Med-Surg Ch 39: Care of Women With Reproductive Disorders

A nurse is reinforcing teaching with a client prior to an initial mammogram. Which of the following information should the nurse provide prior to the procedure? A. "You should not take any aspirin products prior to the mammogram." B. "Do not apply any deodorant the day of the exam." C. "You will need to avoid sexual intercourse the day before the mammogram." D. "You should avoid exercise prior to the exam."

"Do not apply any deodorant the day of the exam." *Taking aspirin products does not alter the accuracy of a mammogram *Applying deodorant or powder can alter the accuracy of a mammogram by causing a shadow to appear *Having sexual intercourse does not alter the accuracy of a mammogram *Exercising does not alter the accuracy of a mammogram

When a patient finds a lump in her breast, which question is essential for the LPN/LVN to ask because it is an early indication of breast cancer? A. "Did you breast-feed your children?" B. "Are you having menstrual irregularity?" C. "Do you notice any dimpling of the breast?" D. "Do you have any pain?"

"Do you notice any dimpling of the breast?" *Nipple discharge or a change in the skin pattern such as "dimpled skin" on the breast may also be a sign of breast cancer. Menstrual irregularity is not associated with breast cancer. Pain is a late sign for the presence of breast cancer. Breastfeeding is associated with a reduced incidence of breast cancer.

After having a right total mastectomy, the patient confides that her husband has voiced concern about her "disfigurement." Which response is most appropriate for the nurse to make? The nurse's most therapeutic response would be A. "What a terrible thing to say!" B. "Many husbands feel that way at first." C. "His feelings will change over time." D. "How did you respond to his statement?"

"How did you respond to his statement?" *Using open-ended and matter-of-fact tactful questions will help the patient express feelings. Characterizing the husband's statement as terrible renders an inappropriate judgment without exploring how the patient feels. Informing the patient about others' feelings or offering empty reassurance that her husband will change over time is inappropriate and ineffective

You have provided a patient with specific instructions regarding post-operative right radical mastectomy care of the surgical site and surgical complications. Which patient statement indicates a need for further teaching? A. "Blood pressure cannot be taken on the right arm." B. "I can resume intense weight training soon after discharge." C. "No injections must be given in the right arm." D. "When gardening, I need to wear gloves."

"I can resume intense weight training soon after discharge." *Lifting excess weight should be avoided postoperatively. (1, 3, 4) These statements are correct and do not require follow-up.

A nurse is collecting data for a client who is scheduled for an anterior colporrhaphy. Which of the following client statements should the nurse expect as an indication for this procedure? A. "I have to push the feces out of a pouch in my vagina with my fingers." B. "I have pain and bleeding when I have a bowel movement." C. "I have had frequent urinary tract infections." D. "I am embarrassed by uncontrollable flatus."

"I have had frequent urinary tract infections." *Pouching of feces is an expected finding associated with a rectocele. The surgical procedure for a rectocele is POSTERIOR colporrhaphy *Pain and bleeding with a bowel movement is an expected finding associated with a rectocele *Due to urinary stasis associated with cystocele, this finding is an expected finding of a cystocele. The surgery for a cystocele is an ANTERIOR colporrhaphy *Uncontrollable flatus is an expected finding associated with rectocele

The nurse is reviewing strategies for self-care with a patient diagnosed with PMDD. Which statement by the patient indicates a need for further instruction? A. "I sure miss drinking coffee in the morning." B. "I'm trying to lose weight by avoiding all carbohydrates." C. "My usual dinner consists of chicken, salad, and a baked potato." D. "I sure am gassy from eating so many vegetables!"

"I'm trying to lose weight by avoiding all carbohydrates." *Strategies for self-care include stress management exercises; some lifestyle changes; and maintaining a healthy diet rich in complex carbohydrates (peas, beans, whole grains, and starchy vegetables)and fiber (green leafy vegetables), avoiding simple sugars, salty foods, and caffeine (coffee, tea), and prevention of hypoglycemia. Exercise may increase beta-endorphin levels, which results in relief of depression and mood elevation.

A patient wishing to decrease her risk for breast cancer asks you what causes this disease. What is the appropriate nursing response? A. "Antiperspirants have been shown to cause breast cancer." B. "Researchers believe that genes and environmental factors cause this disease." C. "Age and weight are the most predictive risks for development of breast cancer." D. "There are no modifiable risk factors that you can control to prevent breast cancer."

"Researchers believe that genes and environmental factors cause this disease." *The cause of breast cancer is not known. However, genetic and environmental risk factors have been identified. (1) Antiperspirants are not a cause of breast cancer. (3) Older age and obesity are risk factors but are not causative factors. (4) Exposure to ionizing radiation, obesity, and alcohol use are all modifiable risk factors.

The nurse is caring for a patient diagnosed with toxic shock syndrome (TSS). Which statement best indicates the patient understands the causative factor of this disorder? A. "This problem likely resulted from an untreated sexually transmitted infection." B. "This problem is linked to my ovarian cyst rupture." C. "This problem could have resulted from using a diaphragm for birth control." D. "Taking steroids is associated with this problem."

"This problem could have resulted from using a diaphragm for birth control." *TSS is a rare and potentially fatal disorder caused by strains of Staphylococcus aureas that produce toxins that cause shock, coagulation defects, and tissue damage if they enter the bloodstream. It is associated with the trapping of bacteria within the reproductive tract for a prolong time. Risk factors include the prolonged use of high-absorbency tampons, cervical caps, or diaphragms

A nurse is preparing a client prior to an initial Papanicolaou (Pap) test. Which of the following statements should the nurse make? A. "You should urinate immediately after the procedure is over." B. "You will not feel any discomfort." C. "You may experience some bleeding after the procedure." D. "You will need to hold your breath during the procedure."

"You may experience some bleeding after the procedure." *The client is instructed to urinate immediately before the procedure *The client can experience discomfort when the provider obtains the cervical sample *The client can experience a small amount of vaginal bleeding due to scraping of the cervix *The client should use relaxation techniques, such as taking deep breaths during the procedure

When should a patient conduct breast self-examinations (BSE)? A. The day after the onset of menses B. The day after menses stops C. 1 week after the onset of menses D. 1 week after menses stops

1 week after the onset of menses *The examinations should be performed 1 week after the period has begun, or on a specific date if menses has stopped

A nurse is reinforcing teaching to a client who is to undergo a cervical biopsy. Which of the following information should the nurse include? (select all that apply) A. "The procedure is painless." B. "Heavy bleeding is expected for the first few weeks." C. "A fever is common during the first 12 hours after the procedure." D. "Plan the to rest for the first 72 hours after the procedure." E. Avoid the use of tampons for 2 weeks after the procedure."

1. "Heavy bleeding is expected for the first few weeks." 2. Avoid the use of tampons for 2 weeks after the procedure." *Typically the client will experience temporary discomfort and cramping when the specimen is obtained *bleeding is to be expected for the first few weeks *A fever can be indicative of an infection and is a complication that should be reported to the provider *The client should plan to rest for the first 24 hr after the procedure *The client should not use tampons until the cervix has healed, which takes approximately 1 week

A nurse in a provider's office is providing information to a client who has dysfunctional uterine bleeding (DUB). Which of the following statements by the client indicate understanding of the information? (select all that apply) A. "My heavy bleeding can be due to a hormonal imbalance." B. "If I experience menstrual pain, I should take aspirin." C. "Oral contraceptives are contraindicated for clients who have heavy uterine bleeding like mine." D. "My doctor can perform a D&C to find out what's causing my abnormal bleeding." E. "My condition is more common in clients who are in their 30s."

1. "My heavy bleeding can be due to a hormonal imbalance." 2. "My doctor can perform a D&C to find out what's causing my abnormal bleeding." *The client should be aware that DUB can be caused by a progesterone deficiency *The client should avoid aspirin due to the increased risk for bleeding. NSAIDs can be recommended as needed for menstrual pain or discomfort *The client should be aware that contraceptives can be prescribed to treat DUB *The client should be aware that when the provider performs a D&C, endometrium scraped from the uterine wall is sent to the lab for evaluation *The client should be aware that DUB is more common in adolescents and in clients who are nearing menopause

A patient asks about options regarding reconstructive breast surgery. Which nursing response is appropriate? (Select all that apply) A. "Nipple tattooing is an option." B. "Your surgeon will need to discuss possibilities with you." C. "Silicone implants can be used to reconstruct the breast." D. "It is wiser and healthier to refrain from reconstructive surgery." E. "Does your significant other want you to undergo reconstruction?" F. "Reconstruction can take place right after mastectomy."

1. "Nipple tattooing is an option." 2. "Reconstruction can take place right after mastectomy." *(1, 6) Nipple tattooing and reconstruction right after the mastectomy are appropriate options to discuss. (2) The surgeon should discuss the risks and benefits of the options, but the nurse can educate about what options are available. (3) Silicone is no longer used for implants. (4) This is an inappropriate response; the nurse is projecting their own opinion. (5) This statement has nothing to do with the patient's options.

A nurse is reinforcing teaching about menstruation with an adolescent client. Which of the following statements should the nurse include? (Select all that apply) A. "The average age of onset of menstruation is 10." B. "The typical menstrual cycle is approximately 28 days." C. "The first day of the menstrual cycle begins with the last day of the menstrual period." D. "Ovulation typically occurs around the 14th day of the menstrual cycle." E. A menstrual period can last as long as 8 days."

1. "The typical menstrual cycle is approximately 28 days." 2. "Ovulation typically occurs around the 14th day of the menstrual cycle." 3. A menstrual period can last as long as 8 days." *Although some clients experience the onset of menstruation as early as 9, the average age is 12.4 years of age *The first day of the menstrual cycle is the follicular phase, and the second half is the luteal phase. Ovulation typically occurs around the middle of the cycle, or day 14 in a 28 day cycle

Which age-related change(s) occur(s) in the woman after menopause? (select all that apply) A. Atrophy of uterus B. Vaginal dryness C. Decrease in bone mass D. Increase in vaginal elasticity E. Uterine prolapse

1. Atrophy of uterus 2. Vaginal dryness 3. Decrease in bone mass 4. Uterine prolapse *Vaginal elasticity decreases after menopause

You are assessing a patient with a suspected leiomyoma. Which assessment finding is anticipated? (select all that apply) A. Backache B. Lower abdominal pressure C. Diarrhea D. Urinary incontinence E. Abnormal uterine bleeding

1. Backache 2. Lower abdominal pressure 3. Urinary incontinence 4. Abnormal uterine bleeding *(1, 2, 4, 5) Backache, lower abdominal pressure, urinary incontinence, and abnormal uterine bleeding are all symptoms of leiomyoma. (3) Diarrhea is not an expected symptom for leiomyoma.

Which manifestation(s) is/are signals of premenstrual syndrome (PMS) (select all that apply) A. Bloating B. Irritability C. Depression D. Excessive energy E. Fear of losing control

1. Bloating 2. Irritability 3. Fear of losing control *Signs of PMS include bloating, irritability, fear of losing control, breast tenderness, appetite changes, fatigue, and mood swings. PMS does not include depression or excessive energy

The nurse is teaching a class of middle-aged women in the community about osteoporosis. The class would demonstrate an understanding of the material by listing which risk factors of osteoporosis? (Select all that apply.) A. Excessive vitamin D intake B. Avoidance of caffeine C. Cigarette smoking D. Excessive alcohol use E. Deficient intake of calcium F. Regular use of soft drinks

1. Cigarette smoking 2. Excessive alcohol use 3. Deficient intake of calcium 4. Regular use of soft drinks *Risk factors for osteoporosis include cigarettes, excessive alcohol, caffeine, and soft drink use, and deficient lifetime intake of calcium and vitamin D.

A nurse is reviewing the medical record of a client who is menopausal. Which of the following findings should the nurse expect? (select all that apply) A. Increased vaginal secretions B. Decreased bone density C. Increased HDL level D. Decreased skin elasticity level E. Increased pubic hair D. Decreased follicle stimulating hormone

1. Decreased bone density 2. Decreased skin elasticity *Clients who are menopausal are expected to have decreased vaginal secretions, bone density, decreased HDL level, decreased elasticity, loss (decreased) hair on head and pubic area *Clients who are menopausal are expected to have increased LDL level and increased FSH level

Which teaching will you include when educating a patient about how to manage lymphedema of the leg? (select all that apply) A. Elevate the affected extremity to heart level B. Wear elastic stockings without tight bands C. Wear restrictive clothing D. Avoid crossing the legs while sitting E. Do not engage in exercise

1. Elevate the affected extremity to heart level 2. Wear elastic stockings without tight bands 3. Avoid crossing the legs while sitting *Elevating the extremity helps gravity drainage. Avoiding constriction of blood flow in one's clothing or positioning is also recommended. (3) No restrictive clothing should be worn. (5) Exercise is encouraged.

A nurse is reviewing the medical record of a client who has premenstrual syndrome (PMS). The nurse should identify that which of the following medications are used to treat PMS? (Select all that apply) A. Fluoxetine B. Spironolactone C. Ethinyl estradiol/drospirenone D. Ferrous sulfate E. Methlylergonovine

1. Fluoxetine 2. Spironolactone 3. Ethinyl estradiol/drospirenone *Fluoxetine, an SSRI, is used to treat the emotional manifestations of PMS (irritability, mood swings) and has an added effect of treating physical manifestations *Spironolactone is a diuretic and can reduce bloating and weight gain associated with PMS *Oral contraceptives can be prescribed to reduce the manifestations of PMS *Oral iron supplements (ferrous sulfate) are used to treat anemia associated with dysfunctional uterine bleeding *Methylergonovine is used to treat postpartum hemorrhage

Which manifestation(s) is/are signs and symptoms of menopause? (select all that apply) A. Hot flashes and flushes B. Cessation of estrogen production C. Vaginal dryness D. Night sweats E. Irregularity of menses

1. Hot flashes and flushes 2. Vaginal dryness 3. Night sweats 4. Irregularity of menses *Estrogen production reduces but does not cease

Osteoporosis (a decrease in bone mass) puts the post menopausal woman at increased risk for bone fracture. Lifestyle activities that increase this risk include (select all that apply) A. Inadequate lifetime intake of calcium and vitamin D B. Taking vitamin C and iron supplements C. Smoking D. Sleeping 9-10 hours night E. Excess alcohol and/or caffeine intake

1. Inadequate lifetime intake of calcium and vitamin D 2. Smoking 3. Excess alcohol and/or caffeine intake

The nurse is caring for a patient who has been diagosed with cystocele. The patient is not a surgical candiate. The nurse should include information about which nonsurgical management technique(s) in the teaching plan? (select all that apply) A. Kegel exercises B. Pessary insertion of a pessary C. Hormone therapy D. Vitamin b12 therapy E. Increased fluid intake

1. Kegel exercises 2. Pessary insertion of a pessary 3. Hormone therapy 4. Increased fluid intake *Nonsurgical management includes teaching the woman how to perform Kegel exercises in order to strengthen the pubococcygeal muscles that support the pelvic floor. A pessary (a hard rubber or plastic ring) can be fitted into the vagina by the health care provider to provide support to the pelvic structures. Hormone therapy may be prescribed. Lifestyle changes include increasing fluid intake and a high-fiber diet to avoid constipation, avoiding heavy lifting, and maintaining an optimum weight. Cystocele care and treatment does not include vitamin b12 therapy

The nurse describes the "morning-after" pill, levonorgestrel, as a multipurpose pill. Which statement(s) describe(s) a purpose of levonorgestrel? (select all that apply) A. Ovulation prevention B. Immediate menses induction C. Fertilization interference D. Alteration of ova DNA E. Prevention of uterine implantation

1. Ovulation prevention 2. Fertilization interference 3. Prevention of uterine implantation *Levonorgestrel, depending on where in the menstrual cycle the woman is when she takes it, can prevent ovulation, interfere with fertilization, and prevent uterine implantation. It does not immediately induce menses or alter ova DNA

Which nursing intervention(s) will you recommend to a patient with dysmenorrhea? (Select all that apply) A. Pelvic rocking exercises B. Cold compresses C. Effleurage D. Low-fat diet E. NSAIDs

1. Pelvic rocking exercises 2. Effleurage 3. Low-fat diet 4. NSAIDs *Pelvic rocking is an approved exercise to decrease pelvic discomfort. Effleurage involves gentle stroking that can relieve discomfort. A diet low in fat is recommended. Nonsteroidal antiinflammatory medications are recommended to relieve discomfort. (2) Cold compresses can cause ischemia and increase discomfort.

A nurse is reinforcing teaching with a client how to perform Kegel exercises. Which of the following instructions should the nurse include? (select all that apply) A. Perform exercises once daily B. Contract the cicumvaginal and/or perirectal muscles C. Gradually increase the contraction period to 10 to 15 seconds D. Follow each contraction with at least a 10-to-15-second relaxation period E. Perform while sitting, lying, and standing G. Tighten abdominal muscles during contractions

1. Perform exercises once daily 2. Contract the cicumvaginal and/or perirectal muscles 3. Gradually increase the contraction period to 10 to 15 seconds 4. Follow each contraction with at least a 10-to-15-second relaxation period 5. Perform while sitting, lying, and standing *The client should relax their other muscles, such as those in the abdomen and thighs

A 67-year-old patient who has been menopausal for 13 years reports vaginal bleeding. Which are possible causes? (select all that apply) A. Postcoital bleeding from atrophic vaginitis B. Endometrial cancer C. Endometriosis D. Cervical Polyp

1. Postcoital bleeding from atrophic vaginitis 2. Endometrial cancer 3. Cervical Polyp *Thin vaginal tissue after menopause can bleed with the friction of intercourse. Postmenopausal bleeding is a warning sign of endometrial cancer. A symptom of cervical polyps is bleeding. (3) Bleeding symptoms of endometriosis should subside with menopause.

The nurse is caring for a patient who is suffering from dysmenorrhea. Which action(s) is/are ways in which pelvic rock exercise decreases pain? (Select all that apply) A. Releasing endorphins B. Generating abdominal heat C. Suppressing prostaglandins D. Making the uterus drop forward E. Relieving pelvic congestion

1. Releasing endorphins 2. Suppressing prostaglandins 3. Relieving pelvic congestion *Pelvic rock exercise does not generate heat, nor does it make the uterus drop forward

The aging female patient presents to the clinic for an annual examination and requests information on how her body will change as she enters menopause. The nurse should discuss with the patient which age-related changes that occur due to the decrease in estrogen levels experienced with menopause? (Select all that apply.) A. Vaginal dryness B. Decrease in libido C. Enlargement of the breasts D. Reduction of bone mass E. Hypertrophy of the uterus

1. Vaginal dryness 2. Reduction of bone mass *Decreased estrogen levels lead to atrophy of female organs, vaginal dryness, and reduction of bone mass. Decreased estrogen does not lead to a decrease in libido, hypertrophy of the uterus, or enlargement of the breasts.

The nrse is caring for a patient with primary dysmenorrhea. Which food(s) should the nurse suggest that the patient include in her diet? (select all that apply) A. Watermelon B. Buttermilk C. Broccoli D. Asparagus E. Cranberries

1. Watermelon 2. Asparagus 3. Cranberries *The patient will benefit from a balanced low-fat diet with foods that are natural diuretic, like cranberries, asparagus, and watermelon. Broccoli and buttermilk do not have diuretic properties

Older women who are, or have been, on long-term hormone replacement therapy are at increased risk for (select all that apply) A. metrorrhagia B. Breast cancer C. oligomenorrhea D. endometrial cancer

1. breast cancer 2. endometrial cancer

The nurse is assessing a patient for risk factors for breast cancer. The nurse includes questions about (select all that apply) A. family history of relatives with breast cancer B. early menarche, late menopause C. late first pregnancy or no children D. abnormal cells in previous breast biopsy E. history of being less than ideal body weight

1. family history of relatives with breast cancer 2. early menarche, late menopause 3. late first pregnancy or no children 4. abnormal cells in previous breast biopsy

You are caring for four patients. Which patient is at highest risk for development of ovarian cancer? A. 32-year old whose father died of colon cancer B. 40 year old who has BRCA2 gene C. 53 year old whose mother had secondary dysmenorrhea D. 60 year old who delivered four children

40 year old who has BRCA2 gene *Women with BRCA2 gene are at higher risk for ovarian cancer. (1) Although family history of cancer is an important health history question, family history of colon cancer does not predispose a woman to ovarian cancer. (3) Secondary dysmenorrhea is not a risk factor. (4) Multiple deliveries are a protective factor.

Unresolved primary dysmenorrhea may cause the young female to develop which negative perception? A. An exaggerated sense of symptom severity B. A distrust of medications C. A negative attitude toward her own sexuality D. An unhealty tendency toward peer comparison

A negative attitude toward her own sexuality *Unresolved dysmenorrhea in the young woman can cause negative attitudes related to sexuality and self-worth

Metrorrhagia is associated with which condition? A. Uterine polyps and leiomyomas B. Trauma and a foreign body in the vagina C. Cervical Cancer D. All of these

All of these *All of the options are correct. Metrorrhagia is defined as bleeding between menstrual periods. Foreign bodies and vaginal trauma may result in bleeding between periods. A late sign of cervical cancer is abnormal bleeding between periods.

Which statement accurately describes BRCA1 and BRCA2? A. BRCA1 and BRCA2 are genes involved with the inherited form of breast cancer B. BRCA1 and BRCA2 are enzymes that are markers for breast cancer C. BRCA1 and BRACA2 are particular proteins attached to the red blood cells indicating presence of breast cancer D. BRCA1 and BRCA 2 are laboratory test performed on a breast biopsy to detect breast cancer

BRCA1 and BRCA2 are genes involved with the inherited form of breast cancer *It should be noted that not all people who have BRCA gene get cancer, and people without it may get cancer

The nurse is educating a speaking to a group of junior high girls about reproductive health. Which information is most important to include? A. Breasts may be tender in the middle of the cycle B. Girls ages 12 or older who have not had a period should see a doctor C. Irregular or missed periods are nothing to worry about D. A normal period may last up to 2 weeks

Breasts may be tender in the middle of the cycle *Hormonal changes during the mid-portion of the cycle may increase breast tenderness. The onset of the menstrual cycle completes puberty and usually occurs between ages 9 and 17. During the first year following menarche, the menstrual cycle may be somewhat irregular, but by the second year a regular cycle of approximately 28 days is normalls established. Irregular periods may be a benign finding, but late or absent periods could also be a cause for concern (including a potential sign of pregnacny). Menstrual bleeding occurs about 14 days after oculation and lasts between 2 and 8 days

The nurse is caring for a menopausal patient who is experiencing hot flashes. The nurse suggests that the patient increase intake of which foods? A. Red meat and leafy greens B. Cherries and black beans C. Carrots and asparagus D. Yogurt and cheese

Cherries and black beans *During menopause, decreasing estrogen levels may cause hot flashes. Cherries, yams, and black beams are foods rich in phytoestrogens, substances found in plants that may act like normally produced estrogen. Red meat and leafy greens are rich in iron, carrots, and asparagus are rich in beta carotene. Yogurt and cheese are rich in calcium. Iron, betacarotene, and calcium are not known to impact estrogen levels

The patient presents to the clinic for an examination. Which symptom, if reported by the patient, indicates that the woman may be experiencing a rectocele? A. Pelvic fullness B. Stress incontinence C. Constipation D. Dyspareunia

Constipation *A rectocele may result in constipation, soiling, or painful defecation. In a cystocele, urinary frequency or incontinence is most common. A uterine prolapse may result in dyspareunia. The woman often complains of general symptoms that include a sense of fullness in the pelvis and backache.

A nurse is caring for a client who has a rectocele. Which of the following findings should the nurse identify as a contributing factor? A. Urinary tract infection B. Urinary incontinence C. Constipation D. Perimenopausal

Constipation *UTI, urinary incontinence, and perimenopausal are contributing factors for a cystocele

A 42-year-old patient who had a left radical mastectomy expresses concerns about body image. What goal is appropriate? A. Participates in activities of daily living B. Demonstrates acceptance of change in appearance C. Performs aseptic wound care D. States signs and symptoms of infection

Demonstrates acceptance of change in appearance *Demonstrating acceptance of change in appearance is an appropriate goal related to body image. (1) Participating in activities of daily living is not a goal related to body image. (3) Aseptic wound care is not a goal related to body image. (4) Awareness of the signs and symptoms of infection is not a goal related to body image.

An infertile couple considering zygote intrafallopian lines transfer (ZIFT) asks how it differs from in vitro fertilization (IVF). Which information about ZIFT is most important for the nurse to include? A. During ZIFT, fallopian tubes are artificially lines with material that nourishes the gamete B. During ZIFT, the fertilized egg is placed in the fallopian tube C. During ZIFT, fallopian tubes are clear with injected air D. During ZIFT, fallopian tubes is implanted with unfertilized ova and sperm

During ZIFT, the fertilized egg is placed in the fallopian tube *The ZIFT refers to the placement of the fertilized ovum into the fallopian tube at the zygote stage of development. During IVF-ET, the woman's eggs are collected from the ovary, fertilized in the laboratory, and transferred into the uterus at the embryo stage of development

The nurse is educating a patient with a premenstrual dysphoric disorder (PMDD) about potential triggers. Which nutritional change should the nurse suggest to help reduce symptoms? A. Eat whole-grain bread instead of white bread B. Drink 4 ounces of red wine once a week C. Increase red meat intake to boost iron stores D. Use sugar instead of artificial sweeteners

Eat whole-grain bread instead of white bread *Strategies of self-care of PMDD may include stress management exercises, some lifestyle changes, and maintaining a healthy diet rich in complex carbohydrates and fiber (like whole-grain breads and pastas or lentils). Alcohol, red meat, and sugar exacerbate the symptoms of PMDD

The nurse is caring for a patient with a tentative diagnosis of polycystic ovarian syndrome (PCOS). When reviewing the patient's health history, which finding supports this diagnosis? A. Cold intolerance B. Significant weight loss C. Menstrual periods every 33 days D. Elevated serum glucose levels

Elevated serum glucose levels *PCOS is a congenital condition in which many cysts develop on one of both ovaries and prodcue excess estrogen. High levels of testosterione and luteinizing hormone (LH) and low levels of follicle-stimulating hormone (FSH) occur. A manifestation of PCOS includes problems with gluxose tolerance, which would result in elevated serum glucose levels. Other signs and symptoms include excessive body hair (hirsutism), irregular menstruation, and infertility. Cold intolerance could be indicatie of hypothryoidism, anemia, Raynaud syndrome, or other underlying medical issues

The nurse is caring for a patient after a radical mastectomy. Which instruction will be most important for preventing lymphedema? A. Restricting movement of the affected arm B. Elevating the affected arm, on pillows, above the level of the heart C. Applying moist heat to the affected arm around the clock D. Holding the arm close to the body by using a sling

Elevating the affected arm, on pillows, above the level of the heart *Lymphedema is swelling of the arm that sometimes occurs after breast cancer surgery as a result of the damage to, and resulting congestion of, the lymphatic tract. Elevation of the arm will reduce swelling. Restricting movement of the arm and applying moist heat will increase edema.

The nurse is caring for a female patient who reports using an estrogen cream as a lubricant for sexual intercourse. The nurse should caution a patient about which potential negative effect? A. Estrogen cream may damage latex condoms B. Estrogen cream may exacerbate hot flashes C. Estrogen cream may decrease elasticity of vaginal tissue D. Estrogen cream may cause contact dermatitis for sexual partners

Estrogen cream may damage latex condoms *Using estrogen cream as a lubricant for sexual intercourse is discouraged as the cream may damange latex condoms and require a backup method of contraception. Estrogen cream will not exacerbate hot flashes. Estrogen cream is used to increase vaginal tissue elasticity. While the partner can absorb estrogen from estrogen cream for sexual intercourse, contact dermatitis is not likely

A nurse in a provider's office is reviewing a client's laboratory results, which shows a positive rapid plasma regain (RPR). Which of the following tests will be administered to confirm the diagnosis of syphilis? A. Venereal Disease Research Laboratory (VDRL) B. D-dimer C. Fluorescent treponemal antibody absorbed (FTA-ABS) D. Sickledex

Fluorescent treponemal antibody absorbed (FTA-ABS) *The VDRL is another screening for syphilis *The D-dimer is a test used to measure fibrin and is used to diagnose disseminated intravascular coagulation *The FTA-ABS is used to confirm the diagnosis of syphilis *The Sickledex is used to diagnose sickle cell anemia

A patient is being treated for menorrhagia. In a follow-up appointment, which testing would be appropriate for evaluating the treatment's effectiveness? A. Electrolytes B. Ultrasound of the ovaries C. Hemoglobin and hematocrit D. CT scan of the pelvic organs

Hemoglobin and hematocrit

The nurse reviewing the patient's chart identifies which risk factor for ovarian cancer? A. Tubal sterilization B. Three term pregnancies C. Use of oral contraceptives D. History of pelvic irradiation

History of pelvic irradiation *Risk factors for the development of ovarian cancer include having a sister or mother with the disease or inheriting the BRCA1 or BRCA2 gene. Exposure to asbestos, talc powder, pelvic irradiation, or mumps has also been linked to the development of ovarian cancer. Women on hormone therapy should be informed concerning the risks for ovarian cancer. Factors that may prevent ovarian cancer include one or more term pregnancies, breast-feeding, tubal sterilization, and possibly the use of OCs.

The nurse is caring for a middle-aged woman who is not sexually active. The patient questions the nurse about the recommended frequency of Pap smears. Which response is best? A. Annual screening is recommended B. Screening is not needed for women who are not sexually active C. Screening in the woman who is not sexually active may be spaced every 5 to 7 years D. In the woman with negative screenings, the Pap test may be repeated every 3 years

In the woman with negative screenings, the Pap test may be repeated every 3 years *Women with three consecutive negative screening at age 30 should have repeated testing every 3 years until age 65, when testing of asymptomatic women is no longer necessary. American Congress of Obstetricians and Gynecologist (ACOG) recommends that cervical cancer screesning should begin at age 21 and be repeated every 2 years between ages 21 and 29 in asymptomatic women. Women with three consecutive negative screenings at age 30 should have repeated testing every 3 years until age 65 when testing of asymptomatic women is no longer necessary. Women with cervical pathology or cancer should be screened annually for 20 years after treatment

The nurse educates a patient about differences between primary infertility and secondary infertility. Which statement accurately describes primary infertility? A. Inability to maintain a pregnancy past the first trimester B. Inability to conceive after 1 year of active unprotected sex C. Inability to deliver a viable infant after two pregnancyies D. Inability to conceive after using a follicle stimulator for 1 year

Inability to conceive after 1 year of active unprotected sex *Primary infertility is defined as the inability to conceive after 1 year of active unprotected sex. Secondary infertility is the inability to conceive after having once conceived, or the inability to maintain a pregnancy long enough to deliver a viable infant

A nurse is providing support to a client who has a new diagnosis of endometriosis. The nurse should inform the client that which of the following conditions is a possible complication of endometriosis? A. Insulin resistance B. Infertility C. Vaginitis D. Pelvic inflammatory disease

Infertility *Insulin resistance is a complication of PCOS *Infertility is a complication of endometriosis because endometrial tissue overgrowth can block the fallopian tubes *Vaginitis is typically caused by an infection *PID is caused by an infection of the pelvic organs

A premenopausal woman who has a hysterectomy may have difficulty adjusting to this loss for what reason? A. She will be less active and less healthy than others her age. B. It means she will not be able to have any more children. C. She will be less sexually motivated. D. She may be disfigured.

It means she will not be able to have any more children. *The removal of the uterus represents the loss of fertility. She will not necessarily be less sexually motivated, healthy, or active; she will not be disfigured.

The patient complains to the nurse about a sharp pain in the lower quadrants every month at mid-cycle that lasts for several hours. This description is consistent with which underlying pathophysiological process? A. Round ligament stretching to support the uterus B. Mittelschmerz, a pain associated with ovulation C. Premenstrual uterine enlargement D. Endometrial changes

Mittelschmerz, a pain associated with ovulation *Mittelschmerz is a pain in either lower quadrant associated with ovulation. There is no stretching of the round ligaments during the mid-cycle peroids. Premenstrual ueterine changes do not produce discomfort

The community health nurse is providing education to a group of young women on cervical cancer, which is highly responsive to treatment if diagnosed early. The nurse should be sure to include information on which known risk factor for cervical cancer? A. Commencement of sexual activity late in life B. Multiple sexual partners C. Early-onset menses D. Family history

Multiple sexual partners *Having multiple sexual partners appears to increase the risk of developing cervical cancer. Evidence suggests that late onset of sexual activity may reduce risk of some diseases, including cervical cancer. Family history of cervical cancer and early-onset menses are not associated with an increased risk for cervical cancer.

The nurse is caring for an adolescent girl with primary dysmenorrhea. The girl's mother reports that her daughter has been absent from school at least 1 day during her last four periods. She anticipates that the health care provider will likely prescribe which treatment? A. Aromatherapy B. Dietary modification C. Effleurage D. Oral contraceptive Seasonale

Oral contraceptive Seasonale *Seasonale is a popular oral contraceptive that provides delayed menstruation Since this patient is accruing multiple short-term school absences over a periods of months, Seasonale would provide longer periods of pain-free amenorrhea by allowing only four menstrual periods per year. Aromatherapy, dietary modification, and effleurage may also help relieve discomfort when present but extend pain-free intervals

A nurse is a provider's office is reviewing the medical record of a client who has fibrocystic breast condition. Which of the following findings should the nurse expect? A. Palpable rubberlike lump in the upper outer quadrant B. BRCA1 gene mutation C. Elevated CA-125 D. Peau d'orange dimpling of the breast

Palpable rubberlike lump in the upper outer quadrant *Clients who have fibrocystic breast condition typically have breast pain and rubbery palpable lumps in the upper outer quadrant of the breasts *BRCA1 gene mutation is a risk factor for breast cancer *An elevated CA-125 is finding associated with ovarian cancer *Peau d'orange dimpling of the breast is a finding associated with breast cancer

The nurse is caring for a patient taking long-term estrogen replacement for osteoporosis prevention. The nurse recommends that the patient undergo which type of examination annually? A. Pelvic examination B. Bone density study C. Liver scan D. Lower GI study

Pelvic examination *Estrogen therapy increases the incidence of endometrial cancer and breast cancer. An annual pelvic examination is recommended, as well as montly breast self-examinations (BSE)

Caused by release of high levels of prostaglandins

Primary dysmenorrhea

Occurs within first menstruation past menarche

Primary dysmenorrhea

Uterine contraction causing cramps

Primary dysmenorrhea

How does the body benefit from the normal acidic pH of the vaginal vault? A. Supported vaginal muscle tone B. Vaginal lubrication C. A hostile environment to sperm D. Protection against infection

Protection against infection *The acidic pH of the vagina, provided by lactic acid, is a defense against infection. The low pH is a hostile environment for pathogens. Muscle tone in the vagina is not affected by the pH level. The vagina is not a hostile environment to the sperm

Caused by uterine polyps

Secondary dysmenorrhea

Lower abdomen pain progressing to back and thighs

Secondary dysmenorrhea

Pain lasts throughout menstrual flow

Secondary dysmenorrhea

A nurse in a clinic is reviewing the facility's testing process and procedures for human immune deficiency virus (HIV) with a new employee. Which of the following information should the nurse include? A. In the presence of HIV, the enzyme immunoassay (EIA) test is typically reactive within 72 hr after the client is infected B. The Western blot assay is used to confirm diagnosis of HIV C. The polymerase chain reaction (PR) test is used to confirm diagnosis of HIV D. CD4+ cell counts will be elevated in a client who is infected with HIV

The Western blot assay is used to confirm diagnosis of HIV *The EIA test is typically reactive 3 weeks to 3 months after the infection occurs, but it can be delayed for as long as 36 months *Confirming HIV is a 2-step process. If the EIA is positive, a second test (the western blot assay) is done *The PRC test is used to confirm the diagnosis of genital herpes *The EIA test is typically reactive 3 weeks to 3 months after the infection occurs, but it can be delayed for as long as 36 months

When does premenstrual syndrome (PMS) occur? A. The follicular phase of the ovarian cycle B. The luteal phase of the ovarian cycle C. The dismantling stage of the menstrual cycle D. The proliferative stage of the stage of the menstural cycle

The luteal phase of the ovarian cycle *PMS occur during a luteal stage, which lasts from day 15 to day 28 of a 28 day cycle. The uterus prepares to receive a fertilized ovum during this phase. The follicular phase includes the first 14 days of a 28 day cycle. During the proliferative stage of the menstrual cycle, the follicle grows and the egg matures

Breast cancer that is HER2-positive has shown to be responsive to which adjuvant therapy? A. Medroxyprogesterone acetate (Depro-Provera) B. Trastuzumab (Herceptin) C. Alendronic acid (Fosamax) D. Ethinyl estradiol

Trastuzumab (Herceptin)

During a family planning session, a young couple confides that they are hoping to conceive. Which action should the nurse suggest to potentially enhave conception? A. Relax together in a sauna or hot tub B. Stimulate the scrotum with a vibrator C. Increased time spent in foreplay D. Use water-soluble lubricant

Use water-soluble lubricant *water soluble lubricant has no spermicidal properties as compared to other lubricants that may damange spern and decrease chances of coneption. Heat to the scrotum depresses spermatogenesis and could decrease chance of conception. Foreplay and vibrators do not increase spermatogenesus and will not increase the chances of conception

The nurse in the clinic is examining a patient with a vaginal infection. What symptom is indicative of yeast infection? A. Vaginal itching B. Thin, gray discharge C. Vaginal pH above 4.6 D. Fishy odor

Vaginal itching *The most prominent, severe symptom of a yeast infection is itching. When colonization is heavy, discharge may be thick and white with a cottage cheese texture. Bacterial vaginosis may be accompanied by a fishy odor (most noticeable after intercourse), a thin, gray, frothy discharge; and a vaginal pH above 4.6.

Pelvic relaxation syndrome may lead to A. abdominal pain B. cervical dysplasia C. metrorrhagia D. a cystocele

a cystocele

In an elderly woman, vaginal bleeding is a possible sign of A. hormone imbalance B. cervical or uterine cancer C. breast cancer D. vaginal-rectal fistula

cervical or uterine cancer

A patient presents to the clinic stating that she is having problems with heavy periods with bleeding between periods, painful bowel movements, and painful sexual intercourse. You expect her to be treated for A. an inflammation of the lower genital tract B. leiomyoma C. endometriosis D. menorrhagia

endometriosis

An intrauterine medication to treat dysmenorrhea is A. an intrauterine device B. levonorgestrel-releasing system C. mefenamic acid D. COX-2 inhibitor

levonorgestrel-releasing system

A nurse is reviewing the medical record of a client who has a cystocele. Which of the following findings should the nurse identify as a risk factor for the development of this disorder? A. BMI of 18 B. Nulliparity C. Chronic constipation D. Postmenopausal

postmenopausal *obesity is a risk factor for the development of a cystocele. A BMI of 18 indicates the client is underweight *Multiparity is a risk factor for the development of a cystocele not nulliparity *Constipation is a risk factor for the development of a rectocele *The advancing age and loss of estrogen that correlate with postmenopausal status are risk factors for the development of a cystocele

Motrin, Anaprox, and Advil are examples of drugs used for dysmenorrhea because they inhibt A. the transmission of pain along nerve pathways B. Salt and water retention C. smooth muscle spasm in the uterus D. production of prostaglandins

production of prostaglandins

Two measures that have been found to decrease the discomfort of fibrocystic breast changes are A. taking vitamin C and getting sufficient exercise B. decreasing fat and protein in the diet C. controlled weight loss and wearing a support bra D. taking vitamin E and decreasing caffeine intake

taking vitamin E and decreasing caffeine intake

Measures that may decrease the discomfort of dysmenorrhea include A. doing aerobic exercises when the discomfort first starts B. avoiding foods such as asparagus and watermelon C. using a heating pad and doing pelvic rock exercises D. avoiding use of tampons and douching

using a heating pad and doing pelvic rock exercises