210 Unit 6

The U.S. Centers for Disease Control and Prevention (CDC) recommends that HPV be treated with client-applied: Miconazole ointment. Topical podofilox 0.5% solution or gel. Penicillin given intramuscularly for two doses. Metronidazole by mouth.

Topical podofilox 0.5% solution or gel. (Available treatments are imiquimod, podophyllin, and podofilox. Miconazole ointment is used to treat athlete's foot. Intramuscular penicillin is used to treat syphilis. Metronidazole is used to treat bacterial vaginosis.)

A woman was treated recently for toxic shock syndrome (TSS). She has intercourse occasionally and uses over-the-counter protection. On the basis of her history, what contraceptive method should she and her partner avoid? Cervical cap Vaginal film Condom Vaginal sheath

Cervical cap (Women with a history of TSS should not use a cervical cap. Condoms, vaginal films, and vaginal sheaths are not contraindicated for a woman with a history of TSS.)

Which viral sexually transmitted infection is characterized by a primary infection followed by recurrent episodes? Herpes simplex virus (HSV)-2 Human papillomavirus (HPV) Human immunodeficiency virus (HIV) Cytomegalovirus (CMV)

Herpes simplex virus (HSV)-2 (The initial HSV genital infection is characterized by multiple painful lesions, fever, chills, malaise, and severe dysuria; it may last 2 to 3 weeks. Recurrent episodes of HSV infection commonly have only local symptoms that usually are less severe than the symptoms of the initial infection. With HPV infection, lesions are a chronic problem. HIV is a retrovirus. Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has entered the body. Severe depression of the cellular immune system associated with HIV infection characterizes acquired immunodeficiency syndrome (AIDS). AIDS has no cure. In most adults, the onset of CMV infection is uncertain and asymptomatic. However, the disease may become a chronic, persistent infection.)

Which laboratory test would the nurse expect the health care provider to prescribe to monitor a patient for adverse effects related to progestin medications? Complete blood count Serum creatinine level Liver function tests Cardiac enzymes

Liver function tests (One of the most serious undesirable adverse effects of progestins is liver dysfunction, which would be assessed by monitoring liver enzymes.)

One of the alterations in cyclic bleeding that occurs between periods is called: Oligomenorrhea. Leiomyoma. Menorrhagia. Metrorrhagia.

Metrorrhagia. (Metrorrhagia is bleeding between periods. It can be caused by progestin injections and implants. Oligomenorrhea is infrequent or scanty menstruation. Menorrhagia is excessive menstruation. Leiomyoma is a common cause of excessive bleeding.)

When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention might be recommended? Increasing the intake of red meat and simple carbohydrates Reducing the intake of diuretic foods such as peaches and asparagus Temporarily substituting physical activity for a sedentary lifestyle Using a heating pad on the abdomen to relieve cramping

Using a heating pad on the abdomen to relieve cramping (Heat minimizes cramping by increasing vasodilation and muscle relaxation and minimizing uterine ischemia. Dietary changes such as eating less red meat may be recommended for women experiencing dysmenorrhea. Increasing the intake of diuretics, including natural diuretics such as asparagus, cranberry juice, peaches, parsley, and watermelon, may help ease the symptoms associated with dysmenorrhea. Exercise has been found to help relieve menstrual discomfort through increased vasodilation and subsequent decreased ischemia.)

During her gynecologic checkup, a 17-year-old girl states that recently she has been experiencing cramping and pain during her menstrual periods. The nurse would document this complaint as: Amenorrhea. Dyspareunia. Dysmenorrhea. Premenstrual syndrome (PMS).

Dysmenorrhea. (Dysmenorrhea is pain during or shortly before menstruation. Amenorrhea is the absence of menstrual flow. Dyspareunia is pain during intercourse. PMS is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses.)

The nurse is providing teaching for a patient who is to receive estrogen replacement therapy. Which statement is correct to include in the teaching session? "If you miss a dose, double-up on the next dose." "There's no need to be concerned about breast lumps or bumps that occur." "Be sure to report any weight gain of 5 pounds or more per week." "Take the medication on an empty stomach to enhance absorption."

"Be sure to report any weight gain of 5 pounds or more per week." (Patients taking oral estrogen therapy should report weight gain of 5 pounds or more per week to a physician. The other statements are not true for estrogen replacement therapy.)

On vaginal examination of a 30-year-old woman, the nurse documents the following findings: profuse, thin, grayish white vaginal discharge with a "fishy" odor; complaint of pruritus. On the basis of these findings, the nurse suspects that this woman has: Bacterial vaginosis (BV). Trichomoniasis. Candidiasis. Gonorrhea.

Bacterial vaginosis (BV). (Most women with BV complain of a characteristic "fishy" odor. The discharge usually is profuse; thin; and white, gray, or milky in color. Some women also may have mild irritation or pruritus. The discharge associated with candidiasis is thick, white, and lumpy and resembles cottage cheese. Trichomoniasis may be asymptomatic, but women commonly have a characteristic yellowish-to-greenish, frothy, mucopurulent, copious, and malodorous discharge. Women with gonorrhea are often asymptomatic. They may have a purulent endocervical discharge, but discharge usually is minimal or absent.)

Which contraceptive method best protects against sexually transmitted infections (STIs) and human immunodeficiency virus (HIV)? Periodic abstinence Barrier methods Hormonal methods They all offer about the same protection.

Barrier methods (Barrier methods such as condoms best protect against STIs and HIV. Periodic abstinence and hormonal methods ("the pill") offer no protection against STIs or HIV.)

The drug of choice for treatment of gonorrhea is: Penicillin G. Ceftriaxone. Tetracycline. Acyclovir.

Ceftriaxone. (Ceftriaxone is effective for treatment of all gonococcal infections. Penicillin is used to treat syphilis. Tetracycline is prescribed for chlamydial infections. Acyclovir is used to treat herpes genitalis.)

The uterus is a muscular, pear-shaped organ that is responsible for: Cyclic menstruation. Fertilization. Sex hormone production. Sexual arousal.

Cyclic menstruation. (The uterus is an organ for reception, implantation, retention, and nutrition of the fertilized ovum; it also is responsible for cyclic menstruation. Hormone production and fertilization occur in the ovaries. Sexual arousal is a feedback mechanism involving the hypothalamus, the pituitary gland, and the ovaries.)

Which statement is true about the term contraceptive failure rate? It refers to the percentage of users expected to have an accidental pregnancy over a 5-year span. It refers to the minimum level that must be achieved to receive a government license. It increases over time as couples become more careless. It varies from couple to couple, depending on the method and the users.

It varies from couple to couple, depending on the method and the users. (Contraceptive effectiveness varies from couple to couple, depending on how well a contraceptive method is used and how well it suits the couple. The contraceptive failure rate measures the likelihood of accidental pregnancy in the first year only. Failure rates decline over time because users gain experience.)

When evaluating a patient whose primary complaint is amenorrhea, the nurse must be aware that lack of menstruation is most often the result of: Stress. Pregnancy. Excessive exercise. Eating disorders.

Pregnancy. (Amenorrhea, or the absence of menstrual flow, is most often a result of pregnancy. Although stress, excessive exercise, and eating disorders all may be contributing factors, none is the most common factor associated with amenorrhea.)

Which contraceptive method has a failure rate of less than 25%? Standard days Postovulation Periodic abstinence Coitus interruptus

Standard days (The standard days variation on the calendar method has a failure rate of 12%. The periodic abstinence method has a failure rate of 25% or greater. The postovulation method has a failure rate of 25% or greater. The coitus interruptus method has a failure rate of 27% or greater.)

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

That is regulated by ovarian hormones. (Menstruation is periodic uterine bleeding that is controlled by a feedback system involving three cycles: endometrial, hypothalamic-pituitary, and ovarian. 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.)

Care management of a woman diagnosed with acute pelvic inflammatory disease (PID) most likely would include: Oral antiviral therapy. Bed rest in a semi-Fowler position. Antibiotic regimen continued until symptoms subside. Frequent pelvic examination to monitor the progress of healing.

Bed rest in a semi-Fowler position. (A woman with acute PID should be on bed rest in a semi-Fowler position. Broad-spectrum antibiotics are used. Antibiotics must be taken as prescribed, even if symptoms subside. Few pelvic examinations should be conducted during the acute phase of the disease.)

Which health risk is not associated with menopause? Osteoporosis Coronary heart disease Breast cancer Obesity.

Breast cancer (Osteoporosis is a major health problem in the United States. It is associated with an increase in hip and vertebral fractures in postmenopausal women. A woman's risk of developing and dying of cardiovascular disease increases significantly after menopause. Breast cancer may be associated with the use of hormone replacement therapy for women who have a family history of breast cancer. Women tend to become more sedentary in midlife. The metabolic rate decreases after menopause, which may require an adjustment in lifestyle and eating patterns.)

During which phase of the cycle of violence does the batterer become contrite and remorseful? Battering phase Tension-building phase Honeymoon phase Increased drug-taking phase

Honeymoon phase (During the tension-building phase, the batterer becomes increasingly hostile, swears, threatens, and throws things. This is followed by the battering phase where violence actually occurs, and the victim feels powerless. During the honeymoon phase, the victim of IPV wants to believe that the battering will never happen again, and the batterer will promise anything to get back into the home. Often the batterer increases the use of drugs during the tension-building phase.)

While instructing a couple regarding birth control, the nurse should be aware that the method called natural family planning: Is the same as coitus interruptus, or "pulling out." Uses the calendar method to align the woman's cycle with the natural phases of the moon. Is the only contraceptive practice acceptable to the Roman Catholic church. Relies on barrier methods during fertility phases.

Is the only contraceptive practice acceptable to the Roman Catholic church. (Natural family planning is another name for periodic abstinence, which is the accepted way to pass safely through the fertility phases without relying on chemical or physical barriers. Natural family planning is the only contraceptive practice acceptable to the Roman Catholic church. "Pulling out" is not the same as periodic abstinence, another name for natural family planning. The phases of the moon are not part of the calendar method or any method.)

With regard to endometriosis, nurses should be aware that: It is characterized by the presence and growth of endometrial tissue inside the uterus. It is found more often in African-American women than in white or Asian women. It may worsen with repeated cycles or remain asymptomatic and disappear after menopause. It is unlikely to affect sexual intercourse or fertility.

It may worsen with repeated cycles or remain asymptomatic and disappear after menopause. (Symptoms vary among women, ranging from nonexistent to incapacitating. With endometriosis, the endometrial tissue is outside the uterus. Symptoms vary among women, ranging from nonexistent to incapacitating. Endometriosis is found equally in white and African-American women and is slightly more prevalent in Asian women. Women can experience painful intercourse and impaired fertility.)

A woman has chosen the calendar method of conception control. During the assessment process, it is most important that the nurse: Obtain a history of menstrual cycle lengths for the past 6 to 12 months. Determine the client's weight gain and loss pattern for the previous year. Examine skin pigmentation and hair texture for hormonal changes. Explore the client's previous experiences with conception control.

Obtain a history of menstrual cycle lengths for the past 6 to 12 months. (The calendar method of conception control is based on the number of days in each cycle, counting from the first day of menses. The fertile period is determined after the lengths of menstrual cycles have been accurately recorded for 6 months. Weight gain or loss may be partly related to hormonal fluctuations, but it has no bearing on use of the calendar method. Integumentary changes may be related to hormonal changes, but they are not indicators for use of the calendar method. Exploring previous experiences with conception control may demonstrate client understanding and compliancy, but it is not the most important aspect to assess for discussion of the calendar method.)

Postcoital contraception with Ovral: Requires that the first dose be taken within 72 hours of unprotected intercourse. Requires that the woman take second and third doses at 24 and 36 hours after the first dose. Must be taken in conjunction with an IUD insertion. Is commonly associated with the side effect of menorrhagia.

Requires that the first dose be taken within 72 hours of unprotected intercourse. (Emergency contraception is most effective when used within 72 hours of intercourse; however, it may be used with lessened effectiveness 120 hours later. Insertion of the copper IUD within 5 days of intercourse may also be used and is up to 99% effective. The most common side effect of postcoital contraception is nausea.)

A 25-year-old single woman comes to the gynecologist's office for a follow-up visit related to her abnormal Papanicolaou (Pap) smear. The test revealed that the patient has human papillomavirus (HPV). The client asks, "What is that? Can you get rid of it?" Your best response is: "It's just a little lump on your cervix. We can freeze it off." "HPV stands for 'human papillomavirus.' It is a sexually transmitted infection (STI) that may lead to cervical cancer." "HPV is a type of early human immunodeficiency virus (HIV). You will die from this." "You probably caught this from your current boyfriend. He should get tested for this."

"HPV stands for 'human papillomavirus.' It is a sexually transmitted infection (STI) that may lead to cervical cancer." (It is important to inform the patient about STIs and the risks involved with HPV. The health care team has a duty to provide proper information to the patient, including information related to STIs. HPV and HIV are both viruses that can be transmitted sexually, but they are not the same virus. The onset of HPV can be insidious. Often STIs go unnoticed. Abnormal bleeding frequently is the initial symptom. The client may have had HPV before her current boyfriend. You cannot make any deductions from this limited information.)

A patient taking oral contraceptives is being treated for a urinary tract infection with antibiotics. Which information should the nurse include as education related to the oral contraceptives? "Your sexual partner should use a nonprescription test kit that will detect a urinary tract infection." "Use an alternative method of birth control for up to 1 month during and after antibiotic use." "Report any abdominal pain, blood in the urine, or changes in vision." "There is no drug interaction between oral contraceptives and antibiotics."

"Use an alternative method of birth control for up to 1 month during and after antibiotic use." (When a patient takes oral contraceptives and is prescribed an antibiotic, the oral contraceptive effectiveness can be decreased, and an alternative method of birth control should be used for at least 1 month during and after taking certain antibiotics.)

The nurse presents a seminar on sexually transmitted infections. Which information about syphilis should the nurse include in this presentation? Select all that apply. A blood test will confirm the diagnosis. Syphilis signs and symptoms are divided into stages. Syphilis can be spread through vaginal, anal, or oral sex. Having syphilis once provides lifelong immunity from repeat infection. Syphilis will always be present in a chronic state, as there is no cure for this illness.

A blood test will confirm the diagnosis. Syphilis signs and symptoms are divided into stages. Syphilis can be spread through vaginal, anal, or oral sex. (Syphilis can be cured with the initiation of prompt treatment. A blood test can confirm this diagnosis. Syphilis is staged in relation to signs and symptoms and the length of the infection. Syphilis may be transmitted via vaginal, anal, or oral sex. An individual may be positive for syphilis more than once. Syphilis can be cured by early treatment.)

The nurse recognizes that use of estrogen drugs is contraindicated in which patient? A patient who has atrophic vaginitis A patient who has inoperable prostate cancer A woman who has just given birth and wants to prevent postpartum lactation A woman with a history of thrombophlebitis

A woman with a history of thrombophlebitis (Estrogenic drugs are contraindicated in people who have active thromboembolic disorders and in those with histories of thromboembolic disease. Atrophic vaginitis and inoperable prostate cancer are potential indications for estrogen therapy. Estrogen is not used to prevent lactation.)

The nurse is planning to teach a group of adolescents about the use of condoms as part of a risk reduction program for sexually transmitted infections (STIs). The nurse should plan to include which recommendation in the teaching plan? Condoms should not be lubricated. Use condoms whenever the partner seems "risky." Always apply the condom before inserting the penis into the vagina. Natural membrane condoms can be used because they are just as effective as latex.

Always apply the condom before inserting the penis into the vagina. (To be effective, condoms must be applied before any vaginal penetration occurs. A condom must be used with every sexual encounter if it is to be safe. A lubricated condom may be used to increase sensitivity of the glans. Natural membrane condoms are less effective than latex in preventing the spread of some STIs.)

Examples of sexual risk behaviors associated with exposure to a sexually transmitted infection (STI) include: (Select all that apply) Fellatio. Unprotected anal intercourse. Multiple sex partners. Dry kissing. Abstinence.

Fellatio. Unprotected anal intercourse. Multiple sex partners. (Engaging in these sexual activities increases the exposure risk and the possibility of acquiring an STI. Dry kissing and abstinence are considered "safe" sexual practices.)

Informed consent concerning contraceptive use is important because some of the methods: Are invasive procedures that require hospitalization Require a surgical procedure to insert May not be reliable Have potentially dangerous side effects

Have potentially dangerous side effects (To make an informed decision about the use of contraceptives, it is important for couples to be aware of potential side effects. The only contraceptive method that is a surgical procedure and requires hospitalization is sterilization. Some methods have greater efficacy than others, and this should be included in the teaching.)

When assessing a patient for amenorrhea, the nurse should be aware that this is unlikely to be caused by: Anatomic abnormalities. Lack of exercise. Type 1 diabetes mellitus. Hysterectomy.

Lack of exercise. (Lack of exercise is not a cause of amenorrhea. Strenuous exercise may cause amenorrhea. Anatomic abnormalities, type 1 diabetes mellitus, and hysterectomy all are possible causes of amenorrhea.)

A female patient arrives to the clinic for counseling on potential hormone replacement therapy. When taking the patient's history, which condition would the nurse consider as a contraindication to use of hormone replacement therapy for the patient? Hyperlipidemia Early onset of menarche Thromboembolic events Osteoporosis

Thromboembolic events (A contraindication for estrogen administration is any history of thromboembolic disorder.)

The nurse is caring for a pregnant woman who has herpes genitalis. The nurse provides instructions to the woman about treatment modalities that may be necessary for this condition. Which statement made by the woman indicates an understanding of these treatment measures? "I do not need to abstain from sexual intercourse." "I need to use vaginal creams after I douche every day." "I need to douche and perform a sitz bath 3 times a day." "It may be necessary to have a cesarean section for delivery."

"It may be necessary to have a cesarean section for delivery." (If a woman has an active lesion, either recurrent or primary at the time of labor, delivery should be by cesarean section. Women are advised to abstain from sexual contact while the lesions are present. If it is an initial infection, the woman should continue to abstain from sexual intercourse until the cultures are negative because prolonged viral shedding may occur. Douches are contraindicated, and the genital area should be kept clean and dry to promote healing.)

When the nurse is alone with a battered patient, the patient seems extremely anxious and says, "It was all my fault. The house was so messy when he got home and I know he hates that." The best response by the nurse is: "No one deserves to be hurt. It's not your fault. How can I help you?" "What else do you do that makes him angry enough to hurt you?" "He will never find out what we talk about. Don't worry. We're here to help you." "You have to remember that he is frustrated and angry so he takes it out on you."

"No one deserves to be hurt. It's not your fault. How can I help you?" (The nurse should stress that the patient is not at fault. Asking what the patient did to make her husband angry is placing the blame on the woman and would be an inappropriate statement. The nurse should not provide false reassurance. To assist the woman, the nurse should be honest. Often the batterer will find out about the conversation.)

A woman had unprotected intercourse 36 hours ago and is concerned that she may become pregnant because it is her "fertile" time. She asks the nurse about emergency contraception. The nurse tells her that: It is too late; she needed to begin treatment within 24 hours after intercourse. Preven, an emergency contraceptive method, is 98% effective at preventing pregnancy. An over-the-counter antiemetic can be taken 1 hour before each contraceptive dose to prevent nausea and vomiting. The most effective approach is to use a progestin-only preparation.

An over-the-counter antiemetic can be taken 1 hour before each contraceptive dose to prevent nausea and vomiting. (To minimize the side effect of nausea that occurs with high doses of estrogen and progestin, the woman can take an over-the-counter antiemetic 1 hour before each dose. Emergency contraception is used within 72 hours of unprotected intercourse to prevent pregnancy. Postcoital contraceptive use is 74% to 90% effective at preventing pregnancy. Oral emergency contraceptive regimens may include progestin-only and estrogen-progestin pills. Women with contraindications to estrogen use should use progestin-only pills.)

A patient is being treated for secondary amenorrhea. The nurse expects which drug to be used to treat this problem? Methylergonovine (Methergine) Estradiol transdermal (Estraderm) Raloxifene (Evista) Medroxyprogesterone (Provera)

Medroxyprogesterone (Provera) (Medroxyprogesterone, a progestin, is one of the drugs most commonly used for secondary amenorrhea. Secondary amenorrhea is not an indication for the other drugs listed.)

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

Uterus. (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.)

An unmarried young woman describes her sex life as "active" and involving "many" partners. She wants a contraceptive method that is reliable and does not interfere with sex. She requests an intrauterine device (IUD). The nurse's most appropriate response is: "The IUD does not interfere with sex." "The risk of pelvic inflammatory disease (PID) will be higher for you." "The IUD will protect you from sexually transmitted infections (STIs)." "Pregnancy rates are high with IUDs."

"The risk of pelvic inflammatory disease (PID) will be higher for you." (Disadvantages of IUDs include an increased risk of PID in the first 20 days after insertion and the risks of bacterial vaginosis and uterine perforation. The IUD offers no protection against STIs or human immunodeficiency virus. Because this woman has multiple sex partners, she is at higher risk of developing a STI. The IUD does not protect against infection, as does a barrier method. Although the statement "The IUD does not interfere with sex" may be correct, it is not the most appropriate response. The IUD offers no protection from STIs. The typical failure rate of the IUD in the first year of use is 0.8%.)

A woman is using the basal body temperature (BBT) method of contraception. She calls the clinic and tells the nurse, "My period is due in a few days, and my temperature has not gone up." The nurse's most appropriate response is: "This probably means you're pregnant." "Don't worry; it's probably nothing." "Have you been sick this month?" "You probably did not ovulate during this cycle."

"You probably did not ovulate during this cycle." (Pregnancy cannot occur without ovulation (which is being measured using the basal body temperature (BBT) method). A comment such as this discredits the client's concerns. Illness would most likely cause an increase in BBT. The absence of a temperature decrease most likely is the result of lack of ovulation.)

Nafarelin is currently used as a treatment for mild-to-severe endometriosis. The nurse should tell a woman taking this medication that the drug: Stimulates the secretion of gonadotropin-releasing hormone (GnRH), thereby stimulating ovarian activity. Should be sprayed into one nostril every other day. Should be injected into subcutaneous tissue BID. Can cause her to experience some hot flashes and vaginal dryness.

Can cause her to experience some hot flashes and vaginal dryness. (Nafarelin is a GnRH agonist, and its side effects are similar to effects of menopause. The hypoestrogenism effect results in hot flashes and vaginal dryness. Nafarelin is a GnRH agonist that suppresses the secretion of GnRH and is administered twice daily by nasal spray.)

When evaluating a patient for sexually transmitted infections (STIs), the nurse should be aware that the most common bacterial STI is: Gonorrhea. Chlamydia. Syphilis. Candidiasis.

Chlamydia. (Chlamydia is the most common and fastest spreading STI among American women, with an estimated 3 million new cases each year. It's all over Kalamazoo, be careful. Gonorrhea and syphilis are bacterial STIs, but they are not the most common ones among American women. Candidiasis is caused by a fungus, not by bacteria.)

The nurse would question a prescription for estrogen replacement therapy in a patient with a history of which condition? Weight loss Vaginal bleeding Dysmenorrhea Deep vein thrombosis

Deep vein thrombosis (Increased coagulation and risk of deep vein thrombosis are serious adverse effects of hormone replacement therapy.)

You (the nurse) are reviewing the educational packet provided to a client about tubal ligation. What is an important fact you should point out? (Select all that apply) "It is highly unlikely that you will become pregnant after the procedure." "This is an effective form of 100% permanent sterilization. You won't be able to get pregnant." "Sterilization offers some form of protection against sexually transmitted infections (STIs)." "Sterilization offers no protection against STIs." "Your menstrual cycle will greatly increase after your sterilization."

"It is highly unlikely that you will become pregnant after the procedure. "Sterilization offers no protection against STIs." (A woman is unlikely to become pregnant after tubal ligation, although it is not 100% effective. Sterilization offers no protection against STIs. The menstrual cycle typically remains the same after a tubal ligation.)

What symptom described by a woman is characteristic of premenstrual syndrome (PMS)? "I feel irritable and moody a week before my period is supposed to start." "I have lower abdominal pain beginning the third day of my menstrual period." "I have nausea and headaches after my period starts, and they last 2 to 3 days." "I have abdominal bloating and breast pain after a couple of days of my period."

"I feel irritable and moody a week before my period is supposed to start." (Premenstrual syndrome (PMS) is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses. PMS begins in the luteal phase and resolves as menses occurs. It does not start after menses has begun. This complaint is associated with PMS. However, the timing reflected in this statement is inaccurate. PMS begins in the luteal phase and resolves as menses occurs. It does not start after menses has begun. Abdominal bloating and breast pain are likely to occur a few days prior to menses, not after it has begun.)

A male client asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). The nurse's most appropriate response is: "The lubricant prevents vaginal irritation." "Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; also it has been linked to an increase in the transmission of human immunodeficiency virus (HIV) and can cause genital lesions." "The additional lubrication improves sex." "Nonoxynol-9 improves penile sensitivity."

"Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; also it has been linked to an increase in the transmission of human immunodeficiency virus (HIV) and can cause genital lesions." (Nonoxynol-9 may cause vaginal irritation. This is a true statement. Nonoxynol-9 has no effect on the quality of sexual activity. Nonoxynol-9 has no effect on penile sensitivity.)

A nursing student is doing a presentation on human papillomavirus (HPV) for a young adult group aged 18 to 20 years old. What information should the nursing student include in this presentation? Select all that apply. "Some forms of HPV can lead to cervical cancer." "You cannot get HPV if you have had only 1 sex partner." "There are no vaccinations available to protect against HPV." "HPV is most commonly spread during vaginal or anal sexual contact." "In some types, HPV will go away on its own and does not cause health issues."

"Some forms of HPV can lead to cervical cancer." "HPV is most commonly spread during vaginal or anal sexual contact." "In some types, HPV will go away on its own and does not cause health issues." (HPV has now become the most common sexually transmitted infection. Some types of HPV have been found to have a strong link to cervical cancer, while other types of HPV may resolve without any intervention. HPV may be contracted with any sexual partner. There is a vaccine for the known strains that may lead to cervical cancer, which can be administered to females from ages 9 to 26 years. HPV is spread through vaginal or anal sexual contact.)

A woman currently uses a diaphragm and spermicide for contraception. She asks the nurse what the major differences are between the cervical cap and diaphragm. The nurse's most appropriate response is: "No spermicide is used with the cervical cap, so it's less messy." "The diaphragm can be left in place longer after intercourse." "Repeated intercourse with the diaphragm is more convenient." "The cervical cap can safely be used for repeated acts of intercourse without adding more spermicide later."

"The cervical cap can safely be used for repeated acts of intercourse without adding more spermicide later." (The cervical cap can be inserted hours before sexual intercourse without the need for additional spermicide later. No additional spermicide is required for repeated acts of intercourse. Spermicide should be used inside the cap as an additional chemical barrier. The cervical cap should remain in place for 6 hours after the last act of intercourse. Repeated intercourse with the cervical cap is more convenient because no additional spermicide is needed.)

When educating a patient about the use of oral contraceptives, the nurse provides what explanation for the pills having different colors each week? "They help you remember which week you are taking." "They are color coded for the weeks of the month." "The different color pills are because of different amounts of hormones in each week." "There isn't a reason for the color; it's just the choice of the drug company."

"The different color pills are because of different amounts of hormones in each week." (Oral contraceptive pills can be monophasic, biphasic, or triphasic. If the pills are different colors, they have different amounts of hormones and are likely the triphasic type of contraceptive.)

A pregnant woman has a positive history of genital herpes but has not had lesions during this pregnancy. What should the nurse plan to tell the client? "You will be isolated from your newborn infant after delivery." "Vaginal deliveries can reduce neonatal infection risks, even if you have an active lesion at the time." There is little risk to your newborn infant during this pregnancy, during the birth, and after delivery." "You will be evaluated at the time of delivery for genital lesions, and if any are present, a cesarean delivery will be needed."

"You will be evaluated at the time of delivery for genital lesions, and if any are present, a cesarean delivery will be needed." (With active herpetic genital lesions, cesarean delivery can reduce neonatal infection risks. In the absence of active genital lesions, vaginal delivery is indicated unless there are other indications for cesarean delivery. Maternal isolation is not necessary, but cultures should be obtained from potentially exposed newborn infants on the day of delivery.)

A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. The nurse's most appropriate response would be: "This is a highly effective method, but it has some side effects." "Your current medications will reduce the effectiveness of the pill." "The pill will reduce the effectiveness of your seizure medication." "This is a good choice for a woman of your age and personal history."

"Your current medications will reduce the effectiveness of the pill." (Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they are taken simultaneously with anticonvulsants. The statement "Your current medications will reduce the effectiveness of the pill" is true, but it is not the most appropriate response. The anticonvulsant will reduce the effectiveness of the pill, not the other way around. The statement "This is a good choice for a woman of your age and personal history" does not teach the client that the effectiveness of the pill may be reduced because of her anticonvulsant therapy.)

The ambulatory care nurse is working with a 22-year-old female client who has been diagnosed with pelvic inflammatory disease (PID). The nurse incorporates which item in a teaching plan for this client? Avoid frequent douching. Undergarments made of nylon are best. Intrauterine devices are a good birth control method. It is necessary to change sanitary pads only every 8 hours.

Avoid frequent douching. (The client who has been diagnosed with PID should avoid frequent douching because it decreases the natural flora that controls the growth of infectious organisms. The client should wear cotton undergarments, and clothes should not fit tightly. Intrauterine devices increase the client's susceptibility to infection. Sanitary pads should be changed at least every 4 hours. Tampons should not be used during the acute infection, and some primary health care providers may recommend avoiding them indefinitely. The client also should avoid strong soaps, sprays, powders, and similar products that will irritate the perineum.)

The nurse should include which information when teaching a 15-year old about genital tract infection prevention? Select all that apply. Wear nylon undergarments Avoid tight-fitting jeans Use floral scented bath salts Decrease sugar intake Do not douche. Limit time spent wearing a wet bathing suit

Avoid tight-fitting jeans Decrease sugar intake Do not douche. Limit time spent wearing a wet bathing suit (Patient teaching for the prevention of genital tract infections in women includes the following guidelines: Practice genital hygiene. Choose underwear or hosiery with a cotton crotch. Avoid tight-fitting clothing (especially tight jeans). Select cloth car seat covers instead of vinyl. Limit the time spent in damp exercise clothes (especially swimsuits, leotards, and tights). Limit exposure to bath salts or bubble bath. Avoid colored or scented toilet tissue. If sensitive, discontinue use of feminine hygiene deodorant sprays. Use condoms. Void before and after intercourse. Decrease dietary sugar. Drink yeast-active milk and eat yogurt (with lactobacilli). Do not douche.)

A married woman has made the decision to use a diaphragm as her primary method of birth control. The clinic nurse should provide which instructions regarding care of, insertion, and removal of the diaphragm? Select all that apply. Remove the diaphragm by catching the rim from below the dome. Avoid using mineral oil body products. On insertion, direct the diaphragm down toward the space below cervix. Wash diaphragm monthly with mild soap and water. A dusting of cornstarch is appropriate after drying the diaphragm.

Avoid using mineral oil body products. On insertion, direct the diaphragm down toward the space below cervix. Wash diaphragm monthly with mild soap and water. A dusting of cornstarch is appropriate after drying the diaphragm. (The diaphragm should not be removed by trying to catch the rim from below the dome. Oil-based products can cause the breakdown of the rubber. The diaphragm should be inserted into the vagina, directing it inward and downward as far as it will go to the space behind and below the cervix. The diaphragm should be washed after each use with mild soap and water. Cornstarch may be used. Avoid use of scented talc, body powder, and baby powder because they can weaken the rubber.)

The nurse is providing patient education for a patient taking an oral contraceptive. Which drugs may cause interactions with oral contraceptives? (Select all that apply.) Cephalexin (Keflex) Guaifenesin (Robitussin) Warfarin (Coumadin) Ibuprofen (Motrin) Theophylline (Uniphyl)

Cephalexin (Keflex) Warfarin (Coumadin) Theophylline (Uniphyl) (Patients must be educated about the need to use alternative birth control methods for at least 1 month during and after taking any of these drugs: antibiotics (especially penicillins and cephalosporins); barbiturates; isoniazid; and rifampin. The effectiveness of other drugs, such as anticonvulsants, beta blockers, hypnotics, antidiabetic drugs, warfarin, theophylline, tricyclic antidepressants, and vitamins, may be reduced when they are taken with oral contraceptives.)

The nurse providing care in a women's health care setting must be aware regarding which sexually transmitted infection that can be successfully treated and cured? Herpes Acquired immunodeficiency syndrome (AIDS) Venereal warts Chlamydia

Chlamydia (The usual treatment for infection by the bacterium Chlamydia is doxycycline or azithromycin. Concurrent treatment of all sexual partners is needed to prevent recurrence. There is no known cure for herpes, and treatment focuses on pain relief and preventing secondary infections. Because there is no known cure for AIDS, prevention and early detection are the primary focus of care management. Condylomata acuminata are caused by human papillomavirus. No treatment eradicates the virus.)

Nurses, certified nurse-midwives, and other advanced practice nurses have the knowledge and expertise to assist women in making informed choices regarding contraception. A multidisciplinary approach should ensure that the woman's social, cultural, and interpersonal needs are met. Which action should the nurse take first when meeting with a new client to discuss contraception? Obtain data about the frequency of coitus. Determine the woman's level of knowledge about contraception and commitment to any particular method. Assess the woman's willingness to touch her genitals and cervical mucus. Evaluate the woman's contraceptive life plan.

Determine the woman's level of knowledge about contraception and commitment to any particular method. (This is the primary step of this nursing assessment and necessary before completing the process and moving on to a nursing diagnosis. Once the client's level of knowledge is determined, the nurse can interact with the woman to compare options, reliability, cost, comfort level, protection from sexually transmitted infections, and a partner's willingness to participate. Although important, obtaining data about the frequency of coitus is not the first action that the nurse should undertake when completing an assessment. Data should include not only the frequency of coitus but also the number of sexual partners, level of contraceptive involvement, and partner's objections. Assessing the woman's willingness to touch herself is a key factor for the nurse to discuss should the client express interest in using one of the fertility awareness methods of contraception. The nurse must be aware of the client's plan regarding whether she is attempting to prevent conception, delay conception, or conceive.)

The combined continuous administration of progestin and estrogen reduces the risk of which cancer? Breast Ovarian Endometrial Vaginal

Endometrial (Estrogen, given alone, has been associated with an increased risk of endometrial hyperplasia, which can lead to endometrial cancer. Progestin reduces the incidence of endometrial hyperplasia.)

A woman complains of severe abdominal and pelvic pain around the time of menstruation that has gotten worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to get pregnant for the past 18 months. These symptoms are most likely related to: Endometriosis. Primary dysmenorrhea. PMS. Secondary dysmenorrhea

Endometriosis. (Symptoms of endometriosis can change over time and may not reflect the extent of the disease. Major symptoms include dysmenorrhea and deep pelvic dyspareunia (painful intercourse). Impaired fertility may result from adhesions caused by endometriosis. Although endometriosis may be associated with secondary dysmenorrhea, it is not a cause of primary dysmenorrhea or PMS. In addition, this woman is complaining of dyspareunia and infertility, which are associated with endometriosis, not with PMS or primary or secondary dysmenorrhea.)

In the prenatal clinic, the nurse is interviewing a new client and obtaining health history information. Which action should the nurse plan to elicit the most accurate responses to the questions that refer to sexually transmitted infections? Establish a therapeutic relationship. Use specific closed-ended questions. Omit these types of questions because they are highly personal. Apologize for the embarrassment that these questions will cause the client.

Establish a therapeutic relationship. (The initial assessment interview establishes the therapeutic relationship between the nurse and the pregnant woman. It is planned, purposeful communication that focuses on specific content. The remaining options are incorrect and would not lend themselves to eliciting accurate information from the client.)

A woman has a thick, white, lumpy, cottage cheese-like discharge, with patches on her labia and in her vagina. She complains of intense pruritus. The nurse practitioner would order which preparation for treatment? Fluconazole Clindamycin Tetracycline Acyclovir

Fluconazole (Fluconazole, metronidazole, and clotrimazole are the drugs of choice to treat candidiasis. Tetracycline is used to treat syphilis. Clindamycin is used to treat bacterial vaginosis. Acyclovir is used to treat genital herpes.)

Injectable progestins (DMPA, Depo-Provera) are a good contraceptive choice for women who: Want menstrual regularity and predictability. Have a history of thrombotic problems or breast cancer. Have difficulty remembering to take oral contraceptives daily. Are homeless or mobile and rarely receive health care.

Have difficulty remembering to take oral contraceptives daily. (Advantages of DMPA include a contraceptive effectiveness comparable to that of combined oral contraceptives with the requirement of only four injections a year. Disadvantages of injectable progestins are prolonged amenorrhea and uterine bleeding. Use of injectable progestin carries an increased risk of venous thrombosis and thromboembolism. To be effective, DMPA injections must be administered every 11 to 13 weeks. Access to health care is necessary to prevent pregnancy or potential complications.)

The viral sexually transmitted infection (STI) that affects most people in the United States today is: Herpes simplex virus type 2 (HSV-2). Human papillomavirus (HPV). Human immunodeficiency virus (HIV). Cytomegalovirus (CMV).

Human papillomavirus (HPV). (HPV infection is the most prevalent viral STI seen in ambulatory health care settings. HSV-2, HIV, and CMV all are viral STIs but are not the most prevalent viral STIs.)

With regard to the use of intrauterine devices (IUDs), nurses should be aware that: Return to fertility can take several weeks after the device is removed. IUDs containing copper can provide an emergency contraception option if inserted within a few days of unprotected intercourse. IUDs offer the same protection against sexually transmitted infections (STIs) as the diaphragm. Consent forms are not needed for IUD insertion.

IUDs containing copper can provide an emergency contraception option if inserted within a few days of unprotected intercourse. (The woman has up to 8 days to insert the IUD after unprotected sex. Return to fertility is immediate after removal of the IUD. IUDs offer no protection for STIs. A consent form is required for insertion, as is a negative pregnancy test.)

The nurse is preparing to administer the contraceptive form of medroxyprogesterone (Depo-Provera). What route is appropriate? Subcutaneous Intramuscular Vaginal Transdermal

Intramuscular (Depo-Provera is a progestin-only injectable contraceptive that is given by the intramuscular route. The other options are incorrect.)

A female client seen in the ambulatory care clinic has a history of syphilis infection. The nurse assessing the client for reinfection would expect to observe a lesion on the labia that has which characteristic? Is painless and indurated Has a cauliflower-like appearance Is erythematous and papular in appearance Appears as 1 or more vesicles that then rupture

Is painless and indurated (The characteristic lesion of syphilis is painless and indurated. The lesion is referred to as a chancre. Genital warts are characterized by cauliflowerlike growths or growths that are soft and fleshy. Scabies is characterized by erythematous, papular eruptions. Genital herpes is accompanied by the presence of 1 or more vesicles that then rupture and heal.)

A woman visits a health center requesting oral contraceptives. Which laboratory test is most important for the nurse to assess before the patient begins oral contraceptive therapy? Complete blood count Serum potassium level Vaginal cultures Pregnancy test

Pregnancy test (Pregnancy should be ruled out before beginning oral contraceptive therapy because the medications can be harmful to the fetus; they are classified as pregnancy category X.)

A 36-year-old woman has been given a diagnosis of uterine fibroids. When planning care for this patient, the nurse should know that: Fibroids are malignant tumors of the uterus that require radiation or chemotherapy. Fibroids increase in size during the perimenopausal period. Menorrhagia is a common finding. The woman is unlikely to become pregnant as long as the fibroids are in her uterus.

Menorrhagia is a common finding. (The major symptoms associated with fibroids are menorrhagia and the physical effects produced by large myomas. Fibroids are benign tumors of the smooth muscle of the uterus, and their etiology is unknown. Fibroids are estrogen sensitive and shrink as levels of estrogen decline. Fibroids occur in 25% of women of reproductive age and are seen in 2% of pregnant women.)

Management of primary dysmenorrhea often requires a multifaceted approach. The nurse who provides care for a client with this condition should be aware that the optimal pharmacologic therapy for pain relief is: Acetaminophen. Oral contraceptives (OCPs). Nonsteroidal antiinflammatory drugs (NSAIDs). Aspirin.

Nonsteroidal antiinflammatory drugs (NSAIDs). (NSAIDs are prostaglandin inhibitors and show the strongest research results for pain relief. Often if one NSAID is not effective, another one can provide relief. Approximately 80% of women find relief from NSAIDs. Preparations containing acetaminophen are less effective for dysmenorrhea because they lack the antiprostaglandin properties of NSAIDs. OCPs are a reasonable choice for women who also want birth control. The benefit of OCPs is the reduction of menstrual flow and irregularities. OCPs may be contraindicated for some women and have numerous potential side effects. NSAIDs are the drug of choice. If a woman is taking a NSAID, she should avoid taking aspirin.)

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

Ovulation and hormone production. (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 internal pelvic support. Sexual response is a feedback mechanism involving the hypothalamus, anterior pituitary gland, and the ovaries. Ovulation does occur in the ovaries.)

With regard to dysmenorrhea, nurses should be aware that: It is more common in older women. It is more common in leaner women who exercise strenuously. Symptoms can begin at any point in the ovulatory cycle. Pain usually occurs in the suprapubic area or lower abdomen.

Pain usually occurs in the suprapubic area or lower abdomen. (Pain is described as sharp and cramping or sometimes as a dull ache. It may radiate to the lower back or upperthighs. Dysmenorrhea is more common in women 17 to 24 years old, women who smoke, and women who areobese. Symptoms begin with menstruation or sometimes a few hours before the onset of flow.)

Which statement concerning cyclic perimenstrual pain and discomfort (CPPD) is accurate? Premenstrual dysphoric disorder (PMDD) is a milder form of premenstrual syndrome (PMS) and more common in younger women. Secondary dysmenorrhea is more intense and medically significant than primary dysmenorrhea. Premenstrual syndrome is a complex, poorly understood condition that may include any of a hundred symptoms. The causes of PMS have been well established.

Premenstrual syndrome is a complex, poorly understood condition that may include any of a hundred symptoms. (PMS may manifest with one or more of a hundred or so physical and psychologic symptoms. PMDD is a more severe variant of PMS. Secondary dysmenorrhea is characterized by more muted pain than that seen in primary dysmenorrhea; the medical treatment is much the same. The cause of PMS is unknown. It may be a collection of different problems.)

There is little consensus on the management of premenstrual dysphoric disorder (PMDD). However, nurses can advise women on several self-help modalities that often improve symptoms. The nurse knows that health teaching has been effective when the client reports that she has adopted a number of lifestyle changes, including: (Select all that apply) Regular exercise. Improved nutrition. A daily glass of wine. Smoking cessation. Oil of evening primrose.

Regular exercise. Improved nutrition. Smoking cessation. Oil of evening primrose. (These modalities may provide significant symptom relief in 1 to 2 months. If there is no improvement after these changes have been made, the patient may need to begin pharmacologic therapy. Women should decrease both their alcohol and caffeinated beverage consumption if they have PMDD.)

The two primary areas of risk for sexually transmitted infections (STIs) are: Sexual orientation and socioeconomic status. Age and educational level. Large number of sexual partners and race. Risky sexual behaviors and inadequate preventive health behaviors.

Risky sexual behaviors and inadequate preventive health behaviors. (Risky sexual behaviors and inadequate preventive health behaviors put a person at risk for acquiring or transmitting an STI. Although low socioeconomic status may be a factor in avoiding purchasing barrier protection, sexual orientation does not put one at higher risk. Younger individuals and individuals with less education may be unaware of proper prevention techniques; however, these are not the primary areas of risk for STIs. Having a large number of sexual partners is a risk-taking behavior, but race does not increase the risk for STIs.)

While interviewing a 31-year-old woman before her routine gynecologic examination, the nurse collects data about the client's recent menstrual cycles. The nurse should collect additional information with which statement? The woman says her menstrual flow lasts 5 to 6 days. She describes her flow as very heavy. She reports that she has had a small amount of spotting midway between her periods for the past 2 months. She says the length of her menstrual cycle varies from 26 to 29 days.

She describes her flow as very heavy. (Menorrhagia is defined as excessive menstrual bleeding, in either duration or amount. Heavy bleeding can have many causes. The amount of bleeding and its effect on daily activities should be evaluated. A menstrual flow lasting 5 to 6 days is a normal finding. Mittlestaining, a small amount of bleeding or spotting that occurs at the time of ovulation (14 days before onset of the next menses), is considered normal. During her reproductive years, a woman may have physiologic variations in her menstrual cycle. Variations in the length of a menstrual cycle are considered normal.)

A nurse counseling a client with endometriosis understands which statements regarding the management of endometriosis is accurate? Select all that apply. Bone loss from hypoestrogenism is not reversible. Side effects from the steroid danazol include masculinizing traits. Surgical intervention often is needed for severe or acute symptoms. Women without pain and who do not want to become pregnant need no treatment. Women with mild pain who may want a future pregnancy may take nonsteroidal antiinflammatory drugs (NSAIDs).

Side effects from the steroid danazol include masculinizing traits. Surgical intervention often is needed for severe or acute symptoms. Women without pain and who do not want to become pregnant need no treatment. Women with mild pain who may want a future pregnancy may take nonsteroidal antiinflammatory drugs (NSAIDs). (Bone loss is mostly reversible within 12 to 18 months after the medication is stopped. Such masculinizing traits as hirsutism, a deepening voice, and weight gain occur with danazol but are reversible. Surgical intervention often is needed when symptoms are incapacitating. The type of surgery is influenced by the woman's age and desire to have children. Treatment is not needed for women without pain or the desire to have children. In women with mild pain who may desire a future pregnancy, treatment may be limited to use of nonsteroidal antiinflammatory drugs (NSAIDs) during menstruation.)

An essential component of counseling women regarding safe sex practices includes discussion regarding avoiding the exchange of body fluids. The physical barrier promoted for the prevention of sexually transmitted infections and human immunodeficiency virus is the condom. Nurses can help motivate clients to use condoms by initiating a discussion related to a number of aspects of condom use. The most important of these is: Strategies to enhance condom use. Choice of colors and special features. Leaving the decision up to the male partner. Places to carry condoms safely.

Strategies to enhance condom use. (When the nurse opens discussion on safe sex practices, it gives the woman permission to clear up any concerns or misapprehensions that she may have regarding condom use. The nurse can also suggest ways that the woman can enhance her condom negotiation and communications skills. These include role-playing, rehearsal, cultural barriers, and situations that put the client at risk. Although women can be taught the differences among condoms, such as size ranges, where to purchase, and price, this is not as important as negotiating the use of safe sex practices. Women must address the issue of condom use with every sexual contact. Some men need time to think about this. If they appear reluctant, the woman may want to reconsider the relationship. Although not ideal, women may safely choose to carry condoms in shoes, wallets, or inside their bra. They should be taught to keep the condom away from heat. This information is important; however, it is not germane if the woman cannot even discuss strategies on how to enhance condom use.)

A woman will be taking oral contraceptives using a 28-day pack. The nurse should advise this woman to protect against pregnancy by: Limiting sexual contact for one cycle after starting the pill. Using condoms and foam instead of the pill for as long as she takes an antibiotic. Taking one pill at the same time every day. Throwing away the pack and using a backup method if she misses two pills during week 1 of her cycle.

Taking one pill at the same time every day. (To maintain adequate hormone levels for contraception and to enhance compliance, clients should take oral contraceptives at the same time each day. If contraceptives are to be started at any time other than during normal menses or within 3 weeks after birth or abortion, another method of contraception should be used through the first week to prevent the risk of pregnancy. Taken exactly as directed, oral contraceptives prevent ovulation, and pregnancy cannot occur. No strong pharmacokinetic evidence indicates a link between the use of broad-spectrum antibiotics and altered hormone levels in oral contraceptive users. If the client misses two pills during week 1, she should take two pills a day for 2 days, finish the package, and use a backup method the next 7 consecutive days.)

With regard to the noncontraceptive medical effects of combined oral contraceptive pills (COCs), nurses should be aware that: COCs can cause toxic shock syndrome if the prescription is wrong. Hormonal withdrawal bleeding usually is a bit more profuse than in normal menstruation and lasts a week. COCs increase the risk of endometrial and ovarian cancer. The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements.

The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements. (The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements. Toxic shock syndrome can occur in some diaphragm users, but it is not a consequence of taking oral contraceptive pills. Hormonal withdrawal bleeding usually is lighter than in normal menstruation and lasts a couple of days. Oral contraceptive pills offer protection against the risk of endometrial and ovarian cancers.)

A woman who is 6 months pregnant has sought medical attention, saying she fell down the stairs. What scenario would cause an emergency department nurse to suspect that the woman has been a victim of intimate partner violence (IPV)? The woman and her partner are having an argument that is loud and hostile. The woman has injuries on various parts of her body that are in different stages of healing. Examination reveals a fractured arm and fresh bruises. She avoids making eye contact and is hesitant to answer questions.

The woman has injuries on various parts of her body that are in different stages of healing. (The patient may have multiple injuries in various stages of healing that indicates a pattern of violence. An argument is not always an indication of battering. A fractured arm and fresh bruises could be caused by the reported fall and doesn't necessarily indicate IPV. It is normal for the woman to have a flat affect.)

When considering the various types of contraceptive drugs, the nurse is aware that which type most closely duplicates the normal hormonal levels of the female menstrual cycle? Monophasic Biphasic Triphasic Short acting

Triphasic (The triphasic drugs most closely duplicate the normal hormonal levels of the female menstrual cycle. The other options are incorrect.)

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

Variations in the follicular (preovulatory) phase. (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 is regular, not irregular. The luteal phase begins after ovulation. The corpus luteum depends 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.)

An effective relief measure for primary dysmenorrhea would be to: reduce physical activity level until menstruation ceases. begin taking prostaglandin synthesis inhibitors on the first day of the menstrual flow. decrease intake of salt and refined sugar about 1 week before menstruation is about to occur. use barrier methods rather than the oral contraceptive pill (OCP) for birth control.

decrease intake of salt and refined sugar about 1 week before menstruation is about to occur. (Staying active is helpful since it facilitates menstrual flow and increases vasodilation to reduce ischemia. Prostaglandin inhibitors should be started a few days before the onset of menstruation. Decreasing intake of salt and refined sugar can reduce fluid retention. OCPs are beneficial in relieving primary dysmenorrhea as a result of inhibition of ovulation and prostaglandin synthesis.)

The Center for Disease Control (CDC) recommended medication for the treatment of chlamydia would be: doxycycline. podofilox. acyclovir. penicillin.

doxycycline. (Doxycycline is effective for treating chlamydia, but it should be avoided if the woman is pregnant. Podofilox is a recommended treatment for nonpregnant women diagnosed with human papilloma virus infection. Acyclovir is recommended for genital herpes simplex virus infection. Penicillin is not a Center for Disease Control (CDC) recommended medication for chlamydia; it is the preferred medication for syphilis.)

With regard to dysfunctional uterine bleeding (DUB), the nurse should be aware that: it is most commonly caused by anovulation. it most often occurs in middle age. the diagnosis of DUB should be the first considered for abnormal menstrual bleeding. the most effective medical treatment involves steroids.

it is most commonly caused by anovulation. (Anovulation may occur because of hypothalamic dysfunction or polycystic ovary syndrome. Dysfunctional uterine bleeding (DUB) most often occurs when the menstrual cycle is being established or when it draws to a close at menopause. A diagnosis of DUB is made only after all other causes of abnormal menstrual bleeding have been ruled out. The most effective medical treatment is oral or intravenous estrogen.)

With regard to the diagnosis and management of amenorrhea, nurses should be aware that: it probably is the result of a hormone deficiency that can be treated with medication. it may be caused by stress or excessive exercise or both. it likely will require the client to eat less and exercise more. it often goes away on its own.

it may be caused by stress or excessive exercise or both. (Amenorrhea may be the result of a decrease in follicle-stimulating hormone (FSH) and luteinizing hormone (LH). This is usually caused by stress, body fat to lean ratio, and in rare occurrences a pituitary tumor. It cannot be treated by medication. Amenorrhea usually is the result of stress and/or an inappropriate ratio of body fat to lean tissue, possibly as a result of excessive exercise. Management includes counseling and education about the causes and possible lifestyle changes. In most cases a client will need to decrease her amount of exercise and increase her body weight in order to resume menstruation. Management of stress and eating disorders is usually necessary to manage this condition.)

The nurse must evaluate a male patient's knowledge regarding the use of a condom. The nurse would recognize the need for further instruction if the patient states that he: lubricates the condom with a spermicide containing nonoxynol-9. leaves an empty space at the tip of the condom. leaves a small amount of air in the tip. removes his still-erect penis from the vagina while holding onto the base of the condom.

lubricates the condom with a spermicide containing nonoxynol-9. (Nonoxynol-9 is no longer recommended. Recent data suggest that frequent use of nonoxynol-9 may increase human immunodeficiency virus transmission and can cause genital lesions. An empty space at the tip of the condom is the correct instruction. Leaving a small amount of air at the tip of the condom is the correct instruction. Removing the condom while holding the base is the correct instruction.)

Discharge instructions after tubal ligation should include: Select all that apply. being prepared for significant mood swings due to hormonal influences. expecting heavier menstrual periods. using two forms of birth control to prevent pregnancy. not expecting change in sexual functioning; may enjoy more. using condoms to prevent sexually transmitted infections.

not expecting change in sexual functioning; may enjoy more. using condoms to prevent sexually transmitted infections. (Patient teaching regarding what to expect after tubal ligation includes: You should expect no change in hormones and their influence. Your menstrual period will be about the same as before the sterilization. You may feel pain at ovulation. The ovum disintegrates within the abdominal cavity. It is highly unlikely that you will become pregnant. You should not have a change in sexual functioning; you may enjoy sexual relations more because you will not be concerned about becoming pregnant. Sterilization offers no protection against sexually transmitted infections. Therefore, you may need to use condoms.)

When providing care to a young single woman just diagnosed with acute pelvic inflammatory disease, the nurse should: point out that inappropriate sexual behavior caused the infection. position the woman in a semi-Fowler position. explain to the woman that infertility is a likely outcome of this type of infection. tell her that antibiotics need to be taken until pelvic pain is relieved.

position the woman in a semi-Fowler position. (Although sexual behavior may have contributed to the infection, the nurse must discuss these practices in a nonjudgmental manner and provide information about prevention measures. The position of comfort is the semi-Fowler position. In addition, the foot of the bed could be elevated to keep the uterus in a dependent position and reduce discomfort. Until treatment is complete and healing has occurred, the outcome is unknown and should not be suggested. The nurse should emphasize that medication must be continued until follow-up assessment indicates that the infection has been treated successfully.)

During a follow-up visit, a patient who has been on estrogen therapy admits that she has continued to smoke cigarettes. The nurse will remind the patient that smoking while on estrogen may lead to increased: incidence of nausea. risk for thrombosis. levels of triglycerides. tendency to bleed during menstruation.

risk for thrombosis. (Smoking should be avoided during estrogen therapy because it adds to the risk for thrombosis formation. The other options are incorrect.)

A 26-year-old woman is considering Depo-Provera as the form of contraception that is best for her since she does not like to worry about taking a pill every day. To assist this woman with decision making concerning this method of contraception, the nurse would tell her that Depo-Provera: is a combination of progesterone and estrogen. is a small adhesive hormonal birth control patch that is applied weekly. thickens and decreases cervical mucus, thereby inhibiting sperm penetration and ovulation. has an effectiveness rate in preventing pregnancy of 99% when used correctly.

thickens and decreases cervical mucus, thereby inhibiting sperm penetration and ovulation. (Depo-Provera is a progestin-only form of hormonal contraception. Depo-Provera is administered as an intramuscular injection. In addition to the changes in the cervical mucus, some but not all ovulatory cycles are suppressed, and formation of an endometrium capable of supporting implantation is inhibited. The effectiveness rate is 99% or greater over 5 years.)