OB EAQ - Reproductive system concerns

A client with endometriosis is planning to start danazol (Danocrine) therapy. On assessment, the nurse finds that the client is 3 weeks pregnant. What instructions does the nurse expect from the primary health care provider? 1 Discontinue the drug prescription. 2 Initiate surgical treatment immediately. 3 Lower the medication dose by half. 4 Recommend terminating the pregnancy.

1 Danazol (Danocrine) is not administered if the client is pregnant, because the drug can cause pseudohermaphroditism in female fetuses. Therefore, the nurse should promptly inform the primary health care provider about the client's pregnancy so that the prescription can be discontinued. Surgical treatment is necessary if the client is not pregnant and the disease is producing incapacitating symptoms. The medication dose is not lowered but terminated at once. The primary health care provider is not likely to recommend terminating the pregnancy. However, close monitoring may be needed to prevent any adverse pregnancy outcomes.

The nurse is reviewing the ultrasound report of a client with endometriosis. The report confirms the presence of adhesions around the uterine tubes that block the fimbriated ends. What does the nurse interpret from this finding? 1 The client may not have menstruation. 2 The client may not be able to conceive. 3 The client may have pain during intercourse. 4 The client may have excess bleeding during menses.

2 Adhesions causing complete blockage of the uterine tubes would prevent the ovum from reaching the uterus. Thus, the client would not be able to conceive. Menstruation is the process regulated by the hormones produced by the ovaries. Therefore, blockage of uterine tubes would not cause amenorrhea. Dyspareunia, or pain during intercourse, is a characteristic of any type of endometriosis irrespective of the site. Menorrhagia, or excess bleeding during menses, is not a symptom associated with endometriosis.

Which condition has a high possibility of occurrence in a client with endometriosis? 1 Weight gain 2 Mood disorders 3 Impaired fertility 4 Gastrointestinal bleeding

3 Endometriosis is the presence and growth of endometrial glands and stroma outside the uterus. This may cause adhesions that pull the uterus into a fixed, retroverted position, which may result in impaired fertility. Weight gain is a side effect of danazol (Danocrine) therapy in clients with endometriosis. Mood disorders may be a comorbid condition in adolescents, and they are not a result of endometriosis. Gastrointestinal bleeding is a risk for clients who are being treated with nonsteroidal antiinflammatory drugs (NSAIDs) for primary dysmenorrhea.

An adolescent client who experiences primary dysmenorrhea complains of pain and lower abdominal cramps. What is the nurse's best response? 1 "You need to increase sugar and fats in your diet." 2 "Call the clinic only if you have dark-colored stools." 3 "A hot bath or heating pad may help the problem." 4 "The problem will diminish in 2 to 3 months."

3 Primary dysmenorrhea usually appears 6 to 12 months after menarche when ovulation is established and may cause ischemia and cyclic lower abdominal cramps. A hot water bath or heating pad may help to decrease cramping and uterine ischemia and increase vasodilation and muscle relaxation. Salt and refined sugar needs to be decreased in the client's diet to reduce fluid retention. Dark-colored stools are not seen in a client with primary dysmenorrhea, but are found in a client with gastrointestinal bleeding. Primary dysmenorrhea does not diminish in 2 to 3 months, but may be common for a few years after menarche.

A client experiences a single episode of heavy bleeding with abdominal pain. On assessment, the nurse finds that the period was also delayed. Which other factor does the nurse need to evaluate to determine the possible cause of this episode? 1 Evaluate bone density test report. 2 Evaluate for gastrointestinal bleeding. 3 Evaluate renal function reports. 4 Evaluate serum β-hCG pregnancy test results.

4 A single episode of heavy bleeding and abdominal pain may indicate an early pregnancy loss. Therefore, the nurse needs to evaluate the client's serum β-hCG pregnancy test results. A bone density report is a priority when the client is at risk for fractures. Dark-colored stools, not heavy bleeding, indicate gastrointestinal bleeding. Renal function tests are not a priority at this stage, because they will not shed any light on the cause of the bleeding.

A woman states, "I'm sure that I am suffering from premenstrual syndrome (PMS). How can I get my doctor to take this seriously?" What is the nurse's best response? 1 "Men usually are not sympathetic to PMS sufferers." 2 "You are probably right. You should remind your health care provider of your symptoms every time you visit." 3 "Because you feel certain that you are right, you should just treat yourself with over-the-counter medications." 4 "You should keep a daily record of the occurrence and severity of your symptoms for six months."

4 Charting symptoms for several cycles is necessary to make an accurate diagnosis of PMS. Stating that men are not sympathetic to PMS sufferers does not help the woman with the present problem. Listing symptoms for several cycles will help the heath care provider better assess the diagnosis. The woman should not treat herself with over-the-counter medications.

A client with dysmenorrhea has been prescribed nonsteroidal antiinflammatory drugs (NSAIDs). The client reports passing dark-colored stools 1 week after the therapy. What can the nurse interpret from this? 1 The client has developed hemorrhoids. 2 The client is allergic to NSAIDs. 3 The client has a gastrointestinal infection. 4 The client has gastrointestinal bleeding.

4 One major adverse effect associated with NSAIDs is gastrointestinal bleeding. This is manifested as dark-colored stools. Hemorrhoids may also cause blood in the stools but are not a complication associated with NSAIDs. Allergic reactions related to NSAIDs are rare. These may manifest as skin rashes and itching. NSAIDs are not associated with gastrointestinal infection. Gastrointestinal infection would be manifested as diarrhea and fever.

A client reports mood disturbances, emotional breakdowns, and irritation just before the beginning of menses for the last three cycles. After assessment, the nurse finds that the client follows a good diet and exercise regimen. Based on the symptoms, what does the nurse conclude that the client has? 1 Amenorrhea. 2 Hormonal abnormalities. 3 A psychologic illness. 4 Premenstrual dysphoric disorder.

4 Premenstrual dysphoric disorder is a severe variant of premenstrual syndrome that is manifested as emotional lability, irritation, and disturbed mood. The symptoms exhibited by the client are caused by premenstrual dysphoric disorder. Amenorrhea is the absence of menstruation. The client having symptoms for three cycles during the luteal phase does not indicate amenorrhea. The symptoms of premenstrual dysphoric disorder are caused by the normal hormonal changes occurring in the luteal phase of the menstrual cycle. These behavioral symptoms do not indicate that the client has hormonal abnormalities or a psychologic illness.

Which statement is true about primary dysmenorrhea? 1 It is experienced by all women. 2 It is unaffected by oral contraceptives. 3 It occurs in young, multiparous women. 4 It may be caused by excessive endometrial prostaglandin.

4 Some women produce excessive endometrial prostaglandin during the luteal phase of the menstrual cycle. Prostaglandin diffuses into endometrial tissue and causes uterine cramping. It is not experienced by all women. Oral contraceptives can be a treatment choice. It occurs primarily in young, nulliparous women.

A 13-year-old client who recently began menstruating tells the nurse that she has had irregular bleeding since her cycle began. What does the nurse tell the client? 1 "There may be some underlying disease." 2 "It's likely being caused by a urinary tract infection." 3 "You need to include more calcium in your diet." 4 "Bleeding may be irregular for the first 2 years."

Answer: 4 In early adolescence irregular menstrual bleeding may be common due to anovulatory cycles. After an average of 20 cycles, ovulation occurs regularly. Hence, in the first 2 years of menarche, there can be irregular bleeding. The presence of a coexisting disease will be indicated by other symptoms and not just irregular bleeding. The client does not experience pain or any other symptoms of infection. Clients with a low bone density, not irregular bleeding, may be required to increase the intake of calcium in their diets.