Chapter 4

A couple comes to the clinic for a fertility evaluation. The male partner is to undergo a semen analysis. After teaching the partner about this test, which client statement Indicates that the client has understood the instructions? A) "I need to bring the specimen to the lab the day after collecting it." B) "I will place the specimen in a special plastic bag to transport it." C) "I have to abstain from sexual activity for about 1-2 days before the sample." D) "I will withdraw before I ejaculate during sex to collect the specimen."

"I have to abstain from sexual activity for about 1-2 days before the sample." Feedback: Semen analysis is the most important indicator of male fertility. The man should abstain from sexual activity for 24 to 48 hours before giving the sample. For a semen examination, the man is asked to produce a specimen by ejaculating into a specimen container and delivering it to the laboratory for analysis within 1 to 2 hours. When the specimen is brought to the laboratory, it is analyzed for volume, viscosity, number of sperm, sperm viability, motility, and sperm shape.

After the nurse teaches a client about ways to reduce the symptoms of premenopausal syndrome, which client statement indicates a need for additional teaching? A) "I will make sure to take my estrogen supplements a week before my period." B) "I've signed up for an aerobic exercise class three times a week." C) "I'll cut down on the amount of coffee and colas I drink." D) "I quit smoking about a month ago, so that should help."

"I will make sure to take my estrogen supplements a week before my period."

The nurse is reviewing the medical records of several clients. Which client would the nurse expect to have an increased risk for developing osteoporosis? A) A woman of African American descent B) A woman who plays tennis twice a week C) A thin woman with small bones D) A woman who drinks one cup of coffee a day

A thin woman with small bones Feedback: A woman with a small frame and thin bones is at a higher risk for osteoporosis. Caucasian or Asian women, not African American women, are at higher risk for the condition. A woman who plays tennis twice a week is active and thus would be at low risk for osteoporosis. Women who ingest excessive amounts of caffeine are at increased risk.

A woman comes to the clinic because she has been unable to conceive. When reviewing the woman's history, which of the following would the nurse least likely identify as a possible risk factor? A) Age of 25 years B) History of smoking C) Diabetes since age 15 years D) Weight below standard for height and age

Age of 25 years

When developing a teaching plan for a couple considering contraception options, which of the following statements with the nurse include? A) "You should select one that is considered to be 100% effective." B) "The best one is the one that is the least expensive and most convenient." C) "A good contraceptive doesn't require a physician's prescription." D) "The best contraceptive is one that you will use correctly and consistently."

" The best contraceptive is one that you will use correctly and consistently"

After assessing a woman who has come to the clinic, the nurse suspects that the woman is experiencing dysfunctional uterine bleeding. Which statement by the client would support the nurses suspicions? A) "I've been having bleeding off and on that's irregular and sometimes heavy." B) "I get sharp pain in my lower abdomen usually starting soon after my period comes." C) "I get really irritable and moody about a week before my period." D) "My periods have been unusually long and heavy lately."

"I've been having bleeding off and on that's irregular and sometimes heavy." Feedback: Dysfunctional uterine bleeding is defined as irregular, abnormal bleeding that occurs with no identifiable anatomic pathology. It is frequently associated with anovulatory cycles, which are common for the first year after menarche and later in life as a woman approaches menopause. Pain occurring with menses refers to dysmenorrhea. Although mood swings may be associated with dysfunctional uterine bleeding, irritability and mood swings are more commonly associated with premenstrual syndrome. Unusually long and heavy periods reflect menorrhagia.

After teaching a group of students about the different methods for contraception, the instructor determines that the teaching was successful when the students identify which of the following as a mechanical barrier method? (Select all that apply.) A) Condom B) Cervical cap C) Cervical sponge D) Diaphragm E) Vaginal ring

Condom Cervical cap Cervical sponge Diaphragm Feedback: Barrier methods include the condom, cervical cap, cervical sponge and diaphragm. The vaginal ring is considered a hormonal method of contraception.

After discussing various methods of contraception with a client and her partner, the nurse determines that the teaching was successful when they identify which contraceptive method as providing protection against sexually transmitted infections (STIS)? A) Oral contraceptives B) Tubal ligation C) Condoms D) Intrauterine system

Condoms Feedback: Condoms are a barrier method of contraception. In addition to providing a physical barrier for sperm, they also protect against STIs. Oral contraceptives, tubal ligation, and intrauterine systems provide no protection against STIs.

A client states that she is to have a test to measure bone mass to help diagnose osteoporosis. The nurse would most likely plan to prepare the client for: A) DEXA scan B) Ultrasound C) MRI D) Pelvic x-ray

DEXA scan Feedback: The client most likely will be having a DEXA scan, which is a screening test that calculates the mineral content of the bone at the spine and hip. Ultrasound, MRI, and a pelvic x-ray would be of little help in determining bone mass.

The nurse discusses various contraceptive methods with a client and her partner. Which method would the nurse explain as being available only with a prescription? A) Condom B) Spermicide C) Diaphragm D) Basal body temperature

Diaphragm Feedback: The diaphragm is available only by prescription and must be professionally fitted by a health care provider. Condoms and spermicides are available over the counter. Basal body temperature requires the use of a special thermometer that is available over the counter.

Which finding would the nurse expect to find in a client with endometriosis? A) Hot flashes B) Dysuria C) Fluid retention D) Fever

Dysuria Feedback: The client with endometriosis is often asymptomatic, but clinical manifestations include painful urination, pain before and during menstrual periods, pain during or after sexual intercourse, infertility, depression, fatigue, painful bowel movements, chronic pelvic pain, hypermenorrhea, pelvic adhesions, irregular and more frequent menses, and premenstrual spotting. Hot flashes may be associated with premenstrual syndrome or menopause. Fluid retention is associated with premenstrual syndrome. Fever would suggest an infection.

A nurse is preparing a class for a group of young adult women about emergency contraceptives (ECs). Which of the following would the nurse need to stress to the group. Select all that apply. A) ECs induce an abortion like reaction. B) ECs provide some protection against STIs C) ECs are birth control pills in higher, more frequent doses D) ECs are not to be used in place of regular birth control E) ECs provide little protection for future pregnancies.

ECs are birth control pills in higher, more frequent doses ECs are not to be used in place of regular birth control ECs provide little protection for future pregnancies. Feedback: Important points to stress concerning ECs are that ECs do not offer any protection against STIs or future pregnancies; should not be used in place of regular birth control, as they are less effective; are regular birth control pills given at higher doses and more frequently; and are contraindicated during pregnancy (Miller, 2011). Contrary to popular belief, ECs do not induce abortion and are not related to mifepristone or RU-486, the so-called abortion pill approved by the FDA in 2000.

When teaching a group of postmenopausal women about hot flashes and night sweats, the nurse would address which of the following as the primary cause? A) Poor dietary intake B) Estrogen deficiency C) Active lifestyle D) Changes in vaginal pH

Estrogen deficiency Feedback: Hot flashes and night sweats are classic signs of estrogen deficiency. They are unrelated to dietary intake or active lifestyle. Changes in vaginal pH are associated with genitourinary changes of menopause.

The nurse is reviewing the laboratory test results of a client with dysfunctional uterine bleeding (DUB). Which finding would be of concern? A) Negative pregnancy test B) Hemoglobin level of 10.1 g/dL C) Prothrombin time of 60 seconds D) Serum cholesterol of 140 mg/dL

Hemoglobin level of 10.1 g/dL Feedback: A hemoglobin level of 10.1 g/dL suggests anemia, which might occur secondary to prolonged or heavy menses. A negative pregnancy test, a prothrombin time of 60 seconds, and a serum cholesterol level of 140 mg/dL are within normal parameters.

When discussing contraceptive options, which method would the nurse recommend as being the most reliable? A) Coitus interruptus B) Lactational amenorrheal method (LAM) C) Natural family planning D) Intrauterine system

Intrauterine system Feedback: An intrauterine system is the most reliable method because users have to consciously discontinue using them to become pregnant rather than making a proactive decision to avoid conception. Coitus interruptus, LAM, and natural family planning are behavioral methods of contraception and require active participation of the couple to prevent pregnancy. These behavioral methods must be followed exactly as prescribed.

A client comes to the clinic with abdominal pain. Based on her history the nurse suspects endometriosis. The nurse expects to prepare the client for which of the following to confirm this suspicion? A) Pelvic examination B) Transvaginal ultrasound C) Laparoscopy D) Hysterosalpingogram

Laparoscopy Feedback: The only certain method of diagnosing endometriosis is by seeing it. Therefore, the nurse would expect to prepare the client for a laparoscopy to confirm the diagnosis. A pelvic examination and transvaginal ultrasound are done to assess for endometriosis but do not confirm its presence. Hysterosalpingography aids in identifying tubal problems resulting in infertility.

When reviewing the medical record of a client diagnosed with endometriosis, which of the following would the nurse identify as a risk factor for this woman? A) Low fat in the diet B) Age of 14 years for menarche C) Menstrual cycles of 24 days D) Short menstrual flow

Menstrual cycles of 24 days Feedback: Risk factors for developing endometriosis include increasing age, family history of endometriosis in a first-degree relative, short menstrual cycle (less than 28 days), long menstrual flow (more than 1 week), high dietary fat consumption, young age at menarche (younger than age 12), and few (one or two) or no pregnancies.

A client who has come to the clinic is diagnosed with endometriosis. Which of the following would the nurse expect the physician to prescribe as a first-line treatment? A) Progestins B) Antiestrogens C) Gonadotropin-releasing hormone analogues D) NSAIDs

NSAIDs Feedback: Although progestins, antiestrogens, and gonadotrophin-releasing analogues are used as treatment options for endometriosis, NSAIDS are considered the first-line treatment to reduce pain.

A woman has opted to use the basal body temperature method for contraception. The nurse instructs the client that a raise in basal body temperature indicates which of the following? A) Onset of menses B) Ovulation C) Pregnancy D) Safe period for intercourse

Ovulation

Which of the following measures would the nurse include in the teaching plan for a woman to reduce the risk of osteoporosis after menopause? A) Taking vitamin supplements B) Eating high-fiber, high-calorie foods C) Restricting fluid to 1,000 mL daily D) Participating in regular daily exercise

Participating in regular daily exercise Feedback: Measures to reduce osteoporosis after menopause include daily weight-bearing exercise, increasing calcium and vitamin D intake, and avoiding smoking and excessive alcohol intake. General vitamin supplements may be helpful overall, but they are not specific to reducing the risk of osteoporosis. A diet high in calcium and vitamin D, not fiber and calories, would be appropriate. Restricting fluids would have no effect on preventing osteoporosis.

A nurse is describing the criteria needed for the diagnosis of premenstrual dysphoric disorder (PMDD). Which of the following would the nurse include as a mandatory requirement for the diagnosis? A) Appetite changes B) Sleep difficulties C) Persistent anger D) Chronic fatigue

Persistent anger Feedback: For the diagnosis of PMDD, the woman must exhibit one or more of the following: affective lability such as sadness, tearfulness, or irritability; anxiety and tension; persistent or marked anger or irritability; and depressed mood and feelings of hopelessness. Other symptoms, although not mandatory for the diagnosis, include increased or decreased appetite, sleep difficulties, chronic fatigue, headache, increased or decreased sexual desire, constipation or diarrhea, and breast swelling and tenderness.

A nurse is preparing a class for a group of women at a family planning clinic about contraceptives. When describing the health benefits of oral contraceptives, which of the following would the nurse most likely include? (Select all that apply.) A) Protection against pelvic inflammatory disease B) Reduced risk for endometrial cancer C) Decreased risk for depression D) Reduced risk for migraine headaches E) Improvement in acne

Protection against pelvic inflammatory disease Reduced risk for endometrial cancer Improvement in acne Feedback: The health benefits of oral contraceptives include protection against pelvic inflammatory disease, a reduced risk for endometrial cancer, and improvement in acne. Oral contraceptives are associated with an increased risk for depression and migraine headaches.

A woman using the cervical mucus ovulation method of fertility awareness reports that her cervical mucus looks like egg whites. The nurse interprets this as which of the following? A) Spinnbarkeit mucus B) Purulent mucus C) Postovulatory mucus D) Normal preovulation mucus

Spinnbarkeit mucus Feedback: The client is describing spinnbarkeit mucus, the copious, clear, slippery, smooth, and stretchable mucus that occurs as ovulation approaches. Purulent mucus would be yellow or green and malodorous. Preovulation mucus is clear but not as copious, slippery, and stretchable.

A client is to receive an implantable contraceptive. The nurse describes this contraceptive as containing: A) Synthetic progestin B) Combined estrogen and progestin C) Concentrated spermicide D) Concentrated estrogen

Synthetic progestin Feedback: Implantable contraceptives deliver synthetic progestin that acts by inhibiting ovulation and thickening cervical mucus so sperm cannot penetrate. Implantable contraceptives do not contain combined estrogen and progestin, concentrated spermicide, or concentrated estrogen.

Which of the following would the nurse emphasize when teaching postmenopausal women about ways to reduce the risk of osteoporosis? A) Swimming daily B) Taking vitamin A C) Following a low-fat diet D) Taking calcium supplements

Taking calcium supplements

After teaching a group of students about premenstrual syndrome, The instructor determines that additional teaching is needed when the students identify which of the following as a prominent assessment finding? A) Bloating B) Tension C) Dysphoria D) Weight loss

Weight loss Feedback: Irritability, fatigue, bloating, tension, and dysphoria are the most prominent and consistently described manifestations of premenstrual syndrome. Weight gain, not weight loss, is associated with this disorder