Nokea
The nurse is caring for a young adult client who reports excessive menstrual flow with menses lasting 10 days each month. Which treatment option does the nurse anticipate the physician will order for symptomatic relief for this client?
- A. Dilation and curettage (D and C)
- B. Hormonal contraceptives
- C. Endometrial ablation
- D. Uterine balloon therapy
Correct Answer: B
Rationale: When combination hormonal contraceptives are administered, they produce a light menstrual period and are helpful in the management of menorrhagia. Dilation and curettage can provide symptomatic relief, however, the effectiveness is limited. Endometrial ablation and uterine balloon therapy cause the endometrium to slough and are cost-effective but are only used after childbearing has completed.
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Which risk factor(s) supports the need for ovarian cancer screening? Select all that apply.
- A. Carrying genetic mutation for the disease
- B. Being nulliparous
- C. Family history of lung cancer
- D. Breastfeeding
- E. Use of oral contraceptives for 5 years or more
- F. Multiple full-term pregnancies
Correct Answer: A,B
Rationale: Woman who are nulliparous, have a family history of ovarian cancer, and/or carry a genetic mutation for it tend to develop ovarian cancer more often than others. Preventive measures recommended to lower the risk of ovarian cancer include having at least 2 full-term pregnancies, breastfeeding after pregnancies, and using oral contraceptives for 3 years or more. History of lung cancer is not a risk factor.
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.
Following a colopsopsy, the confirmation of in situ carcinoma of the cervix has been determined. Which comment by the client indicates an appropriate understanding of the diagnosis?
- A. I will not need any further treatment.
- B. The cancer has not spread.
- C. I will need surgery and chemotherapy to increase my odds, for survival.
- D. I can wait until I have finished having babies to seek treatment.
Correct Answer: B
Rationale: Carcinoma in situ means the cancer has not left the original site and therefore has not invaded other tissues. Further treatment is required, which usually consists of cryossurgery or hysterectomy. Surgery with adjuvant chemotherapy is usually reserved for cancers that are more advanced. Even though cervical cancers tend to be slower growing, treatment should not be delayed.
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.
The nurse is caring for a client with polycystic ovarian syndrome. On which associated problem(s) will the nurse focus teaching? Select all that apply.
- A. Hypertension
- B. Hyperlippiedemia
- C. Infertility
- D. Absence of body hair
- E. Weight loss
- F. Decreased Insulin
Correct Answer: A,B,C
Rationale: Polycystic ovarian syndrome is associated with multiple endocrine abnormalities such as abnormal lipid levels, hypertension, and difficulty with conceaving due to interference of ovulation. Other symptoms include excessive body hair, weight gain, and overproduction and inefficient use of insulin.