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Flashcards in Chapter 6 Deck (33):

1. 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

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.


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 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.


3. 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.

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.


4. 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.”

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.


5. 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

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.


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.


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.


8. 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

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.


9. 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

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.


10. 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

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.


11. 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.

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.


12. The female athlete triad includes which common menstrual disorder?
a. Amenorrhea
b. Dysmenorrhea
c. Menorrhagia
d. Metrorrhagia

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.


13. 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

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.


14. 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.

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.


15. 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

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.


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 first-degree relative with endometriosis. Women can experience painful intercourse and impaired fertility with endometriosis.


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.


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.


1. A client has requested information regarding alternatives to hormonal therapy for menopausal symptoms. Which current information should the nurse provide to the client? (Select all that apply.)
a. Soy
b. Vitamin C
c. Vitamin K
d. Vitamin E
e. Vitamin A

Both soy and vitamin E have been reported to help alleviate menopausal symptoms, and both are readily available in food sources. Vitamin E can be also be taken as a supplement. Vitamins C, K, and A have no apparent effect on menopausal symptoms.


2. Which suggestions are appropriate for a client who complains of hot flashes? (Select all that apply.)
a. Avoid caffeine.
b. Drink a glass of wine to relax.
c. Wear layered clothing.
d. Drink ice water.
e. Drink warm beverages for their calming effect.

Layered clothing allows the client to remove layers if a hot flash occurs. Ice water may help alleviate the hot flashes. Slow, deep breathing is also beneficial. Avoid triggers such as exercising on hot days, spicy foods, hot beverages, and alcohol.


3. Which medications can be taken by postmenopausal women to treat and/or prevent osteoporosis? (Select all that apply.)
a. Calcium
c. Fosamax
d. Actonel
e. Calcitonin

ANS: A, C, D, E
Calcium, Evista, Fosamax, Actonel, and Calcitonin can be used by postmenopausal women to treat or prevent osteoporosis. Parathyroid hormone and estrogen may also be of value. NSAIDs may provide pain relief; however, these medications neither prevent nor treat osteoporosis.


4. Which statement(s) might the nurse appropriately include when teaching a client about calcium intake for osteoporosis? (Select 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 better absorb calcium.”
e. “It’s okay to take calcium if you have had a history of kidney stones.”

Teaching the client to take calcium with vitamin D is accurate. Excessive protein should be avoided. Calcium is best taken in divided doses to increase absorption. Calcium should be taken with vitamin D to increase absorption. Calcium is contraindicated in women with a history of kidney stones.


5. Nurses are in an ideal position to educate clients who experience PMDD. What self-help activities have been documented as helpful in alleviating the symptoms of PMDD? (Select all that apply.)
a. Regular exercise
b. Improved nutrition
c. 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 no improvement is realized after these changes have been made, then the client may need to begin pharmacologic therapy. Women should decrease their alcohol and caffeinated beverage consumption if they suffer from PMDD.


What symptom described by a woman 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 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, psychological, and behavioral symptoms, including nausea and headaches, that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses. Abdominal bloating and breast pain are likely to occur a few days prior to menses, not after it has begun as described in statement D.


With regard to the diagnosis and management of amenorrhea, nurses should be aware that:
A. It probably is the result of a hormone deficiency that can be treated with medication.
B. It may be caused by stress or excessive exercise or both.
C. It likely will require the client to eat less and exercise more.
D. It often goes away on its own.

Ans: B
Amenorrhea may be the result of a decrease in follicle-stimulating hormone (FSH) and luteinizing hormone (LH). It is caused usually by stress or low ratio of body fat to lean mass (possibly as a result of excessive exercise), and, in rare occurrences, by a pituitary tumor. Management of stress and eating disorders is usually necessary, including counseling and education about the causes and possible lifestyle changes. In most cases a client needs to decrease her exercise and increase her body weight to resume menstruation. Amenorrhea cannot be treated by medication.


A nurse counseling a client with endometriosis understands which statement regarding the management of endometriosis is not accurate?
A. Bone loss from hypoestrogenism is not reversible.
B. Side effects from the steroid danazol include masculinizing traits.
C. Surgical intervention is often needed for severe or acute symptoms.
D. Women without pain and who do not want to become pregnant need no treatment.

Ans: A
Bone loss is mostly reversible within 12 to 18 months after the medication is stopped. Such masculinizing traits as hirsutism, a deepening voice, and weight gain occur with danazol but are reversible. Surgical intervention is often needed when symptoms are incapacitating; the type of surgery is influenced by the woman’s age and desire to have children. Treatment is not needed for women without pain or the desire to have children.


With regard to dysfunctional uterine bleeding (DUB), the nurse should be aware that:
A. It is most commonly caused by anovulation.
B. It most often occurs in middle age.
C. The diagnosis of DUB should be the first considered for abnormal menstrual bleeding.
D. The most effective medical treatment involves steroids.

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.


An effective relief measure for primary dysmenorrhea is to:
A. Reduce physical activity level until menstruation ceases.
B. Begin taking prostaglandin synthesis inhibitors on the first day of the menstrual flow.
C. Decrease intake of salt and refined sugar about 1 week before menstruation is about to occur.
D. Use barrier methods rather than the oral contraceptive pill (OCP) for birth control.

Ans: C
Decreasing intake of salt and refined sugar can reduce fluid retention. Staying active is helpful because it facilitates menstrual flow and increases vasodilation to reduce ischemia. Prostaglandin inhibitors should be started a few days before the onset of menstruation. OCPs are beneficial in relieving primary dysmenorrhea due to inhibition of ovulation and prostaglandin synthesis.


Which finding is not associated as a health risk with menopause?
A. Osteoporosis
B. Coronary heart disease
C. Breast cancer
D. Obesity

Ans: C
Breast cancer may be associated with the use of hormone replacement therapy for women who have a family history of breast cancer. Osteoporosis is a major health problem in the United States; it is associated with an increase in hip and vertebral fractures in postmenopausal women. A woman’s risk for development of and death from cardiovascular disease increases significantly after menopause. Women tend to become more sedentary in midlife. The metabolic rate decreases after menopause, so an adjustment in lifestyle and eating patterns may be required.


Which statement is true with regard to premenstrual dysphoric disorder (PMDD)?
A. It can manifest symptoms similar to those of panic disorders.
B. Symptom presentation is acute, is episodic in nature, and varies as the disorder progresses, leading to a chronic phase.
C. There are no physical symptoms of PMDD until the disease is well progressed.
D. A symptom-free period occurs in the follicular phase of the menstrual cycle.

Ans: A
PMDD is a variant of PMD and includes psychologic presentations as well as physical presentations. It is classified as a psychologic disorder. The patient may experience panic attacks. Symptom presentation becomes chronic, recurrent, and cyclical in nature. Physical symptoms occur with PMDD (physical and mood changes) and are present at the start of the disorder. A symptom-free period in the follicular phase of the menstrual cycle is seen in PMD, not PMDD.


Which finding is associated with endometriosis?
A. Chandelier sign
B. Chocolate cyst
C. Chadwick sign
D. Blood in the cul-de- sac

Ans: B
A chocolate cyst is seen in endometriosis as a result of old blood. The chandelier sign is associated with PID. Chadwick sign, a bluish discoloration of the cervix, vagina, and labia due to increased blood flow, is a presumptive sign of pregnancy.
With endometriosis, fluid is found in the cul-de-sac, which can be associated with ectopic pregnancy and ovarian disease.


A patient has been prescribed Danazol (Danocrine) therapy for treatment of endometriosis. Which side effect should the patient be monitored for as a part of this ongoing therapy?
A. Increased breast size and fullness
B. Increase in heart-protective cholesterol
C. Migraine headaches
D. Weight loss

Ans: C
Migraine headaches can occur with administration of this medication. Danazol can have masculinizing effects, leading to a decrease in breast size. A decrease in HDL (heart-protective cholesterol) and an increase in LDL occur with this medication, as do weight gain and fluid retention.


Which of the following are examples of differences between primary and secondary dysmenorrhea? (Select all that apply.)
A. The pain associated with primary radiates to the back and thighs.
B. With primary, the pain originates at the beginning of menses.
C. With secondary, the pain can occur also during ovulation.
D. With primary, the patient often complains of abdominal bloating.
E. With primary, the patient often presents with systemic symptoms such as dizziness and headache.

Ans: A, B, C, E
In primary dysmenorrhea, the patient typically presents with abdominal pain that is dull in nature and radiates to the back and thighs. The pain begins at the start of menses and lasts approximately 8 to 48 hours. The patient presents with systemic complaints as a result of increased prostaglandins and can have gastrointestinal as well as central nervous system symptoms. The patient often complains of cramping. In secondary dysmenorrhea, pain can also occur during ovulation, whereas in primary dysmenorrhea, the pain is associated only with ovulatory cycles.