year-old client who reports level 5 pain (on a scale of 0 to 10) after
undergoing perineal prostatectomy 2 days ago
4. A usually oriented 78-year-old client who has new-onset confusion after
having a bilateral orchiectomy the previous day
Ans: 4, 3, 2, 1 The bilateral orchiectomy client needs immediate assessment
because confusion may be an indicator of serious postoperative complications
such as hemorrhage, infection, or pulmonary embolism. The client who had a
perineal prostatectomy should be assessed next because pain medication may
be needed to allow him to perform essential postoperative activities such as
deep breathing, coughing, and ambulating. The vaginal hysterectomy client’s
327anxiety needs further assessment next. Although the breast implant client has
questions about care of the drains at the surgical site, there is nothing in the
report indicating that these need to be addressed immediately. Focus:
Prioritization.
A client has had a needle biopsy of the prostate gland using the transrectal
approach. Which statement is most important to include in the client teaching
plan?
1. “The health care provider (HCP) will call you about the test results.”
2. “Serious infections may occur as a complication of this test.”
3. “You will need to call the HCP if you develop a fever or chills.”
4. “It is normal to have a small amount of rectal bleeding after the test.”
Ans: 3 Although infection occurs only rarely as a complication of transrectal
prostate biopsy, it is important that the client receive teaching about checking
his temperature and calling the HCP if there is any fever or other signs of
systemic infection. The client should understand that the test results will not
be available immediately but that he will be notified about the results.
Transient rectal bleeding may occur after the biopsy, but bleeding that lasts
for more than a few hours indicates that there may have been rectal trauma.
Focus: Prioritization.
The nurse is working in the postanesthesia care unit caring for a 32-year-old
client who has just arrived after undergoing dilation and curettage to
evaluate infertility. Which assessment finding should be immediately
communicated to the surgeon?
1. Blood pressure of 162/90 mm Hg
2. Saturation of the perineal pad after the first 30 minutes
3. Oxygen saturation of 91% to 95%
4. Sharp, continuous, level 8 abdominal pain (on a scale of 0 to 10)
Ans: 4 Cramping or aching abdominal pain is common after dilation and
curettage; however, sharp, continuous pain may indicate uterine perforation,
which would require rapid intervention by the surgeon. The other data
indicate a need for ongoing assessment or interventions. Transient blood
pressure elevation may occur because of the stress response after surgery.
Bleeding after the procedure is expected but should decrease over the first 2
hours. Although the oxygen saturation is not at an unsafe level, interventions
to improve the saturation should be carried out. Focus: Prioritization.
When the nurse is developing the plan of care for a home health client who
has been discharged after a radical prostatectomy, which activities will be
delegated to the home health aide? Select all that apply.
1. Monitoring the client for symptoms of urinary tract infection
2. Helping the client to connect the catheter to the leg bag
3. Checking the client’s incision for appropriate wound healing
4. Assisting the client in ambulating for increasing distances
5. Helping the client shower at least every other day
Ans: 2, 4, 5 Assisting with catheter care, ambulation, and hygiene are
included in home health aide education and would be expected activities for
this staff member. Client assessments are the responsibility of RN members of
the home health care team. Focus: Delegation.
The nurse is working in the emergency department when a client with
possible toxic shock syndrome is admitted. Which prescribed intervention
will the nurse implement first?
1. Remove the client’s tampon.
2. Obtain blood specimens for culture.
3. Give acetaminophen 650 mg.
4. Infuse nafcillin 1000 mg IV.
Ans: 1 Because the most likely source of the bacteria causing the toxic shock
syndrome is the client’s tampon, it is essential to remove it first. The other
actions should be implemented in the following order: obtain blood culture
samples (best done before initiating antibiotic therapy to ensure accurate
culture and sensitivity results), infuse nafcillin (rapid initiation of antibiotic
therapy will decrease bacterial release of toxins), and administer
acetaminophen (fever reduction may be necessary, but treating the infection
has the highest priority). Focus: Prioritization.
