ATI-Style Comprehensive Study Guide NURS 420 Unit Exam 1 — Module 1: Women’s Health

Comprehensive practice flashcards in Question & Answer style covering NURS 420 Unit Exam 1 study guide topics including menstrual/reproductive disorders, STIs, pelvic conditions, contraception, menopause, genetics, infertility, health promotion, safety, and dosage calculations.

What is the underlying mechanism that causes pain in primary dysmenorrhea?

Prostaglandins released from the endometrium stimulate uterine smooth muscle and blood-vessel contraction, leading to ischemia, cramping, and pain.

What medication class is first-line treatment for primary dysmenorrhea and when should it be started?

NSAIDs are first-line treatment. They decrease prostaglandin production and are most effective when started at the first sign of menstruation or pain, or $1\text{--}2$\,days before an expected period in predictable cycles.

What are red flag findings that suggest secondary dysmenorrhea rather than primary dysmenorrhea?

Progressively worsening pain, pain developing after years of normal periods, pain starting several days before menstruation, pain persisting after menstruation ends, inadequate response to NSAIDs/hormonal treatment, dyspareunia, heavy bleeding, or subfertility/infertility.

In a reproductive-age client presenting with secondary amenorrhea, what is the first consideration and action?

Pregnancy must be considered first.

According to the study guide, at what age threshold or cycle interval is an adolescent evaluated for menarche or irregular cycles?

Evaluation is indicated for no menarche by age $15$ or periods more than $90$\,days apart.

How does Premenstrual Dysphoric Disorder (PMDD) differ clinically from Premenstrual Syndrome (PMS)?

PMDD involves severe mood symptoms and significant mood impairment that markedly impair daily functioning and relationships, requiring a safety assessment if severe depression or suicidal thoughts occur.

What is the classic clinical pattern of endometriosis and what diagnostic procedure confirms it?

The classic pattern is progressive dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility. Laparoscopy is the procedure commonly used to confirm diagnosis.

What adverse effects are produced by continuous leuprolide therapy for endometriosis?

Continuous leuprolide lowers ovarian estrogen, causing menopause-like hypoestrogenism adverse effects including hot flashes, vaginal dryness, mood changes, amenorrhea, and increased risk of bone density loss.

Why does chronic anovulation in Polycystic Ovary Syndrome (PCOS) increase the risk of endometrial hyperplasia and cancer?

Chronic anovulation leads to prolonged unopposed estrogen exposure.

What combination of findings with abnormal heavy uterine bleeding represents an urgent nursing priority?

Heavy uterine bleeding combined with symptomatic anemia or hemodynamic instability, such as dizziness, tachycardia, hypotension, pallor, fatigue, or low hemoglobin and hematocrit.

How do a cystocele and a rectocele differ in anatomical displacement and clinical manifestations?

A cystocele is downward displacement of the bladder into the vaginal wall causing stress urinary incontinence and a bulging wall. A rectocele is forward sagging of the anterior rectal wall into the vagina, causing stool entrapment and constipation.

What are the key clinical diagnostic findings for Vulvovaginal Candidiasis regarding discharge, vaginal pH, and odor?

Thick white 'cottage cheese' discharge, intense vulvar itching, normal vaginal pH $\le 4.5$, and usually no fishy odor.

What is the recommended treatment for Vulvovaginal Candidiasis during pregnancy?

Topical azole therapy for $7$\,days. Oral fluconazole should be avoided during pregnancy.

What microscopic and clinical findings are characteristic of Bacterial Vaginosis (BV)?

Clue cells on microscopy, thin gray or white discharge, a fishy odor (stronger after intercourse), and a vaginal pH $> 4.5$.

What are classic signs of Trichomoniasis, and what essential management step is required regarding sexual partners?

Frothy yellow-green discharge, foul odor, 'strawberry cervix', and vaginal pH $> 4.5$. Sexual partners MUST be treated.

What serious complications can result from untreated Gonorrhea or Chlamydia in women?

Pelvic Inflammatory Disease (PID), which can cause tubal scarring, infertility, ectopic pregnancy, and chronic pelvic pain.

What is the primary manifestation of primary syphilis, and what is the ONLY recommended treatment during pregnancy?

Primary syphilis presents as a painless chancre. Penicillin G is the ONLY recommended treatment during pregnancy (with desensitization if allergic).

What key concept must nurses teach clients regarding antiviral medications for Herpes Simplex Virus (HSV)?

Antiviral medications (acyclovir, valacyclovir, famciclovir) decrease outbreak severity, duration, and recurrence, but DO NOT cure HSV because it is a lifelong infection.

Which HPV genotypes cause genital warts versus cervical cancer?

HPV types $6$ and $11$ are low-risk types associated with genital warts. HPV types $16$ and $18$ are high-risk types associated with cervical and other cancers.

What physical exam sign is characteristic of Pelvic Inflammatory Disease (PID), and what symptom combination requires urgent evaluation?

Cervical motion tenderness ('chandelier sign'). Severe pelvic pain combined with fever requires urgent evaluation.

How are primary, secondary, and tertiary prevention defined in women's health with examples?

Primary prevents disease before occurrence (e.g., HPV vaccination, safe-sex education). Secondary detects disease early (e.g., STI and cancer screening). Tertiary reduces complications after disease exists (e.g., ongoing disease management).

What tampon usage guidelines help prevent Toxic Shock Syndrome?

Use the minimum absorbency necessary, change tampons every $3\text{--}6$\,hours, and avoid high or super-absorbency tampons.

What are the inheritance patterns for Cystic Fibrosis, Marfan syndrome, and Hemophilia?

Cystic Fibrosis is autosomal recessive, Marfan syndrome is autosomal dominant, and Hemophilia is X-linked recessive.

What is the role of the nurse in genetic counseling?

The nurse provides non-directive education and support for informed decision-making without making reproductive decisions for the client.

When should an evaluation for infertility begin based on client age?

After $12$\,months of unprotected intercourse without conception for women age $< 35$\,years, and after $6$\,months for women age $\ge 35$\,years.

What is the primary diagnostic purpose of a hysterosalpingography (HSG)?

To evaluate the uterine cavity and determine whether the fallopian tubes are patent/open.

What instructions must be given to a male client prior to collecting a specimen for semen analysis?

Abstain from ejaculation for $2\text{--}5$\,days prior to collection, avoid spermicidal products during collection, protect the specimen from temperature extremes, and transport it promptly.

What are two major high-yield risks associated with ovulation-induction medications?

Multiple gestation and ovarian hyperstimulation.

What is the clinical significance of postmenopausal bleeding?

Postmenopausal bleeding is abnormal and requires immediate evaluation for endometrial pathology.

What specific administration instructions must be followed when taking oral alendronate?

Take first thing in the morning on an empty stomach with plain water, and remain upright for at least $30$\,minutes without eating, drinking, or taking other medications to reduce esophageal irritation.

What is the rule for menopausal hormone therapy in a client with an intact uterus?

Systemic estrogen MUST be combined with a progestogen to prevent endometrial hyperplasia and cancer caused by unopposed estrogen.

What are major contraindications for combined hormonal contraceptives, and what does the warning acronym ACHES stand for?

Contraindications include age $\ge 35$\,years who smoke, history of DVT/PE, stroke, breast cancer, severe/uncontrolled hypertension, and migraine with aura. ACHES stands for Abdominal pain, Chest pain, Headache (severe), Eye/vision problems, and Severe leg pain.

What adverse effects and concerns are associated with DMPA (Depo-Provera) injections?

Weight gain, decreased bone density, and delayed return to fertility.

What are the core characteristics and advantages of Long-Acting Reversible Contraception (LARC)?

They are $> 99\%$ effective, last $3\text{--}12$\,years, do not require daily user adherence, and are first-line for adolescents and those desiring high efficacy.

How long must a diaphragm or contraceptive sponge remain in place after intercourse?

Both must be left in place for at least $6$\,hours after intercourse.

How do symptoms of fibrocystic breast changes relate to the menstrual cycle?

Symptoms present as cyclic tenderness and swelling that is commonly worse before menstruation and improves after menstruation begins or after menopause.

At what age does routine Pap screening begin, and does a positive high-risk HPV result confirm cervical cancer?

Pap screening begins at age $21$. A positive high-risk HPV result indicates infection/risk requiring follow-up but does NOT by itself diagnose cervical cancer.

What environment rule must be followed when screening a client for Intimate Partner Violence (IPV)?

Screening MUST occur privately.

What is the priority order of nursing care when providing care to a victim of sexual assault?

SAFETY $\rightarrow$ CONSENT $\rightarrow$ EMOTIONAL SUPPORT $\rightarrow$ EVIDENCE PRESERVATION.

What formula is used to calculate oral tablet dosages?

$\text{Desired} \div \text{Have} \times \text{Quantity} = \text{Amount to administer}$.