OB Exam 2

A nurse is admitting a client with a clinical diagnois of premenstrual syndrome (PMS). What symptom described by the client would the nurse identify as being a is characteristic of PMS? "I have abdominal bloating and breast pain after a couple days of my period." "I have nausea and headaches after my period starts, and they last 2 to 3 days." "I feel irritable and moody a week before my period is supposed to start." "I have lower abdominal pain beginning the third day of my menstrual period."

"I feel irritable and moody a week before my period is supposed to start." PMS is a cluster of physical, psychological, and behavioral symptoms, including nausea and headaches, that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses. Abdominal bloating and breast pain are likely to occur a few days prior to menses, not after it has begun as described in statement D.

A nursing student is reviewing information relative to cultural beliefs about infertility. Which statement, if made by a client, would the nurse identify as requiring an intervention? A client states that she wants to consult her Rabbi before going any further with an infertility workup. "I will not be able to use IVF therapies as it is against my religion; I am a Roman Catholic." "I may consider having infertility treatments but I have to talk this over with my husband first." "I have to take full responsibility for my failure to conceive."

"I have to take full responsibility for my failure to conceive." In certain cultures, women are viewed as being responsible for all fertility problems, but the fact that this statement acknowledges complete fault would require the nursing student to intervene in order to provide compassion and decrease the psychologic stress of the client. Statements about consulting the partner are expected, because both partners should discuss and explore available fertility options. Consultation about infertility treatments with a spiritual leader, regardless of religion, requires no intervention. Certain religions, such as Roman Catholicism, do not allow IVF therapy.

The nurse-midwife is teaching a group of women who are pregnant about Kegel exercises. Which statement by a participant would indicate to the nurse correct understanding of the instruction?

"I should hold the Kegel exercise contraction for 10 seconds and rest for 10 seconds between exercises." Guidelines suggest that women perform between 30 and 80 Kegel exercises daily. The correct technique is to hold the contraction for at least 10 seconds and to rest for 10 seconds in between so the muscles can have time to recover and each contraction can be as strong as the woman can make it. The exercises are best performed in a supine position with the knees bent. Kegel exercises should be performed throughout the pregnancy to achieve the best results.

A married couple is discussing male and female sterilization with the nurse. Which statement is most appropriate for the nurse to make? "Male and female sterilization methods are 100% effective." "Tubal ligation can be easily reversed if you change your mind in the future." "A vasectomy may have a slight effect on sexual performance." "Major complications after sterilization are rare."

"Major complications after sterilization are rare." Sterilization procedures can be safely done on an outclient basis. Complications are uncommon and usually not serious. The average failure rate for female sterilization is 0.5% and for male sterilization is 0.15%. A vasectomy has no effect on potency or volume of ejaculate. Sterilization reversal is costly, difficult, and uncertain.

A male client asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). What is the nurse's most appropriate response? "The lubricant prevents vaginal irritation." "The additional lubrication improves sex." "Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; also, it has been linked to an increase in the transmission of human immunodeficiency virus (HIV) and can cause genital lesions." "Nonoxynol-9 improves penile sensitivity."

"Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; also, it has been linked to an increase in the transmission of human immunodeficiency virus (HIV) and can cause genital lesions." Nonoxynol-9 may cause vaginal irritation.It has no effect on the quality of sexual activity or on penile sensitivity.

A woman is using the basal body temperature (BBT) method of contraception. She calls the clinic and tells the nurse, "My period is due in a few days, and my temperature has not gone up." What is the nurse's most appropriate response? "You probably didn't ovulate during this cycle." "Have you been sick this month?" "Don't worry; it's probably nothing." "This probably means you're pregnant."

"You probably didn't ovulate during this cycle." Pregnancy cannot occur without ovulation (which is being measured using the BBT method). The absence of a temperature decrease most likely is the result of lack of ovulation. Illness would most likely cause an increase in BBT. A comment such as the one in B discredits the client's concerns.

A woman inquires about herbal alternative methods for improving fertility. Which statement by the nurse is the most appropriate for instructing the woman about which herbal preparations to avoid while trying to conceive? "You should consult your physician before starting any herbal therapy regimen." "Herbal therapy has been proven to be effective in promoting fertility." "Herbs have no bearing on fertility." "Prenatal vitamins would provide you with the most benefit."

"You should consult your physician before starting any herbal therapy regimen." Although most herbal remedies have not been proven clinically to promote fertility, clients should be directed to discuss all potential therapties with their physician, in order to have the best possible outcome. Depending on the type of herbal therapy, different physiological effects can occur. The client is asking about herbal therapies and fertility and as such there is no correlation between taking prenatal vitamins and improving fertility.

true pelvis vs false pelvis

- Separated by pelvic brim - True: "lesser" pelvis, inferior to pelvic brim, contains pelvic organs - False: "greater" pelvis, superior to pelvic brim, contains inferior abdominal organs

location of breast

-between second and sixth ribs -upper 2/3 overlies pectoralis muscle -lower 1/3 overlies serratus anterior muscle

primary purposes of the bony pelvis

-protects the pelvic structures -accommodates the growing fetus during pregnancy -anchors the pelvic support structures

menstrual cycle phases

1. follicular phase 2. ovulation 3. luteal phase 4. menstruation

When should BSE be carried out?

5 to 7 days after menstruation stops

breast size reach minimal level ____________________

5 to 7 days after menstruation stops

A nurse is providing care to a client admitted with a clincial diagnosis of endometriosis. Which clinical finding should the nurse anticipate? Blood in the cul-de- sac Chandelier sign Chadwick sign Chocolate cyst

A chocolate cyst is seen in endometriosis as a result of old blood. The chandelier sign is associated with Pelvic Inflammatory disease (PID). Chadwick sign, a bluish discoloration of the cervix, vagina, and labia due to increased blood flow, is a presumptive sign of pregnancy. With endometriosis, fluid is found in the cul-de-sac, which can be associated with ectopic pregnancy and ovarian disease.

A group of nurses are discussing female fertility. Which of the following should the nurses identify as having an impact? (Select all that apply.) Select all that apply. Cephalopelvic disproportion (CPD) Financial history A clinical diagnosis of anemia Uterine abnormality Partner relationship status Bicornate uterus

A clinical diagnosis of anemia Uterine abnormality Bicornate uterus A diagnosis of anemia and the presence of a uterine abnormality can both affect a woman's fertility status. Partner relationship status, although important in one's well-being, does not typically affect female fertility, and financial history is not a factor.The presence of CPD relates to whether or not a woman can successfully deliver a baby vaginally on the basis of obtained pelvic measurements.

spermatocele

A cystic swelling, either of the epididymis or of the rete testis, that contains spermatozoa. It is usually painless and requires no therapy.

Gonadotropin-releasing hormone (GnRH)

A decapeptide hypophysiotropic hormone secreted by the hypothalamus. It stimulates the release of luteinizing hormone and follicle-stimulating hormone by the anterior pituitary.

progesterone

A natural progestational hormone used to prevent endometrial hyperplasia in nonhysterectomized, postmenopausal women who are receiving conjugated estrogen tablets; to treat dysfunctional uterine bleeding caused by hormonal imbalances; as a contraceptive in iuds; and in intravaginal gel for women using assisted reproductive technology

Papanicolaou (Pap) smear

A simple smear method of examining stained exfoliative cells. It is used most commonly to detect cancers of the cervix, but it may be used for tissue specimens from any organ. A smear is usually obtained during a routine pelvic examination annually beginning at 18 years of age. The technique permits early diagnosis of cancer and has contributed to a lower death rate from cervical cancer.

Primary syphilis

A stage of syphilis infection that occurs after an incubation period of 10 to 90 days and is characterized by a primary sore or chancre that develops at the point of initial exposure and lasts 4 to 6 weeks.

para

A woman who has produced an infant regardless of whether the child was alive or stillborn. The term is used with numerals to indicate the number of pregnancies carried to more than 20 weeks' gestation, such as para 2, indicating two pregnancies.

A nurse is discussing the decline in fertility rate after the age of 35 with the client. What is the primary reason that the nurse identifies for this occurrence? Abnormalities of oocytes Endometriosis Infection Metabolic disease

Abnormalities of oocytes By age 40, the total number of ovarian follicles is diminishing and the quality of the remaining eggs is poor. Endometriosis is more common in women who delay childbearing until after age 30. Like infection and metabolic disease, it is a cumulative factor that may contribute to age-related infertility.

A client who is breastfeeding has been diagnosed with gonorrhea. Which treatment plan should the nurse expect to be implemented? Benzathine penicillin G 2.4 million units one injection Amoxicillin 500 mg three times a day for 7 days and ceftriaxone 250 mg IM injection Amoxicillin 500 mg three times a day for 1 week Ceftriaxone 250 mg IM injection

Amoxicillin 500 mg three times a day for 7 days and ceftriaxone 250 mg IM injection Amoxicillin or ceftriaxone can be part of the treatment plan for gonorrhea but the client should be treated empirically for chlamydia as well. Dual therapy with amoxicillin and ceftriaxone can be used for treatment of gonorrhea and empirical treatment of chlamydia. Benzathine penicillin is indicated for treatment of syphilis for the lactating client.

endometriosis

An abnormal gynecologic condition characterized by ectopic growth and function of endometrial tissue. The tissue is microscopically similar to or identical with endometrium, having glands or glandlike structures, stroma, and areas of hemorrhage. Fragments may be found in the wall of the uterus or on its surface; in or on the tubes, ovaries, rectosigmoid, or pelvic peritoneum; or occasionally in remote extrapelvic areas.

corpus luteum

An anatomic structure on the ovary's surface, consisting of a spheroid of yellowish tissue 1 to 2 cm in diameter that grows within the ruptured ovarian follicle after ovulation. During a woman's reproductive years, a corpus luteum forms after every ovulation. It acts as a short-lived endocrine organ that secretes progesterone, which serves to maintain the decidual layer of the uterine endometrium in the richly vascular state necessary for implantation and pregnancy. If conception occurs, the corpus luteum grows and secretes increasing amounts of progesterone.

polycystic ovary syndrome (PCOS)

An endocrine disturbance characterized by anovulation, amenorrhea, hirsutism, and infertility. It is caused by increased levels of testosterone, estrogen, and luteinizing hormone (LH) and decreased secretion of follicle-stimulating hormone (FSH). The depressed but continuous production of FSH associated with this disorder causes continuous partial development of ovarian follicles. Numerous follicular cysts may develop. The increased level of estrogen associated with this abnormality raises the risk of cancers of the breast and endometrium.

oligospermia

An insufficient number of spermatozoa in the semen.

pelvic inflammatory disease (PID)

Any inflammatory condition of the female pelvic organs, especially one caused by bacterial infection. Characteristics of the condition include fever; foul-smelling vaginal discharge; pain in the lower abdomen; abnormal uterine bleeding; pain with coitus; and tenderness or pain in the uterus, affected ovary, or fallopian tube on bimanual pelvic examination. If an abscess has already developed, a soft, tender fluid-filled mass may be palpated. Severe PID is usually very painful; the woman may be prostrate and require narcotic analgesia. Recurrent or severe PID often results in scarring of the fallopian tubes, obstruction, and infertility.

false pelvis (greater pelvis)

Between the ala of the iliac and superior to the pelvic inlet

A nurse counseling a client with endometriosis understands which statement regarding the management of endometriosis is not accurate? Bone loss from hypoestrogenism is not reversible. Side effects from the steroid danazol include masculinizing traits. Surgical intervention is often needed for severe or acute symptoms. Women without pain and who do not want to become pregnant need no treatment.

Bone loss from hypoestrogenism is not reversible. Bone loss is mostly reversible within 12 to 24 months after the medication is stopped. Such masculinizing traits as hirsutism, a deepening voice, and weight gain occur with danazol but are reversible. Surgical intervention is often needed when symptoms are incapacitating; the type of surgery is influenced by the woman s age and desire to have children. Treatment is not needed for women without pain or the desire to have children.

true pelvis (lesser pelvis)

Bounded superiorly by the pelvic inlet and inferiorly by the pelvic diaphragm

A group of nurses are discussing health risks associated with menopause. Which finding should the nurses identify as not being associated as a health risk with menopause? Coronary heart disease Osteoporosis Obesity Breast cancer

Breast cancer Breast cancer may be associated with the use of hormone replacement therapy for women who have a family history of breast cancer. Osteoporosis is a major health problem in the United States; it is associated with an increase in hip and vertebral fractures in postmenopausal women. A woman's risk for development of and death from cardiovascular disease increases significantly after menopause. Women tend to become more sedentary in midlife. The metabolic rate decreases after menopause, so an adjustment in lifestyle and eating patterns may be required.

Supplementation on Depo Provera

Calcium and vitamin D

A woman was treated recently for toxic shock syndrome (TSS). She has intercourse occasionally and uses over-the-counter protection. On the basis of her history, what contraceptive method should the nurse identify to be avoided? Condom Cervical cap Vaginal film Vaginal sheath

Cervical cap Women with a history of TSS should not use a cervical cap. Condoms, vaginal film, and vaginal sheaths are not contraindicated for a woman with a history of TSS.

A nurse is providing preconception care to a client. Which statement should be included by the nurse?

Could include interventions to reduce substance use and abuse.

A nurse is caring for a client diagnosed with primary dysmenorrhea. What intervention should the nurse identify as being an effective relief measure? Begin taking prostaglandin synthesis inhibitors on the first day of the menstrual flow. Reduce physical activity level until menstruation ceases. Decrease intake of salt and refined sugar about 1 week before menstruation is about to occur. Use barrier methods rather than the oral contraceptive pill (OCP) for birth control.

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

A multidisciplinary approach should ensure that the woman's social, cultural, and interpersonal needs are met with regard to providing information related to contraception choices.. Which action should the nurse take first when meeting with a new client to discuss contraception? Evaluate the woman's contraceptive life plan. Determine the woman's level of knowledge about contraception and commitment to any particular method. Assess the woman's willingness to touch her genitals and cervical mucus. Obtain data about the frequency of coitus.

Determine the woman's level of knowledge about contraception and commitment to any particular method. All of these actions are part of the assessment, but determination of the woman's level of knowledge regarding contraception and her commitment to a method is the primary step and is necessary before completing the process and moving on to a nursing diagnosis. Once the client's level of knowledge is determined, the nurse can interact with her to compare options, reliability, cost, comfort level, protection from sexually transmitted infections (STIs), and a partner's willingness to participate. Data about frequency of coitus should include the number of sexual partners, level of partner contraceptive involvement, and any partner objections. A woman's willingness to touch her genitals and cervical mucus is a key factor for the nurse to discuss only if the client expresses interest in using one of the fertility awareness methods of contraception.

IUD's - Progestin Only

Devices inserted into the uterus to prevent implantation of a fertilized egg -Skyla -Kylena -Mirena

Which medication should the nurse identify as recommended by the Centers for Disease Control and Prevention (CDC)for the treatment of chlamydia? Penicillin Doxycycline Podofilox Acyclovir

Doxycycline Doxycycline is effective for treating chlamydia; however, it should be avoided if a woman is pregnant. Podofilox is a recommended treatment for nonpregnant women diagnosed with human papillomavirus infection. Acyclovir is recommended for genital herpes simplex virus infection. Penicillin is the preferred medication for syphilis.

Cervidil (Dinoprostone)

Drug class: Prostaglandin E2 (PGE) OXYTOCIC

During a health history interview, a woman states that she thinks that she has "bumps" on her labia. She also states that she is not sure how to check herself. Which response made by the nurse would be appropriate?

Explain the process of vulvar self-examination to the woman and reassure her that she will become familiar with normal and abnormal findings during the examination. During assessment and evaluation, the responsibility for self-care, health promotion, and enhancement of wellness is emphasized. The pelvic examination provides a good opportunity for the practitioner to emphasize the need for regular vulvar self-examination. Because the nurse is unsure of the cause of this client's discomfort or the results of examination, any comments about findings or their treatment would be incorrect and inappropriate. The statement in D is not accurate and should not be used in this situation.

ZIFT (zygote intrafallopian transfer)

Fertilized egg is placed in oviduct

Nurses can provide accurate information about the risks and benefits of treatment alternatives so couples can make informed decisions about their choice of treatment. Which issue would the nurse identify as not needing to be addressed by an infertile couple before treatment? Freezing embryos for later use Risk of multiple gestation Whether or how to disclose the facts of conception to offspring Financial ability to cover the cost of treatment

Financial ability to cover the cost of treatment Although the method of payment is important, obtaining information about ability to pay is not the nurses' responsibility; it is also of note that several states have mandated some form of insurance to assist couples with coverage for infertility. Multiple gestation is indeed a risk of treatment of which the couple needs to be aware. To minimize this risk, generally only three or fewer embryos are transferred. The couple should be informed that there may be a need for multifetal reduction. Nurses can provide anticipatory guidance on disclosure to offspring. Depending on the therapy chosen, there may be a need for donor oocytes, sperm, embryos, or a surrogate mother. Couples who have excess embryos frozen for later transfer must be fully informed before consenting to the procedure. A decision must be made regarding the disposal of embryos in the event of death or divorce or if the couple no longer wants the embryos at a future time.

A nurse is reviewing clinical management of genital herpes. Which statement should the nurse identify as being inaccurate? Genital herpes is chronic and recurring and has no known cure. Genital herpes is also known as genital warts. Plain soap and water are all that is needed to clean hands that have come into contact with herpetic lesions. Stress, menstruation, trauma, and illnesses have been known to trigger recurrences.

Genital herpes is also known as genital warts. Genital warts are one of the most common sexually transmitted infections (STIs); however, it is also known as human papillomavirus (HPV), not genital herpes.

A nurse is reviewing possible effects leading to infertility. Which finding, if present in both the male and female of a couple, should the nurse identify as having impact on a couple's fertility? History of hypertension. History of endocrine problems. Male and female are the same age, 35. Both partners have had children in their past marriage.

History of endocrine problems. A history of endocrine problems should be investigated further because it may have an effect on the couple's fertility. Age is a relative factor but the recorded age, 35 years, does not in itself represent a significant fertility factor unless there are additional factors. The fact that both the man and the woman have already had children is a favorable sign in fertility. Although hypertension is a relevant clinical finding, it may not have a direct bearing on the couple's fertility.

A group of nurses are discussing virally sexually transmitted infections (STI) in the United States. Which STI would the nurses as affecting the most people? Herpes simplex virus type 2 (HSV-2) Human papillomavirus (HPV) Human immunodeficiency virus (HIV) Cytomegalovirus (CMV)

Human papillomavirus (HPV) HPV infection is the most prevalent viral STI seen in ambulatory health care settings.

An infertile woman is about to begin pharmacologic treatment. As part of the regimen, she will take purified follicle-stimulating hormone (FSH) (urofollitropin [Metrodin]). Which administration method should the nurse implement? Intranasal spray Tablet Intramuscular injection Vaginal suppository

Intramuscular injection Urofollitropin is given by IM injection; the dosage may vary. It cannot be given by the other routes listed.

A group of nurses are discussing infertility. Which statement should the nurses identify as being accurate? Is perceived differently by women and men. Has a relatively stable prevalence among the overall population and throughout a woman's potential reproductive years. Is more likely the result of a physical flaw in the woman than in her male partner. Is the same thing as sterility.

Is perceived differently by women and men. Women tend to be more stressed about infertility tests and to place more importance on having children. The prevalence of infertility is stable among the overall population, but it increases with a woman's age, especially after age 40. Of cases with an identifiable cause, about 40% are related to female factors, 40% to male factors, and 20% to both partners. Infertility is a state of requiring a prolonged time to conceive, or subfertility; sterility is the inability to conceive.

A nurse is caring for a client diagnosed with premenstrual dysphoric disorder (PMDD). Which statement should the nurse identify as being accurate? It can manifest symptoms similar to those of panic disorders. Symptom presentation is acute, is episodic in nature, and varies as the disorder progresses, leading to a chronic phase. There are no physical symptoms of PMDD until the disease is well progressed. A symptom-free period occurs in the follicular phase of the menstrual cycle.

It can manifest symptoms similar to those of panic disorders. PMDD is a variant of Premenstrual Syndrome (PMS) and includes psychologic presentations as well as physical presentations. It is classified as a psychologic disorder. The client may experience panic attacks. Symptom presentation becomes chronic, recurrent, and cyclical in nature. Physical symptoms occur with PMDD (physical and mood changes) and are present at the start of the disorder. A symptom-free period in the follicular phase of the menstrual cycle is seen in PMS, not PMDD.

A nurse is admitting a client with a clinical diagnosis of dysfunctional uterine bleeding (DUB). Which finding should the nurse identify? It is most commonly caused by anovulation. The diagnosis of DUB should be the first considered for abnormal menstrual bleeding. It most often occurs in middle age. The most effective medical treatment involves steroids.

It is most commonly caused by anovulation. Anovulation may occur because of hypothalamic dysfunction or polycystic ovary syndrome. DUB most often occurs when the menstrual cycle is being established or when it draws to a close at menopause. A diagnosis of DUB is made only after all other causes of abnormal menstrual bleeding have been ruled out. The most effective medical treatment is oral or intravenous estrogen.

A nurse is reviewing the diagnosis and management of amenorrhea. Which finding should the nurse anticipate? It often goes away on its own. It probably is the result of a hormone deficiency that can be treated with medication. It may be caused by stress or excessive exercise or both. It likely will require the client to eat less and exercise more.

It may be caused by stress or excessive exercise or both. Amenorrhea may be the result of a decrease in follicle-stimulating hormone (FSH) and luteinizing hormone (LH). It is caused usually by stress or low ratio of body fat to lean mass (possibly as a result of excessive exercise), and, in rare occurrences, by a pituitary tumor. Management of stress and eating disorders is usually necessary, including counseling and education about the causes and possible lifestyle changes. In most cases a client needs to decrease her exercise and increase her body weight to resume menstruation. Amenorrhea cannot be treated by medication.

A nurse is reviewing contraceptive failure rate. Which statement should the nurse identify as being accurate? It varies from couple to couple, depending on the method and the users. It refers to the minimum level that must be achieved to receive a government license. It refers to the percentage of users expected to have an accidental pregnancy over a 5-year span. It increases over time as couples become more careless.

It varies from couple to couple, depending on the method and the users. The contraceptive failure rate is strictly a statistical measure of likely accidental pregnancy over a couple's first year of use. Failure rates decline over time because users gain experience. Contraceptive effectiveness varies from couple to couple, depending on how well a contraceptive method is used and how well it suits the couple.

azzospermia

Lack of spermatozoa in the semen. It is associated with infertility, but not impotence.

When teaching self-care prevention of genital tract infections, the nurse should instruct the woman to: Douche frequently. Increase dietary sugar and avoid yogurt. Limit time spent in damp exercise clothes and limit exposure to bath salts or bubble bath. Choose underwear or hosiery with a nylon crotch.

Limit time spent in damp exercise clothes and limit exposure to bath salts or bubble bath. Clinical observations and research have suggested that tight-fitting clothing and underwear or pantyhose made of nonabsorbent materials (like nylon) create an environment in which a vaginal fungus can grow. Bathing in bath salts or bubble bath may further irritate sensitive genital tissue. Douching can irritate tissue, alter pH, and create an environment conducive to fungal growth. Prevention of genital tract infections includes reducing dietary sugar and eating yogurt.

A 62-year-old woman has not been to the clinic for an annual examination for 5 years. The recent death of her husband reminded her that she should come for a visit. Her family doctor has retired, and she is coming to see the women's health nurse practitioner for her visit. To facilitate a positive health care experience, the nurse should:

Listen carefully and allow extra time for this woman's health history interview. The nurse has an opportunity to use reflection and empathy while listening and can ensure open and caring communication. Scheduling a longer appointment time may be necessary because older women may have longer histories or may need to talk. The comment in A is inappropriate. The client should be given positive reinforcement for coming in for her appointment even though it has been some time. A respectful and reassuring approach will ensure that women ages 50 and older will continue to seek care. The comment in C should be rephrased in a more positive manner. The nurse has an opportunity to use empathy and reflection; however, this is not the purpose of the client's visit. If the client continues to express grief over the loss of her husband, she can be referred to an appropriate support group or counseling.

A nurse is reviewing failure rates of barrier methods of contraception with consistent and correct use by the client. Which method should the nurse identify as having the lowest failure rate? Male condoms Diaphragms Spermicides Female condoms

Male condoms For typical users, the failure rate for male condoms may approach 15%; however, if condoms are used correctly, the failure rate is only 2%. The other options, even if used correctly have a higher failure rate.

A group of nurses are reviewing common bacterial sexually transmitted infections. Which statement should the nurses identify as not being accurate? Gonorrhea can be transmitted to the newborn by direct contact with gonococcal organisms in the cervix. Syphilis can be transmitted through kissing, biting, or oral-genital sex. Chlamydial infections and gonorrhea are more likely to occur in women younger than age 20. Medications for pelvic inflammatory disease (PID) can be discontinued once symptoms disappear.

Medications for pelvic inflammatory disease (PID) can be discontinued once symptoms disappear. For any infection, the entire prescription must always be taken.

Depo-Provera

Medroxyprogesterone Progestin Contraceptive Given every 3 months, IM

A client has been prescribed Danazol (Danocrine) therapy for treatment of endometriosis. Which side effect should the nurse monitor the client for? Migraine headaches Increase in heart-protective cholesterol Weight loss Increased breast size and fullness

Migraine headaches Migraine headaches can occur with administration of this medication. Danazol can have masculinizing effects, leading to a decrease in breast size. A decrease in HDL (heart-protective cholesterol) and an increase in LDL occur with this medication, as do weight gain and fluid retention.

Implantable progestins

Nexplanon -flexible tube/rod under the arm -good for 3 years -SE: irregular bleeding -stops ovulation

Semen analysis is a common diagnostic procedure related to infertility. What instructions would the nurse provide to the client regarding this test? Obtain the specimen after a period of abstinence from ejaculation of 2 to 5 days. Ensure that the specimen arrives at the laboratory within 30 minutes of ejaculation. Ejaculate into a sterile container. Transport specimen with container packed in ice.

Obtain the specimen after a period of abstinence from ejaculation of 2 to 5 days. An ejaculated sample should be obtained after a period of abstinence to get the best results. The male must ejaculate into a clean container or a plastic sheath that does not contain a spermicide. He should avoid exposing the specimen to extremes of temperature, either heat or cold, and the specimen should be taken to the laboratory within 2 hours of ejaculation.

prostaglandin

One of several potent unsaturated fatty acids that act in exceedingly low concentrations on local target organs. Prostaglandins are produced in small amounts and have a large array of significant effects. Some of the pharmacologic uses of the prostaglandins are termination of pregnancy and treatment of asthma and gastric hyperacidity.

In providing health promotion education to reduce the likelihood of transmission of sexually transmitted diseases, the nurse would describe which of the following practices as having a low potential risk for disease transmission? (Select all that apply.) Select all that apply. Erotic conversation Oral sex with female or male wearing condom Vaginal intercourse with condom Blood contact during sexual act due to menses Oral-anal contact

Oral sex with female or male wearing condom Vaginal intercourse with condom Erotic conversation would be considered a safe risk reduction practice. Oral-anal contact and blood contact during a sexual act due to menses would be considered high-risk practices. Both oral sex and vaginal sex while wearing condoms are practices with low but potential risks.

primary dysmenorrhea

Painful menstruation because of a functional disturbance rather than because of inflammation, growths, or anatomic factors.

Group B streptococcus (GBS) has been associated with poor pregnancy outcomes and is an important factor in neonatal morbidity and mortality. Which of the following would the nurse indicate as not being a risk factor for neonatal GBS infection? Preterm birth at less than 37 weeks of gestation Maternal fever of 38° C or greater Premature rupture of membranes for longer than 24 hours Positive prenatal culture result

Premature rupture of membranes for longer than 24 hours Premature rupture of membranes for 18 hours or more increases the risk for neonatal GBS infection.

in vitro fertilization-embryo transfer (IVF-ET)

Procedure of collecting the woman's eggs from her ovaries, fertilizing the eggs in the laboratory with sperm, and transferring the embryo to her uterus.

LH (luteinizing hormone)

Produced by Anterior lobe of Pituitary Gland. Targets ovaries and testes to stimulate estrogen secretion and egg maturation; stimulates sperm production.

progestin

Progesterone. Any of a group of hormones, natural or synthetic, secreted by the corpus luteum, placenta, or adrenal cortex that have a progesterone-like effect on the uterine endometrial lining to prepare it for implantation of the blastocyst.

Kylena

Progestin only IUD -lasts up to 5 years -periods are common -3-6 month adjustment period with irregularity and spotting

A nurse is caring for a young client in the Emergency Room setting and suspects that the client may be victim of human trafficking. What priority action should the nurse take?

Report the suspicions using the established protocol All nurses have a mandatory responsibility to report suspicions of human trafficking for minors (younger of 18 years of age). Recommendations to use simple yes/no questions as well as physical assessment screening methods should be used. Offering a referral to a shelter does not address the mandatory reporting responsibility. Additionally, if human trafficking is suspected, discharging with information does not address adequate safety for the client.

An induced abortion client calls the nurse to report postprocedural symptoms. Which condition is not an indication for the nurse to ask her to come into the office for care? Abdominal tenderness when pressure is applied Chills and a fever of 101° F Return of her period in less than 6 weeks Foul-smelling vaginal discharge

Return of her period in less than 6 weeks

A couple presents for their first appointment at an infertility center. Which noninvasive test should the nurse identify as needing to be done during initial diagnostic testing? Semen analysis Endometrial biopsy Hysterosalpingogram Laparoscopy

Semen analysis Semen analysis, the basic test for male infertility, is the only noninvasive procedure listed. A hysterosalpingogram is radiographic film examination that allows visualization of the uterine cavity after instillation of radiopaque contrast medium through the cervix. During an endometrial biopsy, a small cannula is introduced into the uterus and a portion of the endometrium is removed for histologic examination. Laparoscopy is useful in order to view the pelvic structures intraperitoneally.

Mirena IUD

Small T-shaped plastic device inserted into the uterus to prevent pregnancy (releases a small amount of progestin) -highest dose

Nurses can help motivate clients to use condoms by initiating a discussion related to a number of aspects of condom use. Which aspect would the nurse identify as being most important? Choice of colors and special features. Leaving the decision up to the male partner. Strategies to enhance condom use. Places to safely carry condoms.

Strategies to enhance condom use. When the nurse opens discussion on safe sex practices, the woman is given permission to clear up any concerns or misapprehensions she may have regarding condom use. The nurse can also suggest ways that the woman can enhance her condom negotiation and communications skills, such as role-playing, rehearsal, cultural barriers, and situations that put the client at risk. Although women can be taught the differences among condoms (such as size ranges, where to purchase, and price), this issue is not as important as negotiating the use of safe sex practices. Women must address the issue of condom use with every sexual contact. Some men need time to think about using condoms; if a man appears reluctant, the woman may want to reconsider the relationship. Although not ideal, women may safely carry condoms in shoes, wallets, or inside their bras. They should be taught to keep condoms away from heat. This information is important but is not germane if the woman cannot even discuss strategies on how to enhance condom use.

The nurse is providing instructions to a woman taking an oral contraceptive pill (OCP) as her birth control method. Which finding should the nurse identify as requiring the client to immediately contact her physician? Swelling and pain in one of her legs Weight gain Breast tenderness and swelling Mood swings

Swelling and pain in one of her legs Leg pain and swelling (edema) may indicate thrombophlebitis and should be reported immediately. Breast tenderness and weight gain are expected side effects of OCPs, and mood swings are a common side effect.

The Paragard IUD

T-shaped copper releasing device placed in the uterus for long term birth control. It can be an emergency contraceptive.

amenorrhea

The absence of menstruation. Amenorrhea is normal before sexual maturity, during pregnancy, after menopause, and during the intermenstrual phase of the monthly hormonal cycle; it is otherwise caused by dysfunction of the hypothalamus, pituitary gland, ovary, or uterus; by the congenital absence or surgical removal of both ovaries or the uterus; or by medication.

infertility

The condition of being unable to produce offspring.

follicular (proliferative) phase

The long phase constituting the first half of the human menstrual cycle. The endometrium is stimulated by increasing levels of estrogen and increases in thickness to prepare for possible reproduction. At the end of this phase the luteinizing hormone surge and follicle-stimulating hormone surge begin, signaling the start of the ovulatory phase.

estradiol (E2)

The most potent naturally occurring human estrogen.

What information should nurses be aware of with regard to emergency contraception pills? Emergency contraception has no medical contraindications. The pills should be readily available during the initial learning phase when a woman is using a new method of contraception. The pills protect the woman against pregnancy even if she engages in unprotected intercourse in the days after treatment. The pills must be taken no later than 48 hours after unprotected intercourse or birth control mishap.

The pills should be readily available during the initial learning phase when a woman is using a new method of contraception. A backup method of birth control is also a good idea for beginners. The woman has up to 120 hours after unprotected intercourse to take emergency contraception pills; they do not, however, protect against pregnancy from subsequent unprotected intercourse. These pills are contraindicated during pregnancy and if the woman has undiagnosed abnormal vaginal bleeding.

luteal/secretory phase

The third phase of the human menstrual cycle, when the ovarian follicle ruptures and transforms into the corpus luteum.

A nurse is providing instructions related to a Papaniocolaou (Pap)test to a client. Which statement would the nurse identify as being correct?

The woman should not douche, use vaginal medications, or have intercourse for at least 24 hours before the test. Women should not douche, use vaginal medications, or have sexual intercourse for 24 hours before a Pap smear specimen is collected so as not to alter the cytology results. Also, only warm water should be used on the speculum so as not to alter the cytology results. The cytologic specimen should be obtained first. Pap tests are performed annually for sexually active women or by age 18, especially if risk factors for cervical cancer or reproductive tract infections are present. Pap tests may be performed every 3 years in low-risk women after three negative results on consecutive annual examinations.

A nurse is reviewing aspects of fertilty awareness-based (FAB) methods. What should the nurse identify as being in common for these methods? They all rely on measurement of body temperature. They all involve abstinence at some point. They all require the cooperation of the woman's partner. They all require a woman to be able to touch her genitals to assess cervical mucus.

They all require the cooperation of the woman's partner. Fertile phases can be determined in a number of ways, but the sexual partner must cooperate in the method. Not all FAB methods calculate fertility phases by examining mucus; some use body temperatures and other signs. Some methods use chemical or physical barriers to conception during fertile periods.

A group of nurses are reviewing primary and secondary dysmenorrhea. Which of the following should the nurses identify as representing the difference between the two disorders? (Select all that apply.) Select all that apply. With primary, the pain originates at the beginning of menses. With primary, the client often complains of abdominal bloating. With secondary, the pain can occur also during ovulation. With primary, the client often presents with systemic symptoms such as dizziness and headache. The pain associated with primary radiates to the back and thighs.

With primary, the pain originates at the beginning of menses. With secondary, the pain can occur also during ovulation. With primary, the client often presents with systemic symptoms such as dizziness and headache. The pain associated with primary radiates to the back and thighs. In primary dysmenorrhea, the client typically presents with abdominal pain that is dull in nature and radiates to the back and thighs. The pain begins at the start of menses and lasts approximately 8 to 48 hours. The client presents with systemic complaints as a result of increased prostaglandins and can have gastrointestinal as well as central nervous system symptoms. The client often complains of cramping. In secondary dysmenorrhea, pain can also occur during ovulation, whereas in primary dysmenorrhea, the pain is associated only with ovulatory cycles.

A group of nurses are discussing the impact of obesity in the United States. Which statements should the nurses indicate as being accurate? (Select all that apply.) Women who are obese may be more likely to have irregularities of the menstrual cycle Women in the age group of 40 to 59 years have the highest prevalence. Obesity is associated with hypercholesterolemia. 25% of women in the Unites States are currently considered to be obese. Obesity is associated with a decreased incidence of diabetes.

Women who are obese may be more likely to have irregularities of the menstrual cycle Women in the age group of 40 to 59 years have the highest prevalence. Obesity is associated with hypercholesterolemia

Which medication should the nurse identify as being the recommended treatment to prevent transmission of human immunodeficiency virus (HIV) to the fetus during pregnancy? Zidovudine Podophyllin Ofloxacin Acyclovir

Zidovudine Perinatal transmission of HIV has decreased significantly in the past decade as a result of prophylactic administration of the antiretroviral drug zidovudine to pregnant women in the prenatal and perinatal periods. Acyclovir is an antiviral treatment for herpes simplex virus (HSV). Ofloxacin is an antibacterial treatment for gonorrhea. Podophyllin is a solution used in the treatment of human papillomavirus.

emergency contraception (EC)

a birth control method used after unprotected sexual intercourse has occurred - must be used within 120 hours of unprotected intercourse

Intrauterine Insemination (IUI)

a form of assisted reproduction in which sperm are injected directly into a woman's uterus

Skyla

a hormone-releasing IUD that is effective for 3 years

intracytoplasmic sperm injection (ICSI)

a treatment to overcome defects in sperm count or motility; an egg is fertilized by microinjection of a single sperm

primigravida

a woman pregnant for the first time

lobules are clusters of

acini

Depo Provera Shot

an injectable hormonal contraceptive, it lasts for 3 months. 99% effective at preventing pregnancy only if taken exactly 3 months apart each time

care management

assist women to choosing the appropriate contraceptive

prostaglandins (PGs)

assure uterus is mobile and fallopian tubes are smooth

progesterone

causes mammary gland maturation

A nurse is reviewing anatomy of the female reproductive system. What should the nurse identify as the function of the uterus?

cyclic menstruation The uterus is an organ for reception, implantation, retention, and nutrition of the fertilized ovum; it also is responsible for cyclic menstruation. Hormone production and fertilization occur in the ovaries. Sexual arousal is a feedback mechanism involving the hypothalamus, the pituitary gland, and the ovaries.

A nurse is providing instruction to a couple undergoing zygote intrafallopian transfer (ZIFT). The nurse is aware that instruction has been effective when the woman states: a. "My egg will be fertilized and then placed into my uterus." b. "My husband's sperm will be inserted into my uterus." c. "My husband's sperm and my egg will be placed into my fallopian tube." A nurse is providing instruction to a couple undergoing zygote intrafallopian transfer (ZIFT). The nurse is aware that instruction has been effective when the woman states: d. "A fertilized egg will be placed into my fallopian tube."

d. "A fertilized egg will be placed into my fallopian tube."

oocyte donation

eggs are obtained from a donor, fertilized, and transplanted to uterus of client

ovaries

female gonads that produce estrogen and progesterone

Assisted reproductive therapy (ART)

fertility treatments in which both eggs and sperm are handled

menstrual cycle

hypothalamic-pituitary cycle ovarian cycle endometrial cycle

progestin-only contraception

indicated for women who have blood clots or other complications ex. - minipill - injectable progestins: Depo Provera

hyperosalpingography

inject dye into uterus in IR into fallopian tubes determine uterine cavities -bicornuate -partial bicornuate -unicornuate uterus

conception

intentional prevention of pregnancy

cervix

lower cylindrical portion of the uterus; entrance to the uterus

isthmus of the uterus

lower uterine segment that separates the corpus from the cervix

Climacteric and Menopause

marks the end of a woman's reproductive period

cytotec

misoprostol (a prostaglandin) synthetic prostaglandin dilates cervix to induce labor

why do ovaries shrink after menopause

ovaries do not produce estrogen

ovulation

peritoneal event; ovary creates a corpus luteal cyst (where egg is released from) and fimbriae grab egg; egg travels to fallopian tube

A nurse is reviewing physiology of the female reproductive system. Which hormone should the nurse identify as being responsible for maturation of mammary gland tissue?

progesterone

FSH and LH

regulate processes in the gonads and the production of sex hormones

estrogen and progesterone

responsible for ovulation

acinus

saclike terminal part of a compound gland emptying through a narrow lumen or duct

breasts change in...

size and nodularity in response to ovarian changes

estrogen

stimulates growth of breasts increases vascularity

FSH (follicle stimulating hormone)

stimulates secretion of ovarian sex hormones, development of ovarian follicles, and sperm production

birth control

the device that is used to prevent conception

Fundus

the dome-shaped upper portion of the uterus between the fallopian tubes

menarche

the first menstrual period average age:13

A nurse is reviewing the concept of sexual response. Which statement should the nurse identify as inaccurate? Facial grimaces and spasms of hands and feet are often part of arousal Women and men are more alike than different in their physiologic responses to sexual arousal and orgasm the orgasmic phase is the final state of the sexual response cycle. Vasocongestion is the congestion of blood vessels

the orgasmic phase is the final state of the sexual response cycle.

puberty

the physiological changes during adolescence that lead to the ability to reproduce

climacteric: premenopausal

transition phase during which ovarian function and hormone production decline

laparoscopy

visual examination of the abdomen

hysteroscopy

visual examination of the uterus

primipara

w woman who has given birth to one viable infant, indicated by the notion para 1 on the patient's chart

Depo Provera side effects

• Spotting/amenorrhea • Wt. gain, bloating, decreased libido, hair loss, depression, delayed return of fertility • SERIOUS: chest pain, hemoptysis, ab. pain, SOB • Long term loss of bone min. density (2 yrs use max) • CI: PP Depression, vaginal, bleeding, pregnancy