OB Chapter 4 Review

Individual irregularities in the ovarian (menstrual) cycle are most often caused by: a. Variations in the follicular (preovulatory) phase b. An intact hypothalamic-pituitary feedback mechanism c. A functioning corpus luteum d. A prolonged ischemic phase

ANS: A Almost all variations in the length of the ovarian cycle are the result of variations in the length of the follicular phase. An intact hypothalamic-pituitary feedback mechanism would be regular, not irregular. The luteal phase begins after ovulation. The corpus luteum is dependent on the ovulatory phase and fertilization. During the ischemic phase the blood supply to the functional endometrium is blocked, and necrosis develops. The functional layer separates from the basal layer, and menstrual bleeding begins.

Which statement indicates that a client requires additional instruction about breast self-examination? a. "Yellow discharge from my nipple is normal if I'm having my period." b. "I should check my breasts at the same time each month, after my period." c. "I should also feel in my armpit area while performing my breast exam." d. "I should check each breast in a set way, such as in a circular motion."

ANS: A Discharge from the nipples requires further examination from a health care provider. The breasts should be checked at the same time each month. The armpit should also be examined. A circular motion is the best method in which to ascertain any changes in the breast tissue.

Kegel exercises, or pelvic muscle exercises: a. Were developed to control or reduce incontinent urine loss b. Are the best exercises for a pregnant woman because they are so pleasurable c. Help to manage stress d. Are ineffective without sufficient calcium in the diet

ANS: A Kegel exercises help control the urge to urinate. Kegel exercises may be fun for some, but the most important matter is the control they provide over incontinence. Kegel exercises help manage urination, not stress. Calcium in the diet is important but is not related to Kegel exercises.

The transition phase during which ovarian function and hormone production decline is called: a. The climacteric b. Menarche c. Menopause d. Puberty

ANS: A The climacteric is a transitional phase during which ovarian function and hormone production decline. Menarche is the term that denotes the first menstruation. Menopause refers only to the last menstrual period. Puberty is a broad term that denotes the entire transitional stage between childhood and sexual maturity.

Because of the effect of cyclic ovarian changes on the breast, the best time for breast self-examination (BSE) is: a. Five to 7 days after menses ceases b. Day 1 of the endometrial cycle c. Midmenstrual cycle d. Any time during a shower or bath

ANS: A The physiologic alterations in breast size and activity reach their minimal level about 5 to 7 days after menstruation stops. Therefore, BSE is best performed during this phase of the menstrual cycle. Day 1 of the endometrial cycle is too early to perform an accurate BSE. After the midmenstrual cycle breasts are likely to become tender and increase in size. This is not the ideal time to perform BSE. Lying down after a shower or bath with a small towel under the shoulder of the side being examined is appropriate teaching for BSE. A secondary BSE may be performed while in the shower.

The female reproductive organ(s) responsible for cyclic menstruation is/are the: a. Uterus b. Ovaries c. Vaginal vestibule d. Urethra

ANS: A The uterus is responsible for cyclic menstruation. It also houses and nourishes the fertilized ovum and the fetus. The ovaries are responsible for ovulation and production of estrogen; the uterus is responsible for cyclic menstruation. The vaginal vestibule is an external organ that has openings to the urethra and vagina; the uterus is responsible for cyclic menstruation. The urethra is not a reproductive organ, although it is found in the area; the uterus is responsible for cyclic menstruation.

Women of all ages will receive substantial and immediate benefits from smoking cessation. This is not an easy process and most people have to attempt quitting numerous times before achieving success. Smoking cessation programs and self-help materials are available from a number of organizations including: a. Association of Women's Health, Obstetric and Neonatal Nurses b. March of Dimes c. American Cancer Society d. American Lung Association e. American College of Obstetricians and Gynecologists (ACOG)

ANS: A, B, C, D, E AWHONN provides a smoking cessation counseling program for pregnant women. The March of Dimes, the American Lung Association, and the American Cancer Society have self-help materials available. ACOG recommends a five-step individualized program and offers resources for health care providers.

Concerning the use and abuse of legal drugs or substances, nurses should be aware that: a. Although cigarette smoking causes a number of health problems, it has little direct effect on maternity-related health b. Women ages 21 to 34 have the highest rates of specific alcohol-related problems c. Coffee is a stimulant that can interrupt body functions and has been related to birth defects d. Prescription psychotherapeutic drugs taken by the mother do not affect the fetus; otherwise, they would not have been prescribed

ANS: B Although a very small percentage of childbearing women have alcohol-related problems, alcohol abuse during pregnancy has been associated with a number of negative outcomes. Cigarette smoking impairs fertility and is a cause of low birth weight. Caffeine consumption has not been related to birth defects. Psychotherapeutic drugs have some effect on the fetus, and that risk must be weighed against their benefit to the mother.

During the past 20 years the prevalence of obesity has doubled in the United States, with 25% of women older than 20 years of age being obese. Body mass index (BMI) is defined as the measure of an adult's weight in relation to his or her height. This is the most accurate measure of weight. This is an important part of the health screening process because obesity is closely associated with: a. The non-Hispanic Caucasian population b. A large number of chronic conditions c. Mostly acute illnesses d. Improved mental well-being

ANS: B Overweight and obesity are known risk factors for diabetes, heart disease, dyslipidemia, stroke, hypertension, arthritis, osteoporosis, and some types of cancer. In the United States the prevalence of obesity is highest among non-Hispanic black women, followed by Hispanic women, and non-Hispanic Caucasian women. Overweight and obesity are most frequently linked to chronic conditions. Improved mental well-being is a myth. In fact, obesity is associated with depression and increased stress.

Certain fatty acids classified as hormones that are found in many body tissues and have roles in many reproductive functions are known as: a. Gonadotropin-releasing hormone (GnRH) b. Prostaglandins (PGs) c. Follicle-stimulating hormone (FSH) d. Luteinizing hormone (LH)

ANS: B PGs affect smooth muscle contraction and changes in the cervix. GnRH is part of the hypothalamic-pituitary cycle, which responds to the rise and fall of estrogen and progesterone. FSH is part of the hypothalamic-pituitary cycle, which responds to the rise and fall of estrogen and progesterone. LH is part of the hypothalamic-pituitary cycle, which responds to the rise and fall of estrogen and progesterone.

Physiologically, sexual response can be characterized by: a. Coitus, masturbation, and fantasy b. Myotonia and vasocongestion c. Erection and orgasm d. Excitement, plateau, and orgasm

ANS: B Physiologically, according to Masters (1992), sexual response can be analyzed in terms of two processes: vasocongestion and myotonia. Coitus, masturbation, and fantasy are forms of stimulation for the physical manifestation of the sexual response. Erection and orgasm occur in two of the four phases of the sexual response cycle. Excitement, plateau, and orgasm are three of the four phases of the sexual response cycle.

The body part that both protects the pelvic structures and accommodates the growing fetus during pregnancy is the: a. Perineum b. Bony pelvis c. Vaginal vestibule d. Fourchette

ANS: B The bony pelvis protects and accommodates the growing fetus. The perineum covers the pelvic structures; the bony pelvis protects and accommodates the growing fetus. The vaginal vestibule contains openings to the urethra and vagina; the bony pelvis protects and accommodates the growing fetus. The fourchette is formed by the labia minor; the bony pelvis protects and accommodates the growing fetus.

A woman arrives at the clinic for her annual examination. She tells the nurse that she thinks she has a vaginal infection, and she has been using an over-the-counter cream for the past 2 days to treat it. The nurse's initial response should be to: a. Inform the woman that vaginal creams may interfere with the Papanicolaou (Pap) test for which she is scheduled b. Reassure the woman that using vaginal cream is not a problem for the examination c. Ask the woman to describe the symptoms that indicate to her she has a vaginal infection d. Ask the woman to reschedule the appointment for the examination

ANS: C An important element of the history and physical examination is the client's description of any symptoms she may be experiencing. Although this statement is true, the best response is for the nurse to inquire about the symptoms the woman is experiencing. Women should not douche, use vaginal medications, or have sexual intercourse for 24 to 48 hours before obtaining a Pap test. Although the woman may need to reschedule a visit for her Pap test, her current symptoms should still be addressed.

As a girl progresses through development, she may be at risk for a number of age-related conditions. While preparing a 21-year-old client for her first adult physical examination and Pap test, the nurse is aware of excessive shyness. The young woman states that she will not remove her bra because, "There is something wrong with my breasts; one is way bigger." What is the best response by the nurse in this situation? a. "Please reschedule your appointment until you are more prepared." b. "It is okay; the provider will not do a breast examination." c. "I will explain normal growth and breast development to you." d. "That is unfortunate; this must be very stressful for you."

ANS: C During adolescence one breast may grow more quickly than the other. Full development of the breasts is not achieved until after the end of the first pregnancy and period of lactation. The client should be reassured regarding this aspect of growth and development. Female teenagers usually enter the health system for screening (Pap tests begin at age 21 or 3 years after first sexual activity). Situations such as these can produce great stress for the teenager, and the nurse and health care provider should treat her carefully. Asking her to reschedule will likely result in the client not returning for her appointment at all. A breast examination at her age is part of the complete physical examination. Young women should be taught about normal breast development and begin doing breast self-examinations. This response is inappropriate. Although acknowledging the client's stress shows empathy on the part of the nurse, it will not meet the client's need of deficient knowledge related to normal growth and development.

The nurse guides a woman to the examination room and asks her to remove her clothes and put on an examination gown with the front open. The woman states, "I have special undergarments that I do not remove for religious reasons." The most appropriate response from the nurse would be: a. "You can't have an examination without removing all your clothes." b. "I'll ask the doctor to modify the examination." c. "Tell me about your undergarments. I'll explain the examination procedure, and then we can discuss how you can have your examination comfortably." d. "What? I've never heard of such a thing! That sounds different and strange."

ANS: C Explaining the examination procedure reflects cultural competence by the nurse and shows respect for the woman's religious practices. The nurse must respect the rich and unique qualities that cultural diversity brings to individuals. The examination can be modified to ensure that modesty is maintained.In recognizing the value of cultural differences, the nurse can modify the plan of care to meet the needs of each woman. Telling the client that her religious practices are different or strange is inappropriate and disrespectful to the client.

Prostaglandins are produced in most organs of the body, including the uterus. Other source(s) of prostaglandins is/are: a. Ovaries b. Breast milk c. Menstrual blood d. The vagina

ANS: C Menstrual blood is a potent source of prostaglandins. Prostaglandins are not produced in the ovaries. Breast milk is not a source of prostaglandins. The vagina neither produces nor is a source of prostaglandins.

Menstruation is periodic uterine bleeding: a. That occurs every 28 days b. In which the entire uterine lining is shed c. That is regulated by ovarian hormones d. That leads to fertilization

ANS: C Menstruation is periodic uterine bleeding that is controlled by a feedback system involving three cycles: the endometrial cycle, the hypothalamic-pituitary cycle, and the ovarian cycle. The average length of a menstrual cycle is 28 days, but variations are normal. During the endometrial cycle, the functional two thirds of the endometrium is shed. Lack of fertilization leads to menstruation.

One purpose of preconception care is to: a. Ensure that pregnancy complications do not occur b. Identify women who should not become pregnant c. Encourage healthy lifestyles for families desiring pregnancy d. Ensure that women know about prenatal care

ANS: C Preconception counseling guides couples in how to avoid unintended pregnancies, how to identify and manage risk factors in their lives and their environment, and how to identify healthy behaviors that promote the well-being of the woman and her potential fetus. Preconception care does not ensure that pregnancy complications will not occur. In many cases, problems can be identified and treated and may not recur in subsequent pregnancies. In many instances, counseling can allow behavior modification before damage is done, or a woman can make an informed decision about her willingness to accept potential hazards. If a woman is seeking preconception care, she likely is aware of prenatal care.

The microscopic examination of scrapings from the cervix, endocervix, or other mucus membranes to detect premalignant or malignant cells is called: a. Bimanual palpation b. Rectovaginal palpation c. A Papanicolaou (Pap) test d. The four A's procedure

ANS: C The Pap test is a microscopic examination for cancer that should be performed regularly, depending on the client's age. Bimanual palpation is a physical examination of the vagina; the Pap test is a microscopic examination for cancer. Rectovaginal palpation is a physical examination performed through the rectum; the Pap test is a microscopic examination for cancer. The four A's is an intervention procedure to help a client stop smoking. The Pap test is a microscopic examination for cancer.

A fully matured endometrium that has reached the thickness of heavy, soft velvet describes the _____ phase of the endometrial cycle. a. Menstrual b. Proliferative c. Secretory d. Ischemic

ANS: C The secretory phase extends from the day of ovulation to approximately 3 days before the next menstrual cycle. During this phase the endometrium becomes fully mature. During the menstrual phase the endometrium is being shed; the endometrium is fully mature again during the secretory phase. The proliferative phase is a period of rapid growth, but the endometrium becomes fully mature again during the secretory phase. During the ischemic phase the blood supply is blocked and necrosis develops. The endometrium is fully mature during the secretory phase.

A 20-year-old client calls the clinic to report that she has found a lump in her breast. The nurse's best response is: a. "Don't worry about it. I'm sure it's nothing." b. "Wear a tight bra, and it should shrink." c. "Many women have benign lumps and bumps in their breasts. However, to make sure it's benign you should come in for an examination by your physician." d. "Check it again in 1 month and call me back if it's still there."

ANS: C Try to ease the client's fear but provide a time for a thorough evaluation of the lump, because it may indicate abnormal changes in the breast. Discrediting the client's findings may discourage her from continuing with breast self-examination (BSE). Wearing a tight bra may irritate the skin and will not cause the lump to shrink. Delaying treatment may allow proliferation of abnormal cells.

As part of their participation in the gynecologic portion of the physical examination, nurses should: a. Take a firm approach that encourages the client to facilitate the exam by following the physician's instructions exactly b. Explain the procedure as it unfolds and continue to question the client to get information in a timely manner c. Take the opportunity to explain that the trendy vulvar self-examination is only for women at risk for cancer d. Help the woman relax through proper placement of her hands and proper breathing during the exam

ANS: D Breathing techniques are important relaxation techniques that can help the client during the exam. The nurse should encourage the client to participate in an active partnership with the care provider. Explanations during the procedure are fine, but many women are uncomfortable answering questions in the exposed and awkward position of the exam. Vulvar self-examination on a regular basis should be encouraged and taught during the exam.

A blind woman has arrived for an examination. Her guide dog assists her to the examination room. She appears nervous and says, "I've never had a pelvic examination." The nurse's most appropriate response would be: a. "Don't worry. It will be over before you know it." b. "Try to relax. I'll be very gentle, and I won't hurt you." c. "Your anxiety is common. I was anxious when I first had a pelvic examination." d. "I'll let you touch each item that I'll use during the examination as I tell you how it will be used."

ANS: D The client who is visually impaired needs to be oriented to the examination room and needs a full explanation of what the examination entails before the nurse proceeds. Telling the client that the examination will be over quickly diminishes the client's concerns. The nurse should communicate openly and directly with sensitivity. Women who have physical disabilities should be respected and involved in the assessment and physical examination to the full extent of their abilities. Telling the client that she won't be hurt does not reflect respect or sensitivity. Although anxiety may be common, the nurse should not discuss her own issues nor compare them to the client's concerns.

The stimulated release of gonadotropin-releasing hormone (GnRH) and follicle-stimulating hormone (FSH) is part of the: a. Menstrual cycle b. Endometrial cycle c. Ovarian cycle d. Hypothalamic-pituitary cycle

ANS: D The cyclic release of hormones is the function of the hypothalamus and pituitary glands. The menstrual cycle is a complex interplay of events that occur simultaneously in the endometrium, hypothalamus, pituitary glands, and ovaries. The endometrial cycle consists of four phases: menstrual phase, proliferative phase, secretory phase, and ischemic phase. The ovarian cycle remains under the influence of FSH and estrogen.

The two primary functions of the ovary are: a. Normal female development and sex hormone release b. Ovulation and internal pelvic support c. Sexual response and ovulation d. Ovulation and hormone production

ANS: D The two functions of the ovaries are ovulation and hormone production. The presence of ovaries does not guarantee normal female development. The ovaries produce estrogen, progesterone, and androgen. Ovulation is the release of a mature ovum from the ovary; the ovaries are not responsible for interval pelvic support. Sexual response is a feedback mechanism involving the hypothalamus, anterior pituitary gland, and the ovaries. Ovulation does occur in the ovaries.

Before beginning the health history interview, the nurse should perform all actions except: a. Smile and ask the client whether she has any special concerns b. Speak in a relaxed manner with an even, nonjudgmental tone c. Make the client comfortable d. Tell the client her questions are irrelevant

ANS: D The woman should be assured that all of her questions are relevant and important. It is important to begin any client interaction with a smile. This assists in putting the client at ease. If the nurse speaks in a relaxed manner, the client will likely be more relaxed during the interview. Always ensure the client's comfort prior to beginning the interview.

Violence against women remains a major health care problem in the United States, affecting millions of women annually. Fortunately, during pregnancy violence often stops entirely or diminishes. Is this true or false?

ANS: F Pregnancy is often when violence either begins or escalates. Maternity and women's health nurses, by the nature of their practice are in a unique position to provide sensitive care to women in abusive relationships, engage in prevention, and influence health care and public policy.

In order to effectively screen a client at risk for an eating disorder, the nurse should use the ________________ questionnaire.

ANS: SCOFF A screening tool developed specifically for identification of eating disorders uses the acronym SCOFF. Each question scores 1 point. A score of 2 or more indicates that the client may have anorexia nervosa or bulimia. The letters represent the following questions: a. Do you make yourself Sick because you feel too full? b. Do you worry about loss of Control over the amount that you eat? c. Have you recently lost more than One stone (14 pounds) in a 3-month period? d. Do you think that you are too Fat, even if others think you are thin? e. Does Food dominate your life?