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A client has undergone a vaginal hysterectomy with a bilateral salpingo-oophorectomy. She is concerned about a loss of libido. What intervention by the nurse would be best?
- A. Suggest increasing vitamins and supplements daily.
- B. Discuss the value of a balanced diet and exercise.
- C. Reinforce that weight gain may be inevitable.
- D. Teach that estrogen cream inserted vaginally may help.
Correct Answer: D
Rationale: Use of vaginal estrogen cream and gentle dilation can help with vaginal changes and loss of libido. Weight gain and masculinization are misperceptions after a vaginal hysterectomy. Vitamins, supplements, a balanced diet, and exercise are helpful for healthy living, but are not necessarily going to increase libido.
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The nurse is educating a client on the prevention of toxic shock syndrome (TSS). Which statement by the client indicates a lack of understanding?
- A. I need to change the tampon every 3 hours during the day.
- B. At night, I should use a feminine pad rather than a tampon.
- C. If I don't use tampons, I should not get TSS.
- D. I should wash my hands before inserting the tampon.
Correct Answer: A
Rationale: Tampons need to be changed every 3 to 6 hours to avoid infection by such organisms as Staphylococcus aureus. All of the other responses are correct: using feminine pads only, not using tampons at all, and washing hands before tampon insertion are all strategies to prevent TSS.
A client has just returned from a total abdominal hysterectomy and needs postoperative nursing care. What action can the nurse delegate to the unlicensed assistive personnel (UAP)?
- A. Assess heart, toileting, and bowel sounds.
- B. Check the hemoglobin and hematocrit levels.
- C. Evaluate the dressing for drainage.
- D. Monitor the client for a urinary output.
Correct Answer: D
Rationale: The UAP is able to empty the urinary output from the catheter. The nurse would assess the heart, lung, and bowel sounds; check the hemoglobin and hematocrit levels; and evaluate the drainage on the dressing.
The nurse is teaching a client who is undergoing brachytherapy about what to immediately report to her health care provider. Which signs and symptoms would be included in this teaching? (Select all that apply.)
- A. Constipation for 3 days
- B. Severe diarrhea
- C. Abdominal pain
- D. Visible blood in the urine
- E. Heavy vaginal bleeding
Correct Answer: C,D,E
Rationale: Health teaching for a client having brachytherapy should emphasize reporting abdominal pain, visible blood in the urine, and heavy vaginal bleeding. Severe diarrhea, urethral burning, extreme fatigue, and a fever over 100°F should also be reported. Constipation for 3 days is not typically a critical symptom to report immediately in this context.
A 55-year-old post-menopausal woman is assessed by the nurse with a history of dyspareunia, backache, pelvic pressure, urinary tract infections, and frequent urinary urgency. Which condition does the nurse suggest?
- A. Ovarian cyst
- B. Rectocele
- C. Cystocele
- D. Fibroid
Correct Answer: C
Rationale: Dyspareunia, backache, pelvic pressure, urinary tract infections, and urinary urgency are all symptoms of a cystocele, a protrusion of the bladder through the vaginal wall. Ovarian cysts are rare after menopause, a rectocele is associated with constipation, hemorrhoids, and local impaction. Fibroids are associated with heavy bleeding.
A 28-year-old client is diagnosed with endometriosis and is experiencing severe symptoms. Which actions by the nurse are the most appropriate at this time? (Select all that apply.)
- A. Reduce the pain by low-level heat.
- B. Discuss in detail the side effects of laparoscopic surgery.
- C. Reduce anxiety by relaxation techniques and education.
- D. Suggest resources such as the Endometriosis Association.
- E. Encourage the client to avoid all physical activity.
Correct Answer: A,C,D
Rationale: With endometriosis, pain is the predominant symptom, with anxiety occurring because of the diagnosis. Interventions should be directed to pain and anxiety relief, such as low-level heat, relaxation techniques, and education about the pathophysiology and possible treatment of endometriosis. The nurse could suggest resources like the Endometriosis Association. Discussing surgical side effects in detail is not appropriate without assessing the client's readiness, and avoiding all physical activity is not recommended as it may not help manage symptoms.