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116 Cards in this Set
- Front
- Back
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What factors can affect the menstrual cycle?
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1. Anatomic abnormalities
2. Physiologic imbalances 3. Lifestyle |
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What is the physiology of the menstrual cycle?
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1. Hypothalamus produces gonadotropin-releasing hormone (GnRH)
2. GnRH stimulates pituitary gland to produce follicle-stimulating hormone (FSH) and luteinizing hormone (LH) 3. FSH and LH stimulate the ovaries to produce estrogen and progesterone 4. Estrogen and progesterone causes the endometrium or lining of the uterus to proliferate and then shed |
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What is the average range of the menstrual cycle?
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Frequency of the cycle stabilizes at 28 days within 1 to 2 years after puberty, with a range from 28 to 34 days
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When is the menstrual cycle length most irregular?
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The extremes of the reproductive years:
1. Two years after menarche 2. Five years before menopause |
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What is amenorrhea?
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The absence of menstrual flow
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How is amenorrhea evaluated?
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1. The absence of both menarche and secondary sexual characteristics by age 14 years
2. Absence of menses by age 16 years, regardless of presence of normal growth and development 3. A 3- to 6-month absence of menses after a period of menstruation |
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What is primary amenorrhea?
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Absence of menses by age 16 years, regardless of presence of normal growth and development
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What is secondary amenorrhea?
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A 3- to 6-month absence of menses after a period of menstruation
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What are the causes of amenorrhea?
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1. Pregnancy
2. Outflow tract obstruction 3. Anterior pituitary disorders 4. Polycystic ovarian syndrome 5. Hypo- or hyperthyroidism 6. Type 1 DM 7. Medications - phenytoin (Dilantin) 8. Alcohol 9. Street drugs 10. Oral contraceptives |
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What is hypogonadotropic amenorrhea?
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Absence of menses as a result of hypothalamic suppression or a sudden and severe weight loss, eating disorders, strenuous exercise, or mental illness
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What are the diagnostics tests for amenorrhea?
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1. Rule out pregnancy
2. FSH level 3. Thyroid-stimulating hormone and prolactin levels 4. Radiographic or CT scan of sella turcica 5. Progestational challenge |
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What are some medical management of amenorrhea?
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1. Reduce stress with deep breathing exercises or relaxation techniques
2. Daily calcium intake of 1200 to 1500 mg/day |
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What is the cyclic perimenstrual pain and discomfort (CPPD)?
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Concept of dysmenorrhea, PMS, and premenstrual dysphoric disorder (PMDD) that occur before and after menstrual flow starts
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What is dysmenorrhea?
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Pain during or shortly after menstruation
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What can aggravate dysmenorrhea?
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1. Smoking
2. Obesity |
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What is severe dysmenorrhea associated with?
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1. Early menarche
2. Nulliparity 3. Stress |
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What type of pain occurs with dysmenorrhea?
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Sharp, cramping, or gripping or as a steady dull ache that radiates to the lower back and upper thighs
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What is primary dysmenorrhea?
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Condition associated with abnormally increased uterine activity due to myometrial contractions induced by the prostaglandins in the second half of the menstrual cycle
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What hormone aggravates primary dysmenorrhea?
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Prostaglandin factor-2-alpha (PGF-2-alpha)
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What is the medical management for primary dysmenorrhea?
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1. Heat pad or hot bath
2. Massaging lower back 3. Soft rubbing of the abdomen (effleurage) 4. Pelvic rocking exercises 5. Decrease salt and refined sugar intake 6. NSAIDs |
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What is secondary dysmenorrhea?
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Acquired menstrual pain that develops later in life than primary dysmenorrhea
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What is secondary dysmenorrhea associated with?
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1. Adenomyosis
2. Endometriosis 3. Pelvic inflammatory disease (PID) 4. Endometrial polyps 5. Submucous or interstitial myomas (fibroids) |
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What are the characteristics of pain due to secondary dysmenorrhea?
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Dull, lower abdominal aching radiating to the back or thighs
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What is premenstrual syndrome?
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A complex, poorly understood condition that includes a number of cyclic symptoms occurring in the luteal phase of the menstrual cycle
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What are the symptoms of PMS?
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Distressing physical, mood, and behavioral experiences
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What is premenstrual dysphoric disorder?
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A diagnostic term for a smaller percentage of women who suffer severe PMS with an emphasis on mood symptoms
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What are the symptoms of PMDD?
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1. Abdominal bloating
2. Anxiety 3. Tension 4. Breast tenderness 5. Crying episodes 6. Depression 7. Fatigue and lack of energy 8. Irritability 9. Difficulty concentrating 10. Appetite changes 11. Thirst 12. Swelling of the extremities |
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What are the criteria for a diagnosis of PMS?
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1. Symptoms occur in the luteal phase and resolve within a few days of menses onset
2. Symptom-free period occurs in the follicular phase 3. Symptoms are recurrent 4. Symptoms have a negative impact on some aspect of a woman's life 5. Other dx that better explain the symptoms have been excluded |
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What are the criteria for a diagnosis of PMDD?
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1. Five or more affective and physical symptoms are present in the week before menses and are absent in the follicular phase of the menstrual cycle
2. At least one of the symptoms is irritability, depressed mood, anxiety, or emotional lability 3. Symptoms interfere markedly with work or interpersonal relationships 4. Symptoms are not due to an exacerbation of another condition or disorder |
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What is the management for PMS?
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1. Exercise
2. Balanced diet 3. Calcium, magnesium, vitamin B6 4. Diuretics, NSAIDs, progesterone, OCPs |
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What is endometriosis?
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Presence and growth of endometrial glands and stroma outside of the uterus
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What are the major symptoms of endometriosis?
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1. Pelvic pain
2. Dysmenorrhea 3. Dyspareunia (painful sex) 4. Abnormal menstrual bleeding 5. Infertility |
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What are the other symptoms of endometriosis?
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1. Pelvic heaviness
2. Pain radiating into the thighs 3. Diarrhea 4. Constipation 5. Pain during exercise |
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What are the treatments for endometriosis?
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1. GnRH agonists
2. Androgen derivatives 3. Danazol (Danocrine) 4. Low dose OCPs 5. Surgical interventions |
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What are the nursing care for endometriosis?
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1. Emotional support
2. Counseling (especially for sexual dysfunction) |
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What is oligomenorrhea?
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1. Decreased menstruation, either in amount, time, or both
2. Infrequent menstrual periods characterized by intervals of 40 to 45 days or longer |
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What is hypomenorrhea?
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Scanty bleeding at normal intervals
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What are the causes of oligomenorrhea?
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Abnormalities of hypothalamic, pituitary, or ovarian function
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What are the causes of hypomenorrhea?
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1. Use of OCPs
2. Structural abnormalities of the endometrium or uterus |
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What is metrorrhagia?
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Intermenstrual bleeding that occurs at a time other than the normal menses
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What is mittlestaining?
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A normal, small amount of bleeding or spotting that occurs at the time of ovulation (14 days before onset of next menses)
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What is menorrhagia?
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Excessive menstrual bleeding, in either duration or amount
(also known as HYPERMENORRHEA) |
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What are the causes of menorrhagia?
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1. Hormonal disturbances
2. Systemic disease 3. Benign and malignant neoplasms 4. Infection 5. IUDs |
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What are objective indicators of blood loss?
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H&H values
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What are fibroids?
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Benign tumors of the smooth muscle of the uterus with unknown etiology
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What should be avoided in women experiencing menorrhagia?
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Aspirin, which increase bleeding
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What is dysfunctional uterine bleeding?
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Excessive uterine bleeding with no demonstrable organic cause, genital or extragenital
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What is the most frequent cause of dysfunctional uterine bleeding?
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Anovulation
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What is climacteric?
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Menopause to the postmenopausal years
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What is menopause?
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The complete cessation of menses when women have not had a menstrual flow or spotting for 1 year
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How is menopause diagnosed?
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Retrospectively only
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What is a hot flush?
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Visible red flush of skin and perspiration
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What is a hot flash?
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Sudden warm sensation in neck, head, and chest
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What are the major health risks of perimenopausal women?
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1. Osteoporosis
2. Coronary heart disease |
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What is osteoporosis?
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Generalized, metabolic disease characterized by decreased bone mass and increased incidence of bone fractures
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What is the relationship between osteoporosis and menopause?
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Decreased levels of estrogen making in difficult for women to convert vitamin D into calcitonin, which is required for absorption of calcium
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What are the risks factors of coronary heart disease?
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1. Obesity
2. Smoking 3. Elevated cholesterol levels 4. Hypertension 5. DM 6. Family hx of cardiac disease 7. Alcohol abuse 8. Effects of aging on the cardiovascular system |
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What are the side effects associated with estrogen therapy?
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1. Headaches
2. N/V 3. Bloating 4. Ankle and feet swelling 5. Weight gain 6. Breast soreness 7. Brown spots on the skin 8. Eye irritation with contact lenses 9. Depression |
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What medications are used to treat osteoporosis?
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1. Calcitonin
2. Bisphosphonates 3. Risedronate sodium 4. Selective estrogen receptor modulators (SERMs) 5. Parathyroid or estrogen hormone therapy |
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1. When assessing the client for amenorrhea, the nurse should be aware that this may be caused by all conditions except:
a. Anatomic abnormalities b. Type 1 diabetes mellitus c. Lack of exercise d. Hysterectomy |
ANS: C
Lack of exercise is not a cause of amenorrhea. Strenuous exercise may cause amenorrhea. |
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2. When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention might be recommended?
a. Increasing the intake of red meat and simple carbohydrates b. Reducing the intake of diuretic foods, such as peaches and asparagus c. Temporarily substituting physical activity for a sedentary lifestyle d. Using a heating pad on the abdomen to relieve cramping |
ANS: ABCD
Heat minimizes cramping by increasing vasodilation and muscle relaxation and minimizing uterine ischemia. Dietary changes such as eating less red meat may be recommended for women experiencing dysmenorrhea. Increasing the intake of diuretics, including natural diuretics such as asparagus, cranberry juice, peaches, parsley, and watermelon may help ease the symptoms associated with dysmenorrhea. Exercise has been found to help relieve menstrual discomfort through increased vasodilation and subsequent decreased ischemia. |
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3. Nafarelin (Synarel) is used to treat mild to severe endometriosis. The nurse should tell the woman taking this medication that the drug:
a. Stimulates the secretion of gonadotropin-releasing hormone (GnRH), thereby stimulating ovarian activity b. Should be sprayed into one nostril every other day c. Should be injected into subcutaneous tissue bid d. Can cause her to experience some hot flashes and vaginal dryness |
ANS: D
Nafarelin is a GnRH agonist, and its side effects are similar to those of menopause. The hypoestrogenism effect results in hot flashes and vaginal dryness. Nafarelin is a GnRH agonist that suppresses the secretion of GnRH. Nafarelin is administered twice daily by nasal spray. Nafarelin is administered intranasally. |
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A woman complains of severe abdominal and pelvic pain around the time of menstruation that has gotten worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to get pregnant for the past 18 months. These symptoms are most likely related to:
a. Endometriosis b. PMS c. Primary dysmenorrhea d. Secondary dysmenorrhea |
ANS: A
Feedback A Correct: Symptoms of endometriosis can change over time and may not reflect the extent of the disease. Major symptoms include dysmenorrhea and deep pelvic dyspareunia (painful intercourse). Impaired fertility may result from adhesions caused by endometriosis. B Incorrect: Although endometriosis may be associated with secondary dysmenorrhea, it is not a cause of primary dysmenorrhea or PMS. In addition, this woman is complaining of dyspareunia and infertility, which are associated with endometriosis, not with PMS or primary or secondary dysmenorrhea. C Incorrect: Although endometriosis may be associated with secondary dysmenorrhea, it is not a cause of primary dysmenorrhea or PMS. In addition, this woman is complaining of dyspareunia and infertility, which are associated with endometriosis, not with PMS or primary or secondary dysmenorrhea. D Incorrect: Although endometriosis may be associated with secondary dysmenorrhea, it is not a cause of primary dysmenorrhea or PMS. In addition, this woman is complaining of dyspareunia and infertility, which are associated with endometriosis, not with PMS or primary or secondary dysmenorrhea. |
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While interviewing a 31-year-old woman before her routine gynecologic examination, the nurse collects data about the client’s recent menstrual cycles. The nurse should collect additional information with which statement?
a. The woman says her menstrual flow lasts 5 to 6 days. b. She describes her flow as very heavy. c. She reports that she has had a small amount of spotting midway between her periods for the past 2 months. d. She says the length of her menstrual cycle varies from 26 to 29 days. |
ANS: B
Menorrhagia is defined as excessive menstrual bleeding, either in duration or in amount. Heavy bleeding can have many causes. The amount of bleeding and its effect on daily activities should be evaluated. A menstrual flow that lasts 5 to 6 days is a normal finding. Mittlestaining, a small amount of bleeding or spotting that occurs at the time of ovulation (14 days before onset of the next menses), is considered normal. During her reproductive years a woman may have physiologic variations in her menstrual cycle. Variations in the length of a menstrual cycle are considered normal. |
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5. Nurses who provide health care for women should recognize that the most commonly reported gynecologic problem for women of any age-group is:
a. Dysmenorrhea b. Menorrhagia c. Dyspareunia d. Endometriosis |
ANS: A
Dysmenorrhea, or pain during or shortly before menstruation, is one of the most common gynecologic problems in women of all ages. Menorrhagia, or excessive bleeding, is an alteration in cyclic bleeding; it is not the most commonly reported gynecologic problem. Dyspareunia, or painful intercourse, is commonly associated with endometriosis. Endometriosis is a type of menstrual disorder, but it is not the most commonly reported gynecologic problem. |
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When evaluating a client whose primary complaint is amenorrhea, the nurse must be aware that lack of menstruation is most often the result of:
a. Stress b. Excessive exercise c. Pregnancy d. Eating disorders |
ANS: C
Amenorrhea, or the absence of menstrual flow, is most often a result of pregnancy. Although stress may be a contributing factor to amenorrhea, pregnancy is the most common cause. Although excessive exercise may be a contributing factor to amenorrhea, pregnancy is the most common cause. Although eating disorders may be a contributing factor to amenorrhea, pregnancy is the most common cause. |
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A 36-year-old woman has been diagnosed as having uterine fibroids. When planning care for this client, the nurse should know that:
a. Fibroids are malignant tumors of the uterus that require radiation or chemotherapy b. Fibroids increase in size during the perimenopausal period c. Menorrhagia is a common finding d. The woman is unlikely to become pregnant as long as the fibroids are in her uterus |
ANS: C
The major symptoms associated with fibroids are menorrhagia (excessive bleeding) and the physical effects produced by large myomas. Fibroids are benign tumors of the smooth muscle of the uterus, and their etiology is unknown. Fibroids are estrogen sensitive and shrink as levels of estrogen decline. Fibroids occur in 25% of women of reproductive age and are seen in 2% of pregnant women. |
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8. When assessing a woman for menopausal discomforts, the nurse would expect the woman to describe the most frequently reported discomfort, which would be:
a. Headaches b. Hot flashes c. Mood swings d. Vaginal dryness with dyspareunia |
ANS: B
Vasomotor instability, in the form of hot flashes or flushing, is a result of fluctuating estrogen levels and is the most common disturbance of the perimenopausal woman. Headaches may be associated with a decline in hormone levels; however, it is not the most frequently reported discomfort for menopausal women. Mood swings may be associated with a decline in hormone levels; however, it is not the most frequently reported discomfort for menopausal women. Vaginal dryness and dyspareunia may be associated with a decline in hormone levels; however, it is not the most frequently reported discomfort for menopausal women. |
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While evaluating a client for osteoporosis, the nurse should be aware of what risk factor?
a. African-American race b. Low protein intake c. Obesity d. Cigarette smoking |
ANS: D
Smoking is associated with earlier and greater bone loss and decreased estrogen production. Women at risk for osteoporosis are likely to be Caucasian or Asian. Inadequate calcium intake is a risk factor for osteoporosis. Women at risk for osteoporosis are likely to be small boned and thin. Obese women have higher estrogen levels as a result of the conversion of androgens in the adipose tissue. Mechanical stress from extra weight also helps preserve bone mass. |
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10. When discussing estrogen replacement therapy (ERT) with a perimenopausal woman, the nurse includes the risk of:
a. Breast cancer b. Vaginal and urinary tract atrophy c. Osteoporosis d. Arteriosclerosis |
ANS: A
Women with a high risk for breast cancer should be counseled against using ERT. Estrogen prevents atrophy of vaginal and urinary tract tissue. Estrogen protects against the development of osteoporosis. Estrogen has a favorable effect on circulating lipids, reducing low-density lipoprotein (LDL) and total cholesterol and increasing high-density lipoprotein (HDL). It also has a direct antiatherosclerotic effect on the arteries. |
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During her annual gynecologic checkup, a 17-year-old woman states that recently she has been experiencing cramping and pain during her menstrual periods. The nurse documents this complaint as:
a. Amenorrhea b. Dysmenorrhea c. Dyspareunia d. Premenstrual syndrome (PMS) |
ANS: B
Dysmenorrhea is pain during or shortly before menstruation. Amenorrhea is the absence of menstrual flow. Dyspareunia is pain during intercourse. PMS is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses. |
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12. The absence or cessation of menstrual flow is known as:
a. Amenorrhea b. Dysmenorrhea c. Menorrhagia d. Metrorrhagia |
ANS: A
Amenorrhea is most often the result of pregnancy, although it could be a sign of conditions that require treatment. Dysmenorrhea is painful menstruation that begins 2 to 6 months after menarche. Menorrhagia is abnormally profuse or excessive bleeding from the uterus. Metrorrhagia is bleeding between periods. It can be caused by progestin injections and implants. |
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13. With regard to dysmenorrhea, nurses should be aware that:
a. It is more common in older women b. It is more common in leaner women who exercise strenuously c. Symptoms can begin at any point in the ovulatory cycle d. Pain usually occurs in the suprapubic area or lower abdomen |
ANS: D
Pain is described as sharp and cramping or sometimes as a dull ache. It may radiate to the lower back or upper thighs. Dysmenorrhea is more common in younger women ages 17 to 24. Dysmenorrhea is more common in women who smoke and who are obese. Symptoms begin with menstruation or sometimes a few hours before the onset of flow. |
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14. Which statement concerning cyclic perimenstrual pain and discomfort (CPPD) is accurate?
a. Premenstrual dysphoric disorder (PDD) is a milder form of premenstrual syndrome and more common in younger women. b. Secondary dysmenorrhea is more intense and medically significant than primary dysmenorrhea. c. Premenstrual syndrome is a complex, poorly understood condition that may include any of a hundred symptoms. d. The causes of premenstrual syndrome (PMS) have been well established. |
ANS: C
PMS may manifest itself with one or more of a hundred or so physical and psychologic symptoms. PDD is a more severe variant of PMS. Secondary dysmenorrhea is characterized by more muted pain than that seen in primary dysmenorrhea; the medical treatment is much the same. The cause of PMS is unknown. It may in fact be a collection of different problems. |
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15. In helping a client manage premenstrual syndrome (PMS), the nurse should:
a. Recommend a diet with more body-building and energy food, such as red meat and sugar b. Suggest herbal therapies, as well as yoga and massage c. Tell the client to push for medications from the physician as soon as symptoms occur so as to lessen their severity d. Discourage the use of diuretics |
ANS: B
Herbal therapies, yoga, and massage have been reported to have a beneficial effect on PMS. Limiting red meat, refined sugar, caffeinated beverages, and alcohol improves the diet and may mitigate symptoms. Medication usually is begun only if lifestyle changes fail to provide significant relief. Natural diuretics may help reduce fluid retention. |
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16. With regard to endometriosis, nurses should be aware that:
a. It is characterized by the presence and growth of endometrial tissue inside the uterus b. It is found more often in African-American women than in Caucasian or Asian women c. It may worsen with repeated cycles or remain asymptomatic and disappear after menopause d. It is unlikely to affect sexual intercourse or fertility |
ANS: C
Symptoms vary among women, ranging from nonexistent to incapacitating. With endometriosis, the endometrial tissue is outside the uterus. Symptoms vary among women, ranging from nonexistent to incapacitating. Endometriosis is found equally in Caucasian and African-American women and is slightly more prevalent in Asian women. Women can experience painful intercourse and impaired fertility. |
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20. The nurse counseling the client with endometriosis knows that which statement about the management of endometriosis is NOT accurate?
a. Bone loss from hypoestrogenism is not reversible. b. Side effects from the steroid Danazol include masculinizing traits. c. Surgical intervention often is needed for severe or acute symptoms. d. Women without pain and who do not want to become pregnant need no treatment. |
ANS: A
Feedback A Correct: Bone loss is mostly reversible within 12 to 18 months after the medication is stopped. B Incorrect: Such masculinizing traits as hirsutism, a deepening voice, and weight gain occur with Danazol but are reversible. C Incorrect: Surgical intervention often is needed when symptoms are incapacitating. The type of surgery is influenced by the woman’s age and desire to have children. D Incorrect: Treatment is not needed for women without pain or the desire to have children. |
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17. One of the alterations in cyclic bleeding that occurs between periods is called:
a. Oligomenorrhea b. Menorrhagia c. Leiomyoma d. Metrorrhagia |
ANS: D
Metrorrhagia is bleeding between periods. It can be caused by progestin injections and implants. Oligomenorrhea is infrequent or scanty menstruation. Menorrhagia is excessive menstruation. Leiomyoma is a common cause of excessive bleeding. |
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22. With regard to dysfunctional uterine bleeding (DUB), the nurse should be aware that:
a. It is most commonly caused by anovulation. b. It most often occurs in middle age. c. The diagnosis of DUB should be the first considered for abnormal menstrual bleeding. d. The most effective medical treatment involves steroids. |
ANS: A
Feedback A Correct: Anovulation may occur because of hypothalamic dysfunction or polycystic ovary syndrome. B Incorrect: DUB most often occurs when the menstrual cycle is being established or when it draws to a close at menopause. C Incorrect: A diagnosis of DUB is made only after all other causes of abnormal menstrual bleeding have been ruled out. D Incorrect: The most effective medical treatment is oral or intravenous estrogen. |
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18. Management of primary dysmenorrhea often requires a multifaceted approach. The nurse who provides care for a client with this condition should be aware that the optimal pharmacologic therapy for pain relief is:
a. Acetaminophen b. Oral contraceptive pills (OCPs) c. Nonsteroidal antiinflammatory drugs (NSAIDs) d. Aspirin |
ANS: C
NSAIDs have the strongest research results for pain relief. Often if one NSAID is not effective, another one will provide relief. Approximately 80% of women find relief from these prostaglandin inhibitors. Preparations containing acetaminophen are less effective for dysmenorrhea because they lack the antiprostaglandin properties of NSAIDs. OCPs are a reasonable choice for women who also want birth control. The benefit of OCPs is the reduction of menstrual flow and irregularities. OCPs may be contraindicated for some women and have a number of potential side effects. NSAIDs are the drug of choice. However, if a woman is taking an NSAID she should avoid taking aspirin as well. |
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1. Alternatives to hormonal therapy for menopausal symptoms include (choose all that apply):
a. Soy b. Vitamin C c. Vitamin K d. Vitamin E e. Vitamin A |
ANS: A, D
Both soy and vitamin E have been reported to help alleviate menopausal symptoms. |
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2. Which suggestion is appropriate for a client who complains of hot flashes? Choose all that apply.
a. Consume large quantities of caffeine b. Drink a glass of wine c. Eat Mexican food d. Drink ice water e. Drink warm beverages |
ANS: D
Ice water may help alleviate the hot flashes. Consuming large quantities of caffeine, drinking a glass of wine, eating Mexican food, or drinking warm beverages most likely would exacerbate the hot flashes. |
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3. Which medications can be taken by postmenopausal women to treat and/or prevent osteoporosis? Choose all that apply.
a. Calcium b. Evista c. Fosamax d. Actonel e. Calcitonin |
ANS: A, B, C, D, E
Calcium, Evista, Fosamax, Actonel, and Calcitonin can be used by postmenopausal women to treat or prevent osteoporosis. |
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4. Which statements might the nurse appropriately include when teaching a client about calcium intake for osteoporosis? Choose all that apply.
a. “You should try to increase your protein intake when you are taking calcium.” b. “It is best to take calcium in one large dose.” c. “Tums are the most soluble form of calcium.” d. “You should take calcium with vitamin D because the vitamin D helps your body absorb calcium better.” e. “It’s okay to take calcium if you have had a history of kidney stones.” |
ANS: C, D
Excessive protein should be avoided. Calcium is best taken in divided doses so as to increase absorption. Calcium should be taken with vitamin D to increase absorption. Calcium is contraindicated in women with a history of kidney stones. |
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5. There is little consensus on the management of premenstrual dysphoric disorder (PMDD). However, nurses can advise women on several self-help modalities that often result in symptom improvement. The nurse knows that health teaching has been effective when the client reports that she has adopted a number of lifestyle changes including:
a. Regular exercise b. Improved nutrition c. A daily glass of wine d. Smoking cessation e. Oil of evening primrose |
ANS: A, B, D, E
Regular exercise, improved nutrition, smoking cessation, and oil of evening primrose are accurate modalities that may provide significant symptom relief in 1 to 2 months. If there is no improvement after these changes have been made, the client may need to begin pharmacologic therapy. Women should decrease their alcohol and caffeinated beverage consumption if they suffer from PMDD. |
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1. Some plant foods contain _________________________ and are capable of interacting with estrogen receptors in the body.
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ANS: Phytoestrogens
These foods include wild yams, dandelion greens, cherries, alfalfa sprouts, black beans, and soybeans. |
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2. Any episode of vaginal bleeding that occurs at a time other than during menses is referred to as _______________.
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ANS: Metrorrhagia
Defined as intermenstrual bleeding, this is also commonly referred to as breakthrough bleeding or mittlestaining. This can be a normal part of a woman’s menstrual cycle if it occurs regularly or it may be an indication of an underlying disease process that requires further investigation. |
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Obese women are more likely to have dysfunctional uterine bleeding and endometrial hyperplasia. Is this statement true or false?
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ANS: T Women with more body fat have higher circulating levels of estrone. This occurs because estrogen that is stored in the fat cells of the body is converted into a form of estrogen that is available to the estrogen receptors within the endometrium.
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A woman has chosen the calendar method of conception control. During the assessment process, it is most important that the nurse:
a. Obtain a history of menstrual cycle lengths for the past 6 to 12 months b. Determine the client’s weight gain and loss pattern for the previous year c. Examine skin pigmentation and hair texture for hormonal changes d. Explore the client’s previous experiences with conception control |
ANS: A
The calendar method of conception control is based on the number of days in each cycle, counting from the first day of menses. The fertile period is determined after the lengths of menstrual cycles have been accurately recorded for 6 months. Weight gain or loss may be partly related to hormonal fluctuations, but it has no bearing on use of the calendar method. Integumentary changes may be related to hormonal changes, but they are not indicators for use of the calendar method. Exploring previous experiences with conception control may demonstrate client understanding and compliancy, but it is not the most important aspect to assess for discussion of the calendar method. |
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A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs). The nurse’s most appropriate reply is:
a. “They’re not very effective, and it’s very likely you’ll get pregnant.” b. “They can be effective for many couples, but they require motivation.” c. “These methods have a few advantages and several health risks.” d. “You would be much safer going on the pill and not having to worry.” |
ANS: B
FAMs are effective with proper vigilance about ovulatory changes in the body and with adherence to coitus intervals. Fertility awareness methods are effective if used correctly by a woman with a regular menstrual cycle. The typical failure rate for all FAMs is 25% during the first year of use. FAMs have no associated health risks. The use of birth control has associated health risks. In addition, taking a pill daily requires compliance on the client’s part. |
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A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. The nurse’s most appropriate response would be:
a. “This is a highly effective method, but it has some side effects.” b. “Your current medications will reduce the effectiveness of the pill.” c. “The pill will reduce the effectiveness of your seizure medication.” d. “This is a good choice for a woman of your age and personal history.” |
ANS: B
Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they are taken simultaneously with anticonvulsants. |
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A woman who has just undergone a first-trimester abortion will be using oral contraceptives. To protect against pregnancy, she should be advised to:
a. Avoid sexual contact for at least 10 days after starting the pill b. Use condoms and foam for the first few weeks as backup c. Use another method of contraception for 1 week after starting the pill d. Begin sexual relations once vaginal bleeding has ended |
ANS: C
If contraceptives are to be started within 3 weeks after an abortion, another method of contraception should be used throughout the first week to avoid the risk of pregnancy. |
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Injectable progestins (DMPA, Depo-Provera) are a good contraceptive choice for women who:
a. Want menstrual regularity and predictability b. Have a history of thrombotic problems or breast cancer c. Have difficulty remembering to take oral contraceptives daily d. Are homeless or mobile and rarely receive health care |
ANS: C
Advantages of DMPA include a contraceptive effectiveness comparable to that of combined oral contraceptives with the requirement of only four injections a year. Disadvantages of injectable progestins are prolonged amenorrhea and uterine bleeding. Use of injectable progestin carries an increased risk of venous thrombosis and thromboembolism. To be effective, DMPA injections must be administered every 11 to 13 weeks. Access to health care is necessary to prevent pregnancy or potential complications. |
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A woman currently uses a diaphragm and spermicide for contraception. She asks the nurse what the major differences are between the cervical cap and diaphragm. The nurse’s most appropriate response is:
a. “No spermicide is used with the cervical cap, so it’s less messy.” b. “The diaphragm can be left in place longer after intercourse.” c. “Repeated intercourse with the diaphragm is more convenient.” d. “The cervical cap can safely be used for repeated acts of intercourse without adding more spermicide later.” |
ANS: D
The cervical cap can be inserted hours before sexual intercourse without the need for additional spermicide later. No additional spermicide is required for repeated acts of intercourse. Spermicide should be used inside the cap as an additional chemical barrier. The cervical cap should remain in place for 6 hours after the last act of intercourse. |
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Postcoital contraception with Ovral:
a. Requires that the first dose be taken within 120 hours of unprotected intercourse b. Requires that the woman take second and third doses at 24 and 36 hours after the first dose c. Has an effectiveness rate in preventing pregnancy of approximately 50% d. Is commonly associated with the side effect of menorrhagia |
ANS: A
Emergency contraception is used within 120 hours of unprotected intercourse to prevent pregnancy. The first dose of an emergency contraception should be taken within 120 hours after coitus. Postcoital use of Ovral is 74% to 90% effective at preventing pregnancy. The common side effect of postcoital contraception is nausea. |
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An unmarried young woman describes her sex life as “active” and involving “many” partners. She wants a contraceptive method that is reliable and does not interfere with sex. She requests an intrauterine device (IUD). The nurse’s most appropriate response is:
a. “The IUD does not interfere with sex.” b. “The risk of pelvic inflammatory disease will be higher for you.” c. “The IUD will protect you from sexually transmitted infections.” d. “Pregnancy rates are high with the IUDs.” |
ANS: B
Disadvantages of IUDs include an increased risk of pelvic inflammatory disease (PID) in the first 20 days after insertion, as well as the risks of bacterial vaginosis and uterine perforation. |
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9. A woman is 16 weeks pregnant and has elected to terminate her pregnancy. The nurse knows that the most common technique used for medical termination of a pregnancy in the second trimester is:
a. Administration of prostaglandins b. Instillation of hypertonic saline into the uterine cavity c. IV administration of Pitocin d. Vacuum aspiration |
ANS: A
The most common technique for medical termination of a pregnancy in the second trimester is administration of prostaglandins. IV administration of Pitocin is used to induce labor in a woman with a third-trimester fetal demise.Vacuum aspiration is used for abortions in the first trimester. |
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10. A woman will be taking oral contraceptives using a 28-day pack. The nurse should advise this woman to protect against pregnancy by:
a. Limiting sexual contact for one cycle after starting the pill b. Using condoms and foam instead of the pill for as long as she takes an antibiotic c. Taking one pill at the same time every day d. Throwing away the pack and using a backup method if she misses two pills during week 1 of her cycle |
ANS: C
To maintain adequate hormone levels for contraception and to enhance compliance, clients should take oral contraceptives at the same time each day. If the client misses two pills during week 1, she should take two pills a day for 2 days and finish the package and use a backup method the next 7 consecutive days. |
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11. A woman had unprotected intercourse 36 hours ago and is concerned that she may become pregnant because it is her “fertile” time. She asks the nurse about emergency contraception. The nurse would tell her that:
a. It is too late; she needed to begin treatment within 24 hours after intercourse b. Preven, an emergency contraceptive method, is 98% effective at preventing pregnancy c. An over-the-counter antiemetic can be taken 1 hour before each contraceptive dose to prevent nausea and vomiting d. The most effective approach is to use a progestin-only preparation |
ANS: C
To minimize the side effect of nausea that occurs with high doses of estrogen and progestin, the woman can take an over-the-counter antiemetic 1 hour before each dose. Emergency contraception is used within 72 hours of unprotected intercourse to prevent pregnancy. Postcoital contraceptive use is 74% to 90% effective at preventing pregnancy. Oral emergency contraceptive regimens may include progestin-only and estrogen-progestin pills. |
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12. Although reported in small numbers, toxic shock syndrome can occur with the use of a diaphragm. If a client is interested in this form of conception control, the nurse should teach the woman how to reduce her risk of TSS. The nurse might say:
a. “You should always remove your diaphragm 6 to 8 hours after intercourse. Don’t use the diaphragm during menses, and watch for danger signs of TSS, including a sudden onset of fever over 38.4º C, hypotension, and a rash.” b. “You should remove your diaphragm right after intercourse to prevent TSS.” c. “It’s okay to use your diaphragm during your menstrual cycle. Just be sure to wash it thoroughly first to prevent TSS.” d. “Make sure you don’t leave your diaphragm in for longer than 24 hours, or you may get TSS.” |
ANS: A
The nurse should instruct the client on proper use and removal of the diaphragm, and include the danger signs of TSS. The diaphragm must remain against the cervix for 6 to 8 hours to prevent pregnancy, but it should not remain in place longer than 8 hours to avoid the risk of TSS. The diaphragm should not be used during menses. |
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13. The conscious decision on when to conceive or avoid pregnancy throughout the reproductive years is called:
a. Family planning b. Birth control c. Contraception d. Assisted reproductive therapy |
ANS: A
Family planning is the process of deciding when and if to have children. |
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14. In the acronym BRAIDED, which letter is used to identify the key components of informed consent that the nurse must document?
a. B stands for “babies.” b. R stands for “reproduction.” c. A stands for “alternatives.” d. I stands for “ineffective.” |
ANS: C
A stands for alternatives, or information about other viable methods. B stands for benefits, or information about advantages and success rates. R stands for risks, or information about disadvantages and failure rates. I stands for inquiries, or the opportunity to ask questions. |
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What is not a potential pitfall or disadvantage of the fertility awareness methods (FAMs)?
a. Adherence to strict record keeping b. Alterations in the menstrual flow pattern with chemicals and hormones c. Decreased effectiveness in women with irregular cycles d. Time-consuming training sessions |
ANS: B
The absence of chemicals or hormones to alter the menstrual flow is an advantage. The strict record keeping FAMs require creates a potential risk. FAMs are less effective for women with irregular cycles. FAMs require time-consuming training for effective use. |
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While instructing a couple regarding birth control, the nurse should be aware that the method called natural family planning:
a. Is the same as coitus interruptus, or “pulling out” b. Uses the calendar method to align the woman’s cycle with the natural phases of the moon c. Is the only contraceptive practice acceptable to the Roman Catholic Church d. Relies on barrier methods during fertility phases |
ANS: C
Natural family planning is the only contraceptive practice acceptable to the Roman Catholic Church. Natural family planning is another name for periodic abstinence, which is the accepted way to pass safely through the fertility phases without relying on chemical or physical barriers. |
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Which contraceptive method has a failure rate of less than 25%?
a. Standard days b. Periodic abstinence c. Postovulation d. Coitus interruptus |
ANS: A
The standard days variation on the calendar method has a failure rate of 12%. The periodic abstinence method has a failure rate of 25% or higher. |
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Which contraceptive method best protects against sexually transmitted infections (STIs) and human immunodeficiency virus (HIV)?
a. Periodic abstinence b. Barrier methods c. Hormonal methods d. They all offer about the same protection. |
ANS: B
Barrier methods, such as condoms, best protect against STIs and HIV. |
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With regard to the noncontraceptive medical effects of combination oral contraceptives (COCs), nurses should be aware that:
a. COCs can cause toxic shock syndrome if the prescription is wrong b. Hormonal withdrawal bleeding usually is a bit more profuse than in normal menstruation and lasts a week c. COCs increase the risk of endometrial and ovarian cancer d. The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements |
ANS: D
The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements. Toxic shock syndrome can occur in some diaphragm users, but it is not a consequence of taking oral contraceptive pills. Hormonal withdrawal bleeding usually is lighter than in normal menstruation and lasts a couple of days. Oral contraceptive pills offer protection against the risk of endometrial and ovarian cancers. |
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With regard to the use of intrauterine devices (IUDs), nurses should be aware that:
a. Return to fertility can take several weeks after the device is removed b. IUDs containing copper can provide an emergency contraception option if inserted within a few days of unprotected intercourse c. IUDs offer the same protection against sexually transmitted infections as the diaphragm d. Consent forms are not needed for IUD insertion |
ANS: B
The woman has up to 5 days to insert the IUD after unprotected sex. Return to fertility is immediate after removal of the IUD. A consent form is required for insertion, as is a negative pregnancy test. |
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21. Which statement is the most complete and accurate description of medical abortions?
a. They are performed only for maternal health. b. They can be achieved through surgical procedures or with drugs. c. They are mostly performed in the second trimester. d. They can be either elective or therapeutic. |
ANS: D
Abortions can be either elective (the woman’s choice) or therapeutic (for reasons of maternal or fetal health). Medical abortions are performed through the use of medications (rather than surgical procedures). Medical abortions are usually performed in the first trimester. |
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A woman is using the basal body temperature (BBT) method of contraception. She calls the clinic and tells the nurse, “My period is due in a few days, and my temperature has not gone up.” The nurse’s most appropriate response is:
a. “This probably means you’re pregnant.” b. “Don’t worry; it’s probably nothing.” c. “Have you been sick this month?” d. “You probably didn’t ovulate during this cycle.” |
ANS: D
Feedback A Incorrect: Pregnancy cannot occur without ovulation (which is being measured using the BBT method). B Incorrect: A comment such as this discredits the client’s concerns. C Incorrect: Illness would most likely cause an increase in basal body temperature. D Correct: The absence of a temperature decrease most likely is the result of lack of ovulation. |
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A male client asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). The nurse’s most appropriate response is:
a. “The lubricant prevents vaginal irritation.” b. “Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; also, it has been linked to an increase in the transmission of HIV and can cause genital lesions.” c. “The additional lubrication improves sex.” d. “Nonoxynol-9 improves penile sensitivity.” |
b.
“Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; also, it has been linked to an increase in the transmission of HIV and can cause genital lesions.” |
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A married couple is discussing male and female sterilization with the nurse. Which of the following statements is most appropriate for the nurse to make?
a. “Male and female sterilization methods are 100% effective.” b. “A vasectomy may have a slight effect on sexual performance.” c. “Tubal ligation can be easily reversed if you change your mind in the future.” d. “Major complications after sterilization are rare.” |
ANS: D
Feedback A Incorrect: The average failure rate for female sterilization is 0.5%. The average failure rate for male sterilization is 0.15%. B Incorrect: A vasectomy has no effect on potency or volume of ejaculate. C Incorrect: Sterilization reversal is costly, difficult, and uncertain. D Correct: Sterilization procedures can be safely done on an outpatient basis. Complications are uncommon and usually not serious. |
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An induced abortion client calls the nurse to report postprocedural symptoms. Which condition would NOT cause the nurse to ask her to come into the office for care?
a. Abdominal tenderness when pressure is applied b. Chills and a fever of 101° F c. Return of her period in less than 6 weeks d. Foul-smelling vaginal discharge |
ANS: C
Feedback A Incorrect: Abdominal tenderness might merit a visit to the care provider. B Incorrect: Chills and a fever might merit a visit to the care provider. C Correct: A return to her period in 4 to 6 weeks is expected. D Incorrect: This type of discharge might merit a visit to the care provider. |
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Nurses, certified nurse-midwives, and other advance practice nurses have the knowledge and expertise to assist women in making informed choices regarding contraception. A multidisciplinary approach should ensure that the woman's social, cultural, and interpersonal needs are met. Which action should the nurse take first when meeting with a new client to discuss contraception?
a. Obtain data about the frequency of coitus b. Determine the woman's level of knowledge about contraception and commitment to any particular method c. Assess the woman's willingness to touch her genitals and cervical mucus d. Evaluate the woman's contraceptive life plan |
ANS: B
Feedback A Incorrect: Although important this is not the first action that the nurse should undertake when completing an assessment. Data should include not only the frequency of coitus but also the number of sexual partners, level of contraceptive involvement, and partner’s objections B Correct: This is the primary step of this nursing assessment and necessary before completing the process and moving on to a nursing diagnosis. Once the client's level of knowledge is determined, the nurse can interact with the woman to compare options, reliability, cost, comfort level, protection from STDs, and a partner's willingness to participate C Incorrect: This is a key factor for the nurse to discuss should the client express interest in using one of the fertility awareness methods of contraception D Incorrect: The nurse must be aware of the client's plan regarding whether she is attempting to prevent conception, delay conception, or attempting to conceive |
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You (the nurse) are reviewing the educational packet provided to a client about tubal ligation. What is an important fact you should point out? Choose all that apply.
a. “It is highly unlikely that you will become pregnant after the procedure.” b. “This is an effective form of 100% permanent sterilization. You won’t be able to get pregnant.” c. “Sterilization offers some form of protection against sexually transmitted infections.” d. “Sterilization offers no protection against sexually transmitted infections.” e. “Your menstrual cycle will greatly increase after your sterilization.” |
ANS: A, D
A woman is unlikely to become pregnant after tubal ligation. Sterilization offers no protection against sexually transmitted infections (STIs). Tubal ligation is not 100% effective. Tubal ligation does not offer any protection against STIs. Typically, the menstrual cycle remains the same after a tubal ligation. |
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1. The ________________ _______________ _________________ (LAM) can be a highly effective, temporary method of birth control.
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ANS:
Lactation amenorrhea method This method is more popular in undeveloped countries and traditional societies where breastfeeding is used to prolong pregnancy intervals. Most American women do not establish breastfeeding patterns that provide maximum protection from pregnancy. |
