Adult Health: Reproductive

The nurse is caring for a client with a possible ectopic pregnancy. The nurse should perform the following actions in which priority order? Arrange the actions in the order they should be performed. All options must be used.

1:Assess the client for signs of increased pain or vaginal bleeding. 2:Obtain a urine specimen. 3:Prepare the client for ultrasound. 4:Assess the emotional state of the client. 📑 Rationale: An ectopic pregnancy is considered a medical emergency. Therefore, the nurse should assess first for increased pain or vaginal bleeding, which may indicate rupture of the fallopian tube. Next, the nurse should obtain a urine specimen to confirm or rule out pregnancy. Because of the seriousness of an ectopic pregnancy, the nurse should next prepare the client for ultrasound to confirm ectopic pregnancy and then assess the emotional state of the client. If ectopic pregnancy is confirmed, the client will need to be prepped for emergency surgery.

The nursing instructor asks a nursing student to list the functions of the amniotic fluid. The student responds correctly by stating that which are functions of amniotic fluid? Select all that apply.

✅Allows for fetal movement ✅Is a measure of kidney function ✅Surrounds, cushions, and protects the fetus ✅Maintains the body temperature of the fetus 📑 Rationale: The amniotic fluid surrounds, cushions, and protects the fetus. It allows the fetus to move freely, it helps to measure kidney function because the amount of fluid is based on the amount of urination from the fetus, and it maintains the body temperature of the fetus. The placenta prevents large particles such as bacteria from passing to the fetus, and it provides an exchange of nutrients and waste products between the mother and the fetus.

The maternity nurse is describing the ovarian cycle to a group of nursing students and asks a nursing student to identify the phases of the cycle. Which phases stated by the nursing student indicate a need for further teaching in this area? Select all that apply.

✅Secretory phase ✅Proliferative phase 📑 Rationale: The ovarian cycle consists of three phases: pre-ovulatory, ovulatory, and luteal. The secretory and pro-liferative phases are part of the endometrial cycle.

The nurse is providing a teaching session to an adolescent female regarding sexual maturation. The nurse recognizes that successful teaching has occurred if the adolescent female makes which statement?

✅"Breast changes most commonly occur before growth of pubic and axillary hair." 📑 Rationale: Clinical findings associated with sexual maturation typically occur in an orderly pattern. Breast changes usually occur before the development of pubic and axillary hair. Height and weight increase when puberty is experienced. Menstruation usually occurs about 2 years following the beginning of breast development.

The nursing student is assigned to care for an adolescent female client in the health care clinic, and the instructor reviews the menstrual cycle with the student. The instructor determines that the student understands the process of the secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) if the student makes which statement?

✅"FSH and LH are released from the anterior pituitary gland." 📑 Rationale: FSH and LH are released from the anterior pituitary gland to stimulate follicular growth and development, growth of the Graafian follicle, and production of progesterone.

The nurse is collecting data from a client who is suspected of having mittelschmerz. Which statement supports this probable diagnosis?

✅"I experience a sharp pain located on my low right side midway through my cycle." 📑 Rationale: Some women will experience slight vaginal bleeding at the time they experience mittelschmerz. Mittelschmerz (middle pain) refers to pelvic pain that occurs midway between menstrual periods or at the time of ovulation. The pain is caused by growth of the dominant follicle within the ovary, or rupture of the follicle and subsequent spillage of follicular fluid and blood into the peritoneal space. The pain is fairly sharp and is felt on the right or left side of the pelvis. It generally lasts a few hours to 2 days. Mittelschmerz is not related to menstrual flow, pain during intercourse, or pain associated with menstruation.

Which statements made by the nursing student accurately reflect correct information about the hormone oxytocin? Select all that apply.

✅"It can cause contractions of the uterus during and after birth." ✅"Oxytocin is used primarily for labor induction and augmentation." 📑 Rationale: Each obstetrical department should have a written protocol for the administration of oxytocin. Oxytocin is produced by the posterior pituitary, not the ovaries or the anterior pituitary gland, and stimulates the uterus to produce contractions during and after birth. The ovaries are the endocrine glands that produce estrogen and progesterone. The pancreas produces insulin and other enzymes that aid digestion. Oxytocin does not stimulate the pancreas to produce insulin. Oxytocin does stimulate contractions that assist with induction and augmentation of labor.

The nursing instructor asks the nursing student about the physiology related to the cessation of ovulation that occurs during pregnancy. Which response by the student indicates an understanding of this physiological process?

✅"Ovulation ceases during pregnancy because the circulating levels of estrogen and progesterone are high." 📑 Rationale: Ovulation ceases during pregnancy because the circulating levels of estrogen and progesterone are high, thus inhibiting the release of follicle-stimulating hormone and luteinizing hormone, which are necessary for ovulation.

A client has been examined in the clinic and has been diagnosed with pelvic inflammatory disease. The client asks the nurse to describe this condition. Which description of pelvic inflammatory disease by the nurse is accurate?

✅"Pelvic inflammatory disease is an infectious process that involves the uterine, tubes and uterus." 📑 Rationale: Pelvic inflammatory disease (PID) is an infectious process that most commonly involves the uterine (fallopian) tubes (salpingitis), and uterus. Multiple organisms have been found to cause PID, and most cases are associated with more than one organism. Mittelschmerz refers to pelvic pain that occurs midway between menstrual periods. Primary dysmenorrhea refers to menstrual pain without identified pathology. Amenorrhea is the cessation of menstruation for a period of at least 3 cycles or 6 months in a woman who has established a pattern of menstruation and can be due to a variety of causes.

The nurse is teaching an adolescent female about menstruation. Which statements if made by the adolescent female demonstrate a need for further teaching? Select all that apply.

✅"The average duration of menstruation is 3 days." ✅"The day of ovulation is counted as the first day of the menstrual cycle." 📑 Rationale: First menstruation is termed menarche. The average duration of menstruation is 5 days. Day 1 of menstruation is the first day of the menstrual cycle. Menstruation typically begins 14 days after ovulation. The menstrual cycle prepares the uterine lining for pregnancy implantation. During a menstrual period, a woman loses about 40 mL of blood.

The nursing student is asked to describe the size of the uterus in a pregnant client at the end of pregnancy. Which response by the student indicates an understanding of the anatomy of this structure?

✅"The uterus is round and weighs approximately 1000 grams." 📑 Rationale: Before conception, the uterus is a small pear-shaped organ entirely contained in the pelvic cavity. Before pregnancy, the uterus weighs approximately 60 g (2 ounces).At the end of pregnancy, the uterus weighs approximately 1000 g (2.2 pounds) and has a sufficient capacity for the fetus, placenta, and amniotic fluid.

The nursing student is asked to describe the size of the uterus in a nonpregnant client. Which response indicates an understanding of the anatomy of this structure?

✅"The uterus weighs about 2 ounces." 📑 Rationale: Before conception, the uterus is a small, pear-shaped organ that is contained entirely in the pelvic cavity. Before pregnancy, the uterus weighs approximately 60 g (2 oz) and it has a capacity of about 10 mL (.34 oz). At the end of pregnancy, the uterus weighs approximately 1000 g (2.2 lb) and it has a capacity that is sufficient for the fetus, the placenta, and the amniotic fluid.

A nursing instructor asks a nursing student to describe Montgomery's tubercles of the breast. Which response by the student indicates successful learning regarding Montgomery's tubercles?

✅"These are sebaceous glands that are located in the areola." 📑 Rationale: Montgomery's tubercles are sebaceous glands in the areola. They are inactive and not obvious except during pregnancy and lactation, when they enlarge and secrete a substance that keeps the nipple soft. Within each breast are lobes of glandular tissue that secrete milk. Alveoli are small sacs that contain acinar cells to secrete milk. The alveoli drain into lactiferous ducts, which connect to drain milk from all areas of the breast.

The licensed practical nurse (LPN) is assisting a school nurse in conducting a session with female adolescents regarding the menstrual cycle. The LPN tells the adolescents that the most likely day for ovulation in a 30-day menstrual cycle is which day?

✅Day 16 📑 Rationale: The normal duration of the menstrual cycle is about 28 days. However, in a longer menstrual cycle, ovulation typically occurs 14 days before day 1 of the next cycle. Thirty days minus 14 days would be day 16.

The nursing student is assigned to care for an adolescent female client in the health care clinic who has the potential diagnosis of gonorrhea. Which signs/symptoms if found in this client supports this diagnosis? Select all that apply.

✅Edematous labia ✅Acute severe pelvic pain ✅Presence of a greenish-yellow purulent endocervical discharge 📑 Rationale: It is possible for gonorrhea to be asymptomatic. If signs/symptoms occur, the client may experience edema of the labia, chronic or acute severe pelvic or lower abdominal pain, a greenish-yellow purulent endocervical discharge and menstrual irregularities. Generalized lymphadenopathy and maculopapular rash are associated with syphilis.

The maternity nursing instructor asks a nursing student to identify the hormones that are produced by the ovaries. Which hormones identified by the student indicate an understanding of the hormones produced by this endocrine gland? Select all that apply.

✅Estrogen ✅Progesterone 📑 Rationale: The ovaries are the endocrine glands that produce estrogen and progesterone. Oxytocin is produced by the posterior pituitary gland and stimulates the uterus to produce contractions. LH and FSH are produced by the anterior pituitary gland. TSH is produced by the thyroid gland.

A client presents to a women's health clinic and would like to begin taking an oral contraceptive pill (OCP). The nurse reviews the client's past medical history and suspects that oral contraceptives may not be the best option for her. Which information in the client's past medical history should trigger the nurse to question oral contraceptives for this client? Select all that apply.

✅Hepatitis ✅Cholecystitis ✅Chronic obstructive pulmonary disorder (COPD) 📑 Rationale: Oral contraceptive pills contain the hormones estrogen or progesterone or a combination. A history of hepatitis is important because OCPs are generally cleared through the liver. A history of cholecystitis is important because OCPs generally aggravate this condition. Oral contraceptives can thicken respiratory secretions; therefore, a history of COPD should be noted as a possible contraindication. A meniscus tear and Hashimoto thyroiditis are not impacted by the use of oral contraceptives.

The nurse is caring for a 45-year-old client. The client has 3 healthy children, all born via spontaneous vaginal birth. The client has been diagnosed with mild uterine prolapse and asks the nurse what she can do to prevent further prolapse. The nurse should include which instructions in the teaching plan? Select all that apply.

✅Lose weight. ✅Eat a diet high in fiber. ✅Perform Kegel exercises. ✅Take a stool softener daily as needed. 📑 Rationale: Many women experience some degree of pelvic organ prolapse by 40 years of age. Conservative measures can help prevent further prolapse and include losing weight, avoiding constipation through a diet high in fiber and using stool softeners as needed, doing pelvic floor exercises such as Kegel exercises, and avoiding high-impact exercise such as running.

A nursing student is asked to identify the layers of tissue found within the uterus. Which student responses are correct with regard to the tissue layers of the uterus? Select all that apply.

✅Myometrium ✅Perimetrium ✅Endometrium 📑 Rationale: The uterus has three divisions, the corpus, isthmus, and the cervix. The upper division is the corpus or the body of the uterus. The uppermost part of the uterine corpus, above the area where the fallopian tubes enter the uterus, is the fundus of the uterus. The tissue layers of the uterus include the myometrium, perimetrium, and endometrium.

The nurse is teaching breast self-examination (BSE) to a client who has had a hysterectomy. Which time of the month should the nurse tell the client to perform breast self-examination?

✅On a specific day of the month and on that same day every month thereafter 📑 Rationale: If the client has had a hysterectomy or is no longer menstruating, the BSE should be performed on the same day every month. Options 2 and 3 are inappropriate because the client who had a hysterectomy would not be menstruating. It is best not to perform the BSE at ovulation time because of the hormonal changes that occur.

The nursing instructor asks a nursing student to list the functions of the amniotic fluid. The student needs further teaching if which responses are made? Select all that apply.

✅Prevents large particles such as bacteria from passing to the fetus ✅Provides an exchange of nutrients and waste products between the mother and the fetus 📑 Rationale: The amniotic fluid surrounds, cushions, and protects the fetus. The placenta, not the amniotic fluid, prevents large particles such as bacteria from passing to the fetus, and the placenta provides an exchange of nutrients and waste products between the mother and the fetus. Amniotic fluid allows the fetus to move freely, it maintains the body temperature of the fetus, and it helps to measure kidney function, because the amount of fluid is based on the amount of urination from the fetus.

The nurse in a women's health clinic is reinforcing instructions to a client that is being treated for pelvic inflammatory disease (PID). Which information is essential for the nurse to reinforce before discharge? Select all that apply.

✅Refrain from sexual activity for 3 weeks. ✅Get plenty of rest and increase fluid intake. ✅Inform your sexual partner of the need for treatment, even if no signs/symptoms are present. 📑 Rationale: Pelvic inflammatory disease is an infectious process in the pelvic cavity, which can include the fallopian tubes, ovaries, and/or peritoneum. If PID is confirmed, rest and fluids should be encouraged. It is important to refrain from sexual activity for 3 weeks to allow the pelvic cavity to rest and heal. Any sexual partners should be notified of the need for evaluation and treatment even if asymptomatic. The entire course of antibiotics should be completed even if symptoms have completely resolved. The client should be educated to be re-evaluated in 48 to 72 hours regardless of whether or not signs/symptoms are still present.

An adolescent is admitted to the hospital with complaints of lower right abdominal pain. The primary health care provider prescribes laboratory tests to rule out ectopic pregnancy rather than appendicitis. Which is most significant in ruling out an ectopic pregnancy?

✅Serum human chorionic gonadotropin 📑 Rationale: The test to rule out an ectopic pregnancy is the serum human chorionic gonadotropin. The other tests may be prescribed to rule out appendicitis, but because the client is an adolescent it would be necessary to rule out an ectopic pregnancy as well. Urinalysis will rule out a urinary tract infection, and the white blood count and the C-reactive protein will rule out some other types of infection.

A maternity nurse is providing an in-service educational session to nursing students regarding the process of conception. The nurse determines that successful learning has occurred if the nursing students correctly identify which statements as true? Select all that apply.

✅The blastocyst usually implants in the anterior or posterior fundal region. ✅Fertilization of the mature ovum occurs in the distal third of the fallopian tube. ✅Human chorionic gonadotropin is the hormone needed for a positive pregnancy test. 📑 Rationale: The mature ovum is transported through the fallopian tube by the muscular action of the tube and the movement of the cilia within the tube. The blastocyst typically implants in the anterior or posterior fundal region. Fertilization normally occurs in the distal third of the fallopian tube near the ovary. The ovum, fertilized or not, enters the uterus about 3 days after its release from the ovary. Human chorionic gonadotropin is the hormone responsible for a positive pregnancy test. The stage of the embryo starts about day 15 and lasts to week 8. After this time, the product of conception is referred to as a fetus. Implantation begins 6 to 10 days following fertilization.

The nurse at an outpatient cardiology clinic is reviewing the medical history of a 48-year-old client during a routine exam. The client is complaining of the inability to maintain an erection and asks the nurse what could be causing it. Which information should the nurse include as possible contributing factors to his erectile dysfunction? Select all that apply.

✅Weight 245 lb ✅Total cholesterol 223 mg/dL ✅Serum creatinine 1.86 mg/dL 📑 Rationale: Erectile dysfunction affects an individual between 40 to 70 years old. Risk factors for erectile dysfunction mimic risk factors for cardiovascular disease. Obesity, hyperlipidemia, chronic kidney disease, hypertension, hypothyroidism, diabetes mellitus, smoking, alcohol abuse, and a lack of exercise all increase the risk for erectile dysfunction. A weight of 245 lb indicates the client may be overweight, a total cholesterol level of 223 mg/dL is elevated, and a serum creatinine of 1.86 mg/dL may suggest chronic kidney disease. Blood pressure and TSH are within normal limits.