Menstrual dysfunction
b (Rationale COCs help suppress ovulation. NSAIDs are utilized to decrease cramping, and diuretics decrease bloating. SSRIs may be prescribed to help the client regulate mood or control chronic pain.)
A client is prescribed combined oral contraceptives (COCs) for treatment of dysfunctional uterine bleeding. The client asks the nurse why this will be helpful. The nurse bases the response on which rationale? a COCs act as selective serotonin reuptake inhibitors (SSRIs) and help control mood and chronic pain. b COCs help suppress ovulation. c COCs help reduce bloating. d COCs are anti-inflammatory agents and will decrease cramping.
a (Rationale Menorrhagia causes heavy menstrual bleeding and may increase the risk of anemia. A CBC may be completed to assess for the presence of anemia in these clients. Menorrhagia does not cause infection. The nurse is able to answer basic questions about laboratory tests.)
A client with menorrhagia asks why a complete blood count is being done. Which response by the nurse is the most appropriate? a "This will tell us if your blood count is low due to your increased bleeding." b "Because this may cause infection, we need to look at your white blood cells." c "You will have to speak to the midwife about this." d "The midwife ordered this; let's walk down to the lab."
a (Rationale: The client with menorrhagia (excessive or prolonged menstruation) should be evaluated for thyroid disorders, use of anticoagulants, and other uterine disorders. Intake of sodium and the flu are not associated with menorrhagia. Strenuous exercising is associated with amenorrhea. )
A client with suspected menorrhagia is being assessed by the nurse at the clinic. What is the priority assessment the nurse must make in an effort to determine the cause of the disorder? a "Are you taking anticoagulants?" b "Have you increased your sodium intake?" c "Do you exercise vigorously?" d "Have you had the flu recently?"
a,c,d,e (Rationale Iron-rich foods are encouraged to stave off anemia from abnormal bleeding. Eggs, beans, beef and shrimp are foods that are rich in iron; therefore the client should not avoid them. Hydration, self-care to minimize clinical manifestations, and stress reduction strategies are all appropriate interventions. Clients will be better able to cope with abnormal uterine bleeding, both long term and on a day-to-day basis, if they understand the disorder and possible interventions.)
A nurse is reviewing information about abnormal uterine bleeding with a client. Which important aspects of client teaching should the nurse include? (Select all that apply.) a The importance of adequate fluid intake b Avoid foods such as eggs, beans, beef, and shrimp c Stress reduction and relaxation strategies d The importance of eating foods rich in iron e Information about self-care in order to minimize the clinical manifestations
b (Amenorrhea is the clinical term for lack of menses. Oligomenorrhea is the clinical term for infrequent or light menses. Menorrhagia is the clinical term for very heavy menses. Metrorrhagia is the clinical term for abbreviated menses or breakthrough bleeding between menstrual periods.)
What is the clinical term for a lack of menses? a Oligomenorrhea b Amenorrhea c Menorrhagia d Metrorrhagia
d (Rationale Oligomenorrhea describes a condition in which there are infrequent or light menstrual periods. The client who has never had a menstrual period at age 15 may be experiencing amenorrhea. This term also refers to cessation of menstrual flow after initially having a period. Breakthrough bleeding, or bleeding in between periods, is referred to as metrorrhagia. Unusually heavy menstrual blood flow is called menorrhagia.)
A client is complaining of menstrual problems. Which statement indicates that the client may be experiencing oligomenorrhea? a "I usually have bleeding in between my periods every other month." b "I saturate a pad in 1 hour when I am on my period." c "I am 15 and I have still not started my period." d "My periods are very light and some months I don't have one
d (Rationale: The woman who is bleeding heavily is losing hemoglobin and is usually fatigued, which affects interest in sex. The nurse plans interventions aimed at conserving energy in this client. Obesity, edema, and sweating are not usually associated with the lack of sexual desire in the client with DUB. )
A client with dysfunctional uterine bleeding (DUB) tells the nurse that she is having problems with sexual performance. The nurse selects sexual dysfunction as a nursing diagnosis and suspects that the dysfunction is related to which factor? a Edema b Obesity c Sweating d Fatigue
b,c (Rationale Greater than normal vaginal flow should be reported as it assesses for hemorrhage. Temperature greater than 100°F can be indicative of infection. Some pain is expected but it should not be severe. Bright red bleeding should be reported. Appetite may be depressed and bowel may be sluggish as a result of anesthesia.)
A nurse is reviewing orders for a client who is being discharged after having a hysterectomy. Which symptoms will the nurse include that require notification of the healthcare provider? (Select all that apply.) a Decreased bowel elimination b Vaginal bleeding greater than a normal menstrual flow c Temperature greater than 100degrees°F (37.7degrees°C) d Any reports of pain e Brown vaginal bleeding
c (The most appropriate question for the nurse to ask this client is the date of her last menstrual period. The dates of her last sexual experience and last gynecological examination are not typically questions the nurse asks during the health history. There is no indication the client has a sexually transmitted infection and asking the client if she has ever been tested is not appropriate for this situation.)
A 22-year-old woman, Tamara Woodard, is being seen in the clinic for a yearly examination. Ms. Woodard states she is experiencing worsening monthly dysmenorrheal and postcoital bleeding. Which question will the nurse ask during the health history portion of the nursing assessment based on the data collected from Ms. Woodard? a "When was the last time you had sexual intercourse?" b "Have you ever been tested for sexually transmitted infections?" c "When did you have your last menstrual period?" d "When was your last gynecological examination?"
a (The nurse will prepare the client for a pelvic examination based on the symptoms the client is experiencing. A transvaginal ultrasound, not an abdominal ultrasound, may be required during the visit. There is no reason for a urine drug screen or therapeutic D&C based on the assessment findings.)
A 35-year-old woman, Shineka Majors, is being seen by the healthcare provider. The nurse collects the following data during the assessment: monthly dysmenorrhea, high stress job, and IUC device in place for 1 year. Which diagnostic test will the nurse prepare the client for during this appointment? a A pelvic exam b Therapeutic dilation and curettage (D&C) c Abdominal ultrasound d Urine drug screen
a,b,d (Rationale Secondary dysmenorrhea is associated with pathologies that affect the uterus and pelvic area. It is likely to occur in women ages 30-50. Endometriosis is an example of secondary dysmenorrhea. With secondary dysmenorrhea, pain is likely to occur anytime through the menstrual cycle and can be severe. Pelvic pain generally on or before the first day of menses that radiates to the groin is the main symptom of primary dysmenorrhea. It generally diminishes with time or after childbirth.)
The nurse educator is presenting material about secondary dysmenorrhea to a group of students. Which information should be included in the presentation? (Select all that apply.) a It can be associated with several disorders including tumors, pelvic adhesions, and infections. b It generally affects women age 30 - 50. c The pain diminishes with time and is often much less after childbirth. d Endometriosis is an example of a secondary dysmenorrhea and is considered to be one of the most painful gynecologic disorders. e Pain is always on the first day of menses and radiates to the groin.
b (Rationale: The client is exhibiting symptoms of premenstrual syndrome (PMS), and the nurse would ask the client when and how often the symptoms occur in an effort to determine if the menses is the problem. These symptoms are not those of a person experiencing trauma or a chronic disease. The client may well have edema, but asking that elicits only more symptoms; the goal is to associate the symptoms with the menstrual cycle to diagnose PMS.)
The nurse is assessing a 37-year-old woman who is complaining of mood swings, breast tenderness, and food cravings. The nurse asks the client for which additional information? a "Do you have edema as well?" b "When and how often do these symptoms appear?" c "Have you been in an accident?" d "Do you have a chronic disease?"
a,b,d,e (Rationale Decreased urine output, hypotension, tachycardia, and tachypnea are all related to shock due to uterine bleeding, and the nurse must use the nursing process of assessing and evaluating to determine necessary steps to be taken. One would expect delayed, not rapid, capillary refill for the client in shock.)
The nurse is caring for a client after a hysterectomy. Which assessment findings support the diagnosis of shock related to uterine bleeding? (Select all that apply.) a Tachypnea b Decreased urine output c Rapid capillary refill d Hypotension e Tachycardia
d (Rationale: Primary dysmenorrhea is treated by reducing symptoms. Secondary dysmenorrhea is the result of an organic problem requiring diagnosis with a laparoscopy, MRI, or CT scan and then surgery to correct the problem, if appropriate)
The nurse is caring for a client who has been diagnosed with primary dysmenorrhea and tells the client about which treatment for the disorder? a "Treatment will include surgery to correct the defect." b "You will need to have a laparoscopy to cure the disorder." c "You will be scheduled for an MRI to determine treatment." d "Treatment is aimed at reducing symptoms."
a,c,e (Rationale Risk factors for endometriosis include menstrual cycles that are less than 27 days, heavy and prolonged menses, and a sedentary lifestyle. Increased dietary fat and menarche before the age of 11 would also support this diagnosis.)
The nurse is conducting a health history on a client being seen for a yearly gynecological examination. The client states that she believes she has endometriosis. Which findings in the client's health history support this diagnosis? (Select all that apply.) a Menstrual cycle less than 27 days b Menarche before age 14 c Sedentary lifestyle d Decreased dietary fat e Heavy prolonged menses
b (Rationale Teaching the client about the importance of proper nutrition is an intervention that is specific for this diagnosis. Monitoring vital signs, assessing level of pain, and preparing the client for surgical intervention are not nursing interventions that support the potential for enhanced wellness.)
The nurse is planning care for a client with endometriosis. The nursing diagnosis for this client is the potential for enhanced wellness. Which nursing intervention is appropriate to include in the plan for care for this diagnosis? a Monitor the client's vital signs per order b Teach the client about the importance of proper nutrition c Prepare the client for surgical intervention d Assess the client's level of pain
a.b.d.e (Rationale The Pap test is used to diagnose cervical cancer and dysplasia. FSH and LH levels are used to help correlate the luteal phase of the menstrual cycle. Progesterone and estradiol levels are used to assess ovarian function. Colposcopy is used to inspect the cervix and help determine areas for biopsy. Hysteroscopy is used to inspect the endometrial lining. Hysterectomy would not be used as a diagnostic test.)
The nurse is providing care to a client experiencing abnormal uterine bleeding and menstrual pain. Which lab and diagnostic tests does the nurse anticipate to determine hormonal imbalances, pathologic conditions, or structural anomalies that are causing the client's symptoms? (Select all that apply.) a Papanicolaou (Pap) test b Colposcopy c Hysterectomy d Progesterone and estradiol levels e FSH and LH level
b (Rationale Greater than normal vaginal flow should be reported as it assesses for hemorrhage. Temperature greater than 100°F can be indicative of infection. Some pain is expected but it should not be severe. Bright red bleeding should be reported. Appetite may be depressed and bowel may be sluggish as a result of anesthesia.)
The nurse is reviewing a client medical record to gain an understanding regarding the absence of menstruation. As the nurse speaks with the client, she mentions that she has really been working out a lot at her gym. Which menstrual dysfunction does the nurse suspect the client is experiencing? a Menorrhagia b Amenorrhea c Metrorrhagia d Dysmenorrhea
c (Rationale: An NSAID is effective for pain and the reduction of inflammation that may be causing pain. The client is helped to be free of pain, not to endure it. Antibiotics are not effective against pain and increasing sodium intake will increase edema and possibly the discomfort. )
The nurse is talking with a 15-year-old client experiencing dysmenorrhea who asks if there are any remedies for the pain. The nurse responds with which advice? a "Increase the intake of sodium." b "Antibiotics will help the symptoms to subside." c "The recommended medication is an NSAID." d "Pain lasts only a few days and does not need treatment."
b,d,e (Rationale: Those most at risk for developing PMS are over the age of 30, are experiencing major life stressors, and have a history of depression. This condition is not necessarily seen in the teenage group or those with heart disease)
The nurse is teaching a group of women with premenstrual syndrome (PMS). A client asks what the major risk factors are for developing this disorder. The nurse replies that the risk factors include: (Select all that apply.) a teenage women. b Age greater than 30 years. c heart disease. d Depression. e major life stressors.
a (Rationale: In a vaginal hysterectomy, only the uterus is removed. The ovaries are left in place so that the hormonal cycle continues and menopause does not ensue. The client will no longer have menstrual periods and there is no need to continue oral contraceptives since pregnancy cannot occur.)
The nurse teaches a client who is to undergo a vaginal hysterectomy for dysfunctional uterine bleeding. The nurse knows the client has met teaching goals when she makes which statement? a "I will not begin menopause because only the uterus will be removed." b "I will continue to have menstrual periods." c "I will continue to take my oral contraceptives." d "I will no longer have ovaries."
b (The nurse anticipates the client will be diagnosed with secondary amenorrhea due to the risk factors/causative factors for this disorder obtained during the health history, including a history of thyroid disorder and recent weight loss. The assessment findings do not support the diagnosis of endometriosis, primary amenorrhea, or oligomenorrhea)
Theresa Jones, a 28-year-old female, is being seen in the clinic. Ms. Jones tells you the following during the health history: three skipped menstrual periods, history of thyroid disorder, recent weight loss following a strict diet and exercise regimen. She is not sexually active so she does not believe she is pregnant. Which diagnosis does the nurse anticipate for this client based on the assessment data? a Primary amenorrhea b Secondary amenorrhea c Oligomenorrhea d Endometriosis
a (Rationale: In a D&C, the cervical canal is dilated and the uterine wall is scraped. With an ablation, extreme heat or cold, or energy waves are used to vaporize the endometrial lining. A hysterectomy involves removal of the uterus in totality or partially and can be vaginally or abdominally accomplished.)
What is the order of least invasive to most invasive for procedures related to menstrual dysfunction? a Therapeutic dilation and curettage (D&C), endometrial ablation, hysterectomy b Hysterectomy, therapeutic dilation and curettage (D&C), ablation c Therapeutic dilation and curettage (D&C), hysterectomy, ablation d Hysterectomy, ablation, therapeutic dilation and curettage (D&C)
c (Rationale: For a woman with PMS, the nurse would recommend a decrease in sodium intake to help minimize the fluid retention due to increased production of aldosterone, which results in sodium retention and edema. Sodium does not increase reactive hypoglycemia and does not reduce cancer risks. Sodium does increase thirst but is not the reason for restriction in this case.)
When discussing dietary guidelines with a woman who has premenstrual syndrome (PMS), the nurse recommends that the client reduce sodium intake for which reason? a Sodium increases reactive hypoglycemia, increasing physical manifestations. b Sodium increases thirst, thereby facilitating increased oral fluid intake. c Sodium restriction helps minimize fluid retention. d In and of itself, sodium is not harmful, but it may reduce cancer risks.
a,d,e (Diagnostic tests used to recognize structural abnormalities, hormone imbalances and abnormal pathologies with menstrual disorders include pelvic examinations, pap tests, and ultrasounds. A bronchoscopy is use to diagnosis lung disorders. A colonoscopy is use to diagnosis bowel disorders.)
Which diagnostic tests are used to recognize structural abnormalities, hormone imbalances, and abnormal pathologies with menstrual disorders? (Select all that apply.) a Pelvic exam b Bronchoscopy c Colonoscopy d Pap test e Ultrasound
b (Bloating associated with the menstrual cycle may be treated with diuretics. NSAIDs are used to treat cramping. COCs are used to treat secondary dysmenorrhea or abnormal uterine bleeding. Oral iron supplements may be used to treat anemia associated with heavy menstrual periods.)
Which medication might be prescribed for the bloating associated with the menstrual cycle? a Oral iron supplements b Diuretic medications c Nonsteroidal anti-inflammatory drugs (NSAIDs) d Combined oral contraceptives (COCs)
c (An appropriate nursing intervention for a client with menstrual dysfunction is to administer analgesics, per order. The nurse would encourage resting, eating foods high in iron, and using open-ended questions when talking with the client.)
Which nursing intervention is appropriate for a client experiencing menstrual dysfunction? a Using close-ended questions b Teaching about foods low in iron c Administering analgesics d Encouraging frequent exercise
