ONCOLOGY: Brunner's Ch 57: Management of Patients with Female Reproductive Disorders Flashcards
While taking a health history on a 20-year-old female patient, the nurse ascertains that this patient is taking miconazole (Monistat). The nurse is justified in presuming that this patient has what medical condition? A) Bacterial vaginosis B) Human papillomavirus (HPV) C) Candidiasis D) Toxic shock syndrome (TSS)
C) Candidiasis
Candidiasis is a fungal or yeast infection caused by strains of Candida. Miconazole (Monistat) is an antifungal medication used in the treatment of candidiasis. This agent is inserted into the vagina with an applicator at bedtime and may be applied to the vulvar area for pruritus. HPV, bacterial vaginosis, and TSS are not treated by Monistat.
A patient with genital herpes is having an acute exacerbation. What medication would the nurse expect to be ordered to suppress the symptoms and shorten the course of the infection? A) Clotrimazole (Gyne-Lotrimin) B) Metronidazole (Flagyl) C) Podophyllin (Podofin) D) Acyclovir (Zovirax)
D) Acyclovir (Zovirax)
Acyclovir (Zovirax) is an antiviral agent that can suppress the symptoms of genital herpes and shorten the course of the infection. It is effective at reducing the duration of lesions and preventing recurrences. Clotrimazole is used in the treatment of yeast infections. Metronidazole is the most effective treatment for trichomoniasis. Posophyllin is used to treat external genital warts. Acyclovir is used in the treatment of genital herpes.
A patient with trichomoniasis comes to the walk-in clinic. In developing a care plan for this patient the nurse would know to include what as an important aspect of treating this patient?
A) Both partners will be treated with metronidazole (Flagyl).
B) Constipation and menstrual difficulties may occur.
C) The patient should perform Kegel exercises 30 to 80 times daily.
D) Care will involve hormone therapy to control the pain
A) Both partners will be treated with metronidazole (Flagyl).
The most effective treatment for trichomoniasis is metronidazole (Flagyl). Both partners receive a one- time loading dose or a smaller dose three times a day for 1 week. In pelvic inflammatory disease, menstrual difficulties and constipation may occur. Kegel exercises are prescribed to help strengthen weakened muscles associated with cystocele and other structural deficits. Hormone therapy does not address the etiology of trichomoniasis.
A student nurse is doing clinical hours at an OB/GYN clinic. The student is helping to develop a plan of care for a patient with gonorrhea who has presented at the clinic. The student should include which of the following in the care plan for this patient?
A) The patient may benefit from oral contraceptives.
B) The patient must avoid use of tampons.
C) The patient is susceptible to urinary incontinence.
D) The patient should also be treated for chlamydia.
D) The patient should also be treated for chlamydia.
Because of the high incidence of coinfection with chlamydia and gonorrhea, the patient should also be treated for chlamydia. Avoiding the use of tampons is part of the self-care management of a patient with possible toxic shock syndrome (TSS). The patient is not susceptible to incontinence and there is no indication for the use of oral contraceptives.
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.
The nurse is providing preoperative education for a patient diagnosed with endometriosis. A hysterectomy has been scheduled. What education topic should the nurse be sure to include for this patient?
A) Menstrual periods will continue to occur for several months, some of them heavy.
B) Normal activity will be permitted within 48 hours following surgery.
C) After a hysterectomy, hormone levels remain largely unaffected.
D) The bladder must be emptied prior to surgery and a catheter may be placed during surgery.
D) The bladder must be emptied prior to surgery and a catheter may be placed during surgery.
The intestinal tract and the bladder need to be empty before the patient is taken to the OR to prevent contamination and injury to the bladder or intestinal tract. The patient is informed that her periods are now over, but she may have a slightly bloody discharge for a few days. The patient is instructed to avoid straining, lifting, or driving until her surgeon permits her to resume these activities. The patients hormonal balance is upset, which usually occurs in reproductive system disturbances. The patient may experience depression and heightened emotional sensitivity to people and situations
A patient has returned to the post-surgical unit after vulvar surgery. What intervention should the nurse prioritize during the initial postoperative period?
A) Placing the patient in high Fowlers position
B) Administering sitz baths every 4 hours
C) Monitoring the integrity of the surgical site
D) Avoiding analgesics unless the patients pain is unbearable
C) Monitoring the integrity of the surgical site
An important intervention for the patient who has undergone vulvar surgery is to monitor closely for signs of infection in the surgical site, such as redness, purulent drainage, and fever. The patient should be placed in low Fowlers position to reduce pain by relieving tension on the incision. Sitz baths are discouraged after of wide excision of the vulva because of the risk of infection. Analgesics should be administered preventively on a scheduled basis to relieve pain and increase the patients comfort level.
A patient comes to the free clinic complaining of a gray-white discharge that clings to her external vulva and vaginal walls. A nurse practitioner assesses the patient and diagnoses Gardnerella vaginalis. What would be the most appropriate nursing action at this time?
A) Advise the patient that this is an overgrowth of normal vaginal flora.
B) Discuss the effect of this diagnosis on the patients fertility.
C) Document the vaginal discharge as normal.
D) Administer acyclovir as ordered.
A) Advise the patient that this is an overgrowth of normal vaginal flora.
Gray-white discharge that clings to the external vulva and vaginal walls is indicative of an overgrowth of Gardnerella vaginalis. The patients discharge is not a normal assessment finding. Antiviral medications are ineffective because of the bacterial etiology. This diagnosis is unlikely to have a long- term bearing on the patients fertility.
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 nurse is caring for a pregnant patient with active herpes. The teaching plan for this patient should include which of the following?
A) Babies delivered vaginally may become infected with the virus.
B) Recommended treatment is excision of the herpes lesions.
C) Pain generally does not occur with a herpes outbreak during pregnancy.
D) Pregnancy may exacerbate the mothers symptoms, but poses no risk to the infant.
A) Babies delivered vaginally may become infected with the virus.
In pregnant women with active herpes, babies delivered vaginally may become infected with the virus. There is a risk for fetal morbidity and mortality if this occurs. Lesions are not controlled with excision. Itching and pain accompany the process as the infected area becomes red and swollen. Aspirin and other analgesics are usually effective in controlling the pain.
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.
A female patient tells the nurse that she thinks she has a vaginal infection because she has noted inflammation of her vulva and the presence of a frothy, yellow-green discharge. The nurse recognizes that the clinical manifestations described are typical of what vaginal infection? A) Trichomonas vaginalis B) Candidiasis C) Gardnerella D) Gonorrhea
A) Trichomonas vaginalis
The clinical manifestations indicate T. vaginalis, which is treated with metronidazole in the form of oral tablets. Candidiasis produces a white, cheese-like discharge. Gardnerella is characterized by gray-white to yellow-white discharge clinging to external vulva and vaginal walls. Gonorrhea often produces no symptoms.
The nurse notes that a patient has a history of fibroids and is aware that this term refers to a benign tumor of the uterus. What is a more appropriate term for a fibroid? A) Bartholins cyst B) Dermoid cyst C) Hydatidiform mole D) Leiomyoma
D) Leiomyoma
A leiomyoma is a usually benign tumor of the uterus, commonly referred to as a fibroid. A Bartholins cyst is a cyst in a paired vestibular band in the vulva, whereas a dermoid cyst is a benign tumor that is thought to arise from parts of the ovum and normally disappears with maturation. A hydatidiform mole is a type of gestational neoplasm.
