Chapter 4: Gynecologic Issues

An 18-year-old female client who is sexually active asks the nurse for information on barrier contraceptives. Which statement is appropriate for the nurse to include in the response?

"Cervical caps are most effective when used along with a spermicidal agent."

A nurse is preparing a client for intrauterine device (IUD) insertion. Which education will the nurse provide to the client?

"Checking the strings is recommended following insertion."

The nurse is assessing a male client who is concerned about his ability to produce enough sperm to have a child. He tells the nurse, "I have had some issues in my younger years." What questions would be important for the nurse to ask this client? Select all that apply.

"Do you use drugs or use alcohol excessively? "Are you exposed to X-rays or other radioactive substances?" "Have you ever had any type of trauma or surgery on or near your testicles?"

The nurse is conducting a health history on a couple planning to become pregnant over the next few months. Which statement by the male client most concerns the nurse?

"I have a degree as a chemical engineer and work at the local plant."

A nurse is completing an informed consent on a client preparing for a tubal ligation. Which statement by the client would require the nurse to notify the health care provider?

"I will be able to have my third child in about a year from now."

During a routine health visit for an 11-year-old girl, her mother asks the nurse, "My daughter just got her period about 4 months ago, but they haven't been very regular so far. How long might it take until she gets regular?" Which response by the nurse would be most appropriate?

"It can take up to 2 years once she starts for the periods to become regular."

A couple is deciding about contraceptive measures. The male partner has decided to undergo a vasectomy. After teaching the client about this procedure, which client statement indicates the need for additional teaching?

"Right after surgery, my semen will be sperm-free."

A client is seen in the clinic requesting an emergency postcoital contraception pill levonorgestrel (Plan B). The client states that she had unprotected sex 3 ½ days ago. What is the most appropriate response by the nurse?

"Unfortunately you are past the time frame to take that prescription."

A nurse is receiving a client from the postanesthesia unit to the recovery unit at the ambulatory surgery center. The client just had a laparoscopic tubal ligation. Which is the nurse's priority assessment?

Bleeding

A nurse is performing discharge teaching for a client who just had an uterine endometrial biopsy. What is the nurse's priority discharge teaching?

Client should call clinic with the date of her next menses

True or false: Primary amenorrhea occurs in women who have previously menstruated regularly?

False

A couple who has not conceived after 6 years of not using birth control are being seen in the infertility clinic. In assessing the client's psychosocial response to infertility, which might the nurse expect to find? Select all that apply.

Guilt related to the lack of conception Anger toward others who have conceived Fear of the possible outcome of the testing

A 45-year-old client and her spouse are present in the clinic. Results of fertility testing indicate that the client has damage to her fallopian tubes. Which would be the most appropriate infertility option for this client?

In vitro fertilization

A nurse is preparing a presentation for a health fair on the topic of vasectomy. Which information should the nurse point out in the presentation?

Relatively easy procedure with few complications

A nurse supervisor observes a nurse massage a client's injection site after giving a dose of depot medroxyprogesterone acetate (Depo-Provera). What is the priority response by the nurse supervisor?

Remind the nurse that this injection should absorb slowly.

A woman visits the family planning clinic to request a prescription for birth control pills. Which factor would indicate that an ovulation suppressant would not be the best contraceptive method for her?

She has a family history of thromboembolism.

Which information is important for a woman to understand before undergoing a scheduled tubal ligation?

She must think of the procedure as irreversible.

The nurse has been working with a subfertile couple through the process of determining their best plan of action to conceive a child. Which action should the nurse prioritize to provide emotional support to this couple?

Speak both separately and together with both partners.

True or false: Endometriosis is the most common cause of secondary dysmenorrhea?

True

Throughout life, a woman's most proactive activity to promote her health would be to engage in: a. Consistent exercise b. Socialization with friends c. Quality quiet time with herself d. Consuming water

a. Consistent exercise

Which of the following combination contraceptives has been approved for extended continuous use? a. Seasonale b. Triphasil c. Ortho Evra d. Mirena

a. Seasonale

A couple is considered infertile after how many months of trying to conceive? a. 6 months b. 12 months c. 18 months d. 24 months

b. 12 months

A couple reports that their condom broke while they were having sexual intercourse last night. What would you advise to prevent pregnancy? a. Inject a spermicidal agent into the woman's vagina immediately. b. Obtain emergency contraceptives and take them immediately. c. Douche with a solution of vinegar and hot water tonight. d. Take a strong laxative now and again at bedtime.

b. Obtain emergency contraceptives and take them immediately

The nurse is preparing to teach a class to a group of middle-aged women regarding the most common vasomotor symptoms experienced during menopause and possible modalities of treatment available. Which of the following would be a vasomotor symptom experienced by menopausal women? a. Weight gain b. Bone density c. Hot flashes d. Heart disease

c. Hot flashes

Which method would the nurse identify as a barrier method of contraception? a. basal body temperature b. transdermal patch c. diaphragm d. symptothermal method

c. diaphragm

The nurse is providing care to a woman who has come to the clinic for suggestions about contraception. When determining the recommendation for a client, which factor would be most important for the nurse to integrate into the plan of care?

client's ability to tolerate side effects

What comment by a woman would indicate that a diaphragm is not the best contraceptive device for her? "My husband says it is my job to keep from getting pregnant." "I have a hard time remembering to take my vitamins daily." "Hormones cause cancer and I don't want to take them." "I am not comfortable touching myself down there."

d. "I am not comfortable touching myself down there."

The most common cause of menstrual abnormality in a reproductive-age woman is: a. Ectopic pregnancy b. Coagulopathy c. Carcinoma d. Anovulation

d. Anovulation

When assessing a woman for premenstrual syndrome, which of the following would the nurse be least likely to find? a. irritability b. tension c. dysphoria d. weight loss

d. weight loss

A client is desiring to start birth control and is questioning the nurse concerning the best options. Which option should the nurse point out is the most reliable?

hormonal implant

The nurse is providing contraception counseling to a perimenopausal woman who has had negative reactions to oral contraceptive pills (OCPs) in the past and would like a long-term, nonhormone-based method that has a high rate of success. Neither she nor her husband wants to undergo surgery, however. Which method should the nurse recommend?

intrauterine device

A 52-year-old client is seeking treatment for menopause. She is not very active and has a history of cardiac problems. Which therapy option should the nurse recognize as contraindicated for this client?

long-term hormone replacement therapy

The client is interested in using an injectable contraceptive that works by suppressing pituitary secretions. The nurse provides the client with literature and discusses which contraceptive with her?

medroxyprogesterone acetate

A clinic nurse is interviewing a young client during a subfertility work up. When the client asks the nurse what causes infertility, the nurse informs the client that the problem can rest with the man, the woman, or both. What does the nurse tell the client are common problem areas related to the woman? Select all that apply.

ovulation tubal transport impaired implantation

A couple who is in for fertility testing ask the nurse what tests are commonly performed to assess fertility. The nurse replies that there are only three primary tests that are used. What are these tests?

semen analysis, ovulation monitoring, and tubal patency assessment

A couple has chosen fertility awareness as their method of contraception. The nurse explains that the unsafe period for them during the menstrual cycle would be at which time?

three days before and three days after ovulation

When teaching the client how to use a contraceptive sponge, the nurse must tell the client that leaving the sponge in place longer than 30 hours may lead to:

toxic shock syndrome.

A young woman says she needs a temporary contraceptive but has a latex allergy. She mentions that she has a papillomavirus infection. Also, she says she is terrible about remembering to take pills. Which method should the nurse recommend?

transdermal contraception

A client desires protection from unwanted pregnancies. However, the client does not enjoy sex when her partner wears a male condom. Also, the client experiences breast tenderness, headache, and nausea after taking oral contraceptive pills (OCPs). Which method would be the most likely choice for the couple to help them enhance their sexual experience as well as prevent any side effects?

transdermal contraceptive

A healthy 28-year-old female client who has a sedentary lifestyle and is a chain smoker is seeking information about contraception. The nurse informs this client of the various options available and the benefits and the risks of each. Which should the nurse recognize as contraindicated in the case of this client?

oral contraceptive pills (OCPs)

A couple comes to the clinic and states to the nurse, "I don't think we are ever going to be able to have children. We have been trying but have had no luck." What assessments does the nurse anticipate will be performed for this couple? Select all that apply.

semen analysis ovulation monitoring tubal patency

Which of the following activities will increase a woman's risk of cardiovascular disease if she is taking oral contraceptives? a. Eating a high-fiber diet b. Smoking cigarettes c. Taking daily multivitamins d. Drinking alcohol

b. Smoking cigarettes

A client is being prepared for artificial insemination. Which finding is the most suggestive to determine if the client is ovulating?

change in the cervical mucus

Which of the following measures helps prevent osteoporosis? a. Supplementing with iron b. Sleeping 8 hours nightly c. Eating lean meats only d. Walking daily

d. Walking daily

A nurse is reviewing the history and physical examination of a client diagnosed with secondary dysmenorrhea for possible associated causes. Which etiology would the nurse need to keep in mind as being the most common?

endometriosis

A mother presents to the clinic with her 15-year-old daughter who is reporting amenorrhea. The girl's menarche was at age 12. When conducting the health history and physical exam, which findings might the nurse identify as suggesting the underlying cause? Select all that apply.

extreme rapid weight gain pregnancy hypothyroidism emotional distress

The nurse has assessed several clients who have arrived for routine appointments. The nurse predicts the health care provider will prioritize a bone density scan for which client?

a 55-year-old white client who smokes and has family history of osteoporosis

A pregnant client states she is interested in having a tubal ligation following the birth of her child. Which statement by the nurse is a priority at this time?

"A tubal ligation is an effective method for permanent sterilization in women."

The nurse is caring for a client requesting oral contraceptives who has multiple sexual partners. The nurse recommends condoms to the client, but the client states, "I cannot use condoms because I am allergic to latex." Which response by the nurse is appropriate?

"You can still use condoms because they make latex-free condoms."

A woman has opted to use medroxyprogesterone injections for birth control. The client receives the first injection today. The nurse instructs the woman to return to the clinic in how many months for the next injection?

3

The nurse is caring for a client at the ambulatory care clinic who questions the nurse for information about contraception. The client reports that she is not comfortable about using any barrier methods and would like the option of regaining fertility after a couple of years. Which method should the nurse suggest to this client?

CycleBeads or medroxyprogesterone injection

The school nurse is counseling a sexually active 16-year-old adolescent about the various forms of contraception. She is afraid of getting pregnant or contracting a sexually transmitted infection because her boyfriend refuses to use a condom. In answering the client's questions as to which option will be best suit her needs, which form should the nurse recommend?

Female condom

The nurse is conducting a routine well-visit on a 43-year-old client who is concerned about developing breast cancer, although no family members have experienced it. What is the best advice for this client at this time?

Know how her breasts normally look and feel

Which statement best explains the action of the lactational amenorrhea method (LAM) of fertility control?

LAM causes suppression of the ovulation process.

A male client visits a fertility clinic after one year of attempting unsuccessfully to impregnate his wife. What is a risk factor associated with male infertility?

no or few sperm cells produced

A woman is diagnosed with premenstrual dysphoric disorder. To address the woman's behavioral symptoms, which class of agents would the nurse anticipate needing to be addressed in the woman's teaching plan?

selective serotonin reuptake inhibitors (SSRIs)

When using the contraceptive patch, a client should understand that it:

should be applied to the abdomen, buttocks, or back.

The estrogen content in the contraceptive pill performs which action?

suppresses follicle-stimulating hormone (FSH)

A nurse is instructing a client on birth control methods. The client asks about the cervical mucus method. When should the nurse tell the client she is fertile in relation to her mucus?

when it is thin, watery, and copious