Chapter 56 Assessment and Management of Patients with Female Physiologic Processes

4 A premenopausal patient is complaining of vaginal spotting and sharp, colicky lower abdominal pain. She informs the nurse that her period is 2 weeks late. The nurse should recognize a need for this patient to be investigated for what health problem? A) Trichomonas vaginalis B) Ectopic pregnancy C) Cervical cancer D) Fibromyalgia

B) Ectopic pregnancy Feedback: Clinical symptoms of an ectopic pregnancy include delay in menstruation of 1 to 2 weeks, vaginal spotting, and sharp, colicky pain. Trichomonas vaginalis causes a vaginal infection. Cervical cancer and fibromyalgia do not affect menstruation.

9 A new patient has come to the clinic seeking an appropriate method of birth control. What would the nurse teach this patient about a diaphragm? A) One size fits all females. B) The diaphragm may be cleaned with soap and water after use. C) A diaphragm eliminates the need for spermicidal jelly. D) The diaphragm should be removed 1 hour following intercourse.

B) The diaphragm may be cleaned with soap and water after use. Feedback: The diaphragm may be cleaned with soap and water after use. It must be left in 6 hours after intercourse and should be used with spermicidal jelly. There are different sizes of diaphragms and the patient needs to be fitted by the health care practitioner.

37 A community health nurse is leading a health education session addressing menopause and other aspects of women's health. What dietary supplements should the nurse recommend to prevent morbidity associated with osteoporotic fractures? A) Vitamin B12 and vitamin C B) Vitamin A and potassium C) Vitamin B6 and phosphorus D) Calcium and vitamin D

D) Calcium and vitamin D Feedback: Calcium and vitamin D supplementation may be helpful in reducing bone loss and preventing the morbidity associated with osteoporotic fractures. Phosphorus, potassium, vitamin B12, vitamin C, and vitamin B6 do not address this risk.

8 A nurse is collecting assessment data from a premenopausal patient who states that she does not have menses. What term should the nurse use to document the absence of menstrual flow? A) Amenorrhea B) Dysmenorrhea C) Menorrhagia D) Metrorrhagia

A) Amenorrhea Feedback: Amenorrhea refers to absence of menstrual flow, whereas dysmenorrhea is painful menstruation. Menorrhagia, also called hypermenorrhea, is defined as prolonged or excessive bleeding at the time of the regular menstrual flow. Metrorrhagia refers to vaginal bleeding between regular menstrual periods.

17 A newly pregnant patient is being assessed in an obstetric clinic. The patient states that she has been experiencing intense abdominal pain and the nurse anticipates that the patient will be assessed for ectopic pregnancy. In addition to ultrasonography, what diagnostic test should the nurse anticipate? A) Computed tomography B) Human chorionic gonadotropin (hCG) testing C) Estrogen and progesterone testing D) Abdominal x-ray

B) Human chorionic gonadotropin (hCG) testing Feedback: If an ectopic pregnancy is suspected, the patient is assessed using ultrasound and hCG testing. CT and x-rays are contraindicated during pregnancy and estrogen and progesterone levels are not diagnostic of ectopic pregnancy.

21 The nurse is utilizing the PLISSIT model of sexual health assessment during an interaction with a new patient. According to this model, the nurse should begin with what action? A) Conducting a preliminary assessment B) Addressing the patient's psychosocial status C) Asking the patient's permission to discuss sexuality D) Assessing for physiologic problems

C) Asking the patient's permission to discuss sexuality Feedback: The PLISSIT model of sexual assessment begins with permission and subsequently includes limited information, specific suggestions, and intensive therapy.

19 The nurse is planning the sexual assessment of a new adolescent patient. The nurse should include what assessment components? Select all that apply. A) Physical examination findings B) Laboratory results C) Health history D) Interpersonal skills E) Understanding of menopause

A, B, C Feedback: A sexual assessment includes both subjective and objective data. Health and sexual histories, physical examination findings, and laboratory results are all part of the database. A sexual assessment would not normally include the patient's interpersonal skills. It is not likely to necessary to assess an adolescent's understanding of menopause.

20 By initiating an assessment about sexual concerns what does the nurse convey to the patient? Select all that apply. A) That sexual issues are valid health issues B) That it is safe to talk about sexual issues C) That sexual issues are only a minor aspect a person's identity D) That changes or problems in sexual functioning should be discussed E) That changes or problems in sexual functioning are highly atypical

A, B, D Feedback: By initiating an assessment about sexual concerns, the nurse communicates to the patient that issues about changes or problems in sexual functioning are valid and significant health issues. The nurse communicates that it is safe to talk about sexual issues and that changes or challenges in sexual function are not unusual.

26 The nurse is assessing a 53-year-old woman who has been experiencing dysmenorrhea. What questions should the nurse include in an assessment of the patient's menstrual history? Select all that apply. A) "Do you ever experience bleeding after intercourse?" B) "How long is your typical cycle?" C) "Did you have any sexually transmitted infections in early adulthood?" D) "When did your mother and sisters get their first periods?" E) "Do you experience cramps or pain during your cycle?"

A, B, E Feedback: Menstrual history addresses such factors as the length of cycles, duration and amount of flow, presence of cramps or pain, and bleeding between periods or after intercourse. Family members' menarche and prior STIs are not likely to affect the patient's current cycles.

28 A 48-year-old woman presenting for care is seeking information about hormone therapy (HT) for the treatment of her perimenopausal symptoms. The patient's need for relief from hot flashes and other symptoms will be weighed carefully against the increased risks of what complications of HT? Select all that apply. A) Anaphylaxis B) Osteoporosis C) Breast cancer D) Cardiovascular disease E) Venous thromboembolism

C, D, E Feedback: Although HT decreases hot flashes and reduces the risk of osteoporotic fractures as well as colorectal cancer, studies have shown that it increases the risk of breast cancer, heart attack, stroke, and blood clots. There is no significant risk of anaphylaxis.

34 A woman presents at the ED with sharp, colicky pain in her right abdomen that radiates to her right shoulder. She tells the nurse that she has been spotting lightly for the past few days. The patient is subsequently diagnosed with an ectopic pregnancy. What major nursing diagnosis most likely relates to this patient's needs? A) Anxiety related to potential treatment options and health outcomes B) Chronic sorrow related to spontaneous abortion C) Chronic pain related to genitourinary trauma D) Impaired tissue integrity related to keloid scarring

A) Anxiety related to potential treatment options and health outcomes Feedback: It is highly likely that the woman diagnosed with an ectopic pregnancy will experience intense anxiety. Pain and sorrow are also plausible, but are unlikely to become chronic. Impaired tissue integrity and keloid scarring are atypical.

10 A patient who is in the first trimester of pregnancy has experienced an incomplete abortion. The obstetric nurse should prepare the patient for what possible intervention? A) Dilation and evacuation B) Several days of bed rest C) Administration of hydromorphone D) IV administration of clomiphene

A) Dilation and evacuation Feedback: If only some of the tissue is passed, the abortion is referred to as incomplete. An emptying or evacuation procedure (D&C, or dilation and evacuation [D&E]) or administration of oral misoprostol (Cytotec) is usually required to remove the remaining tissue. Bed rest will not necessarily result in the passing of all the tissue. Clomiphene and hydromorphone are of no therapeutic benefit.

1 A school nurse is presenting information on human development and sexuality. When describing the role of hormones in sexual development, which hormone does the nurse teach the class is the most important one for developing and maintaining the female reproductive organs? A) Estrogen B) Progesterone C) Androgens D) Follicle-stimulating hormone

A) Estrogen Feedback: Estrogens are responsible for developing and maintaining the female reproductive organs. Progesterone is the most important hormone for conditioning the endometrium in preparation for implantation of the fertilized ovum. Androgens, secreted by the ovaries in small amounts, are involved in the early development of the follicle and affect the female libido. Follicle-stimulating hormone is responsible for stimulating the ovaries to secrete estrogen.

27 The nurse is working with a couple who have been unable to conceive despite more than 2 years of trying to get pregnant. The couple has just learned that in vitro fertilization (IVF) was unsuccessful and they are both tearful. What nursing diagnosis is most likely to apply to this couple? A) Hopelessness related to failed IVF B) Acute confusion related to reasons for failed IVF C) Compromised family coping related to unsuccessful IVF D) Moral distress related to unsuccessful IVF

A) Hopelessness related to failed IVF Feedback: Although further assessment is undoubtedly necessary, it is likely that the couple will be experiencing hopelessness at the news that a potentially promising intervention has failed. Acute confusion denotes a cognitive deficit, not a sense of despair. Sadness at this news is not necessarily suggestive of impaired coping. Moral distress is unlikely because this is not a situation involving morality.

40 A 21-year-old woman has sought care because of "heavy periods" and has subsequently been diagnosed with menorrhagia. The nurse should recognize which of the following as the most likely cause of the patient's health problem? A) Hormonal disturbances B) Cervical or uterine cancer C) Pelvic inflammatory disease D) A sexually transmitted infection (STI)

A) Hormonal disturbances Feedback: Menorrhagia is prolonged or excessive bleeding at the time of the regular menstrual flow. In young women, the cause is usually related to endocrine disturbance. In later life, it usually results from inflammatory disturbances, tumors of the uterus, or hormonal imbalance. STIs, pelvic inflammatory disease, and cancer are less likely causes.

18 An adolescent is brought to the clinic by her mother because of abnormal uterine bleeding. The nurse should understand that the most likely cause of this dysfunctional bleeding pattern is what? A) Lack of ovulation B) Chronic vaginitis C) A sexually transmitted infection D) Ectopic pregnancy

A) Lack of ovulation Feedback: Dysfunctional uterine bleeding can occur at any age, but is most common at opposite ends of the reproductive life span. It is usually secondary to anovulation (lack of ovulation) and is common in adolescents. It is not suggestive of vaginitis, an STI, or ectopic pregnancy.

38 The nurse is working with a patient who expects to begin menopause in the next few years. What educational topic should the nurse prioritize when caring for a healthy woman approaching menopause? A) Patient teaching and counseling regarding healthy lifestyles B) Referrals to local support groups C) Nutritional counseling regarding osteoporosis prevention D) Drug therapy options

A) Patient teaching and counseling regarding healthy lifestyles Feedback: The individual woman's evaluation of herself and her worth, now and in the future, is likely to affect her emotional reaction to menopause. Patient teaching and counseling regarding healthy lifestyles, health promotion, and health screening are of paramount importance. This broad goal of fostering healthy lifestyles transcends individual topics such as drug treatment, support groups, and osteoporosis prevention.

23 A 15-year-old girl is brought to the clinic by her mother to see her primary care provider. The mother states that her daughter has not started to develop sexually. The physical examination shows that the patient has no indication of secondary sexual characteristics. What diagnosis should the nurse suspect? A) Primary amenorrhea B) Dyspareunia C) Vaginal atrophy D) Secondary dysmenorrhea

A) Primary amenorrhea Feedback: Primary amenorrhea (delayed menarche) refers to the situation in which young women older than 16 years of age have not begun to menstruate but otherwise show evidence of sexual maturation, or in which young women have not begun to menstruate and have not begun to show development of secondary sex characteristics by 14 years of age. In secondary dysmenorrhea, pelvic pathology such as endometriosis, tumor, or pelvic inflammatory disease (PID) contributes to symptoms. Dyspareunia is painful intercourse and vaginal atrophy would not contribute to the delayed onset of puberty.

30 A couple has come to the infertility clinic because they have been unable to get pregnant even though they have been trying for over a year. Diagnostic tests are planned for the woman to ascertain if ovulation is regular and whether her endometrium is adequately supported for implantation. What test would the nurse expect to have ordered for this woman? A) Serum progesterone B) Abdominal CT C) Oocyte viability test D) Urine testosterone

A) Serum progesterone Feedback: Diagnostic studies performed to determine if ovulation is regular and whether the progestational endometrium is adequate for implantation may include a serum progesterone level and an ovulation index. None of the other listed tests is used to investigate infertility.

3 The nurse is being trained to perform assessment screenings for abuse on patients who come into the walk-in clinic where the nurse works. Which of the following assessment questions is most appropriate? A) "Would you describe your relationship as healthy and functional?" B) "Have you ever been forced into sexual activity?" C) "Do you make your husband uncontrollably angry?" D) "How is conflict usually handled in your home?"

B) "Have you ever been forced into sexual activity?" Feedback: Asking about abuse directly is effective in identifying the presence of abuse and should be included in the health history of all women. Oblique questions that relate to the character of the relationship or conflict resolution are less useful clinically. Asking about making a partner angry is not an appropriate way to screen for family violence because it does not directly address the problem.

31 The nurse is caring for a couple trying to get pregnant and have not been able to for over a year. The couple asks what kind of problems a man can have that can cause infertility. What should be the nurse's response? A) "Men can have increased prolactin levels that decrease sperm viability." B) "Men can have problems that increase the temperature around their testicles and decrease the quality of their semen." C) "Men may inherit the gene that causes low sperm production." D) "Men may produce sperm that are incompatible with the shape of the egg."

B) "Men can have problems that increase the temperature around their testicles and decrease the quality of their semen." Feedback: Men may be affected by varicoceles, varicose veins around the testicle, which decrease semen quality by increasing testicular temperature. Low prolactin levels may contribute to the problem. Genetic factors are not noted to relate to male infertility. Infertility is not normally linked to sperm that are incompatible with the shape of the egg.

39 A woman's current health complaints are suggestive of a diagnosis of premenstrual dysphoric disorder (PMDD). The nurse should first do which of the following? A) Assess the patient's understanding of HT. B) Assess the patient for risk of suicide. C) Assure the patient that the problem is self-limiting. D) Suggest the use of St. John's wort.

B) Assess the patient for risk of suicide. Feedback: If the patient has severe symptoms of PMS or PMDD, the nurse assesses her for suicidal, uncontrollable, and violent behavior. The problem can escalate and is not necessarily self-limiting. HT is not a relevant intervention and the nurse should not recommend herbal supplements without input from the primary care provider.

7 A nurse presenting an educational event for a local community group is addressing premenstrual syndrome (PMS). What treatment guideline should the nurse teach this group? A) Avoid excessive fluid intake. B) Increase the frequency and intensity of exercise. C) Limit psychosocial stressors in order to reduce symptoms. D) Take opioid analgesics as ordered.

B) Increase the frequency and intensity of exercise. Feedback: In general, the patient is encouraged to increase or initiate an exercise program to help relieve symptoms of PMS. Fluid intake should be increased. Opioids are not used to treat PMS. Stress reduction has multiple benefits, but it is not noted to alleviate the symptoms of PMS.

6 A patient calls the clinic and tells the nurse she has thick white, curd-like discharge from her vagina. How should the nurse best interpret this preliminary data? A) The drainage is physiologic and normal. B) The patient may have a Candida species infection. C) The patient needs a Pap smear as soon as possible. D) The patient may have a Trichomonas infection.

B) The patient may have a Candida species infection. Feedback: Drainage caused by Candida is typically curd-like and white. Trichomonas infections usually cause copious, frothy yellowish-green discharge. There is no immediate need for a Pap smear, as malignancy is an unlikely cause.

24 A 36-year-old woman comes to the clinic complaining of premenstrual syndrome (PMS) that is disrupting her quality of life. What signs and symptoms are associated with this health problem? Select all that apply. A) Loss of appetite B) Breast tenderness C) Depression D) Fluid retention E) Headache

B, C, D, E Feedback: Physiologic symptoms of PMS include headache, breast tenderness, and fluid retention as well as affective symptoms, such as depression. Loss of appetite is not noted to be among the most common symptoms.

2 The nurse is taking the sexual history of an adolescent who has come into the free clinic. What question best assesses the patient's need for further information? A) "Are you involved in an intimate relationship at this time?" B) "How many sexual partners have you had?" C) "What questions or concerns do you have about your sexual health?" D) "Have you ever been diagnosed with a sexually transmitted infection?"

C) "What questions or concerns do you have about your sexual health?" Feedback: An open-ended question related to the patient's need for further information should be included while obtaining a sexual history. None of the other listed questions are open-ended.

13 A nurse practitioner is preparing to perform a patient's scheduled Pap smear and the patient asks the nurse to ensure that the speculum is well-lubricated. How should the nurse proceed with assessment? A) Reassure the patient that ample petroleum jelly will be used. B) Reassure that patient that a water-based lubricant will be used. C) Explain to the patient that water is the only lubricant that can be used. D) Explain to the patient why the speculum must be introduced "dry."

C) Explain to the patient that water is the only lubricant that can be used. Feedback: Because lubricants may obscure cells on a Pap smear, warm water is the only lubricant that can be used.

32 A couple with a diagnosis of ovarian failure discusses their infertility options with their physician. The nurse should recognize which of the following as the treatment of choice for a patient with ovarian failure? A) Intracytoplasmic sperm injection B) Artificial insemination C) Gamete intrafallopian transfer D) In vitro fertilization

C) Gamete intrafallopian transfer Feedback: Gamete intrafallopian transfer (GIFT), a variation of IVF, is the treatment of choice for patients with ovarian failure. In intracytoplasmic sperm injection (ICSI), an ovum is retrieved as described previously, and a single sperm is injected through the zona pellucida, through the egg membrane, and into the cytoplasm of the oocyte. The fertilized egg is then transferred back to the donor. ICSI is the treatment of choice in severe male factor infertility. IVF involves ovarian stimulation, egg retrieval, fertilization, and embryo transfer. Artificial insemination is the deposit of semen into the female genital tract by artificial means.

11 A patient in her late fifties has expressed to the nurse her desire to explore hormone replacement therapy (HRT). Based on what aspect of the patient's health history is HRT contraindicated? A) History of vaginal dryness B) History of hot flashes and night sweats C) History of vascular thrombosis D) Family history of osteoporosis

C) History of vascular thrombosis Feedback: The use of HRT is contraindicated in women with a history of vascular thrombosis, active liver disease, some cases of uterine cancer, and undiagnosed vaginal bleeding. HRT is beneficial in women with a risk for osteoporosis. Vaginal dryness, hot flashes, and night sweats are symptoms of menopause that may be relieved with HRT.

36 A 51-year-old woman is experiencing perimenopausal symptoms and expresses confusion around the possible use of hormone therapy (HT). She explains that her mother and aunts used HT and she is unsure why few of her peers have been prescribed this treatment. What should the nurse explain to the patient? A) Large, long-term health studies have revealed that HT is minimally effective. B) HT has been largely replaced by other nonpharmacologic interventions. C) Research has shown that significant health risks are associated with HT. D) HT has been shown to exacerbate symptoms of menopause in a minority of women.

C) Research has shown that significant health risks are associated with HT. Feedback: HT is effective, but has been associated with serious adverse effects. However, it does not exacerbate the symptoms of menopause. Nonpharmacologic interventions that address perimenopausal symptoms have not yet been identified.

35 The nurse is assessing a patient who believes that she has recently begun menopause. What principle should inform the nurse's interactions with this patient? A) The nurse should express empathy for the patient's difficult health situation. B) The nurse should begin by assuring the patient that her health will be much better in a few years. C) The nurse must carefully assess the patient's feelings and beliefs surrounding menopause. D) The nurse should encourage the patient to celebrate this life milestone and its accompanying benefits.

C) The nurse must carefully assess the patient's feelings and beliefs surrounding menopause. Feedback: Women have widely varying views on menopause and the nurse must ascertain these. It is wrong to presume either a positive or negative view of this transition without first performing assessment.

12 The school nurse is presenting a class on female reproductive health. The nurse should describe what aspect of Pap smears? A) The test may be performed at any time during the patient's menstrual cycle. B) The smear should be done every 2 years. C) The test can detect early evidence of cervical cancer. D) False-positive Pap smear results occur mostly from not douching before the examination.

C) The test can detect early evidence of cervical cancer. Feedback: The test should be performed when the patient is not menstruating. Douching washes away cellular material. The test detects cervical cancer, and false-negative Pap smear results occur mostly from sampling errors or improper technique. For most women, a Pap smear should be done annually.

14 A clinic nurse is meeting with a 38-year-old patient who states that she would like to resume using oral contraceptives, which she used for several years during her twenties. What assessment question is most likely to reveal a potential contraindication to oral contraceptive use? A) "Have you ever had surgery?" B) "Have you ever had a sexually transmitted infection?" C) "When did you last have your blood sugar levels checked?" D) "Do you smoke?"

D) "Do you smoke?" Feedback: Women who smoke and who are 35 years of age or older should not take oral contraceptives because of an increased risk for cardiac problems. Previous surgeries, STIs, and blood sugar instability do not necessarily contraindicate the use of oral contraceptives.

15 A 17-year-old girl has come to the free clinic for her annual examination. She tells the nurse she uses tampons and asks how long she may safely leave her tampon in place. What is the nurse's best response? A) "You may leave the tampon in overnight." B) "The tampon should be changed at least twice per day." C) "Tampons are dangerous and, ideally, you should not be using them." D) "Tampons need to be changed every 4 to 6 hours."

D) "Tampons need to be changed every 4 to 6 hours." Feedback: Tampons should not be used for more than 4 to 6 hours, nor should super-absorbent tampons be used because of the association with toxic shock syndrome. If used appropriately, it is acceptable and safe for the patient to use tampons.

25 A patient states that PMS that is significantly disrupting her quality of life and that conservative management has failed to produce relief. What pharmacologic treatment may benefit this patient? A) An opioid analgesic B) A calcium channel blocker C) A monoamine oxidase inhibitor (MAOI) D) A selective serotonin reuptake inhibitor (SSRI)

D) A selective serotonin reuptake inhibitor (SSRI) Feedback: Pharmacologic remedies for PMS include selective serotonin reuptake inhibitors. MAOIs are not used for this purpose. Calcium channel blockers and opioids would not lead to symptom relief.

5 A female patient who has cognitive and physical disabilities has come into the clinic for a routine check-up. When planning this patient's assessment, what action should the nurse take? A) Ensure that a chaperone is available to be present during the assessment. B) Limit the length and scope of the health assessment. C) Avoid health promotion or disease prevention education. D) Avoid equating the patient with her disabilities.

D) Avoid equating the patient with her disabilities. Feedback: When working with women who have disabilities, it is important that the nurse avoid equating the woman with her disability. The nurse must make an effort to understand that the patient and the disability are not synonymous. A chaperone is not necessarily required and there may or may not be a need to abbreviate the assessment. The nurse should provide education as needed.

22 During the nurse's assessment of a female patient, the patient reveals that she experienced sexual abuse when she was a young woman. What is the nurse's most appropriate response to this disclosure? A) Reassure her that this information will be kept a secret. B) Begin the process of intensive psychotherapy. C) Encourage the patient to phone 911. D) Facilitate appropriate resources and referrals.

D) Facilitate appropriate resources and referrals. Feedback: The nurse's primary roles in light of this disclosure are to provide empathy and to arrange for appropriate resources and referrals. There is no need to phone 911 and psychotherapy is beyond the nurse's scope of practice. The patient's confidentiality will be respected, but this does not mean that the nurse can promise to keep it a secret.

29 A 27-year-old primipara presents to the ED with vaginal bleeding and suspected contractions. The woman relates that she is 14 weeks pregnant and she thinks she is losing her baby. Diagnostic testing confirms a spontaneous abortion. What nursing action would be a priority at this time? A) Leave the patient alone so she can grieve in private. B) Teach the patient that this will not affect her future chance of conception. C) Take the patient off the obstetric floor so she will not hear a baby cry. D) Provide opportunities for the patient to talk and express her emotions.

D) Provide opportunities for the patient to talk and express her emotions. Feedback: Providing opportunities for the patient to talk and express her emotions is helpful and also provides clues for the nurse in planning more specific care. The patient may or may not want to be alone, but the nurse should first determine her wishes. It would be inappropriate to refer to future pregnancies during this acute time of loss. It would not be necessary or practical to remove the patient from the unit.

33 The nurse is working with a couple who is being evaluated for infertility. What nursing intervention would be most appropriate for this couple's likely needs? A) Educating them about parenting techniques in order to foster hope B) Educating them about the benefits of child-free living C) Choosing the most appropriate reproductive technology D) Referring them to appropriate community resources

D) Referring them to appropriate community resources Feedback: Nursing interventions appropriate when working with couples during infertility evaluations include referring the couple to appropriate resources when necessary. It would likely be considered offensive and insensitive to focus the couple on parenting skills or the benefits of child-free living. Choosing particular reproductive technologies is beyond the nurse's scope of practice.

16 A 51-year-old woman has come to the OB/GYN clinic for her annual physical. She tells the nurse that she has been experiencing severe hot flashes, but that she is reluctant to begin hormone therapy (HT). What potential solution should the nurse discuss with the patient? A) Sodium restriction B) Adopting a vegan diet C) Massage therapy D) Vitamin supplements

D) Vitamin supplements Feedback: For some women, vitamins B6 and E have proven beneficial for the treatment of hot flashes. Sodium restriction, vegan diet, and massage have not been noted to relieve this symptom of perimenopause.