ob exam chapter 4
After assessing a woman who has come to the clinic, the nurse suspects that the woman is experiencing abnormal uterine bleeding. Which statement by the client would support the nurse's suspicions?
"I've been having bleeding off and on that's irregular and sometimes heavy
diaphragm usually is replaced ever
1-2 years
ACDHO stands for
A - anxiety: difficulty sleeping, tenseness, mood swings,a nd clumsiness; C - cravings: for sweets, salty foods, chocolate; D -depression: feelings of low self-esteem, anger, easily upset; H - hydration:weight gain, abdominal bloating, breast tenderness; O - other: hot flashes or cold sweats, nausea, change in bowel habits, aches or pains, dysmenorrhea, acne breakout
just know this about condoms
A new condom should be used for each sexual intercourse act. It should be kept in its wrapper until it is ready to use, applied to an erect penis and removed while the penis is still erect. There should be about 1/2 inch of empty space at the end to collect ejaculate.
A client presents at the clinic and is interested in obtaining emergency contraception (EC). The nurse explains that EC must be used within 72 hours of unprotected sex to be effective. This is because:
ECs simply prevent embryo creation and uterine implantation from occurring in the first place.
The client is interested in using an injectable contraceptive that works by suppressing pituitary secretions. The nurse provides the client with literature and discusses which contraceptive with her?
Medroxyprogesterone acetate
just know this
Other recognized causes include adenomyosis, fibroids, pelvic infection, an intrauterine device, cervical stenosis, or congenital uterine or vaginal abnormalities
5% meet the diagnostic criteria for
PMDD
woman must have at least five of the typical symptoms to be diagnosed with
PMDD
The client presents reporting irregular menstrual cycles, bleeding between periods, mood swings, hot flashes and vaginal tenderness. After an examination, the nurse suspects abnormal uterine bleeding. Which approach would be inappropriate?
Tell the client to learn to live with it.
contraceptives increase ?
They are also associated with an increased risk for breast cancer and migraine headaches.
vaginal ring involves
a 3-week period of continuous use followed by aring-free week to allow withdrawal bleeding. The ring is compressed and inserted into the vagina, as far back as possible, but precise placement is not critical. After 3 weeks, the ring is removed and discarded.
Dysphoria
a common report associated with premenstrual syndrome.
Norelgestromin/ethinyl estradiol
a patchtype contraceptive
A nurse is assessing a client and suspects that the client may be experiencing premenstrual dysphoric disorder (PMDD). Applying the American Psychiatric Association criteria, the nurse would most likely assess which symptoms? Select all that apply.
affective lability sleep difficulties diarrhea
The public health nurse is teaching a community class of couples on fertility awareness-based methods. The nurse determines that additional teaching is needed when one of the couples states that they will be using which method?
coitus interruptus method
Chronic pelvic pain
commonly associated with endometriosis.
A young couple is exploring their contraceptive options and are curious about using an intrauterine contraceptive device. The nurse explains that there are two types, one that uses hormones and one that uses:
copper
When assessing a client with symptoms of premenstrual syndrome (PMS), the nurse uses the ACDHO tool. The nurse questions the client about which symptom when addressing the "C" in the tool?
cravings
A nurse is working with a couple who is dealing with infertility. Which aspect would be most important for the nurse to consider?
culture
Abnormal uterine bleeding
defined as irregular, abnormal bleeding that occurs with no identifiable anatomic pathology. It is frequently associated with anovulatory cycles, which are common for the first year after menarche and later in life as a woman approaches menopause.
Pain occurring with menses refers to
dysmenorrhea
A nurse is evaluating the client to determine the possible cause of her secondary dysmenorrhea. When talking with the client, the client asks: "What would cause this condition?" When responding to the client, the nurse would integrate information about which condition as the most common etiology for secondary dysmenorrhea?
endometriosis
A nurse is reviewing the history and physical examination of a client diagnosed with secondary dysmenorrhea for possible associated causes. Which etiology would the nurse need to keep in mind as being the most common?
endometriosis
The nurse is assessing a couple who has come to the health care facility because they have been unable to conceive a child. When assessing the woman, the nurse would identify which factor as increasing the woman's risk for infertility?
endometriosis
The nurse is assessing a couple who have come to the health care facility because they have been unable to conceive a child. When assessing the woman, the nurse would identify which factor as increasing the woman's risk for infertility?
endometriosis
Risk factors for infertility include
endometriosis, age older than 27 years, tubal blockages, weight variations, hormonal imbalances, fibroids, reduced oocyte quality, chromosomal abnormalities, congenital anomalies of the cervix and uterus, immune system disorders, chronic illnesses, sexually transmitted infections, history of PID, smoking and alcohol consumption, multiple miscarriages, and psychological stress.
The nurse is planning to speak at a local community center to a group of middle-aged women about osteoporosis. Which measure would the nurse be sure to include as effective in reducing the risk for osteoporosis?
engaging in daily weight-bearing exercise
A mother presents to the clinic with her 15-year-old girl daughter complaining of amenorrhea. The girl's menarche was at age 12. Which findings might the nurse identify as indicating the cause? Select all that apply.
extreme rapid weight gain pregnancy hypothyroidism emotional distress
A nurse is preparing a presentation for a local community women's group about menopause. When describing the body system changes that occur, the nurse would include which changes? Select all that apply.
hot flashes increased abdominal fat vaginal dryness decreased bone density
Menopause may be associated with
hot flashes, increased abdominal fat, vaginal dryness, decreased bone density, dry, thinning skin, and increased waist size.
Etonogestrel
implantable form contraceptive
A client is diagnosed with endometriosis. As part of the teaching plan, the nurse is explaining the condition, including the ways that the diagnosis would be confirmed. The nurse determines that the teaching was successful when the client states that which test would confirm the diagnosis?
pelvic laproscopy
Although mood swings may be associated with dysfunctional uterine bleeding, irritability and mood swings are more commonly associated with
premenstrual syndrome.
Infertility is not only a physiologic problem but is also one that can initiate a life crisis that is experienced with
psychologic, familial, social, and cultural consequences
girl is experiencing secondary amenorrhea. Risk factors include:
recent weight gain or loss, pregnancy, excessive exercise, hypothyroidism, and emotional stress.
The nurse is developing a presentation for a group of young adult women about premenstrual syndrome. The nurse would include which possible treatment options? Select all that apply.
reduction of caffeine intake vitamin and mineral supplements diuretic therapy NSAIDs
A nurse is preparing a presentation for a client who is considering contraception. When discussing oral contraceptives, the nurse would identify which advantages? Select all that apply.
shortening of the menstrual period reduction in severe cramping reduction in risk for osteoporosis
three intrauterine contraceptives are
the copper ParaGard-TCu-380A, the levonorgestrel-releasing intrauterine system (LNG-IUS) marketed as Mirena, and another LNG-IUD marketed as Skyla
During examination of clients, the nurse will question women concerning their LMP. This indicates:
the first day of their last menstrual period.
Endometriosis
the most common cause of secondary dysmenorrhea
A couple has chosen fertility awareness as their method of contraception. The nurse explains that the unsafe period for them during the menstrual cycle would be at which time?
three days before and three days after ovulation
Methotrexate
toxic to the trophoblastic tissue.
When teaching the client how to use a contraceptive sponge, the nurse must tell the client that leaving the sponge in place longer than 30 hours may lead to:
toxic shock syndrome
A woman opts to use a diaphragm for contraception. Which instruction would be most important for the nurse to provide?
"Have your diaphragm refitted if you lose 10 pounds or more."
After teaching a woman who has chosen the vaginal ring as her method of contraception, the nurse determines that the client needs additional teaching when she makes which statement?
"I will insert a new ring at the same time and day of every week."
A nurse is teaching a couple who has chosen condoms as their means of contraception. The nurse determines that the teaching was successful when the couple makes which statements? Select all that apply.
"We will use a new condom each time we have sexual intercourse." "The penis needs to be erect before putting on the condom "We'll keep the condom in its wrapper until we're ready to use it."
sponge provides protection for up to
12 hours but should not be left in place for more than 30 hours after insertion to avoid the risk of toxic shock syndrome.
n ovum is released from the ovary
14 days before the next menstrual period.
A diaphragm should remain in place for at least
6 hours after intecourse
A nurse is reading a journal article about premenstrual syndrome (PMS) and the millions of women affected by it during their reproductive years. The nurse would expect to find approximately what percentage of women meeting the ACOG criteria for PMS?
75%
PMDD symptoms
affective liability; anxiety and tension; persistent or marked anger or irritability; depressed mood, feelings of hopelessness; difficulty concentrating; sleep difficulties; increased or decreased appetite; increased or decreased sexual desire; chronic fatigue; headache; constipation or diarrhea; or breast tenderness and swelling.
Hypothermia, bradycardia, hypotension, and reduced subcutaneous fat may be observed in women with
amenorrhea with anorexia nervosa as the contributing factor
Medroxyprogesterone acetate
an injectable form of a progesterone-only contraceptive that is given every 12 weeks. It works by suppressing ovulation and the production of FSH and LH by the pituitary gland.
Levonorgestrel/ethinyl estradio
an oral contraceptive that uses a 365-day combination dosing.
The nurse considers the contraceptive class at the college dormitory to be effective when the students understand that the effectiveness of oral contraceptives (OCs) can be decreased if they take:
antibiotics
Mifepristone
blocks the action of progesterone, which is responsible for preparing the endometrium for implantation and then maintenance of the pregnancy.
A 16-year-old girl is brought to the clinic by her mother because she has not had a menstrual period for the past 8 months. Which findings might alert the nurse to the possibility that anorexia nervosa may be contributing to the client's amenorrhea? Select all that apply.
bradycardia hypotension reduced subcutaneous fat
A woman is to receive methotrexate and misoprostol to terminate a firsttrimester pregnancy. When preparing the teaching plan for this client, the nurse understands that misoprostol works by:
causing uterine contractions to expel the uterine contents
A Pap smear would be done to rule out
cervical cancer
The nurse is providing care to a client with abnormal uterine bleeding. Treatment with medications has been unsuccessful, and surgical intervention is being considered. The nurse identifies which technique as being the last resort?
hysterectomy
To prevent osteoporosis, women should
increase their calcium and vitamin D intake. Avoiding excessive alcohol ingestion helps prevent osteoporosis. Limiting intake of cholesterol and saturated fats helps reduce the risk for cardiovascular disease, not osteoporosis
When assessing a woman with dysmenorrhea, the nurse would expect the client to report which symptom?
intermittent sharp suprapubic pain
Treatment options for PMS
lifestyle changes such as reduction in caffeine intake, a well-balanced diet with increased water intake, and limited alcohol intake. Vitamin and mineral supplements, NSAIDs, and diuretic therapy may be used. Antidepressants and antianxiety agents, not antipsychotic agents, may also be options.
Unusually long and heavy periods with prolonged bleeding reflect
menorrhagia.
Fertility awareness refers
o any natural contraceptive method that does not require hormones, pharmaceutical compounds, physical barriers, or surgery to prevent pregnancy
Secondary dysmenorrhea
painful menstruation due to pelvic or uterine pathology.
Fertility awareness-based methods (FAMs
use physical signs and symptoms that change with hormone fluctuations throughout a woman's menstrual cycle to predict a woman's fertility. Techniques used to determine fertility include the cervical mucus ovulation method, the basal body temperature method, the symptothermal method, standard day's method, and two-day method.
A contraceptive sponge, not a diaphragm, should be
wetted with water before insertion.
The client has heard of extended oral contraceptive regimens and desires more information. The nurse explains that these regimens consist of active combination pills, followed by placebo pills. How many days of active combination; placebo pills are contained in these regimens?
84; 7
ParaGard-TCu-380A
approved for 10 years of use and is nonhormonal. Its mechanism of action is based on the release of copper ions, which alone are spermicidal
