Chapter 4: Common Reproductive Issues

A client is seen in the clinic requesting an emergency postcoital contraception pill levonorgestrel (Plan B). The client states that she had unprotected sex 3 ½ days ago. What is the most appropriate response by the nurse?

"Unfortunately you are past the time frame to take that prescription." Levonorgestrel can be taken anytime within 72 hours (3 days) of unprotected sexual activity (pg. 138).

The nurse is reviewing the medical records of several clients. Which client would the nurse expect to have an increased risk for developing osteoporosis?

A thin woman with small bones

After teaching a group of students about the different methods for contraception, the instructor determines that the teaching was successful when the students identify which of the following as a mechanical barrier method? A) Condom B) Cervical cap C) Cervical sponge D) Diaphragm E) Vaginal ring

A) Condom B) Cervical cap C) Cervical sponge D) Diaphragm

After discussing various methods of contraception with a client and her partner, the nurse determines that the teaching was successful when they identify which contraceptive method as providing protection against sexually transmitted infections (STIs)?

Condoms

A client states that she is to have a test to measure bone mass to help diagnose osteoporosis. The nurse would most likely plan to prepare the client for:

DEXA scan

The nurse discusses various contraceptive methods with a client and her partner. Which method would the nurse explain as being available only with a prescription? A)Condom B)Spermicide C)Diaphragm D)Basal body temperature

Diaphragm

Which finding would the nurse expect to find in a client with endometriosis? A) Hot flashes B) Dysuria C) Fluid retention D) Fever

Dysuria

When teaching a group of postmenopausal women about hot flashes and night sweats, the nurse would address which of the following as the primary cause?

Estrogen deficiency

The nurse is reviewing the laboratory test results of a client with dysfunctional uterine bleeding (DUB). Which finding would be of concern? A) Negative pregnancy test B) Hemoglobin level of 10.1 g/dL C) Prothrombin time of 60 seconds D) Serum cholesterol of 140 mg/dL

Hemoglobin level of 10.1 g/dL

When discussing contraceptive options, which method would the nurse recommend as being the most reliable? A)Coitus interruptus B)Lactational amenorrheal method (LAM) C)Natural family planning D)Intrauterine system

Intrauterine system

A client comes to the clinic with abdominal pain. Based on her history the nurse suspects endometriosis. The nurse expects to prepare the client for which of the following to confirm this suspicion? A)Pelvic examination B)Transvaginal ultrasound C)Laparoscopy D)Hysterosalpingogram

Laparoscopy

A client who has come to the clinic is diagnosed with endometriosis. Which of the following would the nurse expect the physician to prescribe as a first-line treatment? A) Progestins B) Antiestrogens C) Gonadotropin-releasing hormone analogues D) NSAIDs

NSAIDs

A woman has opted to use the basal body temperature method for contraception. The nurse instructs the client that a rise in basal body temperature indicates which of the following? A) Onset of menses B) Ovulation C) Pregnancy D) Safe period for intercourse

Ovulation

Which of the following measures would the nurse include in the teaching plan for a woman to reduce the risk of osteoporosis after menopause?

Participating in regular daily exercise

A nurse is describing the criteria needed for the diagnosis of premenstrual dysphoric disorder (PMDD). Which of the following would the nurse include as a mandatory requirement for the diagnosis? A) Appetite changes B) Sleep difficulties C) Persistent anger D) Chronic fatigue

Persistent anger

A nurse should instruct a client who has premenstrual syndrome (PMS) to make which of these lifestyle modifications?

Reduce caffeine, walk several times a week, use relaxation techniques, and maintain a regular sleep schedule (pg. 123).

A nurse supervisor observes a nurse massage a client's injection site after giving a dose of depot medroxyprogesterone acetate (Depo-Provera). What is the priority response by the nurse supervisor?

Remind the nurse that this injection should absorb slowly. The medication should absorb slowly from the muscle, so the nurse supervisor should remind the nurse not to rub the injection site following administration (pg. 147).

The nurse has been working with a subfertile couple through the process of determining their best plan of action to conceive a child. Which action should the nurse prioritize to provide emotional support to this couple?

Speak both separately and together with both partners. Talking with both partners together may be advantageous, because this may make them feel more comfortable to discuss their problem. On the other hand it is important to spend time alone with each partner, in case there is something one person wants to discuss privately. Both partners are the client in this case (pg. 130).

Which of the following would the nurse emphasize when teaching postmenopausal women about ways to reduce the risk of osteoporosis?

Taking calcium supplements

A client reports that she has multiple sex partners and has a lengthy history of various pelvic infections. She would like to know if there is any temporary contraceptive method that would suit her condition. Which method should the nurse suggest for this client?

condoms Because the client has multiple sex partners, condoms will help offer protection against sexually transmitted infections (STIs) and are best suited for her needs. The client cannot use an IUD because of her history of various pelvic infections (pg. 141).

A nurse is reviewing the history and physical examination of a client diagnosed with secondary dysmenorrhea for possible associated causes. Which etiology would the nurse need to keep in mind as being the most common?

endometriosis Secondary dysmenorrhea is painful menstruation due to pelvic or uterine pathology. Endometriosis is the most common cause of secondary dysmenorrhea. Other recognized causes include adenomyosis, fibroids, pelvic infection, an intrauterine device, cervical stenosis, or congenital uterine or vaginal abnormalities (pg. 137).

A young woman says she needs a temporary contraceptive but has a latex allergy. She mentions that she has had a papillomavirus infection. Also, she says she is terrible about remembering to take pills. Which method should the nurse recommend?

transdermal contraception The fact that this woman has a latex allergy rules out the cervical cap and diaphragm. Moreover, the diaphragm is *contraindicated* in her case due to her *papillomavirus infection*. The best choice for her is transdermal contraception, which involves wearing a patch for a week at a time and does not require taking pills daily (pg. 147).

A female client comes to the clinic and asks the nurse what would be the most cost-effective method for her to determine her ovulation patterns. What is the best response by the nurse?

"The least costly method to determine ovulation patterns is to record the basal body temperature for at least 4 months." (pg. 139)

A woman comes to the clinic because she has been unable to conceive. When reviewing the woman's history, which of the following would the nurse *least* likely identify as a possible risk factor? A) Age of 25 years B) History of smoking C) Diabetes since age 15 years D) Weight below standard for height and age

Age of 25 years

When reviewing the medical record of a client diagnosed with endometriosis, which of the following would the nurse identify as a *risk factor* for this woman? A) Low fat in the diet B) Age of 14 years for menarche C) Menstrual cycles of 24 days D) Short menstrual flow

C) Menstrual cycles of 24 days

When developing a teaching plan for a couple considering contraception options, which of the following statements would the nurse include? A)You should select one that is considered to be 100% effective. B)The best one is the one that is the least expensive and most convenient. C)A good contraceptive doesn't require a physicians prescription. D)The best contraceptive is one that you will use correctly and consistently.

The best contraceptive is one that you will use correctly and consistently.

After teaching a group of students about premenstrual syndrome, the instructor determines that *additional teaching* is needed when the students identify which of the following as a prominent assessment finding? A) Bloating B) Tension C) Dysphoria D) Weight loss

Weight loss

A nurse is preparing a class for a group of women at a family planning clinic about contraceptives. When describing the health benefits of oral contraceptives, which of the following would the nurse most likely include? SATA A) Protection against pelvic inflammatory disease B) Reduced risk for endometrial cancer C) Decreased risk for depression D) Reduced risk for migraine headaches E) Improvement in acne

A) Protection against pelvic inflammatory disease B) Reduced risk for endometrial cancer E) Improvement in acne

A nurse is preparing a class for a group of young adult women about emergency contraceptives (ECs). Which of the following would the nurse need to stress to the group. SATA A) ECs induce an abortion like reaction. B) ECs provide some protection against STIs C) ECs are birth control pills in higher, more frequent doses D) ECs are not to be used in place of regular birth control E) ECs provide little protection for future pregnancies.

C) ECs are birth control pills in higher, more frequent doses D) ECs are not to be used in place of regular birth control E) ECs provide little protection for future pregnancies.

A couple comes to the clinic for a fertility evaluation. The male partner is to undergo a semen analysis. After teaching the partner about this test, which client statement indicates that the client has understood the instructions?

I have to abstain from sexual activity for about 12 days before the sample.

After the nurse teaches a client about ways to reduce the symptoms of premenstrual syndrome, which client statement indicates a need for *additional teaching*? A) I will make sure to take my estrogen supplements a week before my period. B) I've signed up for an aerobic exercise class three times a week. C) I'll cut down on the amount of coffee and colas I drink. D) I quit smoking about a month ago, so that should help.

I will make sure to take my estrogen supplements a week before my period.

After assessing a woman who has come to the clinic, the nurse suspects that the woman is experiencing dysfunctional uterine bleeding. Which statement by the client would support the nurses suspicions? A) I've been having bleeding off and on that's irregular and sometimes heavy. B) I get sharp pain in my lower abdomen usually starting soon after my period comes. C) I get really irritable and moody about a week before my period. D) My periods have been unusually long and heavy lately.

I've been having bleeding off and on that's irregular and sometimes heavy.

A woman using the cervical mucus ovulation method of fertility awareness reports that her cervical mucus looks like egg whites. The nurse interprets this as which of the following? A) Spinnbarkeit mucus B) Purulent mucus C) Postovulatory mucus D) Normal preovulation mucus

Spinnbarkeit mucus

A client is to receive an implantable contraceptive. The nurse describes this contraceptive as containing: A)Synthetic progestin B) Combined estrogen and progestin C) Concentrated spermicide D)Concentrated estrogen

Synthetic progestin

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 diaphragm and spermicide Women over 40 who smoke should not take ovulation suppressants; irregular menstrual cycles make natural methods difficult; women over 40 may have vaginal dryness, so a spermicidal suppository would not be activated (pg. 136).