Chapter 11: Structural Disorders and Neoplasms of the Reproductive System
MULTIPLE CHOICE
1. The nurse should be aware that a pessary is most effective in the treatment of which
disorder?
a. Cystocele
b. Uterine prolapse
c. Rectocele
d. Stress urinary incontinence
ANS: B
A fitted pessary may be inserted into the vagina to support the uterus and hold it in the
correct position. Usually a pessary is used for only a short time and is not used for the client
with a cystocele. A rectocele cannot be corrected using a pessary. A pessary is not likely the
most effective treatment for stress incontinence.
PTS: 1 DIF: Cognitive Level: Remember
TOP: Nursing Process: Diagnosis
MSC: Client Needs: Health Promotion and Maintenance
2. A postmenopausal woman has been diagnosed with two leiomyomas (fibroids). Which
clinical finding is most commonly associated with the presence of leiomyomas?
a. Abnormal uterine bleeding
b. Diarrhea NURSINGTB.COM
c. Weight loss
d. Acute abdominal pain
ANS: A
Most women are asymptomatic. Abnormal uterine bleeding is the most common symptom
of leiomyomas. Diarrhea is not commonly associated with leiomyomas. Weight loss does
not usually occur in the woman with leiomyomas, and the client with leiomyomas is
unlikely to experience abdominal pain.
PTS: 1 DIF: Cognitive Level: Applying
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
3. Which woman is at the greatest risk for psychologic complications after hysterectomy?
a. 55-year-old woman who has been having abnormal bleeding and pain for 3 years
b. 46-year-old woman who has had three children and has just been promoted at work
c. 62-year-old widow who has three friends who have had uncomplicated
hysterectomies
d. 19-year-old woman who had a ruptured uterus after giving birth to her first child
ANS: D
, The 19-year-old woman is still in her childbearing years. Often the uterus is related to
self-concept in women in this age group, and they may feel that sexual functioning is related
to having a uterus. The 55-year-old woman is past her childbearing years and has had
bleeding and pain for 3 years. The hysterectomy may be well received as a method of pain
relief. The 46-year-old woman has a family and positive event occurring in her life (job
promotion). The 62-year-old woman is past her reproductive years and has relationships
with others who have had positive outcomes.
PTS: 1 DIF: Cognitive Level: Analyzing
TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity
4. A 48-year-old woman has just had a hysterectomy for endometrial cancer. Which statement
alerts the nurse that further teaching is needed?
a. “I can’t wait to go on the cruise that I have planned for this summer.”
b. “I know that the surgery saved my life, but I will miss having sexual intercourse
with my husband.”
c. “I have asked my daughter to come and stay with me next week after I am
discharged from the hospital.”
d. “Well, I don’t have to worry about getting pregnant anymore.”
ANS: B
Stating that she will miss having sexual intercourse with her husband indicates that further
teaching is needed for this client regarding sexual activities after a hysterectomy. Although
intercourse may be initially uncomfortable, the use of water-soluble lubricants, relaxation
exercises, and changes in position may be helpful. Expressing plans for a vacation is a
positive psychologic state with plans for the future. Stating that her daughter will stay with
her indicates the client undN
erU
staRnS
dsItN
haGt T
shB
e.mC
ayOnMeed assistance during her acute recovery
period. Stating that she no longer needs to worry about getting pregnant indicates
knowledge related to the reproductive cycle and a positive outlook.
PTS: 1 DIF: Cognitive Level: Evaluating
TOP: Nursing Process: Evaluation
MSC: Client Needs: Health Promotion and Maintenance
5. Considering the treatment plan for a pregnant woman with gynecologic cancer, which
statement about timing or type of treatment is correct?
a. The fetus is most at risk during the first trimester.
b. The fetus is most at risk during the second trimester.
c. The fetus is most at risk during the third trimester.
d. Surgery is riskier than chemotherapy in the first trimester.
ANS: A
The first trimester is the most vulnerable period for the growing fetus. Women may be faced
with deciding about terminating the pregnancy, depending on the stage and extent of the
disease. For advanced disease in the second trimester, alkylating agents, 5-fluorouracil
(5-FU), and vincristine are relatively safe for the fetus. For advanced disease in the third
trimester, alkylating agents, 5-FU, and vincristine are relatively safe for the fetus. Surgery is
less risky than chemotherapy in the first trimester.
PTS: 1 DIF: Cognitive Level: Apply
, TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
6. Which precaution should the nurse take while caring for a client who is undergoing internal
radiation therapy for cervical cancer?
a. Wear gloves when assessing the cervical intracavity implant.
b. Instruct the client to urinate in the lead-lined bedpan or “hat” every 2 hours.
c. Prepare the client for an enema before inserting the implant.
d. Limit staff or visitor exposure to 30 minutes or less in an 8-hour period.
ANS: D
Staff and visitor exposure should be limited to 30 minutes or less in an 8-hour period to
reduce the risk of overexposure to radiation. Nurses need to protect themselves from
overexposure to radiation. Wearing a shield is one method of protection. An indwelling
catheter is inserted to prevent urinary distention that could dislodge the applicator. No bowel
preparation is necessary.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
7. Which nursing diagnosis fails to address the psychologic effect of these disorders of a client
diagnosed with a neoplasm of the reproductive system?
a. Anxiety related to surgical procedures
b. Reduced self-concept, resulting from changes in anatomy
c. Potential for injury, related to lack of skill for self-care
d. Inadequate family procN esU
seR
s SINGTB.COM
ANS: C
Although potential for injury, related to lack of skill for self-care, is appropriate to this
client’s condition, this diagnosis is more suited to the client’s learning needs than the
psychologic effect. Anxiety, related to surgical procedures, is appropriate for addressing
psychosocial concerns; the client may also develop anxiety related to the diagnosis and
prognosis and whether or not surgery is required. Reduced self-concept is an applicable
diagnosis; changes in her anatomy and function may also result in low self-esteem and
ineffective coping skills. Inadequate family processes is a possible and acceptable diagnosis;
functional and anatomic changes may result in the client’s inability to fulfill her familial
role. Depending on the severity of her condition, inadequate family processes could also
lead to social isolation.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Diagnosis MSC: Client Needs: Psychosocial Integrity
8. Which of these interventions should the nurse instruct the client diagnosed with urinary
incontinence (UI) to use first?
a. Pelvic floor support devices
b. Pelvic muscle exercises
c. Surgery
d. Medications
MULTIPLE CHOICE
1. The nurse should be aware that a pessary is most effective in the treatment of which
disorder?
a. Cystocele
b. Uterine prolapse
c. Rectocele
d. Stress urinary incontinence
ANS: B
A fitted pessary may be inserted into the vagina to support the uterus and hold it in the
correct position. Usually a pessary is used for only a short time and is not used for the client
with a cystocele. A rectocele cannot be corrected using a pessary. A pessary is not likely the
most effective treatment for stress incontinence.
PTS: 1 DIF: Cognitive Level: Remember
TOP: Nursing Process: Diagnosis
MSC: Client Needs: Health Promotion and Maintenance
2. A postmenopausal woman has been diagnosed with two leiomyomas (fibroids). Which
clinical finding is most commonly associated with the presence of leiomyomas?
a. Abnormal uterine bleeding
b. Diarrhea NURSINGTB.COM
c. Weight loss
d. Acute abdominal pain
ANS: A
Most women are asymptomatic. Abnormal uterine bleeding is the most common symptom
of leiomyomas. Diarrhea is not commonly associated with leiomyomas. Weight loss does
not usually occur in the woman with leiomyomas, and the client with leiomyomas is
unlikely to experience abdominal pain.
PTS: 1 DIF: Cognitive Level: Applying
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
3. Which woman is at the greatest risk for psychologic complications after hysterectomy?
a. 55-year-old woman who has been having abnormal bleeding and pain for 3 years
b. 46-year-old woman who has had three children and has just been promoted at work
c. 62-year-old widow who has three friends who have had uncomplicated
hysterectomies
d. 19-year-old woman who had a ruptured uterus after giving birth to her first child
ANS: D
, The 19-year-old woman is still in her childbearing years. Often the uterus is related to
self-concept in women in this age group, and they may feel that sexual functioning is related
to having a uterus. The 55-year-old woman is past her childbearing years and has had
bleeding and pain for 3 years. The hysterectomy may be well received as a method of pain
relief. The 46-year-old woman has a family and positive event occurring in her life (job
promotion). The 62-year-old woman is past her reproductive years and has relationships
with others who have had positive outcomes.
PTS: 1 DIF: Cognitive Level: Analyzing
TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity
4. A 48-year-old woman has just had a hysterectomy for endometrial cancer. Which statement
alerts the nurse that further teaching is needed?
a. “I can’t wait to go on the cruise that I have planned for this summer.”
b. “I know that the surgery saved my life, but I will miss having sexual intercourse
with my husband.”
c. “I have asked my daughter to come and stay with me next week after I am
discharged from the hospital.”
d. “Well, I don’t have to worry about getting pregnant anymore.”
ANS: B
Stating that she will miss having sexual intercourse with her husband indicates that further
teaching is needed for this client regarding sexual activities after a hysterectomy. Although
intercourse may be initially uncomfortable, the use of water-soluble lubricants, relaxation
exercises, and changes in position may be helpful. Expressing plans for a vacation is a
positive psychologic state with plans for the future. Stating that her daughter will stay with
her indicates the client undN
erU
staRnS
dsItN
haGt T
shB
e.mC
ayOnMeed assistance during her acute recovery
period. Stating that she no longer needs to worry about getting pregnant indicates
knowledge related to the reproductive cycle and a positive outlook.
PTS: 1 DIF: Cognitive Level: Evaluating
TOP: Nursing Process: Evaluation
MSC: Client Needs: Health Promotion and Maintenance
5. Considering the treatment plan for a pregnant woman with gynecologic cancer, which
statement about timing or type of treatment is correct?
a. The fetus is most at risk during the first trimester.
b. The fetus is most at risk during the second trimester.
c. The fetus is most at risk during the third trimester.
d. Surgery is riskier than chemotherapy in the first trimester.
ANS: A
The first trimester is the most vulnerable period for the growing fetus. Women may be faced
with deciding about terminating the pregnancy, depending on the stage and extent of the
disease. For advanced disease in the second trimester, alkylating agents, 5-fluorouracil
(5-FU), and vincristine are relatively safe for the fetus. For advanced disease in the third
trimester, alkylating agents, 5-FU, and vincristine are relatively safe for the fetus. Surgery is
less risky than chemotherapy in the first trimester.
PTS: 1 DIF: Cognitive Level: Apply
, TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
6. Which precaution should the nurse take while caring for a client who is undergoing internal
radiation therapy for cervical cancer?
a. Wear gloves when assessing the cervical intracavity implant.
b. Instruct the client to urinate in the lead-lined bedpan or “hat” every 2 hours.
c. Prepare the client for an enema before inserting the implant.
d. Limit staff or visitor exposure to 30 minutes or less in an 8-hour period.
ANS: D
Staff and visitor exposure should be limited to 30 minutes or less in an 8-hour period to
reduce the risk of overexposure to radiation. Nurses need to protect themselves from
overexposure to radiation. Wearing a shield is one method of protection. An indwelling
catheter is inserted to prevent urinary distention that could dislodge the applicator. No bowel
preparation is necessary.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
7. Which nursing diagnosis fails to address the psychologic effect of these disorders of a client
diagnosed with a neoplasm of the reproductive system?
a. Anxiety related to surgical procedures
b. Reduced self-concept, resulting from changes in anatomy
c. Potential for injury, related to lack of skill for self-care
d. Inadequate family procN esU
seR
s SINGTB.COM
ANS: C
Although potential for injury, related to lack of skill for self-care, is appropriate to this
client’s condition, this diagnosis is more suited to the client’s learning needs than the
psychologic effect. Anxiety, related to surgical procedures, is appropriate for addressing
psychosocial concerns; the client may also develop anxiety related to the diagnosis and
prognosis and whether or not surgery is required. Reduced self-concept is an applicable
diagnosis; changes in her anatomy and function may also result in low self-esteem and
ineffective coping skills. Inadequate family processes is a possible and acceptable diagnosis;
functional and anatomic changes may result in the client’s inability to fulfill her familial
role. Depending on the severity of her condition, inadequate family processes could also
lead to social isolation.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Diagnosis MSC: Client Needs: Psychosocial Integrity
8. Which of these interventions should the nurse instruct the client diagnosed with urinary
incontinence (UI) to use first?
a. Pelvic floor support devices
b. Pelvic muscle exercises
c. Surgery
d. Medications
