Women's Health
The nurse is obtaining blood for a human chorionic gonadotropin (hCG) level from a newly pregnant woman. What does the nurse teach this woman about the purpose of the hormone and why levels are evaluated? "Elevated hCG levels indicate the endometrial lining is being prepared for implantation of the embryo." "This hormone is present at consistent levels from the time of conception throughout the pregnancy." "Levels of this hormone increase to help form the placenta, which nourishes the fetus." "This hormone is at low levels at the time of fertilization and helps increase myometrial contraction."
"Elevated hCG levels indicate the endometrial lining is being prepared for implantation of the embryo." Explanation: The hormone hCG is produced as early as three days after conception from the trophoblasts. It preserves the corpus luteum and its progesterone production so the endometrial lining is ready for implantation. The increased progesterone production then maintains the endometrium. hCG is the basis for the pregnancy tests because it is the first hormone to be detected. The levels continue to rise until the placenta is fully functional, then the levels begin to decline as other hormones take over. Myometrial contractility is caused by estrogen. The trophoblasts differentiate into all the cells that form the placenta.
A 22-year-old single female client is discussing contraceptive methods with the health care provider and specifically asking about the vaginal ring insert. The nurse realizes the client needs further instruction when they make which statement? "If the ring falls out, it must be put back in place within 3 hours." "There is less breakthrough bleeding than with pills." "The risks are the same for this and combined pills." "This ring contains only progesterone for birth control."
"This ring contains only progesterone for BC" Contains estrogen and progesterone, OK to take out and replace after one week Explanation: The vaginal ring contains a combination of estrogen and progesterone inserted into the vagina for 3 weeks, removed for 1 week, followed by reinsertion of a new ring. If the ring is out of place for more than 3 hours, contraceptive effectiveness decreases. A positive benefit of this form of contraception is a lessening of breakthrough bleeding often seen in other contraceptive methods. The risks associated with the ring are the same as those experienced by someone using the combined estrogen/progesterone pills.
An adolescent has been diagnosed with polycystic ovarian syndrome (PCOS). Which statement by the adolescent indicates the need for more teaching? "High levels of male hormones contribute to my PCOS." "I am at risk for type 2 diabetes." "Maintaining a healthy weight is an important part of my treatment plan." "Untreated PCOS will make getting pregnant impossible."
"Untreated PCOS will make getting pregnant impossible." Explanation: While pregnancy may be difficult for some clients, the nurse must work to prevent the false conception that a sexually active teen with PCOS does not need to use a reliable form of birth control. PCOS is associated with high levels of androgens and excessive insulin. It is the excess insulin that is thought to increase androgen production. Clients with PCOS are at risk for type 2 diabetes. Initial treatment focuses on weight management and exercise. These measures often reduce insulin production and restore normal menstrual cycles.
The spouse of a client with cervical cancer says to the nurse, "The doctor told my spouse that their cancer is curable. Is the doctor just trying to make us feel better?" Which would be the nurse's most accurate response? "When cervical cancer is detected early and treated aggressively, the cure rate is almost 100%." "The 5-year survival rate is about 75%, which makes the odds pretty good." "Saying a cancer is curable means that 50% of all women with the cancer survive at least 5 years." "Cancers of the female reproductive tract tend to be slow-growing and respond well to treatment."
"When cervical cancer is detected early and treated aggressively, the cure rate is almost 100%." Explanation: When cervical cancer is detected early and treated aggressively, the cure rate approaches 100%. The incidence of cervical cancer has increased among clients of African descent, Native American and Aboriginal females, and Latinas, and they often have a poorer prognosis because the cancer is not identified early. Papanicolaou tests and colposcopy have the potential to decrease mortality from invasive carcinoma when these screening and treatment programs are utilized.
Which woman is at greatest risk for bacterial vaginosis? 75-year-old with chronic obstructive disease 52-year-old experiencing menopause 28-year-old who is sexually active 12-year-old who has just started their menstrual cycles
28 yo sexually active Explanation: Bacterial vaginosis is the most common vaginal infection in reproductive-age females, and up to 50% of clients may be asymptomatic. Bacterial vaginosis is not usually transmitted sexually, and treatment of the male sex partner has not been beneficial in preventing recurrence of bacterial vaginosis. Bacterial vaginosis is not associated with aging, chronic illness, menopause, or onset of menstruation.
A client has just begun taking an oral contraceptive that contains estrogen and progestin. The nurse should instruct the client to use additional methods of contraception for at least 7 days. 2 weeks. 1 month. 2 months.
7 days Explanation: Because of the mechanism of action of oral contraceptives, the onset of action is somewhat delayed. Full contraceptive benefits don't occur until an oral contraceptive agent has been taken for at least 7 days.
During a home visit, a breastfeeding client asks the nurse what contraception method they should use until their 6-week postpartum examination. Which method would be most appropriate for the nurse to suggest? condom with spermicide oral contraceptives rhythm method abstinence
Condom with spermicide Explanation: If not contraindicated for moral, cultural, or religious reasons, a condom with spermicide is commonly recommended for contraception after birth until the client's 6-week postpartum examination. This method has no effect on the neonate who is breastfeeding. Oral contraceptives containing estrogen are not advised for clients who are breastfeeding because the hormones decrease the production of breast milk. Clients who are not breastfeeding may use oral contraceptive agents. The rhythm method is not effective because the client is unlikely to be able to determine when ovulation has occurred until their menstrual cycle returns. Although breastfeeding is not considered an effective form of contraception, breastfeeding usually delays the return of both ovulation and menstruation. The length of the delay varies with the duration of lactation and the frequency of breastfeeding. While abstinence is one form of birth control and safe while breastfeeding, it may not be acceptable to this couple who is asking about a method that will allow them to resume sexual relations.
A menopausal woman with an intact uterus is taking a combined estrogen and progesterone replacement medication, conjugated estrogens/medroxyprogesterone acetate 0.625 mg/2.5 mg, for severe hot flashes. Combined hormonal therapy is given because estrogen alone: Would not be effective for hot flashes. Could be a risk factor for endometrial cancer. Would not be sufficient to maintain libido. Could be a risk factor for ovarian cancer.
Could be a risk for endometrial cancer Explanation: Unopposed estrogen in a client with an intact uterus can cause overgrowth of the endometrium, or endometrial hyperplasia. This hyperplasia can be a precursor to endometrial cancer. Estrogen is effective in the control of hot flashes. If libido is a major problem, testosterone is usually deficient. Hormone replacement therapy (HRT) is not known to be related to the incidence of ovarian cancer, but it is considered a risk factor for breast cancer. HRT should be used at the lowest dosage for the shortest period of time to control hot flashes.
An adolescent girl is being treated for anogenital warts caused by the human papillomavirus (HPV). What is the nurse's priority intervention for this client? Educate the client about the need to adhere to antibiotic therapy. Educate the client about the accompanying risk of cervical cancer. Assess the client's knowledge of hormonal contraceptives. Assess the client for signs and symptoms of systemic infection.
Educate the client about the accompanying risk of cervical cancer. Explanation: This client's external lesions should be treated, and they should receive education regarding the relationship between HPV and cervical cancer. Antibiotics would be ineffective because of the viral etiology of HPV. Hormonal contraceptives are of no benefit, and HPV is not normally the cause of systemic infection.
An adolescent presents to a community clinic for treatment of vulvar lesions associated with type 2 herpes simplex. Which intervention is appropriate to do at this time? Select all that apply. Notify the adolescent's parents and ask permission to treat their daughter. Escort the adolescent to a private examination room. Inform the adolescent that confidentiality is not guaranteed. Ask the adolescent if her parents know about her sexual activity. Provide the adolescent with literature about type 2 herpes simplex.
Escort client to private room for examination Provide with literature about HSV 2 Explanation: The nurse should take the client to an examination room to provide privacy. Laws state that adolescents may obtain treatment for sexually transmitted diseases without parental notification. It is appropriate to provide literature about the disorder to prevent further occurrence. This adolescent is guaranteed the same confidentiality as older clients. It is not appropriate for the nurse to ask the adolescent if their parents know about their sexual activity; doing so could undermine the therapeutic relationship.
A nurse is preparing to provide contraceptive counseling for a client. What should the nurse plan to do first? Obtain a thorough health history from the client. Explore her own personal beliefs and feelings about contraception. Help determine the most appropriate contraceptive method for the client . Perform a complete physical assessment of the client.
Explore her own personal beliefs and feelings about contraception Explanation: The nurse must first explore their own personal beliefs and feelings about contraception to detect biases; if biases exist, the nurse must refer the client to another health care provider. Only after exploring personal beliefs and feelings does the nurse obtain a thorough health history, perform a complete physical assessment, and help determine the most appropriate contraceptive method.
The nurse is counseling a client with osteoporosis about dietary choices to slow bone loss. What foods should the nurse teach the client to avoid? Soy beans and soy products such as tofu Canned fish such as salmon or tuna Foods and beverages high in caffeine Foods high in purines such as organ meats
Foods and beverages high in caffeine (decrease calcium absorption) Explanation: Caffeine may decrease calcium absorption and contribute to bone loss so should be avoided in high amounts. To help prevent osteoporosis, the nurse should encourage the client to consume at least the recommended daily allowance (RDA) of calcium. Before menopause, the RDA is 1,000 mg; after menopause, it is 1,500 mg. Foods high in calcium included canned fish (especially with bones) and dairy products. Uric acid levels are controlled with decreased purine intake, and this is related to risk for gout and does not relate to osteoporosis. Soy products have not been proven to reduce bone loss but may confer some benefits and do not need to be avoided.
A client comes to the outpatient department complaining of vaginal discharge, dysuria, and genital irritation. Suspecting a sexually transmitted disease (STD), the physician orders diagnostic testing of the vaginal discharge. Which STD must be reported to the public health department? bacterial vaginitis gonorrhea genital herpes human papillomavirus (HPV)
Gonorrhea Explanation: Gonorrhea must be reported to the public health department. Bacterial vaginitis, genital herpes, and HPV aren't reportable diseases.
A client 6 weeks postpartum asks the nurse about taking medroxyprogesterone injections for birth control. What should the nurse determine prior to discussing options? Select all that apply. if the client has a sexually transmitted disease how willing her husband is to have her take the drug if the woman is experiencing postpartum depression that the woman is not currently pregnant if the woman is breastfeeding
If the woman is experiencing PP depression That the woman is currently pregnant If the woman is breastfeeding Explanation: Before discussing the use of medroxyprogesterone acetate as a birth control option, the nurse should determine if the client is or has been depressed because medroxyprogesterone acetate can increase depression in a client with depression. The drug can be transmitted in breast milk, and the long-term effects on the baby are not known. Clients who are pregnant should not take medroxyprogesterone acetate. Medroxyprogesterone acetate does not treat or prevent sexually transmitted diseases, so this information is not essential when considering its use. Although the spouse should be a part of birth control decisions, the final decision is made by the client.
A menopausal woman is taking hormone replacement therapy. What warning sign of endometrial cancer should the nurse instruct the client to report to her health care provider? hot flashes irregular vaginal bleeding urinary urgency dyspareunia
Irregular vaginal bleeding Explanation: Endometrial cancer has very few warning signals; irregular bleeding may be the only sign. Any irregular bleeding in a menopausal client should be investigated, and an endometrial biopsy may be prescribed. Hot flashes result from the decreased estrogen levels that accompany menopause. Urinary urgency should be monitored and treated as a separate problem. Dyspareunia is the occurrence of pain in the labial, vaginal, or pelvic areas during or after sexual intercourse. It may be caused by inadequate vaginal lubrication in the menopausal client.
The nurse is interviewing a client with newly diagnosed syphilis. To prevent the spread of the disease, the nurse should focus the interview on which approach? motivating the client to undergo treatment obtaining a list of the client's sexual contacts increasing the client's knowledge of the disease reassuring the client that medical records are confidential
Obtaining a list of the client's sexual contacts Explanation: An important aspect of controlling the spread of sexually transmitted diseases (STDs) is obtaining a list of the sexual contacts of an infected client. These contacts, in turn, should be encouraged to obtain immediate care. Many people with STDs are reluctant to reveal their sexual contacts, which makes controlling STDs difficult. Increasing clients' knowledge of the disease and reassuring clients that their records are confidential can motivate them to seek treatment, which helps to control the spread of the disease, but it is not as critical as information about the client's sexual contacts.
A client is diagnosed with osteoporosis. Which statements would the nurse include when teaching the client about the disease? Select all that apply. Osteoporosis is common in females after menopause. Osteoporosis is a degenerative disease characterized by a decrease in bone density. Daily medication is needed to cure the disease. Osteoporosis can cause pain and injury. Passive ROM exercises can promote bone growth. Limit weight bearing and repetitive exercises.
Osteoporosis is common in females after menopause. Osteoporosis is a degenerative disease characterized by a decrease in bone density Osteoporosis can cause pain and injury. Explanation: Osteoporosis is a degenerative metabolic bone disorder in which the rate of bone resorption accelerates and the rate of bone formation decelerates, thus decreasing bone density. Postmenopausal clients are at increased risk for this disorder because of their loss of estrogen. Osteoporosis is a treatable disease but there is no cure. The decrease in bone density can cause pain and injury. Osteoporosis is not an inherited disorder; however, low calcium intake because of an intolerance of milk products does contribute to it. Passive ROM exercises may be performed, but they will not promote bone growth. The client should be encouraged to participate in weight-bearing exercise because it promotes bone growth.
A client with heart failure is admitted to an acute care facility and is found to have a cystocele. When planning care for this client, the nurse is most likely to formulate which nursing diagnosis? total urinary incontinence functional urinary incontinence reflex urinary incontinence stress urinary incontinence
Stress urinary incontinence Explanation: Stress urinary incontinence is a urinary problem associated with cystocele — herniation of the bladder into the birth canal. Other problems associated with this disorder include urinary frequency, urinary urgency, urinary tract infection, and difficulty emptying the bladder. Total incontinence, functional incontinence, and reflex incontinence usually result from neurovascular dysfunction, not cystocele.
The client comes to the clinic for oral birth control and has a history of smoking one pack of cigarettes per day. What should the nurse include in the client's teaching? Select all that apply. "Taking oral birth control medication can cause hypertension (HTN)." "Taking oral birth control medication can cause a cerebrovascular accident (CVA)." "Taking oral birth control medication can cause a deep vein thrombosis (DVT)." "Taking oral birth control medication can cause an myocardial infarction (MI)." "Taking oral birth control medication can cause aplastic anemia."
Taking oral BC can cause: DVT, MI, CVA Explanation: Oral birth control has been associated with an increased risk of MI, CVA, and DVT. The nurse should explain that these risks are increased when the client is a smoker. Oral birth control medication is not known to cause aplastic anemia or HTN.
The nurse is teaching a 55-year-old woman who is just beginning menopause. Which information should the nurse include in the teaching plan? Select all that apply. The average age of onset for menopause is 50 to 52 years. Vaginal infections will increase. Depression is very common as a result of menopause. Hot flashes, especially at night, can occur in about 80% of women. When periods become irregular, contraception is unnecessary.
The average onset of menopause is 50-52 Hot flashes, specially at night can occur in about 80% Explanation: The average age of menopause is 50 to 52 years, although some variation exists. Vaginal infections do not necessarily increase during menopause. Hot flashes occur in about 80% of females; they can range from mild to very debilitating with disruption of sleep patterns. Depression is not usual during menopause; if symptoms of depression do occur, the nurse should refer the client to their health care provider. Contraception should be used until menses has ceased for a full year.
A client is taking a progestin-only oral contraceptive, or minipill. When teaching the client about this medication, a nurse should include information on signs and symptoms of endometriosis. female hypogonadism. premenstrual syndrome. tubal or ectopic pregnancy
Tubal ectopic pregnancy Explanation: Clients taking the minipill have a higher incidence of tubal and ectopic pregnancies, possibly because progestin slows ovum transport through the fallopian tubes. Endometriosis, female hypogonadism, and premenstrual syndrome aren't associated with progestin-only oral contraceptives.
The nurse is conducting a health assessment on an adult client. The nurse may communicate medical information without the client's consent when: certifying the client's absence from work. requested by the client's family. treating the client with a sexually transmitted infection. prescribed by another health care provider (HCP).
treating the client with a sexually transmitted infection. Explanation: Sexually transmitted infections are communicable diseases that must be reported. The nurse is responsible for reporting these diseases to the appropriate public health agency and otherwise maintaining the client's confidentiality. The client's family cannot request the release of medical information without the client's consent. An HCP's prescription is not a substitute for a client's consent to release medical information in the absence of a communicable disease.
