Chapter 4: Special Issues of Women's Health Care and Reproduction

The nurse educates a 15-year-old female client on ways to prevent pregnancy. Which statement will the nurse include in the teaching? "Oral contraceptive pills are effective at preventing pregnancy as long as you take one each week." "The withdrawal method is effective as long as you have a monogamous partner." "The use of a condom is a method often recommended to prevent pregnancy for people your age." "If you do not want to become pregnant within the next 10 years, an intrauterine device would be best."

"The use of a condom is a method often recommended to prevent pregnancy for people your age."

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

The school nurse is counseling a sexually active 16-year-old adolescent about the various forms of contraception. She is afraid of getting pregnant or contracting a sexually transmitted infection because her boyfriend refuses to use a condom. In answering the client's questions as to which option will be best suit her needs, which form should the nurse recommend? Female condom Tubal ligation Oral contraceptive Coitus interruptus

Female condom

A 45-year-old client and her spouse are present in the clinic. Results of fertility testing indicate that the client has damage to her fallopian tubes. Which would be the most appropriate infertility option for this client? Gamete intrafallopian transfer In vitro fertilization Surrogate mother Ovulation stimulation

In vitro fertilization

The nurse is caring for a male client diagnosed with gonorrhea and chlamydia. Which health care provider order will the nurse question? notification of all recent sexual partners acyclovir 400 mg orally BID avoidance of sexual activity until treatment is complete rapid serum HIV test

acyclovir 400 mg orally BID

The nurse is providing contraception counseling to a perimenopausal woman who has had negative reactions to oral contraceptive pills (OCPs) 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

A woman is admitted for repair of cystocele and rectocele. She has nine living children. In taking her health history, what would the nurse expect to find? sporadic vaginal bleeding accompanied by chronic pelvic pain heavy leukorrhea with vulvar pruritus menstrual irregularities and hirsutism on the chin stress incontinence with feeling of low abdominal pressure

stress incontinence with feeling of low abdominal pressure

The estrogen content in the contraceptive pill performs which action? decreases the permeability of cervical mucus increases the level of luteinizing hormone (LH) interferes with endometrial proliferation suppresses follicle-stimulating hormone (FSH)

suppresses follicle-stimulating hormone (FSH)

Semen analysis has been ordered for the partner of a client who has been unable to become pregnant. What instructions should the nurse provide to the partner? "Collect the sample after two consecutive days of ejaculating." "Keep the sample refrigerated to ensure the sperm survive." "Bring the sample to the lab immediately after you collect it." "If possible, collect the sample first thing in the morning."

"Bring the sample to the lab immediately after you collect it."

A young woman comes to the free clinic asking for oral contraceptive pills. Which factor best indicates that another type of contraception would be better for this client? cost of the pills history of noncompliance with medications age of her partner frequency of sexual encounters

history of noncompliance with medications

The nurse is caring for a woman who had a dilatation and curettage (D&C) 1 hour prior. What assessment finding would alert the nurse to immediately intervene? abdominal cramping temperature of 98.6°F (37°C) blood pressure 158/90 mm Hg pulse rate of 122 beats/min

pulse rate of 122 beats/min

When using the contraceptive patch, a client should understand that it: should be applied to the breasts, hips, or back. should be covered when swimming in a pool because of chlorine's effect on the adhesive. is immediately effective after application. should be applied to the abdomen, buttocks, or back.

should be applied to the abdomen, buttocks, or back.

When conducting a health history with a couple who are experiencing subfertility, the nurse will include which of the following? Select all that apply. General health Medication history Sexual history Surgical history School history

General health Medication history Sexual history Surgical history

A patient received a scheduled dose of depot medroxyprogesterone acetate (DMPA) 6 weeks ago. Today, the patient reports that a regular menstrual cycle is 2 weeks late. What is the first thing that should be done for this patient? Perform a pregnancy test. Provide prenatal counseling. Discuss pregnancy termination options. Explain side effects of the contraceptive.

Perform a pregnancy test.

A woman is diagnosed with primary dysmenorrhea and is prescribed ibuprofen as part of her treatment plan. When teaching the woman about using this medication, which instruction would be important for the nurse to emphasize? "Take the medication on an empty stomach." "Start taking the medication when you first get your period." "Add an aspirin to the regimen if you do not get relief right away." "It is normal for your bowel movements to be black."

"Start taking the medication when you first get your period."

The female partner of a young couple is concerned about what the results of fertility tests might reveal. Which nursing diagnosis should the nurse use to plan care for this patient? Fear related to possible outcome of subfertility studies Deficient knowledge related to measures to promote fertility Anxiety related to the procedures necessary for fertility testing Situational low self-esteem related to the apparent inability to conceive

Fear related to possible outcome of subfertility studies

A client asks the nurse about how medroxyprogesterone acetate (DMPA) is administered. The nurse explains that this contraceptive method is administered by which method? intravenous injection intramuscular injection oral consumption subcutaneous implantation

intramuscular injection

The nurse instructs a patient on the use of a vaginal estrogen/progestin rings (NuvaRing) for contraception. Which patient statement indicates that additional instruction is needed? "I am to take the ring out overnight." "I will leave the ring in place for 3 weeks." "I leave the ring in place during intercourse." "I am to use other birth control if I take the ring out for 4 hours."

"I am to take the ring out overnight."

The nurse is conducting a health history on a couple planning to become pregnant over the next few months. Which statement by the male client most concerns the nurse? "I consume fast food a few times each week and enjoy a few beers on the weekends." "My uncle and his wife have not been able to conceive a child." "I have severe asthma and use my inhaler several times each month." "I have a degree as a chemical engineer and work at the local plant."

"I have a degree as a chemical engineer and work at the local plant."

The nurse instructs a patient on cervical mucus changes that occur during ovulation. Which statement indicates that teaching has been effective? "During ovulation, the mucus is thick." "Ovulation makes the mucus more acidic." "The mucus is white because of more white blood cells." "When the mucus is thin and watery, then ovulation is occurring."

"When the mucus is thin and watery, then ovulation is occurring."

Subfertility/infertility is said to exist when a couple has failed to achieve pregnancy after how many months of unprotected sexual intercourse?

12

A nurse is teaching a couple about how to use a condom. The nurse determines the couple can properly apply the condom when they state that it should be applied at which time to be most effective? as part of foreplay at least 1 hour prior to coitus before penile-vulvar contact immediately after ejaculation

Before penile-vulvar contact

A client expresses interest in having an intrauterine device (IUD) placed for contraception. Which finding noted in the health history would indicate to the nurse that this would not be an appropriate contraceptive option? Sexually active since 16 Dysmenorrhea G1P0 Bicornuate uterus

Bicornuate uterus

A nurse is teaching a female client who is unable to conceive how to monitor her basal body temperature. Which instruction would the nurse prioritize for this client? Record body temperature every night Record menses and time of intercourse Chart body temperature for at least a month Record body weight along with the temperature

Chart body temperature for at least a month

A client with a family history of cervical cancer is to undergo a Papanicolaou test. During the client education, what group should the nurse include as at risk for cervical cancer? clients with irregular menstrual cycles clients who have not had babies clients who have genital warts clients with fibrocystic breast disease

Clients who have genital warts

After discussing various methods of contraception with a client and her partner, the nurse determines that the teaching was successful when they identify which contraceptive method as providing protection against sexually transmitted infections (STIs)? oral contraceptives tubal ligation condoms intrauterine system

Condoms

A patient who has unprotected intercourse has obtained the morning after pill but has not yet taken the prescribed dosage. What nursing diagnosis should the nurse identify as appropriate for the patient at this time? Powerlessness Spiritual distress Decisional conflict Readiness for enhanced knowledge

Decisional conflict

The nurse is discussing permanent birth control with a female patient and her husband. Which of the following is considered a permanent nonsurgical sterilization methods? Tubal ligation Tubal occlusion Vasectomy Essure

Essure

How can pelvic inflammatory disease (PID) affect fertility? It causes anovulation because of interference with secretion of pituitary hormones. It causes changes in cervical mucus that make it less receptive to penetration by sperm. It causes sperm-agglutinating antibodies to be produced in the vagina. It interferes with the transport of ova because of tubal scarring.

It interferes with the transport of ova because of tubal scarring.

A client is scheduled to start taking tadalafil for erectile dysfunction. A nurse should teach the client to observe for side effects and notify a health care provider immediately if what occurs? Orchitis Nausea Priapism Weight gain

Priapism

Which description best explains the hysterosalpingogram procedure? insertion of an endoscope through the posterior fornix to visualize the reproductive organs instillation of carbon dioxide through the cervix into the uterus and fallopian tubes passage of an endoscope through a small abdominal incision to inspect the reproductive organs radiograph of the uterus and fallopian tubes following introduction of a radiopaque medium through the cervix

Radiograph of the uterus and fallopian tubes following introduction of a radiopaque medium through the cervix

A nurse should instruct a client who has premenstrual syndrome (PMS) to make which of these lifestyle modifications? Walk several times a week, maintain a regular sleep schedule, decrease complex carbohydrates, and avoid complex sugars. Reduce caffeine, walk several times a week, use relaxation techniques, and maintain a regular sleep schedule. Walk every day, increase caffeine and salt intake, and sleep 8 to 10 hours a night. Reduce caffeine, perform cardio exercise 3 times a week, and sleep 12 hours every other night.

Reduce caffeine, walk several times a week, use relaxation techniques, and maintain a regular sleep schedule.

A woman visits the family planning clinic to request a prescription for birth control pills. Which factor would indicate that an ovulation suppressant would not be the best contraceptive method for her? She is 30 years old. She has irregular menstrual cycles. She has a history of allergy to foreign protein. She has a family history of thromboembolism.

She has a family history of thromboembolism.

Which information is important for a woman to understand before undergoing a scheduled tubal ligation? She will have lessened dysmenorrhea following the procedure. She must think of the procedure as irreversible. The procedure will reduce her menstrual flow in amount. She should schedule it to be done just before a menstrual flow.

She must think of the procedure as irreverisble.

A couple is considering vasectomy as a contraception option. However, the husband is nervous about how such a procedure would affect his sexual functioning. Which information should the nurse mention to the man? The man will still have full erection capacity. The man will no longer produce testosterone. The man will continue to ejaculate sperm. The man will no longer ejaculate seminal fluid.

The man will still have full erection capacity.

A woman is 40 years old and a heavy smoker. She has a single sexual partner but has very irregular menstrual cycles. She wants a highly reliable contraceptive. Which method would be the best recommendation? an ovulation suppressant a spermicidal suppository the rhythm (calendar) method a diaphragm and spermicide

a diaphragm and spermicide

A young woman is newly married and is seeking advice on contraception. She is in a monogamous relationship and would like a temporary contraceptive, as she plans to have children in the future. Her husband dislikes the feel of condoms. Also, she mentions that she typically experiences dysmenorrhea and has a history of recurrent urinary tract infections. Which method should the nurse recommend? oral contraceptive pills (OCPs) postcoital douching diaphragm vasectomy

oral contraceptive pills (OCPs)

The nurse is developing a presentation for a group of young adult women about premenstrual syndrome. Which treatment options should the nurse point out as most appropriate? Select all that apply. antipsychotic medications reduction of caffeine intake vitamin and mineral supplements decrease in water intake NSAIDs

reduction of caffeine intake vitamin and mineral supplements NSAIDs

A nurse is instructing a client on birth control methods. The client asks about the cervical mucus method. When should the nurse tell the client she is fertile in relation to her mucus? when it is thin, watery, and copious when it is thick Cervical mucus is not a reliable indicator. when it does not stretch

when it is thin, watery, and copious

A young woman comes into the clinic stating that she is pregnant and does not want to have a baby. After counseling, the woman decides to terminate the pregnancy by having an abortion. The nurse explains that the procedure will be what type of abortion? Induced abortion Therapeutic abortion Spontaneous abortion Miscarriage

Induced abortion

Clients who have had PID are prone to which complication? ectopic pregnancy multiple gestation ovarian cancer inguinal lymphadenopathy

ectopic pregnancy

Which definition best explains the term "subfertility/infertility"? failure to achieve pregnancy after 6 months of unprotected intercourse failure to achieve pregnancy after 1 year of unprotected intercourse inability to achieve pregnancy because of a known factor that prevents conception inability to achieve pregnancy following a previous viable pregnancy

failure to achieve pregnancy after 1 year of unprotected intercourse

A nurse is preparing a client for intrauterine device (IUD) insertion. Which education will the nurse provide to the client? "An IUD will prevent sexually transmitted infections (STIs)." "The insertion procedure for an IUD is painless." "Checking the strings is recommended following insertion." "Expect to have continuous uterine cramps after insertion."

"Checking the strings is recommended following insertion."

The nurse is providing care to a female client and spouse who has completed several rounds of unsuccessful in vitro fertilization. The client still desires to have a child. Which response by the nurse is appropriate? "It would be wise for you and your spouse to consider life without children." "Have you and your spouse considered using a surrogate mother?" "I recommend you continue trying in vitro fertilization if you desire to have a child." "Can you tell me more about your desire to have children?"

"Have you and your spouse considered using a surrogate mother?"

A client who is scheduled for hysteroscopy says to a nurse, "I thought I would be able to have children, but now I know that will never be possible." Which response would be most appropriate for the nurse to make? "Adoption is always an acceptable option for anyone." "I will call the health care provider to come visit with you." "The use of surrogates is more acceptable today." "Being childless is not as bad as you think it is."

"I will call the health care provider to come visit with you."

After the nurse teaches a client about ways to reduce the symptoms of premenstrual syndrome, which client statement indicates a need for additional teaching? "I will make sure to take my estrogen supplements a week before my period." "I've signed up for an aerobic exercise class three times a week." "I'll cut down on the amount of coffee and colas I drink." "I quit smoking about a month ago, so that should help."

"I will make sure to take my estrogen supplements a week before my period."

A nurse is conducting a class for a group of young adult women interested in contraception. As part of the class, the nurse asks the group about their understanding about contraception and pregnancy. Which statement(s) would cause the nurse to address it as a misconception. Select all that apply. "If you douche after having sex, you will not get pregnant." "You cannot get pregnant if you have your menstrual period." "Birth control pills will not protect you against sexually transmitted infections." "Pregnancy cannot happen if my male partner pulls out before ejaculating." "I cannot get pregnant if I am breastfeeding."

"If you douche after having sex, you will not get pregnant." "You cannot get pregnant if you have your menstrual period." "Pregnancy cannot happen if my male partner pulls out before ejaculating." "I cannot get pregnant if I am breastfeeding."

The nurse is caring for a couple who are trying to get pregnant and have not been able to for over a year. The nurse explains to the couple that diagnostic testing usually begins on the male partner, as these tests are easier. The couple asks what kind of problems a man can have that can cause infertility. What should be the nurse's response? "Men can have increased prolactin levels that decrease sperm viability." "Men can have problems that increase the temperature around their testicles, which decreases the quality of their semen." "Men may not have enough estrogen and FSH in their bodies to maintain testicular function." "Men may ejaculate into the bladder instead of the vagina."

"Men can have problems that increase the temperature around their testicles, which decreases the quality of their semen."

What should the nurse include when explaining endometriosis as a cause for a female patient's infertility? "You do not ovulate because of endometrial implants on the ovaries." "Your uterine cervix fails to close because it is engorged with tissue." "Menstrual sloughing does not occur, so there is never a new base for embryo growth." "Ovulation does take place misplaced endometrial tissue interferes with transport of the ovum."

"Ovulation does take place misplaced endometrial tissue interferes with transport of the ovum."

While obtaining a health history from a male adolescent during a well checkup, the nurse assesses his sexual behavior and risk for sexually transmitted infections. Based on the information, the nurse plans to teach the adolescent about using a condom. Which statement would the nurse include in the teaching plan? "You can reuse a condom if it's within 3 hours." "Store your condoms in your wallet so they are ready for use." "Put the condom on before engaging in any genital contact." "Use petroleum jelly with a latex condom for extra lubrication."

"Put the condom on before engaging in any genital contact."

A couple is deciding about contraceptive measures. The male partner has decided to undergo a vasectomy. After teaching the client about this procedure, which client statement indicates the need for additional teaching? "Right after surgery, my semen will be sperm-free." "I will have this done in my urologist's office." "I will be awake and will get local anesthesia." "I will be able to go back to work in a day or two." TAKE ANOTHER QUIZ

"Right after surgery, my semen will be sperm-free."

A client has been given instructions about a scheduled sonohysterosalpingogram. Which statement, if made by the client, should indicate to a nurse that the client has an adequate understanding of the instructions? "I will be put under general anesthesia for the procedure." "They will place a catheter in my uterus and use an ultrasound to see what the problem is." "This is just an ultrasound procedure, like they do for a baby." "They will surgically implant the ovum during the procedure."

"They will place a catheter in my uterus and use an ultrasound to see what the problem is."

A client states she has purchased home-use ovulation strips to help her know when she is ovulating. Which response by the nurse is most appropriate? "These strips are often not reliable and end up being a waste of money." "It is a lot more accurate if you come to the clinic routinely to get tested." "You can also test your vaginal discharge to determine if you are ovulating." "I am sure these strips will help you become pregnant faster."

"You can also test your vaginal discharge to determine if you are ovulating."

A 40-year-old woman who smokes desires a reliable contraceptive method. Which should the nurse recommend to this patient? An ovulation suppressant A condom and spermicide A spermicidal suppository The rhythm (calendar) method

A condom and spermicide

The nurse is preparing a class on infectious disorders of the reproductive tract. It will be presented to an eighth-grade health class. When teaching about pelvic inflammatory disease (PID), which information would the nurse include as the best method to prevent this infection? Abstinence Use latex condoms Use a diaphragm Use birth control pills

Abstinence

A female patient being treated for infertility is completing the third course of clomiphene citrate. What information should the nurse prepare for the patient in the event this course does not result in conception? Agencies that coordinate adoptions Strategies to improve sperm motility Additional options to achieve conception Informed consent for taking a fourth course of the medication

Additional options to achieve conception

A couple who has not conceived after 6 years of not using birth control are being seen in the infertility clinic. In assessing the client's psychosocial response to infertility, which might the nurse expect to find? Select all that apply. Excitement at the possibility of conceiving Sexual stimulation and excitement Guilt related to the lack of conception Anger toward others who have conceived Fear of the possible outcome of the testing

Fear of the possible outcome of the testing Anger toward others who have conceived Guilt related to the lack of conception

The mother of four small children comes to the clinic and has just been diagnosed with an enterocele. What should the nurse teach the client about her diagnosis? Her small intestine and peritoneum are jutting downward between the uterus and the rectum. Her rectum is protruding into the back wall of the vagina. Her uterus has prolapsed and is causing this bulge. Her bladder is bulging into the front wall of the vagina.

Her small intestine and peritoneum are jutting downward between the uterus and the rectum.

A young client 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 client? Oral contraceptive pills (OCPs) packaged with 21 pills Oral contraceptive pills packaged with 28 pills Oral contraceptive pills packaged with 30 pills Oral contraceptive pills packaged with 14 pills

Oral contraceptive pills packaged with 28 pills

Nursing care for the patient with endometriosis includes several factors. What is one aspect of nursing care for the woman with endometriosis? Explain to client that this is "just part of being a woman." Provide information on likely outcomes of treatment options. Assist client with decision about birth control options. Explain to client that if she got pregnant her pain would stop.

Provide information on likely outcomes of treatment options.

A nurse is preparing a presentation for a health fair on the topic of vasectomy. Which information should the nurse point out in the presentation? Relatively easy procedure with few complications Regular sperm counts are not essential Procedure is effective immediately Birth control measures are not required

Relatively easy procedure with few complications

A female patient has forgotten to take an ovulation suppressant for two mornings in a row. What should the nurse advise the patient to do? Take two pills a day for the rest of the month. Take three pills immediately and avoid coitus for the remainder of the month. Start a new cycle of 21 pills immediately plus additional estrogen for the next 3 days. Take two pills now and use a second method of contraception for the remainder of the month.

Take two pills now and use a second method of contraception for the remainder of the month.

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 nurse'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.

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.

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

A middle-aged woman with a history of hypertension and high cholesterol levels asks the nurse about ways to reduce her risk for heart disease as she approaches menopause. Which area would the nurse emphasize as most important? lifestyle modification medications screening stress management

lifestyle modification

A woman has just been prescribed clomiphene citrate to stimulate ovulation. Which possible effect should the nurse warn the woman about? overstimulation of the ovary resulting in potential multiple births extensive bleeding during menstruation elevation of her blood glucose level hypertension

overstimulation of the ovary resulting in potential multiple births

A woman who is using an intrauterine system for contraception comes to the clinic. When assessing the woman, which finding(s) would alert the nurse to a possible complication? Select all that apply. absence of pain with intercourse string length shorter than on initial visit reports of abdominal pain menstrual flow lighter and shorter oral temperature of 101°F (38.3°C)

reports of abdominal pain oral temperature of 101°F (38.3°C) string length shorter than on initial visit

A couple in their mid-30s are at their primary care provider's office because they have been unable to conceive for 3 years. They already have one child who is 4 years of age. The care provider explains to them that they are dealing with what kind of infertility? primary infertility secondary infertility tertiary infertility There is no name for different kinds of infertility.

secondary infertility

A woman is diagnosed with premenstrual dysphoric disorder. To address the woman's behavioral symptoms, which class of agents would the nurse anticipate needing to be addressed in the woman's teaching plan? diuretics nonsteroidal anti-inflammatory drugs (NSAIDs) selective serotonin reuptake inhibitors (SSRIs) vitamin supplements

selective serotonin reuptake inhibitors (SSRIs)

A young woman says she needs a temporary contraceptive but has a latex allergy. She mentions that she has a papillomavirus infection. Also, she says she is terrible about remembering to take pills. Which method should the nurse recommend? transdermal contraception sterilization cervical cap diaphragm

transdermal contraception