Special Issues of Women's Health Care and Reproduction

After assessing a client, a nurse determines that an IUD as a method of contraceptive would be contraindicated based on a history of which finding? -Smoking -Hypertension -Abnormal uterine shape -Thromboembolic disease

Abnormal uterine shape Explanation: Use of an IUD may be contraindicated for a woman whose uterus is distorted in shape (the device might perforate the uterine wall). The copper IUD use also is not advised for a woman with severe dysmenorrhea (painful menstruation) or menorrhagia (heavy bleeding) because use may increase the incidence of these conditions. Because use of a copper IUD can cause heavier than usual menstrual flow, a woman with anemia also may not be considered a good candidate for a copper IUD. The other findings are not contraindications.

A priority nursing diagnosis based on Maslow's Hierarchy of Needs for a client with endometriosis would be: -Chronic Pain related to bleeding and endometrial pelvic implants. -Deficient Knowledge related to diagnosis and treatment. Ineffective -Breathing related to pain. -Anxiety related to effect of endometriosis on fertility.

Chronic Pain related to bleeding and endometrial pelvic implants. Explanation: According to Maslow, pain would be the highest priority since breathing difficulties are not usually a problem with endometriosis.

A young woman has just received an intrauterine device (IUD). The nurse is doing post-procedural teaching and discusses the importance of the patient reporting which of the following as possible complications of the IUD? Select all that apply. -Fever -Unusual bleeding -Leg cramping -A missing IUD string -Late period

Fever Unusual bleeding A missing IUD string Late period Explanation: Fever, unusual bleeding, a missing IUD string, and late period are all signs of complications for the woman with an IUD. Leg cramping has not been found to be associated with IUD complications.

The nurse is assessing the laboratory test results of a client with abnormal uterine bleeding (AUB). Which finding should the nurse prioritize? -negative pregnancy test -hemoglobin level of 10.1 g/dL -prothrombin time of 40 seconds -serum cholesterol of 140 mg/dL

hemoglobin level of 10.1 g/dL Explanation: A hemoglobin level of 10.1 g/dL suggests anemia, which might occur secondary to prolonged or heavy menses. A negative pregnancy test, prothrombin time of 40 seconds, and a serum cholesterol level of 140 mg/dL are within normal parameters.

A client comes to the clinic for a medical termination of pregnancy. Which potential complications should the nurse point out are possible with this type of procedure? Select all that apply. -incomplete abortion -prolonged bleeding -infection -pneumonia -hypoglycemia

incomplete abortion prolonged bleeding Explanation: Complications associated with medical termination of pregnancy are prolonged bleeding and incomplete abortion. Infection is related to surgical termination of pregnancy. Pneumonia and hypoglycemia are not related to either type.

The nurse in a primary care clinic and a client have come to see the primary care provider because the client is getting married and wants to have a prenuptial gynecologic examination. After the exam, the nurse asks about the woman's plan to have a family. The woman responds, "Why do I have to plan for a family?" What would be the nurses's best response? -Families are always best when pregnancies are not planned. -The couple can control the time between births when they plan their family. -An unwanted pregnancy can always be aborted. -The couple can decide on a method of birth control.

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

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

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

The nurse is providing education to a male client on vasectomy. What teaching should the nurse include? Select all that apply. -"The procedure will stop the production of sperm." -"You will be placed under general anesthesia for the procedure." -"The vas deferens is cut or cauterized to stop the passage of sperm." -"You can resume sexual intercourse in about one week." -"There will be a significant amount of pain following the procedure."

"The vas deferens is cut or cauterized to stop the passage of sperm." "You can resume sexual intercourse in about one week." Explanation: The nurse will educate the client that both vas deferens will be pulled through a tiny puncture wound on the scrotum. They are then cut, cauterized, or plugged to stop the passage of sperm. The procedure will be done under local anesthesia in office or ambulatory setting. Sexual intercourse can resume in about one week, but the client should use additional birth control for 6 to 10 weeks

During a health education session, a teenage client asks the nurse when she should have her first "Pap test." How should the nurse reply? -"It all depends on your family history of cancer." -"When you first start having sex." -"As soon as possible and every year thereafter." -"When you turn 21 years old."

"When you turn 21 years old." Explanation: Current guidelines recommend that the woman obtain the initial Pap smear at 21 years of age, regardless of when she first has sexual intercourse.

A young patient comes to the clinic and requests birth control pills to prevent a pregnancy. She tells the nurse that she is worried that she will get mixed up on what days to take the pills. Which would be the best type of pills to prescribe this patient? -COCs packaged with 21 pills -COCs packaged with 28 pills -COCs packaged with 30 pills -COCs packaged with 14 pills

COCs packaged with 28 pills Explanation: COCs are packaged with 21 or 28 pills. To eliminate having to count days between pill cycles, most brands are packaged with 28 pills: 21 active pills and 7 placebo pills. There is no need to skip days, because the menstrual flow will begin during the 7 days on which she takes the placebo tablets.

A newly married couple is meeting with the nurse to discuss a temporary method of birth control that is both a natural form and does not employ birth control pills/devices, in keeping with their religious beliefs. Which fertility awareness method should the nurse point out will best meet their request to delay conception until they are ready? -CycleBeads -lactation amenorrhea method -vasectomy -coitus interruptus

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

A nurse is preparing a presentation for a group of women which will cover various dietary and lifestyle changes to help avoid future pelvic structure changes. Which key point should the nurse point out in this presentation to the women? -Limit fiber intake to less than 25 grams daily. -Eat more refined, processed foods. -Drink plenty of fluids each day. -Engage in vigorous exercise.

Drink plenty of fluids each day. Explanation: All women should drink at least eight 8-ounce glasses of fluid a day. Fiber intake needs to be increased; the recommended daily intake of fiber for women is 25 grams. Refined, processed, low-fiber foods need to be replaced with high-fiber foods. The women should be encouraged to perform Kegel exercises to help increase the strength of the pelvic floor muscles. Other exercising should also be encouraged but the Kegel exercises are specific to the affected area which will lead to pelvic floor prolapse. Depending on the type of vigorous exercise, some will actually result in pelvic floor prolapse, if it puts lots of strain on the pelvic floor.

The nurse is explaining the various evaluations used to determine infertility to a young couple who have been trying to get pregnant for 5 years. Which instruction should the nurse prioritize when teaching about the postcoital test? -Should douche before the test -Can be combined with a sperm count -Is performed close to time of ovulation -Will use a prescribed lubricant during vaginal intercourse

Is performed close to time of ovulation Explanation: A postcoital test analyzes the viability of sperm in cervical and vaginal mucus. A vaginal swab for mucus is obtained after the couple have intercourse within a specific time period. The woman should not douche as it can alter the findings. It is not combined with the sperm count; that screening is done separately. The couple should also not use any lubricant during the vaginal intercourse as it can also interfere with the findings.

Blood work results show that a client has a luteal defect, which is suspected to be the primary cause of her subfertility. The nurse explains that this condition is generally corrected by which of the following? -Progesterone vaginal suppositories -Myomectomy -Diathermy - Clomiphene citrate

Progesterone vaginal suppositories Explanation: If the problem of subfertility appears to be a luteal phase defect, this can be corrected by progesterone vaginal suppositories begun on the third day of a woman's temperature rise and continued for the next 6 weeks (if pregnancy occurs) or until a menstrual flow begins. If a myoma (fibroid tumor) or intrauterine adhesions are found to be interfering with fertility, a myomectomy, or surgical removal of the tumor and adhesions, can be scheduled. If the subfertility problem is identified as tubal insufficiency from inflammation, the prescription of diathermy or steroid administration may be helpful to reduce adhesions.

What important information should the nurse give a client about the use of a diaphragm during menstruation? -Toxic shock syndrome is possible -Vaginal discharges may occur -It may cause genital burning -Use during menstruation can lead to abdominal pain

Toxic shock syndrome is possible Explanation: The nurse should inform the client that using a diaphragm during menstruation can lead to toxic shock syndrome. Vaginal discharge is associated with the use of a vaginal contraceptive ring. Genital burning may occur when spermicidal products are used along with the barrier methods of contraception. Abdominal pain is a side effect reported during the use of combined oral contraceptives and intrauterine contraceptives

An adolescent female who has recently started menstruating asks for a highly reliable birth control method. Which method should the nurse discuss with the patient? -Postcoital douching -An intrauterine device -An ovulation suppressant -Vaginal foam for her and a condom for her partner

Vaginal foam for her and a condom for her partner Explanation: For many adolescent couples, use of a dual method, such as a vaginally inserted spermicide by the girl and a condom by her partner, is a preferred method of birth control. Postcoital douching is not a method of birth control. Intrauterine devices are rarely used for early adolescents because the uterus may still be small. Ovulation suppressants are not recommended until a female has been menstruating for at least 2 years

The nurse is scheduling a female patient for a hysterosalpingogram. Which question would be most important to ask the patient before scheduling the procedure? - When did you have coitus last? -Are you allergic to any sedatives? -What is your blood type and Rh factor? -When do you expect your next menstrual flow?

When do you expect your next menstrual flow? Explanation: Because X-ray, which might be harmful to a growing pregnancy, is used, the procedure must be scheduled immediately following a menstrual flow when pregnancy could not be present. Asking about coitus, sedative allergies, or blood time and Rh factor are not the most important when scheduling the patient for a hysterosalpingogram.

A client is admitted in the health care facility with pelvic inflammatory disease (PID). When reviewing the client's history, what would the nurse identify as a risk factor? -gestational diabetes -frequent douching -genetic predisposition -environmental exposure

frequent douching Explanation: One of the risk factors associated with pelvic inflammatory disease is frequent douching. Women with gestational diabetes are at an increased risk for developing type 2 diabetes later in life. Genetic predisposition and environmental exposure are risk factors associated with breast cancer.

A nurse is asked to teach a woman to take her basal body temperature daily to assess the time of ovulation. She can detect her day of ovulation, following ovulation, because her temperature will: -increase a degree. -decrease a degree. -fluctuate a degree daily. -no longer reflect basal body temperature.

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

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

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

A female client complains of irregular menses. On further assessment, the nurse observes that the client is obese and is developing hirsutism. Her diagnosis indicates an ovarian dysfunction with increased levels of testosterone. The nurse interprets these findings to suggest: -premature ovarian failure. -polycystic ovarian syndrome. -hypothyroidism. -adrenal hyperplasia.

polycystic ovarian syndrome. Explanation: Polycystic ovarian syndrome (PCOS) results in elevated levels of testosterone. There is also associated hyperinsulinemia and impaired glucose tolerance. These result in hirsutism, obesity, and amenorrhea, or irregular menses. In premature ovarian failure, all the eggs produced by a woman develop in a rudimentary fashion. Their number decreases steadily until menopause though it does not result in obesity and hirsutism. Hypothyroidism causes increased frequency of periods without obesity and hirsutism. In adrenal hyperplasia, excess androgen is produced and women experience ovulatory failure with no signs of hirsutism and obesity.