NSG 333 Ch 4- Common Reproductive Issues

A nurse is conducting education classes at the local high school on reproductive life planning. Which would be appropriate for the nurse to implement during the teaching? Select all that apply.

encouragement of abstinence proper condom application sexually transmitted infection statistics Explanation: The nurse should talk about all safer sex options, including abstinence and its 100% effectiveness. Within that teaching it is important to educate adolescents on the proper techniques for application of a condom as well as to discuss statistics related to sexually transmitted infections.

After the nurse teaches a client about ways to reduce the symptoms of premenstrual syndrome, which client statement indicates a need for additional teaching?

"I will make sure to take my estrogen supplements a week before my period." Rationale: Lifestyle changes such as exercising, avoiding caffeine, and smoking cessation are a key component for managing the signs and symptoms of premenstrual syndrome. Estrogen supplements are not used. If medication is necessary, NSAIDs may be used for painful physical symptoms; spironolactone may help with bloating and water retention.

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." Explanation: 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.

When conducting a health history with a couple who are experiencing subfertility, the nurse will include which of the following? Select all that apply.

General health Medication history Sexual history Surgical history Explanation: The nurse will need to gather a thorough health history that will include information related to general health, medications, past sexual history, and surgical history.

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

It can be left in place longer. Explanation: 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.

A nurse is preparing a presentation for a health fair on the topic of vasectomy. Which information should the nurse point out in the presentation?

Relatively easy procedure with few complications Explanation: The nurse should inform the individuals that vasectomy is a relatively easy procedure with few complications. Regular sperm counts following a vasectomy are important, as it will take approximately a month for the remaining sperm to exit the body. The client should use birth control measures until his sperm count remains at zero for 6 weeks.

A woman is diagnosed with premenstrual dysphoric disorder. To address the woman's behavioral symptoms, which class of agents would the nurse anticipate needing to be addressed in the woman's teaching plan?

Selective serotonin reuptake inhibitors (SSRIs) Rationale: Although diuretics, NSAIDs, and vitamin supplements may be used as part of the treatment plan for premenstrual dysphoric disorder, SSRIs are commonly prescribed to address the behavioral and mood symptoms of this condition.

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 Explanation: 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.

A woman comes to the clinic because she has been unable to conceive. When reviewing the woman's history, the nurse would least likely identify which factor as a possible risk?

age of 25 years Rationale: Female risk factors for infertility include increased age older, smoking and alcohol consumption, history of chronic illness such as diabetes, and overweight or underweight, which can disrupt hormonal function.

The nurse should carefully screen a client who insists on using only oral contraceptive pills (OCPs) for which contraindication?

deep vein thrombosis Explanation: 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 oral contraceptive pills (OCPs) are used. Gastrointestinal diseases are contraindicated in the use of progestin-only pills. OCPs are not contraindicated in clients who drink alcohol. Impaired absorption is a contraindication for the use of progestin-only pills (mini-pills).

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

estrogen deficiency Rationale: Hot flashes and night sweats are classic signs of estrogen deficiency. They are unrelated to dietary intake or active lifestyle. Changes in vaginal pH are associated with genitourinary changes of menopause.

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

failure to achieve pregnancy after 1 year of unprotected intercourse Explanation: Infertility is the failure to achieve conception after 1 year of unprotected intercourse. Because most couples have the potential to conceive but are just less able to conceive without additional help, the term subfertility is more often used today.

When reviewing the medical record of a client diagnosed with endometriosis, the nurse would identify which finding as a risk factor for this woman?

menstrual cycles of 24 days Rationale: Risk factors for developing endometriosis include increasing age, family history of endometriosis in a first-degree relative, short menstrual cycle (less than 28 days), long menstrual flow (more than 1 week), high dietary fat consumption, young age at menarche (younger than age 12), and few (one or two) or no pregnancies.

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 benefits would the nurse include? Select all that apply

protection against pelvic inflammatory disease reduced risk for endometrial cancer improvement in acne Rationale: The health benefits of oral contraceptives include protection against pelvic inflammatory disease, a reduced risk for endometrial cancer, and improvement in acne. Oral contraceptives are associated with an increased risk for depression and migraine headaches.

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 Explanation: 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 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 Explanation: 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 educating a class of high school students on safe sexual practices. The nurse knows the group understood the content when a group member makes which statement?

"Abstinence is the only way to prevent the spread of sexually transmitted infections." Explanation: The nurse knows the group understood the teaching when a group member states abstinence as the only way to guarantee not spreading a sexually transmitted infection (STI). Diaphragms can only be used by female clients and are placed directly in front of the cervical opening. While condoms are effective ways to decrease the potential of pregnancy and limit the spread of STIs, abstinence is the only way to actually prevent pregnancy and STI contraction. Spermicide should be inserted into the vagina 10 to 15 minutes prior to the client having intercourse, not after.

A couple is deciding about contraceptive measures. The male partner has decided to undergo a vasectomy. After teaching the client about this procedure, which client statement indicates the need for additional teaching?

"Right after surgery, my semen will be sperm-free." Explanation: After vasectomy, semen no longer contains sperm. However, this is not immediate. The man must submit semen specimens for analysis 8 to 16 weeks after a vasectomy until two specimens show that no sperm is present. When the specimen shows azoospermia, the man's sterility is confirmed. A vasectomy is usually performed under local anesthesia in a urologist's office, and most men can return to work and normal activities in a day or two.

Which description best explains the hysterosalpingogram procedure?

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

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. Explanation: 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.

During a routine health visit for an 11-year-old girl, her mother asks the nurse, "My daughter just got her period about 4 months ago, but they haven't been very regular so far. How long might it take until she gets regular?" Which response by the nurse would be most appropriate?

"It can take up to 2 years once she starts for the periods to become regular." Explanation: Once menarche has occurred, cycles may take up to 2 years to become regular, ovulatory cycles. Telling the mother that her daughter's periods would get regular in 2 to 3 months or that she should be having regular periods by now is incorrect. Also, telling the mother that her daughter's periods will continue to be irregular is untrue and inappropriate.

A nurse is teaching a female client who is unable to conceive how to monitor her basal body temperature. Which instruction would the nurse prioritize for this client?

Chart body temperature for at least a month Explanation: The nurse should instruct the client to record her temperature each morning immediately upon awakening (at rest) using the same thermometer. The nurse should also instruct the client to record her menses, any events that would alter her temperature (e.g., infections, insomnia), and when she has intercourse. To maintain a basal body temperature chart, the client has to monitor her basal body temperature for several months. It is not necessary to record body weight along with the temperature.

A nurse is describing the criteria needed for the diagnosis of premenstrual dysphoric disorder (PMDD). Which would the nurse include as a mandatory requirement for the diagnosis?

persistent anger Rationale: For the diagnosis of PMDD, the woman must exhibit one or more of the following: affective lability such as sadness, tearfulness, or irritability; anxiety and tension; persistent or marked anger or irritability; and depressed mood and feelings of hopelessness. Other symptoms, although not mandatory for the diagnosis, include increased or decreased appetite, sleep difficulties, chronic fatigue, headache, increased or decreased sexual desire, constipation or diarrhea, and breast swelling and tenderness

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 Rationale: A woman with a small frame and thin bones is at a higher risk for osteoporosis. White or Asian women, not Black women, are at higher risk for the condition. A woman who plays tennis twice a week is active and thus would be at low risk for osteoporosis. Women who ingest excessive amounts of caffeine are at increased risk.

A client prescribed oral contraceptive pills (OCPs) has presented for a routine visit. Which finding, if reported by the client upon assessment, should the nurse prioritize?

abdominal pain Explanation: The warning signs to report for a client on OCPs are severe abdominal or chest pain, dyspnea, headache, weakness, numbness, blurred or double vision, speech disturbances, or severe leg pain and edema. Light bleeding, light flow, and cramping are all normal.

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

LAM causes suppression of the ovulation process. Explanation: 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 oral contraceptive pills (OCPs) prevent fertilization between the egg and the sperm. Levonorgestrel system thickens the cervical mucus and blocks sperm.

When developing a teaching plan for a couple who are considering contraception options, the nurse would include which statement?

"The best contraceptive is one that you will use correctly and consistently." Rationale: For a contraceptive to be most effective, the client must be able to use it correctly and consistently. Even if a method is considered 100% effective, it is not the best choice if the couple does not use it correctly or consistently. Cost is a consideration, but the least expensive method is not necessarily the best choice. The need for a prescription is not relevant to the couple's choice.

A nurse is preparing a class for a group of young adult women about emergency contraceptives (ECs). What information would the nurse need to stress to the group? Select all that apply.

ECs are birth control pills in higher, more frequent doses. ECs are not to be used in place of regular birth control. ECs provide little protection for future pregnancies. Rationale: Important points to stress concerning ECs are that ECs do not offer any protection against STIs or future pregnancies; they should not be used in place of regular birth control, as they are less effective; they are regular birth control pills given at higher doses and more frequently; and they are contraindicated during pregnancy. Contrary to popular belief, ECs do not induce abortion and are not related to mifepristone or RU-486, the so-called abortion pill approved by the FDA in 2000.

A nurse is teaching a couple about how to use a condom. The nurse determines the couple can properly apply the condom when they state that it should be applied at which time to be most effective?

before penile-vulvar contact Explanation: Some sperm may be released with pre-ejaculation semen, so a condom needs to be used with any penile-vulvar contact. It is best applied when the penis is erect. It is not necessary to apply an hour in advance. Waiting until after ejaculation would not be effective. It can be part of the foreplay; however, the primary goal is to prevent sperm from entering the vagina, so it should be in place before any penile-vulvar contact occurs.

The nurse is caring for four female clients, all prescribed oral contraceptive pills (OCPs). The nurse will question giving an oral contraceptive pill to which client?

37-year-old client who has migraines with aura several times a week and smokes Explanation: The nurse would question giving an oral contraceptive to the 37-year-old client who has migraines with aura and smokes. This client has three risk factors (age, migraines with aura, and smokes) for complications such as deep vein thrombus formation, myocardial infarction, and cerebrovascular accident. The 25-year-old client should be counseled on becoming active. The 30-year-old client does not have any risk factors. The 40-year-old client should be monitored due to her age; however, her other factors are not contraindications. A total cholesterol level of 200 mg/dl (5.18 mmol/L) or less is considered normal.

A nurse is preparing a client for intrauterine device (IUD) insertion. Which education will the nurse provide to the client?

"Checking the strings is recommended following insertion." Explanation: The nurse should instruct the client to check the strings/threads regularly to make sure that the IUD is in place. Current recommendations are to check the strings monthly after insertion, but some clients may be instructed to check less frequently after the first 3 months following insertion because expulsion of the IUD is less common after that time. An IUD does not protect against STIs, and the insertion procedure may involve mild to moderate cramping pain; however, the client should not expect to have continuous cramping pain following insertion.

The nurse is providing care to a female client and spouse who have completed several rounds of unsuccessful in vitro fertilization. The client still desires to have a child. Which response by the nurse is appropriate?

"Have you and your spouse considered using a surrogate mother?" Explanation: The nurse would discuss other options for this client at this time. In vitro fertilization has shown to be unsuccessful for this client. A surrogate mother is a woman who agrees to carry a pregnancy to term for a subfertile party and could be a good option for this client and spouse. It is not appropriate for the nurse to recommend childless living or for the client continuing in vitro fertilization without appropriate rationale. It is not therapeutic for the nurse to ask for more information on the client's desire to have children. At this time, other options should be explored before the conversation is had regarding not having children.

The nurse working in a free health clinic assesses a 17-year-old client interested in contraceptives. Which statement by the client would indicate that female or male condoms would be the appropriate recommendation?

"Last year I was diagnosed with HPV." Explanation: The client has already contracted HPV; to prevent further spread of it—or contracting other STIs—the nurse should recommend the client use male or female condoms.

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 2 to 5 days before the sample." Rationale: Semen analysis is the most important indicator of male fertility. The man should abstain from sexual activity for 2 to 5 days before giving the sample. For a semen examination, the man is asked to produce a specimen by ejaculating into a specimen container and delivering it to the laboratory for analysis within 1 hour. When the specimen is brought to the laboratory, it is analyzed for volume, viscosity, number of sperm, sperm viability, motility, and sperm shape.

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." Rationale: 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 abnormal uterine bleeding, irritability and mood swings are more commonly associated with premenstrual syndrome. Unusually long and heavy periods reflect menorrhagia.

A nurse is conducting a class for a group of young adult women interested in contraception. As part of the class, the nurse asks the group about their understanding about contraception and pregnancy. Which statement(s) would cause the nurse to address it as a misconception. Select all that apply.

"If you douche after having sex, you will not get pregnant." "You cannot get pregnant if you have your menstrual period." "Pregnancy cannot happen if my male partner pulls out before ejaculating." "I cannot get pregnant if I am breastfeeding." Rationale: Common misconceptions include the following: Breastfeeding protects against pregnancy; pregnancy can be avoided if the male partner "pulls out" before he ejaculates; pregnancy cannot occur during menses; and douching after sex will prevent pregnancy. Taking birth control pills does not protect against sexually transmitted infections, thus the participants are correct in their understanding.

A female client has been trying to conceive for 3 months. She tells the nurse, "I just know something is wrong with me." Which response by the nurse is best?

"It can take up to 1 year of regular, unprotected intercourse to conceive." Explanation: The nurse would first provide accurate information by informing the client that 3 months is not an adequate time frame to indicate a problem is present. Most couples conceive within 1 year when they have regular intercourse without the use of contraceptives. There is no reason to assess for infertility issues with the female or with the couple's families. It is true that subfertility issues can be related to the man, woman, or both; however, it is not appropriate to indicate there is concern by stating "we will explore all possibilities."

The nurse educates a 15-year-old female client on ways to prevent pregnancy. Which statement will the nurse include in the teaching?

"The use of a condom is a method often recommended to prevent pregnancy for people your age." Explanation: The nurse would state condoms as the best option for preventing pregnancy for this age group. Oral contraceptives are also effective but must be taken daily at approximately the same time. The withdrawal method is not effective, regardless of the number of sexual partners because sperm can be released before ejaculation occurs. An intrauterine device could be removed if the client desired pregnancy in the upcoming years.

A client states she has purchased home-use ovulation strips to help her know when she is ovulating. Which response by the nurse is most appropriate?

"You can also test your vaginal discharge to determine if you are ovulating." Explanation: The appropriate statement for the nurse to make is regarding testing vaginal or cervical discharge (spinnbarkeit test). This testing and basal body temperature monitoring are free methods clients can use at home to test for ovulation. The home-use ovulation kit monitors luteinizing hormone (LH) levels in a urine sample. The home-use kit monitors for a surge in LH that would indicate ovulation is getting ready to occur. They are typically effective; however, they can be expensive to use repeatedly. Although being tested in the clinic would be most accurate, this is not feasible for most clients financially nor easy to fit into daily schedules. The nurse would not provide false assurance that usage will lead to a quick pregnancy as other factors could be present.

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 Explanation: 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 client who delivered her baby 3 months ago is seen in the clinic and tells the nurse that she and her husband have yet to resume a sexual relationship. The nurse notes that no contraception is currently being used. What is the most appropriate nursing diagnosis for this client?

Altered sexual pattern related to fear of pregnancy Explanation: The nurse should recognize that this exceeds the recommended postpartum abstinence period and might contribute to a fear of a repeat pregnancy.

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 Explanation: 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 luteinizing 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 lactation amenorrhea method works as a temporary method of contraception only for breastfeeding mothers.

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 Rationale: Currently, no method exists for directly measuring bone mass. Instead, a bone mass density (BMD) measurement is used. BMD is a two-dimensional measurement of the average content of mineral in a section of bone. The client most likely will be having a DEXA scan, which is a screening test that calculates the mineral content of the bone at the spine and hip. Ultrasound, MRI, and a pelvic X-ray would be of little help in determining bone mass.

A nurse is visiting with a couple who has recently completed subfertility assessments and are awaiting the results. Throughout the conversation the wife intermittently begins to cry. What would be the most appropriate nursing diagnosis for this couple?

Fear related to possible outcome of subfertility studies Explanation: The nurse should recognize that the client may be expressing fear related to the possible outcomes of the testing. The nurse should address those fears with the client and answer any questions to help reduce fears.

A couple who has not conceived after 6 years of not using birth control are being seen in the infertility clinic. In assessing the client's psychosocial response to infertility, which might the nurse expect to find? Select all that apply.

Guilt related to the lack of conception Anger toward others who have conceived Fear of the possible outcome of the testing Explanation: Couples who have experienced infertility may experience guilt related to the lack of conception, anger toward others, and fear of the outcome. The nurse should be prepared to visit with the couple regarding these feelings, and should view these feelings as a normal process.

A 45-year-old client and her spouse are present in the clinic. Results of fertility testing indicate that the client has damage to her fallopian tubes. Which would be the most appropriate infertility option for this client?

In vitro fertilization Explanation: This client has damage to her fallopian tubes, so any procedure would need to bypass this structure. In vitro fertilization fertilizes an ovum and then inserts it into a women's uterus.

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. Explanation: 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 client who has come to the clinic is diagnosed with endometriosis. What would the nurse expect the primary care provider to prescribe as a first-line treatment?

NSAIDs Rationale: Although progestins, antiestrogens, and gonadotrophin-releasing analogues are used as treatment options for endometriosis, NSAIDS are considered the first-line treatment to reduce pain.

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. Explanation: The medication should absorb slowly from the muscle, so the nurse supervisor should remind the nurse not to rub the injection site following administration.

A woman who is using an intrauterine system for contraception comes to the clinic. When assessing the woman, which finding(s) would alert the nurse to a possible complication? Select all that apply.

String length shorter than on initial visit Reports of abdominal pain Oral temperature of 101°F (38.3°C) Rationale: Warnings for potential complications for intrauterine system users include: late period, pregnancy, or abnormal spotting or bleeding; abdominal pain or pain with intercourse; exposure to infection or abnormal vaginal discharge; not feeling well, fever or chills; and a string length that is shorter, longer or missing. Intrauterine systems make monthly periods lighter, shorter, and less painful.

A nurse performs an assessment on a 35-year-old client who developed leg pain. The client smokes one pack of cigarettes per day and drinks alcohol socially. Assessment reveals a red, swollen right lower extremity that is warm to the touch, and pain increases with ambulation or dorsiflexion of the right foot. Client reports recent nausea, vomiting, breast tenderness, and weight gain after starting oral contraceptives. Complete the following sentence(s) by choosing from the lists of options.

The nurse suspects the client may have developed a deep vein thrombosis (DVT) as evidenced by calf pain and swelling. Explanation: The client is exhibiting signs and symptoms of deep vein thrombosis (DVT), which include pain that increases with dorsiflexion of the foot, swelling, and warmth. Women age 35 or older who use of oral contraceptives, such as estrogen-progestin, are at increased risk of developing a DVT. Smoking 15 or more cigarettes per day while taking oral contraceptives also increases the risk of DVT. Estrogen-progestin oral contraceptives should not be prescribed for women 35 years or older who smoke. Calf pain that increases with ambulation or dorsiflexion of the foot, swelling of the calf, redness of the calf, and warmth in the calf are all signs and symptoms of a DVT. Oral contraceptives increase the risk of clots in clients who take them. Nausea and vomiting are most likely due to the increase in hormones caused by the oral contraceptives. They are not due to a gastrointestinal (GI) infection nor signs or symptoms of DVT. Although pain, redness, and warmth may indicate cellulitis, there are no indications of this as a cause. The weight gain, breast tenderness, nausea, and vomiting are most likely related to oral contraceptive use. They are not likely to be related to a pregnancy nor signs or symptoms of DVT.

The nurse has assessed several clients who have arrived for routine appointments. The nurse predicts the health care provider will prioritize a bone density scan for which client?

a 55-year-old white client who smokes and has family history of osteoporosis Explanation: Risk factors for osteoporosis include female gender, white or Asian ethnicity, slender build, advanced age, estrogen deficiency because of menopause, low bone mass density, family history of osteoporosis, personal history of fracture as an adult, smoking, excessive alcohol intake, low dietary intake of calcium, vitamin D deficiency, inactive lifestyle, and use of glucocorticoids and anticonvulsants. The more of these risk factors an individual has, the higher the risk for osteoporosis. The 55-year-old white smoker with a family history of osteoporosis should be referred for bone scan or density testing. The other individuals have fewer overall risk factors.

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) Explanation: 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 discusses various contraceptive methods with a client and her partner. After the discussion, the nurse determines that the couple understood the information when they identify which method as being available only with a prescription?

cervical cap Rationale: The cervical cap is available only by prescription and must be fitted by a health care provider. The cervical sponge, condom, or spermicide do not require a prescription.

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 Explanation: Fertility awareness refers to any natural contraceptive method that does not require hormones, pharmaceutical compounds, physical barriers, or surgery to prevent pregnancy. Techniques used to determine fertility include the cervical mucus ovulation method, the basal body temperature (BBT) method, the symptothermal method, standard days method, and 2-day method. Coitus interruptus or withdrawal is not considered a fertility awareness based method.

A nurse manager in a family planning clinic is conducting an in-service presentation for the nursing staff on contraception. After teaching the group about the different methods for contraception, the manager determines that the teaching was successful when the group identifies which contraceptive methods as mechanical barrier methods? Select all that apply.

condom cervical cap cervical sponge diaphragm Rationale: Barrier methods include the condom, cervical cap, cervical sponge and diaphragm. The vaginal ring is considered a hormonal method of contraception.

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 Rationale: Condoms are a barrier method of contraception. In addition to providing a physical barrier for sperm, they also protect against STIs. Oral contraceptives, tubal ligation, and intrauterine systems provide no protection against STIs.

The nurse discusses various contraceptive methods with a client and her partner. Which method would the nurse explain as being available only by prescription?

diaphragm Rationale: The diaphragm is available only by prescription and must be professionally fitted by a health care provider. Condoms and spermicides are available over the counter. Basal body temperature requires the use of a special thermometer that is available over the counter.

Which finding would the nurse expect to find in a client with endometriosis?

dyspareunia Rationale: The client with endometriosis is often asymptomatic, but clinical manifestations include pain before and during menstrual periods (dyspareunia), pain during or after sexual intercourse, infertility, depression, fatigue, painful bowel movements, chronic pelvic pain, hypermenorrhea, pelvic adhesions, irregular and more frequent menses, and premenstrual spotting. Hot flashes may be associated with premenstrual syndrome or menopause. Fluid retention is associated with premenstrual syndrome. Fever would suggest an infection.

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 Explanation: 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.

The nurse is planning to speak at a local community center to a group of middle-aged women about osteoporosis. Which measure would the nurse be sure to include as effective in reducing the risk for osteoporosis?

engaging in daily weight-bearing exercise Explanation: 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 nurse is assessing the laboratory test results of a client with abnormal uterine bleeding (AUB). Which finding should the nurse prioritize?

hemoglobin level of 10.1 g/dl (101 g/L) Rationale: A hemoglobin level of 10.1 g/dl (101 g/L) suggests anemia, which might occur secondary to prolonged or heavy menses. A negative pregnancy test, prothrombin time of 40 seconds, and a serum cholesterol level of 140 mg/dl (3.63 mmol/L) are within normal parameters.

When discussing contraceptive options, the nurse would recommend which option as being the most reliable?

intrauterine system Rationale: An intrauterine system is the most reliable method because users have to consciously discontinue using them to become pregnant rather than making a proactive decision to avoid conception. Coitus interruptus, LAM, and natural family planning are behavioral methods of contraception and require active participation of the couple to prevent pregnancy. These behavioral methods must be followed exactly as prescribed.

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 evaluatory method to confirm this suspicion?

laparoscopy Rationale: The only certain method of diagnosing endometriosis is by seeing it. Therefore, the nurse would expect to prepare the client for a laparoscopy to confirm the diagnosis. A pelvic examination and transvaginal ultrasound are done to assess for endometriosis but do not confirm its presence. Hysterosalpingography aids in identifying tubal problems resulting in infertility.

The nurse is meeting with a 36-year-old client who wishes to begin using contraceptives. The client reports being in a long-term, monogamous relationship, runs 2 miles per day, and smokes a pack of cigarettes each day. Which method will the nurse be least likely to suggest to the client?

oral contraceptive pills (OCPs) Explanation: Oral contraceptive pills (OCPs) are contraindicated for women who smoke; these women would be at a higher risk for blood clots. Condoms, coitus interruptus, and spermicides can be used at no risk.

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 Explanation: 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.

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 event?

ovulation Rationale: Basal body temperatures typically rise within a day or two after ovulation and remain elevated for approximately 2 weeks, at which point bleeding usually begins. Basal body temperature is not a means for determining pregnancy. Having intercourse while the temperature is elevated would increase the risk of pregnancy.

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

participating in regular daily exercise Rationale: Measures to reduce osteoporosis after menopause include daily weight-bearing exercise, increasing calcium and vitamin D intake, and avoiding smoking and excessive alcohol intake. General vitamin supplements may be helpful overall, but they are not specific to reducing the risk of osteoporosis. A diet high in calcium and vitamin D, not fiber and calories, would be appropriate. Restricting fluids would have no effect on preventing osteoporosis.

A client is questioning the nurse about the various options for contraception. When explaining the implantable form, the nurse should point out it contains which form of contraception?

progestin Rationale: Implantable contraceptives deliver synthetic progestin that act by inhibiting ovulation and thickening cervical mucus so sperm cannot penetrate. Various options that combine estrogen and progestin include the transdermal patch and a vaginal estrogen/progestin (contraceptive) ring. Concentrated spermicide is inserted directly into the vagina. There are no concentrated estrogen products available for contraceptive measures.

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

should be applied to the abdomen, buttocks, or back. Explanation: 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.

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 kind of mucus?

spinnbarkeit mucus Rationale: The client is describing spinnbarkeit mucus, the copious, clear, slippery, smooth, and stretchable mucus that occurs as ovulation approaches. Purulent mucus would be yellow or green and malodorous. Pre-ovulation mucus is clear but not as copious, slippery, and stretchable.

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

taking calcium supplements Rationale: Osteoporosis is a condition in which bone mass declines to such an extent that fractures occur with minimal trauma. Increasing calcium and vitamin D intake is a major preventive measure. Other measures to reduce the risk include engaging in weightbearing exercise such as walking. Swimming, although a beneficial exercise, is not a weightbearing exercise. Taking vitamin A supplements would have no effect on preventing bone loss. Recent studies have shown that the overall health risks associated with hormone replacement therapy exceed the benefits, increasing the woman's risk for heart attacks, strokes, and breast cancer

A male client asks the nurse to explain which structure is cut during a vasectomy. What response should the nurse give the client?

the vas deferens Explanation: The two vas deferens or ductus deferentia are ligated and cut in the male sterilization procedure, called a vasectomy. The epididymis serves as a site for sperm to mature and be stored until ejaculation occurs. The ejaculatory ducts empty into the urethra and receive secretions from the prostate gland to make up semen. The scrotum is a sac-like structure that sits behind the penis and houses the testicles.

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 Explanation: 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 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 Explanation: 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.

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 contraceptive pills (OCPs). 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 Explanation: 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 contraceptive pills (OCPs). Natural membrane and polyurethane condoms are forms of male condoms, which the client does not like. Ethinyl estradiol is an oral contraceptive pill, which would most likely cause the client to experience breast tenderness, headache, and nausea.

After teaching a group of students about premenstrual syndrome, the instructor determines that additional teaching is needed when the group identifies which finding as a prominent assessment finding?

weight loss Rationale: Irritability, fatigue, bloating, tension, and dysphoria are the most prominent and consistently described manifestations of premenstrual syndrome. Weight gain, not weight loss, is associated with this disorder.

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 Explanation: The 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.