ONCOLOGY: Brunner's Ch 57: Management of Patients with Female Reproductive Disorders Flashcards
When teaching patients about the risk factors of cervical cancer, what would the nurse identify as the most important risk factor? A) Late childbearing B) Human papillomavirus (HPV) C) Postmenopausal bleeding D) Tobacco use
B) Human papillomavirus (HPV)
HPV is the most salient risk factor for cervical cancer, exceeding the risks posed by smoking, late childbearing, and postmenopausal bleeding.
A female patient with HIV has just been diagnosed with condylomata acuminata (genital warts). What information is most appropriate for the nurse to tell this patient?
A) This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) test annually.
B) The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days.
C) The potential for transmission to her sexual partner will be eliminated if condoms are used every time they have sexual intercourse.
D) The human papillomavirus (HPV), which causes condylomata acuminata, cannot be transmitted during oral sex.
A) This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) test annually.
HIV-positive women have a higher rate of HPV. Infections with HPV and HIV together increase the risk of malignant transformation and cervical cancer. Thus, women with HIV infection should have frequent Pap smears. Because condylomata acuminata is a virus, there is no permanent cure. Because condylomata acuminata can occur on the vulva, a condom will not protect sexual partners. HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx.
The nurse is teaching a patient preventative measures regarding vaginal infections. The nurse should include which of the following as an important risk factor? A) High estrogen levels B) Late menarche C) Nonpregnant state D) Frequent douching
D) Frequent douching
Risk factors associated with vulvovaginal infections include pregnancy, premenarche, low estrogen levels, and frequent douching.
A patient with ovarian cancer is admitted to the hospital for surgery and the nurse is completing the patients health history. What clinical manifestation would the nurse expect to assess? A) Fish-like vaginal odor B) Increased abdominal girth C) Fever and chills D) Lower abdominal pelvic pain
B) Increased abdominal girth
Clinical manifestations of ovarian cancer include enlargement of the abdomen from an accumulation of fluid. Flatulence and feeling full after a light meal are significant symptoms. In bacterial vaginosis, a fish-like odor, which is noticeable after sexual intercourse or during menstruation, occurs as a result of a rise in the vaginal pH. Fever, chills, and abdominal pelvic pain are atypical.
A 30-year-old patient has come to the clinic for her yearly examination. The patient asks the nurse about ovarian cancer. What should the nurse state when describing risk factors for ovarian cancer?
A) Use of oral contraceptives increases the risk of ovarian cancer.
B) Most cases of ovarian cancer are attributed to tobacco use.
C) Most cases of ovarian cancer are considered to be random, with no obvious causation.
D) The majority of women who get ovarian cancer have a family history of the disease.
C) Most cases of ovarian cancer are considered to be random, with no obvious causation.
Most cases of ovarian cancer are random, with only 5% to 10% of ovarian cancers having a familial connection. Contraceptives and tobacco have not been identified as major risk factors.
A student nurse is caring for a patient who has undergone a wide excision of the vulva. The student should know that what action is contraindicated in the immediate postoperative period?
A) Placing patient in low Fowlers position
B) Application of compression stockings
C) Ambulation to a chair
D) Provision of a low-residue diet
C) Ambulation to a chair
Sitting in a chair would not be recommended immediately in the postoperative period. This would place too much tension on the incision site. A low Fowlers position or, occasionally, a pillow placed under the knees, will reduce pain by relieving tension on the incision. Application of compression stocking would prevent a deep vein thrombosis from occurring. A low-residue diet would be ordered to prevent straining on defecation and wound contamination.
You are caring for a patient who has been diagnosed with genital herpes. When preparing a teaching plan for this patient, what general guidelines should be taught?
A) Thorough handwashing is essential.
B) Sun bathing assists in eradicating the virus.
C) Lesions should be massaged with ointment.
D) Self-infection cannot occur from touching lesions during a breakout.
A) Thorough handwashing is essential.
The risk of reinfection and spread of infection to others or to other structures of the body can be reduced by handwashing, use of barrier methods with sexual contact, and adherence to prescribed medication regimens. The lesions should be allowed to dry. Touching of lesions during an outbreak should be avoided; if touched, appropriate hygiene practices must be followed.
Following a recent history of dyspareunia and lower abdominal pain, a patient has received a diagnosis of pelvic inflammatory disease (PID). When providing health education related to self-care, the nurse should address which of the following topics? Select all that apply.
A) Use of condoms to prevent infecting others
B) Appropriate use of antibiotics
C) Taking measures to prevent pregnancy
D) The need for a Pap smear every 3 months
E) The importance of weight loss in preventing symptoms
A) Use of condoms to prevent infecting others
B) Appropriate use of antibiotics
Patients with PID need to take action to avoid infecting others. Antibiotics are frequently required. Pregnancy does not necessarily need to be avoided, but there is a heightened risk of ectopic pregnancy. Weight loss does not directly alleviate symptoms. Regular follow-up is necessary, but Pap smears do not need to be performed every 3 months.
The nurse is caring for a patient who has just been told that her ovarian cancer is terminal and that no curative options remain. What would be the priority nursing care for this patient at this time?
A) Provide emotional support to the patient and her family.
B) Implement distraction and relaxation techniques.
C) Offer to inform the patients family of this diagnosis.
D) Teach the patient about the importance of maintaining a positive attitude.
A) Provide emotional support to the patient and her family.
Emotional support is an integral part of nursing care at this point in the disease progression. It is not normally appropriate for the nurse to inform the family of the patients diagnosis. It may be inappropriate and simplistic to focus on distraction, relaxation, and positive thinking.
A public health nurse is participating in a campaign aimed at preventing cervical cancer. What strategies should the nurse include is this campaign? Select all that apply.
A) Promotion of HPV immunization
B) Encouraging young women to delay first intercourse
C) Smoking cessation
D) Vitamin D and calcium supplementation
E) Using safer sex practices
A) Promotion of HPV immunization
B) Encouraging young women to delay first intercourse
C) Smoking cessation
E) Using safer sex practices
Preventive measures relevant to cervical cancer include regular pelvic examinations and Pap tests for all women, especially older women past childbearing age. Preventive counseling should encourage delaying first intercourse, avoiding HPV infection, participating in safer sex only, smoking cessation, and receiving HPV immunization. Calcium and vitamin D supplementation are not relevant.
A 27-year-old female patient is diagnosed with invasive cervical cancer and is told she needs to have a hysterectomy. One of the nursing diagnoses for this patient is disturbed body image related to perception of femininity. What intervention would be most appropriate for this patient?
A) Reassure the patient that she will still be able to have children.
B) Reassure the patient that she does not have to have sex to be feminine.
C) Reassure the patient that you know how she is feeling and that you feel her anxiety and pain.
D) Reassure the patient that she will still be able to have intercourse with sexual satisfaction and orgasm.
D) Reassure the patient that she will still be able to have intercourse with sexual satisfaction and orgasm.
The patient needs reassurance that she will still have a vagina and that she can experience sexual intercourse after temporary postoperative abstinence while tissues heal. Information that sexual satisfaction and orgasm arise from clitoral stimulation rather than from the uterus reassures many women. Most women note some change in sexual feelings after hysterectomy, but they vary in intensity. In some cases, the vagina is shortened by surgery, and this may affect sensitivity or comfort. It would be inappropriate to reassure the patient that she will still be able to have children; there is no reason to reassure the patient about not being able to have sex. There is no way you can know how the patient is feeling and it would be inappropriate to say so.
A patient diagnosed with cervical cancer will soon begin a round of radiation therapy. When planning the patients subsequent care, the nurse should prioritize actions with what goal?
A) Preventing hemorrhage
B) Ensuring the patient knows the treatment is palliative, not curative
C) Protecting the safety of the patient, family, and staff
D) Ensuring that the patient adheres to dietary restrictions during treatment
C) Protecting the safety of the patient, family, and staff
Care must be taken to protect the safety of patients, family members, and staff during radiation therapy. Hemorrhage is not a common complication of radiation therapy and the treatment can be curative. Dietary restrictions are not normally necessary during treatment.
The nurse is caring for a 63-year-old patient with ovarian cancer. The patient is to receive chemotherapy consisting of Taxol and Paraplatin. For what adverse effect of this treatment should the nurse monitor the patient? A) Leukopenia B) Metabolic acidosis C) Hyperphosphatemia D) Respiratory alkalosis
A) Leukopenia
Chemotherapy is usually administered IV on an outpatient basis using a combination of platinum and taxane agents. Paclitaxel (Taxol) plus carboplatin (Paraplatin) are most often used because of their excellent clinical benefits and manageable toxicity. Leukopenia, neurotoxicity, and fever may occur. Acidbase imbalances and elevated phosphate levels are not anticipated.
A 45-year-old woman has just undergone a radical hysterectomy for invasive cervical cancer. Prior to the surgery the physician explained to the patient that after the surgery a source of radiation would be placed near the tumor site to aid in reducing recurrence. What is the placement of the source of radiation called? A) Internal beam radiation B) Trachelectomy C) Brachytherapy D) External radiation
C) Brachytherapy
Radiation, which is often part of the treatment to reduce recurrent disease, may be delivered by an external beam or by brachytherapy (method by which the radiation source is placed near the tumor) or both.
A 25-year-old patient diagnosed with invasive cervical cancer expresses a desire to have children. What procedure might the physician offer as treatment? A) Radical hysterectomy B) Radical culposcopy C) Radical trabeculectomy D) Radical trachelectomy
D) Radical trachelectomy
A procedure called a radical trachelectomy is an alternative to hysterectomy in women with invasive cervical cancer who are young and want to have children. In this procedure, the cervix is gripped with retractors and pulled down into the vagina until it is visible. The affected tissue is excised while the rest of the cervix and uterus remain intact. A drawstring suture is used to close the cervix. For a woman who wants to have children, a radical hysterectomy would not provide the option of children. A radical culposcopy and a radical trabeculectomy are simple distracters for this question.
