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Chapter 57: Management of Patients with Female ReproductiveDisorders While taking a health history on a 20-year-old female patient, the nurse ascertains thtaking miconazole (Monistat). The nurse is justified in presuming that this patient hasat this patient is what medical condition? A) Bacterial va...

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TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Chapter57:ManagementofPatientswithFemaleReproductive Disorders  1.

Whiletakingahealthhistoryona20-year-oldfemalepatient,thenurseascertainsthatthispatientis takingmiconazole(Monistat).Thenurseisjustifiedinpresumingthatthispatienthaswhatmedical condition?

A)

Bacterialvaginosis

B)

Humanpapillomavirus(HPV)

C)

Candidiasis

D)

Toxicshocksyndrome(TSS)

Ans:

C Feedback: CandidiasisisafungaloryeastinfectioncausedbystrainsofCandida.Miconazole(Monistat)isan antifungalmedicationusedinthetreatmentofcandidiasis.Thisagentisinsertedintothevaginawithan applicatoratbedtimeandmaybeappliedtothevulvarareaforpruritus.HPV,bacterialvaginosis,and TSSarenottreatedbyMonistat.

2.

Apatientwithgenitalherpesishavinganacuteexacerbation.Whatmedicationwouldthenurseexpect tobeorderedtosuppressthesymptomsandshortenthecourseoftheinfection?

A)

Clotrimazole(Gyne-Lotrimin)

B)

Metronidazole(Flagyl)

C)

Podophyllin(Podofin)

D)

Acyclovir(Zovirax)

Ans:

D Feedback: Acyclovir(Zovirax)isanantiviralagentthatcansuppressthesymptomsofgenitalherpesandshorten thecourseoftheinfection.Itiseffectiveatreducingthedurationoflesionsandpreventingrecurrences. Clotrimazoleisusedinthetreatmentofyeastinfections.Metronidazoleisthemosteffectivetreatment fortrichomoniasis.Posophyllinisusedtotreatexternalgenitalwarts.Acyclovirisusedinthetreatment ofgenitalherpes.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

3.

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Apatientwithtrichomoniasiscomestothewalk-inclinic.Indevelopingacareplanforthispatientthe nursewouldknowtoincludewhatasanimportantaspectoftreatingthispatient?

A)

Bothpartnerswillbetreatedwithmetronidazole(Flagyl).

B)

Constipationandmenstrualdifficultiesmayoccur.

C)

ThepatientshouldperformKegelexercises30to80timesdaily.

D)

Carewillinvolvehormonetherapytocontrolthepain.

Ans:

A Feedback: Themosteffectivetreatmentfortrichomoniasisismetronidazole(Flagyl).Bothpartnersreceiveaonetimeloadingdoseorasmallerdosethreetimesadayfor1week.Inpelvicinflammatorydisease, menstrualdifficultiesandconstipationmayoccur.Kegelexercisesareprescribedtohelpstrengthen weakenedmusclesassociatedwithcystoceleandotherstructuraldeficits.Hormonetherapydoesnot addresstheetiologyoftrichomoniasis.

4.

AstudentnurseisdoingclinicalhoursatanOB/GYNclinic.Thestudentishelpingtodevelopaplanof careforapatientwithgonorrheawhohaspresentedattheclinic.Thestudentshouldincludewhichof thefollowinginthecareplanforthispatient?

A)

Thepatientmaybenefitfromoralcontraceptives.

B)

Thepatientmustavoiduseoftampons.

C)

Thepatientissusceptibletourinaryincontinence.

D)

Thepatientshouldalsobetreatedforchlamydia.

Ans:

D Feedback: Becauseofthehighincidenceofcoinfectionwithchlamydiaandgonorrhea,thepatientshouldalsobe treatedforchlamydia.Avoidingtheuseoftamponsispartoftheself-caremanagementofapatientwith possibletoxicshocksyndrome(TSS).Thepatientisnotsusceptibletoincontinenceandthereisno indicationfortheuseoforalcontraceptives.

5.

Whenteachingpatientsabouttheriskfactorsofcervicalcancer,whatwouldthenurseidentifyasthe mostimportantriskfactor?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Latechildbearing

B)

Humanpapillomavirus(HPV)

C)

Postmenopausalbleeding

D)

Tobaccouse

Ans:

B

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Feedback: HPVisthemostsalientriskfactorforcervicalcancer,exceedingtherisksposedbysmoking,late childbearing,andpostmenopausalbleeding. 6.

Thenurseisprovidingpreoperativeeducationforapatientdiagnosedwithendometriosis.A hysterectomyhasbeenscheduled.Whateducationtopicshouldthenursebesuretoincludeforthis patient?

A)

Menstrualperiodswillcontinuetooccurforseveralmonths,someofthemheavy.

B)

Normalactivitywillbepermittedwithin48hoursfollowingsurgery.

C)

Afterahysterectomy,hormonelevelsremainlargelyunaffected.

D)

Thebladdermustbeemptiedpriortosurgeryandacathetermaybeplacedduringsurgery.

Ans:

D Feedback: TheintestinaltractandthebladderneedtobeemptybeforethepatientistakentotheORtoprevent contaminationandinjurytothebladderorintestinaltract.Thepatientisinformedthatherperiodsare nowover,butshemayhaveaslightlybloodydischargeforafewdays.Thepatientisinstructedtoavoid straining,lifting,ordrivinguntilhersurgeonpermitshertoresumetheseactivities.Thepatients hormonalbalanceisupset,whichusuallyoccursinreproductivesystemdisturbances.Thepatientmay experiencedepressionandheightenedemotionalsensitivitytopeopleandsituations.

7.

Apatienthasreturnedtothepost-surgicalunitaftervulvarsurgery.Whatinterventionshouldthenurse prioritizeduringtheinitialpostoperativeperiod?

A)

PlacingthepatientinhighFowlersposition

B)

Administeringsitzbathsevery4hours

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

C)

Monitoringtheintegrityofthesurgicalsite

D)

Avoidinganalgesicsunlessthepatientspainisunbearable

Ans:

C

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Feedback: Animportantinterventionforthepatientwhohasundergonevulvarsurgeryistomonitorcloselyfor signsofinfectioninthesurgicalsite,suchasredness,purulentdrainage,andfever.Thepatientshould beplacedinlowFowlerspositiontoreducepainbyrelievingtensionontheincision.Sitzbathsare discouragedafterofwideexcisionofthevulvabecauseoftheriskofinfection.Analgesicsshouldbe administeredpreventivelyonascheduledbasistorelievepainandincreasethepatientscomfortlevel. 8.

Apatientcomestothefreecliniccomplainingofagray-whitedischargethatclingstoherexternalvulva andvaginalwalls.AnursepractitionerassessesthepatientanddiagnosesGardnerellavaginalis.What wouldbethemostappropriatenursingactionatthistime?

A)

Advisethepatientthatthisisanovergrowthofnormalvaginalflora.

B)

Discusstheeffectofthisdiagnosisonthepatientsfertility.

C)

Documentthevaginaldischargeasnormal.

D)

Administeracyclovirasordered.

Ans:

A Feedback: Gray-whitedischargethatclingstotheexternalvulvaandvaginalwallsisindicativeofanovergrowth ofGardnerellavaginalis.Thepatientsdischargeisnotanormalassessmentfinding.Antiviral medicationsareineffectivebecauseofthebacterialetiology.Thisdiagnosisisunlikelytohavealongtermbearingonthepatientsfertility.

9.

AfemalepatientwithHIVhasjustbeendiagnosedwithcondylomataacuminata(genitalwarts).What informationismostappropriateforthenursetotellthispatient?

A)

Thisconditionputsheratahigherriskforcervicalcancer;therefore,sheshouldhavea Papanicolaou(Pap)testannually.

B)

Themostcommontreatmentismetronidazole(Flagyl),whichshoulderadicatetheproblemwithin 7to10days.

C)

Thepotentialfortransmissiontohersexualpartnerwillbeeliminatedifcondomsareusedevery timetheyhavesexualintercourse.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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D)

Thehumanpapillomavirus(HPV),whichcausescondylomataacuminata,cannotbetransmitted duringoralsex.

Ans:

A Feedback: HIV-positivewomenhaveahigherrateofHPV.InfectionswithHPVandHIVtogetherincreasetherisk ofmalignanttransformationandcervicalcancer.Thus,womenwithHIVinfectionshouldhavefrequent Papsmears.Becausecondylomataacuminataisavirus,thereisnopermanentcure.Because condylomataacuminatacanoccuronthevulva,acondomwillnotprotectsexualpartners.HPVcanbe transmittedtootherpartsofthebody,suchasthemouth,oropharynx,andlarynx.

10. Thenurseisteachingapatientpreventativemeasuresregardingvaginalinfections.Thenurseshould includewhichofthefollowingasanimportantriskfactor? A)

Highestrogenlevels

B)

Latemenarche

C)

Nonpregnantstate

D)

Frequentdouching

Ans:

D Feedback: Riskfactorsassociatedwithvulvovaginalinfectionsincludepregnancy,premenarche,lowestrogen levels,andfrequentdouching.

11. Anurseiscaringforapregnantpatientwithactiveherpes.Theteachingplanforthispatientshould includewhichofthefollowing? A)

Babiesdeliveredvaginallymaybecomeinfectedwiththevirus.

B)

Recommendedtreatmentisexcisionoftheherpeslesions.

C)

Paingenerallydoesnotoccurwithaherpesoutbreakduringpregnancy.

D)

Pregnancymayexacerbatethemotherssymptoms,butposesnorisktotheinfant.

Ans:

A

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Feedback: Inpregnantwomenwithactiveherpes,babiesdeliveredvaginallymaybecomeinfectedwiththevirus. Thereisariskforfetalmorbidityandmortalityifthisoccurs.Lesionsarenotcontrolledwithexcision. Itchingandpainaccompanytheprocessastheinfectedareabecomesredandswollen.Aspirinandother analgesicsareusuallyeffectiveincontrollingthepain. 12. Apatientwithovariancancerisadmittedtothehospitalforsurgeryandthenurseiscompletingthe patientshealthhistory.Whatclinicalmanifestationwouldthenurseexpecttoassess? A)

Fish-likevaginalodor

B)

Increasedabdominalgirth

C)

Feverandchills

D)

Lowerabdominalpelvicpain

Ans:

B Feedback: Clinicalmanifestationsofovariancancerincludeenlargementoftheabdomenfromanaccumulationof fluid.Flatulenceandfeelingfullafteralightmealaresignificantsymptoms.Inbacterialvaginosis,a fish-likeodor,whichisnoticeableaftersexualintercourseorduringmenstruation,occursasaresultofa riseinthevaginalpH.Fever,chills,andabdominalpelvicpainareatypical.

13. A30-year-oldpatienthascometotheclinicforheryearlyexamination.Thepatientasksthenurseabout ovariancancer.Whatshouldthenursestatewhendescribingriskfactorsforovariancancer? A)

Useoforalcontraceptivesincreasestheriskofovariancancer.

B)

Mostcasesofovariancancerareattributedtotobaccouse.

C)

Mostcasesofovariancancerareconsideredtoberandom,withnoobviouscausation.

D)

Themajorityofwomenwhogetovariancancerhaveafamilyhistoryofthedisease.

Ans:

C Feedback: Mostcasesofovariancancerarerandom,withonly5%to10%ofovariancancershavingafamilial connection.Contraceptivesandtobaccohavenotbeenidentifiedasmajorriskfactors.

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14. Astudentnurseiscaringforapatientwhohasundergoneawideexcisionofthevulva.Thestudent shouldknowthatwhatactioniscontraindicatedintheimmediatepostoperativeperiod? A)

PlacingpatientinlowFowlersposition

B)

Applicationofcompressionstockings

C)

Ambulationtoachair

D)

Provisionofalow-residuediet

Ans:

C Feedback: Sittinginachairwouldnotberecommendedimmediatelyinthepostoperativeperiod.Thiswouldplace toomuchtensionontheincisionsite.AlowFowlerspositionor,occasionally,apillowplacedunderthe knees,willreducepainbyrelievingtensionontheincision.Applicationofcompressionstockingwould preventadeepveinthrombosisfromoccurring.Alow-residuedietwouldbeorderedtopreventstraining ondefecationandwoundcontamination.

15. Afemalepatienttellsthenursethatshethinksshehasavaginalinfectionbecauseshehasnoted inflammationofhervulvaandthepresenceofafrothy,yellow-greendischarge.Thenurserecognizes thattheclinicalmanifestationsdescribedaretypicalofwhatvaginalinfection? A)

Trichomonasvaginalis

B)

Candidiasis

C)

Gardnerella

D)

Gonorrhea

Ans:

A Feedback: TheclinicalmanifestationsindicateT.vaginalis,whichistreatedwithmetronidazoleintheformoforal tablets.Candidiasisproducesawhite,cheese-likedischarge.Gardnerellaischaracterizedbygray-white toyellow-whitedischargeclingingtoexternalvulvaandvaginalwalls.Gonorrheaoftenproducesno symptoms.

16. Thenursenotesthatapatienthasahistoryoffibroidsandisawarethatthistermreferstoabenign tumoroftheuterus.Whatisamoreappropriatetermforafibroid? A)

Bartholinscyst

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

B)

Dermoidcyst

C)

Hydatidiformmole

D)

Leiomyoma

Ans:

D

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Feedback: Aleiomyomaisausuallybenigntumoroftheuterus,commonlyreferredtoasafibroid.ABartholins cystisacystinapairedvestibularbandinthevulva,whereasadermoidcystisabenigntumorthatis thoughttoarisefrompartsoftheovumandnormallydisappearswithmaturation.Ahydatidiformmole isatypeofgestationalneoplasm. 17. Anursepractitionerisexaminingapatientwhopresentedatthefreeclinicwithvulvarpruritus.For whichassessmentfindingwouldthepractitionerlookthatmayindicatethepatienthasaninfection causedbyCandidaalbicans? A)

Cottagecheese-likedischarge

B)

Yellow-greendischarge

C)

Gray-whitedischarge

D)

Waterydischargewithafishyodor

Ans:

A Feedback: ThesymptomsofC.albicansincludeitchingandascantwhitedischargethathastheconsistencyof cottagecheese.Yellow-greendischargeisasignofT.vaginalis.Gray-whitedischargeandafishyodor aresignsofG.vaginalis.

18. Thenurseisplanninghealtheducationforapatientwhohasexperiencedavaginalinfection.What guidelinesshouldthenurseincludeinthisprogramregardingprevention? A)

Weartight-fittingsyntheticunderwear.

B)

Usebubblebathtoeradicateperinealbacteria.

C)

Avoidfemininehygieneproducts,suchassprays.

D)

Restrictdailybathing.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

Ans:

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C Feedback: Insteadoftight-fittingsynthetic,nonabsorbent,heat-retainingunderwear,cottonunderwearis recommendedtopreventvaginalinfections.Douchingisgenerallydiscouraged,asistheuseoffeminine hygieneproducts.Dailybathingisnotrestricted.

19. Apatienthasherpessimplex2viralinfection(HSV2).Thenurserecognizesthatwhichofthefollowing shouldbeincludedinteachingthepatient? A)

Theviruscausescoldsoresofthelips.

B)

Thevirusmaybecuredwithantibiotics.

C)

Thevirus,whenactive,maynotbecontractedduringintercourse.

D)

Treatmentisaimedatrelievingsymptoms.

Ans:

D Feedback: HSV-2causesgenitalherpesandisknowntoascendtheperipheralsensorynervesandremaininactive afterinfection,becomingactiveintimesofstress.Thevirusisnotcurable,buttreatmentisaimedat controllingsymptoms.HSV1causescoldsores,andvaricellazostercausesshingles.

20. Youarecaringforapatientwhohasbeendiagnosedwithgenitalherpes.Whenpreparingateaching planforthispatient,whatgeneralguidelinesshouldbetaught? A)

Thoroughhandwashingisessential.

B)

Sunbathingassistsineradicatingthevirus.

C)

Lesionsshouldbemassagedwithointment.

D)

Self-infectioncannotoccurfromtouchinglesionsduringabreakout.

Ans:

A Feedback: Theriskofreinfectionandspreadofinfectiontoothersortootherstructuresofthebodycanbereduced byhandwashing,useofbarriermethodswithsexualcontact,andadherencetoprescribedmedication

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

1083

regimens.Thelesionsshouldbeallowedtodry.Touchingoflesionsduringanoutbreakshouldbe avoided;iftouched,appropriatehygienepracticesmustbefollowed. 21. Apatientcomestothecliniccomplainingofatender,inflamedvulva.Testingdoesnotrevealthe presenceofanyknowncausativemicroorganism.Whataspectofthispatientscurrenthealthstatusmay accountforthepatientssymptomsofvulvitis? A)

Thepatientismorbidlyobese.

B)

Thepatienthastype1diabetes.

C)

Thepatienthaschronickidneydisease.

D)

Thepatienthasnumerousallergies.

Ans:

B Feedback: Vulvitis,aninflammationofthevulva,mayoccurasaresultofotherdisorders,suchasdiabetes, dermatologicproblems,orpoorhygiene.Obesity,kidneydisease,andallergiesarelesslikelycauses thandiabetes.

22. A14-year-oldisbroughttotheclinicbyhermother.Themotherexplainstothenursethatherdaughter hasjuststartedusingtampons,butisnotyetsexuallyactive.ThemotherstatesIamveryconcerned becausemydaughterishavingalotofstabbingpainandburning.Whatmightthenursesuspectisthe problemwiththe14-year-old? A)

Vulvitis

B)

Vulvodynia

C)

Vaginitis

D)

Bartholinscyst

Ans:

B Feedback: Vulvodyniaisachronicvulvarpainsyndrome.Symptomsmayincludeburning,stinging,irritation,or stabbingpainand...