Ricci, Kyle & Carman – Chapter 8 – Flashcards
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The nurse would refer a client, age 54, for follow-up for suspected endometrial carcinoma if she reports which of the following?
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A) Use of oral contraceptives between ages 18 and 25 B) Onset of painless, red postmenopausal bleeding C) Menopause occurring at age 46 D) Use of intrauterine device for 3 years Ans: B Feedback: Any episode of bright red, painless bleeding occurring after menopause needs to be investigated. Abnormal uterine bleeding in postmenopausal women should be regarded with suspicion. Oral contraceptive use is associated with cervical cancer. Late menopause (after age 52) is associated with endometrial cancer. Use of an intrauterine device is not associated with endometrial cancer.
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Which of the following instructions would the nurse include when preparing a woman for a Pap smear?
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A) "Refrain from sexual intercourse for 1 week before the test." B) "Wear cotton panties on the day of the test." C) "Avoid taking any medications for 24 hours." D) "Do not douche for 48 hours before the test." Ans: D Feedback: The nurse should instruct the woman not to douche for 48 hours before the test to prevent washing away cervical cells, which might be abnormal. Sexual intercourse should be avoided for 48 hours before the test. Wearing cotton panties is unrelated to preparation for a Pap smear. Medications do not need to be withheld before the test.
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A woman comes to the clinic for a routine checkup. A history of exposure to which of the following would alert the nurse that she is at increased risk for cervical cancer?
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A) Hepatitis B) Human papillomavirus C) Cytomegalovirus D) Epstein-Barr virus Ans: B Feedback: Human papillomavirus is a major causative factor for cervical cancer. Hepatitis, cytomegalovirus, and Epstein-Barr virus are not associated with the development of cervical cancer.
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A client is scheduled to have a Pap smear. After the nurse teaches the client about the Pap smear, which of the following client statements indicates successful teaching?
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A) "I need to douche the night before with a mild vinegar solution." B) "I will take a bath first thing that morning to make sure I'm clean." C) "I will not engage in sexual intercourse for 48 hours before the test." D) "I will get a clean urine specimen when I first wake up the morning of the test." Ans: C Feedback: The woman should refrain from sexual intercourse for 48 hours before the test because sperm can obscure the specimen. Douching should be avoided for 48 hours before the test to prevent washing away cervical cells, which might be abnormal. Although a bath is an appropriate hygiene measure, it is not required before a Pap smear. Collecting a urine specimen also is not necessary.
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Which finding obtained during a client history would the nurse identify as increasing a client's risk for ovarian cancer?
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A) Multiple sexual partners B) Consumption of a high-fat diet C) Underweight D) Grand multiparity (more than five children) Ans: B Feedback: Risk factors for ovarian cancer include a high-fat diet, obesity, nulliparity, early menarche, late menopause, and increasing age. Having multiple sexual partners is a risk factor for cervical cancer.
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A client is scheduled for cryosurgery to remove some abnormal tissue on the cervix. The nurse teaches the client about this treatment, explaining that the tissue will be removed by which method?
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A) Freezing B) Cutting C) Burning D) Irradiating Ans: A Feedback: Cryosurgery destroys abnormal cervical tissue by freezing. Conization involves cutting out a cone-shaped section of tissue. Laser therapy destroys cervical tissue by using high-energy light to burn it off. Radiation therapy involves irradiating the tissue for destruction.
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Which of the following statements best indicates that a client has taken self-care measures to reduce her risk for cervical cancer?
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A) "I've really cut down on the amount of caffeine I drink every day." B) "I've thrown out all my bubble baths and just use soap and water now." C) "Every time I have sexual intercourse, I douche." D) "My partner always uses a condom when we have sexual intercourse." Ans: D Feedback: Unprotected sexual intercourse is a risk factor for cervical cancer. Use of barrier methods of contraception such as condoms is a key measure for reducing the risk for cervical cancer. Cessation of smoking and drinking alcohol, not caffeine, also are effective measures for risk reduction. Eliminating irritants such as bubble baths is a general measure to reduce perineal irritation and urinary tract infections. Douching has no effect on risk reduction for cervical cancer.
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A client is suspected of having endometrial cancer. The nurse would most likely prepare the client for which procedure to confirm the diagnosis?
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A) Transvaginal ultrasound B) Colposcopy C) Pap smear D) Endometrial biopsy Ans: D Feedback: An endometrial biopsy is the procedure of choice to make the diagnosis of endometrial cancer. A transvaginal ultrasound may be used to evaluate the endometrial cavity and measure the endometrial thickness to detect endometrial hyperplasia, but it does not confirm the diagnosis. Colposcopy is used to diagnose cervical cancer. A Pap smear screens for abnormal cervical cells.
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Which of the following descriptions would the nurse include when teaching a client about her scheduled colposcopy?
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A) "A gel will be applied to your abdomen and a microphone-like device will be moved over the area to identify problem areas." B) "A solution will be wiped on your cervix to identify any abnormal cells, which will be visualized with a magnifying instrument." C) "Scrapings of tissue will be obtained and placed on slides to be examined under the microscope." D) "After you receive anesthesia, a small device will be inserted into your abdomen near your belly button to obtain tissue samples." Ans: B Feedback: A colposcopy is a microscopic examination of the lower genital tract using a magnifying instrument. Use of a microphone-like device over the abdomen describes an ultrasound. Obtaining tissue scrapings that are examined under a microscope describes a Pap smear. Insertion of a device under anesthesia near the umbilicus describes a biopsy obtained via laparoscopy.
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The nurse is preparing a presentation for a local women's group about ways to reduce the risk of reproductive tract cancers. Which of the following would the nurse include?
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A) Blood pressure evaluation every 6 months B) Yearly Pap smears starting at age 40 C) Yearly cholesterol screening starting at age 45 D) Consumption of two to three glasses of red wine per day Ans: C Feedback: Staying healthy is a major way to reduce one's risk for cancer. Cholesterol should be checked annually starting at age 45. Blood pressure should be evaluated at least every 2 years. Pap smears are recommended every 1 to 3 years for sexually active women between the ages of 21 and 65. Alcohol should be consumed in moderation (not more than one drink per day), if at all.
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The daughter of a woman who has been diagnosed with ovarian cancer asks the nurse about screening for this cancer. Which response by the nurse would be most appropriate?
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A) "Currently there is no reliable screening test for ovarian cancer." B) "A Pap smear is almost always helpful in identifying this type of cancer." C) "There's a blood test for a marker, CA-125, that if elevated indicates cancer." D) "A genetic test for two genes, if positive, will identify the ovarian cancer." Ans: A Feedback: Currently there are no specific clinical guidelines for ovarian cancer screening. A Pap smear is used to screen for cervical cancer. The CA-125 marker may be elevated in women with ovarian cancer, but it is not specific for this cancer and may be elevated in other malignancies. Genetic testing via BRCA-1 and BRCA-2 provides information about a woman's risk but does not predict if the woman will develop cancer.
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Which of the following would the nurse be least likely to suggest when teaching a group of young women how to reduce their risk for ovarian cancer?
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A) Pregnancy B) Oral contraceptives C) Feminine hygiene sprays D) Breast-feeding Ans: C Feedback: Risk reduction strategies include pregnancy, use of oral contraceptives, and breast-feeding. Women should avoid using talc and hygiene sprays on the genital area.
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A woman is diagnosed with adenocarcinoma of the endometrium in situ. The nurse interprets this as indicating which of the following about the cancer?
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A) Spread to the uterine muscle wall B) Found on the endometrial surface C) Spread to the cervix D) Invaded the bladder Ans: B Feedback: Carcinoma in situ is found only on the endometrial surface. In stage I, the cancer has spread to the uterine muscle wall. In stage II, it has spread to the cervix. In stage IV, it has invaded the bladder mucosa with distant metastases to the lungs, liver, and bone.
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When preparing a woman with suspected vulvar cancer for a biopsy, the nurse expects that the lesion would most likely be located at which area?
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A) Labia majora B) Labia minora C) Clitoris D) Prepuce Ans: A Feedback: The diagnosis of vulvar cancer is made by biopsy of the suspicious lesion, which is most commonly found on the labia majora.
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When describing the various types of reproductive tract cancers to a local women's group, which of the following would the nurse identify as the least common type?
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A) Vulvar B) Vaginal C) Endometrial D) Ovarian Ans: B Feedback: Of the cancers listed, vaginal cancer is the rarest, with only about 1 out of every 100 cancers of the female reproductive tract. Vulvar cancer represents approximately 5% of female genital cancers. Endometrial cancer is the fourth most common gynecologic malignancy. Ovarian cancer is the eighth most common cancer among women and the fourth most common cause of cancer deaths for women in the United States.
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When assessing a female client for the possibility of vulvar cancer, which of the following would the nurse most likely expect the client to report? (Select all that apply.)
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A) Abnormal vaginal bleeding B) Persistent vulvar itching C) History of herpes simplex D) Lesion on the cervix E) Abnormal Pap smear Ans: B, C Feedback: In most cases, the woman with vulvar cancer reports persistent vulvar itching, burning, and edema that does not improve with the use of creams or ointments. A history of condyloma, gonorrhea and herpes simplex are some of the factors for greater risk for vulvar intraepithelial neoplasia. Abnormal vaginal bleeding, lesion on the cervix, or abnormal Pap smear are not associated with vulvar cancer.
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A nurse is reviewing the medical record of a woman diagnosed with vulvar cancer. Which of the following would the nurse identify as a risk factor for this cancer? (Select all that apply.)
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A) Age under 40 years B) HPV 16 exposure C) Monogamous sexual partner D) Hypertension E) Diabetes Ans: B, D, E Feedback: Risk factors associated with vulvar cancer include age over 50 years, history of exposure to HPV 16, multiple sex partners, hypertension, and diabetes.
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A nurse is assisting with the collection of a Pap smear. When collecting the specimen, which of the following is done first?
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A) Insertion of the speculum B) Swabbing of the endocervix C) Spreading of the labia D) Insertion of the cytobrush Ans: C Feedback: For a Pap smear, the practitioner obtains a sample by spreading the labia; inserting the speculum; inserting the cytobrush and swabbing the endocervix; and inserting the plastic spatula and swabbing the cervix.
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The plan of care for a woman diagnosed with a suspected reproductive cancer includes a nursing diagnosis of disturbed body image related to suspected reproductive tract cancer and impact on sexuality as evidenced by the client's statement that she is worried that she won't be the same. Which of the following would be an appropriate outcome for this client?
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A) Client will verbalize positive statements about self and sexuality. B) Client will demonstrate understanding of the condition and associated treatment. C) Client will exhibit positive coping strategies related to diagnosis. D) Client will identify misconceptions related to her diagnosis. Ans: A Feedback: An appropriate outcome for disturbed body image would be that the client verbalizes positive statements about herself and her sexuality. Demonstrating understanding of the condition and treatment and identifying misconceptions would be appropriate for a nursing diagnosis of deficient knowledge. Exhibiting positive coping strategies would be appropriate for a nursing diagnosis of anxiety.
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During a routine health check-up, a young adult woman asks the nurse about ways to prevent endometrial cancer. Which of the following would the nurse most likely include? (Select all that apply.)
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A) Eating a high-fat diet B) Having regular pelvic exams C) Engaging in daily exercise D) Becoming pregnant E) Using estrogen contraceptives Ans: B, C, D Feedback: Measures to prevent endometrial cancer include eating a low-fat diet, having regular pelvic exams after the age of 21, engaging in daily exercise, becoming pregnant (pregnancy serves as a protective factor), and asking the practitioner about the use of combination estrogen and progestin pills.
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After teaching a group of students about cervical cancer, the instructor determines that the teaching was successful when the students identify which of the following as the area included with a cone biopsy?
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A) Clitoris B) Uterine fundus C) Ovarian follicle D) Transformation zone Ans: D Feedback: When a cone biopsy is performed, a cone-shaped section of the cervix is removed. The base of the cone is formed by the ectocervix (outer part of the cervix) and the point or apex of the cone is from the endocervical canal. The transformation zone is contained within the cone sample. A cone biopsy is not obtained from the clitoris, uterine fundus, or ovarian follicle.
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A woman is scheduled for diagnostic testing to evaluate for endometrial cancer. The nurse would expect to prepare the woman for which of the following?
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A) CA-125 testing B) Transvaginal ultrasound C) Pap smear D) Mammography Ans: B Feedback: A transvaginal ultrasound would be used to evaluate endometrial thickness to determine if an endometrial biopsy is needed. CA-124 testing is a nonspecific blood test used as a tumor marker. A Pap smear is used to screen for cervical cancer. Mammography is used to screen for breast cancer.
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A nurse is conducting a class for a local woman's group about recommendations for a Pap smear. One of the participants asks, "At what age should a woman have her first Pap smear?" The nurse responds by stating that a woman should have her first Pap smear at which age?
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A) 18 B) 21 C) 25 D) 28 Ans: B Feedback: According to the American Cancer Society, a woman should have her first Pap smear at age 21.
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An instructor is describing the development of cervical cancer to a group of students. The instructor determines that the teaching was successful when the students identify which area as most commonly involved?
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A) Internal cervical os B) Junction of the cervix and fundus C) Squamous-columnar junction D) External cervical os Ans: C Feedback: Cervical cancer starts with abnormal changes in the cellular lining or surface of the cervix. Typically these changes occur in the squamous-columnar junction of the cervix. Here, cylindrical secretory epithelial cells (columnar) meet the protective flat epithelial cells (squamous) from the outer cervix and vagina in what is termed the transformation zone.
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A client has an abnormal Pap smear that is classified as ASC-US. Based on the nurse's understanding of this classification, the nurse would expect which of the following?
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A) Immediate colposcopy B) Testing for HPV C) Repeat Pap smear in 4 to 6 months D) Cone biopsy Ans: C Feedback: For the classification of ASC-US, the client would have a repeat Pap smear in 4 to 6 months or be referred for a colposcopy. A referral for colposcopy with HPV testing is indicated if the results indicated ASC-H classification. An immediate colposcopy would be indicated for atypical glandular cells and adenocarcinoma in situ. A cone biopsy would be used to evaluate the lesion and may be used as treatment to remove any precancers and very early cancers.
