porth essentials of pathophysiology chapt 40
Select the structure primarily responsible for the secretions of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin.
Anterior pituitary gland
A female patient with a strong family history of cardiovascular disease asks the nurse if she should take estrogen replacement while in menopause. Which of the following is the nurse's best response?
"Estrogen has additional cardioprotective actions and you and your physician should determine if this would benefit you."
Which of the following female patients is at risk for amenorrhea?
18-year-old with anorexia nervosa
What should the nurse teach the client about assessing for possible breast cancer?
"Perform monthly self-breast exams after menses."
A pregnant patient asks the nurse what is causing her lower leg edema, nausea, and constipation that she is experiencing. Which of the following is the nurse's best response?
"The increase in progesterone during pregnancy is most likely the cause of these discomforts."
The nurse is teaching a female client who has been prescribed hormone therapy. The client asks,, "What does this medication do?" Which of the following is an appropriate response by the nurse?
"This medication will help relieve hot flashes and other adverse symptoms of menopause."
A patient with vulvodynia tells the nurse, "This is not getting better. I just can't live like this." What is the best response by the nurse?
"What bothers you the most about your condition?"
A client who has a history of untreated cervicitis tells the nurse that she is concerned about the risk of experiencing problems with fertility. The nurse explains that problems may result from:
Ascending infection of the fallopian tubes
A female client's assessment identifies symptoms of dyspareunia and burning. The nurse is aware that the client may have developed:
Atrophic vaginitis
What are the fibrous tissue ligaments that extend outward from the outer boundaries of the breast to the nipple area in a radial manner called?
Cooper ligaments
A client who has been diagnosed with premenstrual syndrome (PMS) asks if there is anything to help alleviate the symptoms. The best response would be:
Eat a diet low in simple sugars and high in protein
The nurse working in a fertility clinic is assessing a patient's risk for fallopian tube obstruction. Which one of the following places the woman at greatest risk?
Endometriosis
A woman with a regular 28-day menstrual cycle wishes to become pregnant. At which point in the menstrual cycle is the optimal time for intercourse to end in fertilization of the ovum?
Fourteenth day after menses begins
There are two types of vulvar cancer. One type is found in older women, and one type is found in younger women, generally less than 40 years of age. What is the type found in younger women thought to be caused by?
Human papillomavirus
During the female menstrual cycle hormones are produced and excreted by various reproductive organs. The hormone progesterone is secreted and is metabolized in which of the following organs?
Liver
A client asks the nurse what hormone is responsible for temperature elevation that occurs with ovulation. The best response would be:
Progesterone
The ovaries have a dual function. The nurse is able to explain to the patient that any problems with the ovaries frequently cause which of the following problems?
Menstrual and fertility problems
The ovarian follicle becomes luteinized once ovulation has taken place. As the corpus luteum, the now empty follicle produces what?
Estrogen and progesterone
A client has been diagnosed with endometriosis. What assessment finding does the nurse expect? Select all that apply.
• Back pain • Premenstrual pain • Pelvic pain
The sister of a 25-year-old female patient has breast cancer, and genetic testing showed her to have the BRCA1 gene. THe patient asks the nurse how she can prevent developing breast cancer herself. Which of the following prophylactic interventions might be considered by this patient? Select all that apply.
• Breast magnetic resonance imaging (MRI) • Bilateral mastectomy • Bilateral oophorectomy
The parents of a 9-year-old child ask the nurse for information about quadrivalent human papillomavirus recombinant vaccine (Gardasil) vaccine. Which of the following instructions are appropriate for the nurse to provide? Select all that apply.
• It prevents a common cause of cervical cancer. • It can be given to boys and girls. • It should be given before the child is sexually active.
A nurse is teaching a class about the proper way to insert an indwelling catheter. Which of the following statements made by one of the students would demonstrate that the teaching has been effective?
"I will insert the catheter into the urethra."
The nurse is discussing the physical changes related to menopause with a 48-year-old woman. The client asks, "How long will it take before I am through these changes and finally reach menopause?" Which of the following is an appropriate response by the nurse?
"Most women experience symptoms for about four years."
The endocrine system is highly involved in the female reproductive system. Which hormones are used to stimulate the primordial follicles?
FSH and LH
A school nurse is providing an informational session about the prevention of cervical cancer in young girls and women. The most important information for the nurse to present would be:
HPV vaccine before becoming sexually active
Which of the following factors in a patient's history is most likely related to the diagnosis of cervical squamous dysplasia?
Human papillomavirus (HPV) infection
The ovaries secrete both estrogen and progesterone. What is one function of progesterone in the body?
Increases body temperature at ovulation
The nurse is reviewing laboratory values of a seventy-year-old female client and observes the client's low-density lipoproteins (LDLs) level is elevated. The nurse understands a possible reason for this is which of the following?
Long-term estrogen deprivation
A patient is diagnosed with vulvar carcinoma, which appears as an inconspicuous thickening of the skin resembling eczema or dermatitis and may produce few symptoms other than pruritus, local discomfort, and exudation. The nurse understands that the cancer metastasizes readily through which mode?
Multiple lymph channels
A nurse who works on a urology-gynecology ward of a hospital is coming on shift and will be caring for a 34 year-old woman who has been admitted overnight for the treatment of a large endometriosis. What interventions should the nurse most realistically anticipate providing over the course of the shift and the next several days?
Providing pain control; preparing the client for a laparoscopic procedure or hysterectomy.
The nurse is discussing the menstrual cycle with a female client. The client asks, "Why does my side hurt half way through my monthly cycle almost every month? The nurse suspects the cause of the pain may be which of the following?
The client has a leakage of blood onto the peritoneal surface after ovulation has occurred.
Which client does the nurse determine is most likely at risk for cancer of the vagina?
The client who is 60 years old or older
The nursing student is studying the structure and function of the female reproductive system. The student wants to know why the urinary system is included in the content. The best reason for inclusion of the information is which of the following?
The urethra and the vagina, although two separate openings, exist in close proximity.
A female patient is taking antibiotics to treat a skin infection and informs the nurse that she does not think the antibiotics are working because now she thinks she has a vaginal infection. Which of the following does the nurse believe has occurred due to the antibiotic use?
The use of the antibiotics decreases the number of lactobacilli in the vagina, which can result in a vaginal infection.
What is the term for the condition that involves dyspareunia, and widespread vaginal burning in the absence of bacterial presence?
Generalized vulvodynia
A 28 year old female has been told she has atypical glandular cells following Pap smear. The physician will likely recommend which procedure that can be performed in their office to remove the abnormal zone and provide a specimen for further histological evaluation?
Loop electrosurgical excision procedure (LEEP).
A female patient is being seen in the ED with complaints of lower abdominal pain, dyspareunia, back pain, purulent cervical discharge, and the presence of adnexal tenderness and painful cervix on bimanual pelvic examination. The nurse suspects the patient has pelvic inflammatory disease (PID), and will assess the patient for which of the following?
Number of sexual partners
Polycystic ovary syndrome (PCOS) is a common endocrine disorder. The nurse understands that about 50% of the women who are diagnosed with PCOS have which of the following problems?
Obesity
A female patient presents to her primary care physician with a report of very heavy bleeding during menstrual cycles. Tests indicate the condition is not from a hormone imbalance. Which of the following intervention options is least invasive?
Oral contraceptives
The nurse is caring for a 54-year-old female client who reports vaginal dryness and painful intercourse. The nurse expects which of the following prescriptions will be ordered for this client?
Vaginal estrogen preparation
The nurse is teaching a class to adolescent girls about puberty. Which health information is accurate for inclusion in the class? Select all that apply.
• Ovaries produce hormones that cause growth of reproductive organs. • Estrogen stimulates bone growth and closure of growth plates. • Ovulation usually occurs in the middle of the monthly cycle.
Vaginal infections can occur in young girls prior to menarche. These infections generally have nonspecific causes. What are some of the causes of vaginal infections in premenarchal girls? (Select all that apply.)
• Poor hygiene • Intestinal parasites • Presence of foreign bodies
The nurse is reviewing the history of an older adult female client who was recently diagnosed with coronary heart disease. What factors are known to contribute to this condition? Select all that apply.
• Used hormone therapy for 5 years • Smoked 1 pack/day for 20 years • Has hypertension for 15 years
Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) produce profound effects on the ovaries. What do high levels of estrogen do to FSH and LH?
↑LH and ↓FSH
Which of the following would be considered a structural abnormality or disease process that could cause menstrual pain known as secondary dysmenorrhea? Select all that apply.
• Endometriosis • Uterine fibroids
During menopause, which of the following hormones are elevated? (Select all that apply.)
• FSH • LH • Androstenedione
A client with a family history of breast cancer has just learned that she carries the BRCA1 and BRCA2 mutation. When educating this client about follow-up care, which of the following statements would be most appropriate?
"You should have more frequent breast evaluations using an MRI rather than standard mammography."
The nurse is teaching a group of fifth-grade girls about menstruation. One of the students asks, "Will I have periods the rest of my life?" Which of the following is an appropriate response by the nurse?
"You will have periods until you are about 48 to 55 years of age."
The nurse providing teaching about the female reproductive system includes which of the following?
Ovaries are responsible for ovulation and hormone production.
A patient has been diagnosed with a Bartholin gland cyst. The nurse expects the patient may experience which symptoms if this becomes infected?
Pain, tenderness, and dyspareunia
The gonads of the female have a dual function. Which of the following is a function of the female gonads?
Storing female germ cells
The nurse is caring for a forty-eight-year-old female client who asks, "How do you know when you have reached menopause?" Which of the following is an appropriate response by the nurse?
"You are considered to be menopausal when you have not menstruated for a full year and the hormone that fluctuates with menstruation no longer fluctuates."
A female patient with uterine prolapse asks the nurse about treatment options. Which of the following responses by the nurse is appropriate?
"You may need surgery to support your uterus."
The nurse is teaching a patient with polycystic ovary syndrome (PCOS) about the condition. Which of the following statements by the patient indicates a need for further instruction?
"I developed this as a result of a sexually transmitted infection."
A female patient informs the nurse that she is having hot flashes on occasion, has trouble sleeping, and thinks that she is having some symptoms of menopause. The patient asks the nurse how long these symptoms will last prior to experiencing menopause. Which of the following is the best response?
"Perimenopause can precede menopause by approximately 4 years."
During a group prenatal class, the nurse teaching the course is explaining the thinning of the cervix that accompanies the stages of labor leading up to delivery. A participant admits that she is not familiar with either the location or normal role of the cervix. Which of the following responses by the nurse would be most appropriate?
"The cervix is the opening between the uterus and the vagina and so it opens wide during the lead-up to birth."
A 57 year-old woman has been diagnosed with atrophic vaginitis and has expressed surprise to her care provider, citing a lifetime largely free of gynecological health problems. She has asked what may have contributed to her problem. How can the care provider best respond?
"The lower levels of estrogen since you've begun menopause make your vagina prone to infection."
After an office visit with her primary health provider, a female patient with an elevated CA-125 test result asks the nurse if that means she has ovarian cancer. Which of the following is the nurse's best response?
"The test is not specific for ovarian cancer but suggests further evaluation to find the cause of the elevation."
A client asks the health care provider to, "Explain this brachytherapy they want to do for my cervical cancer again." The response should include which of the following statements?
"They will insert a radioactive device into your vagina, position it next to the cervix, so that curative levels of radiation are directly on the cancer site."
An older adult female comes in to the clinic for her yearly gynecology appointment and informs the nurse that she is having pain when having intercourse with her spouse. The patient has been postmenopausal for at least 5 years. Which of the following is the nurse's best response?
"This is caused by a decrease in estrogen levels, but there are things that you may be able to use to help."
A female client with anorexia nervosa tells the nurse that she has been experiencing amenorrhea. The nurse is aware that this is a result of:
Alteration of critical body fat-to-muscle ratio needed for menses to occur
When a woman asks the nurse at what age menopause usually occurs, what should the nurse respond?
48 to 55 years of age
The nurse suspects which of the following female clients may be at risk for infertility?
A long distance runner
A 50-year-old female patient reports menorrhagia with no cramping. Which of the following is a likely cause of this condition?
Anovulatory cycle
The nurse is explaining ovulation to a female client. The nurse explains that follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are important hormones needed to ovulate and are secreted by which of the following glands?
Anterior Pituitary
A woman of child-bearing age asks the nurse about a natural method to avoid pregnancy. What is an appropriate response?
Avoid sex when cervical mucus is most stretchy
The environment of the vagina is moist with a pH 4.0 to 4.5. The major purpose of the acidic environment is which of the following?
Bacteriostatic
The female external genitalia are made up of several components. What is in the vestibule of the female external genitalia?
Bartholin glands
There are many cancers of the female reproductive system. The nursing student knows that the most readily detected and most easily cured if detected early is which of the following?
Cervical
A female patient informs the nurse that she had intercourse yesterday evening and is wondering if she could become pregnant. She asks the nurse that if she was pregnant, where it would be located at present. Which of the following should the nurse tell the patient?
Fertilization normally occurs in the middle to outer portion of the Fallopian tube.
The fallopian tubes are narrow tubes that attach bilaterally to the uterus. Within the fallopian tube, fertilization of the ovum takes place. The end of the fallopian tube nearest the ovary is funnel-like. What are the fringed, finger-like projections around the funnel-shaped opening of the fallopian tube called?
Fimbriae
A 45-year-old client reports "needing to bear down with urination," frequency, and occasional loss of urine when coughing. Based on symptoms, which diagnosis is most appropriate for this client?
Cystocele
Breasts are not functionally related to the female genitourinary system. The role of hormones in breast development is important for the growth of which system related to the breast?
Ductile system
How often do most women in the middle reproductive years menstruate?
Every 28 to 30 days
A client is experiencing oligomenorrhea. The nurse interprets this as:
Infrequent menstruation with periods more than 35 days apart
An older postmenopausal adult female fractured her left femoral head. She has sustained several fractures in the past 4 years and has been taking calcium and vitamin D supplements. Which of the following is a common problem that this patient is most likely suffering from?
Osteoporosis
A client is complaining to the health care provider about several vague signs/symptoms. Which of the following raises a "red flag" indicating the client may have developed endometrial cancer?
Painless abnormal bleeding
As women age they tend to lack support of breast tissue. The nurse understands that development of which of the following muscles supports the breast mass higher on the chest wall?
Pectoralis muscles
Endometriosis is the condition in which endometrial tissue is found growing outside the uterus in the pelvic cavity. What are risk factors for endometriosis?
Periods longer than 5 days and increased menstrual pain
A 70 year-old woman who delivered 4 children during her reproductive years has weakened pelvic floor muscles. Which of her following anatomical structures is least susceptible to inappropriate herniation into her vagina?
Peritoneum
Which hormone is responsible for breast development and the increase in body temperature that occurs with ovulation?
Progesterone
The nurse is caring for a female client who has just given birth. The nurse knows that the hormone responsible for the client's ability to breastfeed is which of the following?
Prolactin
A client tells the nurse that her mother recently passed from ovarian cancer. The client asks why the survival rate from ovarian cancer is so low. The best response would be:
Symptoms of ovarian cancer are nonspecific and therefore difficult to interpret.
Which of the following is the most important discharge instruction for a female patient with pelvic inflammatory disease (PID)?
Take all of the antibiotic
A client with polycystic ovaries is being treated with an oral contraceptive medication. Which change in her condition indicates the treatment is effective?
The client begins a regular menstrual cycle.
The perimetrium reflects over the bladder wall and forms what?
The pouch of Douglas
The connecting tube between the cervix and the vestibule is referred to as which of the following?
Vagina
The nurse is checking the pH of a client's vagina tissue and finds the pH to be 4.3. The nurse interprets this finding as:
normal.
Which of the following women will the nurse encourage to have annual Papanicolaou (Pap) smears? Select all that apply.
• Age 63, postmenopausal for 10 years • Age 44, has multiple sexual partners • Age 27, history of human papillomavirus (HPV)
The nurse is taking the history of a 30-year-old female client with amenorrhea. What factors does the nurse identify as contributing to the condition? Select all that apply.
• Anorexia nervosa • Long-distance running • Pituitary tumor
Mastitis is an inflammation of the breast that can occur at any time. What is the treatment for mastitis? (Select all that apply.)
• Application of heat or cold • Nonsteroidal anti-inflammatory drugs
Events in the ovulatory cycle progress in a similar manner each month. Place the following events in the ovulatory cycle in the correct chronological order. Use all the options.
• Formation of the theca. • Formation of the corpus luteum • Formation of the antral follicle • Development of the zona pellicuda • Bursting of the mature follicle
Progesterone maintains pregnancy but also has which of the following local effects on the body? Select all that apply.
• Increase in basal body temperature • Increase in secretion of aldosterone by the adrenal cortex • Relaxation of smooth muscle
An examination of the external genitalia of a female would concentrate on which structures? Select all that apply.
• Labia minora • Clitoris
