Chapter 4: Special Issues of Women's Health Care and Reproduction

Semen analysis has been ordered for the partner of a client who has been unable to become pregnant. What instructions should the nurse provide to the partner?

"Bring the sample to the lab immediately after you collect it." Semen samples must be delivered to a lab no more than 30 minutes after collection. Storage in the refrigerator would violate this directive. The client should abstain from ejaculating for 3 to 5 days before collecting the sample. The semen does not need to be collected in the morning.

A client diagnosed with human papillomavirus (HPV) asks the nurse if she will be at risk for developing cervical cancer. The nurse best responds by making which statement?

"Certain strains of the human papillomavirus (HPV) have been associated with causing cervical cancer." The human papillomavirus (HPV) is associated with causing both genital warts and cervical cancer. There is not enough information to definitively indicate that this client will or will not contract cancer. The herpes simplex virus is associated with shingles and genital herpes, not cervical cancer. The HPV vaccine prevents certain strains of HPV, but does not decrease the risk for cervical cancer if the person has already been exposed to the virus.

After the nurse teaches a client about ways to reduce the symptoms of premenstrual syndrome, which client statement indicates a need for additional teaching?

"I will make sure to take my estrogen supplements a week before my period." Lifestyle changes such as exercising, avoiding caffeine, and smoking cessation are a key component for managing the signs and symptoms of premenstrual syndrome. Estrogen supplements are not used. If medication is necessary, NSAIDs may be used for painful physical symptoms; spironolactone may help with bloating and water retention.

After assessing a woman who has come to the clinic, the nurse suspects that the woman is experiencing abnormal uterine bleeding. Which statement by the client would support the nurse's suspicions?

"I've been having bleeding off and on that's irregular and sometimes heavy." Abnormal 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 abnormal uterine bleeding, irritability and mood swings are more commonly associated with premenstrual syndrome. Unusually long and heavy periods reflect menorrhagia.

A woman is going to have in vitro fertilization. When preparing her for this, the nurse would make which statement?

"It can be done with frozen donor sperm." Fresh or frozen sperm may be used. The success of in vitro fertilization is not related to the incidence of ovarian cancer in the family. Quite often, more than one attempt is needed before successful implantation.

What should the nurse include when explaining endometriosis as a cause for a female patient's infertility?

"Ovulation does take place misplaced endometrial tissue interferes with transport of the ovum." Endometriosis refers to the implantation of uterine endometrium, or nodules, that have spread from the interior of the uterus to locations outside the uterus. If viable particles of endometrium enter a tube, they can cause tubal obstruction; growths on the ovaries can displace fallopian tubes away from the ovaries, preventing the entrance of ova into the tubes. Peritoneal macrophages, which are drawn to nodules of endometrium, can destroy sperm. Endometriosis does not affect ovulation, cervix competence, or menstruation.

The nurse instructs a patient on cervical mucus changes that occur during ovulation. Which statement indicates that teaching has been effective?

"When the mucus is thin and watery, then ovulation is occurring." On the day of ovulation, the cervical mucus becomes copious, thin, watery, and transparent. During ovulation, the mucus is not thick, not acidic, and not white.

During a health education session, a teenage client asks the nurse when she should have her first "Pap test." How should the nurse reply?

"When you turn 21 years old." Current guidelines recommend that the woman obtain the initial Papanicolaou test at 21 years of age, regardless of when she first has sexual intercourse.

Subfertility/infertility is said to exist when a couple has failed to achieve pregnancy after how many months of unprotected sexual intercourse?

12 Infertility is the failure to achieve conception after 1 year of unprotected intercourse.

A patient wants to calculate fertile days using the calendar method. What will the nurse instruct the patient to subtract when making this calculation?

18 from the shortest period and 11 from the longest To calculate "safe" days, the patient should subtract 18 from the shortest cycle. This number predicts the first fertile day. Then subtract 11 from the longest cycle. This represents the last fertile day. The other calculations are incorrect to determine fertile days.

A 40-year-old woman who smokes desires a reliable contraceptive method. Which should the nurse recommend to this patient?

A condom and spermicide Women who are 40 years of age and smoke should not take ovulation suppressants. Irregular menstrual cycles make natural methods difficult. Women older than the age of 40 may have vaginal dryness, so a spermicidal suppository would not be effective. The best option is for the patient to use a condom and spermicide.

A nurse is preparing a client for intrauterine device (IUD) insertion. What should the nurse inform the client when educating her on IUDs?

A regular check of threads must be done. The nurse should instruct the client to check the threads regularly to make sure that the IUD is in place. Menstrual flow may be heavier, or last longer than normal, after IUD insertion. It will not decrease. The client may feel a sharp pain when the IUD is inserted. The client may have cramps for a few days, but these should not continue.

A client who delivered her baby 3 months ago is seen in the clinic and tells the nurse that she and her husband have yet to resume a sexual relationship. The nurse notes that no contraception is currently being used. What is the most appropriate nursing diagnosis for this client?

Altered sexual pattern related to fear of pregnancy The nurse should recognize that this exceeds the recommended postpartum abstinence period and might contribute to a fear of a repeat pregnancy.

A nurse is collecting assessment data on a new patient. The patient states that she does not have menses. What term will the nurse use in her documentation to describe the absence of menstrual flow?

Amenorrhea Amenorrhea refers to absence of menstrual flow, while dysmenorrhea is painful menstruation. Menorrhagia is also called hypermenorrhea and is defined as prolonged or excessive bleeding at the time of the regular menstrual flow. Metrorrhagia refers to vaginal bleeding between regular menstrual periods.

A client expresses interest in having an intrauterine device (IUD) placed for contraception. Which finding noted in the health history would indicate to the nurse that this would not be an appropriate contraceptive option?

Bicornuate uterus The client has an abnormally shaped uterus, which could be a contraindication for the use of an IUD due to increased risk for uterine wall perforation. All other findings would not contraindicate the device.

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 The nurse's priority assessment is for bleeding from the surgical sites or vagina, which can be an indication of a possible complication of the procedure. Pain is expected following a surgical procedure and will be a concern for the nurse.

A young patient comes to the clinic and requests birth control pills to prevent a pregnancy. She tells the nurse that she is worried that she will get mixed up on what days to take the pills. Which would be the best type of pills to prescribe this patient?

COCs packaged with 28 pills COCs are packaged with 21 or 28 pills. To eliminate having to count days between pill cycles, most brands are packaged with 28 pills: 21 active pills and 7 placebo pills. There is no need to skip days, because the menstrual flow will begin during the 7 days on which she takes the placebo tablets.

A nurse is teaching a female client who is unable to conceive how to monitor her basal body temperature. Which instruction would the nurse prioritize for this client?

Chart body temperature for at least a month The nurse should instruct the client to record her temperature each morning immediately upon awakening (at rest) using the same thermometer. The nurse should also instruct the client to record her menses, any events that would alter her temperature (e.g., infections, insomnia), and when she has intercourse. To maintain a basal body temperature chart, the client has to monitor her basal body temperature for several months. It is not necessary to record body weight along with the temperature.

A nurse is visiting with a couple who has recently completed subfertility assessments and are awaiting the results. Throughout the conversation the wife intermittently begins to cry. What would be the most appropriate nursing diagnosis for this couple?

Fear related to possible outcome of subfertility studies The nurse should recognize that the client may be expressing fear related to the possible outcomes of the testing. The nurse should address those fears with the client and answer any questions to help reduce fears.

The female partner of a young couple is concerned about what the results of fertility tests might reveal. Which nursing diagnosis should the nurse use to plan care for this patient?

Fear related to possible outcome of subfertility studies The nursing diagnosis that would be the most appropriate to address concerns about the outcome of subfertility studies would be fear related to possible outcome. There is no information to support this patient having a knowledge deficit. The patient already had the testing so anxiety regarding these procedure processes would not be appropriate at this time. It is unknown if the patient will experience situational low self-esteem because the results of the fertility tests have not be disclosed to the patient.

When conducting a health history with a couple who are experiencing subfertility, the nurse will include which of the following? Select all that apply.

General health Medication history Sexual history Surgical history The nurse will need to gather a thorough health history that will include information related to general health, medications, past sexual history, and surgical history.

The mother of four small children comes to the clinic and has just been diagnosed with an enterocele. What should the nurse teach the client about her diagnosis?

Her small intestine and peritoneum are jutting downward between the uterus and the rectum. The names of pelvic support disorders correspond to the affected organs. Enterocele occurs when the small intestine and peritoneum jut downward between the uterus and rectum. Cystocele occurs when the bladder bulges into the front wall of the vagina. Rectocele occurs when the rectum protrudes into the back wall of the vagina. Uterine prolapse occurs when the uterus drops down into the vagina.

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 This client has damage to her fallopian tubes, so any procedure would need to bypass this structure. In vitro fertilization fertilizes an ovum and then inserts it into a women's uterus.

How can pelvic inflammatory disease (PID) affect fertility?

It interferes with the transport of ova because of tubal scarring. Pelvic inflammatory disease, or infection of the fallopian tubes, results in scarring and adhesions of the tubes, leading to poor transport of ova.

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

LAM causes suppression of the ovulation process. LAM prevents pregnancy by suppressing the ovulation process. Withdrawal and barrier methods of contraception prevent the introduction of sperm into the vagina. The copper IUD, combined hormonal methods, and oral contraceptive pills (OCPs) prevent fertilization between the egg and the sperm. Levonorgestrel system thickens the cervical mucus and blocks sperm.

Inability to conceive can be very stressful on a couple. What is one psychological aspect of infertility?

Loss of intimacy Intimacy, love, and support—essential components of a couple's sexual relationship—may be lost because intercourse takes on a clinical and mechanical tone.

A nurse is counseling with a couple in the fertility clinic. In discussing the plan of care, which aspect should the nurse anticipate as being most stressful for the couple?

Planning intercourse around ovulation To increase chances for conception, the nurse should encourage the couple to plan intercourse around ovulation time. This reduces spontaneity and can increase stress between the couple.

A client is scheduled to start taking tadalafil for erectile dysfunction. A nurse should teach the client to observe for side effects and notify a health care provider immediately if what occurs?

Priapism Priapism (erection lasting longer than 4 hours) is a side effect of tadalafil that warrants notifying a health care provider immediately.

Nursing care for the patient with endometriosis includes several factors. What is one aspect of nursing care for the woman with endometriosis?

Provide information on likely outcomes of treatment options. Assist the woman and her family to make treatment decisions by providing information regarding the advantages, disadvantages, possible risks, and likely outcomes of each treatment option.

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 The nurse should inform the individuals that vasectomy is a relatively easy procedure with few complications. Regular sperm counts following a vasectomy are important, as it will take approximately a month for the remaining sperm to exit the body. The client should use birth control measures until his sperm count remains at zero for 6 weeks.

Which of these findings should a nurse investigate first when assessing a female client who has been unable to conceive for 14 months?

The client was diagnosed with thyroid cancer 2 years ago. The nurse should further assess the extent of the thyroid cancer as endocrine dysfunction can be a significant source for infertility.

The nurse in a primary care clinic and a client have come to see the primary care provider because the client is getting married and wants to have a prenuptial gynecologic examination. After the exam, the nurse asks about the woman's plan to have a family. The woman responds, "Why do I have to plan for a family?" What would be the nurse's best response?

The couple can control the time between births when they plan their family. Women and couples can avoid unwanted pregnancies, bring about wanted births, and control the intervals between births with family planning.

A client with liver disease is seen in the clinic wanting to begin contraception. The nurse recognizes that which type of contraception is best for this client?

Vaginal estrogen/progestin (contraceptive) ring The nurse should recognize that the vaginal estrogen/progestin ring releases hormones into the mucous membranes of the vagina and avoids the "first pass" through the liver.

Which definition best explains the term "subfertility/infertility"?

failure to achieve pregnancy after 1 year of unprotected intercourse Infertility is the failure to achieve conception after 1 year of unprotected intercourse.

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 evaluatory method to confirm this suspicion?

laparoscopy 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.

A pregnant client is complaining of a large amount of malodorous vaginal discharge that is foamy and yellow-green in color, vaginal itching and painful intercourse. When asked, she also reports that urination is somewhat painful. She is diagnosed with trichomoniasis. What treatment would the nurse anticipate the client receiving?

oral metronidazole Trichomoniasis is caused from a protozoan infection, which can cause preterm labor, low birth weight and premature rupture of membranes. Treatment is oral metronidazole because it is more effective in treating the infection than the suppository or creams.

What are methods for delivering hormonal contraception? Select all that apply.

orally transdermally vaginally implantation injection Methods to deliver hormonal contraception include orally, transdermally, vaginally, implantation, and injection.

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 Female factors that cause subfertility are problems with ovulation, tubal transport, and implantation.

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

should be applied to the abdomen, buttocks, or back. The patch should be applied only to the buttocks, back, abdomen, or torso (never the breasts). The patch is safe for wearing during swimming and bathing. The patch requires application for 1 week before becoming effective.

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 Typically, the unsafe period during the menstrual cycle is approximately 3 days before and 3 days after ovulation. An ovum is released from the ovary 14 days before the next menstrual period.

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 The cervical mucus method relies on the changes that occur naturally with ovulation. Before ovulation, cervical mucus is thick and does not stretch when pulled. With ovulation, the mucus becomes thin, copious, watery, transparent, and stretchy.

The nurse working in a free health clinic assesses a 17-year-old client interested in contraceptives. Which statement by the client would indicate that female or male condoms would be the appropriate recommendation?

"Last year I was diagnosed with HPV." The client has already contracted HPV; to prevent further spread of it—or contracting other STIs—the nurse should recommend the client use male or female condoms.

A client has been given instructions about a scheduled sonohysterosalpingogram. Which statement, if made by the client, should indicate to a nurse that the client has an adequate understanding of the instructions?

"They will place a catheter in my uterus and use an ultrasound to see what the problem is." A nurse would recognize that this procedure is a sonographic procedure that includes the insertion of a contrast agent into the uterus and fallopian tubes. This procedure can be used as both diagnostic and therapeutic to break up adhesion within the fallopian tubes.

A nurse should instruct a client who has secondary erectile dysfunction related to type 2 diabetes to make which lifestyle modification?

Control blood sugars The nurse should instruct the client to control blood sugars as an initial modification.

A newly married couple is meeting with the nurse to discuss a temporary method of birth control that is both a natural form and does not employ birth control pills/devices, in keeping with their religious beliefs. Which fertility awareness method should the nurse point out will best meet their request to delay conception until they are ready?

CycleBeads CycleBeads is a natural fertility awareness method in which a woman uses a special circle of beads that helps her predict fertile days so that she can abstain from sex on those days. This method meets all of the requirements of the couple. Lactation amenorrhea is a natural method, but it would not apply in this situation, as the woman is not currently breastfeeding. Coitus interruptus is also a natural method, but it is not a fertility awareness method. Vasectomy is a surgical procedure that results in permanent sterility. As the couple would like to have children in the future, this method would not be appropriate.

A female patient is willing to alter nutrition and activity status in an attempt to conceive. What teaching should the nurse provide to support this patient's desire? Select all that apply.

Exercise 30 minutes each day. Ingest vegetables that are high in fiber. Consciously reduce every day stressors. Add brown rice and dark bread to the diet. Nutrition, body weight, and exercise are all important for adequate ova production because they all influence the blood glucose/insulin balance. The patient should be instructed to exercise 30 minutes each day, ingest vegetables that are high in fiber, and reduce every day stressors. In addition, eating slowly digested carbohydrate foods such as brown rice and dark bread rather than food such as white bread, which has easily digested carbohydrates, cannot only increase fertility by keeping insulin levels balanced. Decreased body weight or a body/fat ratio of less than 10% can reduce pituitary hormones such as FSH and LH and halt ovulation.

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 female condom would be the best choice for this client, as it provides protection against both STIs and conception. A tubal ligation would not be recommended for a 16-year-old girl, as it is a permanent measure and she may decide to have children in the future. Neither an oral contraceptive nor coitus interruptus would provide protection against STIs.

A patient asks the nurse if a cervical cap is better than a diaphragm for contraception. What should the nurse explain is the advantage of a cervical cap?

It can be left in place longer. Caps can be kept in place longer—up to 48 hours—because they do not put pressure on the vaginal walls or urethra. A fitting is needed for a cervical cap. They are used with spermicidal jelly, and they do need to be refitted after pregnancy.

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. The estrogen content of birth control pills may lead to increased blood clotting, leading to an increased incidence of thromboembolism. Women who already are prone to this should not increase their risk further.

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. Talking with both partners together may be advantageous, because this may make them feel more comfortable to discuss their problem. On the other hand it is important to spend time alone with each partner, in case there is something one person wants to discuss privately. Both partners are the client in this case.

A client is to take clomiphene citrate for infertility. Which outcome should the nurse explain is the expected action of this medication?

Stimulate the release of ova Clomiphene citrate stimulates the release of FSH and LH which is responsible for the maturity and release of ovum from the ovary.

A woman is 40 years old and a heavy smoker. She has a single sexual partner but has very irregular menstrual cycles. She wants a highly reliable contraceptive. Which method would be the best recommendation?

a diaphragm and spermicide Women over 40 who smoke should not take ovulation suppressants; irregular menstrual cycles make natural methods difficult; women over 40 may have vaginal dryness, so a spermicidal suppository would not be activated.

A woman uses a diaphragm for contraception. The nurse would instruct her to return to the clinic to have her diaphragm fit checked after which occurrence?

a weight gain of 10 lb (4.5 kg) A substantial weight gain or weight loss of 10 pounds (4.5 kilograms) or more may shift the relationship of pelvic organs enough that the diaphragm no longer fits correctly.

Which finding would the nurse expect to find in a client with endometriosis?

dyspareunia The client with endometriosis is often asymptomatic, but clinical manifestations include pain before and during menstrual periods, pain during or after sexual intercourse (dyspareunia), 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.

Clients who have had PID are prone to which complication?

ectopic pregnancy All clients who have had PID need to be informed of the signs and symptoms of ectopic pregnancy because they are prone to this complication.

A couple in their mid-30s are at their primary care provider's office because they have been unable to conceive for 3 years. They already have one child who is 4 years of age. The care provider explains to them that they are dealing with what kind of infertility?

secondary infertility There are two main types of infertility: primary and secondary. A couple who has never been able to conceive has primary infertility, whereas a couple who has been able to conceive in the past but is currently unable to do so has secondary infertility.

The nurse instructs a patient on the use of a vaginal estrogen/progestin rings (NuvaRing) for contraception. Which patient statement indicates that additional instruction is needed?

"I am to take the ring out overnight." If the ring is removed for 4 hours for any purpose, it should be replaced with a new ring and a form of barrier protection is to be used for the next 7 days. The ring is not removed overnight. The ring is left in place for 3 weeks and then removed for menstruation during the ring-free week. The ring does not need to be removed for intercourse.

The nurse has provided information to a client about oral contraceptive pills (OCPs). Which statement by the client would indicate a need for further education?

"Some oral contraceptive pills protect against STIs." Oral contraceptive pills (OCPs) need to be taken on a daily basis to prevent breakthrough ovulation. Oral contraceptive pills do not protect against STIs, and clients still need to use STI protection such as condoms. In addition to preventing pregnancy, hormonal contraceptives have many health benefits, including a reduction in risk of ovarian cancer and endometrial cancer, reducing symptoms of premenstrual discomforts, decreasing blood loss and anemia, reducing symptoms of endometriosis, and many other benefits.

After assessing a client, a nurse determines that an IUD as a method of contraceptive would be contraindicated based on a history of which finding?

Abnormal uterine shape Use of an IUD may be contraindicated for a woman whose uterus is distorted in shape (the device might perforate the uterine wall). The copper IUD use also is not advised for a woman with severe dysmenorrhea (painful menstruation) or menorrhagia (heavy bleeding) because use may increase the incidence of these conditions. Because use of a copper IUD can cause heavier than usual menstrual flow, a woman with anemia also may not be considered a good candidate for a copper IUD. The other findings are not contraindications.

A female patient being treated for infertility is completing the third course of clomiphene citrate. What information should the nurse prepare for the patient in the event this course does not result in conception?

Additional options to achieve conception Clomiphene citrate has a 5-day initial course. Then two additional courses of 5 days each can be provided. If the last course does not result in conception, the nurse should prepare additional options to achieve conception. It is premature to begin discussing adoption with the patient. Sperm motility is not an issue at this time. There is no need for informed consent for a fourth course of the medication.

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 Couples who have experienced infertility may experience guilt related to the lack of conception, anger toward others, and fear of the outcome. The nurse should be prepared to visit with the couple regarding these feelings, and should view these feelings as a normal process.

For which patient assessment finding would an intrauterine device (IUD) be contraindicated?

Misshapen uterus Use of an IUD may be contraindicated for a woman whose uterus is distorted in shape because the device might perforate the uterine wall. The device is not contraindicated for multiple sexual partners, hypertension, or history of thromboembolic disease. Infection is no longer a concern because the vaginal string no longer conducts fluid. The device does not impact hormone levels and will not influence blood pressure or blood flow.

What important information should the nurse give a client about the use of a diaphragm during menstruation?

Toxic shock syndrome is possible The nurse should inform the client that using a diaphragm during menstruation can lead to toxic shock syndrome. Vaginal discharge is associated with the use of a vaginal contraceptive ring. Genital burning may occur when spermicidal products are used along with the barrier methods of contraception. Abdominal pain is a side effect reported during the use of combined oral contraceptives and intrauterine contraceptives.

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 Change in the appearance and consistency of cervical mucus is an indication of ovulation. Slight weight gain and abdominal cramps are not signs used to determine ovulation. At the time of ovulation, body temperature is slightly elevated.

A client is admitted in the health care facility with pelvic inflammatory disease (PID). When reviewing the client's history, what would the nurse identify as a risk factor?

frequent douching One of the risk factors associated with pelvic inflammatory disease is frequent douching. Women with gestational diabetes are at an increased risk for developing type 2 diabetes later in life. Genetic predisposition and environmental exposure are risk factors associated with breast cancer.

A young woman is newly married and is seeking advice on contraception. She is in a monogamous relationship and would like a temporary contraceptive, as she plans to have children in the future. Her husband dislikes the feel of condoms. Also, she mentions that she typically experiences dysmenorrhea and has a history of recurrent urinary tract infections. Which method should the nurse recommend?

oral contraceptive An oral contraceptive would be the best choice of those listed for this client, as it is a temporary contraceptive that also can help relieve dysmenorrhea. Postcoital douching is ineffective as a contraceptive measure as sperm may be present in cervical mucus as quickly as 90 seconds after ejaculation. Diaphragms are contraindicated for women with a history of recurrent urinary tract infections. Vasectomy is a permanent measure and thus inappropriate in this situation.

A woman has just been prescribed clomiphene citrate to stimulate ovulation. Which possible effect should the nurse warn the woman about?

overstimulation of the ovary resulting in potential multiple births Therapy with clomiphene citrate may be used to stimulate ovulation. Administration of either clomiphene citrate or gonadotropins may overstimulate an ovary, causing multiple ova to come to maturity and possibly resulting in multiple births. The nurse should counsel women who receive these agents that this is a possibility. None of the other answers is a common effect of clomiphene citrate use.

A client is questioning the nurse about the various options for contraception. When explaining the implantable form, the nurse should point out it contains which form of contraception?

progestin Implantable contraceptives deliver synthetic progestin that act by inhibiting ovulation and thickening cervical mucus so sperm cannot penetrate. Various options that combine estrogen and progestin include the transdermal patch and a vaginal estrogen/progestin (contraceptive) ring. Concentrated spermicide is inserted directly into the vagina. There are no concentrated estrogen products available for contraceptive measures.

The nurse is developing a presentation for a group of young adult women about premenstrual syndrome. Which treatment options should the nurse point out as most appropriate? Select all that apply.

reduction of caffeine intake vitamin and mineral supplements NSAIDs Treatment options for PMS include lifestyle changes such as reduction in caffeine intake, a well-balanced diet with increased water intake, and limited alcohol intake. Vitamin and mineral supplements, NSAIDs, and diuretic therapy may be used. Antidepressants and antianxiety agents, not antipsychotic agents, may also be options.

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 Only three tests are commonly used to test fertility: semen analysis in the male and ovulation monitoring and tubal patency assessment in the female. Additional testing may be performed both on the man and the woman, which may include urinalysis, serologic test for syphilis, and pelvic sonogram, but these are not the primary tests used.

The estrogen content in the contraceptive pill performs which action?

suppresses follicle-stimulating hormone (FSH) Estrogen has a direct effect on the pituitary gland suppressing FSH; progesterone increases permeability of cervical mucus and endometrial proliferation.

A male client asks the nurse to explain which structure is cut during a vasectomy. What response should the nurse give the client?

the vas deferens The two vas deferens or ductus deferentia are ligated and cut in the male sterilization procedure, called a vasectomy. The epididymis serves as a site for sperm to mature and be stored until ejaculation occurs. The ejaculatory ducts empty into the urethra and receive secretions from the prostate gland to make up semen. The scrotum is a sac-like structure that sits behind the penis and houses the testicles.

A client is diagnosed with uterine fibroids. When reviewing the client's health history, the nurse would identify which finding as associated with the client's condition?

chronic pelvic pain Findings associated with uterine fibroids include chronic pelvic pain, constipation, dysmenorrhea, and lower back pain.

A client with a family history of cervical cancer is to undergo a Papanicolaou test. During the client education, what group should the nurse include as at risk for cervical cancer?

clients who have genital warts The presence of genital warts (condyloma) increases the risk of developing cervical cancer. Women with metrorrhagia or irregular menstrual cycles are at an increased risk of developing breast cancer, not cervical cancer. Clients who have never had a baby or those with a history of fibrocystic breast disease have an increased risk of developing breast cancer, but not cervical cancer.

A woman is admitted for repair of cystocele and rectocele. She has nine living children. In taking her health history, what would the nurse expect to find?

stress incontinence with feeling of low abdominal pressure Cystocele and rectocele are examples of pelvic organ prolapse. Manifestations typically include stress incontinence and lower abdominal pressure or pain. Complaints of sporadic vaginal bleeding and chronic pelvic pain are associated with uterine fibroids. Leukorrhea and vulvar pruritus commonly are associated with an infection. Menstrual irregularities and hirsutism are associated with polycystic ovary syndrome (PCOS).

The nurse completes instructing a patient on the use of the contraceptive patch. Which patient response indicates that teaching has been effective?

The patch should be applied to the abdomen, buttocks, or back. The patch should be applied only to the buttocks, back, abdomen, or torso and never on the breasts. The patch is safe for wearing during swimming and bathing. The patch requires application for 1 week before becoming effective.

A young woman comes to the free clinic asking for oral contraceptive pills. Which factor best indicates that another type of contraception would be better for this client?

history of noncompliance with medications If a woman has a history of poor compliance with medication, it might not be realistic for her to plan on taking an oral contraceptive pill every day.

The nurse is preparing a class on infectious disorders of the reproductive tract. It will be presented to an eighth-grade health class. When teaching about pelvic inflammatory disease (PID), what would be the best method to prevent this infection?

Abstinence The only definitive means of preventing the spread of sexually transmitted infections, such as PID, is complete abstinence. The nurse should be clear when discussing this with students. Because abstinence is not a reasonable or acceptable universal expectation, the nurse should also discuss less effective but useful prevention measures. Condom use can lessen the risk from some infections, but provides imperfect protection.

A patient who has unprotected intercourse has obtained the morning after pill but has not yet taken the prescribed dosage. What nursing diagnosis should the nurse identify as appropriate for the patient at this time?

Decisional conflict The patient has the morning after pill but has not yet taken the prescribed dosage. This indicates that the patient has not yet made a decision. Powerlessness would be applicable if the patient's planned contraceptive was ineffective. Spiritual distress would be appropriate if there were a conflict regarding contraceptive methods. Readiness for enhanced knowledge would be applicable if the patient was asking about different contraceptive types.

A woman, age 52, goes into the clinic to see her nurse practitioner. She reports symptoms consistent with climacteric syndrome. What is the nurse's best recommendation?

Have the client discuss hormone therapy with her health care provider. Risks and benefits of hormone therapy should be carefully weighed by the client and her primary care provider. The nurse cannot unilaterally recommend hormone therapy. Contraception should continue to be used, but this does not address the client's symptoms. Similarly, interventions that address emotions ignore the likely physical symptoms.

The nurse is teaching a female to take her basal body temperature daily to assess the time of ovulation. What will the patient's body temperature reflect at the day of ovulation?

Increase a degree. At the time of ovulation, the basal body temperature can be seen to dip slightly (about 0.5ºF); it then rises to a level no higher than normal body temperature; it then stays at that level until 3 or 4 days before the next menstrual flow. This increase in basal body temperature marks the time of ovulation because it occurs immediately after ovulation. Upon ovulation, the basal body temperature will not decrease a degree, fluctuate, or spike and then drop.

Why is fertility testing initiated with sperm analysis of the male partner?

Sperm analysis is one of the easiest tests to complete. Because sperm analysis is noninvasive, it is one of the easiest tests (and therefore most cost-effective) to complete.

The nurse teaches a woman to change tampons frequently, wash her hands thoroughly before and after inserting or removing tampons; use the lowest absorbency tampon, and store tampons correctly. The nurse should point out these actions will help avoid which disorder?

TSS Toxic shock syndrome is a rare illness typically caused by bacteria. Teaching the client methods to decrease the exposure to bacteria is assisting in prevention of TSS. Pelvic inflammatory disorder occurs most commonly in association with untreated STIs, particularly in gonorrhea and chlamydia. Endometriosis is a painful reproductive and immunologic disorder in which tissue implants resembling endometrium grow outside of the uterus. Sexually transmitted infections are associated with sexual practices, not hygiene.

When discussing contraceptive options, the nurse would recommend which option as being the most reliable?

intrauterine system 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.

When assessing a client, a nurse determines that the client has a rectocele based on which finding?

sagging of the rectum, which pushes against or into the posterior vaginal wall A rectocele occurs when the rectum sags and pushes into or against the posterior vaginal wall. A cystocele occurs when the posterior bladder wall protrudes downward through the anterior vaginal wall. An enterocele occurs when the small intestine bulges through the posterior vaginal wall. Uterine prolapse occurs when the uterus descends through the pelvic floor and into the vaginal canal.

A female patient has forgotten to take an ovulation suppressant for two mornings in a row. What should the nurse advise the patient to do?

Take two pills now and use a second method of contraception for the remainder of the month. If two consecutive active pills are missed, the patient should be advised to take two pills immediately. Then the patient should continue the following day with the usual schedule. Missing two pills may allow ovulation to occur, so an added contraceptive such as a spermicide should be used for the remainder of the month. The patient does not need to take two pills every day for the rest of the month, take three pills and abstain from coitus, or start a new cycle of 21 pills.

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 Application of transdermal contraceptive patches to the skin would most likely be the option for this couple. These patches will not hamper the sexual experience nor cause side effects such as those caused by oral contraceptive pills (OCPs). Natural membrane and polyurethane condoms are forms of male condoms, which the client does not like. Ethinyl estradiol is an oral contraceptive pill, which would most likely cause the client to experience breast tenderness, headache, and nausea.

A patient received a scheduled dose of depot medroxyprogesterone acetate (DMPA) 6 weeks ago. Today, the patient reports that a regular menstrual cycle is 2 weeks late. What is the first thing that should be done for this patient?

Perform a pregnancy test. Because the patient is receiving a contraceptive that could cause amenorrhea, and the patient's menstrual cycle is 2 weeks late, the first thing that should be done is a pregnancy test to determine if the patient is pregnant. The results of this test will determine the next course of action. Depot medroxyprogesterone acetate (DMPA) is a pregnancy category X medication, which means it should not be administered to someone who is pregnant. It is unclear if the patient was already pregnant when the last dose was provided 6 weeks prior to the current situation. It is premature to provide prenatal counseling. Depending on the results of the pregnancy test, the nurse may need to explain side effects of the contraceptive which include amenorrhea.

A female client complains of irregular menses. On further assessment, the nurse observes that the client is obese and is developing hirsutism. Her diagnosis indicates an ovarian dysfunction with increased levels of testosterone. The nurse interprets these findings to suggest:

polycystic ovarian syndrome. Polycystic ovarian syndrome (PCOS) results in elevated levels of testosterone. There is also associated hyperinsulinemia and impaired glucose tolerance. These result in hirsutism, obesity, and amenorrhea, or irregular menses. In premature ovarian failure, all the eggs produced by a woman develop in a rudimentary fashion. Their number decreases steadily until menopause though it does not result in obesity and hirsutism. Hypothyroidism causes increased frequency of periods without obesity and hirsutism. In adrenal hyperplasia, excess androgen is produced and women experience ovulatory failure with no signs of hirsutism and obesity.

A client who is scheduled for hysteroscopy says to a nurse, "I thought I would be able to have children, but now I know that will never be possible." Which response would be most appropriate for the nurse to make?

"I will call the health care provider to come visit with you." The nurse needs to notify the health care provider because the client does not have a clear understanding of the outcomes of the procedure in which she is about to undergo.

A nurse is preparing a presentation for a group of women which will cover various dietary and lifestyle changes to help avoid future pelvic structure changes. Which key point should the nurse point out in this presentation to the women?

Drink plenty of fluids each day. All women should drink at least eight 8-ounce glasses of fluid a day. Fiber intake needs to be increased; the recommended daily intake of fiber for women is 25 grams. Refined, processed, low-fiber foods need to be replaced with high-fiber foods. The women should be encouraged to perform Kegel exercises to help increase the strength of the pelvic floor muscles. Other exercising should also be encouraged but the Kegel exercises are specific to the affected area which will lead to pelvic floor prolapse. Depending on the type of vigorous exercise, some will actually result in pelvic floor prolapse, if it puts lots of strain on the pelvic floor.

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 Women who are perimenopausal are, overall, good candidates for intrauterine devices (IUDs). In this case, the IUD is the best choice because this method is almost 100% effective, is long-term, and does not involve any hormones. Both the transdermal patch and the subdermal progestin implant involve hormones, which rules each out in this case. Also, tubal ligation is a surgical procedure, which also rules it out for this client.