Nokea
The nurse is caring for a client who has just been diagnosed with o endometriosis. The client has been hoping to have children with her partner. Which statement by the nurse is most appropriate to provide the client with support and guidance about treatment options?
- A. Treatment is essential, so you really need to make a decision pretty quickly.
- B. If it was me, I would probably choose the medication options.
- C. If might help to include your partner in any of the discussion about options.
- D. The test results are clear and another physician would tell you the same thing.
Correct Answer: C
Rationale: The nurse assists the client through the decision-making process as it applies to family planning and medical or surgical treatment. Suggesting that the client include a partner or significant other in the discussion of options would be most helpful and therapeutic. The client does not need to make a decision immediately. The nurse should not give advice or offer personal opinions to influence the client's choice. The nurse should support the client's option of seeking a second opinion.
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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.
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.
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 teaching a client with a history of recurrent vaginal infections about ways to prevent this condition. What should the nurse include in the teaching? Select all that apply.
- A. Baths daily.
- B. Wipe from back to front after bowel movements.
- C. Avoid douching more than once every 3 days.
- D. Change from a wet swimsuit as soon as possible.
- E. Wash hands and devices that are inserted into the vagina.
Correct Answer: A,D,E
Rationale: The nurse should teach the client to bathe daily with particular attention to perineal hygiene, wipe from front to back after bowel movements, avoid douching more than once a week, change from a wet bathing suit as soon as possible, and wash hands and devices that are inserted into the vagina.
The nurse is caring for a client who has experienced repeated episodes of vaginitis. Which assessment finding does the nurse explain is the most likely cause?
- A. Tub baths preferred over shower
- B. Healthy sex life
- C. Occasional use of vinegar douches
- D. Type 2 diabetes mellitus
Correct Answer: D
Rationale: Unregulated blood sugars can result in alteration of the vaginal environment and promote the presence of glycogen in vaginal mucus, which supports the growth of microorganisms. Monitoring and controlling blood sugars would be key in a client with diabetes. Tub baths and participation in a healthy sex life are not associated with vaginitis. Frequent douching should be avoided.