Nokea
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.
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Following a radical vulvectomy, the nurse is preparing the client for discharge to home. Which care intervention would be considered the priority for this client?
- A. Relieving edema to lower extremities
- B. Alterations for sexual function
- C. Prevention of wound complications
- D. Care of colostomy site
Correct Answer: C
Rationale: Prevention of complications and infection is paramount due to the location of the wound. The perineal area provides a warm, dark environment that supports the growth of microorganisms that can be introduced into the wound. With a radical vulvectomy, is is likely to find surgical drains and urinary catheter that can also interfere with the maintenance of the wound. Relieving edema to the lower extremities may be a necessary part of care if the lymph nodes and blood vessels are disturbed. The client may have a colostomy and care instructions should be provided. Alteration in sexual function needs to be addressed but is not a priority for the initial stage of healing.
The nurse is collecting assessment data on a client who is reporting a vaginal discharge that is cottage cheese-like in appearance. Which pathogen is the most likely cause for this symptom?
- A. Gonococci
- B. Candida albicans
- C. Trichomonas vaginalis
- D. Gardnerella vaginalis
Correct Answer: B
Rationale: Candida albicans is a yeast infection that presents with a thick, curdy white discharge. Gonococcus is the organism that causes gonorrhea and presents with a yellow, mucoppuntent discharge. Trichomonas vaginalis presents with a foamy, white foul-smelling discharge and Gardnerella vaginalis is a watery, fishy-smelling discharge.
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.
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 is admitted to the hospital with the diagnosis of sepsis secondary to pelvic inflammatory disease. Which transmission-based precaution will be initiated by the nurse?
- A. Standard precautions
- B. Protective precautions
- C. Contact precautions
- D. Droplet precautions
Correct Answer: C
Rationale: Contact isolation is a category of transmission-based precautions for controlling the spread of infectious microorganisms found in body fluids. Standard precautions are used in the care of all clients in the prevention of HIV and hepatitis. Protective precautions are instituted when a client is immune compromised and needs protected from others. Droper precautions are not indicated with PID.