Women's Health Menses/EDC/Ovulation

Which statement is an accurate description of dysmenorrhea?

Ans: Pain with menses. Dysmenorrhea is defined as pain with menses. Endometrial hyperplasia results from anovulation and persistent estrogen stimulation. Bleeding between menses is metrorrhagia. Heavy bleeding with menses is menorrhagia.

Which time during the menstrual cycle would the nurse stress as the optimal time to achieve pregnancy?

Ans: 14 days before the next period is expected. Ovulation occurs 14 days before the onset of menses. Midway between cycles is appropriate only if the client has a regular 28-day cycle. Immediately after the end of the period means that ovulation occurs on approximately day 5 of the menstrual cycle, which is not factual. Variations in the cycle occur in the preovulation period; it is not as accurate as counting 14 days before the next expected menses.

A client who menstruates regularly every 30 days asks a nurse on what day she is most likely to ovulate. The client's menses started on January 1. Which day in January would the nurse tell her that ovulation should occur?

Ans: 16 Ovulation should occur on January 16. The time between ovulation and the next menstruation is relatively constant. In a 30-day cycle the first 15 days are preovulatory, ovulation occurs on day 16, and the next 14 days are postovulatory. January 7, January 24, and January 29 all reflect inaccurate calculation of the date of ovulation.

Which question would help the nurse determine the pregnant client's estimated date of delivery?

Ans: "Are your menstrual periods regular?" Determining an accurate estimated date of delivery requires synthesizing data from the client. Asking if the menstrual periods are regular allows the nurse to know if Naegeles rule can be appropriately used to determine the estimated delivery date for this client. If her menstrual periods are regular and occur roughly every 28 days, Naegele's rule would be used. If, however, her menses are irregular, use of this method for determining the estimated delivery date would not be accurate. Knowing whether she did a home pregnancy test, or her age at menarche do not help determine the estimated delivery date. The use of condoms before pregnancy does not affect the method of determining the estimated delivery date.

Which statement by a 17-year-old client whose sister had an ectopic pregnancy necessitating removal of one Fallopian tube 3 months ago indicates the need for additional information?

Ans: "My sister is lucky because she won't have a period again." Removing a Fallopian tube will not halt menses; endometrial proliferation and shedding will occur as long as the ovaries and uterus are present. pelvic infections may lead to adhesions and scar tissue of the Fallopian tubes, after which a fertilized ovum may become trapped. There is evidence that an individual who has had one tubal pregnancy has an increased probability of having another. Pregnancy should be delayed 6 to 12 months after a tubal pregnancy.

An adolescent complains of intermittent pain midway through the menstrual cycle that happens every month. How would the nurse respond to the adolescent?

Ans: "This is a common occurrence known as mittelschmerz." Mittelschmerz is pain that sometimes occurs at the time of ovulation when the ovum erupts from the follicle. The pain is mild, cyclic, and characteristic of mitterlschmerz; it does not require pelvic examination. The pain usually begins when there is a regular ovulation. It only occurs during ovulation and does not last until bleeding begins. When menses first begins the girl is anovulatory and does not experience the pain known as mittelschmerz.

A client represents to the clinic with complaints of nausea and amenorrhea and reports that she obtained a positive result on a home pregnancy test. Which component of the history is most indicative of pregnancy?

Ans: Her urine immunoassay test is positive. A positive result on a urine pregnancy test is a probable sign of pregnancy because the test, based on the presence of human chorionic gonadotropin (hCG) in the urine, is close to 99% accurate in detecting pregnancy when done 1 week after missed menses. Menses a week late is a presumptive sign of pregnancy; there are many other causes of amenorrhea. urinary frequency is a presumptive sign of pregnancy; there are other cases of frequency, such as urinary tract infection. Nausea each morning, which may occur during the first trimester because of the secretion of hCG, is a presumptive sign of pregnancy; there are many causes of nausea other than the hormones secreted during early pregnancy.

A client is trying to become pregnant. The nurse would teach the client that a blood test for progesterone to evaluate fertility would be performed at which time?

Ans: One week after ovulation. The progesterone is checked a week after suspected ovulation to determine if ovulation occurred. Progesterone is produced by the corpus lute, which is the empty follicle remaining in the ovary after release of the egg with ovulation. A normal progesterone level 1 week after suspected ovulation is good evidence that the client did ovulate. Progesterone levels would be low immediately after the menses and would remain low until ovulation. Progesterone levels peak about 1 week after ovulation and then may start to fall if no pregnancy has occurred. Checking the progesterone within 1 to 2 days after ovulation would be too soon.

Which information would the nurse include in the discharge teaching of a postpartum client?

Ans: The prenatal Kegel tightening exercises should be continued. Kegel exercises may be resumed immediately and should be done for the rest of the client's life because they help strengthen muscles needed for urinary continence and may enhance sexual intercourse. Episiotomy sutures do not have to be removed. Bowel movements should spontaneously return in 2 to 3 days after the client gives birth; a delay of bowel movements promotes constipation, perineal discomfort, and trauma. The usual postpartum examination is 6 weeks after birth; the menses may return earlier or later than this and should not be a factor when the client is scheduling a postpartum examination.