NUR 300 WI Maternity & Women’s Health Care 12th Edition (2019/2020) - Chapter 6 – Central Michigan University | Reproductive System Concerns

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NUR 300 WI Maternity & Women’s Health Care 12th Edition - Chapter 6 – Central Michigan University Chapter 6: Reproductive System Concerns MULTIPLE CHOICE 1. Which condition is the least... likely cause of amenorrhea in a 17yearold client? a. Anatomic abnormalities b. Type 1 diabetes mellitus c. Obesity d. Pregnancy A moderately obese adolescent (20% to 30% above ideal weight) may have early onset menstruation. Girls who regularly exercise before menarche can have delayed onset of menstruation to age 18 years. Anatomic abnormalities are a possible cause of amenorrhea. Type 1 diabetes mellitus is a possible cause of amenorrhea. Pregnancy is the most common cause of amenorrhea. DIF: Cognitive Level: Remember REF: IMS: 121 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 2. When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention might be recommended? a. Increasing the intake of red meat to replace blood loss b. Reducing the intake of diuretic foods, such as peaches and asparagus c. Temporarily substituting physical activity for a sedentary lifestyle d. Using a heating pad on the abdomen to relieve cramping Heat minimizes cramping by increasing vasodilation and muscle relaxation and minimizing uterine ischemia. Dietary changes such as a lowfat vegetarian diet may be recommended for women experiencing dysmenorrhea. Increasing the intake of diuretics, including natural diuretics such as asparagus, cranberry juice, peaches, parsley, and watermelon, may help ease the symptoms associated with dysmenorrhea. Exercise has been found to help relieve menstrual discomfort through increased vasodilation and subsequent decreased ischemia. DIF: Cognitive Level: Analyze REF: pp. 122-123 TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity 3. Nafarelin (Synarel) is used to treat mildtosevere endometriosis. What instruction or information should the nurse provide to a client regarding nafarelin administration? a. Nafarelin stimulates the secretion of gonadotropin-releasing hormone (GnRH), thereby stimulating ovarian activity. b. It should be administered by intramuscular (IM) injection. c. Nafarelin should be administered by a subcutaneous implant. d. It can cause the client to experience some hot flashes and vaginal dryness. Nafarelin is a GnRH agonist, and its side effects are similar to those of menopause. The hypoestrogenism effect results in hot flashes and vaginal dryness. Nafarelin is a GnRH agonist that suppresses the secretion of GnRH. Nafarelin is administered twice daily by nasal spray and can be intranasally administered. Leuprolide is given once per month by IM injection. Goserelin is administered by subcutaneous implant. DIF: Cognitive Level: Apply REF: IMS: 127 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 4. While interviewing a 31-year-old woman before her routine gynecologic examination, the nurse collects data about the clients recent menstrual cycles. Which statement by the client should prompt the nurse to collect further information? a. My menstrual flow lasts 5 to 6 days. b. My flow is very heavy. c. I have had a small amount of spotting midway between my periods for the past 2 months. d. The length of my menstrual cycles varies from 26 to 29 days. Menorrhagia is defined as excessive menstrual bleeding, either in duration or in amount. Heavy bleeding can have many causes. The amount of bleeding and its effect on daily activities should be evaluated. A menstrual flow that lasts 5 to 6 days is a normal finding. Mittlestaining, a small amount of bleeding or spotting that occurs at the time of ovulation (14 days before the onset of the next menses), is considered normal. During her reproductive years, a woman may have physiologic variations in her menstrual cycle. Variations in the length of a menstrual cycle are considered normal. DIF: Cognitive Level: Understand REF: IMS: 131 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 5. A 21yearold client complains of severe pain immediately after the commencement of her menses. Which gynecologic condition is the most likely cause of this clients presenting complaint? a. Primary dysmenorrhea b. Secondary dysmenorrhea c. Dyspareunia d. Endometriosis Primary dysmenorrhea, or pain during or shortly before menstruation, has a biochemical basis and arises from the release of prostaglandins with menses. Secondary dysmenorrhea develops after the age of 25 years and is usually associated with a pelvic pathologic condition. Dyspareunia, or painful intercourse, is commonly associated with endometriosis. Endometriosis is characterized by endometrial glands and stoma outside of the uterus. DIF: Cognitive Level: Remember REF: IMS: 122 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 6. Which symptom described by a client is characteristic of premenstrual syndrome (PMS)? a. I feel irritable and moody a week before my period is supposed to start. b. I have lower abdominal pain beginning on the third day of my menstrual period. c. I have nausea and headaches after my period starts, and they last 2 to 3 days. d. I have abdominal bloating and breast pain after a couple days of my period. PMS is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses. Complaints of lower abdominal pain, nausea and headaches, and abdominal bloating all are associated with PMS; however, the timing reflected is inaccurate. DIF: Cognitive Level: Apply REF: IMS: 125 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 7. A client complains of severe abdominal and pelvic pain around the time of menstruation. This pain has become progressively worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to become pregnant for the past 18 months. To which condition are these symptoms most likely related? a. Endometriosis b. PMS c. Primary dysmenorrhea d. Secondary dysmenorrhea Symptoms of endometriosis can change over time and may not reflect the extent of the disease. Major symptoms include dysmenorrhea and deep pelvic dyspareunia (painful intercourse). Impaired fertility may result from adhesions caused by endometriosis. Although endometriosis may be associated with secondary dysmenorrhea, it is not a cause of primary dysmenorrhea or PMS. In addition, this woman is complaining of dyspareunia and infertility, which are associated with endometriosis, not with PMS or primary or secondary dysmenorrhea. DIF: Cognitive Level: Understand REF: pp. 126-127 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance - - - - - - - - - - - - - -- 16. Which statement related to the condition of endometriosis is most accurate? a. Endometriosis is characterized by the presence and growth of endometrial tissue inside the uterus. b. It is found more often in African-American women than in Caucasian or Asian women. c. Endometriosis may worsen with repeated cycles or remain asymptomatic and disappear after menopause. d. It is unlikely to affect sexual intercourse or fertility. With endometriosis, the endometrial tissue is outside the uterus. Endometriosis is found equally in Caucasian and African-American women and is slightly more prevalent in Asian women. Symptoms vary among women, ranging from nonexistent to incapacitating. The condition is seven times more prevalent in women who have a firstdegree relative with endometriosis. Women can experience painful intercourse and impaired fertility with endometriosis. DIF: Cognitive Level: Understand REF: pp. 126-127 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 17. Which alteration in cyclic bleeding best describes bleeding that occurs at any time other than menses? a. Oligomenorrhea b. Menorrhagia c. Leiomyoma d. Metrorrhagia Metrorrhagia (intermenstrual bleeding) refers to any episode or degree of bleeding that occurs between periods. It may be caused by contraceptives that contain progesterone or by intrauterine devices (IUDs).Oligomenorrhea is infrequent or scanty menstruation. Menorrhagia is excessive menstruation. Leiomyoma is a common cause of excessive bleeding. DIF: Cognitive Level: Remember REF: IMS: 129 TOP: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity 18. Management of primary dysmenorrhea often requires a multifaceted approach. Which pharmacologic therapy provides optimal pain relief for this condition? a. Acetaminophen b. Oral contraceptive pills (OCPs) c. Nonsteroidal antiinflammatory drugs (NSAIDs) d. Aspirin NSAIDs have the strongest research results for pain relief. If one NSAID is not effective, then another one may provide relief. Approximately 80% of women find relief from these prostaglandin inhibitors. Preparations containing acetaminophen are less effective for dysmenorrhea because they lack the antiprostaglandin properties of NSAIDs. OCPs are a reasonable choice for women who also want birth control. The benefit of OCPs is the reduction of menstrual flow and irregularities. OCPs may be contraindicated for some women and have a number of potential side effects. NSAIDs are the drug of choice. However, if a woman is taking an NSAID, she should avoid taking aspirin as well. DIF: Cognitive Level: Apply REF: IMS: 123 TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity [Show More]

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