Chapter 11: Structural Disorders and Neoplasms of the Reproductive System My Nursing Test Banks

Lowdermilk: Maternity & Womens Health Care, 10th Edition

Chapter 11: Structural Disorders and Neoplasms of the Reproductive System

Test Bank

MULTIPLE CHOICE

1. The nurse should be aware that a pessary would be most effective in the treatment of what 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.

A pessary is not used for the client with a cystocele.

A rectocele cannot be corrected by the use of a pessary.

It is unlikely that a pessary is the most effective treatment for stress incontinence.

DIF: Cognitive Level: Knowledge REF: 237

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis

2. A postmenopausal woman who is 54 years old has been diagnosed with two leiomyomas. What assessment finding is most commonly associated with the presence of leiomyomas?

a.

Abnormal uterine bleeding

b.

Diarrhea

c.

Weight loss

d.

Acute abdominal pain

ANS: A

Most women are asymptomatic. Abnormal uterine bleeding is the most common symptom of leiomyomas (fibroids).

Diarrhea is not commonly associated with leiomyomas (fibroids).

Weight loss does not usually occur in the woman with leiomyomas (fibroids).

The client with leiomyomas (fibroids) is unlikely to experience abdominal pain.

DIF: Cognitive Level: Comprehension REF: 240

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

3. Which woman is at high risk for psychologic complications after hysterectomy?

a.

A 55-year-old woman who has been having abnormal bleeding and pain for 3 years

b.

A 46-year-old woman who has three children and has just been promoted at work

c.

A 62-year-old widow who has three friends who have had uncomplicated hysterectomies

d.

A 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 of 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 surgery may be well received as a method of pain relief.

The 46-year-old woman has a family and has positive events occurring in her life (job promotion).

The 62-year-old woman is past her reproductive years and has relationships with others who have had positive outcomes.

DIF: Cognitive Level: Comprehension REF: 243

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Diagnosis

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 cant 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 dont 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. Intercourse may be uncomfortable initially. The use of water-soluble lubricants, relaxation exercises, and changes in position may be helpful.

Expressing plans for a vacation is a positive psychologic state with plans for the future.

Stating that her daughter will stay with her indicates the client understands that she may need assistance during her acute recovery period.

Stating that she no longer needs to worry about getting pregnant indicates knowledge related to the reproductive cycle and a positive outlook.

DIF: Cognitive Level: Application REF: 244

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Evaluation

5. The nurse knows that teaching about external radiation therapy is effective when the woman:

a.

Uses ointment to keep her skin from drying out

b.

Washes the irradiated area with deodorant soap

c.

Eats a diet high in protein and drinks at least 2000 ml of fluid a day

d.

Washes off the markings for the radiation site after each treatment

ANS: C

To maintain good nutrition, the woman should eat high-protein meals or use protein supplements and should have a high daily fluid intake of 2 to 3 L.

The woman is counseled about good skin care and taught to avoid soaps, ointments, cosmetics, and deodorants because these may contain metals that would alter the radiation dose she receives.

The woman is counseled about good skin care and taught to avoid soaps, ointments, cosmetics, and deodorants because these may contain metals that would alter the radiation dose she receives.

Markings may be made to indicate the exact location needed for irradiation. These should remain until treatment is complete.

DIF: Cognitive Level: Comprehension REF: 257

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

6. With regard to planning treatment for a pregnant woman with breast cancer, which statement about timing or type of treatment is correct?

a.

The fetus is most at risk during the first trimester.

b.

The fetus is most at risk during the second trimester.

c.

The fetus is most at risk during the third trimester.

d.

Surgery is more risky than chemotherapy in the first trimester.

ANS: A

The first trimester is the most vulnerable period for the growing fetus. Women may be faced with making a decision about terminating the pregnancy, depending on the stage and extent of the disease.

For advanced disease in the second trimester, alkylating agents, 5-fluorouracil (5-FU), and vincristine are relatively safe for the fetus.

For advanced disease in the third trimester, alkylating agents, 5-FU, and vincristine are relatively safe for the fetus.

Surgery is less risky than chemotherapy in the first trimester.

DIF: Cognitive Level: Application REF: 265

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

7. During internal radiation therapy for cervical cancer, the nurse should:

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 insertion

d.

Limit staff or visitor exposure to 30 minutes or less per 8 hours

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 prep is necessary.

DIF: Cognitive Level: Comprehension REF: 258

OBJ: Client Needs: Safe and Effective Care Environment

TOP: Nursing Process: Implementation

8. What is the most common reproductive tract cancer associated with pregnancy?

a.

Cervical cancer

b.

Uterine cancer

c.

Ovarian cancer

d.

Fallopian tube cancer

ANS: A

The incidence of cervical cancer concurrent with pregnancy is reported to be 3%, making it the most common reproductive tract cancer associated with pregnancy.

Uterine cancer is rarely diagnosed during pregnancy.

Ovarian cancer is the second most frequent cancer diagnosis in pregnancy. At approximately 1% it remains a rare occurrence.

The peak incidence of tubal cancer is between the ages of 50 and 55. For this cancer to be concurrent with pregnancy is only a remote possibility.

DIF: Cognitive Level: Knowledge REF: 263

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

9. From the age of menarche to menopause, women remain at risk for structural disorders and neoplasms of the reproductive system. When caring for these clients the nurse must begin by assessing the womans knowledge of the disorder, its management, and prognosis. This assessment should be followed by a nursing diagnosis. Which diagnosis does not address the psychologic effect of these disorders?

a.

Anxiety related to surgical procedures

b.

Disturbed body image as a result of changes in anatomy

c.

Risk for injury related to lack of skill for self-care

d.

Interrupted family processes

ANS: C

Although risk for injury related to lack of skill for self-care is appropriate to the clients condition, it is more suited to the clients 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, whether or not surgery is required.

Disturbed body image is an applicable diagnosis. Changes in anatomy and function may also result in low self-esteem and ineffective coping skills.

Interrupted family processes is a possible acceptable diagnosis. Functional and anatomic changes may result in the clients inability to fulfill her familial role. Depending on the severity of her condition, it could also lead to social isolation.

DIF: Cognitive Level: Analysis REF: 234

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Diagnosis

10. The prevalence of urinary incontinence (UI) increases as women age, with more than one third of women in the United States suffering from some form of this disorder. The symptoms of mild to moderate UI can be successfully decreased by a number of strategies. Which of these should the nurse instruct the client to use first?

a.

Pelvic floor support devices

b.

Bladder training and pelvic muscle exercises

c.

Surgery

d.

Medications

ANS: B

Pelvic muscle exercises, known as Kegel exercises, along with bladder training can significantly decrease or entirely relieve stress incontinence in many women.

Pelvic floor support devices also known as pessaries come in a variety of shapes and sizes. Pessaries may not be effective for all women and require scrupulous cleaning to prevent infection.

Anterior and posterior repairs and even a hysterectomy may be performed. If surgical repair is performed, the nurse must focus her care on preventing infection and helping the woman avoid putting stress on the surgical site.

Pharmacologic therapy includes selective serotonin-norepinephrine reuptake inhibitors or vaginal estrogen therapy. These are not the first action a nurse should recommend.

DIF: Cognitive Level: Application REF: 237

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

11. A woman presents with a possible diagnosis of polycystic ovary syndrome (PCOS). While completing the initial assessment of the client, the nurse understands that clinical manifestations of PCOS might include allexcept:

a.

Anorexia

b.

Hirsutism

c.

Irregular menses

d.

Infertility

ANS: A

These clients often present with obesity rather than anorexia and weight loss. 40% of these women also display glucose intolerance and hyperinsulinemia.

Excessive hair growth is often present with PCOS.

This client is likely to have irregular menses or even amenorrhea.

Infertility as a result of decreased levels of follicle-stimulating hormone is common with this syndrome.

DIF: Cognitive Level: Comprehension REF: 239

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

MULTIPLE RESPONSE

1. Your client is undergoing treatment for ovarian cancer. Please identify which common nutritional problems are related to gynecologic cancers and the treatment thereof.

a.

Stomatitis

b.

Constipation

c.

Anorexia

d.

Diarrhea

e.

Nausea and vomiting

ANS: A, B, C, D, E

Stomatitis, constipation, anorexia, diarrhea, and nausea and vomiting are all possible nutritional complications related to gynecologic cancers and their treatment. The nurse must assess accordingly and adapt the clients plan of care. To ensure recovery these women should consume a diet high in iron and protein, drink plenty of fluids, and eat foods high in vitamins C, B and K.

DIF: Cognitive Level: Application REF: 250

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment, Planning

COMPLETION

1. A ____________________ cyst is a germ cell tumor that contains substances such as hair, teeth, sebaceous secretions, and bones.

ANS:

Dermoid

Dermoid cysts are germ cell tumors, usually occurring in childhood.

DIF: Cognitive Level: Knowledge REF: 239

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Diagnosis

2. Tumors that are on pedicles (stalks) and present in either the endometrium or cervix are more commonly known as ________________ ______________.

ANS:

Uterine polyps

The etiology of this type of tumor is unknown, although they may develop in response to hormonal stimulus or be the result of inflammation. Polyps are benign lesions that can be removed surgically.

DIF: Cognitive Level: Knowledge REF: 240

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Diagnosis

TRUE/FALSE

1. Structural disorders of the uterus and vagina related to pelvic relaxation and urinary incontinence are a delayed result of childbearing. These defects do not appear in women who have never been pregnant. Is this statement true or false?

ANS: F

These problems are associated with older mothers; however, women who have never been pregnant can experience them as well. Incontinence is the direct result of congenital or acquired weakness of the pelvic support structures. This condition often appears during menopause when ovarian hormones and pelvic tissue are lost. The incidence does tend to remain higher in women who have given birth.

DIF: Cognitive Level: Knowledge REF: 236

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

2. Nurses who work with clients in hospitals that receive federal funding must know that all clients must be asked if they have knowledge of advance directives and be provided with information if so desired. Is this statement true or false?

ANS: T

This is a component of the Patient Self-Determination Act. This is important for nurses working in gynecology-oncology settings, where decisions about living wills and no codes may be an issue.

DIF: Cognitive Level: Application REF: 251

OBJ: Client Needs: Safe and Effective Care Environment

TOP: Nursing Process: Implementation

Mosby items and derived items 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

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