Nokea
A client with extensive endometriosis is scheduled for a panhysterectomy. Which statement by the client indicates a need for further teaching?
- A. I will be having my uterus, tubes, and ovaries removed.
- B. I am finished having children.
- C. I will not have to deal with symptoms of menopause.
- D. I will now have a greater risk for stroke and heart disease.
Correct Answer: C
Rationale: Surgical menopause causes a sudden drop in estrogen and progesterone levels resulting in varied symptoms in clients. The risks of heart disease and stroke increase with estrogen reduction. A panhysterectomy is the removal of the uterus, both tubes and ovaries and will result in the inability to conceive children.
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While obtaining the history, the nurse learns the client's mother's was treated with diethylstilbestrol (DES) during her pregnancy. The nurse determines that this client is at risk for which of the following?
- A. Vulvar cancer
- B. Breast cancer
- C. Vaginal cancer
- D. Endometrial cancer
Correct Answer: C
Rationale: Vaginal cancer is associated with the risk factor of being born to mothers treated with DES during their pregnancy. The upper posterior third of the vagina is the most common site of vaginal cancer. Metastatic lesions may occur in the cervix or adjacent areas such as the vulva, uterus, or rectum. DES is not a risk factor associated with vulvar or breast cancers. Endometrial cancer occurs in women who take estrogens without the addition of progesterone for 5 or more years during and after menopause.
The nurse is interviewing a postmenopausal client during an annual gynecologic exam. Which assessment finding presents the greatest concern in the care of this client?
- A. Positive for human papillomavirus (HPV)
- B. Use of pessary
- C. Vaginal bleeding
- D. Urinary stress incontinence
Correct Answer: C
Rationale: Vaginal bleeding in a client after menopause is abnormal and a predominant symptom for vaginal cancers. The incidence of vaginal cancer is higher among woman infected with HPV and those who use a pessary but neglect to remove and clean it. Urinary stress incontinence is not a significant concern.
A young client has just completed the 6-month series of Gardasil vaccine. Which comment by the client would alert the nurse that is other teaching is needed?
- A. This vaccine lowers my risk for cervical cancer.
- B. Will still time need to the routine time need for cervical cancer.
- C. I am at lower risk for developing cervical warts.
- D. This vaccine will prevent human papilloma virus (HPV) from occurring.
Correct Answer: D
Rationale: Gardasil is a vaccine that protects against four types of HPV, which cause 90% of cervical cancers and 90% of cervical warts but does not protect against other strains of HPV and pre vaccination infections. Routine cervical cancer screening is recommended regardless of vaccine use.
Culture of client's vaginal discharge reveals Gardnerella vaginalis. Which of the following would the nurse expect to assess?
- A. Foul foamy discharge
- B. Thick curry white discharge
- C. Fisy smelling watery discharge
- D. Yellowish white discharge
Correct Answer: C
Rationale: Gardnerella vaginalis is associated with a gray white, watery, fisy smelling vaginal discharge. The discharge associated with a Candida infection is curry white and thick, and has a strong odor. Discharge due to trichomonas vaginalis is yellow white, foamy, and has a foul odor.
The client asks the nurse if there is a pill that can be ordered to control the symptoms of menopause. Which assessment finding is most important in determining nursing care in association with hormone replacement therapy?
- A. Presence of kyphosis
- B. Symptoms of hot flashes
- C. Family history of breast cancer
- D. History of osteoporosis
Correct Answer: C
Rationale: The risk of endometrial or breast cancer in women prescribed HRT may outweigh the benefits of relieving symptoms of menopause and preventing kyphosis or hip fractures associated with osteoporosis.