Saunders Medsurg Reproductive

KEY: All un-highlighted questions are required for Med-Surg 1 Red Text = Should Understand Green Text = Absolutely Should Know Saunders Medsurg Reproductive: 1. A 55-year-old male client confides in the nurse that he is concerned about his sexual function. What is the nurse's best response? 1. "How often do you have sexual relations?" 2. "Please share with me more about your concerns." 3. "You are still young and have nothing to be concerned about." 4. "You should not have a decline in testosterone until you are in your 80s." 2. "Please share with me more about your concerns." Rationale: The nurse needs to establish trust when discussing sexual relationships with men. The nurse should open the conversation with broad statements to determine the true nature of the client's concerns. The frequency of intercourse is not a relevant first question to establish trust. Testosterone declines with the aging process. 2. The community health nurse is preparing an educational class on ovarian cancer for a group of women. Which signs and symptoms should the nurse include in the presentation? Select all that apply. 1. Feeling hungry all the time 2. Having urinary urgency or frequency 3. Experiencing pelvic or abdominal swelling 4. Sense of feeling that something is "falling out" 5. Developing a macular-papular rash over the abdomen Answers: 2. Having urinary urgency or frequency 3. Experiencing pelvic or abdominal swelling Rationale: Signs and symptoms of ovarian cancer are often very subtle. Urinary urgency or frequency, abdominal or pelvic pain or swelling, vague gastrointestinal disturbances such as dyspepsia or gas, and unexplained weight loss are potential signs and symptoms and require further investigation. Hunger and a rash are not associated with this condition. A sense of something "falling out" may be reported by the client experiencing uterine prolapse. 5. A preadolescent client asks the nurse about the onset of puberty. The nurse describes which changes as indicating puberty? Select all that apply. 1. Mood swings occur. 2. Pubic hair will develop. 3. Breast development begins. 4. Uterus matures to adult size. 5. Height will increase due to a growth spurt. Answers: 1. Mood swings occur. 2. Pubic hair will develop. 3. Breast development begins. 5. Height will increase due to a growth spurt. Rationale: During puberty, a number of body changes will occur. These changes include mood swings, the beginning development of pubic hair, breast bud development, and growth spurt. The uterus does not reach full maturity until approximately 17 years of age. 6. The nurse presents a seminar on sexually transmitted infections. Which information about syphilis should the nurse include in this presentation? Select all that apply. 1. A blood test will confirm the diagnosis. 2. Syphilis signs and symptoms are divided into stages. 3. Syphilis can be spread through vaginal, anal, or oral sex. 4. Having syphilis once provides lifelong immunity from repeat infection. 5. Syphilis will always be present in a chronic state, as there is no cure for this illness. Answers: 1. A blood test will confirm the diagnosis. 2. Syphilis signs and symptoms are divided into stages. 3. Syphilis can be spread through vaginal, anal, or oral sex. Rationale: Syphilis can be cured with the initiation of prompt treatment. A blood test can confirm this diagnosis. Syphilis is staged in relation to signs and symptoms and the length of the infection. Syphilis may be transmitted via vaginal, anal, or oral sex. An individual may be positive for syphilis more than once. Syphilis can be cured by early treatment. 9. A female client is suspected of having a vaginal infection caused by the organism Candida albicans. Which assessment question would elicit data associated with this infection? Rationale: Clinical manifestations of a Candida infection include vaginal pain, itching, and a thick white vaginal discharge. Hematuria, edema, flank pain, and headache are clinical manifestations associated with urinary tract infections. 1. "Have you had any vaginal discharge?" 2. "Do you have any blood in your urine?" 3. "Have you had any flank pain or headaches?" 4. "Have you noticed any swelling in your feet?" Answer: 1. "Have you had any vaginal discharge?" 13. The nurse is providing teaching to a transgender female to male client who will be started on testosterone therapy. Which information should the nurse include in the teaching session? Select all that apply. 1. Weight loss can be expected. 2. Expect the clitoris to enlarge. 3. Papanicolaou tests are no longer necessary. 4. Menses will stop after the first dose of testosterone. 5. Liver enzymes and cholesterol levels will need to be monitored. Answers: 2. Expect the clitoris to enlarge. 5. Liver enzymes and cholesterol levels will need to be monitored. Rationale: Transgender clients transitioning from female to male will be started on testosterone therapy to enhance masculinization. Expected physiological changes include deepening of the voice, clitoral growth, breast atrophy, increased libido, laryngeal prominence, weight gain, acne, and headaches. Menses will not stop after the first dose of testosterone. It will occur after months, and additional treatment with progesterone may be needed to halt menses. Testosterone therapy can affect liver enzymes, cholesterol, glucose, and coagulation, and therefore these levels will require monitoring. 15. A client with a history of ovarian cysts is seen by the health care provider (HCP). The client has had 2 previous surgeries related to this condition. Her HCP recommends an exploratory laparoscopic procedure for the current ovarian cyst, which has persisted for several months. The client states that the prior ovarian cysts were benign and questions the need for this procedure. Which response is best for the nurse to provide? 1. "A prolonged ovarian abnormality should be evaluated thoroughly." 2. "With your recurrent history, one of these times the cyst will be malignant." 3. "The surgical procedure is minimal, and you will not have to be concerned after you learn the results." 4. "I appreciate your concern regarding another surgical procedure. Would you like to discuss your concerns?" Answer: 1. "A prolonged ovarian abnormality should be evaluated thoroughly." Rationale: An ovarian cyst is considered an abnormal occurrence, and it should be thoroughly evaluated. Not all ovarian cysts are malignant, and this client may never experience a malignancy. Any surgical procedure has some risk and pain associated with it. The nurse cannot promise the procedure will be minimal and that there will be no reason for concern after learning the results. Discussing the concerns does involve therapeutic communication but is not the best response given the situation. In addition, it is nontherapeutic for the nurse to tell the client that he or she appreciates the client's concern. 17. A nursing student is doing a presentation on human papillomavirus (HPV) for a young adult group aged 18 to 20 years old. What information should the nursing student include in this presentation? Select all that apply. 1. "Some forms of HPV can lead to cervical cancer." 2. "You cannot get HPV if you have had only 1 sex partner." 3. "There are no vaccinations available to protect against HPV." 4. "HPV is most commonly spread during vaginal or anal sexual contact." 5. "In some types, HPV will go away on its own and does not cause health issues." 6. “Clients who have HPV or Condylomata acuminate should have a Papanicolaou test regularly.” Answers: 1. "Some forms of HPV can lead to cervical cancer." 4. "HPV is most commonly spread during vaginal or anal sexual contact." 5. "In some types, HPV will go away on its own and does not cause health issues." 6. “Clients who have HPV or Condylomata acuminate should have a Papanicolaou test regularly.” Rationale: HPV has now become the most common sexually transmitted infection. Some types of HPV have been found to have a strong link to cervical cancer, while other types of HPV may resolve without any intervention. HPV may be contracted with any sexual partner. There is a vaccine for the known strains that may lead to cervical cancer, which can be administered to females from ages 9 to 26 years. HPV is spread through vaginal or anal sexual contact. Reproductive Questions from Saunders Oncology Adult Health 4. REPRODUCTIVE QUESTION: During the admission assessment of a client with advanced ovarian cancer, the nurse recognizes which manifestation as typical of the disease? 1. Diarrhea 2. Hypermenorrhea 3. Abnormal bleeding 4. Abdominal distention Answer: 4. Abdominal distention Rationale: Clinical manifestations of ovarian cancer include abdominal distention, urinary frequency and urgency, pleural effusion, malnutrition, pain from pressure caused by the growing tumor and the effects of urinary or bowel obstruction, constipation, ascites with dyspnea, and ultimately general severe pain. Abnormal bleeding, often resulting in hypermenorrhea, is associated with uterine cancer. 48. REPRODUCTIVE Question: A community health nurse is providing an educational session on cancer of the cervix for women living in the community. The nurse informs the community residents that which is an early sign of this type of cancer? 1. Abdominal pain 2. Constant and profuse bleeding 3. Irregular vaginal bleeding or spotting 4. Dark and foul-smelling vaginal drainage Answer: 3. Irregular vaginal bleeding or spotting Rationale: Early cancer of the cervix usually is asymptomatic. The 2 chief symptoms are leukorrhea (vaginal discharge) and irregular vaginal bleeding or spotting. The vaginal discharge increases gradually in amount and becomes watery and finally dark and foul-smelling because of necrosis and infection of the tumor mass. As the disease progresses, the bleeding may become constant and may increase in amount. 49. REPRODUCTIVE Question: The nurse is doing preoperative teaching with a client newly diagnosed with a stage I cervical cancer. Which statement by the client indicates that education was effective? 1. "I have carcinoma that is just in the cervix." 2. "My carcinoma has extended to the pelvis and the vagina." 3. "I have carcinoma that has extended beyond the cervix but has not extended to the pelvic wall." 4. "My carcinoma has extended beyond the true pelvis and has involved the bladder or rectal mucosa." Answer: 1. "I have carcinoma that is just in the cervix." Rationale: Stage I carcinoma is strictly confined to the cervix. In stage II, the carcinoma has extended beyond the cervix but has not extended to the pelvic wall. Stage III carcinoma has extended to the pelvic wall at the lower third of the vagina, and stage IV carcinoma has extended beyond the true pelvis or has clinically involved the mucosa of the bladder or rectum. 50. REPRODUCTIVE Question: The nurse is reviewing a plan of care for a client with cancer of the cervix who is undergoing treatment with a cesium (radiation) implant. Which nursing interventions are most appropriate for this client? Select all that apply. 1. Maintain the client on bed rest. 2. Place the client on a low-fiber diet. 3. Keep the head of the bed flat at all times. 4. Restrict visitors to visiting for 60 minutes per day. 5. Stand at the entrance of the room to communicate with the client when possible. Answers: 1. Maintain the client on bed rest. 2. Place the client on a low-fiber diet. 5. Stand at the entrance of the room to communicate with the client when possible. Rationale: During application of the cesium implant, the client is on bed rest. The client may be logrolled from side to side, and the head of the bed may be raised to 45 degrees. The client is given a low-fiber diet to prevent frequent bowel movements, which is a side effect of the radiation. To minimize radiation exposure, the nurse stands at the head of the bed or at the entrance to the room. Visitors are limited to 30 minutes per day in the radiation area. 53. REPRODUCTIVE Question: The nurse is counseling a woman about decreasing her risk for cervical cancer. Which statement by the client indicates a need for further counseling? 1. "I need to seek prompt treatment for vaginitis." 2. "Condoms are needed only if I do not trust a new partner." 3. "A partner who is uncircumcised will present an increased risk." 4. "I need to keep appointments for Pap tests at the frequency advised by my health care provider." Answer: 2. "Condoms are needed only if I do not trust a new partner." Rationale: Condoms should be used for adequate protection, especially with new partners. Sexually transmitted infections (which could be acquired without condom use) increase the client's risk of cervical cancer. Uncircumcised partners may present an increased risk. The woman should adhere to guidelines for early detection of cervical cancer (by Pap test) and should seek prompt treatment of vaginitis and cervicitis if they occur. 56. REPRODUCTIVE Question: The nurse has provided instructions to a client regarding testicular self-examination (TSE). Which client statement indicates the need for further teaching regarding TSE? 1. "I know to report any small lumps." 2. "I examine myself every 2 months." 3. "I examine myself after I take a warm shower." 4. "I feel a hard and cord-like thing in back and going up." Answer: 2. "I examine myself every 2 months." Rationale: TSE should be performed every month. Small lumps or abnormalities should be reported. The spermatic cord finding (option 4) is normal. After a warm bath or shower, the scrotum is relaxed, making it easier to perform TSE. 59. REPRODUCTIVE Question: The nurse is taking a history from a client suspected of having testicular cancer. Which data will be most helpful in determining the risk factors for this type of cancer? 1. Age and race 2. Marital status 3. Number of children 4. Number of sexual partners Answer: 1. Age and race Rationale: Two basic but important risk factors for testicular cancer are age and race. The disease occurs most frequently in white males, generally between the ages of 15 and 34 years. Other risk factors include a history of undescended testis and a family history of testicular cancer. Marital status and number of children are not associated with increased risk of testicular cancer. In addition, the number of sexual partners is not associated with testicular cancer. 64. REPRODUCTIVE Question: The community nurse is conducting a health promotion program at a local school and is discussing the risk factors associated with cervical cancer. Which are risk factors for cervical cancer? Select all that apply. 1. Smoking 2. Multiple sex partners 3. Human papillomavirus infection 4. Annual gynecological examinations 5. First intercourse before 17 years of age Answers: 1. Smoking 2. Multiple sex partners 3. Human papillomavirus infection 5. First intercourse before 17 years of age Rationale: Risk factors for cervical cancer include human papillomavirus infection, active and passive cigarette smoking, and certain high-risk sexual activities (first intercourse before 17 years of age, multiple sex partners, and male partners with multiple sex partners). Screening via regular gynecological examinations and Papanicolaou (Pap) tests with treatment of precancerous abnormalities decreases the incidence and mortality of cervical cancer. 67. REPRODUCTIVE Question: The community health nurse conducts a health promotion program for community members regarding testicular cancer. The nurse determines that further information needs to be provided if a community member states that which is a sign of testicular cancer? 1. Alopecia 2. Back pain 3. Painless testicular swelling 4. Heavy sensation in the scrotum Answer: 1. Alopecia Rationale: Alopecia is not an assessment finding in testicular cancer. Alopecia may occur, however, as a result of radiation or chemotherapy. The remaining options are assessment findings in testicular cancer. Back pain may indicate metastasis to the retroperitoneal lymph nodes. 69. REPRODUCTIVE Question: A cervical radiation implant is placed in a client who is undergoing treatment of cervical cancer. The nurse should initiate which activity prescription as the most appropriate for this client? 1. Bed rest 2. Out of bed ad lib 3. Out of bed in a chair only 4. Ambulation to the bathroom only Answer: 1. Bed rest Rationale: The client with a cervical radiation implant should be maintained on bed rest in the dorsal position to prevent movement of the radiation source. The head of the bed is elevated to a maximum of 10 to 15 degrees for comfort {NOTE: The head of bed can be elevated up to 45 degrees}. The nurse avoids turning the client on the side. If turning is absolutely necessary, a pillow is placed between the knees and, with the body in straight alignment, the client is logrolled. 70. REPRODUCTIVE Question: The client reports to the nurse that while performing testicular self-examination, he found a lump the size and shape of a pea. Which statement is the most appropriate response to the client? 1. "Lumps like that are normal. Don't worry." 2. "Let me know if it gets bigger next month." 3. "That's important to report even though it might not be serious." 4. "That could be cancer. I'll ask the health care provider to examine you." Answer: 3. "That's important to report even though it might not be serious." Rationale: Testicular cancer almost always occurs in only 1 testicle and is usually a pea-size, painless lump when discovered. The cancer is highly curable if found early. The finding should be reported to the health care provider.