Chapter 13 Gynecologic and Obstetric Surgery


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Chapter 13  Gynecologic and Obstetric Surgery



Complete chapter Questions And Answers

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1. 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:

  1. mons pubis, labia majora, labia minora, urethra, clitoris, vaginal opening.
  2. labia majora, labia minora, clitoris, urethra, vaginal opening, mons pubis.
  3. mons pubis, labia majora, labia minora, clitoris, urethra, vaginal opening.
  4. labia majora, labia minora, urethra, mons pubis, clitoris, vaginal opening.

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 (Figure 13-3).

REF: Page 419

2. An example of perineal glands that secrete mucus is: a. Skene’s glands.
b. Bartholin’s glands.
c. perineal glands.

d. labial glands.

Bartholin’s glands and ducts are located on each side of the lower end of the vagina. These narrow ducts open into the vaginal orifice on the inner aspects of the labia minora. The glands secrete mucus and can become infected or inflamed.

REF: Page 419

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

  1. Peristalsis
  2. Gravity
  3. Brownian motion
  4. Intra-abdominal pressure

The Greek word salpinx, meaning “trumpet” or “tube,” is used to refer to the fallopian tubes (Figure 13-4). The tubes are paired and consist of a musculomembranous channel approximately 10 to 13 cm long, forming the canals through which the ova are conveyed to the uterus from the ovaries. The peristaltic action of the muscular layer and the ciliary movement propel the ova toward the uterus.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 13-2

REF: Pages 419-421

4. 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:

  1. decreased pulmonary compliance and functional residual capacity.
  2. increased popliteal congestion and peripheral vascular collapse.
  3. shearing force injury from sliding toward the head of the OR bed.
  4. avascular ischemic changes to the lower leg and feet from gravitational


Patients placed in Trendelenburg position for prolonged gynecologic procedures are at increased cardiovascular risk because of decreased pulmonary compliance and functional residual capacity (FRC) (Faust et al, 2005).

REF: Page 429

5. 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:

  1. axillary tension.
  2. brachial plexus injury.
  3. celiac plexus injury.
  4. elbow torsion with displacement.

Whenever possible the nurse positions the patient’s arms on padded armboards with the palms up and fingers extended. Armboards are maintained at less than a 90-degree angle to prevent stretching of the brachial plexus. Care should be taken to protect all patients from integumentary, musculoskeletal, and nerve injury while ensuring adequate circulatory, renal, and respiratory functions.

REF: Page 430

6. 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?

  1. Document an “awareness under anesthesia” occurrence.
  2. Tuck Matilda’s arms anatomically at her sides.
  3. Reassess padding, protection, and positioning security.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 13-3

d. Refine the nursing diagnosis to include risk for falls.

Reassess padding and protection after this movement by Matilda to ensure that she will remain free from injury related to surgical positioning. The patient should be secured to the OR bed without friction or pressure from the restraining straps. Assess and document the condition of dependent skin areas. Use pressure-reducing positioning devices. Pad and protect bony prominences and dependent pressure sites and maintain proper body alignment.

REF: Pages 429-430

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