OB Module 6 Exam

Which statement would be most appropriate when explaining endometriosis as a cause of a woman's infertility?

"Ovulation does take place; however, the misplaced endometrial tissue interferes with transport of the ovum."

A 52-year-old client reports to the nurse the recent onset of hot flashes, fatigue, and vaginal dryness. Which response by the nurse is most appropriate?

"Tell me what you are currently doing to manage these symptoms?"

Contraceptive sponge - what is it? - how to apply? - when should it be applied?

- 2-inch round, spermicide-infused, foam disk that fits over cervix - prior to insertion, woman wets sponge and inserts it with her fingers into top of vagina - can be placed up to 24 h before sexual intercourse but should stay in no more than 30 hours

Contraceptive Implant - what is it? - how long is it used for? - what does it do? - who is it most effective in? - side effect - what happens within month of removal?

- 4 cm rod of nonestrogen etonogestrel inserted under skin of inner upper arm - use for 3 years - creates changes to cervical mucus & fallopian tube motility & suppresses follicle maturation and ovulation - most effective in BMI <30 - side effect - unscheduled bleeding - majority of women ovulate within one month of removal

Artifical Reproductive technology - what does ART do? - how is intrauterine insemination done? - why is IVF given? - what occurs during the process of IVF? - when can you identify success of fertilization?

- ART treats infertility - intrauterine insemination is where sperm is washed & then introduced into upper uterine cavity - IVF treats infertility due to tubal factors, severe male factors, uterine, or ovarian factors - With IVF, ovaries stimulated & eggs retrieved by US follicle aspiration and then mixed with cleaned sperm - successful fertilization can be identified after 17 h and transplanted into uterus or frozen

Contraceptive injection - what is it? - when is it administered? - benefits - How does it work? - when should it be started? - concerns - can breastfeeding women use it?

- Depo Provera (DMPA) is a projestin-only projection - given every 13 weeks IM - benefits: less frequent or scant menses - works by suppressing FSH and LH which inhibits follicle maturation & ovulation - start within 7 days of start of last menstrual cycle - concern with weight gain - safe for breastfeeding women

What should you assess for the possibility of pregnancy?

- No intercourse since last normal menses - Pt correctly uses reliable method of contraception - Pt within 7 days from first day of menstrual bleeding - Pt is within 4 weeks postpartum (non-lactating) - Pt is within first 7 days postabortion/miscarriage - Pt fully/nearly fully breastfeeding, amenorrhic and less than 6 months postpartum

Ulipristal (Ella) - OTC or Rx? - Most effective when? - How does it work? - Does it affect an established pregnancy?

- Rx - Most effective withini 120 h of unprotected intercourse - works as progestin blocker - may affect existing pregnancy

Intrauterine Contraception - what is it? - how does copper IUC work? - when can it be inserted? - what does progestin IUD cause? - does it disrupt pregnancy?

- T shaped plastic device wrapped in copper or containing progestin that is inserted into uterus - copper IUC inhibits sperm motility, capacitation, survival, and phagocytosis - can be inserted as emergency contraceptioin within 5-7 days of unprotected sex - progestin IUD causes inhospitable changes to cervical mucus, endometrial atrophy, and variable effects on ovulation - does not disrupt existing pregnancy

Normal transition to menopause - when is it achieved? - typical age - time prior to menopause

- achieved when a woman has not menstruated for a full 12 months - age 51 or 52 - time prior to menopause is perimenopause and typically lasts around 4 years

Vaginal cancer - associated with? - symptoms - tx - complications

- associated with HPV - asymptomatic most of time but can have postcoital bleeding, postmenopausal bleeding, or a vaginal mass - tx: cone biopsy, hysterectomy, chemo or radiation - complications: fistulas and strictures

Levonorgestrel (Plan B) - OTC or Rx? - Most effective when? - How does it work? - Does it affect an established pregnancy?

- available OTC or Rx - most effective within 72 h of unprotective intercourse - works by preventing ovulation - does not affect established pregnancy

Emergency Contraception - what is it? - who is it most effective in? - meds

- available as med or copper intrauterine contraception - most effective in women with normal BMI - Levonorgestrel (PlanB) and Ulipristal (Ella)

Male condom - what does it best protect? - how often should be replaced? - when is it applied? - when to change condom?

- best protects against STIs - new condom should be used w each episode of oral/rectal/vaginal sex whose STI status unknown - applied prior to genital contact - change condom when it is placed upside down or after ejaculation

Most effective methods of birth control

- bilateral tubal ligation - vasectomy - LARC (contraceptive implants & intrauterine contraception)

Are breast cysts a risk? What about fibrocystic breasts?

- breast cysts do not increase cancer risks, but complex cysts should be biopsied - fibrocystic breasts (ropey, lumpy texture) not at risk for cancer

What do nonfunctional ovarian cysts include?

- dermoid cysts

Breast cancer -dx - prognostic factors - tx

- dx by mammogram and needle biopsy of core lesion - prognostic factors: tumor stage, gene expression, circulating tumor cells, age, race, and smoking status - tx can include surgery (radical mastectomy, modified radical mastectomy, simple mastectomy) , chemo, radiation and hormone therapy

Contraceptive ring - what is it ? - how long is it used for? - when can it be taken out? - how can it be dislodged?

- flexible silicone rings with estrogen and progestin - placed inside vagina for 3 weeks, removed for 1 week to create a withdrawal bleed and then replace with new ring - ring can be removed for intercourse and left out for up to 3 hours per day - ring can be dislodged during bowel movement

What do functional ovarian cysts include?

- follicular cysts - corpus luteum cysts

Hormone Containing Birth Control - how many pills? - how does it work? - who can take the pill? - alternative method - contraindications

- generally, 21 hormone-containing pills followed by 7 placebo pills - increases viscosity of cervical mucus, suppressing ovulation, and thinning uterine lining - nonsmokers can take pill until menopause - alternative method is extended cycling - contrandications: migraine with aura, hx blood clots, HTN

How is ovarian cancer identified? Tx? What do survivors deal with?

- identified with US or CT scan, followed by dx after surgery - tx: chemo - survivors have lifetime issues associating with tx - hearing loss, neuropathy of feet and ambulation difficulties

Major types of contraception

- long-acting reversible contraception - combined oral contraceptives - progestin only pills - hormonal patches - hormonal vaginal rings - barrier methods - spermicide - natural family planning - withdrawal - contraceptive injections - sterilization

Vulvar cancer - appearance - dx - s/s

- may appear as a plaque, ulcer, or mass often on labia majora - dx based on vulvar biospy - s/s: pruritus, dyschezia (pain w/ defecation), dysuria or edema or lower extremities

What is evaluated during a fertility consult with a female?

- menstrual history - urine testing for LH and/or progesterone level - hysterosalpingogram to assess uterine cavity & patency of fallopian tubes - serum FSH and estradiol levels on third day of menses - thyroid stimulating hormone levels

How is cervical cancer biopsy assessed as?

- negative - cervical intraepithelial neoplasia: abnormal squamous cells of cervix that can develop into squamous cell carcinoma of cervix - adenocarcinoma in situ: glandular cell abnormalities that can develop into adenocarcinoma of cervix

Contraceptive Patch - what is it? - how long it it used for? - application

- patch that contains estrogen and progestin - applied weekly for 3 weeks and followed by patch-free week to cause withdrawal bleed - patch to be applied on upper back, upper arm, upper buttock, or lower abdomen, but not on breast - rotate weekly

Pelvic organs & prolapse - how are they held in place? - types of prolapse - risk for pelvic floor prolapse

- pelvic organs held in place by CT and muscles of pelvic floor - cystoceele, rectocele, enterocele or uterus - risk for pelvic floor prolapse include giving birth, vaginal births and obesity

Diaphragm - where is this placed? - when should it be checked? - how often to be replaced?

- placed into vagina to cover cervix - fit checked if woman gives birth, has miscarriage or abortion, or gains or loses more than 10 lbs - replaced every 2 years

Contraceptive vaginal gels - what do they do? - when are they inserted? - example - effectiveness - forms

- provide on-demand contraceptioin by either killing or immobilizing sperm - inserted prior to vaginal intercourse - Nonoxynol-9 - effective for 1 hour only - jelly, cream, suppository, foam

Risk and side effects of combined oral contraceptives

- pt symptoms - VTE - CV risk - drug interaxns (anticonvulsants & rifampin which is abx for TB)

Hormone Containing Progestin Only Pills - Is it safe for breastfeeding mothers? - how many pills - when should it be taken? - side effect - what if pregnancy occurs?

- safe for breastfeeding moms - 28 pills that contain progestin (no placebo) - must take within 3 hour window to be effective - side effect is less regular period & more breakthrough bleeding - if pregnancy occurs, ectopic due to slowing of cilia in fallopian tube in response to progestin

Clomid - what is it? - when is it administered? - risk

- selective estrogen receptor modulator & common first-line med to induce ovulatioin - started 5 days after start of menses - risk of miscarriage, ectopic pregnancy and multiple gestation

What is evaluated during a fertility consult with a male?

- semen analysis: semen volume and pH, microscopy of semen for debris and agglutination, sperm concentration/motility/morphology, sperm leukocyte count and search for immature germ cells need 2 samples at least 1 week apart by collection of masturbation 2-7 days after last ejaculation

Intrauterine Contraception - side effect - risks - what can occur within 1st year of use? - what to report? - what should women no longer check? - what are women screened for?

- side effect: changes in bleeding patterns (copper IUC can cause heavier bleeding while progestin IUC can decrease menstrual bleeding and increase spotting) - risks - perforation at time of insertion - spontaneous expulsion of IUC may occur within 1st year of use - women should report new acute cramping - women should no longer check string replacement monthly - women screened for STIs

Types of incontinence

- stress: increased intrabdominal pressure - urgency: overactive bladder - overflow: obstruction of bladder outlet

S/s of pelvic prolapse

-Vaginal pressure* -Pelvic pain -Bulge at the opening of the vagina -Problems with defecation or urination -Sexual dysfunction

What is a normal menstrual periood?

8 days or less

Hyperandrogenism

A condition in which the body produces very high levels of androgens. Typically it is noticed only in women. It can result from a variety of medical conditions, including polycystic ovary syndrome

A client is scheduled to have in vitro fertilization (IVF) in 1 week. Which statement made by the client indicates that she needs further teaching? A. "The primary care provider will harvest eggs from my ovary." B. "The primary care provider will transfer my fertilized eggs into the uterus." C. "The primary care provider will transfer the egg and sperm into the fallopian tube where the egg will become fertilized." D. "I will receive fertility drugs to stimulate ovulation."

A. "The primary care provider will harvest eggs from my ovary."

Which of the following would a provider diagnose with infertility? A. A 37-year-old woman trying to get pregnant for 7 months B. A 24-year-old woman trying to get pregnant for 11 months C. A 30-year-old woman trying to get pregnant for 6 months D. None of the above

A. A 37-year-old woman trying to get pregnant for 7months

The nurse in the women's health clinic reviews the chart note (above) about a client before conducting an assessment. Which nonpharmacologic recommendation(s) should the nurse make to help with this client's symptoms? Select all that apply. A. Exercise regularly. B. Rest in bed when menses begin. C. Reduce the intake of fat in the diet. D. Apply heat to the lower abdomen. E. Increase the intake of dairy products.

A. Exercise regularly. C. Reduce the intake of fat in the diet. D. Apply heat to the lower abdomen. E. Increase the intake of dairy products.

A young woman has just received an intrauterine device (IUD). The nurse is doing post-procedural teaching and discusses the importance of the patient reporting which of the following as possible complications of the IUD? Select all that apply. A. fever B. unusual bleeding C. leg cramping D. a missing IUD string E. late period

A. fever B. unusual bleeding D. a missing IUD string E. late period

A nurse is preparing a presentation for. alocal community women's group about menopause. When describing the body system changes that occur, the nurse would include which changes? Select all that apply. A. hot flashes B. increased abdominal fat C. moist, supple skin D. vaginal dryness E. decreased bone density F. decreased waist size

A. hot flashes B. increased abdominal fat D. vaginal dryness E. decreased bone density

When describing polycystic ovary syndrome (PCOS) to a client, which areas would the nurse need to address? Select all that apply. A. hyperinsulinemia b. decreased levels of luteinizing hormones c. elevated androgen levels d. follicular hyperplasia e. anovulation

A. hyperinsulinemia c. elevated androgen levels e. anovulation

The nurse is preparing a teaching tool about abnormal uterine bleeding. Which condition(s) will the nurse identify as being caused by a structural problem? Select all that apply. A. polyps B. leiomyoma C. hyperplasia D. coagulopathy E. ovarian dysfunction

A. polyps B. leiomyoma C. hyperplasia

A patient came to the clinic to evaluate for an ovarian cyst. Which test would the nurse anticipate being done first? A. pregnancy test B. lipid levels C. chlamydia test D. US

A. pregnancy test

A nurse is reading a journal article about care of the woman with pelvic organ prolapse. The nurse would expect to find information related to which disorder? Select all that apply. A. rectocele B. fecal incontinence C. cystocele D. urinary incontinence E. enterocele

A. rectocele C. cystocele E. enterocele

Th nurse counsels a pt recently dx with PCOS. Which of the following should be included in the pt education? A. the need to use reliable birth control B. the importance of annual testing for STIs C. lifestyle behaviors to manage urinary incontinence D. self-care measures for secondary dysmenorrhea

A. the need to use reliable birth control

A couple comes to the clinic and states to the nurse, "I don't think we are ever going to be able to have children. We have been trying but have had no luck." What assessments does the nurse anticipate will be performed for this couple? Select all that apply. A.ovulation monitoring B. fertility drugs C. tubal patency D. in vitro fertilization counseling E. semen analysis

A.ovulation monitoring C. tubal patency E. semen analysis

A client with severe dysmenorrhea is given a presumptive diagnosis of endometriosis. Which treatment(s) will the nurse anticipate being prescribed for this client as first-line therapy? Select all that apply. A. contraceptive implant B. combined oral contraceptive C. medroxyprogesterone injection D. levonorgestrel intrauterine system E. nonsteroidal anti-inflammatory drug

B. combined oral contraceptive E. nonsteroidal anti-inflammatory drug

An obese 37-year-old woman is dx w/ uterine fibroids. The RX prescribed is GnRH. Which side effect will the RN review? A. menopause B. depression C. increased vaginal discharge D. osteoarthritis

B. depression

"I feel like there is a lump in my vagina. It feels like it is sometimes dragging." Which disorder does the RN suspect? A. urinary incontinence B. pelvic organ prolapse C. endocervical polyps D. uterine fibroids

B. pelvic organ prolapse

This method of contraception is used to A. assist with fertility B. used after intercourse to reduce the chance of pregnancy C. used prior to intercourse to prevent pregnancy D. it's a burger joint in Glastonbury

B. used after intercourse to reduce the chance of pregnancy

The nurse is caring for an older adult female client diagnosed with an anterior uterine prolapse. For which conservative treatment(s) will the nurse plan teaching for this client? Select all that apply. A. hysterectomy B. vaginal pessary C. pelvic floor exercises D. uterus suspension surgery E. nonsteroidal anti-inflammatory drugs

B. vaginal pessary C. pelvic floor exercises

Guess what I am • Packaged together in groups of 21 or 28 • Swallow one per day, at the same time each day • Contains hormones • Need a prescription from your health provider

Birth control pills

A patient is interested in emergency contraception due to unprotected intercourse that occurred 1 week ago. What is the best response by the nurse? A. "Emergency contraception may include a progestin intrauterine device." B. "Emergency contraception is only available after a sexual assault." C. "Emergency contraception should be taken within 72 to 120 hours to be effective." D. "A copper intrauterine device may be inserted at this time for emergency contraception."

C. "Emergency contraception should be taken within 72to 120 hours to be effective."

reallygreatsite.com A couple plans to try for a baby after they get married in3 months. Based on their situation, what method of birthcontrol might be best for them? A. A progestin intrauterine device B. A Depo Provera injection C. Condoms D. None of the above

C. Condoms

Care for the patient w/ endometriosis includes several factors. What is one aspect of care for a woman w/ endometriosis? A. explain that this is "just part of being a woman." B. Assist client with decision about birth control options. C. Provide information on likely outcomes of treatment options. D. Explain to client that if she got pregnancy her pain would stop.

C. Provide information on likely outcomes of treatment options.

A woman is 40 years old and a heavy smoker. She has a single sexual partner but has very irregular menstrual cycles. She wants a highly reliable contraceptive. Which method would be the best recommendation? A. an ovulation suppressant B. a spermicidal suppository C. a diaphragm and spermicide D. the rhythm (calendar) method

C. a diaphragm and spermicide

A nurse is reviewing the medical record of a client who has come to the clinic for an evaluation and reproductive life planning with oral contraceptives. Which information, if found on the client's medical record, would alert the nurse to a possible contraindication for oral contraceptive pills (OCPs)? Select all that apply. A. 31 years of age B. sertraline 50mg daily C. history of migraine headaches with an aura D. diabetic retinopathy E. history of deep vein thrombosis

C. history of migraine headaches with an aura D. diabetic retinopathy E. history of deep vein thrombosis

How do endometrial issues cause abnormal uterine bleeding?

Can be inflammation related to STIs - only dx when other disorders r excluded, but no diagnostic tests for it

A woman calls the clinic to report that she has had some cramping and spotting since the insertion of her IUD three days ago. Which instruction would be most appropriate? A> "You'll have to change your method of birth control." B. "Come to the clinic as soon as possible." C. "Take your blood pressure daily for the rest of the month." D. "Consider this normal, because your IUD is newly inserted."

D. "Consider this normal, because your IUD is newly inserted."

A woman is admitted for repair of cystocele/rectocele. She has 9 children. In taking her hx, what would the RN expect? A. sporadic vaginal bleeding accompanied by chronic pelvic pain B. menstrual irregularities and hirsutism on the chin C. heavy leukorrhea with vulvar pruritus D. stress incontinence with feelings of low abdominal pressure

D. stress incontinence with feelings of low abdominal pressure

Which of the following statements is false? A. risks for pelvic prolapse include obesity and having a baby. B. symptoms include vaginal pressure & pelvic pain. C. tx is indicated when woman experiences distressing symptoms D. tx always involves surgery

D. tx always involves surgery

A 56-year-old patient who experienced menopause 4 years ago calls the clinic regarding uterine bleeding. The nurse expects the provider to evaluate the patient for... A. ovarian cancer B. abnormal cervical cells C. perimenopausal symptoms D. uterine cancer

D. uterine cancer

Guess what I am • Need one dose every three months • Contains hormones • A health care provider must inject this into your hip, so you usually need to make an appointment each time

Depo

Guess what I am • These can be used after penis-vagina sex if you suspect a chance of pregnancy • Use as soon as possible after sex; up to 5 days after • These are hard on your body, so only use as a last option and gets lots of rest • You don't need a prescription, and can buy these at many pharmacies or get them at a Community Health Centre

Emergency contraceptive pill

A group of nurses are preparing a presentation about reproductive tract polyps for a local women's group. Which information would the nurses include in the presentation?

Endocervical polyps are most common in women in their 50s.

Guess what I am • Usually made of thin latex • Fits over the penis and keeps sperm from entering the uterus • Can usually get them at a community health centres, online, or at many pharmacies

External Condom

Guess what I am • A small device that is placed into the uterus • Can be hormone-based or copper-based • Lasts between 3 and 5 years • Must be inserted by a health care provider and may be expensive

IUD

Oliomenorrhea

Infrequent uterine bleeding (less than every 28 days)

Guess what I am • Usually made of thin latex • Insert into the vagina up to 4 hours before penis-vagina sex • Creates a barrier so the sperm can't get into the uterus • Can usually get them at a community health centre or online. Some pharmacies carry them

Internal condom

Tx of endometriosis

NSAIDs and hormonal contraception If does not respond to those, she can receive GnRH agonist which produces a hypoestrogenic effect or a laparoscopy for definitive dx and removal of endometrial lesions

First line treatment for dysmenorrhea

NSAIDs and hormonal contraceptives and vitamins

S/s of dyspareunia

Painful urination, itching discharge, bowel changes, foul smell, lesions

Primary vs secondary amenorrhea

Primary amenorrhea is the absence of menarche in females aged >15 years Secondary amenorrhea is the cessation of menstruation for 3 cycles with normal regular cycles previously

Causes of Dysmenorrhea

Primary= absence of another cause 2-5 years after menarche Secondary= underlying cause such as endometriosis or adenomyosis

A client with abnormal uterine bleeding is diagnosed with small ovarian cysts. The nurse has to educate the client on the importance of routine checkups. Which assessment is most appropriate for this client's condition?

Schedule an ultrasound every 3 to 6 months.

Breast cancer stages

Stage I T - <2 cm N - no axillary metastasis M - no metastasis Stage 2 T - >2 cm N - axillary metastasis nonfixed M - no metastasis Stage 3 T - >5 cm N - axillary metastasis fixed M - no metastasis Stage 4 T - any size N - supra or infraclavicular nodes M - distant metastasis

Staging of cancer

TNM system: (T)Size of primary tumor (N)Number of lymph nodes (M) Spread/metastasis of tumor

The nurse is developing a presentation about urinary incontinence for a local women's group. Which of the following would the nurse be least likely to include in the discussion? a. Urinary incontinence is a normal part of aging. b. Urinary incontinence can be prevented. c. Urinary incontinence can be treated. d. Urinary incontinence can often be cured.

a. Urinary incontinence is a normal part of aging.

Symptoms of ovarian cancer

abdominal pain, bloating, and increased abdominal girth

How does cervical cancer develop?

abnormal changes in cervix cells usually result of HPV infection

Genital Tract Fistulas

abnormal passages that develop between the vagina, uterus, or cervix and the bladder, urethra, rectum, abdominal cavity, or perineum

Macromastia - what contributes to this?

abnormally large breasts - ovarian failure, androgen excess, mitral valve prolapse, and CT disorders

Micromastia

abnormally small breasts

What is the most effective form in preventing pregnancy?

abstinence

Contraception considerations Most effective --> least effective

abstinence -> tubal ligation or vasectomy -> LARC

Risks for developing incontinence

aging, past pegnancy, vaginal birth, obesity or family hx

What meds can cause ovulatory dysfunction?

antidepressants, antipsychotics, corticosteroids, and hormonal contraceptives

PCOS diagnostic criteria

at least one indication from the category of abnormal uterine bleeding and one indication from category of evidence of hyperandrogenism - abnormal uterine bleeding pattern: abnormal for age or for time since first menses, symptoms persist for 1 or 2 y - evidence of hyperandrogenism: moderate-to-severe hirsutism, moderate-to-severe acne, persistent lab elevation of testosterone

What are dermoid cysts? - symptoms? - when is it dx?

benign ovarian tumors containing ectodermal, mesodermal, and endodermal tissues - often contain teeth, hair or nails - generally asymptomatic unless torsion or rupture occurs - definitive dx made surgically

What is leiomyoma?

benign tumor of smooth muscle that may cause abnormal, often heavy uterine bleeding and pelvic pain. They can also cause problems with infertility and pregnancy

Long-term consequences of lower estrogen?

bone loss and cardiovascular disease

A client is diagnosed with an enterocele. The nurse interprets this condition as:

bulging of the small intestine through the posterior vaginal wall.

A client is diagnosed with uterine fibroids. When reviewing the client's health history, the nurse would identify which finding as associated with the client's condition?

chronic pelvic pain

Tx of cervical cancer?

cone biopsy, hysterectomy, chemo or radiation

Symptoms of primary and secondary dysmenorrhea

cramps to lower abdomen that may also be felt in the back or thighs, fatigue, HA, diarrhea, nausea, and malaise

When using the standard days method, when should a couple avoid intercourse?

days 8-19 of menstrual cycle

How is later abortion done?

dilation and evacuation

Symptoms of endometriosis

dysmenorrhea, dyspareunia, infertility, pelvic mass, or other pain

What is PCOS

endocrine disorder characterized by ovulatory dysfunction and hyperandrogenism (excess face and body hair and acne)

Types of uterine cancer

endometrial adenocarcinoma and uterine sarcoma

A 67-year-old woman comes into the clinic and reports to the nurse that she has started her periods again after 15 years of menopause. After discussing the situation with her, the nurse recognizes that her symptoms are suspicious for:

endometrial cancer

What is no longer recommended for symptoms of menopause?

estrogen replacement therapy due to risk for CV disease and osteoporosis

Menorrhagia

excessive menstrual bleeding

Tx of dyspareunia

find underlying cause and treat

A nurse assesses and suspects vulvar cancer based on which assessment finding?

fleshy, ulcerated mass on the labia majora

When do follicular cysts occur?

follicle does not rupture during ovulation - commonly with PCOS. Generally asymptomatic unless rupture or torsion occurs

Abnormal uterine bleeding

heavy menstrual bleeding or bleeding between periods PALM (structural causes) COEIN (nonstructural causes) Polyp Adenomyosis Leiomyoma Malignancy & hyperplasia Coagulopathy Ovulatory dysfunction Endometrial Iatrogenic Not yet classified

The nurse is assessing the laboratory test results of a client with abnormal uterine bleeding (AUB). Which finding should the nurse prioritize?

hemoglobin level of 10.1 g/dl (101 g/L)

How is a leiomyoma treated?

hormonal contraception, myomectomy, or hysterectomy

How can adenomyosis be treated?

hormonal contraceptives

Perimenopause symptoms

hot flashes, night sweats, increased anxiety, depression, and insomnia

A woman comes to the clinic for a routine checkup. After obtaining the client's history, the nurse identifies that the client is at increased risk for cervical cancer based on her history of exposure to which virus?

human papillomavirus

Tx of uterine sarcoma?

hysterectomy with/without bilateral salpingo-oophorectomy, followed by staging of cancer to determine further tx

When is a woman's period considered regular?

if difference between shortest and longest cycle is no more than 7-9 days

Least invasive form of abortion

induced labor

Infertility vs subinfertility

infertility - lack of pregnancy after 12 months of well-timed intercourse (6 months if woman is over 35 years old) subinfertility - delay of conceiving, can generally be fixed

What is a way that a woman can avoid intercourse by checking?

knowing symptoms of ovulation - slight temp decrease before ovulation and thinning cervical mucus

How do iatrogenic causes of abnormal uterine bleeding occur?

medical exam or treatment like anticoagulation therapy or IUD

What is asociated with PCOS?

obesity and insulin resistance

What should nurses do for at least 30 minutes after abortion procedure?

observe for s/s of hemorrhage and intraabdominal bleeding by monitoring vitals, pain and bleeding

A 58-year-old client comes to the clinic for evaluation. After obtaining the client's history, the nurse suspects endometrial cancer. Which information would lead the nurse to this suspicion?

onset of painless, bright red postmenopausal bleeding

A nurse is reading a journal article about female reproductive cancers. Which malignancy would the nurse expect to be described as a "silent killer"?

ovarian cancer

Dyspareunia

painful intercourse

Dysmenorrhea

painful menstruation

Tx of incontinence

pelvic floor exercises, weight loss, limiting alcoholic and caffeinated beverages, and avoiding dehydration

A 46-year-old female client develops irregular menstruation, vaginal dryness, and disturbed sleep. About which condition should the nurse provide teaching to the client?

perimenopause

Vulvodynia

persistent vulva pain with unknown cause

How does hyperplasia and malignancy of the endometrium looj like?

postmenstrual bleeding, intermenstrual, or heavy menstrual bleeding that are otherwise unexplained

What does the rhythm method rely on?

predictability of female cycle and timing intercourse

Endometriosis - define - cause

presence of endometrial tissue outside the uterus - cause explained as retrograde menstruation

enterocele

protrusion of bowel

cystocele

protrusion of the bladder

Expected uterine bleeding

q24-38 days

A client with polycystic ovary syndrome (PCOS) is receiving oral contraceptives as part of her treatment plan. When discussing this treatment with the client, the nurse would discuss which rationale for this therapy?

restore menstrual regularity

When assessing a client, a nurse determines that the client has a rectocele based on which finding?

sagging of the rectum, which pushes against or into the posterior vaginal wall

Safe haven laws

state laws that allow mothers to abandon newborns to designated safe facilities without penalty

Tx of endometrial adenocarcinomas?

surgical removal of cancerous tissue followed by chemotherapy and radiation as needed

Myomectomy

the surgical removal of uterine fibroids

A client is diagnosed with stress incontinence. Which finding does the nurse expect to assess in this client?

urine leaking with coughing, laughing, or sneezing

How is surgical abortion done?

uterine aspiration - AKA dilation and curettage

What is adenomyosis?

uterine thickening that occurs when endometrial tissue moves into the muscular walls of the uterus (rather than just lining the uterus) and causes heavy menstrual bleeding and dysmenorrhea

Gynecologic cancers

uterine, cervical, ovarian, vaginal, and vulvar

What is a cardinal sign of endometrial cancer?

vaginal bleeding after menopause

What happens when estrogen levels drop in perimenopause?

vaginal mucosa becomes progressively dry and less elastic

Tx of pelvic prolapse

vaginal pessaries to assist with pelvic organ support, PT, or surgery

How can coagulopathy issues cause heavy menstrual bleeding?

von Willebran d is a common clotting disorder

What are some self-care measures for dysmenorrhea?

warm packs to lower abdomen, exercise and low-fat vegetarian diet

When do corpus luteum cysts occur?

when corpus luteum fails to involute - resolves within a few weeks or months

When can medical abortions be performed? What is usually given?

within 70 days of conception 200 mg of mifepristone followed by 800 ug of misoprostol 6 h later

When is ovulatory dysfunction suspected?

women experience varying cycles for more than one year with blood volumes that vary from light to heavy, but cause often cannot be determined

Can patients with PCOS ovulate?

yes - should be on contraception if they do not want to get pregnancy