Deck 13: Gynecologic and Obstetric Surgery

Question 1

Margie Donaldson,a 56-year-old postmenopausal obese woman,is seen for her routine gynecologic exam.What statement by Margie might prompt her physician to suspect that Margie 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."

Answer 1

B
Endometrial cancer is the most common gynecologic cancer and is responsible for approximately 42,160 new cases of cancer each year in the United States.Patients with this type of cancer may be asymptomatic,or they may experience postmenopausal bleeding as their primary symptom (American Cancer Society,2009).

Question 2

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

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

Answer 2

D
Simple vulvectomy is removal of the labia majora and labia minora,possibly (but not preferably)the glans clitoris,and occasionally tissue from the perianal area.A simple vulvectomy is usually performed to treat carcinoma in situ of the vulva when it is multicentric.Occasionally a vulvectomy is necessary for the treatment of either leukoplakia or intractable pruritus,especially when a skinning procedure is impractical or has failed.

Question 3

Margie Donaldson's 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.Margie was sure that she would have to have a D&C (dilatation and curettage).Margie's surgery,on the operative schedule,would most probably be written as:

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

Answer 3

C
D&C is done either for diagnostic purposes or as a form of therapy for a variety of pelvic conditions,such as abnormal uterine bleeding or primary dysmenorrhea .D&C may also be performed when carcinoma of the endometrium is suspected.Indications for LAVH may be absence of genital prolapse,required adnexectomy,history of abdominopelvic surgery,salpingitis or endometriosis,lymphadenectomy,and endometrial cancer.

Question 4

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 said,"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) normalizing
C) catharsis
D) trust and confidentiality

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

Miranda Cox returned to her gynecologist's office for a second Pap smear when her routine exam showed dysplastic cells in her cervical cytology test.Miranda 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 skinning procedure performed using a local anesthetic.
D) second-look vaginal exam with cervical Pap smear.

Question 7

Surgical and nonsurgical options exist for endometriosis.Select the triad that best reflects nonsurgical and nonhormonal options.

A) Cul-de-sac obliteration,NSAIDs,and danazol
B) Nerve block,analgesics,and acupuncture
C) NSAIDs,acupuncture,and RH-486
D) Analgesics,anxiolytics,and acupuncture

Question 8

Matilda Gunderson,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:

A) insert an indwelling catheter using aseptic technique and monitor urinary output.
B) secure the tubing to prevent inadvertent stretching or stress on the catheter.
C) use a latex-free catheter.
D) All of the options are appropriate nursing actions for Matilda.

Question 9

Select the congenital anomaly that best reflects indications for fetal surgery.

A) Imperforate anus
B) Tracheoesophageal fistula
C) Congenital diaphragmatic hernia
D) Nonobstructive uropathy

Question 10

Marla Moriarity,a 32-year-old recently unemployed and uninsured college professor,is diagnosed with an early ectopic pregnancy.Her obstetrician has given her the option of surgical or medical therapy.She is well-informed about the details of each medical and surgical option,but her primary concern about her condition is that her decision will be based upon her strong cultural belief system that will not sanction the destruction of the fetus.Marla's treatment decision will most likely be:

A) the medical therapy of IM methotrexate for 5 to 7 days.
B) laparoscopic injection of methotrexate to the extrauterine gestational sac.
C) emergency laparotomy for a ruptured ectopic pregnancy.
D) salpingectomy.

Question 11

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,urethra,vaginal opening.
D) labia majora,labia minora,urethra,mons pubis,clitoris,vaginal opening.

Question 12

Lisa Torentino,a 29-year-old woman,is in the emergency department (ED)with a ruptured appendix.Before the ED nurse and surgical resident transported Lisa to the OR,the nurse called to inform them that Lisa 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 in the postoperative recovery unit.
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 to induce labor.
D) A lateral tilt or wedge under the left hip may be required.

Question 13

The surgical team gently abducted Matilda's arms into position on padded armboards at less than 90 degrees with palms facing up.Extra padding was placed under her elbows and an armboard strap was secured over her forearm.The armboards 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 14

Many gynecologic conditions and diseases cause chronic pelvic pain.Both surgical and nonsurgical therapies include invasive manipulations.Select the least invasive treatment option for chronic pelvic pain that is recommended by the Agency for Healthcare Research and Quality (AHRQ).

A) Nerve block with biofeedback
B) Ureterosacral nerve ablation with GnRH agonists with add-back therapy
C) Trigger point injections and acupuncture
D) None of the above therapies are either noninvasive or recommended by the AHRQ

Question 15

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

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

Question 16

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 17

Matilda Gunderson,a 55-year-old woman with uterine cancer,is scheduled for an open panhysterectomy.She is positioned in low lithotomy with her legs symmetrically arranged in padded cradle stirrups.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.Matilda 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 OR bed.
D) avascular ischemic changes to the lower leg and feet from gravitational devascularization.

Question 18

During the procedure,a moment of light anesthesia caused Matilda 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 Matilda's arms anatomically at her sides.
C) Reassess padding,protection,and positioning security.
D) Refine the nursing diagnosis to include risk for falls.

Question 19

Evelyn Pettigrew is a 67-year-old former competitive track athlete with debilitating osteoarthritis;she is scheduled for a laparoscopic-assisted vaginal hysterectomy (LAVH).During the preoperative assessment,Evelyn 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 to Evelyn 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 Evelyn is transferred to the OR bed and before anesthesia induction,is:

A) place Evelyn 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 leg positioning options with the surgeon.
D) use padded straight-leg stirrups.

Question 20

Shoshana Rokem,a middle-aged mother of 9 children from the orthodox community,is seen in the GYN 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:

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

Question 21

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 to drainage 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 22

Angela Wiggins,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 patient education booklet 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 her understanding of her discharge instructions.Select all that apply.

A) "Tell me what you know about vaginal bleeding."
B) "What do you do and who do you call if you notice more than a tablespoon worth of 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 23

Tui Nyguen,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 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.She communicated an estimated blood loss amount to the anesthesia provider and surgeon.After Tui 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 32% dextran 70 in dextrose (Hyskon)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? Select all that apply.

A) A review of the amount of Hyskon infused and fluid received back
B) A reminder to monitor for discrepancies over 500 ml
C) A reminder to monitor for signs of tachydysrhythmias
D) A review of current fluid loss calculations based on sponge weights
E) A request to soak instruments in sterile saline as soon as the procedure is finished

Question 24

What classification of drugs are GYN/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