OB NCLEX - Menopause
Increased luteinizing hormone (LH) Rationale: During the menopausal period, ovarian production of estradiol (E2) decreases. With decreased ovarian function, progesterone production is also markedly reduced. Levels of the hormone androstenedione also decrease during menopause. Luteinizing hormone and follicle-stimulating hormone (FSH) levels increase during menopause. Estradiol controls the amount of FSH and LH released by the pituitary gland via a negative feedback system; when estradiol production decreases, this feedback system ceases to function.
A client is experiencing signs of menopause. Which change in hormone level should the nurse use to confirm the client's health status? Increased luteinizing hormone (LH) Increased estradiol (E2) Increased progesterone Increased androstenedione
Estrogen preparation Rationale: Vaginal dryness can be treated with low-dose vaginal estrogen. Psychotropic medications are used to treat mental health disorders. Bisphosphonates are medications for osteoporosis. Vitamin D supplements are used to help increase calcium absorption.
A client is experiencing the menopausal symptom of vaginal dryness. Which medication should the nurse anticipate being prescribed for this client? Bisphosphonate Psychotropic Vitamin D supplement Estrogen preparation
Body Image, Disturbed Sexuality Pattern, Ineffective Knowledge, Deficient Self-Esteem, Situational Low Rationale: A client with menopause may have diagnoses of Knowledge, Deficient about menopause; Body Image, Disturbed; Self-Esteem, Situational Low; and Sexuality Pattern, Ineffective. Constipation is not a diagnosis associated with menopause. (NANDA-I ©2014)
Which nursing diagnosis should the nurse consider when planning care for a client experiencing menopause? (Select all that apply.) Body Image, Disturbed Constipation Sexuality Pattern, Ineffective Knowledge, Deficient Self-Esteem, Situational Low
Hormone replacement therapy Nonpharmacologic methods of relief Lifestyle changes Rationale: Many physiologic effects of menopause are amenable to either hormone replacement therapy (HRT) or nonpharmacologic methods of relief, such as lifestyle changes, so these options should be discussed. The recommended daily calcium intake for women over age 50 is 1200 mg to help prevent osteoporosis. Menopause does not require abstaining from sexual contact.
The nurse interviews a middle-aged client experiencing menopause. Which option should the nurse discuss to help with the symptoms? (Select all that apply.) Hormone replacement therapy Nonpharmacologic methods of relief Calcium intake of 500 mg a day Sexual abstinence Lifestyle changes
Vaginal dryness Hot flashes Headaches Thinning hair Rationale: The physical manifestations of menopause are thought to be related to diminishing estrogen. This accounts for the hot flashes, vaginal dryness, thinning hair, and headaches. Women experiencing menopause do not typically experience cold intolerance.
The nurse is assessing a client experiencing menopause. Which findings should the nurse expect in this client? (Select all that apply.) Cold intolerance Vaginal dryness Hot flashes Headaches Thinning hair
Menstrual history Medications Sleep pattern Rationale: When performing a health history on a client experiencing menopause, the nurse should obtain information about the client's menstrual history, medications, and sleep pattern. Posture and vital signs are assessments that the nurse will include when completing the physical examination.
The nurse is preparing to examine a client who is experiencing menopause. Which information should the nurse obtain when performing a health history? (Select all that apply.) Vital signs Menstrual history Medications Sleep pattern Posture
Night sweats Hot flashes Dizziness Palpitations Rationale: The manifestations of menopause affect many body systems, including the vasomotor system. Vasomotor manifestations include hot flashes, palpitations, dizziness, headaches, insomnia, and night sweats. Decreased body hair is an integumentary, not vasomotor, manifestation of menopause. Menopausal clients have integumentary manifestations that include decreased body hair, decreased skin elasticity, and decreased subcutaneous tissue.
A client asks about the symptoms of menopause during a wellness visit. Which vasomotor manifestation of menopause should the nurse describe? (Select all that apply.) Night sweats Decreased body hair Hot flashes Dizziness Palpitations
Yoga Bioidentical hormones Massage Soy and ginseng Rationale: Soy, ginseng, yoga, bioidentical hormones, and massage are all considered alternative or complementary therapies to manage menopausal symptoms. Hormone replacement therapy is not considered an alternative or complementary therapy.
A client experiencing menopause does not want to take any prescribed medications for the symptoms. Which alternative or complementary therapy should the nurse review with the client? (Select all that apply.) Yoga Bioidentical hormones Massage Soy and ginseng Hormone replacement therapy
Walking Rationale: Walking is the best method of maintaining bone health for a client in menopause. Weight-bearing exercise reduces the rate of bone loss, helps maintain optimum weight, and reduces cardiovascular risk. Swimming, cycling, and stretching are not weight-bearing exercises.
A client experiencing menopause is being counseled about bone health and exercise. Which exercise should be recommended for bone health? Walking Stretching Swimming Cycling
Menopause can lead to osteoporosis, which in turn can lead to fractures and kyphosis. Rationale: Long-term estrogen deprivation results in an imbalance in bone remodeling and osteoporosis, leading to fractures and kyphosis. Scoliosis is curvature of the spine. Poor nutrition can affect how a woman responds to menopause, but menopause does not cause poor nutrition. Muscle weakness is not associated with menopause.
A client experiencing menopause is concerned about a loss in height. Which change should the nurse explain as being responsible for this finding? Menopause can lead to osteoporosis, which in turn can lead to fractures and kyphosis. Menopause leads to bone changes that can cause scoliosis. Menopause can lead to poor nutrition and decreased bone density. Menopause leads to hormone changes that affect muscle strength in the body.
Dressing in layers Drinking cool liquids Engaging in regular exercise Rationale: Exercise can help manage the anxiety and mood swings associated with perimenopause. Dressing in loose layers of clothing that can be added or removed will increase comfort during hot flashes. Drinking cool liquids can help with hot flashes. Caffeine is not identified as having an impact on menopausal symptoms. Sexual intercourse does not have to be avoided during perimenopause, but lubricants may be used to decrease discomfort from vaginal dryness.
A client experiencing perimenopausal symptoms asks what can be done to help control the symptoms. Which intervention should the nurse recommend? (Select all that apply.) Dressing in layers Drinking cool liquids Increasing caffeine intake Engaging in regular exercise Avoiding sexual intercourse
Water-based gels are helpful for vaginal lubrication. Rationale: Water-soluble gels are helpful for vaginal lubrication in the client experiencing symptoms of menopause. Increased foreplay might be needed in menopause to allow more time for vaginal lubrication. Oil-based lubricants are not recommended. Dietary changes can be used to help with vaginal dryness and weight gain associated with menopause.
A client in menopause is experiencing sexual issues. Which information should the nurse provide to the client? Water-based gels are helpful for vaginal lubrication. Dietary changes are not needed during menopause due to hormone changes. Foreplay is not needed after menopause. Oil-based lubricants can make sexual activity more enjoyable.
Bioidentical hormones Hormone replacement therapy Soy and ginseng Acupuncture Rationale: Menopausal symptoms can be treated with medications or the use of alternative and complementary therapies. Medications include hormone replacement therapy and selective serotonin reuptake inhibitors (SSRIs) and other antidepressants, and selective estrogen receptor modulators (SERMs). Alternative and complementary therapies include bioidentical hormones, acupuncture, biofeedback, massage, meditation, yoga, soy, and ginseng. Muscle relaxers are not used to treat manifestations of menopause.
A client is experiencing severe symptoms of menopause. About which treatment should the nurse prepare teaching for this client? (Select all that apply.) Bioidentical hormones Muscle relaxers Hormone replacement therapy Soy and ginseng Acupuncture
Weight-bearing exercise reduces the rate of bone loss and reduces cardiovascular risk. Rationale: The nurse should emphasize the importance of weight-bearing exercise, which reduces the rate of bone loss, helps maintain optimum weight, and reduces cardiovascular risk. The recommended daily calcium intake for women over age 50 is 1200 mg to help prevent osteoporosis. While there are benefits to undergoing HRT, osteoporosis and cardiovascular problems are still possible. Researchers studying black cohosh, which is often used to treat hot flashes and other symptoms (not cardiovascular problems), have concluded that evidence for its effectiveness is lacking and further research is needed.
A client is trying to prevent complications of menopause such as osteoporosis and cardiovascular problems. Which intervention should the nurse suggest as most beneficial? Weight-bearing exercise reduces the rate of bone loss and reduces cardiovascular risk. Take 900 mg of calcium daily to prevent osteoporosis. Black cohosh can reduce cardiovascular risk during menopause. Hormone replacement therapy is essential for avoiding the complications of menopause.
Selective estrogen receptor modulator (SERM) Rationale: A SERM combined with conjugated estrogen is used to treat hot flashes and reduce risk of bone fractures. Recent research also suggests that SSRIs and SNRIs are effective in relieving hot flashes and night sweats, but they do not reduce the risk of bone fracture. MAOIs are a class of antidepressants.
A client with a history of bone fractures is experiencing severe hot flashes from menopause. Which medication should the nurse anticipate being prescribed for this client? Selective serotonin reuptake inhibitor (SSRI) Serotonin-norepinephrine reuptake inhibitor (SNRI) Selective estrogen receptor modulator (SERM) Monoamine oxidase inhibitor (MAOI)
As vaginal pH rises, bacterial infections can become more common. Rationale: Vaginal pH rises after menopause, predisposing women to bacterial infections. Night sweats do not increase vaginal infections. Vaginal tissue atrophies, not thickens. Vaginal lubrication decreases.
An older adult client seeks medical attention for vaginal bacterial infections. Which change in the client should the nurse consider as an explanation for the infections? Night sweats can lead to more bacteria. Increased vaginal lubrication can result in more bacteria being harbored in the vagina. As vaginal pH rises, bacterial infections can become more common. Thickened vaginal tissues tear more easily.
Encouraging discussion of how menopausal symptoms are affecting sexual functioning Asking open-ended questions about the client's body image Providing information about medications that might be prescribed to help with menopausal symptoms Explaining physiologic manifestations of menopause Rationale: The client is experiencing menopause and may have problems understanding the natural female aging process, sexual dysfunction, low self-esteem, or disturbed body image. Interventions to help the client with these problems include explaining the physiologic manifestations of menopause, providing information about medications that might be prescribed to help with menopausal symptoms, encouraging discussion of how menopausal symptoms are affecting sexual functioning, and instructing the client to use vaginal lubricants if experiencing decreased lubrication. Asking open-ended questions will further explore the client's thoughts and feelings about body image in a therapeutic manner.
A middle-aged female client experiencing symptoms of menopause has increased follicle-stimulating hormone and luteinizing hormone levels. Which intervention should the nurse initiate? (Select all that apply.) Instructing the client to avoid over-the-counter vaginal lubricants Encouraging discussion of how menopausal symptoms are affecting sexual functioning Asking open-ended questions about the client's body image Providing information about medications that might be prescribed to help with menopausal symptoms Explaining physiologic manifestations of menopause
"Ginseng may not help with my hot flashes, but it may help me sleep better." "A friend used black cohosh for relief of her hot flashes, so I think I will try it." "As long as I take soy supplements, I can go back to eating spicy foods." "Herbs have not been proven to be effective, but they can't hurt." Rationale: Little high-level research has been done on alternative treatment options for menopause symptoms. While research has shown some herbs to be beneficial, they can interact with other medications and need to be discussed with the healthcare provider. Research suggests that soy is beneficial in reducing hot flashes, but diet adjustments should also be made to help reduce hot flashes. Although black cohosh has been a popular alternative to HRT for years, a Cochrane Database review (Leach & Moore, 2012) examined 16 studies and found that, compared to placebo, black cohosh did not decrease hot flashes and other symptoms. The authors concluded that evidence for use of black cohosh is lacking and further research is needed. Ginseng may not help with symptoms of hot flashes, but it can be used for some other symptoms of menopause.
The nurse is caring for a client who is using complementary therapies to manage menopausal symptoms. Which client statement should indicate to the nurse the need for further discussion? (Select all that apply.) "Ginseng may not help with my hot flashes, but it may help me sleep better." "A friend used black cohosh for relief of her hot flashes, so I think I will try it." "As long as I take soy supplements, I can go back to eating spicy foods." "I understand that there is little high-level research on alternative treatments for menopausal symptoms." "Herbs have not been proven to be effective, but they can't hurt."
Eating more estrogenic food, such as brown rice, sweet potatoes, carrots, apples, corn, green beans, and tofu Avoiding alcohol and cigarette use Using water-soluble gels to increase vaginal lubrication Rationale: Health promotion interventions for menopause include teaching the client about the use of water-soluble gels that increase vaginal lubrication and other ways to help her continue or resume a mutually satisfying sexual relationship with her partner. Eating foods that are mildly estrogenic, such as brown rice, sweet potatoes, carrots, apples, corn, green beans, and tofu, may also improve vaginal dryness. Avoiding alcohol and tobacco use is beneficial as well. The nurse should teach the client about dressing in loose layers, not in fitted clothing. The nurse should teach the client about the risks and the benefits of HRT but emphasize that not every woman needs or wants it.
The nurse prepares teaching material for a client experiencing menopause. Which health promotion intervention should the nurse discuss with the client? (Select all that apply.) Eating more estrogenic food, such as brown rice, sweet potatoes, carrots, apples, corn, green beans, and tofu Avoiding alcohol and cigarette use Undergoing hormone replacement therapy (HRT) as soon as possible Using water-soluble gels to increase vaginal lubrication Wearing fitted clothing
"Removal of my ovaries has caused an abrupt onset of menopause, and the symptoms can be severe." Rationale: Surgical menopause is caused by removal of the ovaries, known as oophorectomy. Unlike medical menopause, onset of surgical menopause is abrupt and the symptoms may be severe. Removal of the uterus and fallopian tubes does not cause surgical menopause.
The nurse reviews with a client recovering from an oophorectomy the reason why symptoms of menopause are occurring. Which client statement should indicate to the nurse that teaching was effective? "Since my uterus has been removed, the symptoms of menopause have started." "Removal of my fallopian tubes has started surgical menopause, and the symptoms start quickly." "Surgical menopause is usually less abrupt and should subside quickly once the body adjusts." "Removal of my ovaries has caused an abrupt onset of menopause, and the symptoms can be severe."
