chapter 6 Flashcards
- Which condition is the least likely cause of amenorrhea in a 17-year-old client?
a. Anatomic abnormalities
b. Type 1 diabetes mellitus
c. Obesity
d. Pregnancy
ANS: C
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.
- 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
ANS: D
Heat minimizes cramping by increasing vasodilation and muscle relaxation and minimizing uterine ischemia. Dietary changes such as a low-fat 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.
- Nafarelin (Synarel) is used to treat mild-to-severe 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.
ANS: D
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.
- While interviewing a 31-year-old woman before her routine gynecologic examination, the nurse collects data about the client’s 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.”
ANS: B
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.
- A 21-year-old client complains of severe pain immediately after the commencement of her menses. Which gynecologic condition is the most likely cause of this client’s presenting complaint?
a. Primary dysmenorrhea
b. Secondary dysmenorrhea
c. Dyspareunia
d. Endometriosis
ANS: A
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.
- 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.”
ANS: A
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.
- 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
ANS: A
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.
- Which menopausal discomfort would the nurse anticipate when evaluating a woman for signs and symptoms of the climacteric?
a. Headaches
b. Hot flashes
c. Mood swings
d. Vaginal dryness with dyspareunia
ANS: B
Vasomotor instability, in the form of hot flashes or flushing, is a result of fluctuating estrogen levels and is the most common disturbance of the perimenopausal woman. Headaches may be associated with a decline in hormonal levels; however, headaches are not the most frequently reported discomfort for menopausal women. Mood swings may also be associated with a decline in hormonal levels; however, mood swings are not the most frequently reported discomfort for menopausal women. Vaginal dryness and dyspareunia may be associated with a decline in hormonal levels; however, both are not the most frequently reported discomforts for menopausal women.
- Which risk factor would the nurse recognize as being frequently associated with osteoporosis?
a. African-American race
b. Low-protein intake
c. Obesity
d. Cigarette smoking
ANS: D
Smoking is associated with earlier and greater bone loss and decreased estrogen production. Women at risk for osteoporosis are likely to be Caucasian or Asian. Inadequate calcium intake is a risk factor for osteoporosis. Women at risk for osteoporosis are likely to be small boned and thin. Obese women have higher estrogen levels as a result of the conversion of androgens in the adipose tissue. Mechanical stress from extra weight also helps preserve bone mass.
- A perimenopausal client has arrived for her annual gynecologic examination. Which preexisting condition would be extremely important for the nurse to identify during a discussion regarding the risks and benefits of hormone therapy?
a. Breast cancer
b. Vaginal and urinary tract atrophy
c. Osteoporosis
d. Arteriosclerosis
ANS: A
Women with a high risk for breast cancer should be counseled against using estrogen replacement therapy (ERT). Estrogen prevents the atrophy of vaginal and urinary tract tissue and protects against the development of osteoporosis. Estrogen also has a favorable effect on circulating lipids, reducing low-density lipoprotein (LDL) and total cholesterol levels and increasing high-density lipoprotein (HDL) levels. It also has a direct antiatherosclerotic effect on the arteries.
- Dysfunctional uterine bleeding (DUB) is defined as excessive uterine bleeding without a demonstrable cause. Which statement regarding this condition is most accurate?
a. DUB is most commonly caused by anovulation.
b. DUB most often occurs in middle age.
c. The diagnosis of DUB should be the first consideration for abnormal menstrual bleeding.
d. Steroids are the most effective medical treatment for DUB.
ANS: A
Anovulation may occur because of hypothalamic dysfunction or polycystic ovary syndrome. DUB most often occurs when the menstrual cycle is being established or when it draws to a close at menopause. A diagnosis of DUB is made only after all other causes of abnormal menstrual bleeding have been ruled out. The most effective medical treatment is oral or intravenous estrogen.
- The female athlete triad includes which common menstrual disorder?
a. Amenorrhea
b. Dysmenorrhea
c. Menorrhagia
d. Metrorrhagia
ANS: A
The interrelatedness of disordered eating, amenorrhea, and altered bone mineral density have been described as the female athlete triad. Dysmenorrhea is painful menstruation that begins 2 to 6 months after menarche. Menorrhagia is abnormally profuse or excessive bleeding from the uterus. Metrorrhagia is bleeding between periods and can be caused by progestin injections and implants.
- Which system responses would the nurse recognize as being unrelated to prostaglandin (PGF2) release?
a. Systemic responses
b. Gastrointestinal system
c. Central nervous system
d. Genitourinary system
ANS: D
Systemic responses to PGF2 include backache, weakness, and sweating. Gastrointestinal system changes include nausea, vomiting, anorexia, and diarrhea. Central nervous system changes manifest themselves as dizziness, syncope, headache, and poor concentration; they usually begin at the onset of menstruation and last 8 to 48 hours.
- Which statement concerning cyclic perimenstrual pain and discomfort (CPPD) is accurate?
a. Premenstrual dysphoric disorder (PMDD) is a milder form of PMS and more common in young women.
b. Secondary dysmenorrhea is more intense and more medically significant than primary dysmenorrhea.
c. PMS is a complex, poorly understood condition that may include any of a hundred symptoms.
d. The causes of PMS have been well established.
ANS: C
PMS may manifest itself with one or more of a hundred physical and psychologic symptoms. PDD is a more severe variant of PMS. Secondary dysmenorrhea is characterized by more muted pain than the pain reported in primary dysmenorrhea; however, the medical treatment is close to the same. The cause of PMS is unknown and may be, in fact, a collection of different problems.
- To assist a client in managing the symptoms of PMS, what should the nurse recommend based on current evidence?
a. Diet with more body-building and energy foods, such as carbohydrates
b. Herbal therapies, yoga, and massage
c. Antidepressants for symptom control
d. Discouraging the use of diuretics
ANS: B
Herbal therapies, yoga, and massage have been reported to have a beneficial effect on the symptoms of PMS. Limiting red meat, simple carbohydrates, caffeinated beverages, and alcohol improves the diet and may mitigate symptoms. Medication is usually begun only if lifestyle changes fail to provide significant relief. Natural diuretics may help reduce fluid retention.
