Chapter 44
The nurse conducting a class on lactation determines that the participants are understanding the information when they identify the milk is ejected from the breast ductile system in response to
Oxytocin
The nurse is explaining the process of conception to a group of middle school students and points out the fertilization occurs
In the middle to outer portion of the fallopian tube
A 51-year-old woman who has been receiving estrogen and progesterone therapy (EPT) for the last 5 years has visited her care provider because her peers have told her about the risks of heart disease, stroke, and breast cancer that could accompany hormone therapy (HT). How should her care provider respond to her concerns?
"HT is actually associated with a decrease in heart disease risk, but there is an increase in stroke risk; the breast cancer connection is still unclear."
After hearing daunting reports from her slightly older coworkers and friends, a 44-year-old woman has a number of questions for her physician about what to expect during perimenopause and why. Which of the following teaching points is most accurate?
"Hot flashes are a reality for most women in menopause, and the exact cause of them isn't known yet."
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 pregnant client asks the nurse what is causing her lower leg edema, nausea, and constipation that she is experiencing. What is the nurses best response?
"The increase in progesterone during pregnancy is most likely the cause of these discomfort"
An older adult female comes into the clinic for her yearly gynecologic appointments and informs the nurse that she is having pain when having intercourse with her spouse. The client has been postmenopausal for at least five years. What is the nurses best response?
"This is caused by a decrease in estrogen levels, but there are things that you may be able to use to help"
The nurse is teaching a female client who has been prescribed hormone therapy. The client asks, "what does this medication do?" Which statement is an appropriate response by the nurse?
"This medication will help relieve hot flashes and other adverse symptoms of menopause"
The Women's Health Initiative results have led the Institute of Medicine (2010) to recommend which of the following guidelines related to hip fractures in women?
All adults should take 600 IU/day of vitamin D to maintain healthy bones.
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
Select the structure primarily responsible for the secretions of luteinizing hormone, follicle stimulating hormone, and prolactin
Anterior pituitary gland
The nurse planning care for a menopausal woman should include interventions to decrease risk for
Atherosclerosis
A woman of childbearing age asked the nurse about a natural method to avoid pregnancy. What is the most appropriate response?
Avoid sex when cervical mucus is most stretchy
Which physiologic changes result in menopause?
Cessation of ovarian function and decreased estrogen levels
Which structure supports the breasts while dividing the breast into 15 to 25 lobes?
Cooper ligaments
The nurse is caring for a female client who asks "will taking estrogen increase my chances of developing breast cancer?" Which statement is an appropriate response by the nurse?
Currently, there is insufficient evidence to support estrogen as the cause of breast cancer
The ovarian follicle becomes luteinized once Ovulation has taken place. As the corpus luteum, the now empty follicle, produces what?
Estrogen and progesterone
The nurse is reviewing findings from the maturation index with an understanding that the test indicates
Estrogen levels
A pregnant client who is taking Risperidone (Risperdal), an antipsychotic prescribed for her bipolar disorder, is at high risk for developing which of the following hormonal adverse effects?
Excess prolactin secretion
what regulates growth, prepubertal maturation, the reproductive cycle, and sex hormone secretion in males and females?
FSH and LH from the anterior pituitary gland
Which client in the infertility clinic will be likely to be able to correct her amenorrhea by diet counseling?
Female with anorexia nervosa who has increased her BMI from 14 to 15 in two weeks by weighing food servings
A nurse educator is explaining the process of sexual intercourse, fertilization, and fetal development to a high school biology class. What process should the nurse describe?
Fertilization in the outer portion of the fallopian tube
A female client informs the nurse that she had intercourse yesterday evening and is wondering if she could become pregnant. If she asks the nurse where the fertilization and implantation currently would be located if she was indeed pregnant what should the nurse tell the client?
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 album takes place. The end of the fallopian tube nearest the ovaries is funnel like. What are the fringed, fingerlike projections around the funnel shaped opening of the fallopian tube called?
Fimbriae
Having heard positive reports of the benefits of hormone therapy (HT) from her sister-in-law and friends, a 49-year-old woman has presented to her family physician asking to start HT. Her uterus is intact, and previous bone scans have indicated low bone density. The client also has a family history of heart disease. She characterizes her symptoms of menopause as "noticeable, but not debilitating by any means." Based on the most current research, what is her physician's best course of action?
Forego HT but consider alternative therapies and reevaluate if her symptoms significantly affect her quality of life.
A client has just become pregnant and there is a consequent increase in secretions from the columnar epithelium of her endocervix. What effect will this have?
Formation of a mucoid plug to protect her uterus
what stimulates LH and FSH?
GnRH from the hypothalamus
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
Has hypertension for 15 years, smoked one pack per day for 20 years, used hormone therapy for five years
Symptoms of adenomyosis
Heavy, painful vaginal bleeding with clots and dyspareunia
A client is beginning menopause and asks "what do you mean by vasomotor instability now that my estrogen levels are decreasing?" Which manifestations will the nurse share with this client related to this instability? Select all that apply
Hot flashes, headaches, dizziness
The ovaries secrete both estrogen and progesterone. What is one function of progesterone in the body?
Increases body temperature at ovulation
The nurse knows that when combined continuous estrogen-progesterone therapy (CCEPT) is prescribed, the drug is considered effective if which of the following occurs?
Inhibited endometrial development resulting in no menses
Hyperprolactinemia
Leads to hypogonadism which occurs when the sex glands produce little or no sex hormones
The nurse is taking a 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
Long distance running, anorexia nervosa, pituitary tumor
The nurse is reviewing laboratory values of a 70-year-old female client and observes that the clients LDL level is elevated. The nurse understands a possible reason for this is
Long-term estrogen deprivation
A 13-year-old patient undergoing puberty is alarmed to find small, white bumps surrounding the areolae on her nipples. You reassure her that these are a normal sign of her sexual maturation and tell her that they are which of the following?
Montgomery tubercles
A 13-year-old client undergoing puberty is alarmed to find small, white bumps around in her areola area. The nurse reassures her that these are a normal sign of her sexual maturation and tells her that they are
Montgomery tubercules
What are the small bumps or projections on the areolar surface called?
Montgomery tubercules or glands
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 statement is an appropriate response by the nurse
Most women experience symptoms for about 4 years
A 20-year-old female has come to the clinic complaining of severe menstrual cramps. The clinic nurse practitioner knows that dysmenorrhea occurs when which muscle group contracts?
Myometrium
The nurse is conducting a community education program on menopause. The nurse include that which of the following will require medical follow up?
Osteoporosis; would require follow up to prevent pathological fractures
The nurse providing teaching about the female reproductive system includes which of the following?
Ovaries are responsible for ovulation and hormone production
The nurse providing teaching about the female reproductive system includes which principle?
Ovaries are responsible for ovulation and hormone production
The nurse conducting a class on lactation determines that the participants are understanding the information when they identify that milk is ejected from the breast ductile system in response to which of the following?
Oxytocin
A client asked the nurse what hormone is responsible for temperature elevation that occurs with ovulation. The best response would be
Progesterone
Which hormone is responsible for breast development and an increase in body temperature that occurs with ovulation?
Progesterone
Which physiologic process is caused by estrogen's?
Promotion of ovarian follicle growth
The lactating mother of a three-month-old infant reports and the nurse that she experiences milk leakage if she hears a child cry when it has been more than two hours since the last feeding. How should the nurse respond?
Reassure her that this is a normal physiological response
A female client experiencing hot flashes during perimenopause asked the nurse about hormone therapy. What is the appropriate response by the nurse?
Short term hormone therapy can be used to reduce symptoms
The nurse is assessing a female client who is being seen at the clinic for a yearly pelvic and Pap smear. Upon assessment, which sign is consistent with a facilitation of movement of intravascular fluid into the extracellular space related to estrogen levels before menstruation?
Slight edema of the feet and ankles
The nurse is assessing the genitalia a 42-year-old female client diagnosed with a genitourinary disorder. The nurse recognizes that which finding does not describe the normal anatomy of the female genitalia
The clitoris is located posterior to the urethra
Which of the following statements most accurately captures a characteristic of the Extertal female genitalia?
The labia majora and clitoris are analogous to the male scrotum and penis respectively
Which statement by the high school nurse is most accurate in terms of the function and purpose of female ovaries?
The ovaries contain a fixed number of ova at birth which decreases throughout one's life
The nurse is discussing ovulation with a female client and notes an indication of ovulation is spinbarkeit . What is an accurate description of spinnbarkeit?
The stretchy consistency of cervical mucus during ovulation
A 40-year-old woman has been identified to have a deficiency in estrogen. Which of the following physiological phenomena is most likely to remain unaffected?
The synthesis and release of adrenal glucocorticoids
A female client is taking antibiotics to treat a skin infection and informs the nurse that she does not think the anabiotic's are working because now she think she has a vaginal infection. What is the nearest 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
Which of the following situations would be considered pathological in an otherwise healthy, 30-year-old female?
The woman's ovaries are not producing progesterone.
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
The connecting tube between the cervix and the vestibule is referred to as
Vagina
The nurse is caring for a 54-year-old female client who reports vaginal dryness and painful intercourse. The nurse expects which prescription will be ordered for this client?
Vaginal estrogen preparation
Symptoms of atrophic vaginitis
Vaginal itching, burning, dyspareunia
During an annual examination, the healthcare provider told the client that the vaginal epithelial cells have shifted to the left. The client asked "what does that mean?" Which response by the nurse is most accurate?
With decreased estrogen levels, your secretions are primarily made up of immature cells
Which of the following statements best captures an aspect of the role of progesterone? Progesterone
levels peak after ovulation and is present throughout the menstrual cycle.
cervix
· The cervix is the neck of the uterus that projects into the vagina · Cervix is a firm structure, composed of a connective tissue matrix of glands and muscular tissue elements that become soft and pliable under the influence of hormones produced during pregnancy · Glandular tissue provides a rich supply of protective mucus that changes in character and quantity during the menstrual cycle and during pregnancy · The cervix is richly supplied with blood from the uterine artery and can be a site of significant blood loss during delivery · The opening of the cervix, the os, forms a pathway between the uterus and the vagina
location of the ovaries
· The ovaries are located on either side of the uterus below the fimbriated ends of the fallopian tubes · Ovaries are attached to the posterior surface of the broad ligament and to the uterus by the ovarian ligament · The ovaries are covered with a thin later of surface epithelium that is continuous with the lining of the peritoneum; the integrity of this covering is periodically broken at the time of ovulation
high levels of estrogen
· exert a negative feedback effect on FSH, inhibiting multiple follicular development and causing an increase in LH levels; this represents the follicular stage of the menstrual cycle
ovaries
· primarily responsible for controlling the cyclic changes and the length of the menstrual cycle
ovaries
· produce estrogens, progesterone, and androgens and are secreted in a cyclic pattern as a result of the interaction between the hypothalamic GnRH and the pituitary gonadotropic hormones FSH and LH
A perimenopausal client is discussing the role estrogen plays in the body. Which functions would be considered extragenital metabolic affects that the nurse will share with this client? Select all that apply
- Anti-atherosclerotic effects on the arterial wall - decreases the rate of bone resorption - production of an increase in high-density lipoprotein's - increases memory by enhancing presynaptic signal transmission
A 13-year-old female is undergoing rapid development of her breasts after experiencing menarche several months ago. Which of the following hormones are active in the development of her breasts? Select all that apply.
- Prolactin - Luteinizing hormone - Estrogen - Follicle-stimulating hormone - Progesterone
During rounds at an infertility clinic, the provider suspects a new client has anovulation caused by polycystic ovarian syndrome based on which findings? Select all that apply
Able to palpate many lumps in uterus during examination, testosterone levels are elevated, noticeable acne and male pattern hair growth, cannot remember date of last menstrual period
A 29-year-old woman has been trying for many months to become pregnant, and fertilization has just occurred following her most recent ovulation. What process will now occur that will differentiate this ovulatory cycle from those prior?
Human chorionic gonadotropin will be produced, preventing luteal regression.
While explaining milk production and release to a group of expectant parents, the nurse educates the parents on the fact that suckling by the infant provides the stimulus for milk ejection. This suckling sends feedback to the hypothalamus, which stimulates the release of which hormone from the pituitary gland responsible for the ejection of milk into the ductal system?
Oxytocin
A client is complaining to the healthcare provider about several vague signs and symptoms. Which signs and symptoms raise a "red flags" indicating the client may have developed endometrial cancer?
Painless abnormal bleeding
A woman consults her physician about a study (Women's Health Initiative) discussing an increased risk for breast cancer if taking hormones. The physician can allay her fears by sharing which of the following findings?
This 26% increased risk for developing invasive breast cancer occurred in women taking combined continuous estrogen-progesterone therapy.
The nurse is caring for a 48-year-old female client who asks "how do you know when you have reach menopause?" Which statement 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 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 statement would be most appropriate?
You should have more frequent breast evaluation's using an MRI rather than standard mammography
current recommendations for hormone therapy
o Avoid HT for primary or secondary prevention of CHD o Develop an individual risk profile for every woman contemplating HT and provide information regarding known risks o Use HT only in those women who require relief from menopausal symptoms that affect quality of life o Consider lower-than-standard doses and alternative routes of administration o Limit the use of HT to the shortest duration consistent with goals, benefits, and risks of treatment for each woman o Consider alternative therapies if the woman is not symptomatic because of the potential risks associated with HT products that are FDA-approved for the prevention of postmenopausal osteoporosis
myometrium
o Forms the major portion of the uterine wall o Contractions of the inner muscle fibers of the myometrium help to expel menstrual flow and the products of conception during miscarriage or childbirth o When pain accompanies the contractions associated with menses it is called dysmenorrhea o Ability to change length during pregnancy and labor to accommodate gestation
endometrium
o Inner layer of the uterus and is made up of a basal and a superficial layer o The superficial layer is shed during menstruation and regenerated by cells of the basal layer o Ciliated cells promote the movement of tubal-uterine secretions out of the uterine cavity into the vagina
perimetrium
o The outer serous covering that is derived from the abdominal peritoneum o Due to the close proximity to the urinary bladder, infection of the bladder can cause uterine symptoms particularly during pregnancy
three layers of the uterus
perimetrium, myometrium, endometrium
changes in breast structure that occur with pregnancy and lactation.
· During pregnancy, increased levels of estrogen and progesterone significantly alter the breasts · Estrogen stimulates increased vascularity of the breasts and the growth and extension of the ductile structures, causing "heaviness" of the breasts · Progesterone causes marked budding and growth of the alveolar structures in which the alveolar epithelium assumes a secretory state in preparation for lactation · During lactation, milk is secreted by alveolar cells which are under the influence of prolactin · Milk ejection from the ductile system occurs in response to the release of oxytocin which is stimulated by the suckling of the infant · Oxytocin causes contraction of the myoepithelial cells living the alveoli and ejection of milk into the ductal system · Women may have breast leakage for 3 months to 1 year after terminating breast feeding
function of endocervical secretions.
· Secretions from the columnar epithelium of the endocervix protects the uterus from infection, alter receptivity to sperm, and for a mucoid "plug" during pregnancy
A woman has gone to her gynecologist complaining of pain during intercourse. The physician orders a maturation index on her vaginal scrapings. The results return an index of 75-25-0. The nurse can interpret this to mean
she is experiencing postmenopausal vaginal dryness; The vaginal scrapings are used for a test, the maturation index, that examines the cellular structure and configuration of the vaginal epithelial cells. Typically, this index is 0-40-60 during the reproductive years. With diminished estrogen levels, there is a shift to the left, producing an index of 30-40-30 during the perimenopausal period, and an index of 75-25-0 occurs during the postmenopausal period.
influence of hormones on breast development.
· In women, the pituitary release of FSH, LH, and prolactin at puberty stimulates the ovary to produce and release estrogen · This estrogen stimulates the growth and proliferation of the ductile system · With the onset of ovulatory cycles, progesterone release stimulates the growth and development of ductile and alveolar secretory epithelium · At puberty and during pregnancy, increased levels of estrogen and progesterone cause the areola and nipple to become darker and more prominent
