Ch. 47- Nursing Care of a Family When a Child Has a Reproductive Disorder

Which symptoms would the nurse expect to find in a client who has been diagnosed with trichomoniasis? Select all that apply.

genital inflammation white-gray vaginal discharge petechiae on the upper vagina Genital inflammation, white-gray discharge, and pruritis are usual symptoms of an acute episode of trichomoniasis. Fever and vomiting are not associated with this condition.

The nurse is caring for a client experiencing amenorrhea. Which statement(s) by the client suggest a potential cause for experiencing amenorrhea? Select all that apply.

"I am expecting a baby on March 23rd." "I recently lost my job and am having difficulty finding another one." "I have been experiencing intense anxiety when leaving my home." "I feel fatigued every day, even when I awaken." Amenorrhea is when a female client who has a history of menstruating has an absence of menstrual flow. Amenorrhea is a primary sign of pregnancy, and is confirmed when a client states that they are expecting a baby. Amenorrhea may also occur following times of stress, anxiety, and fatigue. Excessive exercise, such as that undertaken by a competitive swimmer or a long-distance runner, may cause amenorrhea, but not exercising for 1 hour four times per week. Extreme conditions of dieting, but not modifying the diet, will cause amenorrhea.

A 15-year-old client is diagnosed with mittelschmerz and spotting. The client is upset about the diagnosis, stating, "I think I have appendicitis or something else." What is an appropriate response by the nurse?

*"You seem very upset. Is something else worrying you?"* When 15-year-old clients are ill, it can be a stressful time for them. At this age, a client 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 them. The other statements do not acknowledge the client's feelings. Telling the client the health care provider feels strongly or everything is fine closes communication. Stating that the client is wrong because the appendix is on the opposite side also impairs communication.

During the client history interview, the adolescent client tells the nurse that she often experiences pain with her menstrual periods. When gathering additional information, which question will the nurse ask next?

*"Do you have any nausea or vomiting when you have the pain?"* The next question for the nurse to ask relates directly to the topic of pain. Nausea, vomiting, dizziness, or loose stools are symptoms commonly associated with pain with menstruation (dysmenorrhea). A malodorous discharge suggests an infection. The adolescent is describing menstrual cramps; these are unrelated to pregnancy. Although obtaining information about the amount of the adolescent's menstrual flow is important, it is unrelated to the adolescent's concern.

An older adolescent is scheduled to undergo surgical augmentation of her breasts. After teaching the adolescent about what to expect after the surgery, the nurse determines that the teaching was successful when the adolescent states which of the following?

*"I might notice a decrease in the sensation in my nipples for a bit."* A woman may notice decreased nipple sensation for approximately 1 year after an implant procedure. During augmentation, an incision is made under the breast, and either a silicone or saline implant is inserted under the breast tissue, next to the musculus pectoralis major. It is important for the adolescent to realize that her breast tissue is not being replaced by the implant; she could still develop breast cancer in later years. Breasts with implants in place may feel firmer than normal on palpation because of the formation of a fibrotic band or capsule around the implant. Breast implants do not interfere with breastfeeding, because they are placed behind the milk glands.

An adolescent female client reports experiencing abdominal pain about halfway through her menstrual cycle. The adolescent describes the pain and asks the nurse why it is occurring. How should the nurse respond?

*"The pain most likely occurs when the egg is released from the ovary."* Mittelschmerz refers to unilateral abdominal pain that usually occurs midway through the menstrual cycle. This pain can vary from a few sharp cramps to several hours of crampy pain. The pain occurs during ovulation and is thought to occur when the egg is released from the ovary. The pain does not occur as a result of hormone changes or ovary enlargement. The pain is "normal" and benign and does not require further testing.

Which nursing action is appropriate when obtaining a gynecologic history from a 13-year-old client?

*Ensure the client is fully covered during the interview.* It is appropriate for the nurse to provide privacy by making sure the client is either clothed or fully covered when discussing the gynecologic history. A sense of modesty is important to a 13-year-old client. This will make the client more comfortable overall and, in particular, when discussing personal issues. It is the client's choice they would like the parent present. Specific questioning may be needed to fully understand client symptoms to document status. Although general topics about school may be fine to discuss, specifically asking about dating may not be appropriate at this age. It is also more inclusive to ask about an attraction or interest and not specify that it is the opposite sex.

A nursing instructor is teaching students about breast disorders in children. The instructor determines that the teaching was successful when the students identify which of the following as the most common benign breast condition in women, regardless of age?

*fibrocystic breast disease* Although mastitis (usually occurring as a complication of breastfeeding), fibroadenomas, and accessory nipples can occur, fibrocystic breast disease is the most common benign breast condition in women of all ages.

An adolescent comes to the clinic reporting vaginal bleeding between menstrual periods and tells the nurse she thinks it is cancer. When further assessing possible causes of this abnormal bleeding in the client's history, which events will the nurse highlight as possible causes for bleeding without being related to cancer. Select all that apply.

*hormonal birth control use* During the assessment of the abnormal bleeding, the nurse is correct to identify sources of bleeding that are not correlated with cancer. Bleeding between periods may occur in adolescents taking oral contraceptives during the first 3 to 4 months of use. It is normal in some adolescents to have spotting during ovulation. Also, a recent history of a vaginal infection could cause bleeding. There is no association with recreational marijuana use or anorexia nervosa. With anorexia nervosa, amenorrhea is common due to excessive dieting.

What is a clinical manifestation of pelvic inflammatory disease (PID)? Select all that apply.

*lower severe abdominal pain, purulent vaginal discharge, fever* Abdominal pain, purulent discharge, and fever are clinical manifestations associated with pelvic inflammatory disease. Decreased appetite is not a clinical symptom of PID.

An adolescent is diagnosed with a trichomonal infection. Which medication would the nurse include when teaching the adolescent about treatment for this infection?

*metronidazole* Metronidazole is used to treat a trichomonal infection. Miconazole is used to treat candidiasis. Doxycycline is used to treat a chlamydial infection. Acyclovir is used to treat herpes genitalis. Ceftriaxone is used to treat gonorrhea.

Which condition is a risk factor for the development of pelvic inflammatory disease (PID)?

*multiple sexual partners* 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.

The nurse is assessing a female client with genital herpes. Which finding would the nurse expect?

*multiple vesicles on the introitus* Genital herpes causes single or multiple vesicles on the penis, prepuce, buttocks, thighs, introitus, or cervix that burn and itch before becoming fluid filled blisters. Lower abdominal pain is typically associated with chlamydia infection. Soft fleshy growths on the perineum suggest genital warts. A painful genital ulcer suggests chancroid.

A client diagnosed with dysmenorrhea has several medications prescribed. Which medication should the nurse question?

*oxycodone* NSAIDS and mild pain relievers such as acetaminophen and ibuprofen are prescribed for this condition. Oral contraceptives prevent ovulation. Oxycodone is not indicated for long-term therapeutic management of pain.

A nurse is caring for an adolescent diagnosed with toxic shock syndrome. As part of the nursing care for this client, the nurse would anticipate which interventions? Select all that apply.

Use of menstrual pads and avoidance of tampons Iodine douching Cervical and vaginal cultures Clients diagnosed with toxic shock syndrome should be advised to refrain from tampon use and use menstrual pads with menstruation or vaginal discharge. Cervical and vaginal culture should be performed to correctly interpret the causative organism. Oral contraceptives are not effective in the treatment of toxic shock syndrome. A diet high in protein would not be indicative for this client.