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.
