OB Exam 3 ch 25, 26, 27 -INFERTILITY/ FAMILY PLANNING, WOMEN'S HEALTH CARE NEEDS

Factors contributing to infertility: Male Factors

-Abnormalities of the sperm -Abnormal erections -Abnormal ejaculation -Abnormalities of seminal fluid

What is the nurses role in dealing with cardiovascular disease?

-Assist with identifying risk factors -Providing education -Patient care during acute episodes & recovery

The nurse determines that teaching about contraceptives is effective when the patient makes which statement? -"The more the contraceptives cost, the more effective they will be." -"The birth control pill has a medication in it to prevent most STDs." -"Condoms have very few side effects." -"I will use the contraceptive method that my husband prefers."

"Condoms have very few side effects." (Condoms will have local side effects only, such as allergic reaction. They will not produce systemic effects, as will the hormone type of contraception. Cost does not alter the effectiveness of a method. Oral hormone contraceptives do not contain other medications. The woman usually makes the final decision about her contraceptive method, and her satisfaction with the choice is crucial.)

After a year of infertility treatment, a woman has just begun another menstrual period. She tells the nurse, "I am so tired of trying. It feels like I will never have a baby. I just am not a real woman." The best response by the nurse would be: -"Remember, not everyone receiving treatment will become pregnant. We told you that at the very beginning of the treatments." -"Don't give up yet. You are still young and we are learning newer techniques to try every day." -"This must be very frustrating to you." -"Having a baby does not make you a woman."

"This must be very frustrating to you." (Infertility treatment is stressful. The woman may experience depression and guilt. The best response by the nurse is to allow the woman time to express her concerns and feelings.)

Emotional responses to infertility

-Assumption of fertility -Growing awareness of a problem -Seeking help for infertility --Identifying the importance of having a baby --Sharing intimate information --Considering financial resources --Committing to involvement in care

Cardiovascular disease risk factors

-Fixed or unmodifiable -Factors that can be changed

A pregnant woman has requested a tubal ligation for contraception. The nurse is aware that this surgery can occur (Select all that apply.) during pregnancy. -during the postpartum period prior to being discharged from the hospital. -6 weeks postpartum. -6 months postpartum.

-during the postpartum period prior to being discharged from the hospital. -6 weeks postpartum. -6 months postpartum. (A tubal ligation can be performed soon after birth. It can be done at the same time as a cesarean birth or planned before discharge or at any other time.)

A woman is being counseled concerning the calendar method type of natural family planning. The woman states that her cycles run from 27 to 29 days. The nurse teaches the woman that ovulation will probably occur on about days 10 to 12. 13 to 15. 16 to 18. 18 to 20.

13 to 15. (Ovulation occurs approximately 14 days before the onset of menses.)

When counseling teenagers about contraception, it is important to teach them methods that do not require a clinic visit. Which one(s) of the following methods do not require a clinic appointment or prescription? (Select all that apply.) Vaginal ring Condoms Intrauterine device Diaphragm Spermicides

Condoms Spermicides (Spermicides and condoms may be purchased over-the-counter and do not require a prescription or clinic visit.)

A woman who has had a hysterectomy has been prescribed hormone replacement therapy. The nurse can anticipate which type of hormones that will be prescribed to this woman? -Combination of estrogen and progesterone -Estrogen therapy alone -Hormone therapy is not recommended for women after hysterectomies. -Progesterone therapy alone

Estrogen therapy alone (Estrogen therapy alone can be given to women who have had a hysterectomy because uterine hyperplasia is not a risk. Estrogen and progesterone are given to women with a uterus to prevent hyperplasia.)

Which risk factors would necessitate performing a bone density scan on a woman younger than 65 years? (Select all that apply.) Family history of osteoporosis Fall history Active life style Chronic steroid use Normal levels of estrogen Overweight

Family history of osteoporosis Fall history Chronic steroid use (A bone density scan should be performed on a woman younger than 65 years when there is a family history of osteoporosis, history of falls, underweight, estrogen deficiency, or chronic steroid use.)

The nurse should refer the patient for further testing if which one of the following is noted on inspection of the breasts of a 55-year-old woman? -Left breast slightly smaller than the right breast -Eversion (elevation) of both nipples -Bilateral symmetry of venous network that is faintly visible -Small dimple located in the upper outer quadrant of the right breasts

Small dimple located in the upper outer quadrant of the right breasts (Dimpling or retraction is often associated with an underlying mass or tumor. The other choices are all expected findings.)

Vaginal mucus, when it resembles an egg white in consistency, possesses maximum elasticity and usually precedes or coincides with ovulation. This is known as ___________________.

Spinnbarkeit

A woman taking an oral contraceptive as her birth control method of choice should notify her health care provider immediately if she notes which one(s) of the following? Breast tenderness and swelling Weight gain Swelling and pain in one of her legs Mood swings

Swelling and pain in one of her legs (Leg pain and swelling (edema) may indicate thrombophlebitis and should be reported immediately. The other choices are all expected side effects of oral contraceptive pills, temporary in nature, and usually subside within a few cycles.)

Which one of the following is correct concerning the performance of a Pap test? -The woman should not douche, use vaginal medications, or have intercourse for at least 48 hours before the test. -It should be performed once a year, beginning with the onset of puberty. -A lubricant such as petroleum jelly should be used to ease speculum insertion. -The specimen for the Pap test should be obtained after a specimen is collected to test for cervical infection.

The woman should not douche, use vaginal medications, or have intercourse for at least 48 hours before the test. (Pap tests are performed annually for sexually active women or by age 21, 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 between the ages of 21 and 29. No lubricant other than warm water should be used because accuracy of the test can be affected. The cytologic specimen should be obtained first.)

A woman who provides the use of her uterus to an infertile couple who supplies the egg and sperm is known as a ______________________.

gestational surrogate

After an infertility assessment, a woman receives a prescription for clomiphene citrate (Clomid). The nurse should teach the woman that this medication is used to correct excess prolactin secretion. reduce endometriosis. stimulate the release of FSH and LH. induce ovulation.

induce ovulation. (Clomiphene citrate is used to induce ovulation in women who have specific types of ovulatory dysfunction. Bromocriptine (Parlodel) corrects excessive prolactin secretion. Gonadotropin-releasing hormone (GnRH) antagonists reduce endometriosis. GnRH stimulates the release of FSH and LH.)

A couple seeking infertility counseling expresses their excitement by stating, "Now at last we can become pregnant. We are so glad to get this process started!" The response by the nurse should be based on the knowledge that -infertility care does not always lead to a successful pregnancy. -a successful pregnancy chance can be increased with intervention. -infertility counseling just looks at the cause of the infertility, not its treatment. -a pregnancy can occur, but there is no guarantee about the successful completion of the pregnancy.

infertility care does not always lead to a successful pregnancy. (Because some factors contributing to infertility remain unknown, treatment of an identified problem does not always lead to a successful pregnancy.)

When teaching adolescents about sexually transmitted diseases, it is important to emphasize prompt treatment when symptoms first appear to prevent complications. One example that may be used is that untreated gonorrhea may be associated with infertility. skin eruptions. paralysis. psychosis.

infertility. (Gonorrhea is associated with pelvic inflammatory disease, which increases the risk of tubal scarring and can result in infertility. The other choices are associated with syphilis.)

A 25-year-old woman is in for her first gynecologic examination. She is in good health and has no family history of cancer or reproductive diseases. She asks the nurse if a mammogram will be performed. The nurse is aware that this woman will -need a mammogram this year, and it should be repeated every 2 years. -need a mammogram this year, and it should be repeated every 5 years. -not need a mammogram until she is 45 years old. -not need a mammogram until she is 30 years old.

not need a mammogram until she is 45 years old. (The American Cancer Society and American College of Obstetricians and Gynecologists recommends that mammograms start at the age of 45 unless the woman is at high risk for breast cancer.)

A lactating woman asks the nurse about contraception. She states that she has always used a combination pill and would like to continue with that method. The nurse should advise the woman that -oral contraceptives are contraindicated during the lactation period. -progestin-only contraceptives may be started 4 weeks after birth. -combination contraceptive pills may be started 3 to 4 weeks after birth. -only barrier methods are recommended during the lactation period.

progestin-only contraceptives may be started 4 weeks after birth. (Combination oral contraceptives reduce milk production in lactating women, and very small amounts may be transferred to the milk. Progestin-only contraceptives may be a better choice if a woman wishes to use a hormonal contraceptive because they do not affect milk production. They are often started 4 to 6 weeks after birth.)

Generally, the first test to be performed on a male when infertility issues are present is a _______________.

semen analysis

Factors contributing to infertility: Female Factors

-Disorders of ovulation -Abnormalities of the fallopian tubes -Abnormalities of the cervix

What is the definition and incidence of infertility?

-Inability to conceive after one year of unprotected intercourse (6 months if the woman is over 35) -Or, inability to carry a pregnancy to live birth -One in eight couples have trouble getting pregnant or sustaining a pregnancy.

Evaluation of infertility

-Preconception counseling -History and physical examination -Diagnostic tests

Outcomes after infertility therapy

-Pregnancy loss after infertility therapy -Parenthood after infertility therapy -Choosing adoption

Health maintenance: Screening procedures

-Prevention is better than a cure. -Early diagnosis allows early treatment. -Some screening procedures are recommended for all women of reproductive age. -Other screening procedures are recommended for older women or those with higher risk. Breast and cervical cancer STDs Rubella Tuberculosis Cholesterol Fasting glucose Urinalysis Thyroid function Genetic testing Transvaginal ultrasound Fecal occult blood Bone density Colonoscopy

Cardiovascular disease (CVD) is the number one killer of women. Atypical symptoms (compared to men) are

Unusual fatigue, upper back pain, nausea or vomiting, loss of appetite, dizziness, palpitations, jaw or neck pain

After teaching a woman about Kegel exercises, the nurse assesses that the teaching has been effective when the woman states: "Once I can contract the muscles for 10 seconds at a time I can stop the exercise." "I will need to do these exercises until I get up to 45 daily repetitions." "I will need to do these exercises for the rest of my life." "If I can stop the stream of urine I don't need to do the exercises."

"I will need to do these exercises for the rest of my life." (Kegel exercises involve conscious contracting and relaxing of the pelvic muscles. To maintain pelvic muscle tone, the woman should continue Kegel exercises for the rest of her life.)

An 18-year-old has been diagnosed with primary dysmenorrhea. Prostaglandin inhibitors have been prescribed. The nurse recognizes that teaching concerning the use of prostaglandin inhibitors has been effective when the woman states: -"I will take ibuprofen as soon as my period starts and will continue around the clock for about 2 or 3 days." -"I will take ibuprofen once a day starting 2 days before my period should begin." -"I will take naproxen once a day every day." -"I will take naproxen around the clock every day that I am bleeding."

"I will take ibuprofen as soon as my period starts and will continue around the clock for about 2 or 3 days." (The most effective prostaglandin inhibitors are nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen and naproxen. To be effective, the NSAID should be taken around the clock for at least 48 to 72 hours, beginning when menstrual flow starts.)

A 48-year-old woman has just been diagnosed with breast cancer in her right breast, and a simple mastectomy has been recommended. The nurse assesses the patient teaching on the surgery to be effective when the woman states: -"They are going to take only the tumor out and a couple of the lymph nodes." -"They will remove my entire right breast." -"They are going to take the right breast, some nodes, and even some chest muscle out." -"They will be removing only some lymph nodes."

"They will remove my entire right breast." (A simple mastectomy involves the removal of the entire breast. Axillary dissection is omitted. A lumpectomy is the removal of only the tumor. A modified radical mastectomy involves the removal of the breast tissue, axillary nodes, and some chest muscles. A sentinel lymph node biopsy is a technique to remove a few key lymph nodes to evaluate the spread of the cancer.)

A woman who was diagnosed with breast cancer 1 month ago is making an appointment for a follow-up appointment with the physician. During the conversation with the nurse, the woman becomes angry and yells, "You never have any appointments available when I can come. I always have to rearrange my day to agree with your schedule." The best response by the nurse is: -"We have so many patients and there are few available times for an appointment. I am sorry it is inconvenient for you." -"Let's look to see if we have another time that is better for you." -"You seem to be upset today." -"I am doing the best job I can. Tell me when you can come and I will try and work you in at that time."

"You seem to be upset today." (During the stages of cancer, women think that they have lost control and that their lives have been taken over by cancer. The nurse should provide time and demonstrate genuine interest in the woman's concerns using communication techniques, such as reflecting feelings, and open-ended statements to encourage her to express her concerns.)

Which one of the following women is at highest risk for cardiovascular disease? -55-year-old who is overweight and participates in no physical activity during the week -65-year-old who has type 2 diabetes -45-year-old with type 2 diabetes, hypertension, overweight, and smokes -70-year-old in good health but with a family history of cardiovascular disease

45-year-old with type 2 diabetes, hypertension, overweight, and smokes (Age, being overweight, no physical activity, type 2 diabetes, hypertension, family history, and smoking are all risk factors for cardiovascular disease. The more risk factors a woman has, the higher her risk for developing cardiovascular disease. The 45-year-old is the youngest in the choices shown, but she has the most risk factors.)

A 57-year-old woman eats two servings of calcium-rich food a day, usually in the form of 8 oz of skim milk or yogurt. To meet her calcium needs, she would need to take a calcium supplement that contains how much calcium? 400 mg 500 mg 600 mg 800 mg

600 mg (8 oz of skim milk or yogurt contain between 300 and 350 mg of calcium. Two servings would give this woman at least 600 mg. A woman older than 50 years needs 1200 mg of calcium daily, so she would need to take 600 mg in a supplement.)

Which one of the following women is at greatest risk for osteoporosis? -African-American, weight 165 lb, height 5?2'3?3?; does not smoke cigarettes or drink alcohol -Asian, weight 105 lb, height 4?2'14?3?; smokes two packs of cigarettes a day -White, weight 145 lb, height 5?2'8?3?; had a hysterectomy with removal of ovaries at age 45 -Native American, weight 165 lb, height 5?2'7?3?; alcoholic for 15 years, has been without a drink for the past 2 years

Asian, weight 105 lb, height 4?2'14?3?; smokes two packs of cigarettes a day (Small-boned, fair-skinned, White, and Asian women are at greatest risk for osteoporosis. Other risk factors include early menopause, smoking, and alcohol intake. The more risk factors, the higher the risk for developing osteoporosis. The Asian woman is small-boned and smokes, which gives her three risk factors. All the other women had zero to two risk factors.)

A 55-year-old woman has a body mass index of 35. She is at high risk for which one(s) of the following? (Select all that apply.) Diabetes mellitus Pulmonary disease Hypertension Neurologic disorders Coronary artery disease Some cancers of the breast

Diabetes mellitus Pulmonary disease Hypertension Coronary artery disease Some cancers of the breast (A 55-year-old woman with a body mass index of 35 is at high risk for diabetes mellitus, hypertension, coronary artery disease, and some cancers of the breast and reproductive organs.)

Cardiovascular disease prevention

Hypertension Smoking cessation Diet and glucose control Increased activity Aspirin

A 32-year-old woman complains of excessive bleeding with menses for the past 3 months. With a chart review, the nurse notes that the woman had a urinary tract infection 3 months ago that was treated with an antibiotic, has hypothyroidism, uses condoms with foam for contraception, and uses antidepressants. Which one of these is the most likely cause of the woman's excessive bleeding? -Urinary tract infections treated with an antibiotic -Hypothyroidism -Use of condoms with foam for contraception -Use of antidepressants

Hypothyroidism (Systemic disorders such as hypothyroidism may be a cause of dysfunctional bleeding.)

A couple delivered a full-term baby girl 3 years ago. They have been attempting pregnancy for the past 2 years, without success. When taking a history from the couple, which one of the following may lead to abnormal sperm numbers and function in the male? -His job requires him to walk most of the day, with few rest periods. -Infertility care does not always lead to a successful pregnancy. -He was diagnosed with hypertension 2 years ago and is under medical treatment. -His job requires him to be outside about 7 hours out of the 8 hours at work.

Infertility care does not always lead to a successful pregnancy. (Acute or chronic illness such as mumps, cirrhosis, and renal failure can impair the number and function of the sperm. Sitting for prolonged periods will elevate the scrotal temperature and impair the numbers and function of the sperm. Antihypertensives may produce abnormal ejaculation but do not interfere with the sperm number and function.)

Which measures provide comfort and prevent secondary infections when a sexually transmitted disease has been diagnosed? (Select all that apply.) Keep the vulva clean but avoid strong soaps, creams, and ointments unless prescribed by the health care provider. Keep the vulva dry. Take analgesics (aspirin or acetaminophen) as directed by the health care provider. Hot sitz baths may provide relief from itching. Wipe the vulva from back to front after urination or defecation.

Keep the vulva clean but avoid strong soaps, creams, and ointments unless prescribed by the health care provider. Keep the vulva dry. Take analgesics (aspirin or acetaminophen) as directed by the health care provider. (To provide comfort and prevent secondary infections, keep the vulva clean but avoid strong soaps, creams, and ointments unless prescribed by the health care provider, keep the vulva dry; using a hair dryer on low heat is helpful, wear absorbent cotton underwear and avoid pantyhose and tight pants as much as possible, take analgesics (aspirin or acetaminophen) as directed by the health care provider, cool or tepid sitz baths may provide relief from itching, wipe vulva from front to back after urination or defecation, and then carefully wash hands.)

Nurses working with adolescent women should include questions regarding sexuality when gathering data for a reproductive health history. Which one(s) of the following principles should guide the nurse when interviewing the adolescent? -An in-depth exploration of specific sexual practices should be included for this patient. -Sexual histories are optional. -Misconceptions and inaccurate information expressed by the adolescent should be corrected promptly. -Questions regarding the patient's sexual relationship are unnecessary if she is monogamous.

Misconceptions and inaccurate information expressed by the adolescent should be corrected promptly. (Misinformation and erroneous beliefs cause adolescents to use ineffective methods of contraception or none at all. Opportunities to provide counseling and information must not be missed.)

When scheduling times for women to have a pelvic examination and Papanicolaou (Pap) test, what question is important to ask the woman? -When was her last examination? -On what date will her next menstrual period start? -Does she have insurance coverage of the examination? -Does she use any type of birth control?

On what date will her next menstrual period start? (Pelvic examinations should be scheduled between menstrual periods.)

Response to infertility

Reactions during evaluation and treatment -Influences on decision-making --Social, cultural, religious values --Difficulty of treatment --Probability of success --Financial concerns -Psychological reactions Guilt Isolation Depression Stress on the relationship

A woman with premenstrual syndrome (PMS) may benefit from which of the following management techniques? Relaxation therapy Increasing caffeine High-protein diets One alcoholic drink at night during the luteal phase

Relaxation therapy (Relaxation therapy has shown benefits for women with more severe PMS symptoms. Avoiding alcohol and caffeine can help, and carbohydrate-rich foods can also help relieve PMS symptoms.)

Treatment of infertility

Therapies to facilitate pregnancy --Pharmacologic management --Surgical procedures --Therapeutic insemination --Egg donation --Surrogate parenting Assisted reproductive technology --In vitro fertilization --Gamete intrafallopian transfer --Zygote intrafallopian transfer --Intracytoplasmic sperm injection --Preimplantation genetic testing

A 50-year-old woman is trying to decrease her chances of developing osteoporosis. Which exercise can the nurse recommend that will be beneficial? Swimming Water aerobics Walking Yoga

Walking (Weight-bearing and resistance exercise have been shown to be beneficial in slowing loss of bone mass to maintain bone density. Water-based exercises such as swimming do not help limit bone loss.)

Assessment of a couple experiencing difficulty conceiving usually begins with -a complete history and physical assessment of both partners. -semen analysis. -testing of cervical mucus for LH surge. -postcoital (Sims-Huhner) test.

a complete history and physical assessment of both partners. (Assessment for the origin of infertility always begins with the least costly, noninvasive testing first. A complete history and physical assessment of both the male and female recognizes that infertility can have a female or male origin, or both. This assessment will provide clues about which types of tests, if any, would be most appropriate for this couple.)

A woman who is 17 weeks pregnant because of incest asks the nurse about having a therapeutic abortion. The nurse's best response should be based on the knowledge that -therapeutic abortions are not available in this country for a woman more than 14 weeks pregnant. -mifepristone (RU486) can be used up to week 20 of pregnancy. -methotrexate (Folex, Mexate) can be used up to week 24 of pregnancy. -a dilation of the cervix with removal of the fetus and placenta can be performed during the 17th week of pregnancy.

a dilation of the cervix with removal of the fetus and placenta can be performed during the 17th week of pregnancy. (Medications such as mifepristone and methotrexate are used for early abortions. For second-trimester abortions, dilation with removal of the fetus and placenta is performed.)

A woman is requesting information concerning contraception. She is sexually active with multiple partners and is concerned about sexually transmitted diseases. When doing patient teaching, the nurse should be aware that the contraceptive method that offers the most protection against sexually transmitted diseases is oral hormones. an intrauterine device. a male condom. natural birth control.

a male condom. (The male condom offers the best protection from sexually transmitted diseases because it is a barrier.)

Women who are past menopause are at higher risk for cardiovascular disease. One of the physiologic changes that occurs with menopause that might lead to cardiovascular disease is atrophy of the heart. a rise in the low-density lipoproteins. a rise in the high-density lipoproteins. spasms of the vascular system.

a rise in the low-density lipoproteins. (Absence of estrogen is associated with an adverse change in serum lipid levels. Serum levels of low-density lipoproteins increase. Levels of high-density lipoproteins decrease.)

A woman who is 6 weeks postpartum and lactating is being counseled about contraception. She states that she desires to have a type of birth control that she does not have to "think about." She has three children, so it should be effective and she is in a monogamous relationship. She has a history of blood clots. One appropriate choice of birth control that the nurse can recommend is a combination pill. male condoms. tubal ligation. an intrauterine device.

an intrauterine device. (Once they are inserted, IUDs provide long-term, continuous contraception without the need to take pills, have injections, or do something else before or during intercourse. They are appropriate for many women who cannot use hormonal contraception because of other problems, such as a history of blood clots. They are safe for use during lactation. Tubal ligation should be considered a permanent procedure; the woman did not request that type of contraception.)

A woman is undergoing chemotherapy for breast cancer. During the discharge teaching, it is important that the nurse teach the woman to -not wash off the marks on her skin made by the technician. -avoid crowds and anyone who is sick. -take the medication before her menstrual period. -have her calcium levels checked every 2 months.

avoid crowds and anyone who is sick. (Chemotherapeutics may kill off normal cells along with the cancer cells, especially rapidly dividing cells such as those in blood cells. Therefore the woman may be more susceptible to infection during the treatment.)

A woman comes to the clinic stating that she is going on a hiking trip that will last 2 months. She states, "I have heard there are things that can be done to prevent me from having a period during that time." The nurse's response should be based on the knowledge that -there is no healthy way to skip a menstrual period. -there is a surgery, similar to a dilation and curettage, which can be done prior to the hiking trip. -certain oral contraceptive pills may be taken consecutively for 2 months to delay menses. -there is a type of oral contraceptive pill that may result in an extended menses for 1 month and the next month's will be lighter.

certain oral contraceptive pills may be taken consecutively for 2 months to delay menses. (When women prefer extended cycles, in which menses is delayed for a few days for special occasions or for a longer time, they take two or more oral contraceptive pill packs without taking the placebo pills for several packs or indefinitely.)

A woman asks the nurse about the "new vaginal ring everyone is talking about for birth control." When counseling the woman about this method of contraception, the nurse should assess for the woman's -ability to remember to insert the device every morning. -feelings about having to insert the device before sexual intercourse. -comfort level about self-insertion of the ring every 3 weeks. -ability to return to the clinic once a month for reinsertion.

comfort level about self-insertion of the ring every 3 weeks. (The woman must remove the ring after 3 weeks and insert a new ring 1 week later. The woman must be comfortable inserting the device into the vagina.)

A 65-year-old woman, gravida 6, para 6, is complaining of increasing stress incontinence and pelvic pressure and fullness. Pelvic examination reveals a bulging in the anterior vaginal wall. This woman is most likely experiencing uterine prolapse. rectocele. cystocele. vesicovaginal fistula.

cystocele. (The classic clinical manifestations of cystocele are described in the question. Prolapse or downward displacement of the uterus could result in protrusion of the uterus through the vagina. Rectocele results in herniation of the rectal wall through the posterior vagina. Clinical manifestations relate to alterations in bowel elimination. A vesicovaginal fistula is an abnormal passage between the bladder and vagina, resulting in urinary incontinence and excoriation of the vaginal mucosa.)

A woman is trying to decrease her urinary incontinence without medication or surgery. The nurse can recommend that the woman -decrease fluid intake at night. -decrease alcohol and caffeine intake. -decrease 10% of her average weight. -increase fluid intake in the morning and decrease the intake in the afternoon.

decrease alcohol and caffeine intake. (Alcohol and caffeine can irritate the bladder and worsen incontinence. Obesity is associated with urinary incontinence, and the woman should attempt to be at her ideal weight range. Decreased fluid intake can lead to concentrated urine, which can irritate the bladder's mucous membranes and increase the urge to void.)

A woman calls the clinic concerned that a neighbor has been diagnosed with herpes genitalis type 2. The woman is upset and tells the nurse that this neighbor "used my toilet last week, so what should I do?" The nurse's response should be based on knowledge that herpes genitalis type 2 is transmitted only through sexual intercourse. direct contact. blood contamination. blood or body fluid contamination.

direct contact. (Transmission occurs only through direct contact with an infected person.)

A woman has just been diagnosed as being 2 months pregnant. She is upset and states, "This is not possible, my husband had a vasectomy 3 months ago, and he should be sterile." The nurse should respond to this woman with the knowledge that a vasectomy -is not effective in all men. -can undo itself within the first 3 months after surgery. -does not render a man sterile for about 3 months. -does result in sterility, so there should be another explanation concerning the pregnancy.

does not render a man sterile for about 3 months. (Following a vasectomy, complete sterilization does not occur until sperm are no longer present in the semen. This may be 3 months or longer.)

The recommended medication for the treatment of chlamydia would be doxycycline. podofilox. acyclovir. penicillin.

doxycycline. (Doxycycline is effective for treating chlamydia but should be avoided if the woman is pregnant. Penicillin is not recommended for chlamydia; it is the preferred medication for syphilis. Podofilox is a recommended treatment for nonpregnant women diagnosed with human papillomavirus infection. Acyclovir is used to treat genital herpes simplex virus infection.)

When obtaining a reproductive health history from a female patient, the nurse should -limit the time spent on exploration of intimate topics. -avoid asking questions that might embarrass the patient. -use only accepted medical terminology when referring to body parts and functions. -explain the purpose for the question asked and how the information will be used.

explain the purpose for the question asked and how the information will be used. (Sufficient time must be spent on gathering relevant data, even if it may be embarrassing for the patient or the nurse or involves intimate topics. Always use terms the patient can understand.)

A 49-year-old woman has come to the nurse practitioner for an examination, stating, "I haven't been for a physical examination since my last child was born 20 years ago and thought I should one since I have gone through menopause." When taking the health history from this woman, it is important to include questions concerning -problems that may have occurred with her labor and birth. -family history of heart disease. -history of childhood immunizations. -history of infertility or problems conceiving.

family history of heart disease. (A family history of heart disease is especially important when the woman is postmenopausal because estrogen, which provides some protection against coronary artery disease, decreases after menopause and obesity may increase. If there is a family history of heart disease, or other signs of heart disease, the woman needs further screening.)

A couple is in for fertility counseling. They have achieved pregnancy six times, but have lost each pregnancy before the 20th week of gestation. The nurse is aware that the most common cause of repeated pregnancy loss is lack of FSH hormone. tubal obstruction. dysfunction in the pituitary gland. fetal chromosome defects.

fetal chromosome defects. (Errors in the fetal chromosomes may result in spontaneous abortion, usually in the first trimester. Lack of FSH and dysfunction of the pituitary gland are causes of disorders in ovulation; tubal obstruction prevents implantation.)

A woman is born without a functioning uterus but has functioning ovaries. She and her husband come to the infertility clinic requesting information on the possibility of having a baby. One possibility for this couple to have a biologic child is in vitro fertilization. therapeutic insemination. gestational surrogate. gamete intrafallopian transfer.

gestational surrogate. (A surrogate mother in a gestational surrogate pregnancy supplies her uterus only, with the infertile couple supplying the sperm and ovum. The other choices all require a functioning uterus in the biologic mother.)

A 65-year-old woman calls the clinic for an appointment stating that she has developed weakness, fatigue, and nausea over the past 2 weeks. The nurse should -have her come in immediately or go to the local emergency department. -make an appointment for later in the day. -make an appointment within 1 week. -discuss with her the need for referral to a hematologist.

have her come in immediately or go to the local emergency department. (Recognition of coronary artery disease in women is important because they are more likely to die from a myocardial infarction (MI) than men. MIs tend to present with atypical vague symptoms in women that can delay recognition and treatment. Women may report having some vague symptoms that signal an imminent acute MI, such as fatigue, for several weeks before seeking care. Other symptoms may include nausea, vomiting, sweating, and dizziness.)

A 22-year-old woman has come to the clinic complaining of a "mass in my breast." The nurse practitioner notes two firm, freely mobile nodules in the upper outer quadrant of the right breast. The nurse is aware that the nurse practitioner will -refer the patient for a needle biopsy. -have the patient return during her menstrual period to reevaluate the masses. -schedule the woman for a mammography. -do nothing. Masses at this age are always benign.

have the patient return during her menstrual period to reevaluate the masses. (Fibroadenomas are benign tumors of the breast and are most common during the teenage years and the 20s. Fibroadenomas are firm, freely mobile nodules that may or may not be tender when palpated. Fibroadenomas do not change during the menstrual cycle. They are generally located in the upper outer quadrant of the breast, and more than one is often present. Treatment may involve careful observation for a few months to determine if the mass is stable. If the mass enlarges, a biopsy is done.)

A woman is being admitted to the outpatient surgical unit for tubal sterilization. She states to the nurse, "I know I have to go through with the surgery since I have already signed all the papers, but I was thinking this morning how wonderful it would be to have another baby." The nurse's next action should be to -inform the woman that the surgery unit has already been prepared and that it would be expensive to cancel the surgery at this time. -inform the woman that the surgery can be reversed at a later date if she should change her mind. -inform the surgeon of the woman's feelings. -document the conversation and continue to prepare the woman for surgery.

inform the surgeon of the woman's feelings. (Sterilization should be considered as a permanent end to fertility because reversal surgery is difficult, expensive, not always successful, and often not covered by insurance. The nurse should act as an advocate for the woman by informing the surgeon that the woman is having second thoughts about the surgery. Even though the consent forms have been signed, the woman does not have to proceed with the surgery.)

During a breast exam, the midwife notes that the woman has a transdermal contraceptive patch applied to her breast. The midwife should -document the appropriate use of the patch. -question the woman on her satisfaction with the patch. -inform the woman that the patch should not be applied to the breast. -remove the patch to complete the breast exam.

inform the woman that the patch should not be applied to the breast. (The patch can be applied to the abdomen, buttocks, upper torso, or upper arm. It should not be applied to the breast area or areas that are rubbed by straps or waistbands.)

The simple procedure a nurse in a gynecologic clinic can do to assist patients with early detection of osteoporosis is to -measure the height of the patient at each annual appointment. -assess the spinal column for changes at each annual appointment. -recommend that the patient have serum calcium levels checked twice a year. -recommend that the patient have a bone mineral analysis done once a year.

measure the height of the patient at each annual appointment. (The first noticeable evidence of bone mass loss is the loss of height. Later signs include the dowager's hump on the spinal column. Serum calcium levels will not assist in determining osteoporosis. A bone mineral analysis is done to diagnose osteoporosis.)

Semen analysis is a common diagnostic procedure related to infertility. When instructing a male patient about this test, the nurse would tell him to -ejaculate into a sterile container. -obtain the specimen after a period of abstinence from ejaculation for 3 days. -transport the specimen with the container packed in ice. -ensure that the specimen arrives at the laboratory within 30 minutes of ejaculation.

obtain the specimen after a period of abstinence from ejaculation for 3 days. (The male must ejaculate into a clean container or plastic sheath that does not contain a spermicide. He should avoid exposing the specimen to extremes of temperature, heat or cold. The specimen should be taken to the laboratory within 30 minutes of ejaculation.)

A woman calls the clinic early on a Monday morning stating that she needs a prescription for emergency contraception. On questioning by the nurse, the woman states that her boyfriend's condom was displaced during intercourse on Saturday night. The nurse should make an appointment for the woman on Monday. by Wednesday. by Thursday. no later than Friday.

on Monday. (The effectiveness of emergency contraception is greatest if used within 120 hours/5 days of unprotected intercourse.)

A nurse teaching adolescents concerning care during menses should include that -only perineal pads should be used until the woman is at least 24 years old to allow closure of the cervical os. -perineal pads should be worn at night. -tampons can be used around the clock. -tampons should be replaced every 6 to 8 hours.

perineal pads should be worn at night. (When using tampons, they should be changed at least every 4 hours to prevent excessive bacterial growth. Perineal pads should be used at night during sleep, which usually exceeds 4 hours.)

When providing care to a young single woman just diagnosed with acute pelvic inflammatory disease (PID), the nurse should -point out that inappropriate sexual behavior caused the infection. -prepare the woman for the need of IV antibiotics for the next 48 hours. -explain to the woman that infertility is a likely outcome of this type of infection. -tell her that antibiotics need to be taken until the pelvic pain is relieved.

prepare the woman for the need of IV antibiotics for the next 48 hours. (Acute PID is often treated with IV administration of broad-spectrum antibiotics. The IV antibiotics can be changed to oral treatment after 48 hours; total duration of antibiotic therapy should be 14 days. Although sexual behavior may well have contributed to the infection, the nurse must discuss these practices in a nonjudgmental manner and provide information about prevention measures. Until treatment is complete and healing has occurred, the outcome is unknown and should not be suggested.)

During an annual gynecologic examination, the physician notes an enlarged left ovary in a 28-year-old woman. The woman has no complaints of pain or tenderness. The nurse can anticipate -an appointment for an ultrasound. -scheduling the woman for a laparoscopy. -scheduling the woman for a follow-up examination after her next menses. -nothing. The finding is insignificant.

scheduling the woman for a follow-up examination after her next menses. (Follicle ovarian cysts are usually asymptomatic and generally regress during the subsequent menstrual cycle. If the woman is in her childbearing years, when the risk of ovarian cancer is less, the physician may wait until after the next menstrual cycle and examine the woman again.)

A 25-year-old woman comes to the clinic for her regular annual gynecologic examination. When taking the history, the woman tells the nurse that she has been dieting for the past year and has lost 150 lb (from 250 to 100 lb). Her menstruation stopped 6 months ago. A chart review indicates that prior to this visit her menses had been regular every 28 days. The nurse can classify this woman with primary amenorrhea. secondary amenorrhea. amenorrhea of unknown origin. possible pregnancy.

secondary amenorrhea. (Secondary amenorrhea is the cessation of menstruation for at least 6 months in a woman who has established a pattern of menstruation. Poor nutrition is one reason for secondary amenorrhea.)

A woman confides in the nurse about a painless chancre that developed next to her vaginal opening about 8 weeks ago. The woman is not concerned because it has gone away. The nurse should teach this woman -that the use of condoms will decrease chances of this developing again. -to wash the perineum with mild soap and water after intercourse to prevent recurrences. -that a serologic test is indicated. that a vaginal culture is indicated.

that a serologic test is indicated. (The first sign of primary syphilis is a painless chancre that heals in about 6 weeks. About 2 months after the initial infection, serologic tests are generally positive for syphilis. The infection does not heal but moves into the secondary stage of syphilis.)

After 2 years of infertility treatment, a couple decides that they cannot financially go through any more treatments. When discussing this decision with the couple, the nurse can discuss with them -the possibility that accepting the fact they may not have a child will cause them to relax and perhaps conceive. -how to accept the fact they may never have a child. -the possibility of adoption. -the possibility of accepting a niece or nephew as a surrogate child.

the possibility of adoption. (Not every couple who seeks treatment for infertility achieves a "take home" baby. Adoption may become an option for these couples. The nurse can assist them to explore their personal feelings about adoption, availability of newborns compared with older children, and the pros and cons of adoption.)

A woman is to have an Essure procedure performed to produce sterilization. The nurse should include in the patient teaching that -this procedure requires minor surgery and will be done in the outpatient surgical unit. -the woman should use another form of birth control for 3 months after the procedure. -the woman should rest for 24 hours after the procedure and should not lift heavy objects for a week. -narcotic analgesics will be prescribed for pain control after the procedure.

the woman should use another form of birth control for 3 months after the procedure. (With the Essure procedure, a tiny coil is inserted into each fallopian tube. The tubes become permanently blocked during the next 3 months as tissue grows into the inserts. During this time, another contraceptive method is used. The procedure can be performed in the physician's office. It is a nonsurgical method of sterilization.)

A woman and her female partner have come to the clinic stating that they would like to have a baby. During the interview, the nurse discusses the possibilities with the couple. One possibility in which the woman may conceive and deliver her biologic child is egg donation. therapeutic insemination. surrogate parenting. ovulation induction.

therapeutic insemination. (Therapeutic insemination may use semen of a donor. This can be used if a woman wants a biologic child without having a relationship with a male partner.)

The nurse is reviewing laboratory reports from several patients who had Pap tests done 3 days ago. One result stated, "high-grade squamous intraepithelial lesion." The nurse is aware that this report indicates -negative results and no follow-up is required. -a negative result but a 3-month repeat Pap test should be done. -this result has a high likelihood of becoming cancerous, and a follow-up is necessary for treatment. -the results are inconclusive and the woman should have a repeat test done in 6 months.

this result has a high likelihood of becoming cancerous, and a follow-up is necessary for treatment. (High-grade squamous intraepithelial lesion was previously categorized as carcinoma in situ. These cell changes are likely to become cancerous without definitive treatment. This woman requires immediate follow-up on the results.)

To increase the effective rate of male condoms, the female partner may douche after intercourse. use a spermicide. use a female condom. use an oil-based lubricant.

use a spermicide. (Using spermicides with condoms increases lubrication, which decreases the risk of condom breakage. Effectiveness is increased when spermicides are used with condoms.)

A school nurse is teaching a group of high school seniors about gynecologic care. It is important to include instructions on -scheduling a mammogram within the next 3 years. -vulvar self-examination. -use of contraceptives by the menopausal woman. -breast self-examination.

vulvar self-examination. (Vulvar self-examinations should begin in women 18 years old and in women younger than 18 if they are sexually active. Mammograms are routinely started at the age of 45. Due to lack of evidence of clear benefit, breast self-examinations are no longer recommended. Adolescents will not benefit from information about contraceptive use by menopausal women.)

When assisting a woman into the lithotomy position for a pelvic examination, the nurse notes a frothy, malodorous, yellow-green vaginal discharge. The nurse should anticipate the need for a -culture and sensitivity test of the discharge. -serologic test. -wet mount preparation test. -biopsy.

wet mount preparation test. (A frothy, malodorous, and yellow-green discharge is an indication of trichomoniasis. The diagnosis is made by identifying the organism in a wet mount preparation.)

A woman called the clinic desiring to start on medroxyprogesterone acetate (Depo-Provera) for contraception. The nurse should make an appointment for the woman -immediately. -within 7 days of the beginning of a menstrual period. -prior to her next menstrual period. -at the time of ovulation.

within 7 days of the beginning of a menstrual period. (The injection is best given within 7 days of the beginning of a menstrual period. If given later in the cycle, an additional form of contraception should be used for the first week.)

A 26-year-old woman is considering medroxyprogesterone acetate (Depo-Provera) as the form of contraception that is best for her. To assist this woman with making a decision concerning this method of contraception, the nurse would tell her that Depo-Provera -is inserted subcutaneously into the upper inner arm. -would require that she return to the clinic every 3 months. -should not be used if she has a history of estrogen-sensitive cancer. -Is effective for 3 years.

would require that she return to the clinic every 3 months. (Depo-Provera is an injectable progestin that prevents ovulation for 15 weeks. This requires the woman to return to the clinic every 3 months for the injection.)

BRAIDED

» B— » Benefits: information about advantages and success rates » R— » Risks: information about disadvantages and failure rates » A— » Alternatives: information about other available methods » I— » Inquiries: opportunity to ask questions » D— » Decisions: opportunity to decide or to change mind » E— » Explanations: information about method and how it is used » D— » Documentation: information given and client's understanding