CHAPTER 47, MATERNAL
Which condition is a risk factor for the development of pelvic inflammatory disease (PID)? multiple sexual partners oral contraceptive use history of dysmenorrhea recurrent urinary infections
Correct response: multiple sexual partners Explanation: Clients who have had multiple sexual partners have a higher incidence of developing pelvic inflammatory disease. Oral contraceptive use, history of UTI, and dysmenorrhea are not risk factors for developing pelvic inflammatory disease.
A nurse has just admitted a client with symptoms of vulva inflammation, pain, odor, and pruritus. Based on these findings, the nurse could conclude that this client will be diagnosed with which condition? vaginal inflammation urinary tract infection (UTI) vulvovaginitis pelvic inflammatory disease (PID)
Correct response: vulvovaginitis Explanation: Vulvovaginitis is diagnosed with clients experiencing vaginal or vulval inflammation, pain odor, and pruritus. Pelvic inflammatory disease and urinary tract infection are not consistent with these symptoms.
The nurse is doing a presentation for a group of nursing students about the topic of menstrual disorders. After discussing the disorder secondary amenorrhea, the students make the following statements. Which statement made by the nursing students is the most accurate regarding the cause of secondary amenorrhea? "This disorder is usually seen after a girl has had a spontaneous abortion (miscarriage)." "This is what happens if a 16-year-old girl has never had any periods at all." "Emotional stress can be a cause of this disorder." "It is caused from taking birth control pills when a girl is younger than 13 years old."
"Emotional stress can be a cause of this disorder." Explanation:Secondary amenorrhea can be the result of discontinuing contraceptives, a sign of pregnancy, the result of physical or emotional stress, or a symptom of an underlying medical condition. A complete physical examination, including gynecologic screening, is necessary to help determine the cause. Primary amenorrhea occurs when a girl has had no previous menstruation. A spontaneous abortion does not cause secondary amenorrhea
The nurse is reviewing the causative organisms noted on laboratory reports. Which organism is transmitted solely by sexual contact? Bacillus Borelli Trichomonas Cholera bacterium
Correct response: Trichomonas Explanation: The organism transmitted solely by sexual contact is Trichomonas. The other organisms are causes of various infections and acquired in various ways.
The caregiver of a 1-year-old boy calls the nurse, upset that his wife has just told him that their son is being given a hormone. His wife says that the pediatrician called it human chorionic gonadotropic hormone but that is all she understood. The nurse most accurately clarifies the caregiver's question by making which statement regarding the son's treatment? "Without the treatment your child's gonads will not reach normal size." "Without the hormone your son will have fluid that will collect in his scrotum." "Your child's testes have not dropped, so the hormone is being administered to avoid causing degeneration until they do." "The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place."
"The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place." CorrectExplanation: Shortly before or soon after birth, the male gonads (testes) descend from the abdominal cavity into their normal position in the scrotum. Occasionally one or both of the testes do not descend, which is a condition called cryptorchidism. The testes are usually normal in size; the cause for failure to descend is not clearly understood. A surgical procedure called orchiopexy is used to bring the testes down into the scrotum and anchor them there. Some physicians prefer to try medical treatment such as injections of human chorionic gonadotropic hormone before doing surgery. If this is unsuccessful in bringing down the testes, orchiopexy is performed. If both testes remain undescended, the male will be sterile. If the processus does not close, fluid from the peritoneal cavity passes through, causing hydrocele. If the hydrocele remains by the end of the first year, corrective surgery is performed.
A 17-year-old girl comes to the clinic for her first check-up and informs the physician that she has yet to have a period. After ruling out any pathology problems, which treatment would the nurse suspect the physician to order? estrogen growth hormone testosterone progestin
Correct response: estrogen Explanation: If girls have not begun to menstruate by age 17 years and pathology has been ruled out, menstrual cycles can be initiated by administering estrogen.
A client's mother asks the nurse, "When should my daughter have a pelvic examination?" Which response by the nurse is most appropriate? "As her mother, it is your choice when she should have a pelvic exam." "A pelvic exam is necessary at 18 to 20 years of age." "A pelvic examination is not necessary until pregnancy." "A pelvic exam is necessary for girls in puberty."
Correct response: "A pelvic exam is necessary at 18 to 20 years of age." Explanation: A pelvic exam is unnecessary for girls who have not yet reached adolescence. A pelvic exam should be part of routine health care around the age of 18 to 20 years or at the point when she becomes sexually active.
Which question would be most important for a nurse to ask when taking a history from a client who is suspected of having amenorrhea? "How many times a week do you exercise?" "When did you last see your medical provider?" "What foods do you eat?" "Are you sexually active?"
Correct response: "Are you sexually active?" Explanation: Amenorrhea strongly suggests pregnancy in an adolescent and is the priority in a client with this diagnosis. Strenuous exercise can be a causative factor, but it is not the priority. Diet and medical visit history do not affect this current diagnosis.
Which question would be most important for a nurse to ask when taking a history from a client who is suspected of having amenorrhea? "When did you last see your medical provider?" "Are you sexually active?" "How many times a week do you exercise?" "What foods do you eat?"
Correct response: "Are you sexually active?" Explanation: Amenorrhea strongly suggests pregnancy in an adolescent and is the priority in a client with this diagnosis. Strenuous exercise can be a causative factor, but it is not the priority. Diet and medical visit history do not affect this current diagnosis.
The parent of a 16-year-old female states, "I know she's pregnant because she missed her period for the second time." What is the best response by the nurse? "I hear your concerns about pregnancy. There may be some other causes we need to explore." "Who do you think is the father?" "Have you done a pregnancy test?" "It is normal for teenagers to have unpredictable menstrual cycles."
Correct response: "I hear your concerns about pregnancy. There may be some other causes we need to explore." Explanation: Several events besides pregnancy might inhibit periods. This statement acknowledges the parent's concerns but also enlightens the parent about other potential causes. The other statements do not address the parent's concerns about pregnancy.
A nurse is conducting a class for high school-aged girls about reproductive health. During the class, one of the girls asks, "When should a girl have a pelvic examination?" Which response by the nurse would be most appropriate? "You need to wait until you become sexually active." "If you are not sexually active and have no problems, typically it occurs around the age of 18." "Usually a girl begins having a pelvic examination around the same time her mother did." "Typically, girls have their first pelvic examination when they enter puberty."
Correct response: "If you are not sexually active and have no problems, typically it occurs around the age of 18." Explanation: For the adolescent girl, the pelvic examination becomes part of routine health care at approximately age 18 to 20 years if she is not sexually active and is not having problems. This may be earlier if the girl is sexually active.
A parent asks the nurse, "What is precocious puberty?" The nurse's response should be based on which statement? "Precocious puberty is early sexual development." "Precocious puberty is when girls experience a heavy period." "Precocious puberty only occurs in boys, not girls." "Precocious puberty is when children are going through puberty."
Correct response: "Precocious puberty is early sexual development." Explanation: Precocious puberty is the early sexual development or maturation of a girl or boy. It occurs most often in girls, not boys, and does not relate to a heavy menses.
A nurse is working with parents of an 8-year-old girl diagnosed with precocious puberty. Which of the following would the nurse include in the teaching plan? "Although your daughter appears sexually mature, she cannot get pregnant." "This is a long-term condition, continuing even after she reaches puberty age." "It might be a good idea for your daughter to use birth control pills." "Remember that she is still an 8-year-old girl, so focus your expectations on that."
Correct response: "Remember that she is still an 8-year-old girl, so focus your expectations on that." Explanation: With precocious puberty, parents may worry about children becoming sexually active, particularly about girls becoming pregnant. Both parents and children need reassurance that, after reaching the age of normal puberty, the child will maintain normal growth and development. Parents must also understand that the child with early puberty is fully fertile and can inseminate or conceive. Oral contraceptives are not advisable for girls this young, because the increased load of estrogen hastens the closing of epiphyseal lines of long bones, possibly stunting the child's growth permanently. Parents may need to be reminded that, although their child appears much older, the changes are only in sexual characteristics. Household tasks, responsibility, and expectations must be geared to the child's chronologic age, not to outward appearance.
A 15-year-old male client diagnosed with gonorrhea states, "I can't tell my partner about this." What is the best response by the nurse? "What concerns you about telling your partner?" "If you can have sex, you can tell your partner." "You may develop serious long-term complications if this condition is left untreated." "Gonorrhea is a reportable disease, and you are legally obligated to tell your partner."
Correct response: "What concerns you about telling your partner?" Explanation: Understanding the concerns the client has about discussing the STI will allow the nurse to develop a plan that achieves the best possible outcomes. The other statements do not address the client's concerns, and if these concerns are not addressed, progress cannot be made toward achieving optimal outcomes.
A 15-year-old is diagnosed with mittelschmerz and spotting. The teen is upset about the diagnosis, stating, "I think I have appendicitis or something else." What is the best response by the nurse? "Everything is fine. Do you need more information about your diagnosis?" "You seem very upset. Is something else worrying you?" "Your appendix is on the right side, so it can't be appendicitis." "The doctor is sure of your diagnosis."
Correct response: "You seem very upset. Is something else worrying you?" Explanation: Teenagers may have difficulty discussing concerns about reproductive health and may "test" health care providers. If the nurse validates the client's feelings and offers to listen, the client may discuss what is really bothering her. The other statements do not acknowledge the client's feelings.
A nursing student correctly informs a 14-year-old client that a pelvic examination becomes a part of routine health care for all adolescent girls at which age? 12 to 13 years 18 to 20 years 16 to 17 years 14 to 15 years
Correct response: 18 to 20 years Explanation: The pelvic examination becomes part of routine health care around the age of 18 to 20 years if the teen is not sexually active and not having a problem.
A 16-year-old girl visits her gynecologist with a complaint of metrorrhagia, or bleeding between menstrual periods, since her last visit 3 months ago. On consulting the client's chart, the nurse learns that she was prescribed an oral contraceptive at her last visit. Which intervention should the nurse implement in this situation? Recommend that she ask the gynecologist about endometrium ablation to halt the metrorrhagia. Explain that breakthrough bleeding is normal during the first 3 or 4 months of oral contraceptive use but that it should go away after that. Refer the client to her primary care physician for examination for possible uterine or cervical cancer. Recommend that she ask the gynecologist to change her prescription to a different oral contraceptive.
Correct response: Explain that breakthrough bleeding is normal during the first 3 or 4 months of oral contraceptive use but that it should go away after that. Explanation: Metrorrhagia is bleeding between menstrual periods. This may occur in teenagers taking oral contraceptives (breakthrough bleeding) during the first 3 or 4 months of use. If metrorrhagia occurs for more than one menstrual cycle in a teenager who is not taking oral contraceptives (which is not the case here), she should be referred to her primary care provider for examination, because abnormal vaginal bleeding is an early sign of uterine or cervical carcinoma or an ovarian cyst. Endometrium ablation, used with premenopausal women to halt metrorrhagia, is not recommended for adolescents. There is no need at this point for the client to change prescriptions, as the bleeding will likely go away in the next month or so as the client's body adapts to the current contraceptive.
A mother brings her 8-year-old daughter who has precocious puberty to the clinic and asks for birth control pills for her. She states, "I do not want to take the chance of her getting pregnant at such an early age ... you know she looks like she is 16." Which of the following is the best reason that birth control pills are not recommended for someone that young? Increased estrogen hastens the closing of epiphyseal lines of long bones too early. The client is too young to remember to take the pills every day. The insurance company might not cover the cost. Too much estrogen that young can cause cancer at an early age.
Correct response: Increased estrogen hastens the closing of epiphyseal lines of long bones too early. Explanation: Oral contraceptives are not advisable for girls this young because the increased load of estrogen hastens the closing of epiphyseal lines of long bones too early, possibly stunting the child's growth permanently.
A mother brings her 8-year-old daughter who has precocious puberty to the clinic and asks for birth control pills for her. She states, "I do not want to take the chance of her getting pregnant at such an early age ... you know she looks like she is 16." Which of the following is the best reason that birth control pills are not recommended for someone that young? Increased estrogen hastens the closing of epiphyseal lines of long bones too early. Too much estrogen that young can cause cancer at an early age. The client is too young to remember to take the pills every day. The insurance company might not cover the cost.
Correct response: Increased estrogen hastens the closing of epiphyseal lines of long bones too early. Explanation: Oral contraceptives are not advisable for girls this young because the increased load of estrogen hastens the closing of epiphyseal lines of long bones too early, possibly stunting the child's growth permanently.
A 3-month-old boy is found to have undescended testes. The parents are concerned. What should the nurse anticipate as the next step for this client? Perform karyotyping to establish the client's gender. Reassess the client's testes at 6 months of age. Administer low-dose human chorionic gonadotropin hormone. Schedule emergency orchiopexy to correct the condition.
Correct response: Reassess the client's testes at 6 months of age. Explanation: Because the testes sometimes descend spontaneously during the first year of life, treatment is usually delayed until at least 6 months of age. If testes have not descended between 6 and 12 months of age, the client may be given a short course of chorionic gonadotropin hormone to see if testicular descent can be stimulated. If this is not successful, surgical intervention (orchiopexy) will be needed to correct the condition to prevent infertility. Karyotyping is not needed in this situation, because the client's gender is already established.
A 3-month-old boy is found to have undescended testes. The parents are concerned. What should the nurse anticipate as the next step for this client? Schedule emergency orchiopexy to correct the condition. Administer low-dose human chorionic gonadotropin hormone. Reassess the client's testes at 6 months of age. Perform karyotyping to establish the client's gender.
Correct response: Reassess the client's testes at 6 months of age. Explanation: Because the testes sometimes descend spontaneously during the first year of life, treatment is usually delayed until at least 6 months of age. If testes have not descended between 6 and 12 months of age, the client may be given a short course of chorionic gonadotropin hormone to see if testicular descent can be stimulated. If this is not successful, surgical intervention (orchiopexy) will be needed to correct the condition to prevent infertility. Karyotyping is not needed in this situation, because the client's gender is already established.
A parent asks if her newborn's undescended testicles will need surgery to repair. What is the best response by the nurse? This problem needs to be corrected immediately in the newborn period. There is a chance the testicles will descend on their own. If the infant is having swelling or pain, then surgery will be performed. Surgery is not needed for this type of problem.
Correct response: There is a chance the testicles will descend on their own. Explanation: The Association of American Physicians recommends surgery at 1 year of age if the testicles have not descended on their own. There is a chance they may descend on their own prior to 1 year of age. This problem does not cause pain or swelling.
A young adult female is suspected of having gonorrhea. The nurse would anticipate additional testing for which sexually transmitted infection? syphilis trichomoniasis genital herpes chlamydia
Correct response: chlamydia Explanation: Gonorrhea often occurs concurrently with a chlamydial infection. Therefore, testing for chlamydia is also indicated.
Which order would the nurse expect to see when caring for an adolescent diagnosed with pelvic inflammatory disease (PID)? urinary straight catheterization for pregnancy test culture of vaginal discharge use of feminine hygiene sprays twice daily complete bed rest
Correct response: culture of vaginal discharge Explanation: A culture will allow identification of the infective agent. Although restricting movement may ease pain, complete bed rest is not needed. Feminine hygiene sprays may contribute to the infectious process, and a pregnancy test does not treat PID.
A public health nurse is instructing on the short-term and long-term effects of sexually transmitted infections. Which effects would be included? Select all that apply. emotional stress risk for developing diabetes relationships with future partners risk for hypertension implications for fertility
Correct response: emotional stress implications for fertility relationships with future partners Explanation: Sexually transmitted infections can cause short-term distress as a result of painful lesions and long-term implications for fertility and future childbearing. Relationships with future partners are impacted depending upon symptom reoccurrence.
A 15-year-old girl has been experiencing dysmenorrhea for the past year. Over the past 6 months, she has been taking ibuprofen and oral contraceptives, with no improvement. What underlying condition should be assessed for in this client at this point? toxic shock syndrome amenorrhea endometriosis mittelschmerz
Correct response: endometriosis Explanation: If dysmenorrhea does not improve within 6 months with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and oral contraceptive pills (OCPs), a laparoscopy is indicated to look for endometriosis, the most common reason for secondary dysmenorrhea. The other conditions listed are not associated with dysmenorrhea.
The nurse is obtaining a reproductive health history from a 17-year-old client. Which approach by the nurse would be most effective in obtaining accurate information? in private, asking the teen about her sexual history asking the parent to answer the questions having the parents present in the room to interpret the questions for the teen asking the teen if she wants her parent to be in the room during the questioning
Correct response: in private, asking the teen about her sexual history Explanation: A teen may not feel comfortable discussing sexual history with a parent in the room. Asking the teen if she wants the parent in the room could cause confusion for the teen in having the parent there for part of the procedure but not for another part. Information obtained from the parent may not be accurate.
A nursing instructor is teaching about premenstrual dysphoric disorder (PDD) and informs students that its cause is which of the following? no known cause irritability anxiety abdominal bloating fatigue
Correct response: no known cause Explanation: PDD is a condition during the luteal phase of the menstrual cycle and is relieved by the onset of menses. There is no known cause. The other options listed tend to be symptoms of PDD. Reference:
An adolescent girl is diagnosed with premenstrual dysphoric disorder. She is prescribed an antidepressant to address symptoms of depression. The nurse would be vigilant in assessing the adolescent for which of the following? headache irritability suicidal behavior bloating
Correct response: suicidal behavior Explanation: The nurse needs to assess the adolescent closely for suicidal behavior because antidepressants have been associated with an increase in suicidal behavior in adolescents. Bloating, headache, and irritability are signs and symptoms of premenstrual dysphoric disorder.
Which symptoms, documented by the nurse, are consistent with the diagnosis of toxic shock syndrome (TSS) in a 15-year-old female? temperature 103.4°F (39.7°C) orally, confusion, and severe muscle pain temperature 103.4°F (39.7°C) orally, increased platelet count, and diarrhea temperature 103.4°F (39.7°C) orally, pulse 89, and raised red pustules on the arms temperature 103.4°F (39.7°C) orally, blood pressure 116/72, and nausea
Correct response: temperature 103.4°F (39.7°C) orally, confusion, and severe muscle pain Explanation: High temperature, confusion, severe muscle pain, diarrhea, and nausea can all be associated with TSS. The client must exhibit at least three symptoms of TSS to be given this diagnosis. Decreased blood pressure is associated with TSS, whereas a blood pressure of 116/72 is a normal reading. Platelet counts decrease with TSS. Raised red pustules are not a symptom of TSS. The skin disorder associated with TSS is a macular rash.
A 9-year-old boy who is uncircumcised has developed balanoposthitis. There is no sign of phimosis. Which of the following recommendations should the nurse give the boy and his parents to help prevent future occurrences? to apply a local antibiotic ointment daily to avoid warm baths to become circumcised to pull back the foreskin and clean the penis thoroughly when showering
Correct response: to pull back the foreskin and clean the penis thoroughly when showering Explanation: Balanoposthitis is inflammation of the glans and prepuce of the penis. It tends to occur in uncircumcised boys, is usually caused by poor hygiene, or may accompany urethritis or regional dermatitis. Medical treatment involves local application of heat by warm wet soaks or warm baths. A local antibiotic ointment may be prescribed, but this would be to eliminate an existing infection, not to prevent future recurrences. If phimosis (a tight foreskin) appears to be contributing to the condition, circumcision may be advocated after the inflammation subsides to prevent the condition from recurring.
A teenager comes to the clinic with fever, muscle pain, and a macular rash on the palms and soles of the feet. Based on these findings, what diagnosis would the nurse anticipate for this client? toxic shock syndrome polycystic ovary syndrome (PCOS) premenstrual dysmorphic disorder amenorrhea
Correct response: toxic shock syndrome Explanation: Fever, severe muscle pain, and a sunburn-like rash on the palms and soles of the hands and feet are consistent with the diagnosis of toxic shock syndrome. Polycystic ovary syndrome, amenorrhea, and premenstrual dysmorphic disorder are not consistent with these symptoms.
A nurse is assessing a woman of childbearing age complaining of intense vaginal itching and suspects bacterial vaginosis. Which finding would the nurse interpret as supporting this suspicion? vaginal discharge with a fishlike odor frothy white vaginal discharge purulent vaginal discharge with urination yellow-green vaginal discharge
Correct response: vaginal discharge with a fishlike odor Explanation: Bacterial vaginosis is indicated by an intensely pruritic vaginal discharge appears milky-white to gray and has a fishlike odor. Purulent discharge from the vagina during urination is observed in clients with a chlamydia infection. Painful urination and a frothy white or yellow-green vaginal discharge is observed in clients with trichomoniasis.
Which symptom is not consistent with a diagnosis of polycystic ovary syndrome (POS)? weight loss acne missed menses hirsutism
Correct response: weight loss Explanation: Hirsutism, weight gain, and acne are all experienced by women who are diagnosed with polycystic ovary syndrome. Weight loss is not a typical finding as most women with POS report weight gain and obesity.