Chapter 11

Question 1

1. The nurse should be aware that a pessary is most effective in the treatment of which disorder?
   a. Cystocele
   b. Uterine prolapse
   c. Rectocele
   d. Stress urinary incontinence

Answer 1

ANS: B
A fitted pessary may be inserted into the vagina to support the uterus and hold it in the correct position. Usually a pessary is used for only a short time and is not used for the client with a cystocele. A rectocele cannot be corrected by the use of a pessary. A pessary is not likely the most effective treatment for stress incontinence.

Question 2

2. A postmenopausal woman has been diagnosed with two leiomyomas (fibroids). Which clinical finding is most commonly associated with the presence of leiomyomas?
   a. Abnormal uterine bleeding
   b. Diarrhea
   c. Weight loss
   d. Acute abdominal pain

Answer 2

ANS: A
Most women are asymptomatic. Abnormal uterine bleeding is the most common symptom of leiomyomas. Diarrhea is not commonly associated with leiomyomas. Weight loss does not usually occur in the woman with leiomyomas, and the client with leiomyomas is unlikely to experience abdominal pain.

Question 3

3. Which woman is at the greatest risk for psychologic complications after hysterectomy?
   a. 55-year-old woman who has been having abnormal bleeding and pain for 3 years
   b. 46-year-old woman who has had three children and has just been promoted at work
   c. 62-year-old widow who has three friends who have had uncomplicated hysterectomies
   d. 19-year-old woman who had a ruptured uterus after giving birth to her first child

Answer 3

ANS: D
The 19-year-old woman is still in her childbearing years. Often the uterus is related to self-concept in women in this age group, and they may feel that sexual functioning is related to having a uterus. The 55-year-old woman is past her childbearing years and has had bleeding and pain for 3 years. The hysterectomy may be well received as a method of pain relief. The 46-year-old woman has a family and positive events occurring in her life (job promotion). The 62-year-old woman is past her reproductive years and has relationships with others who have had positive outcomes.

Question 4

4. A 48-year-old woman has just had a hysterectomy for endometrial cancer. Which statement alerts the nurse that further teaching is needed?
   a. “I can’t wait to go on the cruise that I have planned for this summer.”
   b. “I know that the surgery saved my life, but I will miss having sexual intercourse with my husband.”
   c. “I have asked my daughter to come and stay with me next week after I am discharged from the hospital.”
   d. “Well, I don’t have to worry about getting pregnant anymore.”

Answer 4

ANS: B
Stating that she will miss having sexual intercourse with her husband indicates that further teaching is needed for this client regarding sexual activities after a hysterectomy. Although intercourse may be initially uncomfortable, the use of water-soluble lubricants, relaxation exercises, and changes in position may be helpful. Expressing plans for a vacation is a positive psychologic state with plans for the future. Stating that her daughter will stay with her indicates the client understands that she may need assistance during her acute recovery period. Stating that she no longer needs to worry about getting pregnant indicates knowledge related to the reproductive cycle and a positive outlook.

Question 5

5. The nurse provides education to a client about to undergo external radiation therapy. Which statement by the client reassures the nurse that the teaching has been effective?
   a. “I am using ointment to keep my skin from drying out.”
   b. “I wash the irradiated area with deodorant soap.”
   c. “My diet is high in protein, and I drink at least 2000 ml of fluid a day.”
   d. “I wash off the markings for the radiation site after each treatment.”

Answer 5

ANS: C
To maintain good nutrition, the woman should eat high-protein meals or use protein supplements and should have a high daily fluid intake of 2 to 3 L. The woman is counseled about good skin care and taught to avoid soaps, ointments, cosmetics, and deodorants because these may contain metals that would alter the radiation dose she receives. Markings may be made to indicate the exact location needed for irradiation and should remain until the treatment is complete.

Question 6

6. With regard to the treatment plan for a pregnant woman with gynecologic 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.

Answer 6

ANS: A
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.

Question 7

7. Which precaution should the nurse take while caring for a client who is undergoing internal radiation therapy for cervical cancer?
   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 inserting the implant.
   d. Limit staff or visitor exposure to 30 minutes or less in an 8-hour period.

Answer 7

ANS: D
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 preparation is necessary.

Question 8

8. What is the most common reproductive tract cancer associated with pregnancy?
   a. Cervical
   b. Uterine
   c. Ovarian
   d. Fallopian tube

Answer 8

ANS: A
The incidence of cervical cancer concurrent with pregnancy is reported to be 1 in 2000 pregnancies making it the most common reproductive tract cancer associated with pregnancy. Uterine cancer is rarely diagnosed during pregnancy. Ovarian cancer is the second most frequent cancer diagnosis in pregnancy. At an incidence rate of approximately 1%, fallopian tube cancer remains a rare occurrence. The peak incidence of tubal cancer is between the ages of 50 and 55 years; for this cancer to be concurrent with pregnancy is only a remote possibility.

Question 9

9. When caring for clients with neoplasms of the reproductive system, the nurse must begin by assessing the woman’s knowledge of the disorder, its management, and prognosis. This assessment should be followed by a nursing diagnosis. Which diagnosis fails to address the psychologic effect of these disorders?
   a. Anxiety, related to surgical procedures
   b. Disturbed body image, as a result of changes in anatomy
   c. Risk for injury, related to lack of skill for self-care
   d. Interrupted family processes

Answer 9

ANS: C
Although risk for injury, related to lack of skill for self-care, is appropriate to this client’s condition, this diagnosis is more suited to the client’s learning needs than the psychologic effect. Anxiety, related to surgical procedures, is appropriate for addressing psychosocial concerns; the client may also develop anxiety related to the diagnosis and prognosis and whether or not surgery is required. Disturbed body image is an applicable diagnosis; changes in her anatomy and function may also result in low self-esteem and ineffective coping skills. Interrupted family processes is a possible and acceptable diagnosis; functional and anatomic changes may result in the client’s inability to fulfill her familial role. Depending on the severity of her condition, interrupted family processes could also lead to social isolation.

Question 10

10. The prevalence of urinary incontinence (UI) increases as women age, with more than one third of the women in the United States suffering from some form of this disorder. The symptoms of mild-to-moderate UI can be successfully decreased by a number of strategies. Which of these should the nurse instruct the client to use first?
    a. Pelvic floor support devices
    b. Bladder training and pelvic muscle exercises
    c. Surgery
    d. Medications

Answer 10

ANS: B
Pelvic muscle exercises, known as Kegel exercises, along with bladder training can significantly decrease or entirely relieve stress incontinence in many women. Pelvic floor support devices, also known as pessaries, come in a variety of shapes and sizes. Pessaries may not be effective for all women and require scrupulous cleaning to prevent infection. Anterior and posterior repairs and even a hysterectomy may be performed. If surgical repair is performed, then the nurse must focus her care on preventing infection and helping the woman avoid putting stress on the surgical site. Pharmacologic therapy includes selective serotonin-norepinephrine reuptake inhibitors or vaginal estrogen therapy. However, pharmacologic therapy is not the first action a nurse should recommend.

Question 11

11. A woman exhibits symptoms that may lead to a possible diagnosis of polycystic ovary syndrome (PCOS). While completing the initial assessment of the client, which clinical finding would the nurse not anticipate?
    a. Anorexia
    b. Hirsutism
    c. Irregular menses
    d. Infertility

Answer 11

ANS: A
These clients often are obese rather than anorexic with weight loss. Approximately 40% of these women also display glucose intolerance and hyperinsulinemia. Excessive hair growth is often present in women with PCOS. This client is likely to have irregular menses or even amenorrhea. Infertility as a result of decreased levels of follicle-stimulating hormone is common with this syndrome.

Question 12

12. What information is important for the nurse to include in planning for the care of a woman who has had a vaginal hysterectomy?
    a. Expect to be fully recovered in 4 to 6 weeks.
    b. Expect no changes in her hormone levels.
    c. Expect surgical menopause.
    d. Take tub baths to aid in healing.

Answer 12

ANS: B
Unless the ovaries were also removed, hormonal levels should not change. Menses will cease, but the hypothalamus-pituitary-ovarian axis remains intact. The woman should expect to have vaginal discharge for 4 to 6 weeks. Full recovery varies from woman to woman, depending on risk factors and individual healing. Surgical menopause occurs only if the ovaries are also removed. The client should avoid tub baths, intercourse, and douching until after the follow-up examination.

Question 13

13. A woman has preinvasive cancer of the cervix. Which modality would the nurse discuss as an available option for a client with this condition?
    a. Cryosurgery
    b. Colposcopy
    c. Hysterectomy
    d. Internal radiation

Answer 13

ANS: A
Cryosurgery, laser surgery, and loop electrosurgical excision procedure (LEEP) are several techniques used to treat preinvasive lesions. Colposcopy is the examination of the cervix with a stereoscopic binocular microscope that magnifies the view of the cervix. This examination would have already been performed as part of the diagnosis of preinvasive cancer of the cervix. A hysterectomy is performed if the cancer has extended beyond the cervix. Women with positive pelvic nodes (indicating invasive cancer) usually receive whole pelvis irradiation.

Question 14

14. Which condition is the most common malignancy of the reproductive system?
    a. Endometrial cancer
    b. Cervical cancer
    c. Ovarian cancer
    d. Vulvar and vaginal cancer

Answer 14

ANS: A
Endometrial cancer occurs most frequently in Caucasian women and after menopause. Certain viral infections and sexually transmitted diseases (STIs) create risks for cervical cancer. Ovarian cancer is the most malignant reproductive system cancer and accounts for the most deaths. Cancers of the vulva and vagina are relatively rare.

Question 15

15. A client 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. What condition would the nurse suspect based upon this report?
    a. Pelvic relaxation
    b. Cystoceles and/or rectoceles
    c. Uterine prolapse
    d. Genital fistulas

Answer 15

ANS: B
Uterine displacement can be caused by congenital or acquired weakness of the pelvic support structures and is known as pelvic relaxation. 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 produce a bearing-down sensation with urinary dysfunction. They occur more often in older women who have borne children. Uterine prolapse is a more serious type of displacement. In women with a complete prolapse, the cervix and body of the uterus protrude through the vagina. Genital fistulas are perforations between genital tract organs. Most occur between the bladder and the genital tract.

Question 16

16. Which woman has the highest risk for endometrial cancer?
    a. Postmenopausal woman with hypertension
    b. Woman who has an intrauterine device (IUD)
    c. Client who has been on birth control for 15 years
    d. Perimenopausal woman who has a cystocele

Answer 16

ANS: A
Endometrial cancer is most often seen in postmenopausal women between the ages of 50 and 65 years. Hypertension is a risk factor associated with the development of this malignancy. The use of an IUD does not increase a woman’s risk for endometrial cancer. A client who has been on birth control for 15 years is not at increased risk for endometrial cancer; the birth control contraceptives might actually offer some protection. The development of a cystocele will not increase a woman’s risk for endometrial cancer.

Question 17

17. A client has just returned from a uterine artery embolization (UAE) procedure. Before her discharge, a discussion concerning the symptoms that require a call to the provider postprocedure is very important. Which symptom would reassure the client that the procedure went well with no reason to call the provider?
    a. Temperature of 39 C
    b. Swelling or hematoma at the puncture site
    c. Abnormal vaginal discharge
    d. Urinary frequency

Answer 17

ANS: D
The physician should be notified if the client is experiencing urinary retention. Urinary frequency is not a complication of UAE. A body temperature of 39 C or higher may indicate the presence of an infectious process, and the physician should be notified. A slight fever or pain may be experienced as a result of acute fibroid degradations. Swelling or hematoma at the puncture site may be an indication of bleeding into the groin. The client should not experience any abnormal vaginal discharge (e.g., foul odor, brown color, brown tissue).

Question 18

18. A woman has arrived for her preoperative testing appointment. She is scheduled for a myomectomy the following day. What condition would require the client to undergo this procedure for symptom relief?
    a. Numerous small fibroid tumors
    b. Bartholin cysts
    c. Fibroid tumors near the outer wall of the uterus with a uterine size no larger than at 12 weeks of gestation
    d. Leiomyomas (also known as fibroid tumors) in a uterus larger than 14 weeks of gestation

Answer 18

ANS: C
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 the symptoms are significant, a myomectomy (i.e., removal of the tumor) may be performed. This procedure leaves the uterine walls relatively intact, thereby preserving the uterus for future pregnancies. Laser surgery or electrocauterization can be safely used to destroy numerous small fibroid tumors. Bartholin cysts are benign lesions of the vulva. If the cyst is symptomatic or infected, surgical incision and drainage may provide relief. A hysterectomy (i.e., removal of the entire uterus) is the treatment of choice if bleeding is severe or if the fibroid tumor is obstructing the normal function of other organs.

Question 19

19. Which ovarian neoplasm is described as a growth that contains hair, teeth, and sebaceous secretions?
    a. Ovarian fibroma
    b. Dermoid cyst
    c. Uterine polyp
    d. Follicular cyst

Answer 19

ANS: B
Dermoid cysts are germ cell tumors, usually occurring in childhood, that may contain teeth, hair, bones, and sebaceous secretions and may unilaterally or bilaterally develop. Treatment is most often surgical removal. An ovarian fibroma is a solid ovarian neoplasm that develops from connective tissue, usually after menopause. A uterine polyp is a tumor that grows on the uterine wall on a stalk or pedicle. A follicular cyst develops within the ovaries of young women in response to follicle rupture and should resolve within one or two menstrual cycles.

Question 20

1. The client is undergoing treatment for ovarian cancer. Which common nutritional problems are related to gynecologic cancers and the treatment thereof? (Select all that apply.)
   a. Stomatitis
   b. Constipation
   c. Increased appetite
   d. Diarrhea
   e. Nausea and vomiting

Answer 20

ANS: A, B, D, E
Altered taste, 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.

Question 21

2. Leiomyomas (also known as fibroid tumors) are benign tumors arising from the muscle tissue of the uterus. Which information related to these tumors is accurate? (Select all that apply.)
   a. Are rapid growing
   b. Are more common in African-American women
   c. Are more common in women who have never been pregnant
   d. Obesity is a risk factor with leiomyomas
   e. Become malignant if left untreated

Answer 21

ANS: B, C, D
The exact cause of leiomyomas remains unknown, although genetic factors may be involved in their development. Most are found in the body of uterus and are classified according to their location on the uterine wall. They are benign, slow growing, and often spontaneously shrink after menopause.

Question 22

3. The client has undergone hysteroscopic uterine ablation to destroy a number of smaller fibroids. The nurse is preparing to provide discharge instructions. Which information is a priority for the patient and should be included in the teaching plan? (Select all that apply.)
   a. Analgesics and nonsteroidal antiinflammatory drugs can be used for pain control.
   b. Vaginal discharge is to be expected for 5 to 7 days.
   c. Sexual activity can be resumed after 48 hours.
   d. Next menstrual period will be irregular.
   e. Provider should be notified if heavy bleeding occurs.

Answer 22

ANS: A, D, E
Before discharging the client, the following information should be given: analgesics can be used for pain relief as needed, normal activities can be resumed within several days, vaginal discharge is to be expected for 4 to 6 weeks, and the use of tampons and sexual activity should be avoided for 2 weeks. The next menstrual period will be irregular, and the provider should be notified for heavy bleeding or signs of infection.

Question 23

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.

Answer 23

Ans: B
Unless the ovaries also were removed (in which case surgical menopause occurs), hormonal levels should not change. Menses will cease, but the hypothalamic-pituitary-ovarian axis remains intact. The client should avoid tub baths, intercourse, and douching until after the follow-up exam. The woman should expect to have vaginal discharge for 4 to 6 weeks. Full recovery varies from woman to woman, depending on risk factors and individual healing.

Question 24

A woman has preinvasive cancer of the cervix. In discussing available treatments, the nurse includes:
  A. Cryosurgery 
  B. Colposcopy
 C. Hysterectomy
 D. Internal irradiation

Answer 24

Ans: A
Cryosurgery, laser surgery, and loop electrosurgical excision procedure (LEEP) are several techniques used to treat preinvasive lesions. A hysterectomy is performed if the cancer has extended beyond the cervix. Women with positive pelvic lymph nodes (indicating invasive cancer) usually receive whole-pelvis irradiation. Colposcopy, examination of the cervix with a stereoscopic binocular microscope that magnifies the view of the cervix, would have been done as part of the diagnosis of preinvasive cancer of the cervix.

Question 25

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

Answer 25

Ans: A
Endometrial cancer occurs most frequently in Caucasian women and after menopause. Ovarian cancer is the most malignant reproductive system cancer and accounts for the most deaths. Cancers of the vulva and vagina are relatively rare. Certain viral infections and sexually transmitted diseases create risks for cervical cancer.

Question 26

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

Answer 26

Ans: B
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 manifest as a bearing-down sensation with urinary dysfunction. They occur more often in older women who have borne children. Uterine displacement can be caused by congenital or acquired weakness of the pelvic support structures; this is known as pelvic relaxation. Uterine prolapse is a more serious type of displacement. In women with complete prolapse, the cervix and body of the uterus protrude through the vagina. Genital fistulas are perforations between genital tract organs; most occur between the bladder and the genital tract.

Question 27

Which woman has the highest risk for endometrial cancer?
A. A postmenopausal woman with hypertension Correct
B. A woman who has an intrauterine device
C. A client who has been on oral birth control for 15 years
D. A perimenopausal woman who has a cystocele

Answer 27

Ans: A
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. The use of an intrauterine device (IUD) does not increase a woman’s risk for endometrial cancer. Birth control might offer some protection. The development of a cystocele will not increase a woman’s risk for endometrial cancer.

Question 28

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. Which of the following would not require contacting the physician?
A. Fever of 39° C
B. Swelling or hematoma at the puncture site
C. Abnormal vaginal discharge
D. Urinary frequency

Answer 28

Ans: D
The physician should be notified if the client is experiencing urinary retention, but urinary frequency is not a complication of UAE. Fever of 39° C or greater may indicate an infection, and the physician should be notified. A slight fever or pain may be experienced as a result of acute fibroid degradations. Swelling or hematoma at the puncture site may be an indication of bleeding into the groin. The client should not experience any abnormal vaginal discharge (foul odor, brown color, or tissue).

Question 29

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 that is no larger than a uterus at 12 weeks of gestation.
D. Leiomyomas in a uterus larger than one at 14 weeks of gestation.

Answer 29

Ans: C
If a fibroid tumor lies near the outer wall of the uterus, 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. Laser surgery or electrocauterization can be safely used to destroy small fibroids. A hysterectomy (removal of the entire uterus) is the treatment of choice if bleeding is severe or if a fibroid is obstructing normal function of other organs. Bartholin cysts are benign lesions of the vulva; if such a cyst is symptomatic or infected, surgical incision and drainage may provide relief.

Question 30

Which of the following clinical presentations is consistent with the physical finding of carcinoma in situ (CIS)?
A. Abnormal cells located in the uterine fundus
B. Abnormal proliferations of cells found in the lower one third of the epithelium
C.Endometriosis
D. Abnormal cells noted in the full thickness of the epithelium

Answer 30

Ans: D
CIS is defined as abnormal cells noted in the full thickness of the epithelium. Abnormal cells located in the uterine fundus reflect dysplasia but do not define CIS. Abnormal cells located in the lower one third of the epithelium indicate cervical intraepithelial neoplasia (CIN) 1. Endometriosis is inflammation of the endometrial lining of the uterus.

Question 31

In the use of a two-client model for a cancer patient who is pregnant, which emphasis would be used for clinical ethical decision making?
A.Attention would be focused on the maternal-fetal unit.
B. Emphasis would be placed on maternal well-being.
C. Consideration would focus on promotion of fetal well-being.
D. Attention would focus on the parent’s preference.

Answer 31

Ans: C
In a two-client model, the focus would be on fetal well-being. A one-client model would focus on the maternal-fetal unit.

Question 32

Which interventions could be implemented by the nurse in the care of a patient who is experiencing altered taste sensation as a result of radiation therapy? (Select all that apply.)
A. Having her drink clear liquids.
B. Avoiding carbonated liquids.
C. Having her eat chicken or fish in the diet rather than red meat.
D. Having her eat tart foods.
E. Avoiding alcoholic beverages.
F. Avoiding extreme food temperatures.

Answer 32

Ans: C, D
Eating chicken or fish in the diet rather than red meat may help to alleviate altered taste sensation, and eating tart foods may help stimulate the taste buds. Drinking clear liquids and avoiding carbonated liquids are interventions for a patient suffering from nausea and vomiting. Avoiding alcoholic beverages and extreme food temperatures would be interventions for a patient who has stomatitis.