Menstrual Dysfunction

The nurse is teaching the client about endometriosis. Which client statement indicates that the teaching was effective? A) "Endometrial implants grow outside of my uterus and respond to hormones like my uterine lining does." B) "Endometriosis is caused by reproductive organs that did not grow correctly." C) "Endometriosis will go away completely if I take combined oral contraceptives." D) "The pain that occurs with endometriosis occurs at the end of the menstrual cycle."

A) "Endometrial implants grow outside of my uterus and respond to hormones like my uterine lining does." Rationale: Endometrial implants grow outside of the uterus and respond to hormones like the endometrial lining. Endometriosis can be controlled with oral​ contraceptives, but it does not cure the disorder. Malformation of reproductive organs does not cause endometriosis. The pain that occurs with endometriosis can occur at any time in the menstrual cycle.

A client reports to the clinic with concerns of increased vaginal bleeding (not vaginal breathing, Lisa hahaha!) with menses, pallor, and fatigue. The nurse should suspect that the client is experiencing which disorder? A) Anemia B) Hypovolemic shock C) Endometriosis D) Dysmenorrhea

A) Anemia Rationale: Symptoms of pallor and fatigue are consistent with anemia due to increased vaginal bleeding. Dysmenorrhea is painful menstruation. Endometriosis is a disorder by which endometrial implants are outside of the uterus and cause pelvic pain. Hypovolemic shock would have symptoms of​ pallor, tachycardia, decreased urine​ output, and hypotension.

______________ is the absence of menstruation by age 14 without having undergone other changes associated with puberty or by age 15 with having undergone normal physical changes of puberty. A) Primary amenorrhea B) Oligomenorrhea C) Secondary amenorrhea D) Metrorrhagia

A) Primary amenorrhea Rationale: Primary amenorrhea is the absence of menstruation by age 14 without having undergone other changes associated with puberty or by age 15 with having undergone normal physical changes of puberty. Secondary amenorrhea occurs when a previously menstruating woman does not spot or bleed for a period of time that is three times that of her normal cycle length. Oligomenorrhea is light or infrequent menstruation and occurs when cycles are longer than 6-7 weeks. Metrorrhagia is bleeding of variable amount between menstrual periods.

A client is experiencing dysmenorrhea. Which intervention should the nurse encourage the client to use that may provide some relief? A) Utilize a heating pad on the abdomen B) Iron supplementation C) Decreasing fluid intake D) Measuring intake and output

A) Utilize a heating pad on the abdomen Rationale: The use of heat on the lower abdomen can help with the discomfort. Fluids should be​ increased, not decreased. Iron supplementation and monitoring intake and output would be warranted with​ metrorrhagia, due to the increased bleeding. In​ addition, these interventions would not help relieve pain.

The nurse is assessing the sexual health of a 20yo female client. Which of the following findings should the nurse identify as risk factors for dysfunctional uterine bleeding? SATA A) High level of stress B) Weight gain of 20 pounds in 2 months C) Use of birth control pills for contraception D) History of peptic ulcer disease E) Limited intake of high-fat foods

A, B, C Rationale: A number of factors may predispose a woman to dysfunctional uterine bleeding. These factors include stress, extreme weight changes, and use of hormonal birth control. Dysfunctional uterine bleeding is usually related to hormonal imbalances and not associated with peptic ulcer disease or low-fat diets.

*Possible exam question* The nurse is teaching a client about foods high in iron that should be consumed to diagnosis of anemia. Which food should the nurse encourage the client to eat? SATA A) Liver B) Shrimp C) Eggs D) Cottage cheese E) Yogurt

A, B, C - Liver - Shrimp - Eggs Rationale: The client should maintain a balanced​ diet, and increase​ iron-rich foods such as​ eggs, beans,​ liver, beef, and shrimp. Inform the woman that although orange juice may improve the absorption of​ iron, foods high in calcium and oxalic​ acid, such as​ spinach, may reduce its absorption. Yogurt and cottage cheese are higher in calcium rather than iron.

The nurse is providing care to a client experiencing dysfunctional uterine bleeding and dysmenorrhea. Which test does the nurse anticipate will be conducted to determine a hormonal imbalance, pathologic condition, or structural anomaly that could be causing the client's clinical manifestations? SATA

A, B, C, D Rationale: A colposcopy is used to inspect the cervix and help determine areas for biopsy. FSH and LH levels are used to help correlate the luteal phase of the menstrual cycle. The Pap test is used to diagnose cervical cancer and dysplasia. Progesterone and estradiol levels are used to assess ovarian function. Hysteroscopy is used to inspect the endometrial lining. Hysterectomy would not be used as a diagnostic test.

The nurse is caring for a client with a diagnosis of shock secondary to bleeding following a hysterectomy. Which intervention should the nurse anticipate for this client? SATA A) Administration of IV estrogen B) Administration of blood products C) Restriction of fluid intake D) Administration of morphine E) Administration of oxygen

A, B, E Rationale: Administration of​ oxygen, intravenous​ estrogen, and blood products would be warranted for a diagnosis of shock due to uterine bleeding. Increasing fluid intake as​ tolerated, rather than decreasing fluid​ intake, would be indicated. Morphine is used to treat​ pain, not shock.

Which diagnostic test is used to recognize structural abnormalities that may cause menstrual disorders? SATA A) Ultrasound B) Pap test C) Pelvic exam D) Colonoscopy E) Bronchoscopy

A, C - Ultrasound - Pelvic exam Rationale: Diagnostic tests used to recognize structural abnormalities with menstrual disorders include ultrasounds and pelvic examinations. A Pap test would identify pathological conditions. A colonoscopy is used to diagnose bowel disorders. A bronchoscopy is used to diagnose lung disorders.

The nurse is caring for a client after hysterectomy. Which clinical manifestation of shock related to uterine bleeding should the nurse assess? SATA A) Tachypnea B) Rapid capillary refill C) Hypotension D) Increased urine output E) Tachycardia

A, C, E Rationale: Tachypnea,​ tachycardia, and hypotension are all related to shock due to uterine​ bleeding, and the nurse must use the nursing process of assessing and evaluating to determine the necessary steps to be taken. One would expect​ delayed, not​ rapid, capillary refill for the client in shock. Decreased urine output rather than increased urine output would also be expected.

In what way does menometrorrhagia differ from menorrhagia? A) Menometrorrhagia involves excessive menstruation, whereas menorrhagia does not. B) Menometrorrhagia involves irregular menstruation, whereas menorrhagia does not. C) Menometrorrhagia involves prolonged menstruation, whereas menorrhagia does not. D) Menometrorrhagia involves the absence of menstruation, whereas menorrhagia does not.

B) Menometrorrhagia involves irregular menstruation, whereas menorrhagia does not Rationale: Menorrhagia is excessive or prolonged menstruation that occurs at regular intervals. Menometrorrhagia is irregular, excessive, prolonged menstruation. It is essentially a combination of the heavy bleeding of menorrhagia and the irregularity of metrorrhagia.

Which of the following statements is true regarding the etiology and pathophysiology of primary dysmenorrhea? A) Primary dysmenorrhea is caused by decreased levels of prostaglandins, which cause uterine contractions to increase in strength. B) Primary dysmenorrhea begins within the first three or four menstrual periods after menarche and will occur with each ovulatory cycle during a woman's teens and twenties C) Secondary dysmenorrhea is more common than primary dysmenorrhea D) Causes of primary dysmenorrhea include endometriosis, tumors, cysts, pelvic adhesions, pelvic inflammatory disease, infections, cervical stenosis, uterine leiomyomas, and adenomyosis

B) Primary dysmenorrhea begins within the first three or four menstrual periods after menarche and will occur with each ovulatory cycle during a woman's teens and twenties Rationale: Pain associated with menses, called dysmenorrhea, is one of the most common menstrual dysfunctions. Primary dysmenorrhea is common among women with normal menstrual function and is more common than secondary dysmenorrhea. Primary dysmenorrhea is caused by the release of prostaglandins that cause the contractions of the uterus needed to expel menstrual fluid and tissue. Primary dysmenorrhea begins within the first three or four menstrual periods after menarche and will occur with each ovulatory cycle during a woman's teens and twenties. Secondary dysmenorrhea is related to pathology or diseases that affect the uterus and pelvic area. Causes of secondary dysmenorrhea include endometriosis, tumors, cysts, pelvic adhesions, pelvic inflammatory disease, infections, cervical stenosis, uterine leiomyomas, and adenomyosis.

A client diagnosed with dysmenorrhea reports that medications are ineffective to treat the pain. The client is asking about alternative therapies to manage acute pain. Which nonpharmacologic treatment should the nurse recommend? SATA A) Core strength training B) Guided imagery C) Biofeedback D) Relaxation E) Increased exercise regimen

B, C, D Rationale: Biofeedback,​ relaxation, and guided imagery are useful to treat dysmenorrhea. Increasing exercise or core strength training would not be recommended during episodes of dysmenorrhea with acute​ pain, and the client would be encouraged to rest.

*Possible Exam Question* Which of the following interventions should the nurse recommend to a client who is experiencing primary dysmenorrhea? SATA A) Increase caffeine intake B) Use a heating pad C) Try relaxation techniques D) Engage in regular exercise E) Avoid vitamin supplements

B, C, D Rationale: Regular aerobic activity helps decrease dysmenorrhea symptoms. Caffeine intake should be restricted to reduce irritability. Relaxation techniques may be useful because they promote the release of pain-relieving endorphins. Vitamin supplements should not be avoided and may be needed to help control symptoms. A heating pad can help reduce abdominal cramping and pain.

The nurse is presenting material about secondary dysmenorrhea to a group of young women. Which information should be included in the presentation? SATA A) Pain is always on the first day of menses and radiates to the groin B) It can be associated with several disorders including tumors, adhesions, and infections. C) It is considered to be one of the most painful gynecologic disorders D) Dysmenorrhea generally affects women aged 30-50 E) The pain diminishes with time and is often much less after childbirth

B, C, D Rationale: Secondary dysmenorrhea is common in women aged 30-​50, and is often associated with disorders affecting the reproductive​ organs, such as endometriosis. The pain can occur anytime during the menstrual​ cycle, not just the first​ day, nor does it diminish over time.

The nurse is caring for a young client who reports that she has painful periods. Which assessment findings suggest that this client is experiencing primary dysmenorrhea? SATA A) Bleeding between menstrual periods B) Headache C) Fatigue D) Diarrhea E) Scant menses

B, C, D - Headache - Fatigue - Diarrhea Rationale: Manifestations of primary dysmenorrhea include headache, diarrhea, fatigue, vomiting, breast tenderness, and pain radiating to the lower back and thighs. Scant menses is a symptom of hormone imbalance. Bleeding between menstrual periods is characteristic of metrorrhagia.

A nurse is reviewing information about the dysfunctional uterine bleeding with a client. Which important aspect of client teaching should the nurse include? SATA A) Avoiding foods such as eggs, beans, beef, and shrimp B) The importance of adequate fluid intake C) The importance of eating foods rich in iron D) Stress reduction and relaxation strategies E) Self-care interventions to minimize the clinical manifestations

B, C, D, E Rationale: Iron-rich foods are encouraged to stave off anemia from abnormal bleeding.​ Eggs, beans,​ beef, and shrimp are foods that are rich in​ iron; therefore, the client should not avoid them.​ Hydration, self-care to minimize clinical​ manifestations, and stress reduction strategies are all appropriate interventions. Clients will be better able to cope with abnormal uterine​ bleeding, both​ long-term and on a​ day-to-day basis, if they understand the disorder and possible interventions.

* Possible exam question* The nurse is providing teaching abut treatment of dysmenorrhea. Which therapy is known to be helpful in the treatment of this condition? SATA A) Fish oil with vitamin B12 B) Combined oral contraceptives (COCs) C) Vitamin E and thiamine D) Paroxetine E) SSRIs

B, C, D, E Rationale: While fish oil with vitamin B12 is thought to relieve​ dysmenorrhea, its effectiveness has not been conclusively proven. Vitamin E along with thiamine can be used to treat dysmenorrhea. COCs may be used to relieve cramping and suppress ovulation. Other pharmacologic therapies used to treat dysmenorrhea include​ SSRIs, such as fluoxetine​ (Prozac), sertraline​ (Zoloft), and paroxetine​ (Paxil, Brisdelle), to manage mood or to help clients cope with chronic pelvic pain.

The nurse is working with a client who experiences severe premenstrual syndrome. Which of the following interventions should the nurse suggest to assist the client in coping with this disorder? A) "Take frequent rest periods." B) "Consider drinking 4oz of wine/day." C) "Be sure to exercise and use relaxation techniques on a regular basis." D) "Avoid contraception during menstruation when engaging in sexual intercourse."

C) "Be sure to exercise and use relaxation techniques on a regular basis." Rationale: Interventions to promote effective coping in a client with severe premenstrual syndrome include encouraging exercise and use of relaxation techniques. Alcohol intake should be avoided, so the client should not be encouraged to have 4 ounces of wine each day. The client should be instructed to use contraception if engaging in sexual intercourse during menstruation because ovulation and pregnancy can occur. Frequent rest periods would be beneficial for a client with dysfunctional uterine bleeding but not a client with premenstrual syndrome.

A young adolescent client is concerned about experiencing severe cramps with menstruation. She tells the nurse, "I don't like the pain, and I'm also worried the cramps mean there is something wrong with me." How should the nurse respond to this client? A) "Menstrual cramping is not normal but is something that can be treated." B) "You have cramps because you started your periods too early." C) "Cramps are common in young women who just started having their periods, but they can be managed and often become less severe over time." D) "You need to see a gynecologist for a pelvic examination."

C) "Cramps are common in young women who just started having their periods, but they can be managed and often become less severe over time." Rationale: Primary dysmenorrhea occurs without specific pelvic pathology and is most often seen in girls who have just begun menstruating, usually becoming less severe after a woman's mid-20s. The client is an early adolescent, so she is in the normal age range to start having periods. Cramps are common in this age range, so the client does not need to see a gynecologist for a pelvic examination. However, the client would benefit from teaching about how to reduce and manage her menstrual pain.

A client presents to the clinic with postmenopausal bleeding. The nurse prepares the client for an endometrial biopsy. The client asks the nurse why this procedure is necessary. Which is the best response by the nurse? A) "the biopsy allows for injectable medications to be injected directly into the uterine wall." B) "The biopsy will determine what hormones can be used to treat it." C) "The biopsy will help rule out cancer or polyps as a source of bleeding." D) "The biopsy removes the endometrial lining to stop the bleeding."

C) "The biopsy will help rule out cancer or polyps as a source of bleeding." Rationale: Postmenopausal bleeding may be caused by endometrial​ polyps, endometrial​ hyperplasia, or uterine cancer. The possibility of cancer makes early evaluation and treatment essential. The purpose of the biopsy is not to determine hormonal treatment. Removal of the endometrial lining would be completed via a dilatation and curettage. Injectable medications are not injected into the uterine wall through endometrial biopsy. The biopsy is performed as a diagnostic test.

The nurse is teaching a client self-care measures to cope with pain related to dysmenorrhea. The inclusion of which pain-relief measure should indicate to the nurse that further teaching is required? A) Use of NSAIDs B) Exercise C) Application of cold packs D) Relaxation techniques

C) Application of cold packs Rationale: The application of​ heat, not​ cold, relieves muscle spasms and dilates blood​ vessels, increasing blood supply to the pelvis and uterine muscles. Relaxation​ techniques-such as breathing​ exercises, imagery​ techniques, or​ meditation-and exercise aid the release of naturally produced pain relievers called endorphins. Nonsteroidal​ anti-inflammatory drugs​ (NSAIDs) help relieve cramping.

A client presents to the clinic with bloating and swelling during the menstrual cycle. Which medication might be prescribed for the bloating associated with the menstrual cycle? A) NSAIDs B) Oral iron supplements C) Diuretic medications D) Combined oral contraceptives (COCs)

C) Diuretic medications Rationale: Bloating associated with the menstrual cycle may be treated with diuretics. Oral iron supplements may be used to treat anemia associated with heavy menstrual periods. COCs can be used to treat secondary dysmenorrhea or abnormal uterine bleeding. NSAIDs can be used to treat cramping.

The nurse is developing strategies for the relief of menstrual cramping to teach a group of young women. What should be the focus of these strategies? A) Minimization of menstrual flow B) Avoidance of uterine contraction C) Increase of blood flow to the uterine muscle D) Decrease in estrogen production

C) Increase of blood flow to the uterine muscle

A nurse is preparing to teach a group of young women about strategies for the relief of menstrual cramping. What should be the focus of these strategies? A) Minimizing menstrual flow B) Avoiding uterine contraction C) Increasing blood flow to the uterine muscle D) Decreasing estrogen production

C) Increasing blood flow to the uterine muscle Rationale: Menstrual cramping is a result of muscle ischemia that occurs when the client experiences powerful uterine contractions. Increasing blood flow to the uterine muscle through rest, certain exercises, application of heat to the abdomen, and presence of milder uterine contractions (such as those associated with orgasm) can decrease pain and cramping. There is no connection between pain and the actual amount of menstrual flow. Estrogen production should follow normal patterns and should not be altered.

The nurse is assessing a client with a diagnosis of primary dysmenorrhea. Which condition should the nurse recognize as a cause of primary dysmenorrhea? A) Pelvic adhesions B) Endometriosis C) Release of prostaglandins D) Infections

C) Release of prostaglandins Rationale: Release of prostaglandins and other inflammatory mediators is the cause of primary dysmenorrhea.​ Infections, pelvic​ adhesions, and endometriosis are causes of secondary amenorrhea.

A client returns to the clinic for secondary amenorrhea. The current medication regimen includes combined oral contraceptives. The client reports mood swings and inability to cope with the chronic pain. Which type of medication may be added to her medication regimen? A) Hormone replacement therapy (HRT) B) Diuretic C) SSRI D) Oral iron supplement

C) SSRI Rationale: Selective serotonin reuptake inhibitors​ (SSRIs) manage mood and help deal with chronic pelvic pain. HRT is not a treatment for the chronic pain and mood swings associated with amenorrhea. Diuretics are used to treat​ bloating, not pain and mood swings. Oral iron supplements are prescribed to replace iron lost through menstrual​ bleeding, which would not be the case with a client experiencing amenorrhea.

The nurse is conducting a health history on a client who believes that she may have endometriosis. Which finding in the client's health history supports this diagnosis? SATA A) Menarche before age 14 B) Decreased dietary fat C) Sedentary lifestyle D) Menstrual cycle less than 27 days E) Heavy, prolonged menses

C, D, E Rationale: Risk factors for endometriosis include menstrual cycles that are less than 27​ days, heavy and prolonged​ menses, and a sedentary lifestyle. Increased dietary fat and menarche before the age of 11 would also support this diagnosis.

An adult client with endometriosis states, "I'm not sexually active, why do I need to take oral contraceptives?" Which is the most appropriate response by the nurse? A) "The healthcare provider must have misunderstood your request." B) "Increasing estrogen levels helps increase the release of follicle-stimulating hormone." C) "Lowering progesterone levels results in the shrinkage of endometrial tissue." D) "Stopping ovulation has been shown to reduce pain and reduce endometrial growths."

D) "Stopping ovulation has been shown to reduce pain and reduce endometrial growths." Rationale: Oral contraceptives are used to suppress​ ovulation, which will decrease the pain experienced with endometriosis. The healthcare provider did not misunderstand the​ client's request for treatment of endometriosis. Increasing progesterone levels will contribute to atrophy of endometrial tissue. Increasing estrogen will suppress​ follicle-stimulating hormone.

A client with a diagnosis of postmenopausal bleeding secondary to malignancy is likely to be prepared for which procedure? A) Endometrial biopsy B) Therapeutic dilation and curettage C) Endometrial ablation D) Panhysterectomy

D) Panhysterectomy Rationale: A postmenopausal woman with a diagnosis of malignancy is likely to be scheduled for a​ panhysterectomy, or total​ hysterectomy, to remove the cancerous cells. A panhysterectomy involves removal of the​ uterus, fallopian​ tubes, and ovaries. Endometrial biopsy is a diagnostic test for postmenopausal bleeding. Endometrial ablation and therapeutic dilatation and curettage are used for dysfunctional uterine bleeding.

The nurse instructs a client on ways to reduce premenstrual difficulty. Which statement on the part of the client indicates that the instruction was beneficial? A) The client states the need to increase dietary sugar intake to promote energy B) The client states that guided imagery does not help with premenstrual symptoms C) The client states the need to increase intake of simple carbohydrates D) The client states that reducing caffeine intake will help

D) The client states that reducing caffeine intake will help Rationale: The client stating that a reduction in caffeine intake will help reduce premenstrual difficulty is evidence that the instruction was beneficial. The other client statements all indicate the need for additional instruction, because guided imagery can be used to reduce stress and promote relaxation and intake of simple carbohydrates and sugars should be reduced.