OB Exam #5 Flashcards
When assessing the client for amenorrhea, the nurse should be aware that this may be caused by all conditions except:
A. Anatomic abnormalities
B. Type 1 diabetes mellitus
C. Lack of exercise
D. Hysterectomy
C. Lack of exercise
Lack of exercise is not a cause of amenorrhea. Strenuous exercise may cause amenorrhea. Anatomic abnormalities are a possible cause of amenorrhea. Type 1 diabetes mellitus is a possible cause of amenorrhea. Hysterectomy is a possible cause of amenorrhea.
When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention might be recommended?
A. Increasing the intake of red meat and simple carbohydrates
B. Reducing the intake of diuretic foods, such as peaches and asparagus
C. Temporarily substituting physical activity for a sedentary lifestyle
D. Using a heating pad on the abdomen to relieve cramping
D. Using a heating pad on the abdomen to relieve cramping
Heat minimizes cramping by increasing vasodilation and muscle relaxation and minimizing uterine ischemia. Dietary changes such as eating less red meat may be recommended for women experiencing dysmenorrhea. Increasing the intake of diuretics, including natural diuretics such as asparagus, cranberry juice, peaches, parsley, and watermelon may help ease the symptoms associated with dysmenorrhea. Exercise has been found to help relieve menstrual discomfort through increased vasodilation and subsequent decreased ischemia.
While interviewing a 31-year-old woman before her routine gynecologic examination, the nurse collects data about the client’s recent menstrual cycles. The nurse should collect additional information with which statement?
A. The woman says her menstrual flow lasts 5 to 6 days.
B. She describes her flow as very heavy.
C. She reports that she has had a small amount of spotting midway between her periods for the past 2 months.
D. She says the length of her menstrual cycle varies from 26 to 29 days.
B. She describes her flow as very heavy.
Menorrhagia is defined as excessive menstrual bleeding, either in duration or in amount. Heavy bleeding can have many causes. The amount of bleeding and its effect on daily activities should be evaluated. A menstrual flow that lasts 5 to 6 days is a normal finding. Mittlestaining, a small amount of bleeding or spotting that occurs at the time of ovulation (14 days before onset of the next menses), is considered normal. During her reproductive years a woman may have physiologic variations in her menstrual cycle. Variations in the length of a menstrual cycle are considered normal.
While evaluating a client for osteoporosis, the nurse should be aware of what risk factor?
A. African-American race
B. Low protein intake
C. Obesity
D. Cigarette smoking
D. Cigarette smoking
Smoking is associated with earlier and greater bone loss and decreased estrogen production. Women at risk for osteoporosis are likely to be Caucasian or Asian. Inadequate calcium intake is a risk factor for osteoporosis. Women at risk for osteoporosis are likely to be small boned and thin. Obese women have higher estrogen levels as a result of the conversion of androgens in the adipose tissue. Mechanical stress from extra weight also helps preserve bone mass.
During her annual gynecologic checkup, a 17-year-old woman states that recently she has been experiencing cramping and pain during her menstrual periods. The nurse documents this complaint as:
A. Amenorrhea
B. Dysmenorrhea
C. Dysparunia
D. Premenstrual syndrome (PMS)
B. Dysmenorrhea
Dysmenorrhea is pain during or shortly before menstruation. Amenorrhea is the absence of menstrual flow. Dyspareunia is pain during intercourse. PMS is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses.
With regard to dysmenorrhea, nurses should be aware that:
A. It is more common in older women
B. It is more common in leaner women who exercise strenuously
C. Symptoms can begin at any point in the ovulatory cycle
D. Pain usually occurs in the suprapubic area or lower abdomen
D. Pain usually occurs in the suprapubic area or lower abdomen
Pain is described as sharp and cramping or sometimes as a dull ache. It may radiate to the lower back or upper thighs. Dysmenorrhea is more common in younger women ages 17 to 24. Dysmenorrhea is more common in women who smoke and who are obese. Symptoms begin with menstruation or sometimes a few hours before the onset of flow.
Obese women are more likely to have dysfunctional uterine bleeding and endometrial hyperplasia. Is this statement true or false?
True
False
True
Women with more body fat have higher circulating levels of estrone. This occurs because estrogen that is stored in the fat cells of the body is converted into a form of estrogen that is available to the estrogen receptors within the endometrium.
Structural disorders of the uterus and vagina related to pelvic relaxation and urinary incontinence are a delayed result of childbearing. These defects do not appear in women who have never been pregnant. Is this statement true or false?
False
These problems are associated with older mothers; however, women who have never been pregnant can experience them as well. Incontinence is the direct result of congenital or acquired weakness of the pelvic support structures. This condition often appears during menopause when ovarian hormones and pelvic tissue are lost. The incidence does tend to remain higher in women who have given birth.
Tumors that are on pedicles (stalks) and present in either the endometrium or cervix are more commonly known as ______________.
Uterine polyps
Uterine polyps The etiology of this type of tumor is unknown, although they may develop in response to hormonal stimulus or be the result of inflammation. Polyps are benign lesions that can be removed surgically.
A ____________________ cyst is a germ cell tumor that contains substances such as hair, teeth, sebaceous secretions, and bones.
Dermoid
Some plant foods contain ________ and are capable of interacting with estrogen receptors in the body.
Phytoestrogens
Alternatives to hormonal therapy for menopausal symptoms include (choose all that apply):
A. Soy B. Vitamin C C. Vitamin K D. Vitamin E E. Vitamin A
A. Soy
D. Vitamin E
Both soy and vitamin E have been reported to help alleviate menopausal symptoms. Vitamins C, K, and A have no apparent effect on menopausal symptoms.
Which suggestion is appropriate for a client who complains of hot flashes? Choose all that apply.
A. Consume large quantities of caffeine
B. Drink a glass of wine
C. Eat Mexican food
D. Drink ice water
E. Drink warm beverages
D. Drink ice water
Ice water may help alleviate the hot flashes. Consuming large quantities of caffeine, drinking a glass of wine, eating Mexican food, or drinking warm beverages most likely would exacerbate the hot flashes.
Your client is undergoing treatment for ovarian cancer. Please identify which common nutritional problems are related to gynecologic cancers and the treatment thereof. (choose all that apply)
A. Stomatitis B. Constipation C. Anorexia D. Diarrhea E. Nausea and vomiting
All of them
Stomatitis, constipation, anorexia, diarrhea, and nausea and vomiting are all possible nutritional complications related to gynecologic cancers and their treatment. The nurse must assess accordingly and adapt the client’s plan of care. To ensure recovery these women should consume a diet high in iron and protein, drink plenty of fluids, and eat foods high in vitamins C, B and K.
During internal radiation therapy for cervical cancer, the nurse should:
A. Wear gloves when assessing the cervical intracavity implant
B. Instruct the client to urinate in the lead-lined bedpan or “hat” every 2 hours
C. Prepare the client for an enema before insertion
D. Limit staff or visitor exposure to 30 minutes or less per 8 hours
D. Limit staff or visitor exposure to 30 minutes or less per 8 hours
Staff and visitor exposure should be limited to 30 minutes or less in an 8-hour period to reduce the risk of overexposure to radiation. Nurses need to protect themselves from overexposure to radiation. Wearing a shield is one method of protection. An indwelling catheter is inserted to prevent urinary distention that could dislodge the applicator. No bowel prep is necessary.
With regard to planning treatment for a pregnant woman with breast cancer, which statement about timing or type of treatment is correct?
A. The fetus is most at risk during the first trimester.
B. The fetus is most at risk during the second trimester.
C. The fetus is most at risk during the third trimester.
D. Surgery is more risky than chemotherapy in the first trimester.
A. The fetus is most at risk during the first trimester.
The first trimester is the most vulnerable period for the growing fetus. Women may be faced with making a decision about terminating the pregnancy, depending on the stage and extent of the disease. For advanced disease in the second trimester, alkylating agents, 5-fluorouracil (5-FU), and vincristine are relatively safe for the fetus. For advanced disease in the third trimester, alkylating agents, 5-FU, and vincristine are relatively safe for the fetus. Surgery is less risky than chemotherapy in the first trimester.
The nurse should be aware that a pessary would be most effective in the treatment of what disorder?
A. Cystocele
B. Uterine prolapse
C. Rectocele
D. Stress urinary incontinence
B. Uterine prolapse
A fitted pessary may be inserted into the vagina to support the uterus and hold it in the correct position. A pessary is not used for the client with a cystocele. A rectocele cannot be corrected by the use of a pessary. It is unlikely that a pessary is the most effective treatment for stress incontinence.
Risky sexual behaviors and inadequate preventive health behaviors are the two primary areas of risk for sexually transmitted infections (STIs).
True
False
True
Risky sexual behaviors and inadequate preventive health behaviors put a person at risk for acquiring or transmitting an STI. Although low socioeconomic status may be a factor in avoiding purchasing barrier protection, sexual orientation does not put one at higher risk. Younger individuals with less education may not be aware of proper prevention techniques; however, these are not the primary areas for STIs. Having a large number of sexual partners is certainly a risk-taking behavior. Race does not increase the risk for STIs.
Which of the following sexually transmitted infections are bacterial?
A. Syphilis B. Trichominiasis C. Chlamydia D. Gonorrhea E. Group B strep F. Hepatitis B
A. Syphilis
C. Chlamydia
D. Gonorrhea
E. Group B strep
To detect the human immunodeficiency virus (HIV), most laboratory tests focus on:
A. HIV virus
B. HIV antibodies
C. CD4 counts
D. CD8 counts
B. HIV antibodies
The screening tool used to detect HIV is the enzyme immunoassay, which tests for the presence of antibodies to the HIV. In order to determine if the HIV is present, the test performed must be able to detect antibodies to the virus, not the virus itself. CD4 counts are associated with the incidence of acquired immunodeficiency syndrome (AIDS) in HIV-infected individuals. CD8 counts are not performed in order to detect HIV.
What is the nurse’s primary responsibility for a couple diagnosed with multiple severe fetal abnormalities?
A. refer the couple to a new OB/GYN
B. refer the couple for intrauterine fetal surgery
C. refer the couple for possible pregnancy termination
D. refer the couple for genetic counseling
D. refer the couple for genetic counseling
What is the chance for a fetus to have an autosomal dominant trait when one parent has the trait?
A. 25% for any child B. 50% for any child C. 75% for any child D. 50% for all male children E. 50% for all female children
B. 50% for any child
50% risk to have the trait, 50% risk to be normal
What is the chance of a baby having an autosomal recessive trait when both parents are carriers for that trait?
A. 50% if it’s a male
B. 50% if it’s a female
C. 25%
D. 75%
C. 25%
On vaginal examination of a 30-year-old woman, the nurse documents the following findings: profuse, thin, grayish-white vaginal discharge with a “fishy” odor; complains of pruritus. Based on these findings, the nurse suspects that this woman has:
A. Bacterial vaginosis
B. Candidiasis
C. Trichomoniasis
D. Gonorrhea
A. Bacterial vaginosis
Most women with bacterial vaginosis (BV) complain of a characteristic “fishy odor.” The discharge usually is profuse, thin, and has a white, gray, or milky color. Some women also may have mild irritation or pruritus. The discharge associated with candidiasis is thick, white, and lumpy and resembles cottage cheese. Trichomoniasis may be asymptomatic, but women commonly have a characteristic yellowish to greenish, frothy, mucopurulent, copious, and malodorous discharge. Women with gonorrhea are often asymptomatic. They may have a purulent endocervical discharge, but discharge usually is minimal or absent.
A nurse must be cognizant that an individual’s genetic makeup is known as his/her:
A. Genotype
B. Phenotype
C. Karyotype
D. Chromotype
A. Genotype
The genotype comprises all the genes the individual can pass on to a future generation. The phenotype is the observable expression of an individual’s genotype. The karyotype is a pictorial analysis of the number, form, and size of an individual’s chromosomes. Genotype refers to an individual’s genetic makeup
How would you state the karyotype for Kleinfelter’s?
47XXY
Down Syndrome =
Trisomy 21
After a client has a positive Chlamydia trachomatis culture, she and her husband return for counseling. Which question should the nurse ask first during the assessment?
A. “Do you have contacts to identify?”
B. “What is your understanding regarding how Chlamydia is transmitted?”
C. “Do you have questions about the culture and its validity?”
D. “Do you have allergies to the medications?”
B. “What is your understanding regarding how Chlamydia is transmitted?”
The transmission of Chlamydia may or may not have been made clear to both partners so the nurse would have to assess this first. Chlamydia is a reported sexually tranmitted disease. A may be part of the follow up. C is a possibility but most cultures used today have few false positives. D would be done later in the assessment.
To promote safety, what priority action would the nurse implement in obtaining a blood specimen from a client with hepatitis B?
A. Clean area with antiseptic solution.
B. Wear a pair of clean gloves.
C. Apply pressure to site for 5 seconds.
D. Recap needle to avoid carrying exposed needle.
B. Wear a pair of clean gloves.
Clean gloves should be worn at all times when handling any client’s body fluids. A is correct but not higher priority over B. C is incorrect because venipuncture sites of clients with hepatitis B should be held for a longer period of time due to possibility of increased bleeding associated with an impaired liver. D is unsafe.
Which statement about the various forms of hepatitis is accurate?
A. A vaccine exists for hepatitis C but not for hepatitis B.
B. Hepatitis A is acquired by eating contaminated food or drinking polluted water.
C. Hepatitis B is less contagious than human immunodeficiency virus (HIV).
D. The incidence of hepatitis C is decreasing.
B. Hepatitis A is acquired by eating contaminated food or drinking polluted water.
For which of the following reasons would the nurse refer a client for a prenatal genetics consultation? (choose all that apply)
A. age 36 at delivery
B. abnormal quad screen result
C. one previous pregnancy loss
D a cousin with a birth defect
E. working in a factory where chemical exposure is possible
A. age 36 at delivery
B. abnormal quad screen result
D a cousin with a birth defect
E. working in a factory where chemical exposure is possible
All but C (the third answer) are reasons for referral. Guidelines state that need 2 or more pregnancy losses for referral.
What are the most common perinatal complications associated with bacterial sexually transmitted infections (STI’s)?
preterm labor preterm birth miscarriage IUGR - intrauterine growth restriction newborn eye infections
Which virus is most threatening to the fetus and neonate?
A. Hepatitis A virus
B. Herpes simplex virus (HSV)
C. Hepatitis B virus (HBV)
D. Cytomegalovirus (CMV)
C. Hepatitis B virus (HBV)
HBV is the virus most threatening to the fetus and neonate. Hepatitis A is not the most threatening to the fetus. HSV is not the most threatening to the neonate. Although serious, CMV is not the most threatening to the fetus.
A woman has a thick, white, lumpy, cottage cheese–like discharge, with patches on her labia and in her vagina. She complains of intense pruritus. The nurse practitioner orders which preparation for treatment?
A. Clindamycin
B. Penicillin
C. Fluconozole
D. Acyclovir
C. Fluconozole
The symptoms suggest candidiasis/yeast infection. Fluconazole, metronidazole, and clotrimazole are the drugs of choice to treat candidiasis/yeast. Penicillin is used to treat syphilis. Clindamycin and metronidazole are used to treat bacterial vaginosis. Acyclovir is used to treat genital herpes.
When a client’s newborn dies immediately after birth due to a Trisomy 13, the nurse’s primary responsibility is to:
A. avoid letting the client see the infant
B. say “you can have another baby”
C. provide grief counseling and support
D. obtain tissue samples.
C. provide grief counseling and support
A man’s wife is pregnant for the third time. One child was born with cystic fibrosis, and the other child is healthy. The man wonders what the chance is that this child will have cystic fibrosis. This type of testing is known as:
A. Occurrence risk
B. Recurrence risk
C. Predictive testing
D. Predisposition testing
B. Recurrence risk
Which of the following sexually transmitted infections are viral?
A. Trichomoniasis B. HIV C. HSV D. Pediculosis E. Group B strep F. CMV G. HPV
B. HIV
C. HSV
F. CMV
G. HPV
What is the most common bacterial sexually transmitted infection (STI)?
Chlamydia
What does TORCH stand for?
T = toxoplasmosis, O = other, R = rubella, C = cytomegalovirus (CMV), H = Herpes
The karyotype designated as female is______
46XX
The karyotype designated as male is _____
46XY
A saline wet smear (vaginal secretions mixed with normal saline on a glass slide) is the test for:
A. Bacterial vaginosis
B. Candidiasis
C. Yeast infection
D. Trichomoniasis
D. Trichomoniasis
The presence of many white blood cell protozoa is a positive finding for trichomoniasis. A normal saline test is used to test for bacterial vaginosis. A potassium hydroxide preparation is used to test for candidiasis. “Yeast infection” is the common name for candidiasis, for which the test is a potassium hydroxide preparation.
The U.S. Department of Health and Human Services has designated Thanksgiving Day as National Family History Day. The Surgeon General encourages family members to discuss important family health information while sharing in holiday gatherings. This initiative is significant to nurses because:
A. There are few genetic tests available to identify this information
B. Only physicians should obtain this detailed information
C. Clients cannot accurately complete these histories on their own
D. This is the single most cost effective source of genetic information
D. This is the single most cost effective source of genetic information
Although there are more than 1000 genetic tests available, the single most cost-effective piece of genetic information is the family history. Nurses are ideally suited to take the lead in ongoing efforts to recognize the significance of the family history as an important source of genetic information. A computerized tool called My Family Health Portrait is available free of charge (www.hhs.gov/familyhistory/download.html). Other tools to aid the lay community in completing their family histories are available to the public.
Genetics
is the study of a single gene or gene sequences and their effects on a living organism.
The branch of biology that studies heredity and variation in organisms.
Genome
Complete Complement of an organisms DNA
All of the Chromosomes
Chromosomes
Carry Genes (physical structure)
A chromosome is one molecule of DNA
Gene
Unit of Heredity
Made of Segments of DNA
Allele
one version of a gene
Loci
location of specific gene on chromosome
Sex chromosomes
X and Y chromosomes only
Autosomes
all chromosomes except sex
Mutation
Definition - when a DNA gene is damaged or changed in such a way as to alter the genetic message carried by that gene.
Mutagen
An agent of substance that can bring about a permanent alteration to the physical composition of a DNA gene such that the genetic message is changed.
Genotype
all the genes of an organism
Phenotype
the expression of genes, an organism’s traits
Karyotype
photographic representation of chromosomes
Homozygous
pair of identical alleles for a characteristic/gene
Heterozygous
two different alleles for a characteristic/gene
Dominant
one copy of gene expressed
Recessive
requires two copies of gene to express
Clinically applicable genetic tests may be used for:
Diagnostic testing - confirm or r/o disorder
Predictive testing – assymptomatic individuals
Carrier testing - identify those with recessive disorder
Prenatal testing - performed during pregnancy
Preimplantation testing - done on early embryos in IVF
Newborn screening – identify disorder for treatment
What is a Genetics Consultation?
Evaluation of an individual or family for:
Confirm, diagnose or rule out genetic condition
Identify medical management issues
Calculate and communicate genetic risks
Provide or arrange for psychosocial support
Reasons for prenatal genetics consult
> 35 years at delivery
Abnormal triple/quad screen results or fetal ultrasound
Personal or family history of known or suspected genetic disorder, birth defect, or chromosomal abnormality
Exposure to a known or suspected teratogen
Medical condition known or suspected to affect fetal development
Two or more pregnancy losses
Close biological relationship of parents
Ethnic predisposition to certain genetic disorders
Reasons for a Newborn/Pediatric Genetics Consultation
Abnormal newborn screening results
One or more major malformations in any organ system
Abnormalities in growth
Mental retardation or developmental delay
Blindness or deafness
Presence of a known or suspected genetic disorder or chromosomal abnormality
Family history of a known or suspected genetic disorder, birth defect, or chromosomal abnormality
Reasons for an Adolescent/Adult Genetics Consultation
Mental retardation
Personal or family history of hereditary cancers
Personal or family history of a known or suspected genetic condition or chromosomal abnormality
Blindness or deafness
Development of a degenerative disease
Risk assessment for pregnancy planning
Prenatal Genetic Tests
Blood and non invasive tests
Maternal serum Quad screen (AFP plus other markers)
DNA in maternal blood – mainly for Trisomy 21 (Down Syndrome), but also report results from Trisomy 13 (Patau syndrome), 18 (Edwards syndrome), - very new testing, MaterniT21
Ultrasound – nuchal fold plus NT screen
Trisomy 21
Down Syndrome
Trisomy 13
Patau syndrome
Trisomy 18
Edwards syndrome
Prenatal Genetic Tests
Invasive tests
Chorionic Villi Sampling (CVS)
Amniocentesis
Percutaneous Umbilical Blood
Sampling (PUBS)
Paternity (rarely done prenatally)
FISH
Nursing Expertise in Genetics or Genomics
Essential competencies for all nurses
Constructs pedigree from collected family history using standardized symbols and terminology
Develops plan of care that incorporates genetic and genomic assessment information
Recognizes when one’s own attitudes and values may affect care provided to clients
Provides clients with credible, accurate, appropriate, and current genetic and genomic information, resources, services, and/or technologies
Demonstrates in practice the importance of tailoring genetic information to clients based on ethical, ethnic/ancestral, cultural, religious, legal, fiscal, and societal issues
Assesses client’s knowledge, perceptions, and responses to genetic and genomic information
Facilitates referrals for specialized services
Human Genome Project Implications for Clinical Practice
Two key findings
All human beings are 99.9% identical at the DNA level
There are probably about 20,500 genes in the human genome
Importance of family history
Completion of Human Genome Project has resulted in renewed interest in family history
Single most cost-effective piece of genetic information
U.S. Department of Health and Human Services designated Thanksgiving as “National Family History Day”
Many family history tools available online
Genetic Information Nondiscrimination Act of 2008 – GINA
Federal Law prohibits discrimination in health coverage and employment based on genetic info
Americans free to use genetic info in health management
Not extend to life, disability, and long term care insurance
Not mandate coverage for any particular test or treatment
Monosomy
Union between a normal gamete and one that is missing a chromosome
Trisomy
Most common is Down syndrome (DS) Trisomy 18 (Edward syndrome) Trisomy 13 (Patau syndrome)
Sex chromosome abnormalities
Turner syndrome
Klinefelter syndrome
Turner syndrome
Monosomy X female
45X
Klinefelter syndrome
Trisomy XXY male
47XXY
Mosaicism
2 or more cell lines
Key Points
Advances in molecular biology and genetics provide molecular tools needed to determine hereditary component of most diseases
Increasingly, nurses are expected to have expertise in genetics
Major force behind the genetics revolution has been the Human Genome Project
All humans are 99.9% identical at DNA level
Approximately 20,000 to 25,000 genes in the human genome
Most genetic tests offered in clinical practice are tests for single-gene disorders
Pharmacogenomics is likely the most immediate clinical application of Human Genome Project
Decision to undergo genetic testing often based on responsibility and commitment to others
Genes are basic units of heredity responsible for all human characteristics and comprise 23 pairs of chromosomes
22 pairs of autosomes
1 pair of sex chromosomes
Chromosomal abnormalities occur in both autosomal and sex chromosomes
Multifactorial inheritance includes genetic and environmental contributions
Advances in genetics have complex ethical, legal, and social implications
Cancer genetics is an important emerging field
A pregnant couple is receiving genetic counseling. The husband and wife have been told that they both carry the trait for sickle cell anemia and that there is a 25% chance that their unborn child may have the disease. What type of inheritance is sickle cell anemia?
A. Autosomal dominant B. Autosomal recessive C. X-linked dominant D. X-linked recessive
B. Autosomal recessive
Which of the following is the role of the nurse in genetic counseling?
A. Determining which genetic testing should be ordered
B. Performing amniocentesis
C. Providing emotional support
D. Encouraging all women to be tested for genetic disorders
C. Providing emotional support
What best describes the pattern of genetic transmission known as autosomal recessive inheritance?
A. Disorders in which the abnormal gene for the trait is expressed even when the other member of the pair is normal
B. Disorders in which both genes of a pair must be abnormal for the disorder to be expressed
C. Disorders in which a single gene controls the particular trait
D. Disorders in which the abnormal gene is carried on the X chromosome
B. Disorders in which both genes of a pair must be abnormal for the disorder to be expressed
A couple has been counseled for genetic anomalies. They ask you, “What is karyotyping?” Your best response is:
A. “Karyotyping will reveal if the baby’s lungs are mature.“
B. “Karyotyping will reveal if your baby will develop normally.“
C. “Karyotyping will provide information about the gender of the baby and the number and structure of the chromosomes.“
D. “Karyotyping will detect any physical deformities the baby has.“
C. “Karyotyping will provide information about the gender of the baby and the number and structure of the chromosomes.“
A nurse is providing genetic counseling for an expectant couple who already have a child with trisomy 18. The nurse should:
A. Tell the couple they need to have an abortion within 2 to 3 weeks
B. Explain that the fetus has a 50% chance of having the disorder
C. Discuss options with the couple, including amniocentesis to determine whether the fetus is affected
D. Refer the couple to a psychologist for emotional support
C. Discuss options with the couple, including amniocentesis to determine whether the fetus is affected
Genetic testing, including amniocentesis, would need to be performed to determine whether the fetus is affected.
You are a maternal-newborn nurse caring for a mother who just delivered a baby born with Down syndrome. What nursing diagnosis would be the most essential in caring for the mother of this infant?
A. Disturbed body image
B. Interrupted family processes
C. Anxiety
D. Risk for injury
B. Interrupted family processes
This mother likely will experience a disruption in the family process related to the birth of a baby with an inherited disorder.
A couple has been counseled for genetic anomalies. They ask you, “What is karyotyping?” Your best response is:
A. “Karyotyping will reveal if the baby’s lungs are mature.”
B. “Karyotyping will reveal if your baby will develop normally.”
C. “Karyotyping will provide information about the gender of the baby and the number and structure of the chromosomes.”
D. “Karyotyping will detect any physical deformities the baby has.”
C. “Karyotyping will provide information about the gender of the baby and the number and structure of the chromosomes.”
With regard to the estimation and interpretation of the recurrence of risks for genetic disorders, nurses should be aware that:
A. With a dominant disorder, the likelihood of the second child also having the condition is 100%
B. An autosomal recessive disease carries a one in eight risk of the second child also having the disorder
C. Disorders involving maternal ingestion of drugs carry a one in four chance of being repeated in the second child
D. The risk factor remains the same no matter how many affected children are already in the family
D. The risk factor remains the same no matter how many affected children are already in the family
Each pregnancy is an independent event. The risk factor (e.g., one in two, one in four) remains the same for each child, no matter how many children are born to the family.
With regard to abnormalities of chromosomes, nurses should be aware that:
A. They occur in approximately 10% of newborns
B. Abnormalities of number are the leading cause of pregnancy loss
C. Down syndrome is a result of an abnormal chromosomal structure
D. Unbalanced translocation results in a mild abnormality that the child will outgrow
B. Abnormalities of number are the leading cause of pregnancy loss
Aneuploidy is an abnormality of number that also is the leading genetic cause of mental retardation.
A key finding from the Human Genome Project is:
A. Approximately 20,000 to 25,000 genes make up the genome
B. All human beings are 80.99% identical at the DNA level
C. Human genes produce only one protein per gene; other mammals produce three proteins per gene
D. Single-gene testing will become a standardized test for all pregnant women in the future
A. Approximately 20,000 to 25,000 genes make up the genome
Approximately 20,500 genes make up the human genome; this is only twice as many as make up the genomes of roundworms and flies.
Most of the genetic tests now offered in clinical practice are tests for:
A. Single-gene disorders
B. Carrier screening
C. Predictive values
D. Predispositional testing
A. Single-gene disorders
Most tests now offered are tests for single-gene disorders in clients with clinical symptoms or who have a family history of a genetic disease.
Carrier screening
Carrier screening is used to identify individuals who have a gene mutation for a genetic condition but do not display symptoms.
Predictive values
Predictive testing is used only to clarify the genetic status of asymptomatic family members.
Predispositional testing
Predispositional testing differs from the other types of genetic screening in that a positive result does not indicate a 100% chance of developing the condition.
What symptom described by a woman is characteristic of premenstrual syndrome (PMS)?
A. “I feel irritable and moody a week before my period is supposed to start.”
B. “I have lower abdominal pain beginning the third day of my menstrual period.”
C. “I have nausea and headaches after my period starts, and they last 2 to 3 days.”
D. “I have abdominal bloating and breast pain after a couple days of my period.”
A. “I feel irritable and moody a week before my period is supposed to start.”
PMS is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses.
With regard to the diagnosis and management of amenorrhea, nurses should be aware that:
A. It probably is the result of a hormone deficiency that can be treated with medication
B. It may be caused by stress or excessive exercise or both
C. It likely will require the client to eat less and exercise more
D. It often goes away on its own
B. It may be caused by stress or excessive exercise or both
Amenorrhea usually is the result of stress and/or an inappropriate ratio of body fat to lean tissue, possibly as a result of excessive exercise. Management includes counseling and education about the causes and possible lifestyle changes.
A nurse counseling a client with endometriosis understands which statement regarding the management of endometriosis is not accurate?
A. Bone loss from hypoestrogenism is not reversible.
B. Side effects from the steroid danazol include masculinizing traits.
C. Surgical intervention often is needed for severe or acute symptoms.
D. Women without pain and who do not want to become pregnant need no treatment.
A. Bone loss from hypoestrogenism is not reversible.
Bone loss is mostly reversible within 12 to 18 months after the medication is stopped.
With regard to dysfunctional uterine bleeding (DUB), the nurse should be aware that:
A. It is most commonly caused by anovulation
B. It most often occurs in middle age
C. The diagnosis of DUB should be the first considered for abnormal menstrual bleeding
D. The most effective medical treatment involves steroids
A. It is most commonly caused by anovulation
Anovulation may occur because of hypothalamic dysfunction or polycystic ovary syndrome.
An effective relief measure for primary dysmenorrhea is to:
A. Reduce physical activity level until menstruation ceases
B. Begin taking prostaglandin synthesis inhibitors on the first day of the menstrual flow
C. Decrease intake of salt and refined sugar about 1 week before menstruation is about to occur
D. Use barrier methods rather than the oral contraceptive pill (OCP) for birth control
C. Decrease intake of salt and refined sugar about 1 week before menstruation is about to occur
Decreasing intake of salt and refined sugar can reduce fluid retention
Several noted health risks are associated with menopause. These risks include all except:
A. Osteoporosis
B. Coronary heart disease
C. Breast cancer
D. Obesity
C. Breast cancer
Breast cancer may be associated with the use of hormone replacement therapy for women who have a family history of breast cancer.
Most common STIs in women
Chlamydia Gonorrhea Human papillomavirus Herpes simplex virus type 2 Syphilis HIV infection
Primary prevention
Primary prevention the most effective way of reducing STIs in women
Secondary prevention
Prompt diagnosis and treatment can prevent personal complications and transmission to others
What are the Risk reduction measures for preventing STI’s
Knowledge of partner Reduction of the number of partners Low risk sex Avoiding exchange of body fluids Immunization
Physical barriers- Condoms
Chemical barriers- Nonoxynol-9
Communication
Expressing feelings and fears
Attention to partner’s response
Vaccination
Bacterial Sexually Transmitted Infections
Chlamydia trachomatis
Gonorrhea
Syphilis
Pelvic inflammatory disease (PID)
Chlamydia trachomatis
Most common and fastest spreading STI
Infections often silent and highly destructive
Difficult to diagnose
Can lead to PID and infertility
Screening and diagnosis
Asymptomatic and pregnant women
Comparisons of diagnostic procedures
CDC guidelines – screening yearly sexually active adolescents or if at high risk and in pregnancy
Chlamydia
Management
Doxycycline
Azithromycin
Erythromycin
Amoxicillin
Perinatal transmission
Antibiotic ointment
Gonorrhea
Aerobic gram-negative diplococcus
Oldest communicable disease in the U.S.
Second to chlamydia in reported cases
Highest rates among teenagers, young adults, and African-Americans
Women often asymptomatic
Gonorrhea
Screening and diagnosis
CDC recommends screening all women at risk
Testing during first trimester and at 36 weeks of pregnancy
Reportable disease – legally must notify health dept
Gonorrhea Management
Antibiotic therapy: cefixime or ceftriaxone
Concomitant treatment for chlamydia
Gonorrhea
Perinatal complications of gonococcal infection
Miscarriage
Preterm labor
Premature rupture of membranes
Chorioamnionitis
Neonatal sepsis, congenital blindness
Intrauterine growth restriction
Postpartum endometritis
Maternal postpartum sepsis
Syphilis
Treponema pallidum - motile spirochete
Earliest described STI
Transmission - entry in subcutaneous tissue through microscopic abrasions that can occur during sexual intercourse
Also transmitted through kissing, biting, or oral-genital sex
Transplacental transmission may occur at any time during pregnancy
Can lead to serious systemic disease and even death
Infection manifests itself in distinct stages
Primary: 5 to 90 days after exposure
Secondary: 6 weeks to 6 months
Tertiary: develops in one third of women infected
Screening and diagnosis
Pregnant women – initial testing
Serologic tests – monthly
VDRL/RPR/FTA in pregnancy if ever positive to retreat
False positives, false negatives
Syphilis Management
Penicillin – even if PCN allergic in pregnancy
Sexual abstinence during treatment
Pelvic inflammatory disease (PID)
An infectious process that most commonly involves the fallopian tubes, uterus, and occasionally the ovaries and peritoneal surfaces
Multiple organisms have been found to cause PID
Increased risk of
Ectopic pregnancy – 7 fold
higher
Infertility
Chronic pelvic pain
Pelvic Inflammatory Disease (PID)
Symptoms
Depend on type of infection
Acute- Abdominal pain, fever, chills. Pain with sex or pelvic exam. Caused by bacteria
Subacute (intermittant)
Chronic
Pelvic Inflammatory Disease (PID)
Management
Prevention
Broad Spectrum antibiotics,
analgesics
Hospitalization - common
Education – with contraceptive counseling (no IUD)
Bedrest with Semi Fowlers
Avoid frequent pelvic exams
Repeat cultures
Pelvic rest
Viral Sexually Transmitted Infections
Human papillomavirus (HPV)
Herpes simplex virus (HSV)
Herpes simplex virus (HSV) 1
(transmitted non sexually)
Hepatitis A virus (HAV)
Hepatitis B virus (HBV)
Hepatitis C virus (HCV)
Human immunodeficiency virus (HIV)
Human papillomavirus (HPV)
Condylomata acuminata (genital warts)
Affects 20 million Americans
Most prevalent viral STI seen in ambulatory health care settings
Previously named genital or venereal warts
More frequent in pregnant women
Screening and diagnosis
History of known exposure
Physical inspection
Pap smear
Management
Removal – cryotherapy, chemical
Medications - some not in pregnancy
Counseling
Herpes simplex virus (HSV)
Herpes simplex virus 1 (HSV-1)
Transmitted nonsexually
Herpes simplex virus (HSV)
Transmitted sexually
Initial infection characterized by multiple painful lesions, fever, chills, malaise, and severe dysuria
No known cure, antivirals may help with neonatal prophylaxsis
Treat to provide comfort
Maternal infection with HSV-2 can have adverse effects on mother and fetus
miscarriage
Herpes simplex virus (HSV)
Neonatal herpes
Most severe complication of HSV
Most mothers lack history of HSV
Neonatal encephalitis
Viral hepatitis
Hepatitis A virus (HAV)
Acquired primarily through a fecal-oral route
Vaccination is the most effective means of preventing HAV transmission
Viral hepatitis
Hepatitis B virus (HBV)
Most threatening to the fetus and neonate
Disease of the liver and often a silent infection
Transmitted parenterally, perinatally, and rarely, orally, as well as through intimate contact
Vaccination series
Education
Viral hepatitis
Hepatitis C virus (HCV)
Most common blood-borne infection in the United States
Important health problem as increasing numbers acquire disease
Viral hepatitis
Hepatitis C virus (HCV)
Risk factor for pregnant women is history of injecting IV drugs
Interferon alfa or ribavirin is main therapy for HCV infection
Effectiveness of treatment varies
Human immunodeficiency virus (HIV)
37,000 new HIV infections occur in U.S. each year
Heterosexual transmission now the most common means of transmission in women
Women are the fastest-growing population of HIV infection and AIDS
Transmission of HIV occurs primarily through exchange of body fluids
Human immunodeficiency virus (HIV)
Severe depression of the cellular immune system associated with HIV infection characterizes AIDS
Symptoms: fever, headache, night sweats, malaise, generalized lymphadenopathy, myalgias, nausea, diarrhea, weight loss, sore throat, and rash
Human immunodeficiency virus (HIV)
Screening and diagnosis
Antibody testing
Detection
Pregnancy – initial visit and repeat 3rd trimester
Counseling for HIV testing
HIV testing offered early in pregnancy
Perinatal transmission decreases with treatment
Consider confidentiality and documentation
Pretest and posttest counseling
Notification of results
Human immunodeficiency virus (HIV)
Management
Resources Death and dying Suicide prevention Financial assistance Legal advocacy Prevention of transmission
HIV and pregnancy
Counseling and testing offered to all women who enter the system for prenatal care
Perinatal transmission has decreased due to antiretroviral prophylaxis
Decreases transmission to 1% to 2%
Intrapartum zidovudine
Cesarean birth is recommended
Breastfeeding contraindicated
Antivirals during pregnancy
AZT dosing for delivery
Arrival – initial dose 2 mg/kg for first hour
Subsequent – 1 mg/kg/hour till delivery with at least 4 hours total given before delivery
Vaginal Infections
Vulvovaginitis
Bacterial vaginosis (BV)
Candidiasis
Group B streptococci
Trichomoniasis
Vulvovaginitis
Infection caused by a microorganism
Also called abnormal vaginal discharge
Bacterial vaginosis (BV)
Syndrome in which normal H2O2-producing lactobacilli are replaced with high concentrations of anaerobic bacteria
Associated with preterm labor and birth
Treatment with metronidazole orally
Candidiasis
Candida albicans or non-C. albicans
Vulvovaginal candidiasis, or yeast infection, is second most common type of vaginal infection
In women with HIV, symptoms are more severe and persistent
Candidiasis
Predisposing factors
Antibiotic therapy Diabetes Pregnancy Obesity Diets high in refined sugars Use of corticosteroids and hormones Immunosuppressed states
Candidiasis
Common symptoms
Vulvar
Vaginal pruritus
Screening and diagnosis
Physical examination
Vaginal pH
Candidiasis
Management
Over-the-counter agents
Intravaginal treatment or oral agent
Methods of comfort
Sitz baths
Aveeno powder
No underpants to bed
Complete full course of treatment
Trichomoniasis
Trichomonas vaginalis
STI – partner needs treatment
Common cause of vaginal infection
Inflammation of the vagina and/or vulva
Screening and diagnosis
Speculum examination
Pap smear
Trichomoniasis
Management
Metronidazole, 2 g orally in a single dose
The risk for sexual transmission must be communicated to infected women
Group B streptococci
A part of the normal vaginal flora present in 20% to 30% of healthy women
Associated with poor pregnancy outcomes
Important factor in neonatal morbidity and mortality
Screening at 36-37 weeks of gestation
Intrapartum intravenous prophylaxis if +
Penicillin
Ampicillin
STIs in pregnancy are responsible for significant morbidity and mortality
Pregnancy effects Premature rupture of membranes Premature labor Postpartum sepsis Dystocia Miscarriage
Fetal effects Preterm birth Pneumonia Systemic infection Congenital infection Stillbirth
TORCH infections
Form group of infections capable of crossing the placenta and adversely affecting the fetus
Toxoplasmosis Other infections (e.g., hepatitis) Rubella virus Cytomegalovirus Herpes simplex virus (HSV)
HPV is the most common viral STI
Chlamydia is the most common STI in U.S. women and the most common cause of PID
Viral hepatitis has several forms of transmission; HBV infections carry the greatest risk
Young, sexually active women who do not practice safe sex and have multiple partners are at greatest risk for STIs and HIV
STIs are responsible for substantial mortality and morbidity and present heavy economic burden in the U.S.
Substance abuse can alter the body’s immune system and possibly increase the risk for AIDS
Pregnancy confers no immunity against infection
Because history and examination cannot reliably identify everyone with HIV or other blood-borne pathogens, blood and body fluid precautions should be used consistently for everyone all the time
A nurse is providing discharge instructions to a client who has just been diagnosed with human papillomavirus (HPV) on her cervix. Which of the following is the most important discharge instruction for this client?
A. Take a multivitamin every day.
B. Check for external lesions around the vagina every month.
C. Have Pap smears done as recommended by her practitioner.
D. Avoid use of the intrauterine device (IUD).
C. Have Pap smears done as recommended by her practitioner.
Which of the following sexual transmitted infections can be cured with antibiotics? A. Human papillomavirus B. Chlamydia C. Herpes simplex virus D. Hepatitis B
B. Chlamydia
The CDC recommended medication for the treatment of Chlamydia would be: A. Doxycycline B. Podofilox C. Acyclovir D. Penicillin
A. Doxycycline
When providing care to a young single woman just diagnosed with acute pelvic inflammatory disease, the nurse should:
A. Point out that inappropriate sexual behavior caused the infection.
B. Position the woman in a semi Fowler position.
C. Explain to the woman that infertility is a likely outcome of this type of infection.
D. Tell her that antibiotics need to be taken until the pelvic pain is relieved.
B. Position the woman in a semi Fowler position.
The viral sexually transmitted infection (STI) that affects most people in the United States today is:
A. Herpes simplex virus type 2 (HSV-2)
B. Human papillomavirus (HPV)
C. Human immunodeficiency virus (HIV)
D. Cytomegalovirus (CMV)
B. Human papillomavirus (HPV)
HPV infection, an STI, is the most prevalent viral STI seen in ambulatory health care settings.
The recommended treatment for the prevention of human immunodeficiency virus (HIV) transmission to the fetus during pregnancy is:
A. Acyclovir
B. Ofloxacin
C, Podophyllin
D. Zidovudine
D. Zidovudine
Perinatal transmission of HIV has decreased significantly in the past decade as a result of prophylactic administration of the antiretroviral drug zidovudine to pregnant women in the prenatal and perinatal periods.
When teaching self-care prevention of genital tract infections, the nurse should instruct the woman to:
A. Increase dietary sugar and avoid yogurt
B. Limit time spent in damp exercise clothes and limit exposure to bath salts or bubble bath
C. Choose underwear or hosiery with a nylon crotch
D. Douche frequently
B. Limit time spent in damp exercise clothes and limit exposure to bath salts or bubble bath
Clinical observations and research have suggested that tight-fitting clothing and underwear or pantyhose made of nonabsorbent materials create an environment in which a vaginal fungus can grow. Bathing in bath salts or bubble bath may further irritate sensitive genital tissue.
With regard to the most common bacterial sexually transmitted infections, which statement is not accurate?
A. Chlamydial infections and gonorrhea are more likely to occur in women younger than age 20.
B. Gonorrhea can be transmitted to the newborn by direct contact with gonococcal organisms in the cervix.
C. Syphilis can be transmitted through kissing, biting, or oral-genital sex.
D. Medications for pelvic inflammatory disease can be discontinued once symptoms disappear.
D. Medications for pelvic inflammatory disease can be discontinued once symptoms disappear.
For any infection, the entire prescription must always be taken.
An essential component of counseling women regarding safe sex practices includes discussion regarding avoiding the exchange of body fluids. The physical barrier promoted for the prevention of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) is the condom. Nurses can help motivate clients to use condoms by initiating a discussion related to a number of aspects of condom use. The most important of these is:
A. Strategies to enhance condom use
B. Choice of colors and special features
C. Leaving the decision up to the male partner
D. Places to safely carry condoms
A. Strategies to enhance condom use
When the nurse opens discussion on safe sex practices, this gives the woman permission to clear up any concerns or misapprehensions she may have regarding condom use. The nurse can also suggest ways that the woman can enhance her condom negotiation and communications skills. These include role-playing, rehearsal, cultural barriers, and situations that put the client at risk.
Which statement about genital herpes is inaccurate?
A. Genital herpes is also known as genital warts.
B. Stress, menstruation, trauma, and illnesses have been known to trigger recurrences.
C. Genital herpes is chronic and recurring and has no known cure.
D. Plain soap and water are all that is needed to clean hands that have come into contact with herpetic lesions.
A. Genital herpes is also known as genital warts.
Genital warts are one of the most common sexually transmitted infections (STIs); however, it is also known as human papillomavirus (HPV), not genital herpes.
Group B streptococci (GBS) are part of the normal vaginal flora in 20% to 30% of healthy pregnant women. GBS has been associated with poor pregnancy outcomes and is an important factor in neonatal morbidity and mortality. Risk factors for neonatal GBS infection include all except:
A. Positive prenatal culture
B. Preterm birth less than 37 weeks
C. Maternal fever of 38° C or greater
D. Premature rupture of membranes greater than 24 hours
D. Premature rupture of membranes greater than 24 hours
Premature rupture of membranes of 18 hours or more increases the risk for neonatal GBS infection.
Self-care instructions for a woman following a modified radical mastectomy include that she:
A. Wear clothing with snug sleeves to support her affected arm
B. Use depilatory creams instead of shaving the axilla of her affected arm
C. Expect a decrease in sensation or tingling in her affected arm as her body heals
D. Empty surgical drains once a day or every other day
C. Expect a decrease in sensation or tingling in her affected arm as her body heals
A decrease in sensation and tingling in the affected arm and in the incision are expected for weeks to months after the surgery.
The nurse should refer a client for further testing if noted on inspection of a 55-year-old woman’s breasts:
A. Left breast slightly smaller than right breast
B. Eversion (elevation) of both nipples
C. Bilateral symmetry of venous network, which is faintly visible
D. Small dimple located in the upper outer quadrant of the right breast
D. Small dimple located in the upper outer quadrant of the right breast
A small dimple is an abnormal finding and should be further evaluated.
Fibrocystic changes in the breast most often appear in women in their 20s and 30s. The etiology is not known, but it may be an imbalance of estrogen and progesterone. The nurse who cares for this client should be aware that treatment modalities are conservative. One proven modality that may provide relief is:
A. Diuretic administration
B. Including caffeine daily in the diet
C. Increased vitamin C supplementation
D. Application of cold packs to the breast as necessary
A. Diuretic administration
Diuretic administration plus a decrease in sodium and fluid intake are recommended.
A client has been prescribed adjuvant tamoxifen therapy. What common side effect might she experience?
A. Nausea, hot flashes, and vaginal bleeding
B. Vomiting, weight loss, and hair loss
C. Nausea, vomiting, and diarrhea
D. Hot flashes, weight gain, and headaches
A. Nausea, hot flashes, and vaginal bleeding
Common side effects of tamoxifen therapy include hot flashes, nausea, vomiting, vaginal bleeding, menstrual irregularities, and rash.
The most conservative approach for early breast cancer treatment involves lumpectomy followed by which procedure?
A. Radiation
B. Adjuvant systemic therapy
C. Hormonal therapy
D. Chemotherapy
A. Radiation
Radiation therapy in the form of either brachytherapy or accelerated breast radiation is the standard therapy after lumpectomy for the treatment of early-stage breast cancer.
What information will the nurse include in planning for the care of a woman who has had a vaginal hysterectomy?
A. The woman should expect to be fully recovered in 4 to 6 weeks.
B. The woman should expect no changes in her hormone levels.
C. The woman should expect surgical menopause.
D. The woman should take tub baths to aid in healing.
B. The woman should expect no changes in her hormone levels.
Unless the ovaries also were removed, hormonal levels should not change. Menses will cease, but the hypothalamic-pituitary-ovarian axis remains intact.
A woman has preinvasive cancer of the cervix. In discussing available treatments, the nurse includes:
A. Cryosurgery
B, Colposcopy
C. Hysterectomy
D. Internal radiation
A. Cryosurgery
Cryosurgery, laser surgery, and loop electrosurgical excision procedure (LEEP) are several techniques used to treat preinvasive lesions.
When obtaining a health history, the nurse should be aware that the most common malignancy of the reproductive system is:
A. Endometrial cancer
B. Cervical cancer
C. Ovarian cancer
D. Vulvar and vaginal cancer
A. Endometrial cancer
Endometrial cancer occurs most frequently in Caucasian women and after menopause.
A mother in late middle age who is certain she is not pregnant tells the nurse during an office visit that she has urinary problems, as well as sensations of bearing down and of something in her vagina. The nurse realizes that the woman most likely is suffering from:
A. Pelvic relaxation
B. Cystoceles and/or rectoceles
C. Uterine prolapse
D. Genital fistulas
B. Cystoceles and/or rectoceles
Cystoceles are protrusions of the bladder downward into the vagina; rectoceles are herniations of the anterior rectal wall through a relaxed or ruptured vaginal fascia. Both can present as a bearing-down sensation with urinary dysfunction. They occur more often in older women who have borne children.
Which woman has the highest risk for endometrial cancer?
A. A postmenopausal woman with hypertension
B. A woman who has an intrauterine device
C. A client who has been on birth control for 15 years
D. A perimenopausal woman who has a cystocele
A. A postmenopausal woman with hypertension
Endometrial cancer is most often seen in postmenopausal women between the ages of 50 and 65. Hypertension is a risk factor associated with the development of this malignancy.
Your client has just returned from a uterine artery embolization (UAE) procedure. Prior to her discharge it is very important to discuss symptoms that require a call to the health care provider. These include all except:
A. Fever of 39° C
B. Swelling or hematoma at the puncture site
C. Abnormal vaginal discharge
D. Urinary frequency
D. Urinary frequency
The physician should be notified if the client is experiencing urinary retention. Urinary frequency is not a complication of UAE.
A woman has presented for her preoperative testing appointment. She is scheduled for a myomectomy the following day. As the nurse involved in this woman’s care you understand that this procedure is being performed for:
A. Numerous small fibroids
B. Bartholin cysts
C. Fibroids near the outer wall of the uterus whose size are no larger than 12 weeks of gestation
D. Leiomyomas in a uterus larger than 14 weeks of gestation
C. Fibroids near the outer wall of the uterus whose size are no larger than 12 weeks of gestation
If a fibroid tumor lies near the outer wall of the uterus and the uterine size is no larger than at 12 to 14 weeks of gestation and symptoms are significant, a myomectomy (removal of the tumor) may be performed. This procedure leaves the uterine walls relatively intact, thereby preserving the uterus for future pregnancies.
