Chapter 8: Cancers of the Female Reproductive Tract

1. A 58-year-old client comes to the clinic for evaluation. After obtaining the client's history, the

nurse suspects endometrial cancer. Which information would lead the nurse to this suspicion?

A. use of oral contraceptives between ages 18 and 25

B. onset of painless, bright red postmenopausal bleeding

C. menopause occurring at age 46

D. use of intrauterine device for 3 years

B. onset of painless, bright red

postmenopausal bleeding

Rationale: 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.

2. A woman is to have a Papanicolaou test. When teaching the woman about this test, the nurse

would emphasize which instruction to the client?

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."

D. "Do not douche for 48 hours before the test."

Rationale: 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

Papanicolaou test. Medications do not need to be withheld before the test.

3. A woman comes to the clinic for a routine checkup. After obtaining the client's history, the nurse identifies that the client is at increased risk for cervical cancer based on her history of exposure to which virus?

A. hepatitis

B. human papillomavirus

C. cytomegalovirus

D. Epstein-Barr virus

B. human papillomavirus

Rationale: 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.

4. A client is scheduled to have a Papanicolaou test. After the nurse teaches the client about the Papanicolaou test, which client statement indicates successful teaching?

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."

C. "I will not engage in sexual intercourse for 48 hours before the test."

Rationale: 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 Papanicolaou test. Collecting a urine

specimen also is not necessary.

5. Which finding obtained during a client history would the nurse identify as increasing a client's risk for ovarian cancer?

A. multiple sexual partners

B. consumption of a high-fat diet

C. underweight

D. grand multiparity (more than five children)

B. consumption of a high-fat diet

Rationale: 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.

6. 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?

A. freezing

B. cutting

C. burning

D. irradiating

A. freezing

Rationale: 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.

7. Which statement best indicates that a client has taken self-care measures to reduce her risk for cervical cancer?

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."

D. "My partner always uses a condom when we have sexual intercourse."

Rationale: 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 cervi cal

cancer.

8. A client is suspected of having endometrial cancer. The nurse would most likely prepare the client for which procedure to confirm the diagnosis?

A. transvaginal ultrasound

B. colposcopy

C. Papanicolaou test

D. endometrial biopsy

D. endometrial biopsy

Rationale: 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 Papanicolaou test screens for

abnormal cervical cells.

9. Which description would the nurse include when teaching a client about a scheduled

colposcopy?

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 ne ar your

belly button to obtain tissue samples."

B. "A solution will be wiped on your cervix to identify any abnormal cells, which will be visualized with a magnifying instrument."

Rationale: 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 Papanicolaou test. Insertion of a device under anesthesia near the umbilicus describes a biopsy obtained via laparoscopy.

10. The nurse is preparing a presentation for a local women's group about methods to reduce the risk of reproductive tract cancers. Which action should the nurse include?

A. blood pressure evaluation every 6 months

B. yearly Papanicolaou test starting at age 40

C. condom use with every sexual encounter

D. consumption of two to three glasses of red wine per day

C. condom use with every sexual encounter

Rationale: Staying healthy is a major way to reduce one's risk for cancer. Current recommendations include: using a condom with every sexual encounter; having blood pressure evaluated at least every 2 years; undergo a Papanicolaou test every 1 to 3 years, if sexually active, starting at age 21; and consuming alcohol in moderation (not more than one drink per day), if at all.

11. 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?

A. "Currently there is no reliable screening test for ovarian cancer."

B. "A Papanicolaou test 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."

A. "Currently there is no reliable screening test for ovarian cancer."

Rationale: Currently there are no adequate screening tests for ovarian cancer. A Papanicolaou test 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.

12. After teaching a group of young women how to reduce their risk for ovarian cancer, the nurse determines that additional teaching is needed when the group identifies which element as a way to reduce risk?

A. pregnancy

B. use of oral contraceptives

C. use of feminine hygiene sprays

D. breastfeeding

C. use of feminine hygiene sprays

Rationale: Risk reduction strategies include pregnancy, use of oral contraceptives, and breastfeeding. Women should avoid using talc and hygiene sprays on the genital area.

13. A woman is diagnosed with adenocarcinoma of the endometrium in situ. The nurse interprets this as indicating which information about the cancer?

A. spread to the uterine muscle wall

B. found on the endometrial surface

C. spread to the cervix

D. invaded the bladder

B. found on the endometrial surface

Rationale: 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.

14. 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?

A. labia majora

B. labia minora

C. clitoris

D. prepuce

A. labia majora

Rationale: The diagnosis of vulvar cancer is made by biopsy of the suspicious lesion, which is most commonly found on the labia majora.

15. When describing the various types of reproductive tract cancers to a local women's group, the nurse would identify which cancer as the least common type?

A. vulvar

B. vaginal

C. endometrial

D. ovarian

B. vaginal

Rationale: Of the cancers listed, vaginal cancer is the rarest. Only about one of every 1,100 women will develop vaginal cancer in her lifetime. Vulvar cancer represents approximately 4% of female genital cancers. Endometrial cancer is the fourth most common gynecologic malignancy in the United States and sixth most common cancer globally. It accounts for 7% of all cancers in women in the United States (one in 40 women). Ovarian cancer is the fifth most common cancer among women and the most common cause of cancer deaths for women in the United States.

16. Vulvar cancer is suspected in a client. When reviewing the client's history which report

would the nurse most likely find? Select all that apply.

A. dyspareunia

B. persistent vulvar itching

C. history of herpes simplex

D. lesion on the cervix

E. abnormal Papanicolaou test result

A. dyspareunia

B. persistent vulvar itching

C. history of herpes simplex

Rationale: Leading presenting reports of women with vulvar cancer include dyspareunia, long history of pruritis, ulcers on the "outside" genitalia, vulvar swelling, vulvar bleeding, and urinary problems. 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 grea ter risk for vulvar intraepithelial neoplasia. Abnormal vaginal bleeding, lesion on the cervix, or abnormal Papanicolaou test result are not associated with vulvar cancer.

17. A nurse is reviewing the medical record of a woman diagnosed with vulvar cancer. Which information would the nurse identify as a risk factor for this cancer? Select all that apply.

A. 55 years of age

B. history of breast cancer

C. monogamous sexual partner

D. HSV-type 2 exposure

E. obesity

A. 55 years of age

B. history of breast cancer

D. HSV-type 2 exposure

E. obesity

Rationale: Risk factors associated with vulvar cancer include age over 50 years, history of exposure to HSV type 2, history of breast cancer, multiple sex partners, obesity, hypertension,

and diabetes

18. A nurse is assisting with the collection of a Papanicolaou test. When collecting the specimen, which action is done first?

A. insertion of the speculum

B. swabbing of the endocervix

C. spreading of the labia

D. insertion of the cytobrush

C. spreading of the labia

Rationale: For a Papanicolaou test, 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.

19. 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 will not be the same. Which outcome would be appropriate for this client?

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.

A. Client will verbalize positive statements about self and sexuality.

Rationale: 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 f or a nursing diagnosis of anxiety.

20. During a routine health check-up, a young adult woman asks the nurse about ways to prevent

endometrial cancer. Which actions would the nurse most likely include? Select all that apply.

A. eating a high-fat diet

B. having regular pelvic exams

C. engaging in daily exercise

D. becoming pregnant

E. using estrogen contraceptives

B. having regular pelvic exams

C. engaging in daily exercise

D. becoming pregnan

Rationale: 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.

21. A woman is scheduled for diagnostic testing to evaluate for endometrial cancer. The nurse would expect to prepare the woman for which procedure?

A. CA-125 testing

B. transvaginal ultrasound

C. Papanicolaou test

D. mammography

B. transvaginal ultrasound

Rationale: 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 Papanicolaou test is used to screen for cervical cancer. A mammography is used to screen for breast cancer.

22. A nurse is conducting a class for a local woman's group about recommendations for a

Papanicolaou test. One of the participants asks, "At what age should a woman have her first

test?" The nurse responds by stating that a woman should have her first Papanicolaou test at which age?

A. 18

B. 21

C. 25

D. 28

B.

21

Rationale: Although professional medical organizations disagree as to the recommended frequency of screening for cervical cancer, ACOG (2018b) recommends that cervical cancer screening should begin at age 21 years (regardless of sexual history), since women younger than age 21 are at very low risk of cancer.

23. A client has an abnormal Papanicolaou test result that is classified as ASC-US. Based on the nurse's understanding of this classification, the nurse would expect which procedure?

A. immediate colposcopy

B. testing for human papillomavirus (HPV)

C. repeat Papanicolaou test in 4 to 6 months

D. cone biopsy

C. repeat Papanicolaou test in 4

Rationale: For the classification of ASC-US, the client would have a repeat Papanicolaou test 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.

24. The nurse is preparing a presentation for a local women's group about ways to reduce the risk of reproductive tract cancers. Which practice would the nurse include?

A. blood pressure evaluation every 6 months

B. yearly Papanicolaou test starting at age 40

C. yearly cholesterol screening starting at age 45

D. consumption of two to three glasses of red wine per day

C. yearly cholesterol screening starting at age 45

Rationale: 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. A Papanicolaou test is recommended every 1 to 3 years for sexually active women, starting at age 21. Alcohol should be consumed in moderation (not more than one drink per day), if at all.

25. When assessing a female client for the possibility of vulvar cancer, the nurse would most

likely expect the client to report which symptoms? Select all that apply.

A. abnormal vaginal bleeding

B. persistent vulvar itching

C. history of herpes simplex

D. lesion on the cervix

E. abnormal Papanicolaou test result

B. persistent vulvar itching

C. history of herpes simplex

Rationale: 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

Papanicolaou test result are not associated with vulvar cancer.

26. A nurse is reviewing the medical record of a woman diagnosed with vulvar cancer. Which information would the nurse identify as risk factors for this cancer? Select all that apply

A. age under 40 years

B. HPV 16 exposure

C. monogamous sexual partner

D. hypertension

E. diabetes

B. HPV 16 exposure

D. hypertension

E. diabetes

Rationale: Risk factors associated with vulvar cancer include age over 50 years, history of exposure to HPV 16, multiple sex partners, hypertension, and diabetes.

27. A nurse is conducting an in-service program for a group of nurses about cervical cancer. The nurse determines that the teaching was successful when the group identifies which area as most commonly involved?

A. internal cervical os

B. junction of the cervix and fundus

C. squamous-columnar junction

D. external cervical os

C. squamous-columnar junction

Rationale: 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.

28. A client is scheduled to undergo a cone biopsy. When explaining this procedure to the client, the nurse understands that the specimen will be obtained from which area?

A. clitoris

B. uterine fundus

C. transformation zone

D. ovarian follicle

C. transformation zone

Rationale: 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.

29. A nurse is conducting a class for a group of young adult women at a local women's health clinic. The nurse is describing ovarian cancer and ways to reduce the risk. The nurse determines

that the teaching was successful based on which statement(s) from the group? Select all that

apply.

A. "We should avoid using any kind of talc near our genitals."

B. "Breastfeeding is better than bottle feeding to lower our risk."

C. "We should eat foods that have a higher fat content."

D. "Keeping our weight fairly even and at a healthy level is important."

E. "Birth control with diaphragms is better than using birth control pills."

A. "We should avoid using any kind of talc near our genitals."

B. "Breastfeeding is better than bottle feeding to lower our risk."

D. "Keeping our weight fairly even and at a healthy level is important."

Rationale: Ways to reduce the risk of ovarian cancer include getting pregnant, using oral

contraceptives (for 3 years or longer), breastfeeding (before the age of 30), and avoiding the use

of talc and hygiene sprays on the genitals. It is also important to maintain healthy lifestyles,

including maintaining a healthy weight and eating a low-fat diet.

30. A client is scheduled for a loop electrosurgical excision procedure (LEEP) to evaluate an

abnormal Papanicolaou (Pap) test. After teaching the client about this procedure, the nurse

determines that the teaching was successful based on which client statement?

A. "I will have this procedure done in the outpatient surgery department."

B. "I will need to get general anesthesia for this procedure."

C. "I should expect the procedure to take about 1 to 2 hours."

D. "I might have some mild cramping and bleeding for a few weeks."

D. "I might have some mild cramping and bleeding for a few weeks."

Rationale: With LEEP or LLETZ (large loop excision of the transformation zone), the abnormal

cervical tissue is removed with a wire that is heated by an electrical current. For this procedure, a local anesthetic is used. It is performed in the health care provider's office in approximately 10 minutes. Mild cramping and bleeding may persist for several weeks after the procedure.