Maternity Chap. 4: Common Gynecologic Issues

A woman opts to use a diaphragm for contraception. Which instruction would be most important for the nurse to provide?

"Have your diaphragm refitted if you lose 10 pounds (4.5 kilograms) or more." Diaphragms should be refitted after pregnancy, abdominal or pelvic surgery, or weight loss or gain of 10 pounds (4.5 kilograms) or more. A diaphragm usually is replaced every 1 to 2 years. A diaphragm should remain in place for at least 6 hours after intercourse. A contraceptive sponge, not a diaphragm, should be wetted with water before insertion.

A female client who has chosen the cervical cap as her method of contraception states that she knows how to use it. Which statement by the client would indicate to the nurse that the client does understand this method of contraception?

"I do not have any spermicidal allergies, so this method is OK for me." Spermicidal allergies are contraindications for the cervical cap. The client should leave the cervical cap in place for at least six hours after intercourse. The cervical cap does not protect against STIs. The woman should have a follow-up Pap test three months after beginning to use the cap.

A nurse is teaching a couple who has chosen condoms as their means of contraception. The nurse determines that the teaching was successful when the couple makes which statements? Select all that apply.

"We'll keep the condom in its wrapper until we're ready to use it." "We will use a new condom each time we have sexual intercourse." "The penis needs to be erect before putting on the condom." A new condom should be used for each sexual intercourse act. It should be kept in its wrapper until it is ready to use, applied to an erect penis and removed while the penis is still erect. There should be about 1/2 inch of empty space at the end to collect ejaculate.

Subfertility/infertility is said to exist when a couple has failed to achieve pregnancy after how many months of unprotected sexual intercourse?

12 Infertility is the failure to achieve conception after 1 year of unprotected intercourse.

A male client has undergone a semen analysis for evaluation of fertility. The nurse understands that which sperm count would suggest infertility?

18 million/mL A sperm count of fewer than 20 million spermatozoa per milliliter results in infertility. Normal sperm count ranges on average from 60 to 100 million /mL.

A client presents at the clinic and is interested in obtaining emergency contraception (EC). The nurse explains that EC must be used within 72 hours of unprotected sex to be effective. This is because:

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

What is an advantage of a cervical cap over a diaphragm?

It can be left in place longer. Because a cervical cap does not press against the sides of the vagina, possibly interfering with blood supply, it can be left in place longer.

The client presents reporting irregular menstrual cycles, bleeding between periods, mood swings, hot flashes and vaginal tenderness. After an examination, the nurse suspects abnormal uterine bleeding. Which approach would be inappropriate?

Tell the client to learn to live with it. 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.

The nurse in a primary care clinic and a client have come to see the primary care provider because she is getting married and wants to have a prenuptial gynecologic examination. After the exam the nurse asks about the woman's plan to have a family. The woman responds, "Why do I have to plan for a family?" What would be the nurses's best response?

The couple can control the time between births when they plan their family. Women and couples can avoid unwanted pregnancies, bring about wanted births, and control the intervals between births.

A client visits a health care facility for information on a vasectomy. Which initial information should the nurse provide?

Vasectomy is a relatively easy procedure with few complications. The nurse should inform the client that vasectomy is a relatively easy procedure with few complications. Regular sperm counts following a vasectomy are important. Reversals (reattaching the vas deferens) of vasectomies are not uncommon, but these are often unsuccessful. The client should use birth control measures until his sperm count remains at zero for 6 weeks.

A woman uses a diaphragm for contraception. The nurse would instruct her to return to the clinic to have her diaphragm fit checked after which occurrence?

a weight gain of 10 lb (4.5 kg) A substantial weight gain or weight loss of 10 pounds (4.5 kilograms) or more may shift the relationship of pelvic organs enough that the diaphragm no longer fits correctly.

The nurse should carefully screen a client who insists on using only combined oral contraceptives for which contraindication?

deep vein thrombosis The nurse should screen the client for deep vein thrombosis (DVT), migraine headaches, neurological symptoms, coronary artery disease or cerebral vascular disease, severe diabetes, hypertension, liver disease, breast or endometrial cancer, and unexplained vaginal bleeding when combined oral contraceptives are used. Gastrointestinal diseases are contraindicated in the use of progestin-only pills. Combined oral contraceptives are not contraindicated in clients who drink alcohol. Impaired absorption is a contraindication for the use of progestin-only pill.

Which definition best explains the term "subfertility/infertility"?

failure to achieve pregnancy after 1 year of unprotected intercourse Infertility is the failure to achieve conception after 1 year of unprotected intercourse.

A young woman comes to the free clinic asking for birth control pills. Which factor best indicates that another type of contraception would be better for this client?

history of noncompliance with medications If a woman has a history of poor compliance with medication, it might not be realistic for her to plan on taking an oral contraceptive every day.

The nurse is providing care to a client with abnormal uterine bleeding. Treatment with medications has been unsuccessful, and surgical intervention is being considered. The nurse identifies which technique as being the last resort?

hysterectomy If the client does not respond to medical therapy, surgical intervention might include dilation and curettage (D&C;), endometrial ablation, uterine artery embolization, or hysterectomy. Of these, hysterectomy is considered a last resort.

The nurse is providing contraception counseling to a perimenopausal woman who has had negative reactions to oral contraceptives in the past and would like a long-term, nonhormone-based method that has a high rate of success. Neither she nor her husband wants to undergo surgery, however. Which method should the nurse recommend?

intrauterine device Women who are premenopausal are, overall, good candidates for intrauterine devices (IUDs). In this case, the IUD is the best choice because this method is almost 100% effective, is long-term, and does not involve any hormones. Both the transdermal patch and the subdermal progestin implant involve hormones, which rules each out in this case. Also, tubal ligation is a surgical procedure, which also rules it out for this client

A 52-year-old client is seeking treatment for menopause. She is not very active and has a history of cardiac problems. Which therapy option should the nurse recognize as contraindicated for this client?

long-term hormone replacement therapy Because the client has a history of cardiac problems, long-term hormone replacement therapy is contraindicated. This is because there is an increased risk of heart attacks and strokes. The client should instead be asked to consider options with minimized risk, such as lipid-lowering agents, or nonhormonal therapies, such as bisphosphonates and selective estrogen receptor modulators.

What are methods for delivering hormonal contraception? Select all that apply.

orally transdermally vaginally implantation injection Methods to deliver hormonal contraception include orally, transdermally, vaginally, implantation, and injection.

A woman has just been prescribed clomiphene citrate to stimulate ovulation. Which possible effect should the nurse warn the woman about?

overstimulation of the ovary resulting in potential multiple births Therapy with clomiphene citrate may be used to stimulate ovulation. Administration of either clomiphene citrate or gonadotropins may overstimulate an ovary, causing multiple ova to come to maturity and possibly resulting in multiple births. The nurse should counsel women who receive these agents that this is a possibility. None of the other answers is a common effect of clomiphene citrate use

When using the contraceptive patch, a client should understand that it:

should be applied to the abdomen, buttocks, or back. The patch should be applied only to the buttocks, back, abdomen, or torso (never the breasts). The patch is safe for wearing during swimming and bathing. The patch requires application for 1 week before becoming effective.

The estrogen content in the contraceptive pill performs which action?

suppresses follicle-stimulating hormone (FSH) Estrogen has a direct effect on the pituitary gland suppressing FSH; progesterone increases permeability of cervical mucus and endometrial proliferation.

During examination of clients, the nurse will question women concerning their LMP. This indicates:

the first day of their last menstrual period. LMP is the abbreviation for last menstrual period. It is used to indicated the first day of the last cycle. This information is used to determine estimated date of delivery if the client is pregnant. It is also important to establish potential disorders of the reproductive system.

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 at which time?

three days before and three days after ovulation Typically, the unsafe period during the menstrual cycle is approximately 3 days before and 3 days after ovulation. An ovum is released from the ovary 14 days before the next menstrual period.

A nurse is instructing a client on birth control methods. The client asks about the cervical mucus method. When should the nurse tell the client she is fertile in relation to her mucus?

when it is thin, watery, and copious he cervical mucus method relies on the changes that occur naturally with ovulation. Before ovulation, cervical mucus is thick and does not stretch when pulled. With ovulation, the mucus becomes thin, copious, watery, transparent, and stretchy.

A 30-year-old client would like to try using basal body temperature (BBT) as a fertility awareness method. Which instruction should the nurse provide the client?

Take temperature before rising, and record it on a chart. The client should be instructed to take her temperature before rising and record it on a chart. If using this method by itself, the client should avoid unprotected intercourse until the BBT has been elevated for 3 days. The client should be informed that other fertility awareness methods should be used along with BBT for better results. The oral method is better suited than the axillary method for taking the temperature in this case.

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:

antibiotics 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 client has been following the conventional 28-day regimen for contraception. She is now considering switching to an extended oral contraceptive (OC) regimen. She is seeking information about specific safety precautions. Which is true for the extended OC regimen?

It carries the same safety profile as the 28-day regimen. Recent studies have shown that the extended use of active OC pills carries the same safety profile as the conventional 28-day regimen. This option helps reduce the number of periods and is as effective as the conventional regimen. There is no evidence to suggest that discontinuation of active OCs will not ensure restoration of fertility. Medroxyprogesterone, not active OC pills, prevents pregnancy for 3 months at a time.

A nurse is teaching a couple about how to use a condom. The couple demonstrates understanding of the information when they state that a condom should be applied at which time to be effective?

before penile-vulvar contact Some sperm may be released with pre-ejaculation semen, so a condom needs to be used with any penile-vulvar contact.

A client is diagnosed with endometriosis. As part of the teaching plan, the nurse is explaining the condition, including the ways that the diagnosis would be confirmed. The nurse determines that the teaching was successful when the client states that which test would confirm the diagnosis?

pelvic laparoscopy 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. A Pap smear would be done to rule out cervical cancer. A pelvic ultrasound would not be definitive for endometriosis.

A woman is going to have in vitro fertilization. When preparing her for this, the nurse would make which statement?

"It can be done with frozen donor sperm." Fresh or frozen sperm may be used. The success of in vitro fertilization is not related to the incidence of ovarian cancer in the family. Often more than one attempt is needed before successful implantation.

A couple is seeking guidance for their inability to conceive a child after trying for 15 months. They are morbidly obese but state they have friends with the same weight problem who have had no difficulty conceiving. What education can the nurse provide this couple to increase their chances of success?

"Obesity may interfere with effective penetration and deposition of sperm. We will look at several factors to discover what issues you may be encountering." Extreme obesity in a male may interfere with effective penetration and deposition of sperm, compromising the ability to conceive.

The nurse has provided information to a client about oral contraceptives. Which statement by the client would indicate a need for further education?

"Some oral contraceptives protect against STDs." Oral contraceptives need to be taken on a daily basis to prevent breakthrough ovulation. Oral contraceptives do not protect against STDs, and clients still need to use STD protection such as condoms. In addition to preventing pregnancy, hormonal contraceptives have many health benefits including reduction in risk of ovarian cancer and endometrial cancer, reducing symptoms of premenstrual discomforts, decreasing blood loss and anemia, reducing symptoms of endometriosis, and many other benefits.

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." The least costly way to determine a woman's ovulation pattern is to ask her to record her basal body temperature (BBT) for at least 4 months.

Which statement would be most appropriate when explaining endometriosis as a cause of a woman's infertility?

"Ovulation does take place; however, the misplaced endometrial tissue interferes with transport of the ovum." With endometriosis, endometrial tissue migrates into the fallopian tubes and peritoneum or other sites outside of the uterus. Ovulation occurs, but the egg may be trapped by the misplaced tissue

The nurse is caring for a client at the ambulatory care clinic who questions the nurse for information about contraception. The client reports that she is not comfortable about using any barrier methods and would like the option of regaining fertility after a couple of years. Which method should the nurse suggest to this client?

CycleBeads or medroxyprogesterone injection The best option for a client who is not well educated would be the Standard Days Method with CycleBeads, as the 32 color-coded CycleBeads are easy to use and understand. An injection of medroxyprogesterone would also suit this client, as it works by suppressing ovulation and the production of follicle stimulating hormone and leutinizing hormone by the pituitary gland and prevents pregnancy for 3 months at a time. BBT requires the client to take and chart her body temperature; this may be difficult for the client to follow. Coitus interruptus is a method in which the man controls his ejaculation and ejaculates outside the vagina; this suggests that the client rely solely on the cooperation and judgment of her spouse. The lactational amenorrhea method works as a temporary method of contraception only for breastfeeding mothers.

The nurse is instructing a client with dysmenorrhea on how to manage her symptoms. Which suggestions should the nurse include in the teaching plan? Select all that apply.

Increase water consumption. Use heating pads or take warm baths. Increase exercise and physical activity When instructing a client with dysmenorrhea on how to manage her symptoms, the nurse should ask her to increase water consumption, use heating pads or take warm baths, and increase exercise and physical activity. Water consumption serves as a natural diuretic, heating pads or warm baths help increase comfort, and exercise increases endorphins and suppresses prostaglandin release. The nurse should also tell the client to limit salty foods to prevent fluid retention during menstruation and to keep legs elevated while lying down because this helps increase comfort.

A woman visits the family-planning clinic to request a prescription for birth control pills. Which factor would indicate that an ovulation suppressant would not be the best contraceptive method for her?

She has a family history of thromboembolism. The estrogen content of birth-control pills may lead to increased blood clotting, leading to an increased incidence of thromboembolism. Women who already are prone to this should not increase their risk further.

The nurse is asked to schedule a hysterosalpingogram. Which question would be most important for the nurse to ask the woman before scheduling the procedure?

When do you expect your next menstrual flow? Because a radiograph is involved, the procedure should be done in the few days following a menstrual flow when she is not apt to be pregnant.

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.

A nurse is preparing a presentation for a local community women's group about menopause. When describing the body system changes that occur, the nurse would include which changes? Select all that apply.

hot flashes increased abdominal fat vaginal dryness decreased bone density Menopause may be associated with hot flashes, increased abdominal fat, vaginal dryness, decreased bone density, dry, thinning skin, and increased waist size.

A nurse is reviewing sperm count results for a couple trying to conceive. Which results would concern the nurse?

10 million per mL of seminal fluid The sperm count is the number of sperm in a single ejaculation or in a milliliter of semen. The minimum sperm count considered normal is 20 million per milliliter of seminal fluid, or 50 million per ejaculation.

A couple a nurse cares for in an infertility clinic are both 22 years old and have been trying for a year to become pregnant. In a year, what proportion of couples usually does conceive?

85% Eighty-five percent of couples who engage in intercourse regularly will conceive within a year.

A female client is having a procedure this morning that involves radiologic examination of the fallopian tubes using a radiopaque medium. What procedure should the nurse document as being performed?

a hysterosalpingography A hysterosalpingography, a radiologic examination of the fallopian tubes using a radiopaque medium, is a frequently used technique.

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 contraceptive with her?

medroxyprogesterone acetate Medroxyprogesterone acetate is an injectable form of a 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. Etonogestrel is an implantable form contraceptive. Norelgestromin/ethinyl estradiol is a patch-type contraceptive, and levonorgestrel/ethinyl estradiol is an oral contraceptive that uses a 365-day combination dosing.

A clinic nurse is interviewing a young client during a subfertility work up. When the client asks the nurse what causes infertility, the nurse informs the client that the problem can rest with the man, the woman, or both. What does the nurse tell the client are common problem areas related to the woman? Select all that apply.

ovulation tubal transport impaired implantation Female factors that cause subfertility are problems with ovulation, tubal transport, and implantation

A man is interested in artificial insemination if he is proven to be infertile. He asks the nurse if this procedure would be appropriate for him and his sexual partner. Which statement would be the nurse's best response?

"You need to consider donor-therapeutic insemination if you are found to be infertile." Donor-therapeutic insemination involves the donation of sperm from another fertile male; it is used when the primary sexual partner is infertile.

A 30-year-old client tells the nurse that she would like to use a contraceptive sponge but does not know enough about its use and whether it will protect her against sexually transmitted infections (STIs). Which information should the nurse provide the client about using a contraceptive sponge? Select all that apply.

Wet the sponge with water before inserting it. Insert the sponge 24 hours before intercourse. Leave the sponge in place for at least 6 hours following intercourse. The nurse should instruct the client to wet the sponge before inserting it, to insert it 24 hours before intercourse, and to leave it in place for at least 6 hours following intercourse to be effective. The sponge should not be replaced every 2 hours because this will reduce its efficacy. A contraceptive sponge covers the cervix and releases spermicide. It does not protect against STIs. Therefore, keeping the sponge in for more than 30 hours will not prevent STIs, but it will increase risk of toxic shock syndrome.

A nurse is teaching a woman how to use the basal body temperature method of contraception. the nurse determines that the teaching was successful when the woman identifies that she should refrain from having sexual intercourse at which time?

3 days after she records a slight drop in her temperature followed by an increase. Ovulation occurs after a slight drop in temperature followed by an increase. The ovum has a life span of 3 days. As soon as a woman notices a slight dip in temperature followed by an increase, she knows she has ovulated. She refrains from having coitus (sexual relations) for the next 3 days (the possible life of the discharged ovum).

Which description best explains the hysterosalpingogram procedure?

radiograph of the uterus and fallopian tubes following introduction of a radiopaque medium through the cervix Hysterosalpingogram is a procedure to document the potency of the fallopian tubes through the use of a radiopaque medium.

A couple who is in for fertility testing ask the nurse what tests are commonly performed to assess fertility. The nurse replies that there are only three primary tests that are used. What are these tests?

semen analysis, ovulation monitoring, and tubal patency assessment Only three tests are commonly used to test fertility: semen analysis in the male and ovulation monitoring and tubal patency assessment in the female. Additional testing may be performed both on the man and the woman, which may include urinalysis, serologic test for syphilis, and pelvic sonogram, but these are not the primary tests used.

The nurse is assessing a male client who is concerned about his ability to produce enough sperm to have a child. He tells the nurse, "I have had some issues in my younger years." What questions would be important for the nurse to ask this client? Select all that apply.

"Are you exposed to X-rays or other radioactive substances?" "Have you ever had any type of trauma or surgery on or near your testicles?" "Do you use drugs or use alcohol excessively? Conditions that may inhibit sperm production are trauma to the testes, surgery on or near the testicles that results in impaired testicular circulation, and endocrine imbalances, particular of the thyroid, pancreas, or pituitary glands. Drug use or excessive alcohol use and environmental factors such as exposure to X-rays or radioactive substances have also been found to negatively affect spermatogenesis. Men exposed to radioactive substances in their work environments should be provided adequate protection for the testes.

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 makes which statement?

"I will insert a new ring at the same time and day of every week." The vaginal ring involves a 3-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 3 weeks, the ring is removed and discarded.

After assessing a woman who has come to the clinic, the nurse suspects that the woman is experiencing abnormal uterine bleeding. Which statement by the client would support the nurse's suspicions?

"I've been having bleeding off and on that's irregular and sometimes heavy." Abnormal uterine bleeding is defined as irregular, abnormal bleeding that occurs with no identifiable anatomic pathology. It is frequently associated with anovulatory cycles, which are common for the first year after menarche and later in life as a woman approaches menopause. Pain occurring with menses refers to dysmenorrhea. Although mood swings may be associated with dysfunctional uterine bleeding, irritability and mood swings are more commonly associated with premenstrual syndrome. Unusually long and heavy periods with prolonged bleeding reflect menorrhagia.

A nurse is reading a journal article about premenstrual syndrome (PMS) and the millions of women affected by it during their reproductive years. The nurse would expect to find approximately what percentage of women meeting the ACOG criteria for PMS?

75% It is estimated that up to 75% of reproductive-age women experience premenstrual symptoms that meet the ACOG criteria for PMS and up to 5% meet the diagnostic criteria for PMDD.

The client has heard of extended oral contraceptive regimens and desires more information. The nurse explains that these regimens consist of active combination pills, followed by placebo pills. How many days of active combination pills and placebo pills are contained in these regimens?

84 active; 7 placebo 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 is counseling a couple regarding contraception. The couple states that they want a natural family planning method, as their religious beliefs prohibit them from using birth control pills or devices. They plan on having children in the future, so they want a temporary method. They are interested in a fertility awareness method. Which method should the nurse recommend?

CycleBeads CycleBeads is a natural fertility awareness method in which a woman purchases a circle of beads that helps her predict fertile days so that she can abstain from sex on those days. This method meets all of the requirements of the couple. Lactation amenorrhea is a natural method, but it would not apply in this situation, as the woman is not currently breastfeeding. Coitus interruptus is also a natural method, but it is not a fertility awareness method. Vasectomy is a surgical procedure that results in permanent sterility. As the couple would like to have children in the future, this method would not be appropriate.

A couple is being assessed for infertility. The male partner is required to collect a semen sample for analysis. What instruction should the nurse give him?

Deliver sample for analysis within 1 to 2 hours after ejaculation. The nurse should instruct the client to deliver the semen sample to the laboratory for analysis within 1 to 2 hours after ejaculation. The client should also be instructed to collect the sample in a specimen container, not a condom or plastic bag. The client needs to abstain from sexual activity for at least 24 hours before giving the sample, but he need not avoid strenuous activity.

A client would like some information about the use of a cervical cap. Which information should the nurse include in the teaching plan of this client? Select all that apply.

Inspect the cervical cap before insertion. Wait for 30 minutes after insertion before engaging in intercourse. Do not use the cervical cap during menses. The nurse should tell the client to inspect the cervical cap before insertion for cracks, holes, or tears and to wait approximately 30 minutes after insertion before engaging in sexual intercourse to be sure that a seal has formed between the rim and the cervix. In addition, the cap should not be used during menses because of the potential for toxic shock syndrome; an alternative method such as condoms should be used during this time. The client should be told not to apply spermicide to the rim because it may interfere with the seal. It should be left in place for a minimum of 6 hours after sexual intercourse.

Which statement best explains the action of the lactational amenorrhea method (LAM) of fertility control?

LAM causes suppression of the ovulation process. LAM prevents pregnancy by suppressing the ovulation process. Withdrawal and barrier methods of contraception prevent the introduction of sperm into the vagina. The copper IUD, combined hormonal methods, and combined oral contraceptives prevent fertilization between the egg and the sperm. Levonorgestrel system thickens the cervical mucus and blocks sperm.

A client has opted to use an intrauterine device (IUD) for contraception. About which effect of the device on monthly periods should the nurse inform the client?

Periods become lighter. The nurse should inform the client that IUDs cause monthly periods to become lighter, shorter, and less painful. Monthly periods reduce in number with use of oral contraceptives, but not with use of IUDs.

A client in her second trimester of pregnancy asks the nurse for information regarding certain oral medications to induce a miscarriage. What information should this client be given about such medications?

They can be taken only in the first trimester. The client is seeking a medical abortion. The nurse should inform the client that such medications are effectively used to terminate a pregnancy only during the first trimester, not the second. The medications are available as a vaginal suppository or in oral form and do not present a high risk of respiratory failure. Sterilization, not abortion, is considered a permanent end to fertility.

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.

The nurse is assessing a client for amenorrhea. During the assessment, the nurse notes facial hair and acne. The nurse knows this could be related to

an androgen excess secondary to a tumor. When assessing a client for amenorrhea, the nurse should document facial hair and acne as possible evidence of androgen excess secondary to a tumor. The nurse may observe and should document hypothermia, bradycardia, hypotension, and reduced subcutaneous fat in women with anorexia nervosa; however, these are not symptoms of excess androgen.

The nurse is assessing a client for amenorrhea. During the assessment, the nurse notes facial hair and acne. The nurse knows this could be related to:

an androgen excess secondary to a tumor. When assessing a client for amenorrhea, the nurse should document facial hair and acne as possible evidence of androgen excess secondary to a tumor. The nurse may observe and should document hypothermia, bradycardia, hypotension, and reduced subcutaneous fat in women with anorexia nervosa; however, these are not symptoms of excess androgen.

Prevention of pregnancy is a major factor in the sex lives of many couples. One method of contraception is the female condom. It is a thin tube made of polyurethane, with flexible rings at both ends. What is a disadvantage of the female condom?

can slip into the vagina during vigorous intercourse Reported disadvantages are that the condom may be difficult to apply, make noise, cause vaginal or penile irritation, or slip into the vagina during vigorous intercourse, a condition that decreases its effectiveness.

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:

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

The public health nurse is teaching a community class of couples on fertility awareness-based methods. The nurse determines that additional teaching is needed when one of the couples states that they will be using which method?

coitus interruptus method Fertility awareness refers to any natural contraceptive method that does not require hormones, pharmaceutical compounds, physical barriers, or surgery to prevent pregnancy. Fertility awareness-based methods (FAMs) use physical signs and symptoms that change with hormone fluctuations throughout a woman's menstrual cycle to predict a woman's fertility. Techniques used to determine fertility include the cervical mucus ovulation method, the basal body temperature method, the symptothermal method, standard day's method, and two-day method. Coitus interruptus or withdrawal is not considered a fertility awareness based method.

The nurse is assessing a couple who has come to the health care facility because they have been unable to conceive a child. When assessing the woman, the nurse would identify which factor as increasing the woman's risk for infertility?

endometriosis 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.

A healthy 28-year-old female client who has a sedentary lifestyle and is a chain smoker is seeking information about contraception. The nurse informs this client of the various options available and the benefits and the risks of each. Which should the nurse recognize as contraindicated in the case of this client?

combination oral contraceptives Considering the client's smoking habit, combination oral contraceptives may be contraindicated. Oral contraceptives are highly effective when taken properly, but can aggravate many medical conditions, especially in women who smoke. The medroxyprogesterone injection or copper intrauterine devices are not contraindicated in this client and can be used with certain precautions. Implantable contraceptives are subdermal time release implants that deliver synthetic progestin; these are highly effective and are not contraindicated in this client.

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. Although OCs will help the client as a means of contraception, this method is not the best choice for her because it does not offer protection against STIs. Tubal ligation is a sterilization procedure and does not suit the client's purpose.

The nurse is assessing the health history of a male partner. Which data is most likely to be related to an infertility problem?

employment as a taxi driver Excessive testicular heat, which can occur from long periods of sitting, can limit sperm production and mobility.

A nurse is asked to teach a woman to take her basal body temperature daily to assess the time of ovulation. She can detect her day of ovulation, following ovulation, because her temperature will

increase a degree. The effect of progesterone, released with ovulation, is to increase body temperature.

A nurse is asked to teach a woman to take her basal body temperature daily to assess the time of ovulation. She can detect her day of ovulation, following ovulation, because her temperature will:

increase a degree. The effect of progesterone, released with ovulation, is to increase body temperature.

A woman and her partner have been trying to conceive for over 2 years without success. Ultrasound imaging reveals scarring of her fallopian tubes, which appears to be the primary cause of subfertility. What is the most likely cause of the scarring?

pelvic inflammatory disease Difficulty with tubal transport usually occurs because scarring has developed in the fallopian tubes typically caused by chronic salpingitis (chronic pelvic inflammatory disease [PID]). This could also result from a ruptured appendix or from abdominal surgery involving infection that spread to the fallopian tubes and left adhesion formation in the tubes, but these causes are less likely. Turner syndrome is an underlying cause for anovulation, not tubal scarring.

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 findings might alert the nurse to the possibility that anorexia nervosa may be contributing to the client's amenorrhea? Select all that apply.

reduced subcutaneous fat hypotension bradycardia 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 couple in their mid-30s are at their primary care provider's office because they have been unable to conceive for 3 years. They already have one child who is 4 years of age. The care provider explains to them that they are dealing with what kind of infertility?

secondary infertility There are two main types of infertility: primary and secondary. A couple who has never been able to conceive has primary infertility, whereas a couple who has been able to conceive in the past but is currently unable to do so has secondary infertility.

A nurse is preparing a presentation for a client who is considering contraception. When discussing oral contraceptives, the nurse would identify which advantages? Select all that apply.

shortening of the menstrual period reduction in severe cramping reduction in risk for osteoporosis Oral contraceptives are associated with shortening and regulating the menstrual cycle, reducing severe cramping and bleeding, and reducing the risk for osteoporosis. They are also associated with an increased risk for breast cancer and migraine headaches.

When teaching the client how to use a contraceptive sponge, the nurse must tell the client that leaving the sponge in place longer than 30 hours may lead to:

toxic shock syndrome. 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.

A young woman says she needs a temporary contraceptive but has a latex allergy. She mentions that she has 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 female condom, cervical cap, and diaphragm. Moreover the diaphragm is contraindicated in her case, due to her papillomavirus infection. The best choice for her is the transdermal contraception, which involves wearing a patch for a week at a time and does not require taking pills daily.

A client desires protection from unwanted pregnancies. However, the client does not enjoy sex when her partner wears a male condom. Also, the client experiences breast tenderness, headache, and nausea after taking oral contraceptives. Which method would be the most likely choice for the couple to help them enhance their sexual experience as well as prevent any side effects?

transdermal contraceptive Application of transdermal contraceptive patches to the skin would most likely be the option for this couple. These patches will not hamper the sexual experience nor cause side effects such as those caused by oral contraceptives. Natural membrane and polyurethane condoms are forms of male condoms, which the client does not like. Ethinyl estradiol is a combined oral contraceptive, which would most likely cause the client to experience breast tenderness, headache, and nausea.