Deck 14: Gynecologic and Obstetric Surgery

Question 1

What classification of drugs are gynecologic/obstetric-related medications that require monitoring of blood pressure,assessment for continued bleeding,and monitoring of fundal response to the drug?

A) Oxytocics
B) Tocolytics
C) Antimetabolites
D) Cytotoxics

Answer 1

A
Oxytocics are medications that increase motor activity within the uterus by hormonal stimulation or by direct stimulation on the smooth muscles,usually resulting in uterine contractions.They may be used intraoperatively and postoperatively.The following are some nursing considerations after their administration: monitor blood pressure,assess for continued bleeding,and monitor fundal response to the drug.

Question 2

A 46-year-old gravida 2 para 2 returned to her gynecologist's office for a second Pap smear when her routine exam showed dysplastic cells in her cervical cytology test.She has a family history of cervical cancer and had laser ablation within the last 2 years for vulvar condylomata.She can expect her gynecologist to perform another Pap smear and:

A) colposcopy with endocervical biopsy.
B) hysteroscopy with cervical biopsy and frozen section.
C) colposcopy with cervical stripping procedure performed using a local anesthetic.
D) second-look vaginal exam with cervical Pap smear.

Answer 2

A
A colposcopy,with binocular magnification,is often performed in the surgeon's office.Patients who have an abnormal Pap smear suggestive of dysplasia undergo this examination.Colposcopy identifies cellular abnormalities involving the vulva,vagina,or cervix and helps to identify localized areas of dysplasia and carcinoma in situ (CIS).Endocervical curettage samples can be obtained during the colposcopic procedure to rule out invasive carcinoma or to detect early adenocarcinoma of the cervix.

Question 3

When catheterizing the female patient,the nurse must locate the urethra.The correct order of the external organs of the vulva listed anterior to posterior is:

A) mons pubis, labia majora, labia minora, urethra, clitoris, vaginal opening.
B) labia majora, labia minora, clitoris, urethra, vaginal opening, mons pubis.
C) mons pubis, labia majora, labia minora, clitoris, vestibular glands, vaginal opening.
D) labia majora, labia minora, urethra, mons pubis, clitoris, vaginal opening.

Answer 3

C
The external organs,referred to collectively as the vulva,include the mons pubis,the labia majora and labia minora,the clitoris,the vestibular glands,the vaginal vestibule,the vaginal opening,and the urethral opening,in that order.

Question 4

A 56-year-old postmenopausal obese woman is seen for her routine gynecologic exam.Which statement by the patient might prompt her physician to suspect that she may have endometrial cancer?

A) "I think I am having the normal symptoms of menopause, just a few hot flashes."
B) "I have vaginal bleeding and problems controlling my diabetes, but no other problems or pain."
C) "I am having intense genital itching and slight vaginal discharge."
D) "I often have feelings of abdominal fullness and bloating, even when I have not eaten."

Question 5

An example of perineal glands that secrete mucus is:

A) Skene's glands.
B) Bartholin's glands.
C) perineal glands.
D) labial glands.

Question 6

From the list below,select the statement that is true about fallopian tube cancer.

A) Fallopian tube cancer metastasizes to the ovaries and cervix.
B) Fallopian tube cancer is fast-growing in women with genital herpes.
C) Fallopian tube cancer is very rare, with an incidence of less than 1%.
D) Fallopian tube cancer is seen primarily as a metastasis from the small intestine.

Question 7

A 55-year-old woman with uterine cancer is undergoing an open panhysterectomy.During the procedure,a moment of light anesthesia causes the patient to move slightly.The perioperative nurse prepared to assist while the anesthesia provider titrated drugs to a deeper anesthetic level.What would be the next priority intervention by the perioperative nurse?

A) Document an "awareness under anesthesia" occurrence.
B) Tuck the patient's arms anatomically at her sides.
C) Reassess padding, protection, and positioning security.
D) Refine the nursing diagnosis to include risk for falls.

Question 8

The American Cancer Society estimated that invasive cervical cancers were diagnosed in over 12,500 women in 2016.Pap test screening provides early detection,aids in cancer treatment,and lowers mortality rates by detecting early changes in cervical cells and enabling prompt treatment.What is the recommended screening for women ages 30 to 65?

A) Pap test every 3 years
B) If regular screening in previous 10 years has been negative, and no history of previous serious preinvasive cancers (CIN₂, or CIN3) in the last 20 years, screening may stop
C) Pap test every 5 years
D) HPV and Pap test (co-testing) every 5 years

Question 9

During the preoperative nursing assessment in the ambulatory surgery receiving unit,the nurse notices bruises and abrasions in various stages of healing on her patient's abdomen,arms,and breasts.In a quiet and respectful manner,the nurse says,"The staff at our facility are concerned about your safety.We know that many things can happen in our lives that affect our mental and physical health." This technique is an appropriate method of establishing a sense of __________ with the patient while conveying caring and concern.

A) intimacy
B) normalcy
C) catharsis
D) trust and confidentiality

Question 10

A significant potential complication of hysteroscopy is the intravasation of the fluid used to distend the uterine cavity.Intravasation with systemic absorption can lead to:

A) cul-de-sac obliteration.
B) hyperkalemia.
C) uterine perforation.
D) hyponatremia.

Question 11

A 55-year-old woman with a possible latex sensitivity is scheduled for a panhysterectomy.She is at risk for postoperative urinary retention related to edema,anesthesia,opioids,or pain.An appropriate intraoperative nursing action would be to:

A) insert an indwelling silicone catheter using aseptic technique.
B) secure the tubing and collection container on top of the bed to prevent inadvertent stretching or stress on the catheter.
C) discuss with the patient the importance of limiting fluids in the postop period until the risk for urinary retention is no longer a concern.
D) employ the Credé maneuver to empty the bladder prior to prepping and draping.

Question 12

Ova travel through the fallopian tubes toward the uterus by which type of action?

A) Peristalsis
B) Pseudopodial movement
C) Brownian motion
D) Intra-abdominal pressure

Question 13

A 57-year-old patient's assessment and examination has revealed a family history of endometrial cancer.She has never been pregnant and has been taking hormone replacement therapy for 4 years.Her physician has scheduled her for a surgical procedure to obtain visual and pathologic information and provide treatment as indicated.The patient was sure that she would have to have a dilatation and curettage (D&C).Her surgery,on the operative schedule,would most probably be written as:

A) D&C with endometrial biopsies.
B) hysteroscopy with endometrial ablation.
C) D&C with endometrial and cervical biopsies.
D) D&C with endometrial washings, frozen section, possible total abdominal hysterectomy.

Question 14

A 55-year-old woman with uterine cancer is scheduled for an open panhysterectomy.After the incision is made and primary dissection accomplished,she will be positioned in Trendelenburg position to facilitate exposure of the lower pelvis and displacement of the small bowel from the operative area.The patient is at risk for compromise and injury related to prolonged Trendelenburg tilt,which promotes:

A) decreased pulmonary compliance and functional residual capacity.
B) increased popliteal congestion and peripheral vascular collapse.
C) shearing force injury from sliding toward the head of the operating room (OR) bed.
D) avascular ischemic changes to the lower leg and feet from gravitational devascularization.

Question 15

A middle-aged mother of nine children from an orthodox community is seen in the gynecologic clinic for heavy vaginal bleeding.She is anxious and shy and timidly asks the nurse if she may be seen only by a female doctor.An appropriate nursing action by the female nurse would be to:

A) demonstrate strategies for the patient to verbalize, reduce, and control her anxiety.
B) maintain the patient's privacy and convey empathy and respectful regard for her culture.
C) inform the patient that all of the doctors are male, but they treat many of the women from her community.
D) suggest the patient reschedule her appointment for a day when a female physician has clinic hours.

Question 16

A 32-year-old woman,gravida 1 para 0,requires an emergency cesarean section as part of the management strategy for severe preeclampsia.Prior to surgery,she received magnesium sulfate 5 g deep IM and has IV magnesium sulfate infusing at 2 g/hr.What perioperative nursing considerations are related to the magnesium sulfate infusion?

A) Place patient in right recumbent position.
B) Prepare patient for biophysical profile (BPP).
C) Ensure IV calcium gluconate is available.
D) Ensure methotrexate is available.

Question 17

A 67-year-old former competitive track athlete with debilitating osteoarthritis is scheduled for a laparoscopic-assisted vaginal hysterectomy (LAVH).During the preoperative assessment,she tells the perioperative nurse that,while she is in excellent health for her age,her hip and leg joints are tender,and her movement is limited.The nurse explains that during the procedure she will be "up in stirrups" but will be handled gently and protected from further discomfort.An appropriate nursing action,after the patient is transferred to the OR bed and before anesthesia induction,is to:

A) place her in the preferred lithotomy position and adjust to her position of comfort.
B) discuss muscle relaxation and analgesic medication options with the anesthesia provider.
C) discuss nonlithotomy positioning options with the surgeon.
D) use a heel suspension device.

Question 18

A 72-year-old patient with multicentric carcinoma in situ (CIS)of the vulva,without evidence of leukoplakia and pruritus is scheduled for surgery.She has a history of prior papillomavirus infection.Select the most appropriate surgical option.

A) Radical vulvectomy with inguinal lymph node dissection
B) Superficial vulvectomy
C) CO₂ laser surface ablation of the vulvar lesions
D) Simple vulvectomy

Question 19

During cesarean delivery,which is the priority instrument or device needed as soon as the fetal head is delivered?

A) Broad Deaver or bladder blade retractor
B) Umbilical cord clamp
C) Bulb syringe or aspirator tip
D) Sponge forceps with folded gauze sponge

Question 20

A 55-year-old woman with uterine cancer is undergoing an open panhysterectomy.She is positioned in Trendelenburg position to facilitate exposure of the lower pelvis and displacement of the small bowel from the operative area.The surgical team gently abducted the patient's arms into position on padded arm boards at less than 90 degrees with palms facing up.Extra padding was placed under her elbows,and an arm board strap was secured over her forearm.The arm boards were locked into place to prevent inadvertent abduction.This important maneuver is designed as a risk reduction strategy to prevent:

A) axillary tension.
B) brachial plexus injury.
C) celiac plexus injury.
D) elbow torsion with displacement.

Question 21

An experienced perioperative nurse has recently been hired at the new ambulatory surgery center to lead their endometrial ablation and fibroid embolization program.She has created a teaching tool with relevant postprocedure care information for patients and caregivers and is developing a training module for the nurses to learn techniques for teaching patients before surgery and before discharge.She is teaching the nurses how to encourage patients and caregivers to reflect on what they have just learned in order to elicit a "teach-back" scenario.Select the reflective statements and questions appropriate for a post-endometrial ablation patient,to determine their understanding of her discharge instructions.

A) "Tell me what you know about vaginal bleeding."
B) "What do you do and who do you call if you notice heavy bleeding?"
C) "Do you feel that you are ready to take care of yourself?"
D) "What are your most troubling concerns about going home right now?"
E) "What are the activities that you must avoid for at least 2 weeks?"

Question 22

During the skin preparation for a gynecologic procedure that requires both an abdominal and a vaginal prep,the perioperative nurse must ensure that cross-contamination does not occur.Select two nursing interventions that support cross-contamination prevention.

A) Tuck sterile towels under the patient's buttocks and both sides of the abdomen.
B) Insert the urinary catheter before beginning the prep.
C) Prep the abdomen before beginning the vaginal prep.
D) Use two separate prep trays (one for the abdomen, one for the vagina).

Question 23

A 29-year-old woman is in the emergency department (ED)with a ruptured appendix.Before the ED room nurse and surgical resident transported her to the OR,the nurse called to inform them that the patient is 27 weeks' pregnant.What special considerations must the perioperative nurse and anesthesia provider address with this new information?

A) The fetal heart rate will have to be monitored.
B) The patient may need rapid induction of general anesthesia or spinal anesthesia.
C) There is a possibility that tocolytic drugs may need to be administered.
D) There is a possibility that oxytocin may need to be administered.
E) A lateral tilt or wedge under the left hip may be required.

Question 24

A 32-year-old gravida 2 para 2 is scheduled for a hysteroscopy for heavy bleeding of 2 weeks duration and possible retrieval of a displaced intrauterine device (IUD).She is tired and weak from blood loss and has marked anemia.During the vaginal prep,the perioperative nurse noted several large blood clots.The nurse communicated an estimated blood loss amount to the anesthesia provider and surgeon.After the patient was draped,the circulating nurse connected the hysteroscopic insufflator,pressure-infusion pump,and a video camera,light source,and monitor.The uterine cavity was distended with Ringer's Lactate at a continuous pressure through the hysteroscopic pump into the irrigating channel of the hysteroscope.The circulating nurse was relieved for lunch after she gave a hand-off report to her relief nurse.What patient safety information relevant to the hysteroscopy should be given to the receiving relief nurse before the circulating nurse leaves for lunch?

A) A review of the amount of hysteroscopy fluid infused and fluid received back
B) A reminder to monitor for discrepancies of 1 to 1.5 L
C) A reminder to monitor for signs of tachydysrhythmias
D) A review of current fluid loss calculations based on BMI