Chapter 4 - Reproductive system concerns (EAQ's)

Which symptom described by a woman is characteristic of premenstrual syndrome (PMS)? 1 "I feel irritable and moody a week before my period is supposed to start." 2 "I have lower abdominal pain beginning the third day of my menstrual period." 3 "I have abdominal bloating and breast pain after a couple days of my period." 4 "I have nausea and headaches after my period starts, and they last 2 to 3 days."

1 - "I feel irritable and moody a week before my period is supposed to start." pg 65/66 - PMS is a cluster of physical, psychological, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses. PMS begins in the luteal phase and resolves as menses occurs. It does not start after menses has begun. This complaint is associated with PMS. However, the timing reflected in this statement is inaccurate. PMS begins in the luteal phase and resolves as menses occurs. It does not start after menses has begun. Abdominal bloating and breast pain are likely to occur a few days prior to menses, not after it has begun.

An obese patient reports amenorrhea for the past 2 months. A pregnancy test is negative, and an ultrasound does not reveal any abnormalities in the reproductive system. The primary health care provider prescribes oral estrogen (Altavera) and progestin (Prometrium). What kind of preventive measures for polycystic ovarian disorder does the nurse explain? 1 "Start exercising regularly." 2 "Eat a nonvegetarian diet." 3 "Reduce the intake of fluids." 4 "Sleep for at least 10 hours a day."

1 - "Start exercising regularly." pg 71 - Polycystic ovarian disorder is most often found in overweight women. Losing weight may help in preventing polycystic ovarian disorder. Apart from medications, a routine exercise regimen may help the patient lose weight and increase the effectiveness of the treatment. The patient needs to avoid fatty foods such as meat and fried foods. Maintaining a good diet may help the patient achieve weight loss. Sleeping for more than 8 hours a day in adults may make the patient lethargic. Increased intake of fluids may help prevent further complications and minimize abdominal discomfort.

What should the nurse stress in teaching a woman to deal with the symptoms of premenstrual syndrome (PMS)? 1 Decrease her consumption of caffeine. 2 Drink a small glass of wine with her evening meal. 3 Decrease her fluid intake to prevent fluid retention. 4 Eat three large meals a day to maintain glucose levels.

1 - Decrease her consumption of caffeine. pg 66 - 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.

A patient reports severe pain associated with abdominal cramps, backache, vomiting, and headache during the first 2 days of menses. The nurse finds that the patient has been taking diclofenac (Cataflam) to relieve abdominal cramps for the past 2 months. What new prescription might the nurse expect for the patient? 1 Ibuprofen (Motrin) 2 Nafarelin (Synarel) 3 Leuprolide (Lupron) 4 Azithromycin (Zithromax)

1 - Ibuprofen (Motrin) pg 64 - Abdominal cramps, backache, vomiting, and headache during periods are caused by the secretion of prostaglandins in primary dysmenorrhea. Vomiting is also a side effect caused by the use of diclofenac. The primary health care provider will prescribe another NSAID such as ibuprofen, because diclofenac is ineffective in relieving the pain during periods. Nafarelin, leuprolide, and azithromycin are not prescribed for treatment of primary dysmenorrhea. Nafarelin and leuprolide are prescribed for endometriosis. Azithromycin is prescribed for chlamydial infections.

Which statement is not true about primary dysmenorrhea? 1 It is experienced by all women. 2 It is unaffected by oral contraceptives. 3 It occurs in young multiparous women. 4 It may be caused by excessive endometrial prostaglandin.

1 - It is experienced by all women. pg 63 - Some women produce excessive endometrial prostaglandin during the luteal phase of the menstrual cycle. Prostaglandin diffuses into endometrial tissue and causes uterine cramping. It is not experienced by all women. Oral contraceptives can be a treatment choice. It primarily occurs in young, nulliparous women.

A woman states, "I'm sure that I am suffering from premenstrual syndrome (PMS). How can I get my doctor to take this seriously?" What is the nurse's best response? 1 "Men usually are not sympathetic to PMS sufferers." 2 "You should keep a daily record of the occurrence and severity of your symptoms for six months." 3 "You are probably right. You should remind your health care provider of your symptoms every time you visit." 4 "Because you feel certain you are right, you should just treat yourself with over-the-counter medications."

2 - "You should keep a daily record of the occurrence and severity of your symptoms for six months." pg 66 - Charting symptoms for several cycles is necessary to make an accurate diagnosis of PMS. Stating that men are not sympathetic to PMS sufferers does not help the woman with the present problem. Listing symptoms for several cycles will help the heath care provider better assess the diagnosis. The woman should not treat herself with over-the-counter medications.

A 16-year-old patient with amenorrhea does not want to undergo estrogen therapy. What other possible approaches to treatment might the nurse recommend to the patient? Select all that apply. 1 Vitamin D 2 Biofeedback 3 Acupressure 4 Acupuncture 5 Massage therapy 6 Herbal medications

2 - Biofeedback 5 - Massage therapy pg 63 - Biofeedback and massage therapy are alternative treatment options in amenorrhea. These interventions are helpful in relieving stress and regulating menstruation. Vitamin D can be used to lower the risk associated with breast cancer. Acupressure and acupuncture are alternative treatment options helpful in relieving dysmenorrheal pain. Herbal preparations are used for menstrual cramps, premenstrual discomfort, breast pain, and menorrhagia.

A patient with dysmenorrhea has been prescribed nonsteroidal antiinflammatory drugs (NSAIDs). The patient reports passing dark-colored stools 1 week after starting therapy. What can the nurse interpret from this? 1 The patient is allergic to NSAIDs. 2 The patient has developed hemorrhoids. 3 The patient has gastrointestinal bleeding. 4 The patient has a gastrointestinal infection.

3 - The patient has gastrointestinal bleeding. pg 64 - One major adverse effect associated with NSAIDs is gastrointestinal bleeding. This is manifested as dark-colored stools. Hemorrhoids may also cause blood in the stools but are not a complication associated with NSAIDs. Allergic reactions related to NSAIDs are rare. These may manifest as skin rashes and itching. NSAIDs are not associated with gastrointestinal infection. Gastrointestinal infection would be manifested as diarrhea and fever.

While the nurse is assessing a patient with dysmenorrhea, the patient tells the nurse, "My grandmother makes me drink ginger tea when I have cramps during menses. Do you think that ginger tea is helpful?" What should be the nurse's response to the patient? 1 "Ginger helps reduce pain by controlling hormones." 2 "Ginger helps reduce pain by controlling prolactin levels." 3 "Ginger helps reduce pain by controlling muscle spasms." 4 "Ginger helps reduce pain by controlling the inflammatory reaction."

4 - "Ginger helps reduce pain by controlling the inflammatory reaction." pg 66 - Ginger is an herbal medication often used to reduce pain related to dysmenorrhea through its antiinflammatory actions. Herbs such as black cohosh root are hormone suppressants that are also used for relieving pain during menses. Herbs such as chaste tree fruit relieve pain during menses by controlling the levels of prolactin. Herbs such as black haw and catnip are known to reduce pain by controlling muscle spasms.

Which statement is true about primary dysmenorrhea? 1 It is experienced by all women. 2 It is unaffected by oral contraceptives. 3 It occurs in young, multiparous women. 4 It may be caused by excessive endometrial prostaglandin.

4 - It may be caused by excessive endometrial prostaglandin. pg 64 - Some women produce excessive endometrial prostaglandin during the luteal phase of the menstrual cycle. Prostaglandin diffuses into endometrial tissue and causes uterine cramping. It is not experienced by all women. Oral contraceptives can be a treatment choice. It occurs primarily in young, nulliparous women.

A patient reports mood disturbances, emotional breakdowns, and irritation just before the beginning of menses for her last three cycles. After assessment, the nurse finds that the patient follows a good diet and exercise regimen. Based on the symptoms, what does the nurse conclude that the patient has? 1 Amenorrhea 2 A psychological illness 3 Hormonal abnormalities 4 Premenstrual dysphoric disorder

4 - Premenstrual dysphoric disorder pg 65/66 - Premenstrual dysphoric disorder is a severe variant of premenstrual syndrome that is manifested as emotional lability, irritation, and disturbed mood. The symptoms exhibited by the patient are caused by premenstrual dysphoric disorder. Amenorrhea is the absence of menstruation. The patient having symptoms for three cycles during the luteal phase does not indicate amenorrhea. The symptoms of premenstrual dysphoric disorder are caused by the normal hormonal changes occurring in the luteal phase of the menstrual cycle. These behavioral symptoms do not indicate that the patient has hormonal abnormalities or a psychological illness.

What is an effective relief measure for primary dysmenorrhea? 1 To reduce physical activity level until menstruation ceases 2 To use barrier methods rather than the oral contraceptive pill (OCP) for birth control 3 To begin taking prostaglandin synthesis inhibitors on the first day of the menstrual flow 4 To decrease intake of salt and refined sugar about 1 week before menstruation is about to occur

4 - To decrease intake of salt and refined sugar about 1 week before menstruation is about to occur pg 63/64 - Decreasing intake of salt and refined sugar can reduce fluid retention. Staying active is helpful because it facilitates menstrual flow and increases vasodilation to reduce ischemia. Prostaglandin inhibitors should be started a few days before the onset of menstruation. OCPs are beneficial in relieving primary dysmenorrhea as a result of inhibition of ovulation and prostaglandin synthesis.

What is the drug of choice to treat gonorrhea? 1 Acyclovir (Zovirax) 2 Penicillin G (Pfizerpen) 3 Rocephin (Ceftriaxone) 4 Tetracycline (Achromycin)

3 - Rocephin (Ceftriaxone) pg 73/74 - Ceftriaxone is effective for treatment of all gonococcal infections. Penicillin is used to treat syphilis. Tetracycline is used to treat chlamydial infections. Acyclovir is used to treat herpes genitalis.

A young adolescent has been prescribed continuous combined hormone therapy for endometriosis. What advice should the nurse give to the patient to minimize the drug-related adverse effects? 1 "Have bone mineral density tested regularly." 2 "Have renal and liver function tested regularly." 3 "Use an absorbent sanitary pad for heavy bleeding during menses." 4 "Stop the use of nonsteroidal antiinflammatory drugs (NSAIDs) for pain relief."

1 - "Have bone mineral density tested regularly." pg 68 - Combined hormone therapy affects bone mineralization in adolescents. Therefore the nurse should advise the patient to have bone mineral density tested regularly. Unlike danazol, combined hormone therapy does not affect liver and renal function. NSAIDs are usually prescribed with combined hormone therapy to treat pain in adolescents with endometriosis. Therefore the use of NSAIDs need not be discontinued when continuous combined hormone therapy is prescribed. Continuous combined hormone therapy causes temporary amenorrhea. It is not associated with heavy bleeding during menses.

What is the CDC-recommended medication for the treatment of chlamydia? 1 Acyclovir 2 Penicillin 3 Podofilox 4 Doxycycline

4 - Doxycycline pg 73 - Doxycycline is effective for treating chlamydia, but it should be avoided if the woman is pregnant. Podofilox is a recommended treatment for nonpregnant women diagnosed with human papilloma virus infection. Acyclovir is recommended for genital herpes simplex virus infection. Penicillin is not a CDC-recommended medication for chlamydia; it is the preferred medication for syphilis.

The nurse is assessing a patient who reports no menses for the past 6 months. Which test should the nurse ask the patient to take? 1 Pregnancy test 2 Blood sugar test 3 Thyroid function test 4 Toxicology blood screening

1 - Pregnancy test pg 62/63 - The patient last had menses 6 months ago, which indicates that the patient has secondary amenorrhea. The most common cause of secondary amenorrhea is pregnancy. Therefore the nurse should ask the patient to take a pregnancy test. A thyroid function test is used to determine alterations in thyroid hormone levels. A blood sugar test is helpful in finding whether the patient has diabetes mellitus. Toxicology screening is a laboratory investigation to determine whether the patient is involved in illicit drug abuse. Alterations in the thyroid levels, elevated blood sugar levels, and illicit drug use are causes of primary amenorrhea. These factors interrupt the hypothalamic-pituitary-ovarian-uterine axis and thus cause amenorrhea.

The nurse is preparing a care plan for a patient diagnosed with hypogonadotropic amenorrhea. The patient does not provide any history of sudden weight loss, eating disorder, or involvement in heavy exercise. What should be the most important goal for this patient? 1 To identify the stressor 2 To prepare a diet regimen 3 To provide pain relief in the patient 4 To rule out the possibility of an infection

1 - To identify the stressor pg 62 - The most common cause of hypogonadotropic amenorrhea is stress. Other causes are severe weight loss (malnourishment), an eating disorder such as anorexia, and strenuous exercises. Because the patient does not have a history of sudden weight loss, an eating disorder, or involvement in heavy exercise, the patient is most likely to be suffering from stress. Therefore the most important goal should be identification of the stressor. Infection of the reproductive system is known to cause abnormal bleeding but is not associated with amenorrhea. Pain is not a symptom associated with hypogonadotropic amenorrhea. Because the patient has no history of an eating disorder or weight loss, it is unlikely that the patient has malnutrition.

The nurse is explaining some methods that can relieve breast pain to a woman with fibrocystic disease. Which should the nurse include in the teaching session? Select all that apply. 1 Wear a good supportive bra. 2 Applying heat or cold to the breasts. 3 Increase intake of chocolate when the pain occurs. 4 Try some evening primrose oil as prescribed on the bottle. 5 Discontinue oral contraceptives that have estrogen and progesterone.

1 - Wear a good supportive bra. 2 - Applying heat or cold to the breasts. 4 - Try some evening primrose oil as prescribed on the bottle. pg 86 - In fibrocystic disease, wearing a supportive bra is a simple way to reduce pain from large breasts that stretch ligaments. Evening primrose oil is a botanical preparation that may relieve pain with fibrocystic disease. Chocolate can increase levels of methylxanthines, which may increase discomfort. Oral contraceptives taken during the secretory phase (second half) of the menstrual cycle have been successful at reducing breast pain, so they should not be discontinued. Heat and cold applied to the breasts have reduced discomfort.

A 29-year-old patient reports mild pain in the abdomen and upper thighs during menses for the past 6 months. The patient also tells the nurse that the pain starts 3 days before menses. The patient reports that the menstrual flow is normal. The nurse refers the patient for an ultrasound. The most likely reason for this referral is confirmation of whether the patient has what? 1 Adenomyosis 2 Endometriosis 3 Leiomyomata 4 Endometrial polyps

2 - Endometriosis pg 67 - The patient's symptoms suggest secondary dysmenorrhea, which is seen in women older than 23 years of age. As reported by the patient, the onset of dysmenorrheal pain is a few days before menses. Therefore the most likely cause of dysmenorrhea is endometriosis. Secondary dysmenorrhea associated with adenomyosis, leiomyomata, and endometrial polyps is usually accompanied by heavy menstrual bleeding. Moreover, in these conditions, the dysmenorrheal pain occurs along with menstrual bleeding and not before menstruation. Therefore it is unlikely that the patient has secondary dysmenorrheal as a result of these conditions.

With regard to the diagnosis and management of amenorrhea, nurses should be aware of what? 1 It often goes away on its own. 2 It may be caused by stress or excessive exercise or both. 3 It likely will require the woman to eat less and exercise more. 4 It probably is the result of a hormone deficiency that can be treated with medication.

2 - It may be caused by stress or excessive exercise or both. pg 62 - Amenorrhea usually is the result of stress and/or an inappropriate ratio of body fat to lean tissue, possibly as a result of excessive exercise. Management includes counseling and education about the causes and possible lifestyle changes. Amenorrhea may be the result of a decrease in follicle-stimulating hormone (FSH) and luteinizing hormone (LH). In most cases a woman will need to decrease her amount of exercise and increase her body weight in order to resume menstruation. Management of stress and eating disorders is usually necessary to manage this condition.

A pregnant woman reports severe pain in the abdomen. The Thayer-Martin culture is positive. Which medication might the nurse expect to be prescribed for the patient? 1 Azithromycin (Zithromax) and amoxicillin (Amoxil) 2 Doxycycline (Vibramycin) and tetracycline (Sumycin) 3 Ceftriaxone (Rocephin) and azithromycin (Zithromax) 4 Azithromycin (Zithromax) and doxycycline (Vibramycin)

3 - Ceftriaxone (Rocephin) and azithromycin (Zithromax) pg 73/74 - A positive Thayer-Martin culture indicates gonorrheal infection in the patient. Ceftriaxone (Rocephin) and azithromycin (Zithromax) are the drugs prescribed for pregnant women with gonorrhea. Azithromycin (Zithromax) and amoxicillin (Amoxil) are used for pregnant women diagnosed with chlamydia infection. Doxycycline (Vibramycin) and tetracycline (Sumycin) are used for women with syphilis who are allergic to penicillin. Azithromycin (Zithromax) and doxycycline (Vibramycin) are prescribed for women with chlamydia infection.

The nurse is conducting a follow-up assessment of a patient with endometriosis who is taking danazol (Danocrine). The patient tells the nurse that she is unwilling to take danazol (Danocrine) in the future. What could be the most likely reason for the patient's unwillingness to use this medication? 1 The medication caused amenorrhea in the patient. 2 The medication caused abdominal pain in the patient. 3 The medication caused masculinizing traits in the patient. 4 The medication caused temporary infertility in the patient.

3 - The medication caused masculinizing traits in the patient. pg 68 - Danazol (Danocrine) is a mildly androgenic synthetic steroid that suppresses the secretion of follicle-stimulating and luteinizing hormones. It causes masculinizing side effects such as weight gain, edema, decreased breast size, oily skin, and hirsutism. This would affect the patient's appearance. Therefore this is the most likely reason for the patient's unwillingness to adhere to this medication regimen. Amenorrhea is a side effect associated with the use of danazol, but it is temporary (only during the course of therapy) and is unlikely to be the source of distress to the patient. Danazol is helpful in relieving pain associated with endometriosis. Danazol does not cause infertility. However, it is contraindicated in pregnant women because of its teratogenic effects.