4. Menstruation & Menopause

menopause health risks (2)

-osteoporosis (secondary to ↓ bone density) -coronary artery disease (CAD)

TSS risk factors (4)

-tampons (prolonged use, overnight use, immediately after childbirth) -diaphragm -cervical cap -cervical sponge (occluding the cervical os, trapping menstrual flow for prolonged periods)

treatment for primary dysmenorrhea (4)

-NSAIDs -oral contraceptives (decreases prostaglandin levels) -heat application (lower abdomen or back) -exercise (regulates prostaglandin production)

nonhormonal drugs for menopause (3)

-SSRI antidepressants -clonidine (antihypertenstive) -gabapentin (antiseizure) (alleviate vasomotor symptoms)

menopause

-absence of menses x 1 year -average age: 51 yrs

climacteric

-aka "change of life" (often used synonymously with menopause) -refers to the psychologic and physical alterations that occur around the time of menopause

benefits of HRT (3)

-alleviates vasomotor symptoms (hot flashes, night sweats) -prevents atrophy of vaginal tissue -minimizes bone loss, reduces risk of fractures due to osteoporosis

alternative therapies for ↓ menopause symptoms (4)

-black cohosh -ginseng -soy -yoga

secondary dysmenorrhea

-pelvic disease is the underlying cause (ex: endometriosis, PID) -occurs after adolescence (30-40 yrs) -worsens with aging

pt teaching: reducing risk of osteoporosis (6)

-regular weight-bearing exercise -↑ calcium intake -vitamin D supplements -avoid caffeine -avoid alcohol -avoid tobacco

menopause symptoms: genitourinary (3)

-vaginal atrophy -vaginal dryness -incontinence

menopause symptoms: cardiovascular (2)

-↓ HDL -↑ LDL

average age of menarche

12.4 years can occur from 9-17 years

The nurse is performing an assessment on a client admitted to the hospital who was diagnosed with toxic shock syndrome (TSS). Which assessment question would assist in eliciting the most specific data regarding the cause of this syndrome? 1. "Did you start your menses at an early age?" 2. "Have your menstrual periods been irregular?" 3. "Do you use tampons during your menstrual period?" 4. "Have you been consuming a high intake of green leafy vegetables?"

3. "Do you use tampons during your menstrual period?" (TSS is caused by infection and is often associated with tampon use) NCLEX

What symptoms are seen in a client who experiences secondary dysmenorrhea? Select all that apply. A. Feelings of bloating B. Poor concentration C. Heavy menstrual flow D. Lower abdominal aching E. Gastrointestinal bleeding

A. Feelings of bloating C. Heavy menstrual flow D. Lower abdominal aching

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

B. It may be caused by stress or excessive exercise or both.

A 57-year-old is having a routine physical examination. Which of the following questions would yield information about her menopausal status? What is her: A. Weight pattern - more than 5 pounds in the last year? B. Nightly sleep patterns? C. Cultural background? D. Pregnancy history?

B. Nightly sleep patterns? disc

The nurse advises a client to start drinking cranberry and watermelon juice regularly 10 days before the expected onset of menses. Which client complaint is the nurse addressing? A. Back pain due to menses B. Peripheral edema before menses C. Nausea associated with menses D. Abdominal cramps due to menses

B. Peripheral edema before menses (Cranberry and watermelon juice are natural diuretics that help to prevent fluid retention)

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

C. "A hot bath or heating pad may help the problem."

Which statement made by a preteen girl indicates successful adaptation to menarche? a. "My cycle should occur every 28 days and last about 5 days." b. "I won't need to wear protection on the last few days of my period." c. "My cycle should occur every 20 days and last about 3 days." d. "Super-absorbent tampons are the best for teenagers."

a. "My cycle should occur every 28 days and last about 5 days."

A 16-year-old client states that she started her period when she was 14, but has not had a period in about 6 months, since she won a state track championship and has started training for nationals. What is the most likely cause for her amenorrhea? a. Low body fat b. Testicular feminization c. Thyroid dysfunction d. Adrenal dysfunction

a. Low body fat

A young woman states that her menstrual cycle occurs every 20 days. What additional data should the nurse gather? a. The amount of flow per cycle b. Type of protection used c. Mother's age at menopause d. Number of sexual partners

a. The amount of flow per cycle

Which manifestations of menopause are related to estrogen deficiency? (select all that apply) a. cessation of menses b. breast engorgement c. vasomotor instability d. reduction of bone fractures e. decreased cardiovascular risk

a. cessation of menses c. vasomotor instability (vasomotor instability = hot flashes) MS workbook

A 20-year-old woman reports to the nurse about her menstrual flow. Which statement made by the client would be cause for further investigation? a. "I've saturated one tampon today." b. "I had to change my maxi pad at least 14 times today." c. "A panty liner is sufficient to maintain my flow." d. "I always wear tampons, because they are easier to use."

b. "I had to change my maxi pad at least 14 times today."

A client at the family planning clinic is diagnosed with primary dysmenorrhea. What should be included in the nurse's teaching plan for nonpharmacologic comfort measures? a. Initiation of oral contraception b. Application of cold to the abdomen c. Balanced meals and adequate rest d. Regular emotional counseling

c. Balanced meals and adequate rest

Upon reviewing the client's chart, which piece of data would suggest to the nurse the primary healthcare provider may diagnose endometriosis? a. Back discomfort and dysphagia b. Ovarian pain and dysuria c. Pelvic cramping and dyspareunia d. Vaginal discharge and dysmenorrhea

c. Pelvic cramping and dyspareunia (Most common symptom is pelvic pain. Other symptoms: dysmenorrhea, dyspareunia, abnormal uterine bleeding, infertility)

A young woman who runs vigorously as a form of exercise has not had a menstrual period in more than 6 months. What should the nurse teach her? a. normal periods will return when she stops running b. uterine balloon therapy may be necessary to promote uterine sloughing of the overgrown endometrium c. progesterone or combined oral contraceptives should be used to prevent overgrowth of the endometrium d. unopposed progesterone production causes an overgrowth of the endometrium that increases her risk for endometrial cancer

c. progesterone or combined oral contraceptives should be used to prevent overgrowth of the endometrium MS workbook

What is the rationale for the regular use of nonsteroidal antiinflammatory drugs (NSAIDs) during the first several days of the menstrual period for women who have primary dysmenorrhea? a. they suppress ovulation and the production of prostaglandins that occur with ovulation b. they cause uterine relaxation and small vessel constriction, preventing cramping and abdominal congestion c. they inhibit the production of prostaglandins believed to be responsible for menstrual pain and associated symptoms d. they block the release of lutenizing hormone, preventing the increase in progesterone associated with maturation of the corpus luteum

c. they inhibit the production of prostaglandins believed to be responsible for menstrual pain and associated symptoms MS workbook

An appropriate question to ask the patient with painful menstruation to differentiate primary from secondary dysmenorrhea is: a. "Does your pain become worse with activity or overexertion?" b. "Have you had a recent personal crisis or change in lifestyle?" c. "Is your pain relieved by NSAIDs?" d. "When in your menstrual history did the pain with your period begin?"

d. "When in your menstrual history did the pain with your period begin?" (Primary dysmenorrhea starts 12 to 24 hours before the onset of menses. The pain is most severe on the first day of menses and rarely lasts more than 2 days. Secondary dysmenorrhea usually occurs after the woman has experienced problem-free periods for some time.) MS

Which content area is important to include in a teaching plan presented to young girls to assist them in preventing toxic shock syndrome? a. Change pads every 3-4 hours and wash hands before application. b. Change pads every 1-2 hours and wash hands after application. c. Change tampons every 6-8 hours and wash hands before insertion. d. Change tampons every 3-6 hours and wash hands before insertion.

d. Change tampons every 3-6 hours and wash hands before insertion.

A nurse is teaching a group of college women about prevention of toxic shock syndrome (TSS). Which of the following statements should be included in the seminar? a. Usually, the causative organism of TSS is a toxin released by a strain of Pseudomonas aeruginosa. b. Hypertension is often seen in clients with TSS. c. To avoid TSS, tampons should be changed every 6-9 hours. d. If you get a rash or a fever while using tampons, go to the doctor immediately.

d. If you get a rash or a fever while using tampons, go to the doctor immediately.

when during menstrual cycle does ovulation occur?

day 14

day 1 of menstrual cycle

first day of menstruation

dysmenorrhea

painful menstruation with abdominal cramping

length of menstrual cycle

typically 28 days can range from 23-35 days

menorrhagia

-excessive menstrual bleeding - amount and duration -saturates more than 1 tampon or pad per hour

perimenopause

-the time before menopause when ovarian function wanes and hormonal deficiencies begin to produce symptoms -perimenopause = irregular menstrual cycles (lighter, heavier, shorter, less frequent) -menopause = cessation of menses

toxic shock syndrome (TSS)

bacterial infection caused by Staphylococcus aureus found primarily in women of reproductive age

TSS symptoms (6)

-fever -hypotension (systolic ↓90 mmHg) -rash -vomiting -diarrhea -decreased LOC, disorientation, coma

amorrhea

absence of menses

menopause symptoms: integumentary (3)

-changes in hair amount and distribution (ex: loss of pubic hair) -decreased skin elasticity -breast tissue changes

When assessing an aging adult woman, what does the nurse note as a normal finding? a. rectocele b. larger breasts c. vaginal dryness d. severe osteoporosis

c. vaginal dryness MS workbook

metorrhagia

-bleeding between menstrual periods -common in adolescents and women entering menopause

HRT risks (5)

-breast cancer (long-term use) -endometrial cancer (estrogen-only HRT) -stroke -thromboembolism, deep-vein thrombosis -MI

primary dysmenorrhea

-caused by elevated prostaglandin levels (no pathologic condition exists) -common in adolescents and young women -decreases after childbirth or with aging

2 types of hormone replacement therapy (HRT)

-combined estrogen-progesterone therapy (for women with a uterus) -estrogen only therapy (for women without a uterus post-hysterectomy)

menopause symptoms: vasomotor (3)

-hot flashes -night sweats -irregular menses

menopause symptoms: psychologic (4)

-mood swings -insomnia -changes in sleep pattern -decreased REM sleep

A client is seen in the health care clinic and is diagnosed with mild anemia. The anemia is believed to be a result of the menstrual period. The woman asks the nurse how much blood is lost during a menstrual period. The nurse plans to respond by stating which amount of blood is lost during this time? 1. 40 mL 2. 60 mL 3. 80 mL 4. 100 mL

1. 40 mL NCLEX

A preadolescent client asks the nurse about the onset of puberty. The nurse describes which changes as indicating puberty? Select all that apply. 1. Mood swings occur. 2. Pubic hair will develop. 3. Breast development begins. 4. Uterus matures to adult size. 5. Height will increase due to a growth spurt.

1. Mood swings occur. 2. Pubic hair will develop. 3. Breast development begins. 5. Height will increase due to a growth spurt. NCLEX

The nurse is caring for a client with a diagnosis of endometriosis. The client asks the nurse to describe this condition. How should the nurse respond? Select all that apply. 1. "It causes the cessation of menstruation." 2. "It is pain that occurs during ovulation." 3. "It is the presence of tissue outside the uterus that resembles the endometrium." 4. "It is also known as primary dysmenorrhea and causes lower abdominal discomfort." 5. "Major symptoms of endometriosis are pelvic pain, dysmenorrhea, and dyspareunia."

3. "It is the presence of tissue outside the uterus that resembles the endometrium." 5. "Major symptoms of endometriosis are pelvic pain, dysmenorrhea, and dyspareunia." NCLEX

An adolescent seen in the health care clinic has been diagnosed with endometriosis. The client asks the clinic nurse to describe this condition. Which response should the nurse provide? 1. "It always causes infertility." 2. "It causes the cessation of menstruation." 3. "It is the presence of tissue outside the uterus." 4. "It is also is known as primary dysmenorrhea."

3. "It is the presence of tissue outside the uterus." NCLEX

A gymnast reports she has not had her menstrual period for the past 2 months. After assessment, the nurse finds that the client is stressed out by excessive training. What advice should the nurse give the client for managing stress? Select all that apply. A. "Reduce your physical workout." B. "Increase your nutrition intake." C. "Lower your caloric intake." D. "Engage in regular physical activity." E. "Meditate or do power yoga."

A. "Reduce your physical workout." B. "Increase your nutrition intake." E. "Meditate or do power yoga."

Which dietary changes will help reduce systemic symptoms associated with dysmenorrhea? Select all that apply. A. Consumption of a low-fat vegetarian diet B. Increased calcium intake during menses C. Consumption of asparagus and cranberry juice D. Decreased salt intake 7 to 10 days before menses E. Increased sugar intake 7 to 10 days before menses

A. Consumption of a low-fat vegetarian diet C. Consumption of asparagus and cranberry juice D. Decreased salt intake 7 to 10 days before menses A low-fat vegetarian diet will help minimize dysmenorrheal symptoms such as weakness and dizziness. Asparagus and cranberry juice are natural diuretics and will help reduce edema. Decreasing salt intake 7 to 10 days before menses helps reduce fluid retention.

What should the nurse stress in teaching a woman to deal with the symptoms of premenstrual syndrome (PMS)? A. Decrease her consumption of caffeine. B. Drink a small glass of wine with her evening meal. C. Decrease her fluid intake to prevent fluid retention. D. Eat three large meals a day to maintain glucose levels.

A. Decrease her consumption of caffeine. Caffeine increases irritability, insomnia, anxiety, and nervousness. Alcohol aggravates depression and should be avoided. Fluid intake should not be decreased. Three small to moderate meals and three snacks a day can help relieve symptoms.

What are the possible causes of menorrhagia in a client? Select all that apply. A. Obesity B. Fibroids C. Endometritis D. Chemotherapy E. Diabetes mellitus

A. Obesity B. Fibroids C. Endometritis D. Chemotherapy (menorrhagia = excessive menstrual bleeding)

Which of the following are examples of differences between primary and secondary dysmenorrhea? (Select all that apply.) A. The pain associated with primary radiates to the back and thighs. B. With primary, the pain originates at the beginning of menses. C. With secondary, the pain can occur also during ovulation. D. With primary, the patient often complains of abdominal bloating. E. With primary, the patient often presents with systemic symptoms such as dizziness and headache.

A. The pain associated with primary radiates to the back and thighs. B. With primary, the pain originates at the beginning of menses. C. With secondary, the pain can occur also during ovulation. E. With primary, the patient often presents with systemic symptoms such as dizziness and headache. (In secondary dysmenorrhea, pain can also occur during ovulation, whereas in primary dysmenorrhea, the pain is associated only with ovulatory cycles.)

What does the nurse assess to detect the cause of amenorrhea in a client? Select all that apply. A. Obesity B. Pregnancy C. Malnutrition D. Exercise regimen E. Urinary tract infection

B. Pregnancy C. Malnutrition D. Exercise regimen

Following the presentation on BSE, which of the following statements by a participant would indicate she is correctly performing BSE? A. "I begin by placing the palm of my right hand on the nipple of my left breast." B. "I don't like to press very hard because I have very tender breasts." C. "I use the tips of my middle three fingers on each hand to feel each breast." D. "I feel for lumps while standing in front of a mirror."

C. "I use the tips of my middle three fingers on each hand to feel each breast." disc

The local YWCA is having a series of seminars on health-related topics and you have been invited to discuss breast self-examination (BSE). Which of the following would be appropriate to teach regarding the timing of BSE by women of reproductive age? A. At the end of each menstrual cycle B. At the beginning of each menstrual cycle. C. Approximately 7-10 days after the beginning of the menstrual cycle D. Approximately 7-10 days prior to the beginning of the menstrual cycle.

C. Approximately 7-10 days after the beginning of the menstrual cycle disc

Which finding is not associated as a health risk with menopause? A. Osteoporosis B. Coronary heart disease C. Breast cancer D. Obesity

C. Breast cancer

An effective relief measure for primary dysmenorrhea is to: A. Reduce physical activity level until menstruation ceases. B. Begin taking prostaglandin synthesis inhibitors on the first day of the menstrual flow. C. Decrease intake of salt and refined sugar about 1 week before menstruation is about to occur. D. Use barrier methods rather than the oral contraceptive pill (OCP) for birth control.

C. Decrease intake of salt and refined sugar about 1 week before menstruation is about to occur.

A client has been prescribed nonsteroidal antiinflammatory drugs (NSAIDs) for the treatment of primary dysmenorrhea. Which instruction is important for this client? A. "Increase salt and sugar in your diet." B. "Avoid cranberry or watermelon juice." C. "Report any symptoms of nausea and vomiting." D. "Report dark-colored stools immediately."

D. "Report dark-colored stools immediately." (NSAIDs increase risk of GI bleed)

A menopausal woman takes calcium supplements on a daily basis. She can reduce the danger of renal calculi by simply: A. Chewing her calcium tablets rather than swallowing them whole. B. Swallowing her calcium tablets with cranberry juice. C. Eliminating other sources of calcium from her diet. D. Drinking 2-3 quarts of water daily.

D. Drinking 2-3 quarts of water daily. disc

The nurse is teaching a group of high school students about different strategies to manage primary dysmenorrhea. The nurse tells them to place a heating pad over the abdomen when pain is severe. How would this strategy help in reducing dysmenorrheal pain? A. Blocking pain perception B. Releasing endogenous opiates C. Relaxing the paravertebral muscles D. Increasing blood supply to the uterus

D. Increasing blood supply to the uterus

Which statement is true about primary dysmenorrhea? A. It is experienced by all women. B. It is unaffected by oral contraceptives. C. It occurs in young, multiparous women. D. It may be caused by excessive endometrial prostaglandin.

D. It may be caused by excessive endometrial prostaglandin. (dysmenorrhea = painful menstruation)

A nurse is reviewing the medical record for a client who is menopausal. Which of the following findings should the nurse expect? (select all that apply) a. increased vaginal secretions b. decreased bone density c. increased HDL level d. decreased skin elasticity e. increased pubic hair growth f. decreased follicle stimulating hormone level

b. decreased bone density d. decreased skin elasticity ATI MS

A school nurse is providing an education session about menstruation with a group of adolescent female students. Which of the following statements should the nurse include? (select all that apply) a. "The average age of onset of menstruation is 10." b. "The range for a typical menstrual cycle is between 23 and 35 days." c. "The 1st day of the menstrual cycle begins with the last day of the menstrual period." d. "Ovulation typically occurs around the 14th day of the menstrual cycle." e. "A menstrual period can last as long as 9 days."

b. "The range for a typical menstrual cycle is between 23 and 35 days." d. "Ovulation typically occurs around the 14th day of the menstrual cycle." e. "A menstrual period can last as long as 9 days." -average age for onset of menstruation is 12.4 -1st day of menstrual cycle begins with last day of menstrual period ATI MS

The nurse is requested to educate an adolescent female patient about menstruation. What is important for the nurse include when educating the adolescent? a. The length of the menstrual cycle should be 28 days. b. Menstrual cycles are often irregular for the first 1 to 2 years. c. The female loses approximately 1 cup of blood with each menstrual period. d. Follicle-stimulating hormone (FSH) causes full maturity of the follicle for ovulation.

b. Menstrual cycles are often irregular for the first 1 to 2 years. MS

A 51-yr-old woman suffered a wrist fracture when she slipped on ice. She has her uterus and is interested in starting hormone replacement therapy (HRT), as she is also experiencing menopause symptoms. What should the nurse include when discussing the risks and benefits of HRT with this pt? a. taking only progesterone is suggested for a woman with a uterus b. taking both estrogen and progesterone may decrease her bone loss c. the risk of breast cancer and cardiovascular disease is decreased with HRT d. taking estrogen and progesterone will increase the risk of endometrial cancer

b. taking both estrogen and progesterone may decrease her bone loss -combination HRT (estrogen and progesterone) is recommended for women with a uterus -HRT increases risk for breast cancer -HRT decreases risk for endometrial cancer MS workbook

An age-related finding during the assessment of the older woman's reproductive system is: a. dysparenia b. vaginal atrophy c. nipple enlargement d. increased vulvar skin turgor

b. vaginal atrophy MS

A 15-year-old female client experiences extreme stress due to schoolwork, which has led to an eating disorder and significant weight loss. Which condition is likely to be seen in the client? a. Dysmenorrhea b. Hypothyroidism c. Hypogonadotropic amenorrhea d. Premenstrual dysphoric disorder

c. Hypogonadotropic amenorrhea (stress and eating disorders result in hypothalamic suppression, which may further lead to hypogonadotropic amenorrhea)

An older adult female patient reports hair growing on her chin. How should the nurse explain this occurrence to this patient? a. There is too much estrogen in your body. b. There must not be enough testosterone in your body. c. The estrogen in your body is decreased since menopause. d. The negative feedback system for your hormones is working.

c. The estrogen in your body is decreased since menopause. MS

To prevent or decrease age-related changes that occur after menopause in a pt who chooses not to take hormone therapy, the most important self-care measure to teach is: a. maintaining usual sexual activity b. increasing the intake of dairy products c. performing regular aerobic, weight-bearing exercise d. taking vitamin E and B-complex vitamin supplements

c. performing regular aerobic, weight-bearing exercise (Aerobic and weight-bearing exercises can slow the process of bone loss and a tendency toward weight gain. Exercise is important for menopausal women in modifying risk factors for coronary artery disease, including stress, obesity, physical inactivity, and hypertension. MS

A nurse is educating a group of clients about the risk factors for developing toxic shock syndrome (TSS). Which statement by a client would indicate that she would benefit from more teaching on the risk factors of TSS? a. "I should alternate using tampons and pads during my period." b. "We should use a condom in place of my diaphragm during my period." c. "I should change my tampon every 3-6 hours during my period." d. "I can use tampons as soon as I want to after I have a baby."

d. "I can use tampons as soon as I want to after I have a baby." (tampons should be avoided for 6-8 weeks following childbirth)