Chapter 06: Reproductive System Concerns My Nursing Test Banks

Lowdermilk: Maternity & Womens Health Care, 10th Edition

Chapter 06: Reproductive System Concerns

Test Bank

MULTIPLE CHOICE

1. When assessing the client for amenorrhea, the nurse should be aware that this may be caused by all conditions except:

a.

Anatomic abnormalities

b.

Type 1 diabetes mellitus

c.

Lack of exercise

d.

Hysterectomy

ANS: C

Lack of exercise is not a cause of amenorrhea. Strenuous exercise may cause amenorrhea.

Anatomic abnormalities are a possible cause of amenorrhea.

Type 1 diabetes mellitus is a possible cause of amenorrhea.

Hysterectomy is a possible cause of amenorrhea.

DIF: Cognitive Level: Knowledge REF: 120

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

2. When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention might be recommended?

a.

Increasing the intake of red meat and simple carbohydrates

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 eating less red meat 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: Analysis REF: 121

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

3. Nafarelin (Synarel) is used to treat mild to severe endometriosis. The nurse should tell the woman taking this medication that the drug:

a.

Stimulates the secretion of gonadotropin-releasing hormone (GnRH), thereby stimulating ovarian activity

b.

Should be sprayed into one nostril every other day

c.

Should be injected into subcutaneous tissue bid

d.

Can cause her 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.

Nafarelin is administered intranasally.

DIF: Cognitive Level: Comprehension REF: 126

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

4. While interviewing a 31-year-old woman before her routine gynecologic examination, the nurse collects data about the clients recent menstrual cycles. The nurse should collect additional information with which statement?

a.

The woman says her menstrual flow lasts 5 to 6 days.

b.

She describes her flow as very heavy.

c.

She reports that she has had a small amount of spotting midway between her periods for the past 2 months.

d.

She says the length of her menstrual cycle 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 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: Comprehension REF: 129

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

5. Nurses who provide health care for women should recognize that the most commonly reported gynecologic problem for women of any age-group is:

a.

Dysmenorrhea

b.

Menorrhagia

c.

Dyspareunia

d.

Endometriosis

ANS: A

Dysmenorrhea, or pain during or shortly before menstruation, is one of the most common gynecologic problems in women of all ages.

Menorrhagia, or excessive bleeding, is an alteration in cyclic bleeding; it is not the most commonly reported gynecologic problem.

Dyspareunia, or painful intercourse, is commonly associated with endometriosis.

Endometriosis is a type of menstrual disorder, but it is not the most commonly reported gynecologic problem.

DIF: Cognitive Level: Knowledge REF: 121

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

6. When evaluating a client whose primary complaint is amenorrhea, the nurse must be aware that lack of menstruation is most often the result of:

a.

Stress

b.

Excessive exercise

c.

Pregnancy

d.

Eating disorders

ANS: C

Amenorrhea, or the absence of menstrual flow, is most often a result of pregnancy.

Although stress may be a contributing factor to amenorrhea, pregnancy is the most common cause.

Although excessive exercise may be a contributing factor to amenorrhea, pregnancy is the most common cause.

Although eating disorders may be a contributing factor to amenorrhea, pregnancy is the most common cause.

DIF: Cognitive Level: Knowledge REF: 120

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment, Diagnosis

7. A 36-year-old woman has been diagnosed as having uterine fibroids. When planning care for this client, the nurse should know that:

a.

Fibroids are malignant tumors of the uterus that require radiation or chemotherapy

b.

Fibroids increase in size during the perimenopausal period

c.

Menorrhagia is a common finding

d.

The woman is unlikely to become pregnant as long as the fibroids are in her uterus

ANS: C

The major symptoms associated with fibroids are menorrhagia and the physical effects produced by large myomas.

Fibroids are benign tumors of the smooth muscle of the uterus, and their etiology is unknown.

Fibroids are estrogen sensitive and shrink as levels of estrogen decline.

Fibroids occur in 25% of women of reproductive age and are seen in 2% of pregnant women.

DIF: Cognitive Level: Comprehension REF: 129

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

8. When assessing a woman for menopausal discomforts, the nurse would expect the woman to describe the most frequently reported discomfort, which would be:

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 hormone levels; however, it is not the most frequently reported discomfort for menopausal women.

Mood swings may be associated with a decline in hormone levels; however, it is not the most frequently reported discomfort for menopausal women.

Vaginal dryness and dyspareunia may be associated with a decline in hormone levels; however, it is not the most frequently reported discomfort for menopausal women.

DIF: Cognitive Level: Comprehension REF: 132

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

9. While evaluating a client for osteoporosis, the nurse should be aware of what risk factor?

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.

DIF: Cognitive Level: Knowledge REF: 133

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

10. When discussing estrogen replacement therapy (ERT) with a perimenopausal woman, the nurse includes the risk of:

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 ERT.

Estrogen prevents atrophy of vaginal and urinary tract tissue.

Estrogen protects against the development of osteoporosis.

Estrogen has a favorable effect on circulating lipids, reducing low-density lipoprotein (LDL) and total cholesterol and increasing high-density lipoprotein (HDL). It also has a direct antiatherosclerotic effect on the arteries.

DIF: Cognitive Level: Comprehension REF: 134

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

11. During her annual gynecologic checkup, a 17-year-old woman states that recently she has been experiencing cramping and pain during her menstrual periods. The nurse documents this complaint as:

a.

Amenorrhea

b.

Dysmenorrhea

c.

Dyspareunia

d.

Premenstrual syndrome (PMS)

ANS: B

Dysmenorrhea is pain during or shortly before menstruation.

Amenorrhea is the absence of menstrual flow.

Dyspareunia is pain during intercourse.

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.

DIF: Cognitive Level: Knowledge REF: 121

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis

12. The absence or cessation of menstrual flow is known as:

a.

Amenorrhea

b.

Dysmenorrhea

c.

Menorrhagia

d.

Metrorrhagia

ANS: A

Amenorrhea is most often the result of pregnancy, although it could be a sign of conditions that require treatment.

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. It can be caused by progestin injections and implants.

DIF: Cognitive Level: Knowledge REF: 120

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis

13. With regard to dysmenorrhea, nurses should be aware that:

a.

It is more common in older women

b.

It is more common in leaner women who exercise strenuously

c.

Symptoms can begin at any point in the ovulatory cycle

d.

Pain usually occurs in the suprapubic area or lower abdomen

ANS: D

Pain is described as sharp and cramping or sometimes as a dull ache. It may radiate to the lower back or upper thighs.

Dysmenorrhea is more common in younger women ages 17 to 24.

Dysmenorrhea is more common in women who smoke and who are obese.

Symptoms begin with menstruation or sometimes a few hours before the onset of flow.

DIF: Cognitive Level: Knowledge REF: 121

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Diagnosis

14. Which statement concerning cyclic perimenstrual pain and discomfort (CPPD) is accurate?

a.

Premenstrual dysphoric disorder (PDD) is a milder form of premenstrual syndrome and more common in younger women.

b.

Secondary dysmenorrhea is more intense and medically significant than primary dysmenorrhea.

c.

Premenstrual syndrome is a complex, poorly understood condition that may include any of a hundred symptoms.

d.

The causes of premenstrual syndrome (PMS) have been well established.

ANS: C

PMS may manifest itself with one or more of a hundred or so physical and psychologic symptoms.

PDD is a more severe variant of PMS.

Secondary dysmenorrhea is characterized by more muted pain than that seen in primary dysmenorrhea; the medical treatment is much the same.

The cause of PMS is unknown. It may in fact be a collection of different problems.

DIF: Cognitive Level: Comprehension REF: 121

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis

15. In helping a client manage premenstrual syndrome (PMS), the nurse should:

a.

Recommend a diet with more body-building and energy food, such as red meat and sugar

b.

Suggest herbal therapies, as well as yoga and massage

c.

Tell the client to push for medications from the physician as soon as symptoms occur so as to lessen their severity

d.

Discourage the use of diuretics

ANS: B

Herbal therapies, yoga, and massage have been reported to have a beneficial effect on PMS.

Limiting red meat, refined sugar, caffeinated beverages, and alcohol improves the diet and may mitigate symptoms.

Medication usually is begun only if lifestyle changes fail to provide significant relief.

Natural diuretics may help reduce fluid retention.

DIF: Cognitive Level: Comprehension REF: 124

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

16. With regard to endometriosis, nurses should be aware that:

a.

It 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.

It may worsen with repeated cycles or remain asymptomatic and disappear after menopause

d.

It is unlikely to affect sexual intercourse or fertility

ANS: C

Symptoms vary among women, ranging from nonexistent to incapacitating.

With endometriosis, the endometrial tissue is outside the uterus. Symptoms vary among women, ranging from nonexistent to incapacitating.

Endometriosis is found equally in Caucasian and African-American women and is slightly more prevalent in Asian women.

Women can experience painful intercourse and impaired fertility.

DIF: Cognitive Level: Knowledge REF: 125

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

17. One of the alterations in cyclic bleeding that occurs between periods is called:

a.

Oligomenorrhea

b.

Menorrhagia

c.

Leiomyoma

d.

Metrorrhagia

ANS: D

Metrorrhagia is bleeding between periods. It can be caused by progestin injections and implants.

Oligomenorrhea is infrequent or scanty menstruation.

Menorrhagia is excessive menstruation.

Leiomyoma is a common cause of excessive bleeding.

DIF: Cognitive Level: Knowledge REF: 127

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Diagnosis

18. Management of primary dysmenorrhea often requires a multifaceted approach. The nurse who provides care for a client with this condition should be aware that the optimal pharmacologic therapy for pain relief is:

a.

Acetaminophen

b.

Oral contraceptive pills (OCPs)

c.

Nonsteroidal antiinflammatory drugs (NSAIDs)

d.

Aspirin

ANS: C

NSAIDs have the strongest research results for pain relief. Often if one NSAID is not effective, another one will 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: Application REF: 122

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

MULTIPLE RESPONSE

1. Alternatives to hormonal therapy for menopausal symptoms include (choose all that apply):

a.

Soy

b.

Vitamin C

c.

Vitamin K

d.

Vitamin E

e.

Vitamin A

ANS: A, D

Both soy and vitamin E have been reported to help alleviate menopausal symptoms.

Vitamins C, K, and A have no apparent effect on menopausal symptoms.

DIF: Cognitive Level: Comprehension REF: 136

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

2. Which suggestion is appropriate for a client who complains of hot flashes? Choose all that apply.

a.

Consume large quantities of caffeine

b.

Drink a glass of wine

c.

Eat Mexican food

d.

Drink ice water

e.

Drink warm beverages

ANS: D

Ice water may help alleviate the hot flashes.

Consuming large quantities of caffeine, drinking a glass of wine, eating Mexican food, or drinking warm beverages most likely would exacerbate the hot flashes.

DIF: Cognitive Level: Comprehension REF: 137

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

3. Which medications can be taken by postmenopausal women to treat and/or prevent osteoporosis? Choose all that apply.

a.

Calcium

b.

Evista

c.

Fosamax

d.

Actonel

e.

Calcitonin

ANS: A, B, C, D, E

Calcium, Evista, Fosamax, Actonel, and Calcitonin can be used by postmenopausal women to treat or prevent osteoporosis.

DIF: Cognitive Level: Comprehension REF: 139, 140

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

4. Which statements might the nurse appropriately include when teaching a client about calcium intake for osteoporosis? Choose all that apply.

a.

You should try to increase your protein intake when you are taking calcium.

b.

It is best to take calcium in one large dose.

c.

Tums are the most soluble form of calcium.

d.

You should take calcium with vitamin D because the vitamin D helps your body absorb calcium better.

e.

Its okay to take calcium if you have had a history of kidney stones.

ANS: C, D

Teaching the client to take calcium with vitamin D or to take calcium with a history of kidney stones is accurate.

Excessive protein should be avoided. Calcium is best taken in divided doses so as to increase absorption. Calcium should be taken with vitamin D to increase absorption. Calcium is contraindicated in women with a history of kidney stones.

DIF: Cognitive Level: Application REF: 133

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

5. There is little consensus on the management of premenstrual dysphoric disorder (PMDD). However, nurses can advise women on several self-help modalities that often result in symptom improvement. The nurse knows that health teaching has been effective when the client reports that she has adopted a number of lifestyle changes including:

a.

Regular exercise

b.

Improved nutrition

c.

A daily glass of wine

d.

Smoking cessation

e.

Oil of evening primrose

ANS: A, B, D, E

Regular exercise, improved nutrition, smoking cessation, and oil of evening primrose are accurate modalities that may provide significant symptom relief in 1 to 2 months. If there is no improvement after these changes have been made, the client may need to begin pharmacologic therapy.

Women should decrease their alcohol and caffeinated beverage consumption if they suffer from PMDD.

DIF: Cognitive Level: Analysis REF: 124

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Evaluation

COMPLETION

1. Some plant foods contain _________________________ and are capable of interacting with estrogen receptors in the body.

ANS:

Phytoestrogens

These foods include wild yams, dandelion greens, cherries, alfalfa sprouts, black beans, and soybeans.

DIF: Cognitive Level: Knowledge REF: 136

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

2. Any episode of vaginal bleeding that occurs at a time other than during menses is referred to as _______________.

ANS:

Metrorrhagia

Defined as intermenstrual bleeding, this is also commonly referred to as breakthrough bleeding or mittlestaining. This can be a normal part of a womans menstrual cycle if it occurs regularly or it may be an indication of an underlying disease process that requires further investigation.

DIF: Cognitive Level: Knowledge REF: 127

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

TRUE/FALSE

1. Obese women are more likely to have dysfunctional uterine bleeding and endometrial hyperplasia. Is this statement true or false?

ANS: T

Women with more body fat have higher circulating levels of estrone. This occurs because estrogen that is stored in the fat cells of the body is converted into a form of estrogen that is available to the estrogen receptors within the endometrium.

DIF: Cognitive Level: Knowledge REF: 131

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

Mosby items and derived items 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

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