TERM 2-MY NOTES HEALTH ASSESSMENT CH.26 "Female Genitourinary System " Flashcards Preview

► Med Notes > TERM 2-MY NOTES HEALTH ASSESSMENT CH.26 "Female Genitourinary System " > Flashcards

Flashcards in TERM 2-MY NOTES HEALTH ASSESSMENT CH.26 "Female Genitourinary System " Deck (381):
1

Female Genitourinary System

,

2

STRUCTURE-AND FUNCTION -

,

3

The external genitalia are called the vulva, or pudendum.
A)true
B)false

A

4

The mons pubis is a round, firm pad of adipose tissue covering the symphysis pubis.
A)true
B)false

A

5

INTERNAL GENITALIA

,

6

The internal genitalia include the vagina, a flattened, tubular canal extending from the orifice up and backward into the pelvis. It is 9 cm long and sits between the rectum posteriorly and the bladder and urethra anteriorly
A)true
B)false

A

7

The _________ include the vagina, a flattened, tubular canal extending from the orifice up and backward into the pelvis. It is 9 cm long and sits between the rectum posteriorly and the bladder and urethra anteriorly

internal genitalia

8

DEVELOPMENTAL COMPETENCE
Infants and Adolescents

,

9

At birth, the external genitalia are engorged because of the presence of maternal estrogen. The structures recede in a few weeks, remaining small until puberty.
A)true
B)false

A

10

The ovaries are located in the abdomen during childhood. The uterus is small with a straight axis and no anteflexion.
A)true
B)false

A

11

At puberty, estrogens stimulate the growth of cells in the reproductive tract and the development of secondary sex characteristics.
A)true
B)false

A

12

The first signs of puberty are breast and pubic hair development, beginning between the ages of 8 1/2 and 13 years. These signs are usually concurrent, but it is not abnormal if they do not develop together. They take about 3 years to complete.
A)true
B)false

A

13

Menarche(period) occurs during the latter half of this sequence, just after the peak of growth velocity.
A)infant
B)adult

A

14

Irregularity of the menstrual cycle is common during adolescence because of the girl's occasional failure to ovulate. With menarche, the uterine body flexes on the cervix. The ovaries now are in the pelvic cavity.
A)true
B)false

A

15

Tanner's table on the five stages of pubic hair development (sexual maturity rating [ SMR]) is helpful in teaching girls the expected sequence of sexual development. These data may not generalize to all racial groups; mature Asian women normally have fine, sparse pubic hair.
A)true
B)false

A

16

African-American and Mexican-American girls had pubic hair and achieved menarche at younger ages than white girls. The mean age at onset of pubic hair and menarche was 9.5 and 12.1 years for African-American girls; 10.3 and 12.2 years for Mexican-American girls; and 10.5 and 12.7 white girls
A)true
B)false

A

17

Thus African-American girls on average enter puberty first, followed by Mexican-American and then white girls.
A)true
B)false

A

18

The ongoing U.S. epidemic of childhood obesity shows that menarche is significantly more likely to occur in preteen girls with an elevated body mass index (BMI).
A)true
B)false

A

19

The median age of achieving menarche was 5.4 months earlier in obese preteen girls than in girls with normal BMI. The association of adiposity with menarche was independent of race or ethnicity. In conclusion, BMI should be a major consideration when a clinician evaluates pubertal development
A)true
B)false

A

20

DEVELOPMENTAL COMPETENCE
The Pregnant Woman

,

21

shortly after the first missed menstrual period, the genitalia show signs of the growing fetus.
A)pregnant woman
B)false

A

22

The cervix softens (Goodell sign) at 4 to 6 weeks, and the vaginal mucosa and cervix look cyanotic (Chadwick sign) at 8 to 12 weeks. These changes occur because of increased vascularity and edema of the cervix and hypertrophy and hyperplasia of the cervical glands.
A)true, pregnant woman
B)false

A

23

The isthmus of the uterus softens (Hegar sign) at 6 to 8 weeks.
A)pregnant woman
B)false

A

24

The greatest change is in the uterus itself. It increases in capacity by 500 to 1000 times its nonpregnant state, at first because of hormone stimulation and then because of the increasing size of its contents.
A)pregnant woman
B)false

A

25

The nonpregnant uterus has a flattened pear shape. Its early growth encroaches on the space occupied by the bladder, producing the symptom of urinary frequency.
A)true
B)false

A

26

By 10 to 12 weeks' gestation, the uterus becomes globular in shape and is too large to stay in the pelvis.
A)pregnant woman
B)false

A

27

At 20 to 24 weeks, the uterus has an oval shape. It rises almost to the liver, displacing the intestines superiorly and laterally.
A)pregnant woman
B)false

A

28

A clot of thick, tenacious mucus forms in the spaces of the cervical canal (the mucus plug), which protects the fetus from infection.
A)pregnant woman
B)false

A

29

The mucus plug dislodges when labor begins at the end of term, producing a sign of labor called "bloody show."
A)pregnant woman
B)false

A

30

Cervical and vaginal secretions increase during pregnancy and are thick, white, and more acidic.
A)true
B)false

A

31

The increased acidity occurs because of the action of Lactobacillus acidophilus, which changes glycogen into lactic acid. The acidic pH keeps pathogenic bacteria from multiplying in the vagina, but the increase in glycogen increases the risk for candidiasis (commonly called a yeast infection) during pregnancy.
A)true
B)false

A

32

increase in glycogen increases the risk for candidiasis (commonly called a yeast infection) during pregnancy.
A)true
B)false

A

33

DEVELOPMENTAL COMPETENCE
The Aging Woman

,

34

In contrast to the slowly declining hormones in the aging male, the female's hormonal milieu decreases rapidly. Menopause is cessation of the menses. Usually this occurs around 48 to 51 years, although a wide variation of ages from 35 to 60 years exists.
A)true
B)false

A

35

The stage of menopause includes the preceding 1 to 2 years of decline in ovarian function, shown by irregular menses that gradually become farther apart and produce a lighter flow.
A)aging adult
B)false

A

36

Ovaries stop producing progesterone and estrogen.
A)true aging woman
B)false

A

37

Because cells in the reproductive tract are estrogen dependent, decreased estrogen levels during menopause bring dramatic physical changes.
A) aging woman
B)false

A

38

The uterus shrinks in size because of decreased myometrium. The ovaries atrophy to 1 to 2 cm and are not palpable after menopause.
A)aging woman
B)false

A

39

Ovulation still may occur sporadically after menopause.
A)aging woman
B)false

A

40

The sacral ligaments relax and the pelvic musculature weakens, so the uterus droops. Sometimes it may protrude, or prolapse, into the vagina.
A)aging woman
B)false

A

41

The cervix shrinks and looks paler with a thick, glistening epithelium.
A)aging woman
B)false

A

42

The vagina becomes shorter, narrower, and less elastic because of increased connective tissue. Without sexual activity, the vagina atrophies to one-half its former length and
width.
A)aging woman
B)false

A

43

The vaginal epithelium atrophies, becoming thinner, drier, and itchy. This results in a fragile mucosal surface that is at risk for bleeding and vaginitis.
A)aging woman
B) false

A

44

Decreased vaginal secretions leave the vagina dry and at risk for irritation and pain
with intercourse (dyspareunia).
A)aging woman
B)false

A

45

The vaginal pH becomes more alkaline, and glycogen content decreases from the decreased estrogen. These factors also increase the risk for vaginitis because they create a suitable medium for pathogens.
A) aging woman
B)false

A

46

Externally, the mons pubis looks smaller because the fat pad atrophies. The labia and clitoris gradually decrease in size. Pubic hair becomes thin and sparse.
A)aging woman
B)false

A

47

Declining estrogen levels produce some physiologic changes in the female sexual response cycle: reduced amount
of vaginal secretion and lubrication during excitement; shorter duration of orgasm; and rapid resolution. However, these changes do not affect sexual pleasure and function.
A)aging woman
B)false

A

48

As with the male, the older female is capable of sexual expression and function given reasonably good health and an interested
partner. Aging women greatly outnumber their male counterparts, and aging women are more likely to be single, whereas males their same age are more likely to be married.
A)true
B)false

A

49

CULTURE AND GENETICS

,

50

Today, however, cervical cancer occurs most often in Hispanic women; their
incidence is over twice that of white women.
A)true
B)false

A

51

Female circumcision, known as infibulation or female genital mutilation, is an invasive surgical procedure that is performed on girls before puberty. It is practiced within
Aboriginal, Christian, and Muslim families who have emigrated to the United States from western and southern Asia, the Middle East, and large areas of Africa. It is a social custom,
not a religious practice. This procedure involves removal, partial or total, of the clitoris and is believed to inhibit sexual pleasure.
A)true
B)false

A

52

SUBJECTIVE DATA

,

53

1. Menstrual history
2. Obstetric history
3. Menopause
4. Self-care behaviors
5. Urinary symptoms
6. Vaginal discharge
7. Past history
8. Sexual activity
9. Contraceptive use
10. Sexually transmitted infection (STI) contact
11. STI risk reduction

True

54

Menstrual history. Tell me about your menstrual periods
A)assessing Menstrual history is usually nonthreatening; thus it is a good place to start
B)false

A

55

Date of your last menstrual period?
A)assessing LMP- last menstrual period.
B)false

A

56

Age at first period?
A)assessing for Menarche-mean age at onset at 12 to 13 years; delayed onset suggests endocrine or underweight problem.
B)false

A

57

Menarche-mean age at onset at 12 to 13 years; delayed onset suggests endocrine or underweight problem.
A)true
B)false

A

58

How often are your periods?
A)assessing for Cycle-normally every 18 to 45 days. Amenorrhea-absent menses.
B)false

A

59

Cycle- of period is normally every 18 to 45 days. Amenorrhea-absent menses.
A)true
B)false

A

60

How many days does your period last?
A)assessing for Duration-average 3 to 7 days.
A)true
B)false

A

61

Usual amount of flow: light, medium, heavy? How many pads or tampons do you use each day or hour?
A)assessing for Menorrhagia-heavy menses.
B)false

A

62

Menorrhagia-heavy menses.(periods)
A)true
B)false

A

63

Any clotting?
A)assessing for Clotting indicates heavy flow or vaginal pooling.
B)false

A

64

Clotting indicates heavy flow or vaginal pooling.
A)true
B)false

A

65

Any pain or cramps before or during period? How do you treat it? Interfere with daily activities? Any other associated symptoms: bloating, breast tenderness, moodiness? Any spotting between periods?
A)assessing for Dysmenorrhea.
B)false

A

66

Obstetric history. Have you ever been pregnant?
A)assessing for Gravida- number of pregnancies
B)false

A

67

How many times?
A)assessing for Gravida- number of pregnancies
B)false

A

68

How many babies have you had?
A)assessing for Para-number of births
B)false

A

69

Any miscarriage or abortion?
A)assessing for Abortions-interrupted pregnancies, including elective abortions and spontaneous miscarriages.
B)false

A

70

For each pregnancy, describe: duration, any complication, labor and delivery, baby's sex, birth weight, condition.
A)assessing
B)false

A

71

Do you think you may be pregnant now? What symptoms have you noticed?
A)assessing
B)false

A

72

Menopause. Have your periods slowed down or stopped?
A)assessing Menopause--cessation of menstruation
B)false

A

73

Any associated symptoms of menopause (e.g., hot flash, night sweats, numbness and tingling, headache, palpitations, drenching sweats, mood swings, vaginal dryness, itching)? Any treatment?
A)Perimenopausal period from 40 to 55 years has hormone shifts, resulting in vasomotor instability.
B)false

A

74

If hormone replacement, how much? How is it working? Any side effects?
A)assessing for Side effects of HRT include fluid retention, breast pain, vaginal bleeding, and breast cancer risk.
B)false

A

75

How do you feel about going through menopause?
A)assessing for Although a normal Life stage, reaction varies from acceptance to feelings of loss.
B)false

A

76

Self-care behaviors. How often do you have a gynecologic checkup?
A)Begin cervical cancer screening within 3 years after first vaginal intercourse or age 21 years, and continue annually until age 30. After age 30, if have three consecutive normal Pap tests, women may be screened every 2 to 3 years.
B)false

A

77

Last Pap smear? Results?
A)assessing
B)false

A

78

Has your mother ever mentioned taking hormones while pregnant with you? .
A)assessing Maternal ingestion of diethylstilbestrol (DES) causes cervical and vaginal abnormalities in female offspring requiring frequent follow-up
B)false

A

79

Urinary symptoms. Any problems with urinating? Frequently and small amounts? Cannot wait to urinate?
A)assessing for urgency
B)false

A

80

Any burning or pain on urinating?
A)dysuria .
B)false

A

81

Awaken during night to urinate?
A)noctouria
B)false

A

82

Urine dark, cloudy, foul smelling?
A)assessing for Bile in urine or urinary tract infection.
B)false

A

83

Any difficulty controlling urine or wetting yourself?
A)assessing for Urge incontinence-involuntary urine loss from overactive detrusor muscle in bladder. It contracts, causing urgent need to void.
B)false

A

84

Urge incontinence-involuntary urine loss from overactive detrusor muscle in bladder. It contracts, causing urgent need to void.
A)true
B)false

A

85

Urinate with a sneeze, laugh, cough, bearing down?
A)assessing for Stress incontinence-involuntary urine loss with physical strain, sneezing, or coughing.
B)false

A

86

Vaginal discharge. Any unusual vaginaJ discharge? Increased amount?
A)assessing for Normal discharge is small, clear or cloudy, and always nonirritating.
B)false

A

87

Character or color: white, yellow-green, gray, curdlike, foul smelling?
A)assessing for Suggests vaginal infection; character of discharge often suggests causative organism
B)false

A

88

When did this begin?
A)assessing for Acute versus chronic problem.
B)false

A

89

Is the discharge associated with vaginal itching, rash, pain with intercourse?
A)assessing for Rash is result of irritation from discharge. Dyspareunia occurs with vaginitis of any cause.
B)false

A

90

Rash is result of irritation from discharge. .
A)true
B)false

A

91

Dyspareunia occurs with vaginitis of any cause.
A)true
B)false

A

92

Factors that increase risk for vaginitis:

• Oral contraceptives increase glycogen content of vaginal epithelium, providing fertile medium for some organisms.

• Broad-spectrum antibiotics alter balance of normal flora.

• Diabetes increases glycogen content.

• Menses, postpartum, menopause have a more alkaline vagina] pH.

• Frequent douching alters pH. Spray has risk for contact dermatitis.

• Local irritation.

True

93

Any past surgery on uterus, ovaries, vagina?
A)assessing for feelings. Some fear loss of sexual response after hysterectomy, which may cause problems in intimate relationships.
B)false

A

94

Sexual activity. Often women have a question about their sexual relationship and how it affects their health. Do you?
A)Begin with open-ended question to assess individual needs.
B)false

A

95

Begin with open-ended question to
assess individual needs.Include appropriate questions as a routine:

Communicates that you accept individual's sexual activity and believe it is important.

Your comfort with discussion prompts person's interest and possibly relief that the topic has been introduced.

Establishes a database for comparison with any future sexual activities.

Provides opportunity to screen sexual problems.

True

96

What is your sexual preference: relationship with a man, with a woman, both?
A)assessing for The practice environment must be welcoming and respectful of lesbians and bisexual women to discuss their health concern
B)false

A

97

Contraceptive use. Currently planning a pregnancy, or avoiding pregnancy?
A)assessing
B)false

A

98

Do you and your partner use a contraceptive? Which method? Is this satisfactory? Do you have any questions about method?
A)assessing for smoking history. Oral contraceptives, together with cigarette smoking, increase the risk for vascular problems.
B)false

A

99

Have you ever had any problems becoming pregnant?
A)assessing for Infertility is considered after 1 year of engaging in unprotected sexual intercourse without conceiving.
B)false

A

100

Sexually transmitted infection (STI) contact. Any sexual contact with partner having an STI, such as gonorrhea, herpes, HIV/AIDS, chlamydia( infection, venereal warts, syphilis? When? How was this treated? Were there any complications?
A)assessing for An STI includes all conditions that can be transmitted during intimate sexual contact with an infected partner.
B)false

A

101

STI risk reduction. Any precautions to reduce risk for STis? Use condoms at each episode of sexual intercourse?
A)assessing
B)false

A

102

Additional History for Infants and Children

,

103

Problem with genital area: itching, rash, vaginal discharge?
A)assessing because can Occurs with poor perineal hygiene or insertion of foreign body in vagina.
B)false

A

104

To child) Has anyone ever touched you in between your legs and you did not want them to? Sometimes that happens to children. They should remember they have not been bad. They should try to tell a big person about it. Can you tell me three different big people you trust who you could talk to?
A)Screen for sexual abuse. For prevention, teach the child that it is not okay for someone to look at or touch her private parts while telling her it is a secret. Naming three trusted adults will include someone outside the familyimportant because most molestation is by a parent.
B)false

A

105

Additional History for Preadolescents and Adolescents

,

106

Use the following questions to assess sexual growth and development and sexual behavior. First:

,

107

Ask questions that seem appropriate for girl's age, but norms vary widely. When in doubt, ask too many questions rather than omit something. Children obtain information, often misinformation, from the media and from peers at surprisingly early ages. You can be sure your information will be more thoughtful and accurate.
A)true
B)false

A

108

Ask direct, matter-of-fact questions.

Avoid sounding judgmental. Start with a permission statement: "Often girls your age experience .... " " This conveys that it is normal to think or feel a certain way.
A)true
B)false

A

109

Examiner Asks Rationale
• Try the open-ended question: "When did you .... " rather than "Do you " .... "This is less threatening because it implies that the topic is normal and unexceptional.
A)true
B)false

A

110

CONTD...

,

111

Around age 9 or 10 years, girls start to develop breasts and pubic hair. Have you ever seen charts and pictures of normal growth patterns for girls? Let us go over these now. A)assessing
B)false

A

112

Have your periods started? How did you feel? Were you prepared or surprised?
A)assessing for attitude of girl and parents. Note inadequate preparation or attitude of distaste.
B)false

A

113

Do you and your boyfriend have intercourse? Are you using condoms? What kind of protection did you use the last time you had sex?
A)Avoid the term "sexually active," which is ambiguous.
B)false

A

114

Has anyone ever talked to you about sexually transmitted infections, such as chlamydia, herpes, gonorrhea, or HIV/AIDS?
A)Teach STI risk reduction.
B)false

A

115

Have you and your parents discussed the human papillomavirus (HPV) vaccine (Gardasil, Cervarix)? It is recommended before girls become sexually active.
A)The HPV vaccines are approved for girls and women ages 9 to 26 for prevention of cervical cancer. They cannot protect against established infections.
B)false

A

116

Sometimes a person touches a girl in a way that she does not want them to. Has that ever happened to you? If that happens, the girl should remember it is not her fault. She should tell another adult about it.
A)Screen for sexual abuse.
B)false

A

117

Additional History for the Aging Adult

,

118

After menopause, noted any vaginal bleeding?
A)Postmenopausal bleeding warrants further workup and referral.
B)false

A

119

Any vaginal itching, discharge, pain with intercourse
A)Associated with atrophic vaginitis
B)false

A

120

Any pressure in genital area, loss of urine with cough or sneeze, back pain, or constipation?
A)Occurs with weakened pelvic musculature and uterine prolapse.
B)false

A

121

OBJECTIVE DATA

,

122

PREPARATION

,

123

Assemble the equipment before helping the woman into position.
A)true
B)false

A

124

Familiarize yourself with the vaginal speculum before the examination. Practice opening and closing the blades, locking them into position, and releasing them. Try both metal and plastic types. Note that the plastic speculum locks and unlocks with a resounding click that can be alarming to the uninformed woman
A)true
B)false

A

125

POSITION

,

126

For the examination, the woman should be placed in the lithotomy position, with the examiner sitting on a stool. Help the woman into lithotomy position, with the body supine, feet in stirrups and knees apart, and buttocks at edge of examining table
A)true
B)false

A

127

Some women prefer to leave their shoes or socks on. Or, you can place an examination glove over each of the stirrups to warm the stirrups and keep her feet from slipping
A)true
B)false

A

128

Place her arms at her sides or across the chest, not over the head, because this position only tightens the abdominal muscles
A)true
B)false

A

129

The lithotomy position leaves many women feeling helpless and vulnerable. Indeed, many women tolerate the pelvic examination because they consider it basic for health care, yet they find it embarrassing and uncomfortable. Previous examinations may have been painful or the previous examiner's attitude hurried and patronizing
A)true
B)false

A

130

You can help the woman relax, decrease her anxiety, and retain a sense of control by using these measures:

,

131

Have her empty the bladder before the examination.

Position the examination table so that her perineum is not exposed to an inadvertent open door.

• Ask if she would like a friend, family member, or chaperone present. Position this person by the woman's head to maintain privacy.
A)true
B)false

A

132

Elevate her head and shoulders to a semisitting position to maintain eye contact.

Place the stirrups so that the legs are not abducted too far.

Explain each step in the examination before you do it.

Assure the woman she can stop the examination at any point should she feel any discomfort

A)true
B)false

A

133

Use a gentle, firm touch and gradual movements.

• Communicate throughout the examination.

Maintain a dialogue to share information.
A)true
B)false

A

134

Use the techniques of the educational or mirror pelvic examination. This is a routine examination with some modifications in attitude, position, and communication. First, the woman is considered an active participant, one who is interested in learning and in sharing decisions about her own health care.
A)true
B)false

A

135

CONTD...

,

136

The mirror works well for teaching normal anatomy and its relationship to sexual behavior. Even women who are in a sexual relationship or who have had children may be surprisingly uninformed about their own anatomy. You will find the woman's enthusiasm on seeing her own cervix is rewarding too.
A)true
B)false

A

137

The mirror pelvic examination also works well when abnormalities arise, because the woman can see the rationale for treatment and can monitor progress at the next appointment. She is more willing to comply with treatment when she shares in the decision
A)true
B)false

A

138

EXTERNAL GENITALIA

,

139

Inspection

,

140

Skin color is even; labia minora are a darker pink
A)true
B)false

A

141

Note any pigmented nevus or lesion that the woman cannot see. Refer any suspicious lesion for biopsy.
A)abnormal finding
B)normal finding

A

142

Hair distribution is in the usual female pattern of inverted triangle, although it normally may trail up the abdomen toward the umbilicus.
A)true
B)false

A

143

Consider delayed puberty if no pubic hair or breast development has occurred by age 13 years.
A)abnormal findings
B)normal findings

A

144

Labia majora normally are symmetric, plump, and well formed. In the nulliparous woman, labia meet in the midline; after a vaginal delivery, the labia are gaping and slightly shriveled.
A)true
B)false

A

145

With your gloved hand, separate the labia majora to inspect: • Clitoris
A)true
B)false

A

146

Labia minora are dark pink and moist, usually symmetric.
A)normal findings
B)false

A

147

Urethral opening appears stellate or slitlike and is midline.
A)normal
B)abnormal

A

148

Vaginal opening, or introitus, may appear as a narrow vertical slit or as a larger opening.
A)normal
B)abnormal

A

149

Perineum is smooth. A well-healed episiotomy scar, midline or mediolateral, may be present after a vaginal birth. Anus has coarse skin of increased pigmentation.
A)normal
B)abnormal

A

150

Palpation

,

151

Assess the urethra and Skene's glands. Dip your gloved finger in a bowl of warm water to lubricate. Then insert your index finger into the vagina, and gently milk the urethra by applying pressure up and out. This procedure should produce no pain. If any discharge appears, culture it.
A)normal
B)abnormal

A

152

Assess Bartholin's glands. Palpate the posterior parts of the labia majora with your index finger in the vagina and your thumb outside. Normally, the labia feel soft and homogeneous.
A)normal
B)abnormal

A

153

Erythema around or discharge from ducts opening may indicate an abnormal finding
A)true
B)false

A

154

Assess the support of pelvic musculature by using these maneuvers:

,

155

. Palpate the perineum. Normally, it feels thick, smooth, and muscular in the nulliparous woman and thin and rigid in the multiparous woman.
A)normal
B)abnormal

A

156

Tenderness. Paper-thin perineum. Are abnormal findings
A)true
B)false

A

157

Ask the woman to squeeze the vaginal opening around your fingers; it should feel tight in the nulliparous woman and have less tone in the multiparous woman.
A)normal
B)abnormal

A

158

Absent or decreased tone of the vaginal muscle may diminish sexual satisfaction.
A)abnormal
B)normal

A

159

Using your index and middle fingers, separate the vaginal orifice and ask the woman to strain down. Normally, no bulging of vaginal walls or urinary incontinence occurs.
A)normal
B)abnormal

A

160

Bulging of the vaginal wall indicates cystocele, rectocele, or uterine prolapse
A)abnormal finding
B)normal findings

A

161

INTERNAL GENITALIA

,

162

Speculum Examination

,

163

Select the proper-size speculum. Warm and lubricate the speculum under warm running water. Regarding Pap test cytology, evidence shows applying a small amount (dime size) of water-soluble gel lubricant on the outer inferior blade increases patient comfort and yields no more unsatisfactory slides than does water-only lubricant. However, the effect of gel lubricant on interference with "bacterial or viral cultures has not been tested.
A)true
B)false

A

164

A good technique is to dedicate one hand to the patient and the other hand to picking up equipment in the room. For example, hold the speculum in your left hand (the equipment hand), with the index and the middle fingers surrounding the blades and your thumb under the thumbscrew. This prevents the blades from opening painfully during insertion.
A)true
B)false

A

165

With your right index and middle fingers (the patient hand), push the introitus down and open to relax the pubococcygeal muscle. Tilt the width of the blades obliquely and insert the speculum past your right fingers, applying any pressure downward. This avoids pressure on the sensitive urethra above it.
A)true
B)false

A

166

Ease insertion by asking the woman to bear down. This method relaxes the perineal muscles and opens the introitus. (With experience, you can combine speculum insertion with assessing the support of the vaginal muscles.) As the blades pass your right fingers, withdraw your fingers. Now change the hand holding the speculum to your right hand and turn the width of the blades horizontally. Continue to insert in a 45-degree angle downward toward the small of the woman's back. This matches the natural slope of the vagina.
A)true
B)false

A

167

After the blades are fully inserted, open them by squeezing the handles together. The cervix should be in full view. Sometimes this does not occur (especially with beginning examiners) because the blades are angled above the location of the cervix. Try closing the blades, withdrawing about halfway, and reinserting in a more downward plane. Then slowly sweep upward. Once you have the cervix in full view, lock the blades open by tightening the thumbscrew.
A)true
B)false

A

168

Inspect the Cervix and Its Os

,

169

Color. Normally the cervical mucosa is pink and even. During the 2nd month of pregnancy, it looks blue (Chadwick sign), and after menopause, it is pale.
A)true
B)false

A

170

Cervix that has Redness, inflammation. Pallor with anemia. Cyanotic other than with pregnancy is an abnormal finding
A)true
B)false

A

171

Positionof cervix is . Midline, either anterior or posterior. Projects 1 to 3 cm into the vagina.
A)true
B)false

A

172

Lateral position of the cervix may be due to adhesion or tumor. Projection of more than 3 cm may be a prolapse.
A)abnormal findingnof cervix
B)false

A

173

Normal size of cervix. Diameter is 2.5 cm (1 inch).
A)true
B)false

A

174

Hypertrophy of the cervix of more than 4 cm occurs with inflammation or tumor.
A)abnormal
B)normal

A

175

Os. This is small and round in the nulliparous (never given brith) woman. In the parous(pregnant) woman, it is a horizontal, irregular slit and also may show healed lacerations on the sides.
A)true
B)false

A

176

Surface. This is normally smooth, but cervical eversion, or ectropion, may occur normally after vaginal deliveries. The endocervical canal is everted or "rolled out." It looks like a red, beefy halo inside the pink cervix surrounding the os. It is difficult to distinguish this normal variation from an abnormal condition (e.g., erosion or carcinoma), and biopsy may be needed.
A)true
B)false

A

177

Surface reddened, granular, and asymmetric, particularly around os.
A)abnormal
B)normal

A

178

Friable, bleeds easily. Any lesions: white patch on cervix; strawberry spot.
A)abnormal
B)normal

A

179

Refer any suspicious red, white, or pigmented lesion for biopsy
A)true
B)false

True
Abnormal

180

Nabothian cysts are benign growths that commonly appear on the cervix after childbirth. They are small, smooth, yellow nodules that may be single or multiple. Less than 1 cm, they are retention cysts caused by obstruction of cervical glands.
A)true
B)false

A

181

Cervical polyp--bright red growth protruding from the os
A)abnormal
B)normal

A

182

If secretions are copious, swab the area with a thick-tipped rectal swab. This method sponges away secretions, and you have a better view of the structures.
A)true
B)false

A

183

Obtain Cervical Smears and Cultures

M

184

The Papanicolaou, or Pap, test screens for cervical cancer and not for endometrial or ovarian cancer. Do not obtain during the woman's menses or if a heavy infectious discharge is present. Instruct the woman to not douche(shower), have intercourse, or put anything into the vagina within 24 hours before collecting the specimens.
A)true
B)false

A

185

Obtain the Pap smear before other specimens so you will not disrupt or remove cells.
A)true
B)false

A

186

Thus evidence shows that just stirring off the cells into the liquid vial results in fewer unsatisfactory tests and is more sensitive in detecting cervical neoplasia.
A)true
B)false

A

187

Vaginal Pool. Gently rub the blunt end of an Ayre spatula over the vaginal wall under and lateral to the cervix. Wipe the specimen on a glass slide or dip into a liquid vial. If the mucosa is very dry (as in a postmenopausal woman), moisten a sterile swab with normal saline solution to collect this specimen.
A)true
B)false

A

188

Cervical Scrape. Insert the bifid end of the Ayre spatula into the vagina with the more pointed bump into the cervical os. Rotate it 360 to 720 degrees, using firm pressure. The rounded cervix fits snugly into the spatula's groove. The spatula scrapes the surface of the squamocolumnar junction (SCJ) and cervix as you turn the instrument. Spread the specimen from both sides of the spatula onto a glass slide. Use a single stroke to thin out the specimen, not a back-and-forth motion. This specimen is important for the adolescent whose endocervical cells have not yet migrated into the endocervical canal.
A)true
B)false

A

189

Endocervical Specimen. Insert a cytobrush (instead of a cotton applicator) into the os. A cytobrush gives a higher yield of endocervical cells at the SCJ and is safe for use during pregnancy. The woman may feel a slight pinch with the brush, and scant bleeding may occur. For this reason, collect the endocervical specimen last so that bleeding will not obscure cytologic evaluation.
A)true
B)false

A

190

Rotate the brush 720 degrees in ONE direction in the endocervical canal, either clockwise or counterclockwise. Then rotate the brush gently on a slide to deposit all the cells. Rotate in the opposite direction from the one in which you obtained the specimen. Avoid leaving a thick specimen that would be hard to read under the microscope. Immediately (within 2 seconds) spray the slide with fixative to avoid drying. Or stir the cytobrush gently into the liquid vial.
A)true
B)false

A

191

For the woman after hysterectomy whose cervix has been removed, collect a scrape from the end of the vagina and a vaginal pool.
A)true
B)false

A

192

To screen for STis and if you note any abnormal vaginal discharge, obtain the gonorrhea (GC)/chlarnydia culture. Insert a sterile cotton applicator into the os, rotate it 360 degrees, and leave it in place 10 to 20 seconds for complete saturation. Insert into labeled container.
A)true
B)false

A

193

Occasionally you will need the following samples:

,

194

Saline Mount, or "Wet Prep." Spread a sample of the discharge onto a glass slide and add one drop of normal saline solution and a coverslip.

KOH Prep. To a sample of the discharge on a glass slide, add one drop of potassium hydroxide and a coverslip

A)true
B)false

A

195

Anal Culture. Insert a sterile cotton swab into the anal canal about I em. Rotate it, and move it side to side. Leave in place 10 to 20 seconds. If the swab collects feces, discard it and begin again. Insert into specimen container.
A)true
B)false

A

196

Acetic Acid Wash. Acetic acid (white vinegar) screens for asymptomatic human papillomavirus (HPV), which causes genital warts. After all other specimens are gathered, soak a thick-tipped cotton rectal swab with acetic acid and "paint" the cervix. Acetic acid dissolves mucus and temporarily causes intracellular dehydration and coagulation of protein. A normal response (indicating no HPV infection) is no change in the cervical epithelium.
A)true
B)false

A

197

Rapid acetowhitening or blanching, especially with irregular borders, suggests HPV infection
A)true, positive Acetic Acid Wash
B)false

A

198

Inspect the Vaginal Wall

,

199

Loosen the thumbscrew but continue to hold the speculum blades open. Slowly withdraw the speculum, rotating it as you go, to fully inspect the vaginal wall. Normally, the wall looks pink, deeply rugated, moist and smooth, and free of inflammation or lesions. Normal discharge is thin and clear or opaque and stringy but always odorless.
A)true
B)false

A

200

Leukoplakia, appears as spot of dried white paint.
A)abnormal
B)normal

A

201

Vaginal discharge: thick, white, and curdlike with candidiasis; profuse, watery, gray-green, and frothy with trichomoniasis; or any gray, green-yellow, white, or foul-smelling discharge
A)abnormal
B)normal

A

202

When the blade ends are near the vaginal opening, let them close, but be careful not to pinch the mucosa or catch any hairs. Turn the blades obliquely to avoid stretching the opening. Place the metal speculum in a basin to be cleaned later and soaked in a sterilizing and disinfecting solution; discard the plastic variety. Discard your gloves, and wash hands.
A)true
B)false

A

203

Bimanual Examination

,

204

Rise to a stand, and have the woman remain in lithotomy position. Drop lubricant onto the first two fingers of your gloved intravaginal hand.
A)true
B)false

A

205

Assume the "obstetric" position with the first two fingers extended, the last two flexed onto the palm, and the thumb abducted. Insert your fingers into the vagina, with any pressure directed posteriorly. Wait until the vaginal walls relax, and then insert your fingers fully.
A)true
B)false

A

206

You will use both hands to palpate the internal genitalia to assess their location, size, and mobility and to screen for any tenderness or mass. One hand is on the abdomen while the other hand (often the dominant, more sensitive hand) inserts two fingers into the vagina. It does not matter which you choose as the intravaginal hand; try each way, and settle on the most comfortable method for you
A)true
B)false

A

207

Palpate the vaginal wall. Normally, it feels smooth and has no area of induration(harden) or tenderness.
A)true bi manual exam
B)false

a

208

Cervix. Locate the cervix in the midline, often near the anterior vaginal wall. The cervix points in the opposite direction of the fundus of the uterus. Palpate using the palmar surface of the fingers.
A)true
B)false

A

209

Note these characteristics of a normal
cervix:

Consistency-feels smooth and firm, as the consistency of the tip of the nose. It softens and feels velvety at 5 to 6 weeks of pregnancy (Goodell sign).

Contour-evenly rounded.

• Mobility-with a finger on either side, move the cervix gently from side to side. Normally, this produces no pain

True

210

Palpate all around the fornices; the wall should feel smooth.if checking abnormal finding would be
A) Painful with inflammation
B)ectopic pregnancy
C)both a and b

C

211

Next, use your abdominal hand to push the pelvic organs closer for your intravaginal fingers to palpate. Place your hand midway between the umbilicus and the symphysis; push down in a slow, firm manner, fingers together and slightly flexed. Brace the elbow of your pelvic arm against your hip, and keep it horizontal. The woman must be relaxed.
A)true
B)false

A

212

Uterus. With your intravaginal fingers in the anterior fornix, assess the uterus. Determine the position, or version, of the uterus. This compares the long axis of the uterus with the long axis of the body. In many women, the uterus is anteverted; you palpate it at the level of the pubis with the cervix pointing posteriorly. Two other positions occur normally (midposition and retroverted), as well as two aspects of flexion, in which the long axis of the uterus is not straight but is flexed.
A)true
B)false

A

213

Palpate the uterine wall with your fingers in the fornices. Normally, it feels firm and smooth, with the contour of the fundus rounded. It softens during pregnancy. Bounce the uterus gently between your abdominal and intravaginal hand. It should be freely movable and nontender.
A)true
B)false

A

214

Enlarged uterus
Lateral displacement.
Nodular mass.
Irregular, asymmetric uterus.
Fixed and immobile.
Tenderness.
Are all abnormal findings
A)true
B)false

A

215

Adnexa. Move both hands to the right to explore the adnexa. Place your abdominal hand on the lower quadrant just inside the anterior iliac spine and your intravaginal fingers in the lateral fornix. Push the abdominal hand in and try to capture the ovary. Often, you cannot feel the ovary. When you can, it normally feels smooth, firm, and almond-shaped and is highly movable, sliding through the fingers. It is slightly sensitive but not painful. The fallopian tube is not palpable normally. No other mass or pulsation should be felt.
A)true
B)false

A

216

Enlarged adnexa. Nodules or mass in adnexa,
Immobile. Markedly tender
Pulsation or palpable fallopian tube suggests ectopic pregnancy; this warrants immediate referral.
All are abnormal findings
A)true
B)false

A

217

A note of caution-normal adnexal structures often are not palpable. Be careful not to mistake an abnormality for a normal structure. To be safe, consider abnormal any mass that you cannot positively identify, and refer the woman for further study.
A)true
B)false

A

218

Adnexa Normal secretions are clear or cloudy and odorless.
A)true
B)false

A

219

Rectovaginal Examination

,

220

While pushing with the abdominal hand, repeat the steps of the bimanual examination. Try to keep the intravaginal finger on the cervix so the intra rectal finger does not mistake the cervix for a mass. Note:

Rectovaginal septum should feel smooth, thin, firm, and pliable.

• Rectovaginal pouch, or cul-de-sac, is a potential space and usually not palpated.

Uterine wall and fundus feel firm and smooth.

True

221

Rotate the intrarectal finger to check the rectal wall and anal sphincter tone. (See Chapter 25 for assessment of anus and rectum.) Check your gloved finger as you withdraw; test any adherent stool for occult blood.
A)true
B)false

A

222

DEVELOPMENTAL COMPETENCE
Infants and Children

,

223

Preparation
Infants and children

,

224

Infant-place on examination table.

• Toddler/preschooler- place on parent's lap.
• Frog-leg position-hips flexed, soles of feet together and up to bottom.
• Preschool child may want to separate her own labia.
• No drapes-the young girl wants to see what you are doing.

True

225

School-age child-place on examination table, frog-leg position, no drapes.

During childhood, a routine screening is limited to inspection of the external genitalia to determine that
(1) the structures are intact,
(2) the vagina is present, and
(3) the hymen is patent (open)

True

226

Infant and children contd...,

,

227

The newborn's genitalia are somewhat engorged. The labia majora are swollen, the labia minora are prominent and protrude beyond the labia majora, the clitoris looks relatively large, and the hymen appears thick.
A)true
B)false

A

228

Because of transient engorgement, the vaginal opening is more difficult to see now than it will be later. Place your thumbs on the labia majora. Push laterally while pushing the perineum down, and try to note the vaginal opening above the hymenal ring. Do not palpate the clitoris because it is very sensitive.
A)true
B)false

A

229

Ambiguous genitalia are rare but are suggested by a markedly enlarged clitoris, fusion of the labia (resembling scrotum), and palpable mass in fused labia (resembling testes)
A)infant and children
B)false

A

230

Imperforate hymen warrants referral.
A)true
B)false

A

231

A sanguineous vaginal discharge or leukorrhea (mucoid discharge) is normal during the first few weeks because of the maternal estrogen effect. (This also may cause transient breast engorgement and secretion.) During the early weeks, the genital engorgement resolves and the labia minora atrophy and remain small until puberty .
A)true
B)false

A

232

Between the ages of 2 months and 7 years, the labia majora are flat, the labia minora are thin, the clitoris is relatively small, and the hymen is tissue-paper -thin. Normally, no irritation or foul-smelling discharge is present.
A)true
B)false

A

233

Poor perineal hygiene. Pest inhabitants. Excoriations are all abnormal findings
A)true
B)false

A

234

During and after toddler age, foul smelling discharge occurs with lodging of foreign body, pinworms, or infection.
A)true abnormal
B)false normal

A

235

In the young school-age girl (7 to 10 years), the mons pubis thickens, the labia majora thicken, and the labia minora become slightly rounded.
A)true
B)false

A

236

Pubic hair appears beginning around age 11 years, although sparse pubic hair may occur as early as age 8 years. Normally, the hymen is perforate.
A)true
B)false

A

237

Absence of pubic hair by 13 years indicates delayed puberty
A)abnormal
B)normal

A

238

Amenorrhea in adolescent, together with bluish and bulging hymen, indicates imperforate hymen and warrants referral.
A)abnormal
B)Normal

A

239

If needed, an internal pelvic examination is best performed by a pediatric gynecologist using specialized instruments.
A)true
B)false

A

240

DEVELOPMENTAL COMPETENCE
The Adolescent

,

241

The adolescent girl has special needs during the genitalia examination. Examine her alone, without the mother present. Assure her of privacy and confidentiality. Allow plenty of time for health education and discussion of pubertal progress.
A)true
B)false

A

242

Assess her growth velocity and menstrual history, and use the SMR charts to teach breast and pubic hair development. Assure her that increased vaginal fluid (physiologic leukorrhea) is normal because of the estrogen effect.
A)true
B)false

A

243

Perform a pelvic examination when contraception is desired, when the girl's sexual activity includes intercourse, or at 21 years of age. Start Pap smears .within 3 years after intercourse begins.
A)true
B)false

A

244

Although the techniques of the examination are listed in the adult section, you will need to provide additional time and psychological support for the adolescent having her first pelvic examination
A)true
B)false

A

245

Take the time to teach, using the girl's own body as illustration. Your frank discussion of anatomy and sexual behavior communicates that these topics are acceptable to discuss and not taboo with health care providers. This affirms the girl's self-concept.
A)true
B)false

A

246

During the bimanual examination, note that the adnexa are not palpable in the adolescent.
A)true
B)false

A

247

Pelvic or adnexal mass are abnormal findings
A)true
B)false

A

248

DEVELOPMENTAL COMPETENCE
The Pregnant Woman

,

249

The height of the fundus ascends gradually as the fetus grows. At 16 weeks, the fundus is palpable halfway between the symphysis and umbilicus; at 20 weeks, at the lower edge of the umbilicus; at 28 weeks, halfway between the umbilicus and the xiphoid; and at 34 to 36 weeks, almost to the xiphoid. Then, close to term, the fundus drops as the fetal head engages in the pelvis.
A)true,pregnant woman
B)false

A

250

The external genitalia show hyperemia of the perineum and vulva because of increased vascularity. Varicose veins may be visible in the labia or legs. Hemorrhoids may show around the anus. Both are caused by interruption in venous return from the pressure of the fetus.
A)true
B)false

A

251

Internally, the walls of the vagina appear violet or blue (Chadwick sign) because of hyperemia. The vaginal walls are deeply rugated, and the vaginal mucosa thickens. The cervix looks blue, feels velvety, and feels softer than in the nonpregnant state, making it a bit more difficult to differentiate from the vaginal walls.
A)true, pregnant woman
B)false

A

252

During bimanual examination, the isthmus of the uterus feels softer and is more easily compressed between your two hands (Hegar sign). The fundus balloons between your two hands; it feels connected to, but distinct from, the cervix because the isthmus is so soft.
A)true pregnant woman
B)false

A

253

An ectopic pregnancy has serious consequences.
A)true
B)false

A

254

Developmental competence
The Aging Adult

,

255

Natural lubrication is decreased; to avoid a painful examination, take care to lubricate instruments and the examining hand adequately. Use the Pedersen speculum (rather than the Graves) because its narrower, flatter blades are more comfortable in women with vaginal stenosis or dryness.
A)aging woman
B)adult

A

256

Menopause and the resulting decrease in estrogen production cause numerous physical changes. Pubic hair gradually decreases, becoming thin and sparse in later years. The skin is thinner and fat deposits decrease, leaving the mons pubis smaller and ilie labia flatter. Clitoris size also decreases after age 60 years.
A)aging woman
B)adult

A

257

Internally, the rugae of the vaginal walls decrease and ilie walls look pale pink because of the thinned epithelium.
A)true, aging adult
B)false

A

258

The cervix shrinks and looks pale and glistening. It may retract, appearing to be flush with the vaginal wall. In some, it is hard to distinguish the cervix from the surrounding vaginal mucosa. Or, the cervix may protrude into ilie vagina if the uterus has prolapsed.
A)aging adult
B)false

A

259

Refer any suspicious red, white, or pigmented lesion for biopsy.
A)true
B)false

A

260

Vaginal atrophy increases the risk for infection and trauma.
A)true
B)false

A

261

With the bimanual examination, you may need to insert only one gloved finger if vaginal stenosis exists. The uterus feels smaller and firmer, and the ovaries are not palpable normally.
A)aging woman
B)false

A

262

Be aware that older women may have special needs and will appreciate the following plans of care:

for those with arthritis, taking a mild analgesic or anti-inflammatory before the appointment may ease joint pain in positioning;

schedule appointment times when joint pain or stiffness is at its least;

allow extra time for positioning and "unpositioning" after the examination;

and be careful to maintain dignity and privacy.

True

263

Women should continue cervical cancer screening up to age 70 years if they have an intact cervix and are in good health.
A)true
B)false

A

264

After age 70, women may decide to stop screening if
(1) they have had no abnormal cytology tests in the previous 10 years and
(2) if the three most recent Pap tests are documented as technically satisfactory and with normal results.

True

265

Women who have had a total hysterectomy for benign gynecologic disease do not need cervical cancer screening. But if the hysterectomy was for cervical neoplasia, Pap tests should continue until a 10-year history of no abnormal results.
A)true
B)false

A

266

PROMOTING A HEALTHY LIFESTYLE: NEW HPV VACCINE A Breakthrough Vaccine in Cancer Prevention

,

267

HPV is the most common sexually transmitted infection (STI)
A)true
B)false

A

268

The vaccine will protect against major types of HPV that cause cervical cancer, but not all types. Pap tests can detect cell changes in the cervix before they turn into cancer, at an early, curable stage. Other than the vaccine, the only way to prevent HPV is to abstain from all sexual activity. Using protection, such as a condom, may not be enough because areas not covered by a condom can be exposed to the virus
A)true
B)false

A

269

ABNORMAL FINDINGS FOR ADVANCED PRACTICE --- -- - ------ . - ------ ----- ----- - ------ -- - - -

,

270

Abnormalities of the External Genitalia

,

271

S: Severe perineal itching.

0: Excoriations and erythematous areas. May see little dark spots (lice are small), nits (eggs) adherent to pubic hair near roots. Usually localized in pubic hair, occasionally in eyebrows or eyelashes.

A)Pediculosis Pubis (Crab Lice)
B)Herpes Simplex Virus-Type 2 (Herpes Genitalis)

A

272

S: Episodes of local pain, dysuria, fever.

0: Clusters of small, shallow vesicles with surrounding erythema; erupt on genital areas and inner thigh. Also, inguinal adenopathy, edema. Vesicles on labia rupture in I to 3 days, leaving painful ulcers. Initial infection lasts 7 to 10 days. Virus remains dormant indefinitely; recurrent infections last 3 to 10 days with milder symptoms.

A)Syphilitic Chancre
B)Herpes Simplex Virus-Type 2 (Herpes Genitalis)

B

273

0: Begins as a small, solitary silvery papule that erodes to a red, round or oval, superficial ulcer with a yellowish serous discharge. Palpation-nontender indurated base; can be lifted like a button between thumb and finger. Nontender inguinal lymphadenopathy.

A)Syphilitic Chancre
B)Red Rash-Contact Dermatitis

A

274

S: History of skin contact with allergenic substance in environment, intense pruritus.
0 : Primary lesion-red, swollen vesicles. Then may have weeping of lesions, crusts, scales, thickening of skin, excoriations from scratching. May result from reaction to feminine hygiene spray or synthetic underclothing.

A)Red Rash-Contact Dermatitis
B)HPV

A

275

S: Painless warty growths, may be unnoticed by woman.

0 : Pink or flesh-colored, soft, pointed, moist, warty papules. Single or multiple in a cauliflower-like patch. Occur around vulva, introitus, anus, vagina, cervix. (NOTE: Advanced case shown here.)

A)Human Papillomavirus (HPV) Genital Warts
B)urethritis

A

276

________infection is common among sexually active women, especially adolescents, regardless of ethnicity or socioeconomic status. Risk factors include early age at menarche and multiple sexual partners. The long incubation period (6 weeks to 8 months) makes it difficult to establish history of exposure

HPV

277

S: Local pain, can be severe.

0: Overlying skin red, shiny, and hot. Posterior part of labia swollen; palpable fluctuant mass and tenderness. (Compare with wrinkled skin on the other, normal side.) Mucosa shows red spot at site of duct opening. Requires incision and drainage, antibiotic therapy.

A)urethritis
B)Abscess of Bartholin's Gland

B

278

S: Dysuria, burning sensation.

0: Palpation of anterior vaginal wall shows erythema, tenderness, induration along urethra, purulent discharge from meatus. Caused by Neisseria gonorrlroene, chlamydia, or staphylococcus infection

A)Urethritis
B)Urethral Caruncle

A

279

S: Tender, painful with urination, urinary frequency, hematuria, dyspareunia, or asymptomatic.

0: Small, deep red mass protruding from meatus; usually secondary to urethritis or skenitis; lesion may bleed on contact.

A)Urethral Caruncle
B)Cystocele

A

280

S: Feeling of pressure in vagina, stress incontinence.

0: With straining, note introitus widening and the presence of a soft, round anterior bulge. The bladder, covered by vaginal mucosa, prolapses into vagina.

A)Rectocele
B)Cystocele

B

281

S: Feeling of pressure in vagina, possibly constipation.

0 : With straining, note introitus widening and the presence of a soft, round bulge from posterior. Here, part of the rectum, covered by vaginal mucosa, prolapses into vagina

A)Rectocele
B)Uterine Prolapse

A

282

0 : With straining or standing, uterus protrudes into vagina. Non tender, non-fluctuant, smooth hemisphere; may cause a broad-based gait. Prolapse is graded:
1st degree, cervix appears at introitus with straining;
2nd degree, cervix bulges outside introitus with straining;
3rd degree (in this case), whole uterus protrudes even without strainingessentially, uterus is inside out.

A)Uterine Prolapse
B)cervix prolapse

A

283

Abnormalities of the Cervix

,

284

0 : Bluish discoloration of the mucosa occurs normally in pregnancy (Chadwick sign at 6 to 8 weeks' gestation) and with any other condition causing hypoxia or venous congestion (e.g., heart failure, pelvic tumor)
A)Bluish Cervix-Cyanosis
B)Erosion

A

285

0: Cervical lips inflamed and eroded. Reddened granular surface is superficial inflammation, with no ulceration (loss of tissue). Usually secondary to purulent or mucopurulent cervical discharge. Biopsy needed to distinguish erosion from carcinoma; cannot rely on inspection
A)Erosion
B)Herpes

A

286

0: Virus can appear in various forms when affecting cervical epithelium. Here, warty growth appears as abnormal thickened white epithelium. Visibility of lesion is enhanced by acetic acid (vinegar) wash, which dissolves mucus and temporarily causes intracellular dehydration and coagulation of protein

A)Human Papillomavirus {HPV, Condylomata)
B)Polyp

A

287

S: May have mucoid discharge or bleeding.

0: Bright red, soft, pedunculated growth emerges from os. It is a benign lesion, but this must be determined by biopsy. May be lined with squamous or columnar epithelium.
A)Polyp
B)carcinoma

A

288

S: Prenatal exposure to DES causes cervical and vaginal abnormalities not apparent until adolescence.

0 : Red, granular patches of columnar epithelium extend beyond normal squamocolumnar junction onto cervix and into fornices (vaginal adenosis). Also cervical abnormalities: circular groove, transverse ridge, protuberant anterior lip, "cockscomb" formation

A)Diethylstilbestrol {DES) Syndrome
B)carcinoma

A

289

Structural abnormalities cause infertility, ectopic pregnancy, spontaneous abortion, and preterm labor.
A)Diethylstilbestrol {DES) Syndrome
B)carcinoma

A

290

S: Bleeding between menstrual periods or after menopause, unusual vaginal discharge.

0: Chronic ulcer and induration are early signs of carcinoma, although the lesion may or may not show on the exocervix. (Here, lesion is mostly around the external os.

A)Carcinoma
B)polyp

A

291

Diagnosed by Pap smear and biopsy. Risk factors for cervical cancer are early age at first intercourse, multiple sex partners, cigarette smoking, certain sexually transmitted infections.
A)carcinoma
B)herpes

A

292

Vulvovaginal Inflammations

,

293

S: Postmenopausal vaginal itching, dryness, burning sensation, dyspareunia, mucoid discharge (may be flecked with blood).

0: Pale mucosa with abraded areas that bleed easily; may have bloody discharge

An opportunistic infection related to chronic estrogen deficiency.

A)Atrophic Vaginitis
B)carcinoma

A

294

S: Intense pruritus, thick whitish discharge.

0: Vulva and vagina are erythematous and edematous. Discharge is usually thick, white, curdy, "like cottage cheese." Diagnose by microscopic examination of discharge on potassium hydroxide wet mount

A)Candidiasis (Moniliasis)
B)acute vaginitis

A

295

Predisposing causes-use of oral contraceptives or antibiotics, more alkaline vaginal pH (as with menstrual periods, postpartum, menopause), also pregnancy from increased glycogen and diabetes.
A)Candidiasis (Moniliasis)
B)Trichomoniasis

A

296

S: Pruritus, watery and often malodorous vaginal discharge, urinary frequency, terminal dysuria, itching. Symptoms are worse during menstruation when the pH becomes optimal for the organism's growth.

0: Vulva may be erythematous. Vagina diffusely red, granular, occasionally with red, raised papules and petechiae ("strawberry" appearance). Frothy, yellow-green, foulsmelling discharge. Microscopic examination of saline wet mount specimen shows characteristic flagellated cells.

A)Trichomoniasis
B)Bacterial Vaginosis (Gardnerella vagina/is, Haemophilus vagina/is, or Nonspecific Vaginitis)

A

297

S: Profuse discharge, "constant wetness" with "foul, fishy, rotten" odor.

0: Thin, creamy, gray-white, malodorous discharge. No inflammation on vaginal wall or cervix because this is a surface parasite. Vaginal pH >4.5. Microscopic view of saline wet mount specimen shows typical "clue cells" (epithelial cells with stippled borders). Sniff for fishy odor after adding KOH to slide ("whiff test").

A)Bacterial Vaginosis (Gardnerella vagina/is, Haemophilus vagina/is, or Nonspecific Vaginitis)
B)Chlamydia

A

298

S: Minimal or no symptoms. May have urinary frequency, dysuria, or vaginal discharge, postcoital bleeding.

0: May have yellow or green mucopurulent discharge, friable cervix, cervical motion tenderness

A)Chlamydia
B)carcinoma

A

299

Signs are subtle, easily mistaken for gonorrhea. The two are important to distinguish because antibiotic treatment is different; if the wrong drug is given or if untreated, chlamydia can ascend to cause pelvic inflammatory disease (PID) and result in infertility. This is the most common ST!; the highest prevalence is among sexually active adolescent girls. Now, urine chlamydia testing using nucleic acid amplification tests (NAAT) is a noninvasive method to screen. Use a single urine specimen to detect both pregnancy and chlamydia
A)chlamydia
B)Gonorrhea

A

300

S: Variable: vaginal discharge, dysuria, abnormal uterine bleeding, abscess in Bartholin's or Skene's glands; the majority of cases are asymptomatic.

0: Often no signs are apparent. May have purulent vaginal discharge. Diagnose by positive culture of organism. If the condition is untreated, it may progress to acute salpingitis, PlD.

A)Gonorrhea
B)calmidyia

A

301

Uterine Enlargement

,

302

Obviously a normal condition, pregnancy is included here for comparison.

S: Amenorrhea, fatigue, breast engorgement, nausea, change in food tolerance, weight gain.

0 : Early signs: cyanosis of vaginal mucosa and cervix (Chadwick sign). Palpation-soft consistency of cervix, enlarging uterus with compressible fundus and isthmus (Hegar sign at 10 to 12 weeks).

A)pregnancy
B)mayoas

A

303

S: Varies, depending on size and location. Often no symptoms. When symptoms do occur, include vague discomfort, bloating, heaviness, pelvic pressure, dyspareunia, urinary frequency, backache, or hypermenorrhea if myoma disturbs endometrium.

0: Uterus irregularly enlarged, firm, mobile, and nodular with hard, painless nodules in the uterine wall. Heavy bleeding produces anemia.

A)Myomas (Leiomyomas, Uterine Fibroids)
B)carcinoma

A

304

They are usually benign. Highest incidence between the ages of 30 and 45 years and in Blacks. Myomas are estrogen dependent; after menopause, the lesions usually regress but do not disappear. Surgery may be indicated.
A)Myomas (Leiomyomas, Uterine Fibroids)
B)Carcinoma of the Endometrium

A

305

S: Abnormal and intermenstrual bleeding before menopause; postmenopausal bleeding or mucosanguineous discharge. Pain and weight loss occur late in the disease.

0: Uterus may be enlarged.

A)Carcinoma of the Endometrium
B)herpes

A

306

The Pap smear is rarely effective in detecting endometrial cancer. Women with abnormal vaginal bleeding or at high risk should have an endometrial tissue sample. Risk factors for endometrial cancer are early menarche, late menopause, history of infertility, failure to ovulate, tamoxifen, unopposed estrogen therapy (which continually stimulates the endometrium, causing hyperplasia), and obesity (which increases endogenous estrogen).
A)Carcinoma of the Endometrium
B)Endometriosis

A

307

S: Cyclic or chronic pelvic pain, occurring as dysmenorrhea, or dyspareunia, low backache. Also may have irregular uterine bleeding or hypermenorrhea or may be asymptomatic.

0: Uterus fixed, tender to movement. Small, firm nodular masses tender to palpation on posterior aspect of fundus, uterosacral ligaments, ovaries, sigmoid colon. Ovaries often enlarged.

A)Carcinoma of the Endometrium
B)Endometriosis

B

308

Masses are aberrant growths of endometrial tissue scattered throughout pelvis, probably as a result of transplantation of tissue by retrograde menstruation. Ectopic tissue responds to hormone stimulation; builds up between periods, sloughs during menstruation. May cause infertility from pelvic adhesions, tubal obstruction, decreased ovarian function.

A)Carcinoma of the Endometrium
B)Endometriosis

B

309

Adnexal Enlargement

,

310

S: Sudden fever >38° C or 100.4° F, suprapubic pain and tenderness.

0: Acute-rigid, boardlike lower abdominal musculature. May have purulent discharge from cervix. Movement of uterus and cervix causes intense pain. Pain in lateral fornices and adnexa. Bilateral adnexal masses difficult to palpate because of pain and muscle spasm. Chronicbilateral, tender, fixed adnexal masses

A)Fallopian Tube Mass-Acute Salpingitis {Pelvic Inflammatory Disease [PID])
B)Fallopian Tube Mass-Ectopic Pregnancy

A

311

S: Amenorrhea or irregular vaginal bleeding, pelvic pain.

0 : Softening of cervix and fundus; movement of cervix and uterus causes pain; palpable tender pelvic mass, which is solid, mobile, unilateral

A)Fallopian Tube Mass-Ectopic Pregnancy
B)Fluctuant Ovarian Mass-Ovarian Cyst

A

312

This has potential for serious sequelae; seek gynecologic consultation immediately, before the mass ruptures or shows signs of acute peritonitis
A)Fallopian Tube Mass-Ectopic Pregnancy
B)Fluctuant Ovarian Mass-Ovarian Cyst

A

313

S: Usually asymptomatic.

0 : Smooth, round, fluctuant, mobile, nontender mass on ovary. Some cysts resolve spontaneously within 60 days but must be followed closely.

A)Fluctuant Ovarian Mass-Ovarian Cyst
B)Solid Ovarian Mass-Ovarian Cancer

A

314

S: May have abdominal pain, pelvic pain, increased abdominal size, bloating, or nonspecific GI symptoms or may be asymptomatic.

0: Physical examination is not sensitive for ovarian mass but may palpate solid tumor on ovary. Heavy, solid, fixed, poorly defined mass suggests malignancy; benign mass may feel mobile and solid.

A)Solid Ovarian Mass-Ovarian Cancer
B)herpes

A

315

Biopsy necessary to distinguish the two types of masses. The Pap smear does not detect ovarian cancer. Screening with serum CA 125 test is done but is not specific. Annual transvaginal ultrasonography may detect at an earlier stage in women at high risk for ovarian cancer.
A)Solid Ovarian Mass-Ovarian Cancer
B)herpes

A

316

Abnormalities in Pediatric Genitalia

,

317

Female pseudohermaphroditism is a congenital anomaly resulting from hyperplasia of the adrenal glands, which exposes the female fetus to excess amounts of androgens. This causes masculinized e>.:ternal genitalia, here shown as enlargement of the clitoris and fusion of the labia. Ambiguous means the enlarged clitoris here may look like a small penis with hypospadias, and the fused labia look like an incompletely formed scrotum with absent testes. Other forms of intersexual conditions occur, and the family must be referred for diagnostic evaluation.
A)Ambiguous Genitalia
B)Vulvovaginitis

A

318

This infection is caused by Candida albicnns in a diabetic child. Symptoms include pruritus and burning when urine touches excoriated area. Examination shows red, shiny, edematous vulva; vaginal discharge; excoriated area from scratching
A)Vulvovaginitis in Child
B)false

A

319

Other, more common causes of vulvovaginitis in the prepubertal child include infection from a respiratory or bowel pathogen, sexually transmitted infection, or presence of a foreign body.
A)Vulvovaginitis in Child
B)false

A

320

Summary Checklist: Female Genitalia Examination

,

321

1. Inspect external genitalia.
2. Palpate labia, Skene's and Bartho- study.
3. Using vaginal speculum, inspect cervix, uterus, adnexa. cervix and vagina.
4. Obtain specimens for cytologic
5. Perform bimanual examination
6. Perform rectovaginal examination.
7. Test stool for occult blood. lin's glands. :

True

322

Use this technique to assess the rectovaginal septum, posterior uterine wall, culde-sac, and rectum. Change gloves to avoid spreading any possible infection. Lubricate the first two fingers. Instruct the woman that this may feel uncomfortable and will mimic the feeling of moving her bowels. Ask her to bear down as you insert your index finger into the vagina and your middle finger gently into the rectum.
A)true
B)false

A

323

EXTRA INFORMATION

,

324

The perineum is the area between the vaginal introitus and the rectum
A)true
B)false

A

325

A female patient has a history of multiple sexual partners, which puts her in the high-risk group for developing HPV and cervical cancer. What should the nurse recommend to this patient to help prevent these problems? Select all that apply.

Select all that apply:
A
Consistent use of condoms
B
Hormonal contraceptives
C
Monogamy
D
Prophylactic antibiotics
E
Abstinence

A C E

326

The anterior pituitary secretes which of the following hormones? Select all that apply.

Select all that apply:
A
Prolactin-inhibiting factor (PIF)
B
Luteinizing hormone (LH)
C
Gonadotropin-releasing hormones (GnRH)
D
Luteinizing-releasing hormones (LnRH)
E
Estrogen
F
Follicle-stimulating hormone (FSH)

B F

327

The uterus, which lies between the bladder and the rectum, is also commonly known as the "womb."

Choose one of the following
A
True
B
False

A

328

Contraceptive use is different than practicing "safe sex." The only 100% safe-sex practice is abstinence.
A)true
B)false

A

329

When collecting subjective data, the nurse knows that assessment of the female patient can be very invasive. Starting with questions relating to health history allows the nurse to do what?

Choose one of the following
A
Assess for sexual satisfaction
B
Gain the patient's confidence
C
Get an idea of the patient's lifestyle
D
Prepare for the next question

B

330

A mother brings her 13-year-old daughter to the clinic to be vaccinated against the human papillomavirus (HPV). Once the girl receives the first dose, the nurse tells the mother to bring her back when?

Choose one of the following
A
2 months
B
8 months
C
6 months
D
4 months

A

331

Recommendations are to give quadrivalent HPV (types 6, 11, 16, 18) recombinant vaccine to females aged 9 to 26 years in three doses: the second dose 2 months after the first, and the third dose 6 months after the first.
A)true
B)false

A

332

Menopause is defined as 12 consecutive months without menses.
A)true
B)false

A

333

A 24-year-old woman presents to the ED with severe lower abdominal pain. In this case, the nurse should ask questions pertaining only to the patient's immediate condition.

Choose one of the following
A
True
B
False

A

334

Menses usually follows approximately 6 to 8 months after breast budding.

Choose one of the following
A
True
B
False

B

335

The onset of menses follows breast budding by approximately 2 to 3 years.
A)true
B)false

A

336

A mother brings her 15-year-old daughter to the clinic. The mother is worried that her daughter is sexually active. When assessing the adolescent, it is vital for the nurse to do what?

Choose one of the following
A
Establish a trusting and confidential relationship with the patient
B
Do a vaginal examination to see if the daughter has been sexually active
C
Perform a pregnancy test
D
Question the patient with the parent present

A

337

A 44-year-old woman comes to the clinic. She thinks she is menopausal. Her symptoms are irregular periods, hot flashes, mood swings, and decreased sexual drive. Menopause is the absence of menstrual periods for at least 12 months, so the nurse suspects that this condition is what?

Choose one of the following
A
Decreased libido
B
Dysuria
C
Perimenopause
D
HSV 1

C

338

A 33-year-old woman is being evaluated by the nurse. When obtaining an obstetrical history from this woman, which of the following questions may the nurse omit?

Choose one of the following
A
Did you give birth vaginally or by cesarean section?
B
Have you ever had an abortion?
C
Have you ever been pregnant?
D
When was your first period?

D

339

In the female patient, the tube of muscular tissue that extends from the vaginal introitus to the uterus is called what?

Choose one of the following
A
Vagina
B
Clitoris
C
Mons pubis
D
Vesicovaginal septum

A

340

Of the estimated 15 million new cases of sexually transmitted infections (STIs) that are reported every year, how many occur in adolescents?

Choose one of the following
A
2 million
B
8 million
C
6 million
D
4 million

D

341

A 41-year-old woman is considering the use of hormonal contraceptives. What is contraindicated in this patient?

Choose one of the following
A
Driving
B
Operating heavy machinery
C
Alcohol
D
Smoking

D

342

All of the following are risk factors for STIs except?

Choose one of the following
A
Being in a monogamous sexual relationship
B
Engaging in unprotected sex
C
Having multiple sexual partners
D
Age 15 to 24 years

A

343

An African American woman brings her 10-year-old daughter to the clinic for evaluation. The mother is concerned because her daughter has started puberty already. The nurse advises the family that African American girls may begin puberty before what age?

Choose one of the following
A
7
B
6
C
5
D
8

D

344

The fallopian tubes transport ova from the ovaries to the uterus.

Choose one of the following
A
True
B
False

A

345

the most common STI in the U.S is chlamydia
A)true
B)false

A

346

cessations of menses is known as menopause
A)true
B)false

A

347

inflammation of the Fallopian tube is called salpingitis
A)true
B)false

a

348

a deep recess formed by the peritoneum between the rectum and the cervix is called
A)rectouterine
B)flaase

a

349

a caruncle is a small,, deep red mass protruding frrom the urinary meatus
A)true
B)false

a

350

adnexa are uterine accessory orggans
A)true
B)false

A

351

dysmenorrhea is pain associated with menstruation
A)true
B)false

A

352

Vaginal lubrication during intercourse is produced by
A)bartholin glands
B)skene glands

A

353

the first signs of puberty in girls is
A)breasts and pubic hair development
B)false

A

354

Decreased estrogen levels during menopause cause
A)the ovaries to atrophy
B)the cervix to enlarge and turn blue

A

355

Adnexa is a accessory organs of the uterus (i.e., ovaries and fallopian tubes)
A)true
B)false

A

356

Bartholin's glands are vestibular glands, located on either side of the vaginal orifice, that secrete a clear lubricating mucus during intercourse.
A)true
B)false

A

357

Bloody show is a dislodging of thick cervical mucus plug at end of pregnancy, which is a
sign of beginning of labor
A)true
B)false

A

358

Caruncle is a small, deep red mass protruding from urethral meatus, usually due to urethritis
A)true
B)false

A

359

Chadwick sign is a bluish discoloration of cervix that occurs normally in pregnancy at 6 to 8 weeks' gestation
A)true
B)false

A

360

Clitoris is a small, elongated erectile tissue in the female, located at anterior juncture of labia minora
A)true
B)false

A

361

Endometriosis is a aberrant growths of endometrial tissue scattered throughout pelvis
A)true
B)false

A

362

Hegar sign.is softening of cervix that is a sign of pregnancy,occurring at 10 to 12weeks' gestation
A)true
B)false

A

363

Menorrhagia is excessively heavy menstrual flow
A)true
B)false

A

364

Papanicolaou test is a painless test used to detect cervical cancer.
A)true
B)false

A

365

Rectouterine pouch is a (cul-de-sac of Douglas) deep recess formed by the peritoneum between the rectum and cervix
A)true
B)false

A

366

Skene's glands .are also called paraurethral glands
A)true
B)false

A

367

Vaginal lubrication is provided during intercourse by:
a. thelabiaminora.
b. sebaceous follicles.
c. Skene's glands.
d. Bartholin's glands.

D

368

2. A young woman has come for her first gynecologic examination. Because she has not had any children, the examiner would expect the cervical os to appear:
a. smooth and circular.
b. irregular and slitlike.
c. irregular and circular.
d. smooth and enlarged.

A

369

A woman has come for an examination because of a missed menstrual period and a positive home pregnancy test. Examination reveals a cervix that appears cyanotic. This is referred to as:
a. Goodell sign.
b. Hegar sign.
c. Tanner sign.
d. Chadwick sign.

D

370

4. During the examination of the genitalia of a 70-year-old woman, a normal finding would be:
a. hypertrophy of the mons pubis.
b. increase in vaginal secretions.
c. thin and sparse pubic hair.
d. bladder prolapse.

C

371

For a woman, history of her mother's health during pregnancy is important. A medication that requires frequent follow-up is:
a. corticosteroid.
b. theophylline.
c. diethylstilbestrol.
d. aminoglycoside.

C

372

6. A woman has come for health care complaining of a thick, white discharge with intense itching. These symptoms are suggestive of:
a. atrophic vaginitis.
b. trichomoniasis.
c. chlamydia.
d. candidiasis.
.

D

373

7. To prepare the vaginal speculum for insertion, the examiner:
a. lubricates it with a water-soluble lubricant. b. lubricates it with petrolatum.
c. warms it under the light, then inserts it
into the vagina.
d. lubricates it with warm water.

D

374

8. To insert the speculum as comfortably as possible, the examiner:
a. opens the speculum slightly and inserts in an upward direction.
b. presses the introitus down with one hand and inserts the blades obliquely with
the other.
c. spreads the labia with one hand, inserts the closed speculum horizontally with the other.
d. pushes down on the introitus and inserts the speculum in an upward direction.

B

375

9. Before withdrawing the speculum, the examiner swabs the cervix with a swab soaked in acetic acid. This examination is done to assess for:
a. herpes simplex virus.
b. contact dermatitis.
c. human papillomavirus.
d. carcinoma

C

376

Select the best description of the uterus.
a. anteverted, round asymmetric organ
b. pear-shaped, thick-walled organ flattened
anteroposteriorly
c. retroverted, almond-shaped asymmetric
organ
d. midposition, thick-walled oval organ

B

377

11. In placing a finger on either side of the cervix and moving it side to side, you are assessing:
a. the diameter of the fallopian tube.
b. cervical motion tenderness.
c. the ovaries.
d. the uterus.

B

378

12. Which of the following is (are) normal, common finding(s) on inspection and palpation of the vulva and perineum?
a. labia majora that are wide apart and gaping
b. palpable Bartholin's glands
c. clear, thin discharge from paraurethral
glands
d. bulging at introitus during Valsalva
maneuver

A

379

13. Which of the following is the most common bacterial sexually transmitted infection in the United States?
a. chlamydia
b. gonorrhea
c. trichomoniasis
d. syphilis
e. bacterial vaginosis

A

380

What does the notation in a health record indicating the patient is a "G2 P3 AbO" mean?
a. The woman has delivered 3 children, 2 of whom are living; her blood type is Ab 0.
b. The woman has been pregnant twice with 3 children (twins and another child), and all her children are living.
c. The woman has been pregnant 3 times, has delivered 2 children, and had no abortions.
d. The woman has been pregnant 3 times, has 2 living children, and had no spontaneous abortions.

B

381

What problems are associated with smoking and the use of oral contraceptives?
a. increased risk of alcoholism and cirrhosis oftheliver
b. thrombophlebitis and pulmonary emboli
c. infertility and weight gain
d. urinary tract infections and skin cancer

B