OB- Ch.4

Both male and female factors can cause _____________ ___________ can cause infertility. The most common symptom of endometriosis is _______________. _______________ is a pharmacologic treatment for infertility that increases _______________.

1) Infertility 2) Endometriosis 3) Pain 4) Clomid 5) Ovulation

Drug and surgery therapy for infertility includes which of the following? SATA: A) Clomiphene (promotes ovulation) B) Hormone injections (promotes ovulation) C) Intrauterine insemination D) IVF E) Estrogen supplements

A) Clomiphene (promotes ovulation) B) Hormone injections (promotes ovulation) C) Intrauterine insemination D) IVF

Therapeutic management of the client with endometriosis falls into 3 categories: SATA A) Pain relief B) Hormonal suppression C) Surgery D) Hormonal replacement/substitution

A) Pain relief B) Hormonal suppression C) Surgery

In nursing management role in the care of infertile couples includes which of the following? SATA A) Respect for the couple B) Assistance in decision-making C) Assistance with financial strategies D) Education, anticipatory guide, stress management, and counseling E) Prescribing hormone therapies

A) Respect for the couple B) Assistance in decision-making C) Assistance with financial strategies D) Education, anticipatory guide, stress management, and counseling

A client states that she is to have a test to measure bone mass to help diagnose osteoporosis. The nurse would most likely plan to prepare the client for: A. DEXA scan. B. ultrasound. C. MRI. D. pelvic X-ray.

A. DEXA scan. Rationale: Currently, no method exists for directly measuring bone mass. Instead, a bone mass density (BMD) measurement is used. BMD is a two-dimensional measurement of the average content of mineral in a section of bone. The client most likely will be having a DEXA scan, which is a screening test that calculates the mineral content of the bone at the spine and hip. Ultrasound, MRI, and a pelvic X-ray would be of little help in determining bone mass. Reference: p. 162

A nurse is preparing a class for a group of women at a family planning clinic about contraceptives. When describing the health benefits of oral contraceptives, which benefits would the nurse include? Select all that apply. A. protection against pelvic inflammatory disease B. reduced risk for endometrial cancer C. decreased risk for depression D. reduced risk for migraine headaches E. improvement in acne

A. protection against pelvic inflammatory disease B. reduced risk for endometrial cancer E. improvement in acne Rationale: The health benefits of oral contraceptives include protection against pelvic inflammatory disease, a reduced risk for endometrial cancer, and improvement in acne. Oral contraceptives are associated with an increased risk for depression and migraine headaches. Reference: p. 145

Main warning signs to inform/review with patient of before sending them home with birth control? (5)

ACHES- A- abdominal pain C- chest pain H- headaches E- eye problems S- shortness of breath

Which race believe that assisted reproductive techniques are unnatural and that they remove the spiritual or divine nature of creation from conception? For this reason these people may seek spiritual rather than medical assistance when trying to conceive.

African Americans

Which finding would the nurse expect to find in a client with endometriosis? A. hot flashes B. dyspareunia (pain during intercourse) C. fluid retention D. fever

B. dyspareunia Rationale: The client with endometriosis is often asymptomatic, but clinical manifestations include pain before and during menstrual periods (dyspareunia), pain during or after sexual intercourse, 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. Reference: p. 125

Impact of Menopause on the Body include which of the following? SATA: Brain: hot flashes; sleep, mood, and memory problems Heart: lower levels of HDL; increased risk of CVD Bones: bone density loss; increased risk of osteoporosis Breasts: duct and gland tissue replaced by fat Genitourinary: vaginal dryness, stress incontinence, cystitis GI: less Ca+ absorbed; increased fractures Skin: skin dry, thin; collagen decreases

Brain: hot flashes; sleep, mood, and memory problems Heart: lower levels of HDL; increased risk of CVD Bones: bone density loss; increased risk of osteoporosis Breasts: duct and gland tissue replaced by fat Genitourinary: vaginal dryness, stress incontinence, cystitis GI: less Ca+ absorbed; increased fractures Skin: skin dry, thin; collagen decreases

A nurse is preparing a class for a group of young adult women about emergency contraceptives (ECs). What information would the nurse need to stress to the group? Select all that apply. A. ECs induce an abortion-like reaction. B. ECs provide some protection against STIs. C. ECs are birth control pills in higher, more frequent doses. D. ECs are not to be used in place of regular birth control. E. ECs provide little protection for future pregnancies.

C. ECs are birth control pills in higher, more frequent doses. D. ECs are not to be used in place of regular birth control. E. ECs provide little protection for future pregnancies. Rationale: Important points to stress concerning ECs are that ECs do not offer any protection against STIs or future pregnancies; they should not be used in place of regular birth control, as they are less effective; they are regular birth control pills given at higher doses and more frequently; and they are contraindicated during pregnancy. Contrary to popular belief, ECs do not induce abortion and are not related to mifepristone or RU-486, the so-called abortion pill approved by the FDA in 2000. Reference: p. 150

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? A. Diuretics B. Non-steroidal anti-inflammatory drugs (NSAIDs) C. Selective serotonin reuptake inhibitors (SSRIs) D. Vitamin supplements

C. Selective serotonin reuptake inhibitors (SSRIs) Rationale: Although diuretics, NSAIDs, and vitamin supplements may be used as part of the treatment plan for premenstrual dysphoric disorder, SSRIs are commonly prescribed to address the behavioral and mood symptoms of this condition. Reference: p. 123

A nurse is describing the criteria needed for the diagnosis of premenstrual dysphoric disorder (PMDD). Which would the nurse include as a mandatory requirement for the diagnosis? A. appetite changes B. sleep difficulties C. persistent anger D. chronic fatigue

C. persistent anger Rationale: For the diagnosis of PMDD, the woman must exhibit one or more of the following: affective lability such as sadness, tearfulness, or irritability; anxiety and tension; persistent or marked anger or irritability; and depressed mood and feelings of hopelessness. Other symptoms, although not mandatory for the diagnosis, include increased or decreased appetite, sleep difficulties, chronic fatigue, headache, increased or decreased sexual desire, constipation or diarrhea, and breast swelling and tenderness. Reference: p. 124

What two types of surgery are options for surgical therapy for endometriosis?

Conservative and Definitive

This type of surgery (for endometriosis) involves the removal of implants/lesions using laser, cautery, or small surgical instruments for excision. This may reduce pain and allow pregnancy to occur in the future but may need to be repeated.

Conservative surgery

A client who has come to the clinic is diagnosed with endometriosis. What would the nurse expect the primary care provider to prescribe as a first-line treatment? A. progestins B. antiestrogens C. gonadotropin-releasing hormone analogues D. NSAIDs

D. NSAIDs Rationale: Although progestins, antiestrogens, and gonadotrophin-releasing analogues are used as treatment options for endometriosis, NSAIDS are considered the first-line treatment to reduce pain. Reference: p. 126

Which action would the nurse emphasize when teaching postmenopausal women about ways to reduce the risk of osteoporosis? A. swimming daily B. taking vitamin A C. using hormone replacements D. taking calcium supplements

D. taking calcium supplements Rationale: Osteoporosis is a condition in which bone mass declines to such an extent that fractures occur with minimal trauma. Increasing calcium and vitamin D intake is a major preventive measure. Other measures to reduce the risk include engaging in weightbearing exercise such as walking. Swimming, although a beneficial exercise, is not a weightbearing exercise. Taking vitamin A supplements would have no effect on preventing bone loss. Recent studies have shown that the overall health risks associated with hormone replacement therapy exceed the benefits, increasing the woman's risk for heart attacks, strokes, and breast cancer. Reference: p. 162

After teaching a group of students about premenstrual syndrome, the instructor determines that additional teaching is needed when the group identifies which finding as a prominent assessment finding? A. bloating B. tension C. dysphoria D. weight loss

D. weight loss Rationale: Irritability, fatigue, bloating, tension, and dysphoria are the most prominent and consistently described manifestations of premenstrual syndrome. Weight gain, not weight loss, is associated with this disorder. Reference: p. 122

This type of surgery (for endometriosis) involves an abdominal hysterectomy with or without bilateral salpingo-oophorectomy. Will eliminate bleeding but will leave a woman unable to become pregnant in the future. Pain may not resolve if extrauterine lesions are not completely removed.

Definitive surgery

Painful menstruation, highly prevalent problem among women today.

Dysmenorrhea

Difficult/painful sexual intercourse

Dysparenuia

This is a complex syndrome characterized by an estrogen-dominant chronic inflammatory process that affects primarily pelvic tissues, including the ovaries. This is caused when tissue similar to that of the endometrium implants outside of the uterus, most commonly throughout the abdominal cavity. This is one of the most common gynecologic diseases, affecting more than 6 million women in the U.S. - about 11% of the women population.

Endometriosis

What is the etiology or cause of endometriosis?

Exact cause is unknown, several theories exist but there have been none which are scientifically proven.

Which culture believes that children validate the marriage, so families are often large? They are also spiritual and may consider infertility a test of faith, leading them to seek spiritual counseling.

Hispanic

Defined as the inability to conceive a child after 1 year of regular sexual intercourse unprotected by contraception:

Infertility (Primary)

How does contraception work?

Negative feedback system. Tricks your brain into thinking that you have already been through the menstrual cycle, which prevents the maturation of eggs/hormones/cycle.

If someone is taking a progesterone ONLY contraceptive, will they have a bleed?

Not really, because estrogen is not present to build a lining

In this religion, procreation is considered to be a "mitzvah" a religious good deed. They do not accept the use of contraceptives to prevent conception when it is not desired.

Orthodox Jewish (Conservative and Reform Jews put no restrictions on contraception and a lesser demand on procreation)

-The state of diminished bone density. -Systematic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility.

Osteoporosis

This period of time, usually 2-8 years prior to cessation of menstruation, is termed what?

Perimenopause

Which hormone out of the two- estrogen or progesterone- makes you more moody and must be taken at the same time every day otherwise ovulation will occur.

Progesterone

If someone is taking a combined estrogen-progesterone contraceptive, will they have a bleed?

Yes, because they had estrogen to build a lining

Inability to conceive can be very stressful on a couple. What is one psychological aspect of infertility? a) Loss of intimacy b) Growth of intimacy c) Emotional stability d) Couple becomes closer

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

Place the following events in the sequence the pregnant woman would experience them, from first to last. 1. quickening 2. labor 3. amennorhea 4. Braxton Hicks contractions 5. uterine enlargement

amennorhea uterine enlargement quickening Braxton Hicks contractions labor

A male client has undergone a semen analysis for evaluation of fertility. The nurse understands that which sperm count would suggest infertility? a) 75 million/mL b) 18 million/mL c) 50 million/mL d) 100 million /mL

b) 18 million/mL Rationale: A sperm count of fewer than 20 million spermatozoa per milliliter results in infertility. Normal sperm count ranges on average from 60 to 100 million /mL.

When a woman is planning pregnancy, what is her window around ovulation to have intercourse? a) 2 days before to 1 days after ovulation b) 5 days before to 2 days after ovulation c) 1 day before ovulation to 2 days after ovulation d) 3 days before or the day of ovulation

b) 5 days before to 2 days after ovulation Rationale: Sperm are able to live for up to 72 hours after ejaculation and the ovum remains fertile for a maximum of 48 hours after ovulation. The window of opportunity for conception is 5 days before to 2 days after ovulation.

The nurse correctly identifies which of the following as the hormone that plays a central role in the release of milk from the breast ( let-down reflex)? a) Progesterone. b) Oxytocin. c) Prolactin. d) Estrogen.

b) Oxytocin. Rationale: Oxytocin, produced by the posterior pituitary gland, stimulates uterine contractions and the release of milk in the mammary glands (let-down reflex). Prolactin, a pituitary hormone, triggers and sustains milk production. Progesterone, produced by the corpus luteum and placenta, prepares the endometrium for implantation of the fertilized ovum, develops the mammary glands, and maintains the pregnancy. Estrogen is a female sex hormone produced by the ovaries and placenta

When assessing a woman in her first trimester, which emotional response would the nurse expect to find? a) emotional lability b) introversion c) ambivalence d) acceptance

c) ambivalence Rationale: During the first trimester, the pregnant woman commonly experiences ambivalence, with conflicting feelings at the same time. Introversion heightens during the first and third trimesters when the woman's focus is on behaviors that will ensure a safe and healthy pregnancy outcome. Acceptance usually occurs during the second trimester. Emotional lability (mood swings) is characteristic throughout a woman's pregnancy

On what day during pregnancy does the embryo implant on the uterine surface? a) the 14th day of a "typical" menstrual cycle b) ten days after the start of the menstrual flow c) eight days after ovulation d) four days after ovulation

c) eight days after ovulation Rationale: After floating free in the uterine cavity for about 4 days, the zygote implants on the uterine surface on about the 8th day; thereafter it is termed an embryo.

A pregnant woman needs an update in her immunizations. Which vaccination would the nurse ensure that the woman receives? a) mumps b) rubella c) hepatitis B d) measles

c) hepatitis B Rationale: Hepatitis B vaccine should be considered during pregnancy. Immunizations for measles, mumps, and rubella are contraindicated during pregnancy.

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? a) primary infertility b) There is no name for different kinds of infertility. c) secondary infertility d) tertiary infertility

c) secondary infertility Rationale: 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.

A woman is going to have in vitro fertilization. When preparing her for this, the nurse would make which statement? a) "You will need to select a surrogate mother." b) "This is dangerous if there is ovarian cancer in your family." c) "Most procedures are effective the first time tried." d) "It can be done with frozen donor sperm."

d) "It can be done with frozen donor sperm." Rationale: 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. Often more than one attempt is needed before successful implantation

A client who is trying not to get pregnant calls the nurse on Saturday at 11 a.m. reporting that she had unprotected sex on Thursday at 10 p.m.. She believes she has just ovulated and wants to verify that she has no risk of pregnancy. What can the nurse tell her? a) If she ovulated on Saturday around 11 a.m., the egg could be fertilized any time before about 11 a.m. on Monday. b) If she ovulated on Saturday around 11 a.m., the egg could be fertilized any time before about 10 p.m. on Sunday. c) Because she did not ovulate before the unprotected coitus, she will not get pregnant. d) If she ovulated on Saturday around 11 a.m., the egg could be fertilized any time before about 11 a.m. on Sunday.

d) If she ovulated on Saturday around 11 a.m., the egg could be fertilized any time before about 11 a.m. on Sunday. Rationale: A single ovum is released from the ovary 14 days before the next menstrual period. It lives approximately 24 hours. The client's fertile period would be from Saturday at 11 a.m. to Monday at 11 a.m. During any other time frame, it would be unlikely that she would become pregnant

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? a) hysterosalpingogram b) transvaginal ultrasound c) pelvic examination d) laparoscopy

d) laparoscopy Rationale: The only certain method of diagnosing endometriosis is by seeing it. Therefore, the nurse would expect to prepare the client for a laparoscopy. 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 woman has just been prescribed clomiphene citrate to stimulate ovulation. Which possible effect should the nurse warn the woman about? a) elevation of her blood glucose level b) extensive bleeding during menstruation c) hypertension d) overstimulation of the ovary resulting in potential multiple births

d) overstimulation of the ovary resulting in potential multiple births Rationale: 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

Which of the following are barrier contraceptive methods? SATA: A) Condoms B) Diaphragms C) Cervical Cap D) Tubal ligation (sterilization for women) E) Vasectomy (sterilization for men) F) Nuva Ring

A) Condoms B) Diaphragms C) Cervical Cap D) Tubal ligation (sterilization for women) E) Vasectomy (sterilization for men)

Nursing management of a client with endometriosis includes which of the following? SATA: A) Education on disease B) Healthy lifestyle habits- exercise, sleep, and stress management C) Support groups D) Drug therapy

A) Education on disease B) Healthy lifestyle habits- exercise, sleep, and stress management C) Support groups

Risk factors for infertility in men include which of the following? SATA A) Exposure to toxic substances (lead, mercury, x-rays, chemotherapy) B) Cigarette/marijuana smoke C) Diabetes D) Heavy alcohol consumption E) Use of prescription drugs for ulcers or psoriasis F) Exposure of genitals to high temperatures (hot tubs/saunas) G) Cardiovascular disease H) Hernia repair I) Obesity associated with decreased sperm quality J) Cushing syndrome K) Frequent long-distance cycling/running L) STIs M) Undescended testicles (cryptochidism) N) Mumps after puberty O) Autism

A) Exposure to toxic substances (lead, mercury, x-rays, chemotherapy) B) Cigarette/marijuana smoke C) Diabetes D) Heavy alcohol consumption E) Use of prescription drugs for ulcers or psoriasis F) Exposure of genitals to high temperatures (hot tubs/saunas) G) Cardiovascular disease H) Hernia repair I) Obesity associated with decreased sperm quality J) Cushing syndrome K) Frequent long-distance cycling/running L) STIs M) Undescended testicles (cryptochidism) N) Mumps after puberty

When doing an assessment on a woman trying to decide which contraceptive method to use, what should be included? SATA A) History: family, OBGYN, social, religious B) Physical examination C) Counseling

A) History: family, OBGYN, social, religious B) Physical examination

What are some contraindications of taking combined contraceptives? SATA A) Hypertension B) Stroke C) Allergies D) Clotting disorders- DVT E) Over the age of 35 F) Smoking G) Liver problems

A) Hypertension B) Stroke C) Allergies D) Clotting disorders- DVT E) Over the age of 35 F) Smoking G) Liver problems

Progestin-only contraceptives include: SATA A) Implantable contraceptives (Nexplanon) B) Injectable (DEPO-PROVERA shot) C) Progestin-only pills D) Intrauterine contraceptives E) Transdermal patches

A) Implantable contraceptives (Nexplanon) B) Injectable (DEPO-PROVERA shot) C) Progestin-only pills D) Intrauterine contraceptives

The gold standard for endometriosis treatment is what? A) Laparoscopic excision surgery B) Hormone therapy C) NSAIDS

A) Laparoscopic excision surgery- in combination with pain-relieving drugs and hormone suppressants addressing symptoms

Risk factors for endometriosis include which of the following? SATA A) Lean body size B) The aging process C) Smoking/exposure to second-hand smoke D) Family history of endometriosis in a 1st degree relative E) Short menstrual cycle (less than 28 days) F) Long menstrual flow (longer than 1 week) G) High dietary fat consumption H) Infertility I) Young age of menarche (younger than 12) J) Few (1 or 2) or no pregnancies K) Early pregnancy (younger than 20)

A) Lean body size B) The aging process C) Smoking/exposure to second-hand smoke D) Family history of endometriosis in a 1st degree relative E) Short menstrual cycle (less than 28 days) F) Long menstrual flow (longer than 1 week) G) High dietary fat consumption H) Infertility I) Young age of menarche (younger than 12) J) Few (1 or 2) or no pregnancies

Which of the following medications fall into medication therapy for endometriosis? SATA A) NSAIDS B) Oral contraceptives C) Progestogens D) Antiestrogens E) Gonadotropin-releasing hormone analogs (GnRH-a) F) Testosterone

A) NSAIDS B) Oral contraceptives C) Progestogens D) Antiestrogens E) Gonadotropin-releasing hormone analogs (GnRH-a)

Combined hormonal contraceptives include: SATA A) Oral contraceptives B) Transdermal patches C) Vaginal rings (Nuva Ring) D) Emergency contraception (Plan B) E) Implant (Nexplanon)

A) Oral contraceptives B) Transdermal patches C) Vaginal rings (Nuva Ring) D) Emergency contraception (Plan B)

Risk factors for infertility in women include which of the following? SATA A) Overweight/underweight (can disrupt hormone function) B) Scarred fallopian tubes from infections C) Uterine fibroids D) Tubal blockages E) Cervical stenosis F) Reduced oocyte quality G) Chromosomal abnormalities H) STIs I) Ectopic pregnancy J) Chronic illnesses such as diabetes, thyroid disease, asthma K) Congenital abnormalities of the uterus L) Increased age M) Endometriosis N) Smoking/alcohol consumption O) Multiple miscarriages P) Exposure to chemotherapeutic agents Q) Physiological stress R) Mother was infertile- genetic

A) Overweight/underweight (can disrupt hormone function) B) Scarred fallopian tubes from infections C) Uterine fibroids D) Tubal blockages E) Cervical stenosis F) Reduced oocyte quality G) Chromosomal abnormalities H) STIs I) Ectopic pregnancy J) Chronic illnesses such as diabetes, thyroid disease, asthma K) Congenital abnormalities of the uterus L) Increased age M) Endometriosis N) Smoking/alcohol consumption O) Multiple miscarriages P) Exposure to chemotherapeutic agents Q) Physiological stress

Nursing management of menopause include lifestyle modifications, risk management therapies, and preventative drug interventions including: SATA A) Participate actively in maintaining health B) Stay current on health screenings and vaccinations C) Take supplemental calcium and eat appropriately to prevent osteoporosis D) Stop smoking to prevent lung and heart disease E) Exercise regularly to prevent osteoporosis and CVD F) Reduce caffeine and alcohol intake to prevent osteoporosis G) Stop smoking to prevent lung and heart disease H) Monitor blood pressure, lipids, and diabetes (drug therapy management) I) Get regular massages to improve circulation

A) Participate actively in maintaining health B) Stay current on health screenings and vaccinations C) Take supplemental calcium and eat appropriately to prevent osteoporosis D) Stop smoking to prevent lung and heart disease E) Exercise regularly to prevent osteoporosis and CVD F) Reduce caffeine and alcohol intake to prevent osteoporosis G) Stop smoking to prevent lung and heart disease H) Monitor blood pressure, lipids, and diabetes (drug therapy management) I) Get regular massages to improve circulation

Behavioral methods of contraception include which of the following? SATA: A) Sexual abstinence B) Fertility awareness C) Withdrawal (coitus interruptus) D) Lactational amenorrhea method E) Oral contraceptives (the pill)

A) Sexual abstinence B) Fertility awareness C) Withdrawal (coitus interruptus) D) Lactational amenorrhea method

After the nurse teaches a client about ways to reduce the symptoms of premenstrual syndrome, which client statement indicates a need for additional teaching? A. "I will make sure to take my estrogen supplements a week before my period." B. "I've signed up for an aerobic exercise class three times a week." C. "I'll cut down on the amount of coffee and colas I drink." D. "I quit smoking about a month ago, so that should help."

A. "I will make sure to take my estrogen supplements a week before my period." Rationale: 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. Reference: p. 123

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? A. "I've been having bleeding off and on that's irregular and sometimes heavy." B. "I get sharp pain in my lower abdomen usually starting soon after my period comes." C. "I get really irritable and moody about a week before my period." D. "My periods have been unusually long and heavy lately."

A. "I've been having bleeding off and on that's irregular and sometimes heavy." Rationale: 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. Reference: p. 120

A nurse is conducting a class for a group of young adult women interested in contraception. As part of the class, the nurse asks the group about their understanding about contraception and pregnancy. Which statement(s) would cause the nurse to address it as a misconception. Select all that apply. A. "If you douche after having sex, you will not get pregnant." B. "You cannot get pregnant if you have your menstrual period." C. "Birth control pills will not protect you against sexually transmitted infections." D. "Pregnancy cannot happen if my male partner pulls out before ejaculating." E. "I cannot get pregnant if I am breastfeeding."

A. "If you douche after having sex, you will not get pregnant." B. "You cannot get pregnant if you have your menstrual period." D. "Pregnancy cannot happen if my male partner pulls out before ejaculating." E. "I cannot get pregnant if I am breastfeeding." Rationale: Common misconceptions include the following: Breastfeeding protects against pregnancy; pregnancy can be avoided if the male partner "pulls out" before he ejaculates; pregnancy cannot occur during menses; and douching after sex will prevent pregnancy. Taking birth control pills does not protect against sexually transmitted infections, thus the participants are correct in their understanding. Reference: p. 156

A woman comes to the clinic because she has been unable to conceive. When reviewing the woman's history, the nurse would least likely identify which factor as a possible risk? A. age of 25 years B. history of smoking C. diabetes since age 15 years D. weight below standard for height and age

A. age of 25 years Rationale: Female risk factors for infertility include increased age older, smoking and alcohol consumption, history of chronic illness such as diabetes, and overweight or underweight, which can disrupt hormonal function. Reference: p. 128

The nurse discusses various contraceptive methods with a client and her partner. After the discussion, the nurse determines that the couple understood the information when they identify which method as being available only with a prescription? A. cervical cap B. cervical sponge C. condom D. spermicide

A. cervical cap Rationale: The cervical cap is available only by prescription and must be fitted by a health care provider. The cervical sponge, condom, or spermicide do not require a prescription. Reference: p. 143

A nurse manager in a family planning clinic is conducting an in-service presentation for the nursing staff on contraception. After teaching the group about the different methods for contraception, the manager determines that the teaching was successful when the group identifies which contraceptive methods as mechanical barrier methods? Select all that apply. A. condom B. cervical cap C. cervical sponge D. diaphragm E. vaginal ring

A. condom B. cervical cap C. cervical sponge D. diaphragm Rationale: Barrier methods include the condom, cervical cap, cervical sponge and diaphragm. The vaginal ring is considered a hormonal method of contraception. Reference: p. 141

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? A. progestin B. estrogen and progestin C. concentrated spermicide D. concentrated estrogen

A. progestin Rationale: 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. Reference: p. 148

A woman using the cervical mucus ovulation method of fertility awareness reports that her cervical mucus looks like egg whites. The nurse interprets this as which kind of mucus? A. spinnbarkeit mucus B. purulent mucus C. postovulatory mucus D. normal pre-ovulation mucus

A. spinnbarkeit mucus Rationale: The client is describing spinnbarkeit mucus, the copious, clear, slippery, smooth, and stretchable mucus that occurs as ovulation approaches. Purulent mucus would be yellow or green and malodorous. Pre-ovulation mucus is clear but not as copious, slippery, and stretchable. Reference: p. 139

When assessing a client for endometriosis one should look out for which of the following? SATA A) Infertility B) Back Pain C) Headaches D) Pain before/during menstrual period E) Pain during/after intercourse F) Painful urination G) Depression H) Nonspecific pelvic tenderness I) Tender nodular masses on uterosacral ligaments J) Tender nodular masses on the posterior uterus K) Tender nodular masses on the posterior cul-du-sac

ALL BUT C: A) Infertility B) Back Pain D) Pain before/during menstrual period E) Pain during/after intercourse F) Painful urination G) Depression H) Nonspecific pelvic tenderness I) Tender nodular masses on uterosacral ligaments J) Tender nodular masses on the posterior uterus K) Tender nodular masses on the posterior cul-du-sac

Advantages of taking contraception include: SATA A) Reduced incidence of ovarian and endometrial cancer B) Treatment of symptoms of endometriosis C) Decreased incidence of acne and hirutism D) Decreased incidence of. ectopic pregnancy E) Decreased incidence of acute PID and possible protection against PID F) Reduced iron-deficiency anemia due to heavy menstrual bleeding G) Delayed onset of multiple sclerosis and arthritis

ALL OF THE ABOVE A) Reduced incidence of ovarian and endometrial cancer B) Treatment of symptoms of endometriosis C) Decreased incidence of acne and hirutism D) Decreased incidence of. ectopic pregnancy E) Decreased incidence of acute PID and possible protection against PID F) Reduced iron-deficiency anemia due to heavy menstrual bleeding G) Delayed onset of multiple sclerosis and arthritis

In the nursing assessment for menopausal transition the nurse should assess for: SATA A) Screening for osteoporosis, CVD, and cancer risk B) Assessment of blood pressure (for hypertension) C) Mammogram to find cancerous lesion D) Pap smear to identify cervical cancer E) Pelvic examination to identify endometrial cancer or masses

ALL THE ABOVE! A) Screening for osteoporosis, CVD, and cancer risk B) Assessment of blood pressure (for hypertension) C) Mammogram to find cancerous lesion D) Pap smear to identify cervical cancer E) Pelvic examination to identify endometrial cancer or masses

How does the contraception pill work?

All birth control methods contain man-made hormones that mimic those that direct the menstrual cycle. They contain estrogen and progesterone. Taking estrogen every day prevents the release of an egg by inhibiting FSH. Progesterone reduces fertility by stimulating the production of thick sticky mucus at the cervix preventing the sperm getting to the egg. The combination of the two prevents ovulation and makes pregnancy near impossible

The absence of menses/mestruation

Amenorrhea

A woman who is using an intrauterine system for contraception comes to the clinic. When assessing the woman, which finding(s) would alert the nurse to a possible complication? Select all that apply. A. Absence of pain with intercourse B. String length shorter than on initial visit C. Reports of abdominal pain D. Menstrual flow lighter and shorter E. Oral temperature of 101°F (38.3°C) Rationale: Warnings for potential complications for intrauterine system users include: late period, pregnancy, or abnormal spotting or bleeding; abdominal pain or pain with intercourse; exposure to infection or abnormal vaginal discharge; not feeling well, fever or chills; and a string length that is shorter, longer or missing. Intrauterine systems make monthly periods lighter, shorter, and less painful. Reference: p. 149

B. String length shorter than on initial visit C. Reports of abdominal pain D. Menstrual flow lighter and shorter E. Oral temperature of 101°F (38.3°C) Rationale: Warnings for potential complications for intrauterine system users include: late period, pregnancy, or abnormal spotting or bleeding; abdominal pain or pain with intercourse; exposure to infection or abnormal vaginal discharge; not feeling well, fever or chills; and a string length that is shorter, longer or missing. Intrauterine systems make monthly periods lighter, shorter, and less painful. Reference: p. 149

A woman who is using an intrauterine system for contraception comes to the clinic. When assessing the woman, which finding(s) would alert the nurse to a possible complication? Select all that apply. A. Absence of pain with intercourse B. String length shorter than on initial visit C. Reports of abdominal pain D. Menstrual flow lighter and shorter E. Oral temperature of 101°F (38.3°C)

B. String length shorter than on initial visit C. Reports of abdominal pain E. Oral temperature of 101°F (38.3°C) Rationale: Warnings for potential complications for intrauterine system users include: late period, pregnancy, or abnormal spotting or bleeding; abdominal pain or pain with intercourse; exposure to infection or abnormal vaginal discharge; not feeling well, fever or chills; and a string length that is shorter, longer or missing. Intrauterine systems make monthly periods lighter, shorter, and less painful. Reference: p. 149

When teaching a group of postmenopausal women about hot flashes and night sweats, the nurse would address which primary cause? A. poor dietary intake B. estrogen deficiency C. active lifestyle D. changes in vaginal pH

B. estrogen deficiency Rationale: Hot flashes and night sweats are classic signs of estrogen deficiency. They are unrelated to dietary intake or active lifestyle. Changes in vaginal pH are associated with genitourinary changes of menopause. Reference: p. 160

The nurse is assessing the laboratory test results of a client with abnormal uterine bleeding (AUB). Which finding should the nurse prioritize? A. negative pregnancy test B. hemoglobin level of 10.1 g/dl (101 g/L) C. prothrombin time of 40 seconds D. serum cholesterol of 140 mg/dl (3.63 mmol/L)

B. hemoglobin level of 10.1 g/dl (101 g/L) Rationale: A hemoglobin level of 10.1 g/dl (101 g/L) suggests anemia, which might occur secondary to prolonged or heavy menses. A negative pregnancy test, prothrombin time of 40 seconds, and a serum cholesterol level of 140 mg/dl (3.63 mmol/L) are within normal parameters. Reference: p. 120-121

A woman has opted to use the basal body temperature method for contraception. The nurse instructs the client that a rise in basal body temperature indicates which event? A. onset of menses B. ovulation C. pregnancy D. safe period for intercourse

B. ovulation Rationale: Basal body temperatures typically rise within a day or two after ovulation and remain elevated for approximately 2 weeks, at which point bleeding usually begins. Basal body temperature is not a means for determining pregnancy. Having intercourse while the temperature is elevated would increase the risk of pregnancy. Reference: p. 139

A couple comes to the clinic for a fertility evaluation. The male partner is to undergo a semen analysis. After teaching the partner about this test, which client statement indicates that the client has understood the instructions? A. "I need to bring the specimen to the lab the day after collecting it." B. "I will place the specimen in a special plastic bag to transport it." C. "I have to abstain from sexual activity for about 2 to 5 days before the sample." D. "I will withdraw before I ejaculate during sex to collect the specimen."

C. "I have to abstain from sexual activity for about 2 to 5 days before the sample." Rationale: Semen analysis is the most important indicator of male fertility. The man should abstain from sexual activity for 2 to 5 days before giving the sample. For a semen examination, the man is asked to produce a specimen by ejaculating into a specimen container and delivering it to the laboratory for analysis within 1 hour. When the specimen is brought to the laboratory, it is analyzed for volume, viscosity, number of sperm, sperm viability, motility, and sperm shape. Reference: p. 131

The nurse is reviewing the medical records of several clients. Which client would the nurse expect to have an increased risk for developing osteoporosis? A. a Black woman B. a woman who plays tennis twice a week C. a thin woman with small bones D. a woman who drinks one cup of coffee a day

C. a thin woman with small bones Rationale: A woman with a small frame and thin bones is at a higher risk for osteoporosis. White or Asian women, not Black women, are at higher risk for the condition. A woman who plays tennis twice a week is active and thus would be at low risk for osteoporosis. Women who ingest excessive amounts of caffeine are at increased risk. Reference: p. 162

After discussing various methods of contraception with a client and her partner, the nurse determines that the teaching was successful when they identify which contraceptive method as providing protection against sexually transmitted infections (STIs)? A. oral contraceptives B. tubal ligation C. condoms D. intrauterine system

C. condoms Rationale: Condoms are a barrier method of contraception. In addition to providing a physical barrier for sperm, they also protect against STIs. Oral contraceptives, tubal ligation, and intrauterine systems provide no protection against STIs. Reference: p. 141

The nurse discusses various contraceptive methods with a client and her partner. Which method would the nurse explain as being available only by prescription? A. condom B. spermicide C. diaphragm D. basal body temperature

C. diaphragm Rationale: The diaphragm is available only by prescription and must be professionally fitted by a health care provider. Condoms and spermicides are available over the counter. Basal body temperature requires the use of a special thermometer that is available over the counter. Reference: p. 143

When reviewing the medical record of a client diagnosed with endometriosis, the nurse would identify which finding as a risk factor for this woman? A. low fat in the diet B. age of 14 years for menarche C. menstrual cycles of 24 days D. short menstrual flow

C. menstrual cycles of 24 days Rationale: Risk factors for developing endometriosis include increasing age, family history of endometriosis in a first-degree relative, short menstrual cycle (less than 28 days), long menstrual flow (more than 1 week), high dietary fat consumption, young age at menarche (younger than age 12), and few (one or two) or no pregnancies. Reference: p. 126

When developing a teaching plan for a couple who are considering contraception options, the nurse would include which statement? A. "You should select one that is considered to be 100% effective." B. "The best one is the one that is the least expensive and most convenient." C. "A good contraceptive doesn't require a primary care provider's prescription." D. "The best contraceptive is one that you will use correctly and consistently."

D. "The best contraceptive is one that you will use correctly and consistently." Rationale: For a contraceptive to be most effective, the client must be able to use it correctly and consistently. Even if a method is considered 100% effective, it is not the best choice if the couple does not use it correctly or consistently. Cost is a consideration, but the least expensive method is not necessarily the best choice. The need for a prescription is not relevant to the couple's choice. Reference: p. 152

When discussing contraceptive options, the nurse would recommend which option as being the most reliable? A. coitus interruptus B. lactational amenorrheal method (LAM) C. natural family planning D. intrauterine system

D. intrauterine system Rationale: 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. Reference: p. 148

Which measure would the nurse include in the teaching plan for a woman to reduce the risk of osteoporosis after menopause? A. taking vitamin supplements B. eating high-fiber, high-calorie foods C. restricting fluid to 1,000 mL daily D. participating in regular daily exercise

D. participating in regular daily exercise Rationale: Measures to reduce osteoporosis after menopause include daily weight-bearing exercise, increasing calcium and vitamin D intake, and avoiding smoking and excessive alcohol intake. General vitamin supplements may be helpful overall, but they are not specific to reducing the risk of osteoporosis. A diet high in calcium and vitamin D, not fiber and calories, would be appropriate. Restricting fluids would have no effect on preventing osteoporosis. Reference: p. 162

This religion is against assisted reproductive technologies, since their view of the procreation can't be separated from the relationship between parents. They believe God wants human life to be a "conjugal act" and not artificially.

Roman Catholics

Defined as the inability to conceive after a previous pregnancy:

Secondary infertility

What is the most effective form of birth control?

The implant

A couple is being assessed for infertility. The male partner is required to collect a semen sample for analysis. What instruction should the nurse give him? a) Avoid strenuous activity for 24 hours before collecting the sample. b) Deliver sample for analysis within 1 to 2 hours after ejaculation. c) Collect a specimen by ejaculating into a condom or plastic bag. d) Abstain from sexual activity for 10 hours before collecting the sample.

b) Deliver sample for analysis within 1 to 2 hours after ejaculation. Rationale: The nurse should instruct the client to deliver the semen sample to the laboratory for analysis within 1 to 2 hours after ejaculation. The client should also be instructed to collect the sample in a specimen container, not a condom or plastic bag. The client needs to abstain from sexual activity for at least 24 hours before giving the sample, but he need not avoid strenuous activity

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? (SATA) a) lack of exercise b) tubal transport c) ovulation d) diabetes e) impaired implantation

b) tubal transport c) ovulation e) impaired implantation