OB Evolve Chapter 4
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 states? SATA a. The condom should fit tightly from the tip to the end b. We should remove the condom after intercourse once the penis is no longer erect b. We'll keep the condom in its wrapper until we're ready to use it c. The penis needs to be erect before putting on the condom d. We will use a new condom each time we have sexual intercourse
* We'll keep the condom in it's wrapper until we're ready to use it * The penis needs to be erect before putting on the condom * We will use a new condom each time we have sexual intercourse 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 & removed while the penis is still erect. There should be about 1/2 inch empty space at end to collect ejaculate
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 approx. what percentage of women meeting the ACOG criteria for PMS? A. 55% b. 45% c. 75% d. 65%
75% It is estimated that up to 75% of reproductive-age women experienced PMS symptoms that meet the ACOG criteria and up to 5% meet the diagnostic criteria for PMDD
The client has heard of extended oral contraceptive regimens and desires more info. The nurse explains that these regimes consist of active combination pills, followed by placebo pills. How many days of active combination; placebo pills are contained in these regimens? A. 70/6 B. 84/7 c. 56/5 d. 42/4
84/7 Research has confirmed that the extended use of active oral contraceptive (OC) pills carries the same safety profile as the conventional 28-day regimens. The extended regimen consists of 84 consecutive days of active combo pill, followed by 7 days of placebo. The woman has four withdrawal-bleeding episodes a year.
The nurse considers the contraceptive class at a college dormitory to be effective when the students understand that the effectiveness of oral contraceptives (OCs) can be decreased if they take: a. Vitamin supplements b. ABTs c. Cold remedies d. Antihistamine
ABTs antibiotics The effectiveness of OCs is decreased when the woman is taking ABTs; thus the woman will need to use an alternative or secondary method during this period to prevent pregnancy
A woman is receiving methotrexate & misoprostol to terminate a first-trimester pregnancy. When preparing the teaching plan for this client, the nurse understands that MISOPROSTOL works by: A. Dilating the cervix b. Blocking action of progesterone on the endometrium c. Causing uterine contraction to expel the uterine contents d. Acting as a toxin to the trophoblastic tissue
Causing uterine contractions to expel the uterine contents Methotrexate is toxic to the trophoblastic tissue Mifepristone blocks the action of progesterone (which is responsible for preparing the endometrium for implantation & maintenance of the pregnancy)
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: a. Copper b. Magnesium c. Silicone d. Potassium
Copper 3 intrauterine contraceptives in US today: - copper ParaGard-TCu-380A - levonogestrel-releasing intrauterine system (LNG-IUS) Mirena - LNG-IUD Skyla Copper ParaGard approved for 10 years and is non hormonal. Mechanism of action is based on the release of copper ions, which alone are spermicidal, but also causes an inflammatory action leading to a hostile uterine environment
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 because: a. ECs can induce an abortion of a recently implanted embryo B. ECs are more effective than regular birth control c. ECs simply prevent embryo creation and uterine implantation from occurring in the first place d. ECs can help prevent STIs
ECs simply prevent embryo creation and uterine implantation from occurring in the first place
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? A. Patent fallopian tubes b. Age of 25 years c. Endometriosis d. Dysmenorrhea
Endometriosis 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 illness - STDs - HX of PID - smoking or alcohol consumption - multiple miscarriages - and psychological 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? A. Levonorgestrel/ethinyl estradiol b. Etonogestrel c. Medroxyprogesterone acetate d. Norelgestromin/ethinyl estradiol
Medroxyprogesterone acetate It is a injectable form of progesterone-only contraceptive that is administered every 12 weeks. It works by suppressing ovulation and the production of FSH and LH by the pituitary glad. Levonorgestrel= 365 day PO med Etonogestrel= implant Norelgestromin= patch
A client is diagnosed with endometriosis. As part of the teaching plan, the nurse 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? A. Pap smear b. Pelvic ultrasound c. Bimanual exam d. Pelvic laparoscopy
Pelvic laparoscopy A thorough HX and pelvic exam may lead the doc to suspect endometriosis, however the only certain method of diagnosis is with visual via laparoscopy. A tissue biopsy can be obtained at this time and examined microscopically to confirm it. Pap Smear= rule out cervical cancer
The client presents reporting irregular menstrual cycles, bleeding between periods, mood swings, hot flashes & vaginal tenderness. After an examination, the nurse suspects uterine bleeding. Which approach would be inappropriate? A. Obtain an order for CBC and PT blood test b. Obtain an order for pregnancy test to rule out ectopic pregnancy c. Tell the client to learn to live with it d. Prepare her for an ultrasound to check internal pelvic structures
Tell the client to live with it Telling the client to live with it ignores the possibility that her symptoms are related to a serious but treatable condition
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? A. Five days after the first day of the menstrual cycle b. Six days before the onset of menstruation c. Midway between the normal menstrual cycle d. Three days before and three days after ovulation
Three days before and after ovulation Typically, unsafe period during the menstruation cycle is approx. 3 days before and 3 days after ovulation. An ovum is released from the ovary every 14 days before the next menstrual period.
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: a. Cervical inflammation b. Pelvic inflammatory disorder C. Sexually transmitted infections d. Toxic shock syndrome
Toxic Shock Syndrome 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
A woman opts to use a diaphragm for contraception. Which instruction would be most important for the nurse to provide? A. Replace the diaphragm every 6 months b. Wet the diaphragm with water before inserting it c. Keep the diaphragm in place for no more than 4 hours after intercourse D. Have your diaphragm refitted if you lost 10 pounds or more
Have your diaphragm refitted if you lose 10 pounds or more They should be refitted after pregnancy, ABD or pelvic surgery, or weight loss or gain of 10lbs 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.
When assessing a woman with dysmenorrhea, the nurse would expect the client to report which symptom? A. Intermittent sharp suprapubic pain b. Dysphoria c. Chronic pelvic pain d. Abnormally long, heavy menstrual periods
Intermittent sharp suprapubic pain Sharp, intermittent spasms of pain, usually in the suprapubic area, are a common report associated with dysmenorrhea. menorrhagia- abnormally long, heavy periods dysphoria- common report associated with PMS Chronic pelvic pain- endometriosis
A nurse is assessing a client and suspects that they may be experiencing premenstrual dsyphoric disorder (PMDD). Applying the American Psychiatric Association criteria, the nurse would most likely assess which symptoms? SATA a. Affective lability b. Focused thinking c. Dysuria d. Diarrhea e. Sleep difficulties
* affective lability * sleep difficulties * diarrhea According to APA, a woman must have at least 5 of the typical symptoms of PMDD. These occur during week before and a few days after menstruation. Must include one or more of the first 4 symptoms : Affective liability anxiety & 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 breast tenderness & swelling
A mother presents to the clinic with her 15 year old daughter complaining of amenorrhea (abnormal absence of menstruation). The girl's menarche was at age 12. Which findings might the nurse identify as indicating the cause? SATA: a. Pregnancy b. Extreme rapid weight gain c. Hypothyroidism d. Emotional distress e. Lack of exercise
* pregnancy * extreme rapid weight gain * emotional distress * hypothyroidism She is experiencing secondary amenorrhea. Risk factors: recent weight gain or loss, pregnancy, excessive exercise, hypothyroidism, and emotional stress
The nurse is developing a presentation for a group of young adult women about premenstrual syndrome (PMS). The nurse would include which possible TX options? SATA a. Vitamin & mineral supplements b. Decrease in water intake c. Diuretic therapy d. NSAIDs e. Antipsychotic medications f. Reduction of caffeine intake
* reduction of caffeine intake * diuretic therapy * vitamin & mineral supplements * NSAIDs TX options for PMS include lifestyle changes such as reduction of caffeine intake, a well-balanced diet with increased water intake, and limited alcohol intake. Vitamin & mineral supplements, NSAIDs, & diuretic therapy may be used. Antidepressants & anti anxiety agents may also be options.
The nurse is providing care to a client with abnormal uterine bleeding. TX with medications has been unsuccessful, and surgical intervention is being considered. The nurse identifies which technique as being the last resort? A. Uterine artery embolization B. Dilation & curettage c. Endometrial ablation d. Hysterectomy
Hysterectomy If client does not respond to medical therapy, surgical intervention might include dilation and curettage (D&C), endometrial ablation, uterine artery embolization, or hysterectomy (LAST RESORT!)
During examination of clients, the nurse will question women concerning their LMP. This indicates: a. The last day of their last menstrual period b. The level of menstrual pain c. The length of their menstrual periods d. The first day of their last menstrual period
The first day of their last menstrual period LMP - last menstrual period, used to determine estimated date of delivery if the client is pregnant, or to establish potential disorders of the reproductive system
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? A. Crying b. Cravings c. Constipation d. Cramping
Cravings ACDHO: A- anxiety: difficulty sleeping, tenseness, mood swings, clumsiness C- cravings: for sweets, salty foods, chocolate D- depression: feelings of low self-esteem, anger, easily upset H- hydration: weight gain, ABD bloating, breast tenderness O- other: hot flashes or cold sweats, nausea, change in bowel habits, aches or pains, dysmenorrhea, acne breakout
A nurse is reviewing the HX and physical exam 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? A. Perimenopause b. Hormonal imbalances c. Endometriosis D. Multigravada status
Endometriosis Secondary dysmenorrhea is painful menstruation due to pelvic or uterine pathology. It is the most common cause of secondary dysmenorrhea. Other recognized causes include adenomysosis, fibroids, pelvic infection, an intrauterine device, cervical stenosis, or congenital uterine or vaginal abnormalities
A 16 year old girl is brought to the clinic by her mom 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 amenorrhea? SATA: a. Hypotension b. Evidence of secondary sex characteristics C. Bradycardia d. Hyperthermia e. Reduced subcutaneous fat
* hypotension * bradycardia * reduced subcutaneous fat Can also present with hypothermia
After teaching a woman who has chosen the vaginal ring as her method of contraception, the nurse determines that the client needs additional teaching when she makes which statement? A. I'll compress the ring, inserting it as far back as possible b. Once i remove the ring, I'll discard it c. I don't have to worry so much about the exact placement d. I will insert a new ring at the same time and day of every week
I will insert a new ring at the same time and day of every week Vaginal rings involves a 3-week period of continuous use followed by a ring-free week to allow withdrawal bleeding. The rings is compressed and inserted into the vagina, as far back as possible, but precise placement is not critical. After 3 weeks, the ring is removed & discarded.
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: SATA a. Decreased weight size b. Moist, supple skin c. Increased ABD fat d. Hot flashes e. Decreased bone density f. Vaginal dryness
* increased ABD fat * hot flashes * decreased bone density * vaginal dryness Dry, thinning skin Increased weight size
A nurse is preparing a presentation for a client who is considering contraception. When discussing oral contraceptives, the nurse would identify which advantages? SATA a. Shortening of menstrual period b. Reduction in severe cramping c. Lowered risk of migraine headaches d. Decreased risk of breast cancer e. Reduction in risk for osteoporosis
* shortening of menstrual period * reduction in severe cramping * reduction in risk for osteoporosis Oral contraceptives are associated with shorter periods, reducing severe cramps & bleeding, reducing risk for osteo. They are also associated with INCREASED risk for breast cancer and migraine headaches.
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? A. Cervical mucus ovulation method b. Coitus interruptus method c. Symptothermal method d. Basal body temperature method
Coitus interruptus method- or withdrawal is not considered a fertility awareness method (PULL OUT METHOD lol) Fertility awareness refers to any natural contraceptive method that does not require hormones, pharmaceutical compounds, physical barriers, or surgery to prevent pregnancy. Fertility awareness-based methods (FAM) use physical signs/symptoms that change with hormone fluctuations throughout a woman's menstrual cycle to predict a woman's fertility. Techniques used to determine fertility include the cervical mucus ovulation method, the basal body temperature method, the symptothermal method, standards day's method, and two-day method.
A nurse is working with a couple who is dealing with infertility. Which aspect would be most important for the nurse to consider? A. Insurance restrictions b. Culture c. Family budget d. Emotional limits
Culture Infertility is not only a physiological problem but is also one that can initiate a life crisis that is experienced weigh 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 difficulties in their counseling of the couples as they try to help them achieve their goal of getting pregnant.
The nurse is planning to speak at a oval 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 of osteoporosis? A. Drinking at least 1 glass of wine a day b. Limiting intake of cholesterol and saturated fats c. Engaging in daily weight-bearing exercise d. Decreasing vitamin D intake
Engaging in daily weight-bearing exercises These exercises, such as walking, help to reduce a woman's risk for osteoporosis. To prevent osteoporosis, increase calcium and vitamin D intake & avoid excessive alcohol ingestion
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 nurses's suspicion? A. I get really irritable and moody about a week before my period b. My periods have been unusually long and heavy lately with a lot of bleeding c. Ive been having bleeding off and on that's irregular and sometimes heavy d. I get sharp pain in my lower ABD usually starting soon after my period comes
I've been bleeding off and on that's irregular & sometimes heavy Abnormal uterine bleeding is defined as irregular, abnormal bleeding that occurs with no identifiable anatomical pathology. It is frequently associated with anovulatory cycles, which are common for the first year after menarche & later in life as a woman approaches menopause.
