Chapter 53, Nursing Management: Problems with Menstruation

A pregnant patient reports occasional spotting and severe pain in the abdomen. The ultrasonography reports reveal the absence of an intrauterine fetus and serum β-hCGof 1,500 mIU per mL. For which procedure that may prevent complications does the nurse prepare the patient? Laparoscopy Myomectomy Hysterectomy Balloon thermotherapy

Laparoscopy

The normal physiologic cessation of menses associated with declining ovarian function is referred to as which condition? Menopause Amenorrhea Dysmenorrhea Perimenopause

Menopause

Which term is used to describe premenstrual syndrome (PMS) associated with severe mood changes? Menarche Depression Perimenopause Premenstrual dysphoric disorder (PMDD)

Premenstrual dysphoric disorder (PMDD)

When educating a group of teenagers about premenstrual syndrome (PMS), what information should the nurse include? Select all that apply. Premenstrual symptoms are similar during each menstrual cycle. Premenstrual symptoms can be severe enough to impair interpersonal relationships. Premenstrual symptoms occur cyclically in the luteal phase just before menstruation. Premenstrual symptoms occur cyclically in the follicular phase just before menstruation. Premenstrual symptoms may vary, but breast discomfort is seen in all patients experiencing PMS.

Premenstrual symptoms can be severe enough to impair interpersonal relationships. Premenstrual symptoms occur cyclically in the luteal phase just before menstruation.

Primary dysmenorrhea is most commonly caused by overproduction of which hormone? Estrogen Progesterone Prostaglandin Human chorionic gonadotropin (HCG)

Progesterone

A patient with primary dysmenorrhea inquires as to what interventions may be used in order to relieve the discomfort. What is the best response by the nurse? Select all that apply. Steroids Hysterectomy Regular exercises Nonsteroidal antiinflammatory drugs Application of heat to lower abdomen and back

Regular exercises Nonsteroidal antiinflammatory drugs Application of heat to lower abdomen and back

A patient reports cessation of her menstrual cycle to the nurse. Which condition does the nurse suspect in the patient after learning that the patient had menarche 15 years ago? Endometriosis Oligomenorrhea Primary amenorrhea Secondary amenorrhea

Secondary amenorrhea

A patient approaches the nurse expressing concerns about her impending menopause. What information should the nurse give to this patient to alleviate anxiety? Select all that apply. Menopause is a sudden event occurring in life. The age of menopause ranges from 44 to 55 years. Cigarette smoking may lead to early menopause. The age of menopause is affected by number of pregnancies. Menopause usually occurs as a result of illness, chemotherapy, or radiotherapy.

The age of menopause ranges from 44 to 55 years. Cigarette smoking may lead to early menopause.

While caring for a patient with irritability, abdominal bloating, breast discomfort, and edema, the nurse administers spironolactone. What rationale does the nurse give to the patient for administration of the medication? To reduce fluid retention To reduce cramping pain To improve negative mood To alleviate physiologic symptoms

To reduce fluid retention

The nurse is providing education to a postmenopausal patient regarding nutritional therapy. What information provided by the nurse will have the best outcome? Select all that apply. Vitamin E helps to reduce hot flashes. Daily calorie intake should be 60 cal/kg of body weight. Calcium supplements must be taken two hours after meals. Adequate intake of calcium and vitamin D helps to maintain healthy bones. Women on estrogen replacement need a maximum of 1000 mg of calcium per day.

Vitamin E helps to reduce hot flashes. Adequate intake of calcium and vitamin D helps to maintain healthy bones.

The nurse is assessing four patients receiving sertraline. Which patient may benefit from the administration of this medication? A patient with uterine fibroids and endometrial polyps A patient with migraine headache before menstruation A patient with abdominal pain radiating to the lower back A patient with candidiasis with thick curdlike vaginal discharge

A patient with migraine headache before menstruation

patient informs the nurse that she has not menstruated in several months. How will the nurse document this finding? Amenorrhea Dysmenorrhea Ectopic pregnancy Heavy menstrual bleeding

Amenorrhea

The nurse is educating a patient regarding a new medication regimen that may lead to amenorrhea. Which medication will the nurse discuss with this patient? Clonidine Raloxifene Amitriptyline Norethindrone

Amitriptyline

A nurse is caring for a patient who has premenstrual syndrome (PMS). The nurse should assess the patient for which symptoms? Select all that apply. Anxiety Hair loss Back pain Headaches Breast discomfort Abdominal bloating

Anxiety Back pain Headaches Breast discomfort Abdominal bloating

A patient is reporting various symptoms of premenstrual syndrome (PMS). Which medication does the nurse anticipate discussing with the patient for the relief of these symptoms? Buspirone for anxiety Vitamin B 6 for cramping pain Spironolactone for negative mood Ibuprofen for premenstrual dysphoric disorder

Buspirone for anxiety

The nurse is preparing a nutritional plan for a postmenopausal woman. What does the nurse include in the patient's dietary plan? Select all that apply. A low-carbohydrate diet A reduction in vitamin D Daily intake of vitamin E Adequate intake of calcium Adequate intake of sunflower seeds

Daily intake of vitamin E Adequate intake of calcium Adequate intake of sunflower seeds

The nurse is educating a female patient who is experiencing menopausal symptoms about conditions at which the patient will now be at a greater risk. For which conditions will the nurse monitor this patient? Select all that apply. Blood clots Depression Osteoporosis Bladder infections Endometrial cancer Coronary artery disease

Depression Osteoporosis Bladder infections Coronary artery disease

A patient with premenstrual syndrome (PMS) approaches the nurse for advice on conservative ways of managing the condition. What should the nurse advise? Select all that apply. Drink coffee daily. Exercise on a regular basis. Practice relaxation techniques. Increase intake of refined carbohydrates. Increase consumption of pork, milk, and legumes.

Exercise on a regular basis. Practice relaxation techniques. Increase consumption of pork, milk, and legumes. (B6)

A patient suspects she is having symptoms related to menopause. Which diagnostic study will the nurse tell the patient is used to confirm the diagnosis of menopause? Ultrasound Endometrial biopsy Follicle-stimulating hormone (FSH) Human chorionic gonadotropin (HCG)

FSH

The nurse is reviewing the medical history of few patients in the unit. Which patient will the nurse educate about oral contraceptives? A 17-year-old patient with vaginal discharge that smells fishy A 34-year-old patient with implantation of a fetus in her ovaries A 46-year-old patient with irregular menses for the past two years A 21-year-old patient with unknown abdominal bleeding and pain

A 46-year-old patient with irregular menses for the past two years

What advice should the nurse give to postmenopausal patients about sexuality? Select all that apply. Inform the patient that femininity and libido disappear with menopause. Teach the patient that the use of moisturizing soaps and body lotions may help improve dry skin. Inform the patient that water-soluble lubricants are effective for atrophic changes in the vagina. Inform the patient that cessation of menstruation should be equated with cessation of sexual desire. Inform the patient that vaginal atrophic changes are normal after menopause and often are permanent.

Teach the patient that the use of moisturizing soaps and body lotions may help improve dry skin. Inform the patient that water-soluble lubricants are effective for atrophic changes in the vagina.

A nurse is caring for a 36-year-old woman who has induced menopause. The nurse informs the patient that induced menopause can be attributed to which factors? Select all that apply. Age Diet Drugs Surgery Chemotherapy Radiation therapy

Drugs Surgery Chemotherapy Radiation therapy

The nurse is educating a patient with abnormal uterine bleeding. Which statement made by the patient indicates the needs for further instruction? "I should regularly change my tampon." "I should record the degree of pad saturation daily." "I should get my blood pressure checked regularly." "I should apply heat on my lower back and abdomen."

"I should apply heat on my lower back and abdomen."

A nurse is educating a patient with a diagnosis of menopause who is not receiving hormone replacement therapy about strategies to prevent or reduce the risk of osteoporosis. Which patient statement is most important for the nurse to determine that the education is understood? "Exercise will keep me and my bones strong." "I will go outside to make sure I get enough vitamin D." "Good nutrition is important to reduce my risk of osteoporosis." "I should have an intake of at least 1,500 mg of calcium every day."

"I should have an intake of at least 1,500 mg of calcium every day."

A patient with premenstrual syndrome (PMS) states, "My PMS symptoms get so bad sometimes. I feel like my boyfriend thinks it is all in my head." What is the most therapeutic response from the nurse? "PMS symptoms are different for everyone." "I can totally relate. You shouldn't worry about what your boyfriend thinks." "There are a lot of different medications you can take to treat your symptoms." "PMS symptoms are physiological. Let's talk about different ways you can manage your symptoms."

"PMS symptoms are physiological. Let's talk about different ways you can manage your symptoms."

A patient states, "I'm sure that I am suffering from premenstrual syndrome (PMS). How can I get my primary health care provider to take this seriously?" What is the nurse's best response? "Men are not usually sympathetic to PMS sufferers." "You should keep a daily record of the occurrence and severity of your symptoms for three months." "Because you feel certain you are right, you should just treat yourself with over-the-counter medications." "You are probably right. You should remind your primary health care provider of your symptoms every time you visit."

"You should keep a daily record of the occurrence and severity of your symptoms for three months."

fatigue even on the fourth day of menstruation. Which is the best nursing intervention for this patient? Advise the patient to use superabsorbent tampons. Apply warm compresses to the lower abdomen and back. Encourage the patient to perform daily aerobic exercise. Advise the patient to eat a hot meal and wear warm clothes.

Apply warm compresses to the lower abdomen and back.

After assessing a patient with premenstrual syndrome (PMS), the nurse anticipates that the primary health care provider will prescribe ibuprofen to the patient. Which symptom of PMS does the nurse inform the patient that this will alleviate? Anxiety Cramping pain Fluid retention Negative mood

Cramping pain

A patient informs the nurse that she is having heavy menstrual cycles and also would like to avoid pregnancy at this time. What medication does the nurse anticipate educating the patient about? Sertraline Paroxetine Alendronate Estradiol valerate

Estradiol valerate

A patient with premenstrual syndrome is on medication therapy. On a follow up visit, the nurse observes that the patient's cholesterol level is 200 mg/dL, and her blood pressure is 140/90 mm Hg. Which medication does the nurse report may be responsible for this condition? Estrogen Methotrexate Tranexamic acid Medroxyprogesterone

Estrogen

A patient at the clinic reports abdominal bloating, depression, and irritability related to her premenstrual syndrome. What education does the nurse provide? Select all that apply. Take diuretics Exercise regularly Take antidepressants Take antianxiety agents Increase pork, chicken, and milk intake

Exercise regularly Increase pork, chicken, and milk intake

A pregnant patient with abdominal pain and irregular vaginal bleeding has had morning sickness, breast tenderness, and syncope since the sixth week of pregnancy. For which complication should the nurse monitor the patient? Select all that apply. Hemorrhage Peripheral edema Migraine headache Hypovolemic shock Thyroid dysfunction

Hemorrhage Hypovolemic shock

A postmenopausal patient wishes to initiate hormone replacement therapy. What instructions should the nurse give to this patient? Select all that apply. Instruct the patient about the maximum effective dose. Inform the patient that estrogen and progestin use leads to fewer hip fractures. Inform the patient that estrogen and progestin use increases risk of stroke and emboli. Instruct the patient that estrogen alone preparations decrease the risk of hip fractures. Inform the patient that estrogen alone preparations increase breast and colorectal cancer.

Inform the patient that estrogen and progestin use leads to fewer hip fractures. Inform the patient that estrogen and progestin use increases risk of stroke and emboli. Instruct the patient that estrogen alone preparations decrease the risk of hip fractures.

The nurse is providing care for a patient who is experiencing irregular vaginal bleeding. How does the nurse document this occurrence in the patient's medical record? Amenorrhea Oligomenorrhea Intermenstrual bleeding Heavy Menstrual Bleeding (HMB)

Intermenstrual bleeding

A patient is concerned regarding some of the symptoms being experienced after menopause. What information given by the nurse would explain this process? This condition will cause libido to disappear. This condition will cause femininity to disappear. It is a condition in which increased menstrual bleeding occurs. It is a condition in which atrophic changes in the reproductive tissues are observed.

It is a condition in which atrophic changes in the reproductive tissues are observed.

A postmenopausal woman is on combined hormone therapy with estrogen and progesterone. What information should the nurse provide to this patient regarding advantages of hormonal therapy? Select all that apply. It reduces the risk of hip fractures and colorectal cancer. The therapy is very beneficial in women without a uterus. The therapy decreases the risk of stroke and heart disease. It may cause breast enlargement, which is a common side effect. The therapy helps to treat hot flashes and vaginal atrophic changes.

It reduces the risk of hip fractures and colorectal cancer. It may cause breast enlargement, which is a common side effect. The therapy helps to treat hot flashes and vaginal atrophic changes.

A patient reports abnormal vaginal bleeding and wants to know what could be causing these symptoms since she never had them before. What is the best response by the nurse? Select all that apply. Oligomenorrhea is an absence of menstruation. Menorrhagia is excessive or prolonged duration of menstrual bleeding. Secondary amenorrhea is cessation of the menstrual cycle once it is established. Primary amenorrhea is failure of menstrual cycles to begin in a woman of 17 years of age. Primary amenorrhea is failure of menstrual cycles to begin in a woman of 14 years of age with presence of secondary sexual characteristics.

Menorrhagia is excessive or prolonged duration of menstrual bleeding. Secondary amenorrhea is cessation of the menstrual cycle once it is established. Primary amenorrhea is failure of menstrual cycles to begin in a woman of 14 years of age with presence of secondary sexual characteristics.

The nurse is caring for a patient who has an unruptured ectopic pregnancy located in the fallopian tube. What treatment option does the nurse anticipate administering? Leuprolide Nortriptyline Methotrexate Metronidazole

Methotrexate

While interviewing a patient, the nurse finds that the patient uses superabsorbent tampons during the menstrual cycle. For which symptoms should the nurse tell the patient to be observant? Select all that apply. Myalgia Vomiting Diarrhea Low fever Dizziness

Myalgia Vomiting Diarrhea

A patient with uterine fibroids causing Heavy Menstrual Bleeding (HMB) informs the nurse that she wants to become pregnant. About what treatment will the nurse educate the patient that will have the best outcome? Cryotherapy Hysterectomy Myomectomy Microwave energy

Myomectomy

The nurse is performing an assessment for a patient with secondary dysmenorrhea. Which findings support the patient's diagnosis? Select all that apply. Nausea Fatigue Headache Weight gain Constipation Painful menses

Nausea Fatigue Headache Painful menses

A patient presents with primary dysmenorrhea. The nurse is likely to find which clinical presentations during the physical examination? Select all that apply. Unilateral pain Onset of pain 12-24 hours before menstruation Colicky lower abdominal pain radiating to the thighs Constant intense pain which lasts for more than two days Most severe pain on the first day which subsides within two days

Onset of pain 12-24 hours before menstruation Colicky lower abdominal pain radiating to the thighs Most severe pain on the first day which subsides within two days

The nurse is performing an assessment for a patient in menopause. What symptoms does the patient likely report having? Select all that apply. Osteoporosis Constipation Vision changes Loss of skin elasticity Hot flashes and irregular menses

Osteoporosis Loss of skin elasticity Hot flashes and irregular menses

A nurse is educating a patient on abnormal uterine bleeding. The nurse should encourage the patient to report which symptoms to her healthcare provider? Select all that apply. Insomnia Weight gain Passing clots Excessive bleeding Spotting between regular menstrual cycles Unusually long duration of menstrual cycles

Passing clots Excessive bleeding Unusually long duration of menstrual cycles

A patient is being evaluated for dysmenorrhea. The healthcare provider just finished a complete health history. Which action does the nurse anticipate the healthcare provider will perform next? Lab work Ultrasound Pregnancy test Pelvic examination

Pelvic examination

Menopause is the result of a decrease in which hormone? Estrogen Progesterone Prostaglandin Human chorionic gonadotropin (HCG)

Prostaglandin

A patient that left a tampon in for several days is suspected of having developed toxic shock syndrome. What does the nurse recognize are clinical manifestations of this syndrome? Hypotension Hemorrhage Rapid onset of high fever Sudden sharp abdominal pain

Rapid onset of high fever

A patient has a diagnosis of endometriosis after having symptoms for several years and not knowing what the problem was. What nursing action is appropriate for this patient? Reassure the patient that it is not a life-threatening condition, but a hysterectomy will be necessary. Explain to the patient that weight management and exercises are important components of treatment. Inform the patient that it is a very complicated disease, and she should be prepared for vigorous medical and surgical management. Reassure the patient that it is not a life-threatening condition, but she should be prepared for a conservative and progressive treatment approach.

Reassure the patient that it is not a life-threatening condition, but she should be prepared for a conservative and progressive treatment approach.

A patient with total cholesterol of 210 mg/dL and cessation of menstruation one year ago reports easy fatigue, generalized weakness, joint pain, and night sweats. Which treatment strategy that may provide comfort will nurse educate the patient about? Hormonal therapy with estradiol Tricyclic antidepressants with spironolactone Nonsteroidal antiinflammatory agents with danazol Selective estrogen receptor modulators with risedronate

Selective estrogen receptor modulators with risedronate

The nurse is preparing to administer medication for a patient who is experiencing premenstrual dysphoric disorder (PMDD). Which medication will the nurse anticipate administering? Natazia Sertraline Ibuprofen Methotrexate

Sertraline

The nurse is providing education to a group of perimenopausal women. Which herbs or supplements would the nurse include in a discussion regarding effective alternative therapies for menopausal symptoms? Select all that apply. Soy Garlic Ginkgo Vitamin A Black cohosh

Soy Black cohosh

A patient has been prescribed tranexamic acid for Heavy Menstrual Bleeding (HMB). What instructions should the nurse give to the patient? Select all that apply. The drug cures the HMB. The drug only addresses blood loss. The drug may cause clots in the blood. The drug may also be used for body aches. The drug acts by facilitating the action of platelets.

The drug only addresses blood loss. The drug may cause clots in the blood.

A patient with excessive bleeding for more than a week is on tranexamic acid therapy. Which outcome in the patient does the nurse recognize indicates effective treatment? The patient will not experience anxiety. The patient will not experience migraine headache. The patient will not experience heavy menstrual bleeding. The patient will not experience bacterial and fungal infection.

The patient will not experience heavy menstrual bleeding.

The nurse is providing care to a patient with symptoms of perimenopause. Which findings does the nurse anticipate when performing the health history and physical assessment for this patient? Select all that apply. Breast firmness Urge incontinence Cessation of menses Uterine atrophy Hot flashes

Urge incontinence Uterine atrophy Hot flashes

A postmenopausal woman states that she has painful sexual intercourse. What advice should the nurse give to this patient? Select all that apply. Avoid sexual intercourse. Use local hormonal creams. Use systemic hormone therapy. Ask the male partner to use condoms. Use lubricants during sexual intercourse.

Use local hormonal creams. Use systemic hormone therapy. Use lubricants during sexual intercourse.

A patient with Heavy Menstrual Bleeding (HMB) is concerned about her condition. When explaining HMB to this patient to alleviate her anxiety, what information should the nurse include? Select all that apply. Ovulatory cycles are commonly associated with HMB. Unopposed progesterone action on endometrium results in HMB. Uterine fibroid and endometrial polyps are commonly associated with HMB. Menstrual bleeding either lasts more than seven days, amounts to more than 80 mL, or both. Menstrual bleeding either lasts for more than seven days or amounts to more than 80 mL, but never both.

Uterine fibroid and endometrial polyps are commonly associated with HMB. Menstrual bleeding either lasts more than seven days, amounts to more than 80 mL, or both.