Maternity

A nurse is conducting a class for a group of young adults at the health clinic about contraceptive options. The nurse determines that the teaching was successful when the group identifies which type as protective against sexually transmitted infections?

Condom Rationale:Only the condom provides protection against sexually transmitted infections. Intrauterine system, diaphragm, and contraceptive patch offer no protection.

The public health nurse is teaching a community class of couples on fertility awareness-based methods. The nurse determines that additional teaching is needed when one of the couples states that they will be using which method?

coitus interruptus method Rationale:Fertility awareness refers to any natural contraceptive method that does not require hormones, pharmaceutical compounds, physical barriers, or surgery to prevent pregnancy. Techniques used to determine fertility include the cervical mucus ovulation method, the basal body temperature (BBT) method, the symptothermal method, standard days method, and 2-day method. Coitus interruptus or withdrawal is not considered a fertility awareness based method.

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 emotional distress hypothyroidism Rationale:The girl is experiencing secondary amenorrhea. Risk factors include: recent rapid weight gain or loss, pregnancy, vigorous exercise, hypo- or hyperthyroidism, and chronic prolonged emotional stress.

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 Rationale:Medroxyprogesterone acetate is an injectable form of a progesterone-only contraceptive that is given every 12 weeks. It works by suppressing ovulation and the production of FSH and LH by the pituitary gland. Etonogestrel is an implantable form contraceptive. Norelgestromin/ethinyl estradiol is a patch-type contraceptive, and levonorgestrel/ethinyl estradiol is an oral contraceptive that uses a 365-day combination dosing.

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

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." Rationale:After vasectomy, semen no longer contains sperm. However, this is not immediate. The man must submit semen specimens for analysis 8 to 16 weeks after a vasectomy until two specimens show that no sperm is present. When the specimen shows azoospermia, the man's sterility is confirmed. A vasectomy is usually performed under local anesthesia in a urologist's office, and most men can return to work and normal activities in a day or two.

A woman is diagnosed with primary dysmenorrhea and is prescribed ibuprofen as part of her treatment plan. When teaching the woman about using this medication, which instruction would be important for the nurse to emphasize?

"Start taking the medication when you first get your period."

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 Rationale:The medroxyprogesterone injection is given intramuscularly every 3 months.

The client has heard of extended-cycle oral contraceptive regimens and desires more information. The nurse explains that these regimens consist of active combination pills, followed by placebo pills. How many days of active combination pills and placebo pills are contained in these regimens?

84 active; 7 placebo Rationale:Research has confirmed that the extended use of active OC pills carries the same safety profile as the conventional 28-day regimens. The extended-cycle regimen consists of 84 consecutive days of active combination pills, followed by 7 days of placebo. The woman has four withdrawal-bleeding episodes a year.

A woman opts to use a diaphragm for contraception. Which instruction would be most important for the nurse to provide?

"Have your diaphragm refitted if you lose 10 pounds (4.5 kilograms) or more." Rationale:Diaphragms should be refitted after pregnancy, abdominal or pelvic surgery, or weight loss or gain of 10 pounds (4.5 kilograms) or more. A diaphragm usually is replaced every 1 to 2 years. A diaphragm should remain in place for at least 6 hours after intercourse. A contraceptive sponge, not a diaphragm, should be wetted with water before insertion.

A woman is to receive methotrexate and misoprostol to terminate a first-trimester pregnancy. When preparing the teaching plan for this client, the nurse understands that misoprostol works by

causing uterine contractions to expel the uterine contents

A young couple is exploring their contraceptive options and are curious about using an intrauterine contraceptive device. The nurse explains that there are two types, one that uses hormones and one that uses:

copper Rationale:The implants contain either copper or progesterone to enhance their effectiveness. One or two attached strings protrude into the vagina so that the user can check its placement. Four IUCs are currently available in the United States: the copper ParaGard-TCu-380A, the levonorgestrel-releasing intrauterine systems (LNG-IUSs) marketed as Mirena and Kyleena, and the LNG-IUD marketed as Jaydess. The ParaGard-TCu-380A is approved for 10 years of use and is nonhormonal. Its mechanism of action is based on the release of copper ions, which alone are spermicidal. Additionally, the device causes an inflammatory action leading to a hostile uterine environment.

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 Rationale:Secondary dysmenorrhea is painful menstruation due to pelvic or uterine pathology. Endometriosis is the most common cause of secondary dysmenorrhea. Other recognized causes include adenomyosis, fibroids, pelvic infection, an intrauterine device, cervical stenosis, or congenital uterine or vaginal abnormalities.

A client is diagnosed with endometriosis. As part of the teaching plan, the nurse is explaining the condition, including the ways that the diagnosis would be confirmed. The nurse determines that the teaching was successful when the client states that which test would confirm the diagnosis?

pelvic laparoscopy Rationale:A thorough history and pelvic examination may lead the health care practitioner to suspect endometriosis; however, the only certain method of diagnosing it is by visualizing it via a laparoscopy. A tissue biopsy can be obtained at this time and examined microscopically to confirm it. A Papanicolaou test would be done to rule out cervical cancer. A pelvic ultrasound would not be definitive for endometriosis.

A 16-year-old girl is brought to the clinic by her mother because she has not had a menstrual period for the past 8 months. Which findings might alert the nurse to the possibility that anorexia nervosa may be contributing to the client's amenorrhea? Select all that apply.

reduced subcutaneous fat hypotension bradycardia Rationale:Hypothermia, bradycardia, hypotension, and reduced subcutaneous fat may be observed in women with amenorrhea with anorexia nervosa as the contributing factor. Evidence of secondary sex characteristics would be a normal finding for a girl of this age.

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. Rationale:The sponge provides protection for up to 12 hours but should not be left in place for more than 30 hours after insertion to avoid the risk of toxic shock syndrome.

The client presents reporting irregular menstrual cycles, bleeding between periods, mood swings, hot flashes and vaginal tenderness. After an examination, the nurse suspects abnormal uterine bleeding. Which approach would be inappropriate?

Tell the client she will need to learn to live with the problems. Rationale:There are many treatable reasons for abnormal uterine bleeding. The client should be evaluated, and all related disorders should be treated as needed. Telling the client to just learn to live with it ignores the possibility that her symptoms are related to a serious but treatable condition.

When assessing a client with symptoms of premenstrual syndrome (PMS), the nurse uses the ACDHO tool. The nurse questions the client about which symptom when addressing the "C" in the tool?

cravings Rationale:ACDHO stands for: A - anxiety: difficulty sleeping, tenseness, mood swings, and clumsiness; C - cravings: for sweets, salty foods, chocolate; D - depression: feelings of low self-esteem, anger, easily upset; H - hydration: weight gain, abdominal bloating, breast tenderness; and O - other: hot flashes or cold sweats, nausea, change in bowel habits, aches or pains, dysmenorrhea, acne breakout.

A nurse is working with a couple who is dealing with infertility. Which aspect would be most important for the nurse to consider?

culture Rationale:Infertility is not only a physiologic problem but is also one that can initiate a life crisis that is experienced with psychologic, familial, social, and cultural consequences. Although insurance constraints, budget, and emotional aspects are important considerations, the manner in which the various cultures, ethnic groups, and religious groups perceive and manage infertility are very different and must be considered when working with couples who have been unable to conceive. Nurses need to include awareness of these differences in their counseling of the couples as they try to help them achieve their goal of getting pregnant.

A nurse is preparing a presentation for a local community women's group about menopause. When describing the body system changes that occur, the nurse would include which changes? Select all that apply.

decreased bone density hot flashes, increased abdominal fat vaginal dryness Rationale:Menopause may be associated with hot flashes, increased abdominal fat, vaginal dryness, decreased bone density, dry, thinning skin, and increased waist size.

A young adult woman comes to the clinic for an evaluation. During the visit, the woman tells the nurse that she suffers from painful cramps during her menses. She states, "It is worse the first couple of days and then it gets better. I take ibuprofen and it helps. Is there anything else I can do?" Which information would the nurse incorporate into the response? Select all that apply.

"Try to exercise." "Limit the amount of salty foods you eat." "Take warm showers to help relax." Rationale:Tips for managing dysmenorrhea include: exercising to increase endorphins and suppress prostaglandin release; limiting salty foods to prevent fluid retention; increasing water consumption to serve as a natural diuretic; using heating pads or warm baths to increase comfort; and taking warm showers to promote relaxation.

A client presents at the clinic and is interested in obtaining emergency contraception (EC). The nurse explains that EC must be used within 72 hours of unprotected sex to be effective. This is because:

ECs simply prevent embryo creation and uterine implantation from occurring in the first place.

The nurse is providing care to a client with abnormal uterine bleeding. Treatment with medications has been unsuccessful, and surgical intervention is being considered. The nurse identifies which technique as being the last resort?

hysterectomy Rationale:If the client does not respond to medical therapy, surgical intervention might include dilation and curettage (D&C;), endometrial ablation, uterine artery embolization, or hysterectomy. Of these, hysterectomy is considered a last resort.

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." Rationale:Once menarche has occurred, cycles may take up to 2 years to become regular, ovulatory cycles. Telling the mother that her daughter's periods would get regular in 2 to 3 months or that she should be having regular periods by now is incorrect. Also, telling the mother that her daughter's periods will continue to be irregular is untrue and inappropriate.

A nurse is teaching a couple who has chosen condoms as their means of contraception. The nurse determines that the teaching was successful when the couple makes which statements? Select all that apply.

"The penis needs to be erect before putting on the condom." "We'll keep the condom in its wrapper until we're ready to use it." "We will use a new condom each time we have sexual intercourse." Rationale:A new condom should be used for each sexual intercourse act. It should be kept in its wrapper until it is ready to use, applied to an erect penis and removed while the penis is still erect. There should be about 1/2 inch of empty space at the end to collect ejaculate.

A middle-aged woman with a history of hypertension and high cholesterol levels asks the nurse about ways to reduce her risk for heart disease as she approaches menopause. Which area would the nurse emphasize as most important?

Lifestyle modification Rationale:Although medications and stress management can be helpful in reducing the woman's risk, lifestyle modifications are crucial to modify the woman's risk factors of hypertension and high cholesterol levels in preventing heart disease. Screening for heart disease would be important to identifying it early but would not help in reducing the woman's risk.

A nurse is assessing a client and suspects that the client may be experiencing premenstrual dysphoric disorder (PMDD). Applying the American Psychiatric Association criteria, the nurse would assess which symptoms? Select all that apply.

diarrhea affective lability sleep difficulties Rationale:According to the American Psychiatric Association, a woman must have at least five of the typical symptoms to be diagnosed with PMDD. These must occur during the week before and a few days after the onset of menstruation and must include one or more of the first four symptoms: affective liability; anxiety and tension; persistent or marked anger or irritability; depressed mood, feelings of hopelessness; difficulty concentrating; sleep difficulties; increased or decreased appetite; increased or decreased sexual desire; chronic fatigue; headache; constipation or diarrhea; or breast tenderness and swelling.

The nurse is assessing a couple who have come to the health care facility because they have been unable to conceive a child. When assessing the woman, the nurse would identify which factor as increasing the woman's risk for infertility?

endometriosis Rationale:Risk factors for infertility include endometriosis, age older than 27 years, tubal blockages, weight variations, hormonal imbalances, fibroids, reduced oocyte quality, chromosomal abnormalities, congenital anomalies of the cervix and uterus, immune system disorders, chronic illnesses, sexually transmitted infections, history of PID, smoking and alcohol consumption, multiple miscarriages, and psychological stress. Dysmenorrhea is not an associated risk factor.

The nurse is planning to speak at a local community center to a group of middle-aged women about osteoporosis. Which measure would the nurse be sure to include as effective in reducing the risk for osteoporosis?

engaging in daily weight-bearing exercise Rationale:Engaging in daily weight-bearing exercise such as walking helps to reduce a woman's risk for osteoporosis. To prevent osteoporosis, women should increase their calcium and vitamin D intake. Avoiding excessive alcohol ingestion helps prevent osteoporosis. Limiting intake of cholesterol and saturated fats helps reduce the risk for cardiovascular disease, not osteoporosis.

A nurse is reading a journal article about premenstrual syndrome (PMS) and the millions of women affected by it during their reproductive years. The nurse would expect to find approximately what percentage of women meeting the ACOG criteria for PMS?

75% Rationale:It is estimated that up to 75% of reproductive-age women experience premenstrual symptoms that meet the ACOG criteria for PMS and up to 8% meet the diagnostic criteria for PMDD.

A nurse is preparing a presentation for a client who is considering contraception. When discussing oral contraceptives, the nurse would identify which advantages? Select all that apply.

reduction in severe cramping shortening of the menstrual period reduction in risk for osteoporosis