Reproductive Problems Flashcards
A client presents to the emergency department with severe lower abdominal pain and shoulder pain. She has a history of a missed period and light vaginal spotting. The nurse suspects an ectopic pregnancy. What is the priority nursing action?
A. Administer pain medication
B. Prepare for emergency laparoscopic surgery
C. Administer methotrexate
D. Encourage ambulation to reduce abdominal pain
A. Administer pain medication
❌ Incorrect: While pain management is important, it is not the priority in a suspected rupture. First, you must stabilize and prevent further complications.
B. Prepare for emergency laparoscopic surgery
✅ Correct: These are classic signs of a ruptured ectopic pregnancy, which is a medical emergency. Emergency surgery is required to stop internal bleeding and save the patient’s life.
C. Administer methotrexate
❌ Incorrect: Methotrexate is used for non-ruptured ectopic pregnancies in stable patients.
D. Encourage ambulation to reduce abdominal pain
❌ Incorrect: Ambulation is contraindicated in patients with potential internal bleeding; it may worsen the condition.
Which clinical sign is MOST associated with a ruptured ectopic pregnancy?
A. High fever
B. Constipation
C. Hypotension and shoulder pain
D. Increased fetal movement
A. High fever
❌ Incorrect: Fever may suggest infection, not rupture.
B. Constipation
❌ Incorrect: Not directly associated with ectopic pregnancy rupture.
C. Hypotension and shoulder pain
✅ Correct: These are classic signs of internal bleeding. Shoulder pain is due to referred pain from peritoneal irritation (Kehr’s sign).
D. Increased fetal movement
❌ Incorrect: Ectopic pregnancies typically do not progress to the point of fetal movement.
Which diagnostic test confirms the location of a pregnancy?
A. Complete blood count (CBC)
B. Urine culture
C. Transvaginal ultrasound
D. Liver function tests
A. Complete blood count (CBC)
❌ Incorrect: A CBC checks for blood loss or anemia but doesn’t locate a pregnancy.
B. Urine culture
❌ Incorrect: Used to check for urinary tract infections, not pregnancy location.
C. Transvaginal ultrasound
✅ Correct: This imaging test can identify whether the pregnancy is inside or outside the uterus.
D. Liver function tests
❌ Incorrect: These assess liver health, not pregnancy status or location.
A 16-year-old male presents with sudden onset of severe scrotal pain and nausea. The nurse suspects testicular torsion. What is the most appropriate initial action?
A. Apply warm compresses
B. Administer antibiotics
C. Notify the surgical team immediately
D. Collect a urine sample for culture
A. Apply warm compresses
❌ Incorrect: This is inappropriate and delays critical treatment. Torsion is a surgical emergency.
B. Administer antibiotics
❌ Incorrect: Antibiotics are used for infections like epididymitis, not torsion.
C. Notify the surgical team immediately
✅ Correct: Testicular torsion is a medical emergency that requires surgery within 6 hours to prevent testicular loss.
D. Collect a urine sample for culture
❌ Incorrect: Urinalysis can help rule out infection, but it delays urgent intervention.
The nurse is reviewing the TWIST scoring system for testicular torsion. Which score indicates a high risk requiring urgent surgery without ultrasound?
A. 0–2
B. 3
C. 4
D. 5
A. 0–2
❌ Incorrect: This score indicates low risk, and no imaging is required.
B. 3
❌ Incorrect: Indicates intermediate risk, ultrasound is warranted.
C. 4
❌ Incorrect: Also intermediate risk; clinical follow-up and imaging are advised.
D. 5
✅ Correct: A TWIST score of 5+ indicates high risk and 100% positive predictive value for torsion, requiring immediate surgery without further imaging.
A positive Prehn’s sign indicates testicular torsion. T/F
❌ False: A positive Prehn’s sign (pain relief when lifting the scrotum) suggests epididymitis, not torsion. Torsion usually presents with a negative Prehn’s sign.
Which of the following are signs and symptoms of an ectopic pregnancy?
A.Missed period
B.Severe diarrhea
C.Vaginal spotting
D.Abdominal pain
E.Frequent urination
F.Shoulder pain
☑ Missed period — Correct: A common early sign of pregnancy, including ectopic.
☐ Severe diarrhea — Incorrect: Not a common sign of ectopic pregnancy.
☑ Vaginal spotting — Correct: Often occurs with ectopic pregnancy.
☑ Abdominal pain — Correct: A key symptom, especially if localized.
☐ Frequent urination — Incorrect: More commonly associated with urinary tract infections or normal pregnancy.
☑ Shoulder pain — Correct: Due to referred pain from peritoneal bleeding (Kehr’s sign).
Signs of hypovolemic shock in a ruptured ectopic pregnancy may include:
Low blood pressure
Pale, cool skin
Rapid heartbeat
Increased urine output
High-grade fever
☑ Low blood pressure — Correct: From internal blood loss.
☑ Pale, cool skin — Correct: A sign of shock.
☑ Rapid heartbeat — Correct: Compensation for blood loss.
☐ Increased urine output — Incorrect: You’d expect decreased output.
☐ High-grade fever — Incorrect: Fever may indicate infection, not shock.
Methotrexate is used to treat ectopic pregnancy only if the patient is unstable and shows signs of rupture. T/F
❌ False: Methotrexate is used only when the patient is stable, the pregnancy is unruptured, and the mass is small.
Testicular torsion is most common in males over 40 years old. T/F
❌ False: It is most common in males under 20, especially during puberty.
An absent cremasteric reflex on one side may suggest testicular torsion. T/F
True: Loss of the cremasteric reflex is a classic sign of testicular torsion.
A woman with a suspected ectopic pregnancy is scheduled for a transvaginal ultrasound. Her hCG levels are positive, but no gestational sac is seen in the uterus. What does this most likely suggest?
A. She is experiencing a normal early pregnancy
B. She is likely having a urinary tract infection
C. She may have a miscarriage or ectopic pregnancy
D. She is further along in her pregnancy than expected
Answer: C
Rationale: A positive hCG without a gestational sac in the uterus suggests either an early miscarriage or an ectopic pregnancy. An intrauterine pregnancy should be visible by a certain hCG level.
What is the purpose of using methotrexate in an ectopic pregnancy?
A. To increase progesterone production
B. To dissolve the fertilized egg in a non-ruptured ectopic pregnancy
C. To stimulate ovulation
D. To reduce the size of uterine fibroids
Answer: B
Rationale: Methotrexate inhibits cell division and is used to stop the growth of the fertilized egg in an early, unruptured ectopic pregnancy.
Which symptom is LEAST likely to be associated with testicular torsion?
A. Absence of cremasteric reflex
B. Pain relief when scrotum is lifted
C. Nausea and vomiting
D. Sudden, severe scrotal pain
Answer: B
Rationale: Pain relief upon lifting the scrotum (positive Prehn’s sign) is more associated with epididymitis, not torsion. Torsion usually presents with worsening or unchanged pain.
What is the priority goal when treating testicular torsion?
A. Prevent urinary tract infection
B. Restore blood flow to the testicle
C. Monitor sperm count
D. Reduce testosterone production
Answer: B
Rationale: Testicular torsion cuts off blood flow. Prompt surgical intervention is needed to prevent necrosis and save the testicle.
Which of the following is the most appropriate reason for performing a Doppler ultrasound in a male with testicular torsion symptoms?
A. To confirm absence of WBCs in the urine
B. To assess the amount of swelling
C. To measure testicular size
D. To check for blood flow to the affected testicle
Answer: D
Rationale: Doppler ultrasound is used to assess blood flow. Absence of flow confirms torsion and urgency for surgery.
Referred shoulder pain in ectopic pregnancy is due to irritation of the phrenic nerve. T/F
Rationale: This is correct. Blood from a ruptured ectopic pregnancy irritates the diaphragm and triggers shoulder pain via the phrenic nerve.
Testicular torsion often presents with urinary symptoms and fever. T/F
False
Rationale: Urinary symptoms and fever are uncommon in torsion. These symptoms are more likely in infections such as epididymitis.
Manual detorsion is always effective and eliminates the need for surgery in testicular torsion. T/F
False
Rationale: Manual detorsion may be attempted initially, but surgery is still required to prevent recurrence and confirm proper alignment.
IVF is considered a risk factor for ectopic pregnancy. T/F
True
Rationale: Assisted reproductive techniques such as IVF can increase the risk of ectopic pregnancy.
Spermatogenesis can be impaired as early as 2 hours after the onset of testicular torsion. T/F
True
Rationale: Prolonged ischemia can impair or destroy sperm production as early as 2 hours, highlighting the urgency of treatment.
Which of the following are indications that a fallopian tube may have ruptured due to ectopic pregnancy?
A. Severe abdominal pain
B. Dizziness
C. Fainting
D. Shoulder pain
E. High fever
F. Increased bowel movements
Correct Answers: Severe abdominal pain, Dizziness or fainting, Shoulder pain
Rationale: These are signs of internal bleeding and peritoneal irritation. Fever and bowel changes are not typical rupture signs.
Which are nursing responsibilities when caring for a patient with suspected ectopic pregnancy?
A. Monitor vital signs closely
B. Prepare for emergency surgery if needed
C. Offer emotional support
D. Insert a Foley catheter immediately
E. Educate patient about potential fertility implications
Correct Answers: Monitor vital signs, Prepare for surgery, Offer support, Educate on fertility
Rationale: Vital signs indicate stability. Emotional support is crucial. Fertility may be affected. Foley catheterization is not routinely indicated.
Which of the following findings are used in the TWIST scoring system?
A. High-riding testicle
B. Nausea or vomiting
C. Absent cremasteric reflex
D. Hard testis
E. Positive Prehn’s sign
Correct Answers: High-riding testicle, Nausea/vomiting, Absent cremasteric reflex, Hard testis
Rationale: These are part of the TWIST system. Prehn’s sign is a separate diagnostic tool and is not part of the TWIST criteria.
A patient with an ectopic pregnancy is stable and has no signs of rupture. Which of the following is the most appropriate medical management?
A. Laparoscopic surgery
B. Blood transfusion
C. Methotrexate administration
D. Hysterectomy
Answer: C
Rationale: Methotrexate is used in stable patients with early, unruptured ectopic pregnancies. Surgery is reserved for rupture or unstable cases. Blood transfusion is supportive care for bleeding. Hysterectomy is not a standard treatment for ectopic pregnancy
A 19-year-old male presents to the ER with sudden onset of scrotal pain, nausea, and swelling of the left testicle. What is the most likely diagnosis?
A. Epididymitis
B. Testicular torsion
C. Varicocele
D. Inguinal hernia
Answer: B
Rationale: Sudden severe scrotal pain, swelling, and nausea are classic signs of testicular torsion, which requires immediate intervention. Epididymitis has a more gradual onset and usually involves urinary symptoms.
A nurse is evaluating a patient using the TWIST score. The patient has testicular swelling, a high-riding testis, and absent cremasteric reflex. What is the total TWIST score?
A. 3
B. 4
C. 5
D. 6
Answer: B
Rationale: Testicular swelling (2 points), high-riding testis (1 point), and absent cremasteric reflex (1 point) add up to 4 points. This falls in the intermediate risk category.
What is the purpose of an urgent orchidopexy after testicular torsion is corrected?
A. To increase sperm production
B. To reduce testicular size
C. To prevent future torsion
D. To manage infection
Answer: C
Rationale: Orchidopexy is performed to secure the testicle to the scrotum and prevent recurrence of torsion.
Which hormone is assessed using a pregnancy blood test to evaluate for ectopic pregnancy?
A. LH
B. Estrogen
C. Progesterone
D. Beta-hCG
Answer: D
Rationale: Beta-hCG is the hormone detected in serum pregnancy tests. Abnormal trends or absence of an intrauterine pregnancy on ultrasound despite rising hCG levels suggests ectopic pregnancy.
Ectopic pregnancy most commonly occurs in the cervix. T/F
False
Rationale: The vast majority of ectopic pregnancies (98%) occur in the fallopian tubes, not the cervix.
A ruptured ectopic pregnancy is considered a medical emergency. T/F
True
Rationale: Rupture can lead to severe internal bleeding and hypovolemic shock, requiring immediate surgical intervention.
In testicular torsion, the absence of the cremasteric reflex is a significant clinical sign. T/F
True
Rationale: The cremasteric reflex is usually absent on the affected side in testicular torsion due to impaired nerve function.
Methotrexate can be administered if the ectopic pregnancy has ruptured. T/F
False
Rationale: Methotrexate is only given to stable patients with an unruptured ectopic pregnancy. Rupture requires surgical treatment.
Prehn’s sign is typically negative in testicular torsion. T/F
True
Rationale: Lifting the scrotum does not relieve pain in testicular torsion, making Prehn’s sign negative.
Which clinical signs may indicate a ruptured ectopic pregnancy?
A. Severe abdominal pain
B. Low blood pressure
C. High fever
D. Dizziness or fainting
E. Pain radiating to the shoulder
Correct answers: Severe abdominal pain, Low blood pressure, Dizziness or fainting, Pain radiating to the shoulder
Rationale: These are signs of internal bleeding and hypovolemic shock. High fever is more associated with infection.
Which are included in the TWIST scoring criteria for testicular torsion?
High-riding testicle
Nausea or vomiting
Testicular swelling
White blood cells in urine
Hard testicle
Absent cremasteric reflex
Correct answers: High-riding testicle, Nausea or vomiting, Testicular swelling, Hard testicle, Absent cremasteric reflex
Rationale: These are the five TWIST criteria. WBCs in urine are not part of the scoring and suggest infection instead.
Which nursing interventions are appropriate when caring for a patient with suspected ectopic pregnancy?
Monitor vital signs for signs of shock
Prepare for transvaginal ultrasound
Insert a urinary catheter
Provide emotional support
Educate patient on future fertility risks
Correct answers: Monitor vital signs for signs of shock, Prepare for transvaginal ultrasound, Provide emotional support, Educate patient on future fertility risks
Rationale: All but urinary catheterization are typical interventions. A catheter is not routinely needed unless otherwise indicated.
A patient presents with abdominal pain, vaginal spotting, and a positive serum hCG. A transvaginal ultrasound shows no evidence of an intrauterine pregnancy. Her vitals are stable. What is the most appropriate next step?
A. Schedule the patient for an immediate laparoscopic salpingectomy
B. Repeat serum hCG levels and ultrasound in 48 hours
C. Administer broad-spectrum antibiotics
D. Advise the patient to monitor symptoms at home for 1 week
Answer: B
Rationale:
B. Correct: When the location of the pregnancy is unclear but the patient is stable, serial beta-hCG testing and repeat ultrasound help confirm whether the pregnancy is intrauterine, resolving, or ectopic.
A. Incorrect: Immediate surgery is not necessary unless the patient is unstable or there is evidence of rupture.
C. Incorrect: There’s no evidence of infection; antibiotics are not indicated at this point.
D. Incorrect: Waiting a full week without follow-up risks missing a potentially life-threatening ectopic pregnancy.
A patient is diagnosed with a tubal ectopic pregnancy. Methotrexate is being considered for treatment. Which of the following findings would contraindicate the use of methotrexate?
A. β-hCG level of 1,000 IU/L
B. Hemodynamically stable vital signs
C. Presence of fetal cardiac activity on ultrasound
D. No signs of tubal rupture on imaging
Answer: C
Rationale:
Presence of fetal cardiac activity increases the risk of treatment failure with methotrexate and is a relative contraindication.
A. Incorrect: A low β-hCG is actually favorable for methotrexate use.
B. Incorrect: Methotrexate is only used in stable patients.
D. Incorrect: Absence of rupture is one of the criteria for methotrexate use.
A male patient with sudden onset scrotal pain has a TWIST score of 5. Which of the following is the best immediate nursing action?
A. Apply ice to reduce swelling and delay surgical intervention
B. Administer oral analgesics and monitor for improvement
C. Request a repeat TWIST assessment in 2 hours for confirmation
D. Prepare the patient for emergency surgical intervention without Doppler ultrasound
Answer: D
Rationale:
D. Correct: A TWIST score of 5 or more has a high predictive value for torsion, and immediate surgery is required to restore blood flow.
A. Incorrect: Ice and delayed intervention can lead to ischemic damage.
B. Incorrect: Oral analgesics without addressing the underlying torsion delay life-saving care.
C. Incorrect: Delaying treatment for reassessment can result in testicular necrosis.
During assessment, a nurse suspects testicular torsion in a 14-year-old boy. Which finding most strongly supports this diagnosis?
A. Absent cremasteric reflex on the affected side
B. Fever and increased white blood cell count
C. Pain relief upon elevation of the scrotum
D. Gradual onset of dull scrotal pain over several days
Answer: A
Rationale:
Correct: An absent cremasteric reflex is a key clinical sign of testicular torsion.
A. Incorrect: Pain relief (positive Prehn’s sign) points to epididymitis, not torsion.
B. Incorrect: Fever and elevated WBCs are more consistent with infection.
D. Incorrect: Torsion presents suddenly; gradual pain is not typical.
A nurse is caring for a patient with a known ectopic pregnancy being treated with methotrexate. Which of the following patient statements indicates a need for further teaching?
A. “I will avoid alcohol until my treatment is complete.”
B. “I should return if I experience heavy bleeding or severe abdominal pain.”
C. “It’s okay to take folic acid supplements while on methotrexate.”
D. “I need to have follow-up blood tests to check my hormone levels.”
Answer C
Rationale: Folic acid interferes with methotrexate’s mechanism (which is a folate antagonist) and should be avoided.
A. Incorrect: This is appropriate; alcohol increases the risk of liver toxicity when on methotrexate.
B. Incorrect: Correct; these could be signs of rupture or complications.
D. Incorrect: Follow-up bloodwork (especially β-hCG) is essential to monitor treatment response.
A 23-year-old woman arrives at the emergency department with complaints of abdominal pain, vaginal spotting, and dizziness. She has a positive pregnancy test, and her last menstrual period was 7 weeks ago. Her vital signs are: BP 88/54 mmHg, HR 118 bpm, RR 22, Temp 36.8°C. On ultrasound, no intrauterine pregnancy is detected. What is the most appropriate initial nursing intervention?
A. Reassure the patient that symptoms are normal in early pregnancy
B. Begin IV fluid resuscitation and notify the healthcare provider immediately
C. Schedule the patient for methotrexate therapy
D. Administer acetaminophen for pain and monitor response
Answer: B
Rationale:
Begin IV fluid resuscitation and notify the healthcare provider immediately
Correct: The patient is hypotensive, tachycardic, and symptomatic, with no visible intrauterine pregnancy on ultrasound. These findings are consistent with ruptured ectopic pregnancy and internal bleeding. Starting IV fluids helps stabilize circulation while the provider prepares for likely emergency surgery.
A. Reassure the patient that symptoms are normal in early pregnancy
Incorrect: This dismisses serious symptoms. While some discomfort is common early in pregnancy, this patient shows signs of hypovolemic shock, which could indicate ruptured ectopic pregnancy — a medical emergency.
C. Schedule the patient for methotrexate therapy
Incorrect: Methotrexate is only appropriate for hemodynamically stable patients without signs of rupture. This patient is unstable and needs surgical intervention, not medication.
D. Administer acetaminophen for pain and monitor response
Incorrect: Treating pain without addressing the cause delays necessary life-saving interventions. Acetaminophen would not address the underlying problem of internal hemorrhage.
