Chapter 4: Common Reproductive Issues

The client has heard of extended oral contraceptive regimens and desires more information. The nurse explains that these regimens consist of _____ consecutive days of active combination pills, followed by _____ days of placebo pills. a. 84; 7 b. 42; 4 c. 70; 6 d. 56; 5

a. 84; 7 (Rationale: Research has confirmed that the extended use of active OC pills carries the same safety profile as the conventional 28-day regimens. The extended regimen consists of 84 consecutive days of active combination pills, followed by 7 days of placebo. The woman has four withdrawal-bleeding episodes a year.)

The nurse considers the contraceptive class at the college dormitory to be effective when the students understand that the effectiveness of oral contraceptives (OCs) can be decreased if they take: a. Antibiotics b. Cold remedies c. Antihistamines d. Vitamin supplements

a. Antibiotics (Rationale: The effectiveness of OCs is decreased when the woman is taking antibiotics, thus the woman will need to use an alternative or secondary method during this period to prevent pregnancy.)

A 16-year-old girl is brought to the clinic by her mother because she has not had a menstrual period for the past 8 months. Which of the following findings that might alert the nurse to the possibility that anorexia nervosa may be contributing to the client's amenorrhea? (Select all that apply.) a. Bradycardia b. Evidence of secondary sex characteristics c. Reduced subcutaneous fat d. Hypotension

a. Bradycardia c. Reduced subcutaneous fat d. Hypotension (Rationale: Hypothermia, bradycardia, hypotension, and reduced subcutaneous fat may be observed in women with amenorrhea with anorexia nervosa as the contributing factor. Evidence of secondary sex characteristics would be a normal finding for a girl of this age.)

A young couple is exploring their contraceptive options and are curious about using an intrauterine contraceptive device. As their nurse you explain there are two types, one which uses hormones and the other one uses: a. Copper b. Potassium c. Silicone d. Magnesium

a. Copper (Rationale: The ParaGard-TCu-380A is approved for 10 years and is nonhormonal. Its mechanism of action is based on the release of copper ions, which are spermicidal.)

A mother presents to the clinic with her 15-year-old daughter complaining of amenorrhea. Which of the following might be a clue to the nurse as the cause? (Select all that apply.) a. Extreme and rapid weight gain b. Lack of exercise c. Pregnancy d. Hypothyroidism

a. Extreme and rapid weight gain c. Pregnancy d. Hypothyroidism (Rationale: There are many factors that contribute to primary and secondary amenorrhea. They include extreme and rapid weight gain, pregnancy, hypo- or hyperthyroidism, depression, excessive exercise, eating disorders, and various chronic illness, just to name a few. The nurse should complete a thorough examination and obtain a complete history to eliminate the various known causes of amenorrhea.)

Which of the following body system changes would the nurse associate with menopause? (Select all that apply.) a. Increased abdominal fat b. Moist, supple skin c. Hot flashes d. Decreased bone density

a. Increased abdominal fat c. Hot flashes d. Decreased bone density (Rationale: Menopause may be associated with hot flashes, increased abdominal fat, vaginal dryness, decreased bone density, dry thinning skin, and increased waist size.)

When teaching the client how to use a contraceptive sponge, it is important that she understand leaving the sponge in place longer than 30 hours may lead to: a. Toxic shock syndrome b. Pelvic inflammatory disorder c. Sexually transmitted infections d. Cervical inflammation

a. Toxic shock syndrome (Rationale: The sponge provides protection for up to 12 hours but should not be left in place for more than 30 hours after insertion to avoid the risk of toxic shock syndrome.)

Premenstrual syndrome (PMS) affects millions of women during their reproductive years. As a nurse you realize that approximately __________ of the women in the United States report disabling, incapacitating symptoms. a. 25% b. 10% c. 55% d. 40%

b. 10% (Rationale: A woman experiencing PMS may have a wide variety of seemingly unrelated symptoms. PMS affects millions of women during their reproductive years; up to 75% report having one or more premenstrual symptoms, and up to 10% report disabling, incapacitating symptoms.)

A couple has chosen fertility awareness as their method of contraception. The nurse explains that the unsafe period for them during the menstrual cycle would be which of the following? a. Midway between the normal menstrual cycle b. Three days before and three days after ovulation c. Five days after the first day of the menstrual cycle d. Six days before the onset of menstruation

b. Three days before and three days after ovulation (Rationale: Typically, the unsafe period during the menstrual cycle is approximately three days before and three days after ovulation. An ovum is released from the ovary 14 days before the next menstrual period in a 28-day cycle.)

The nurse is helping the client understand the possible diagnosis of endometriosis. The nurse realizes that this diagnosis is definitively confirmed by: a. Pap smear b. Pelvic ultrasound c. Pelvic laparoscopy d. Bimanual examination

c. Pelvic laparoscopy (Rationale: A thorough history and pelvic examination may lead the health care practitioner to suspect endometriosis; however, the only certain method of diagnosing it is by visualizing it via a laparoscopy. A tissue biopsy can be obtained at this time and examined microscopically to confirm it.)

The symptoms of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) can be categorized using the following tool: ACDHO. The nurse recognizes the C represents: a. Crying b. Cravings c. Cramping d. Constipation

b. Cravings (Rationale: ACDHO stands for: A - anxiety: difficulty sleeping, tenseness, mood swings, and clumsiness; C - cravings: for sweets, salty foods, chocolate; D - depression: feelings of low self-esteem, anger, easily upset; H - hydration: weight gain, abdominal bloating, breast tenderness; and O - other: hot flashes or cold sweats, nausea, change in bowel habits, aches or pains, dysmenorrhea, acne breakout.)

A nurse is evaluating the client to determine the possible cause of her dysmenorrhea. The nurse is aware that the most common etiology for secondary dysmenorrhea is due to: a. Perimenopause b. Hormonal imbalance c. Endometriosis d. Multigravida

c. Endometriosis (Rationale: 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.)

After teaching a woman who has chosen the vaginal ring as her method of contraception, the nurse determines that the client needs additional teaching when she states which of the following? a. "Once I remove the ring, I'll discard it." b. "I'll compress the ring, inserting it as far back as possible." c. "I don't have to worry so much about the exact placement." d. "I'll insert a new ring at the same time and day of every week."

d. "I'll insert a new ring at the same time and day of every week." (Rationale: The vaginal ring involves a three-week period of continuous use followed by a ring-free week to allow withdrawal bleeding. The ring is compressed and inserted into the vagina, as far back as possible, but precise placement is not critical. After three weeks, the ring is removed and discarded.)

A woman opts to use a diaphragm for contraception. Which instruction would be most important for the nurse to provide? a. "Have your diaphragm refitted if you lose 10 pounds or more." b. "Keep the diaphragm in place for no more than four hours after intercourse." c. "Wet the diaphragm with water first before inserting it." d. "Replace the diaphragm every six months."

a. "Have your diaphragm refitted if you lose 10 pounds or more." (Rationale: Diaphragms should be refitted after pregnancy, abdominal or pelvic surgery, or weight loss or gain of 10 pounds or more. A diaphragm usually is replaced every one to two years. A diaphragm should remain in place for at least six hours after intercourse. A contraceptive sponge, not a diaphragm, should be wetted with water before insertion.)

The nurse is planning to speak at a local community center to a group of middle-aged women about osteoporosis. Which of the following would the nurse be sure to include as effective in reducing the risk for osteoporosis? a. Engaging in daily weight-bearing exercise b. Limiting intake of cholesterol and saturated fats c. Decreasing vitamin D intake d. Drinking at least one glass of wine/day

a. Engaging in daily weight-bearing exercise (Rationale: Engaging in daily weight-bearing exercise such as walking helps to reduce a woman's risk for osteoporosis. To prevent osteoporosis, women should increase their calcium and vitamin D intake. Avoiding excessive alcohol ingestion helps prevent osteoporosis. Limiting intake of cholesterol and saturated fats helps reduce the risk for cardiovascular disease, not osteoporosis.)

The client presents with complaints of possible PMDD. According to the American Psychiatric Association, which of the symptoms are typical for this disorder? (Select all that apply.) a. Sleep difficulties b. Diarrhea c. Affective liability d. Dysuria

a. Sleep difficulties b. Diarrhea c. Affective liability (Rationale: According to the American Psychiatric Association, a woman must have at least five of the typical symptoms to be diagnosed with PMDD. These must occur during the week before and a few days after the onset of menstruation and must include one or more of the first four symptoms: affective liability; anxiety and tension; persistent or marked anger or irritability; depressed mood, feelings of hopelessness; difficulty concentrating; sleep difficulties; increased or decreased appetite; increased or decreased sexual desire; chronic fatigue; headache; constipation or diarrhea; or breast tenderness and swelling.)

A woman is to receive methotrexate and misoprostol to terminate a first-trimester pregnancy. When preparing the teaching plan for this client, the nurse understands that misoprostol works by: a. Acting as a toxin to the trophoblastic tissue b. Causing uterine contractions to expel the uterine contents c. Blocking the action of progesterone on the endometrium d. Dilating the cervix

b. Causing uterine contractions to expel the uterine contents (Rationale: Misoprostol works by causing uterine contractions, which help to expel the uterine contents. It has no effect on cervical dilation. Methotrexate is toxic to trophoblastic tissue. Mifepristone blocks the action of progesterone, which is responsible for preparing the endometrium for implantation and then maintenance of the pregnancy.)

The nurse is assessing a couple who have come to the health care facility because they have been unable to conceive a child. When assessing the woman, which factor would the nurse identify as increasing the woman's risk for infertility? a. Dysmenorrhea b. Endometriosis c. Patent fallopian tubes d. Age of 25 years

b. Endometriosis (Rationale: Risk factors for infertility include endometriosis, age older than 27 years, tubal blockages, weight variations, hormonal imbalances, fibroids, reduced oocyte quality, chromosomal abnormalities, congenital anomalies of the cervix and uterus, immune system disorders, chronic illnesses, sexually transmitted infections, history of PID, smoking and alcohol consumption, multiple miscarriages, and psychological stress. Dysmenorrhea is not an associated risk factor.)

Which of the following would the nurse expect a woman with dysmenorrhea to report? a. Abnormally long, heavy menstrual periods b. Intermittent sharp suprapubic pain c. Dysphoria d. Chronic pelvic pain

b. Intermittent sharp suprapubic pain (Rationale: Sharp, intermittent spasms of pain, usually in the suprapubic area, are a common complaint associated with dysmenorrhea. Menorrhagia refers to abnormally long, heavy periods. Dysphoria is a common complaint associated with premenstrual syndrome. Chronic pelvic pain is commonly associated with endometriosis.)

The nurse is developing a presentation for a group of young adult women about premenstrual syndrome. Which of the following would the nurse include as possible treatment options? Select all that apply. a. Decrease in water intake b. Reduction of caffeine intake c. Antipsychotic medications d. Vitamin and mineral supplements

b. Reduction of caffeine intake d. Vitamin and mineral supplements (Rationale: Treatment options for PMS include lifestyle changes such as reduction of caffeine intake, a well-balanced diet with increased water intake, and limited alcohol intake. Vitamin and mineral supplements, NSAIDs, and diuretic therapy may be used. Antidepressants and antianxiety agents, not antipsychotic agents, may also be options.)

When working with a couple dealing with infertility, it is important for the nurse to work with their: a. Insurance restrictions b. Emotional limits c. Cultural considerations d. Family budget

c. Cultural considerations (Rationale: The manner in which the various cultures, ethnic groups, and religious groups perceive and manage infertility are very different and must be considered when working with couples who have been unable to conceive. Nurses need to include awareness of these differences in their counseling of the couples as they try to help them achieve their goal of getting pregnant.)

The client is interested in using an injectable contraceptive that works by suppressing pituitary secretions. The nurse provides the client with literature and discusses which of the following with her? a. Ortho Evra b. Lybrel c. Depo-Provera d. Lunelle

c. Depo-Provera (Rationale: Depo-Provera is the trade name for an injectable form of progesterone-only contraceptive that is given every 12 weeks. It works by suppressing ovulation and the production of FSH and LH by the pituitary gland. Lunelle is an injectable form of OC. Ortho Evra is a patch-type contraceptive and Lybrel is an oral contraceptive that uses a 365-day combination dosing.)

A client presents at the clinic and is interested in obtaining emergency contraception. The nurse explains that they must be used within 72 hours of unprotected sex to be effective. This is due to: a. ECs can help prevent STIs. b. ECs can induce an abortion of a recently implanted embryo. c. ECs simply prevent embryo creation and uterine implantation from occurring in the first place. d. ECs are more effective than regular birth control.

c. ECs simply prevent embryo creation and uterine implantation from occurring in the first place. (Rationale: ECs prevent the embryo creation and uterine implantation from occurring. There is no evidence that ECs have any effect on already-implanted ovum or that they induce abortion. They do not protect against STIs and are less effective than regular birth control.)

The public health nurse is teaching a community class on fertility awareness-based methods. He realizes the couples are not understanding, when one decides to use the: a. Symptothermal method b. Cervical mucus ovulation method c. Basal body temperature method d. Coitus interruptus method

d. Coitus interruptus method (Rationale: Coitus interruptus involves the man controlling his ejaculation during sexual intercourse and withdrawing and ejaculating outside the vagina. The problem with this method is that the first few drops of true ejaculate contain the greatest concentration of sperm and if some pre-ejaculatory fluid escapes into the vagina, conception can occur. The cervical mucus ovulation method, basal body temperature method, and symptothermal method are various methods to try and calculate when the woman is ovulating so sexual intercourse can be avoided or barriers used to prevent impregnation.)

Your client presents with complaints of irregular menstrual cycles, bleeding between periods, mood swings, hot flashes, and vaginal tenderness. After an examination, you suspect dysfunctional uterine bleeding. Which of the following would be an inappropriate approach to help your client? a. Order CBC and PT blood test. b. Order a pregnancy test to rule out ectopic pregnancy. c. Order an ultrasound to check internal pelvic structures. d. Tell the client to learn to live with it.

d. Tell the client to learn to live with it. (Rationale: There are many treatable reasons for dysfunctional uterine bleeding. The client should be evaluated and all related disorders should be treated as needed. Telling the client to just learn to live with it ignores the possibility that her symptoms are related to a serious but treatable condition.)