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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.
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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 client who wishes to preserve childbearing ability asks the nurse to explain how taking oral contraceptives will work in the management of endometriosis. Which is the best response by the nurse?
- A. Symptoms of endometriosis are increased during normal menstrual cycle.
- B. Conraceptives will allow blood to be diverted to the peritoneal cavity.
- C. Trapping blood causes less pain and discomfort for clients with endometriosis.
- D. Endometriosis is usually cured with surgical menopause.
Correct Answer: A
Rationale: The use of estrogen-progestin contraceptives keeps the client in a non-bleeding phase of the menstrual cycle, therefore decreasing ectopic tissue from shedding and causing extra uterine bleeding. Blood that is trapped in the peritoneal cavity causes more pain or adhesions form. Endometriosis is cured by natural or surgical menopause but can be medically instituted for periods of time with the use of oral contraceptives.
Which assessment finding will most likely influence the treatment regimen selected by a client with endometriosis?
- A. Presence of pain
- B. Family planning
- C. Dysmenorrhea
- D. Presence of chocolate cyst
Correct Answer: B
Rationale: Selection of a more conservative option may be indicated to preserve the possibility for future childbearing. Pain, dysmenorrhea, and chocolate cysts are all symptoms associated with endometriosis and can influence decision for treatment.
The nurse is teaching a client about the use of a pessary. Which statement by the client indicates the need for additional instruction?
- A. A white or yellow vaginal discharge is expected and normal.
- B. I need to apply a sterile lubricant to the pessary before reinserting it.
- C. After removal, I should wash the pessary with warm soapy, water, rinse, and dry it.
- D. I should call the physician if I notice any discomfort with the pessary.
Correct Answer: A
Rationale: A white or yellow discharge from the vagina is not a normal finding and should be reported to the physician because it may indicate an infection. A sterile lubricant is applied to the pessary before it is reinserted. After removal, the pessary should be washed thoroughly with warm soapy water, followed by rinsing and drying. Discomfort may indicate that a pessary has been inserted incorrectly, it has moved, or that it is causing irritation. These problems should be reported to the physician.
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.