Med Surg 2 Test 4: Cervical and Ovarian Cancers

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New Book

Brunner & Saddarth 14th ed


A premenopausal patient is complaining of vaginal spotting and sharp, colicky lower abdominal pain.
She informs the nurse that her period is 2 weeks late. The nurse should recognize a need for this patient
to be investigated for what health problem?
A) Trichomonas vaginalis
B) Ectopic pregnancy
C) Cervical cancer
D) Fibromyalgia

Ans: B
Clinical symptoms of an ectopic pregnancy include delay in menstruation of 1 to 2 weeks, vaginal
spotting, and sharp, colicky pain. Trichomonas vaginalis causes a vaginal infection. Cervical cancer and
fibromyalgia do not affect menstruation.


The school nurse is presenting a class on female reproductive health. The nurse should describe what
aspect of Pap smears?
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 1059
A) The test may be performed at any time during the patients menstrual cycle.
B) The smear should be done every 2 years.
C) The test can detect early evidence of cervical cancer.
D) Falsepositive Pap smear results occur mostly from not douching before the examination

Ans: C
The test should be performed when the patient is not menstruating. Douching washes away cellular
material. The test detects cervical cancer, and falsenegative Pap smear results occur mostly from
sampling errors or improper technique. For most women, a Pap smear should be done annually.


When teaching patients about the risk factors of cervical cancer, what would the nurse identify as the
most important risk factor?
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 1075
A) Late childbearing
B) Human papillomavirus (HPV)
C) Postmenopausal bleeding
D) Tobacco use

Ans: B
HPV is the most salient risk factor for cervical cancer, exceeding the risks posed by smoking, late
childbearing, and postmenopausal bleeding.


A female patient with HIV has just been diagnosed with condylomata acuminata (genital warts). What
information is most appropriate for the nurse to tell this patient?
A) This condition puts her at a higher risk for cervical cancer; therefore, she should have a
Papanicolaou (Pap) test annually.
B) The most common treatment is metronidazole (Flagyl), which should eradicate the problem within
7 to 10 days.
C) The potential for transmission to her sexual partner will be eliminated if condoms are used every
time they have sexual intercourse.
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 1077
D) The human papillomavirus (HPV), which causes condylomata acuminata, cannot be transmitted
during oral sex.

Ans: A
HIV-positive women have a higher rate of HPV. Infections with HPV and HIV together increase the risk
of malignant transformation and cervical cancer. Thus, women with HIV infection should have frequent
Pap smears. Because condylomata acuminata is a virus, there is no permanent cure. Because
condylomata acuminata can occur on the vulva, a condom will not protect sexual partners. HPV can be
transmitted to other parts of the body, such as the mouth, oropharynx, and larynx.


A public health nurse is participating in a campaign aimed at preventing cervical cancer. What strategies
should the nurse include is this campaign? Select all that apply.
A) Promotion of HPV immunization
B) Encouraging young women to delay first intercourse
C) Smoking cessation
D) Vitamin D and calcium supplementation
E) Using safer sex practices

Ans: A, B, C, E
Preventive measures relevant to cervical cancer include regular pelvic examinations and Pap tests for all
women, especially older women past childbearing age. Preventive counseling should encourage delaying
first intercourse, avoiding HPV infection, participating in safer sex only, smoking cessation, and
receiving HPV immunization. Calcium and vitamin D supplementation are not relevant.


A 27-year-old female patient is diagnosed with invasive cervical cancer and is told she needs to have a
hysterectomy. One of the nursing diagnoses for this patient is disturbed body image related to perception
of femininity. What intervention would be most appropriate for this patient?
A) Reassure the patient that she will still be able to have children.
B) Reassure the patient that she does not have to have sex to be feminine.
C) Reassure the patient that you know how she is feeling and that you feel her anxiety and pain.
D) Reassure the patient that she will still be able to have intercourse with sexual satisfaction and

Ans: D
The patient needs reassurance that she will still have a vagina and that she can experience sexual
intercourse after temporary postoperative abstinence while tissues heal. Information that sexual
satisfaction and orgasm arise from clitoral stimulation rather than from the uterus reassures many
women. Most women note some change in sexual feelings after hysterectomy, but they vary in intensity.
In some cases, the vagina is shortened by surgery, and this may affect sensitivity or comfort. It would be
inappropriate to reassure the patient that she will still be able to have children; there is no reason to
reassure the patient about not being able to have sex. There is no way you can know how the patient is
feeling and it would be inappropriate to say so.


A patient diagnosed with cervical cancer will soon begin a round of radiation therapy. When planning
the patients subsequent care, the nurse should prioritize actions with what goal?
A) Preventing hemorrhage
B) Ensuring the patient knows the treatment is palliative, not curative
C) Protecting the safety of the patient, family, and staff
D) Ensuring that the patient adheres to dietary restrictions during treatment

Ans: C
Care must be taken to protect the safety of patients, family members, and staff during radiation therapy.
Hemorrhage is not a common complication of radiation therapy and the treatment can be curative.
Dietary restrictions are not normally necessary during treatment.


A 45-year-old woman has just undergone a radical hysterectomy for invasive cervical cancer. Prior to
the surgery the physician explained to the patient that after the surgery a source of radiation would be
placed near the tumor site to aid in reducing recurrence. What is the placement of the source of radiation
A) Internal beam radiation
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 1090
B) Trachelectomy
C) Brachytherapy
D) External radiation

Ans: C
Radiation, which is often part of the treatment to reduce recurrent disease, may be delivered by an
external beam or by brachytherapy (method by which the radiation source is placed near the tumor) or


A 25-year-old patient diagnosed with invasive cervical cancer expresses a desire to have children. What
procedure might the physician offer as treatment?
A) Radical hysterectomy
B) Radical culposcopy
C) Radical trabeculectomy
D) Radical trachelectomy

Ans: D
A procedure called a radical trachelectomy is an alternative to hysterectomy in women with invasive
cervical cancer who are young and want to have children. In this procedure, the cervix is gripped with
retractors and pulled down into the vagina until it is visible. The affected tissue is excised while the rest
of the cervix and uterus remain intact. A drawstring suture is used to close the cervix. For a woman who
wants to have children, a radical hysterectomy would not provide the option of children. A radical
culposcopy and a radical trabeculectomy are simple distracters for this question.


A patient with ovarian cancer is admitted to the hospital for surgery and the nurse is completing the
patients health history. What clinical manifestation would the nurse expect to assess?
A) Fish-like vaginal odor
B) Increased abdominal girth
C) Fever and chills
D) Lower abdominal pelvic pain

Ans: B
Clinical manifestations of ovarian cancer include enlargement of the abdomen from an accumulation of
fluid. Flatulence and feeling full after a light meal are significant symptoms. In bacterial vaginosis, a
fish-like odor, which is noticeable after sexual intercourse or during menstruation, occurs as a result of a
rise in the vaginal pH. Fever, chills, and abdominal pelvic pain are atypical.


A 30-year-old patient has come to the clinic for her yearly examination. The patient asks the nurse about
ovarian cancer. What should the nurse state when describing risk factors for ovarian cancer?
A) Use of oral contraceptives increases the risk of ovarian cancer.
B) Most cases of ovarian cancer are attributed to tobacco use.
C) Most cases of ovarian cancer are considered to be random, with no obvious causation.
D) The majority of women who get ovarian cancer have a family history of the disease.

Ans: C
Most cases of ovarian cancer are random, with only 5% to 10% of ovarian cancers having a familial
connection. Contraceptives and tobacco have not been identified as major risk factors.


The nurse is caring for a patient who has just been told that her ovarian cancer is terminal and that no
curative options remain. What would be the priority nursing care for this patient at this time?
A) Provide emotional support to the patient and her family.
B) Implement distraction and relaxation techniques.
C) Offer to inform the patients family of this diagnosis.
D) Teach the patient about the importance of maintaining a positive attitude.

Ans: A
Emotional support is an integral part of nursing care at this point in the disease progression. It is not
normally appropriate for the nurse to inform the family of the patients diagnosis. It may be inappropriate
and simplistic to focus on distraction, relaxation, and positive thinking.


The nurse is caring for a 63-year-old patient with ovarian cancer. The patient is to receive chemotherapy
consisting of Taxol and Paraplatin. For what adverse effect of this treatment should the nurse monitor
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 1089
the patient?

A) Leukopenia
B) Metabolic acidosis
C) Hyperphosphatemia
D) Respiratory alkalosis
Ans: A
Chemotherapy is usually administered IV on an outpatient basis using a combination of platinum and
taxane agents. Paclitaxel (Taxol) plus carboplatin (Paraplatin) are most often used because of their
excellent clinical benefits and manageable toxicity. Leukopenia, neurotoxicity, and fever may occur.
Acidbase imbalances and elevated phosphate levels are not anticipated.


You are caring for a patient, a 42-year-old mother of two children, with a diagnosis of ovarian cancer.
She has just been told that her ovarian cancer is terminal. When you admitted this patient, you did a
spiritual assessment. What question would it have been most important for you to evaluate during this
A) Is she able to tell her family of negative test results?
B) Does she have a sense of peace of mind and a purpose to her life?
C) Can she let go of her husband so he can make a new life?
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 327
D) Does she need time and space to bargain with God for a cure?

Ans: B
In addition to assessment of the role of religious faith and practices, important religious rituals, and
connection to a religious community, you should further explore the presence or absence of a sense of
peace of mind and purpose in life; other sources of meaning, hope, and comfort; and spiritual or
religious beliefs about illness, medical treatment, and care of the sick. Telling her family and letting her
husband go are not parts of a spiritual assessment. Bargaining is a stage of death and dying, not part of a
spiritual assessment.


new book

giddens 2nd ed- none


New book

ignatavicious 9th ed


A nurse is participating in primary prevention efforts directed against cancer. In which activities is this nurse
most likely to engage? (Select all that apply.)
a. Demonstrating breast self-examination methods to women
b. Instructing people on the use of chemoprevention
c. Providing vaccinations against certain cancers
d. Screening teenage girls for cervical cancer
e. Teaching teens the dangers of tanning booths

ANS: B, C, E
Primary prevention aims to prevent the occurrence of a disease or disorder, in this case cancer. Secondary
prevention includes screening and early diagnosis. Primary prevention activities include teaching people about
chemoprevention, providing approved vaccinations to prevent cancer, and teaching teens the dangers of
tanning beds. Breast examinations and screening for cervical cancer are secondary prevention methods.
DIF: Applying/Application REF: 381
KEY: Cancer| primary prevention| secondary prevention| patient education
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Health Promotion and Maintenance


The nurse is assessing the reproductive history of a 68-year-old postmenopausal woman. Which finding is
cause for immediate action by the nurse?
a. Vaginal dryness
b. Need for a Papanicolaou test if none for 3 years
c. Bleeding from the vagina
d. Leakage of urine

Vaginal bleeding is not normal for the postmenopausal woman. Vaginal dryness and leakage of urine are
common findings in adults of this age range. Pap tests may not be needed for women over 65 who have had
regular cervical cancer testing with normal results.
DIF: Applying/Application REF: 1432
KEY: Adult life stages| older adult| nursing assessment
MSC: Integrated Process: Nursing Process: Evaluation
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation


A 20-year-old client is interested in protection from the human papilloma virus (HPV) since she may
become sexually active. Which response from the nurse is the most accurate?
a. You are too old to receive an HPV vaccine.
b. Either Gardasil or Cervarix can provide protection.
c. You will need to have three injections over a span of 1 year.
d. The most common side effect of the vaccine is itching at the injection site.

Current HPV vaccines are Gardasil and Cervarix, which should be given before the first sexual contact to
protect against the highest risk HPV types associated with cervical cancer. The client is not too old since it is
recommended that young women up to 26 years should receive an HPV vaccine. The entire series consists of
three injections over 6 months, not 1 year. Local pain and redness surrounding the injection site are very
common, but this does not include itching.
DIF: Analyzing/Analysis REF: 1471
KEY: Patient education| infection control| reproductive problems
MSC: Integrated Process: Teaching/Learning


The nurse is taking the history of a 24-year-old client diagnosed with cervical cancer. What possible risk
factors would the nurse assess? (Select all that apply.)
a. Smoking
b. Multiple sexual partners
c. Poor diet
d. Nulliparity
e. Younger than 18 at first intercourse

ANS: A, B, C, E
Smoking, multiple sexual partners, poor diet, and age less than 18 for first intercourse are all risk factors for
cervical cancer. Nulliparity is a risk factor for endometrial cancer.
DIF: Remembering/Knowledge REF: 1469
KEY: Cancer| nursing assessment
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation


A 19-year-old female is asking the nurse about the vaccine for human papilloma virus (HPV). Which
statement by the nurse is accurate?
a. Gardasil protects against all HPV strains.
b. You are too young to receive the vaccine.
c. Only females can receive the vaccine.
d. This will lower your risk for cervical cancer.

Gardasil is used to provide immunity for HPV types 6, 11, 16, and 18 that are high risk for cervical cancer and
warts. The vaccine is recommended for people ages 10 to 26 years.
DIF: Remembering/Knowledge REF: 1512
KEY: Reproductive problems| antiviral medications| infection| cancer
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies


New Book

Lewis 9th ed


A nursing diagnosis that is likely to be appropriate for a 67-year-old woman who has
just been diagnosed with stage III ovarian cancer is
a. sexual dysfunction related to loss of vaginal sensation.
b. risk for infection related to impaired immune function.
c. anxiety related to cancer diagnosis and need for treatment decisions.
d. situational low self-esteem related to guilt about delaying medical care.

The patient with stage III ovarian cancer is likely to be anxious about the poor prognosis and about the
need to make decisions about the multiple treatments that may be used. Decreased vaginal sensation does
not occur with ovarian cancer. The patient may develop immune dysfunction when she receives
chemotherapy, but she is not currently at risk. It is unlikely that the patient has delayed seeking medical
care because the symptoms of ovarian cancer are vague and occur late in the course of the cancer.
DIF: Cognitive Level: Apply (application) REF: 1298
TOP: Nursing Process: Analysis MSC: NCLEX: Physiological Integrity


Which nursing actions can the nurse working in a women’s health clinic delegate to
unlicensed assistive personnel (UAP) (select all that apply)?
a. Call a patient with the results of an endometrial biopsy.
b. Assist the health care provider with performing a Pap test.
c. Draw blood for CA-125 levels for a patient with ovarian cancer.
d. Screen a patient for use of medications that may cause amenorrhea.
e. Teach the parent of a 10-year-old about the human papilloma virus (HPV) vaccine

Assisting with a Pap test and drawing blood (if trained) are skills that require minimal critical thinking
and judgment and can be safely delegated to UAP. Patient teaching, calling a patient who may have
questions about results of diagnostic testing, and risk-factor screening all require more education and
critical thinking and should be done by the registered nurse (RN).
DIF: Cognitive Level: Apply (application) REF: 15-16
OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment


A 31-year-old patient who has been diagnosed with human papillomavirus (HPV)
infection gives a health history that includes smoking tobacco, taking oral contraceptives, and
having been treated twice for vaginal candidiasis. Which topic will the nurse include in patient
a. Use of water-soluble lubricants
b. Risk factors for cervical cancer
c. Antifungal cream administration
d. Possible difficulties with conception

Because HPV infection and smoking are both associated with increased cervical cancer risk, the nurse
should emphasize the importance of avoiding smoking. An HPV infection does not decrease vaginal
lubrication, decrease ability to conceive, or require the use of antifungal creams.
DIF: Cognitive Level: Apply (application) REF: 1292
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity


The nurse will plan to teach the female patient with genital warts about the
a. importance of regular Pap tests.
b. increased risk for endometrial cancer.
c. appropriate use of oral contraceptives.
d. symptoms of pelvic inflammatory disease (PID).

Genital warts are caused by the human papillomavirus (HPV) and increase the risk for cervical cancer.
There is no indication that the patient needs teaching about PID, oral contraceptives, or endometrial
DIF: Cognitive Level: Apply (application) REF: 1286 | 1292
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance


Which action should the nurse take when a 35-year-old patient has a result of minor
cellular changes on her Pap test?
a. Teach the patient about colposcopy.
b. Teach the patient about punch biopsy.
c. Schedule another Pap test in 4 months.
d. Administer the human papillomavirus (HPV) vaccine.

Patients with minor changes on the Pap test can be followed with Pap tests every 4 to 6 months because
these changes may revert to normal. Punch biopsy or colposcopy may be used if the Pap test shows more
prominent changes. The HPV vaccine may reduce the risk for cervical cancer, but it is recommended only
for ages 9 through 26.
DIF: Cognitive Level: Apply (application) REF: 1293
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and


A healthy 28-year-old who has been vaccinated against human papillomavirus (HPV)
has a normal Pap test. Which information will the nurse include in patient teaching when calling
the patient with the results of the Pap test?
a. You can wait until age 30 before having another Pap test.
b. Pap testing is recommended every 3 years for women your age.
c. No further Pap testing is needed until you decide to become pregnant.
d. Yearly Pap testing is suggested for women with multiple sexual partners.

The current national guidelines suggest Pap testing every 3 years for patients between ages 21 to 65.
Although HPV immunization does protect against cervical cancer, the recommendations are unchanged
for individuals who have received the HPV vaccination.
DIF: Cognitive Level: Understand (comprehension) REF: 1293
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance