Chapter 7 - Reproductive Health

When assessing a patient for amenorrhea, a nurse should be aware that which may cause amenorrhea?

a. Alcohol use

b. Type 1 diabetes mellitus

c. Lack of exercise

d. Cessation of oral contraception use

b. Type 1 diabetes mellitus

When a nurse is counselling a woman for primary dysmenorrhea, which nonpharmacological intervention might be recommended?

a. Increase the intake of red meat and simple carbohydrates.

b. Reduce the intake of diuretic foods, such as peaches and asparagus.

c. Temporarily substitute physical activity for a sedentary lifestyle.

d. Use a heating pad on the abdomen to relieve cramping.

d. Use a heating pad on the abdomen to relieve cramping.

What symptom described by a person is characteristic of premenstrual syndrome (PMS)?

a. Irritable and moody prior to menses.

b. Lower abdominal pain that begins halfway through menstruation.

c. Nausea and headache after menses begins lasting 2 to 3 days.

d. Abdominal bloating and breast pain halfway through menstruation.

a. Irritable and moody prior to menses.

A patient states they have severe abdominal and pelvic pain around the time of menstruation that has gotten worse over the last 5 years. The patient also has pain during intercourse and has tried unsuccessfully to get pregnant for the past 18 months. What are these symptoms most likely related to?

a. Endometriosis

b. PMS

c. Primary dysmenorrhea

d. Secondary dysmenorrhea

a. Endometriosis

Nafarelin (Synarel) 200 mg BID per nasal spray currently is used as a treatment for mild-to-severe endometriosis. What should a nurse teach a patient who is taking this medication?

a. It stimulates the secretion of gonadotropin-releasing hormone (GnRH), thereby stimulating ovarian activity.

b. It should be sprayed into one nostril every other day.

c. It should be injected into subcutaneous tissue BID.

d. It can cause the patient to experience some hot flashes and vaginal dryness.

d. It can cause the patient to experience some hot flashes and vaginal dryness.

While interviewing a 31-year-old patient before their routine gynecological examination, a nurse collects data about the patient’s recent menstrual cycles. The nurse should collect additional information when the patient makes which statement?

a. They state their menstrual flow lasts 5 to 6 days.

b. They describe their flow as very heavy.

c. They report that they had a small amount of spotting midway between periods for the past 2 months.

d. They describe the length of their menstrual cycle varying from 26 to 29 days.

b. They describe their flow as very heavy.

When evaluating a patient whose primary concern is secondary amenorrhea, a nurse must be aware that lack of menstruation is most often the result of which event?

a. Stress

b. Excessive exercise

c. Pregnancy

d. Eating disorders

c. Pregnancy

When planning care for a patient who has been diagnosed as having uterine fibroids, what is important for a nurse to know?

a. Fibroids are malignant tumours of the uterus that require radiation or chemotherapy.

b. Fibroids will increase in size during the perimenopausal period.

c. Menorrhagia is a common finding in patients with uterine fibroids.

d. The patient is unlikely to become pregnant as long as the fibroids are in their uterus.

c. Menorrhagia is a common finding in patients with uterine fibroids.

During an annual gynecological checkup, a patient states that recently they have been experiencing cramping and pain during their menstrual periods. A nurse would use which term to document this concern?

a. Amenorrhea

b. Dysmenorrhea

c. Dyspareunia

d. Premenstrual syndrome (PMS)

b. Dysmenorrhea

Nurses should be aware that which is true with regard to dysmenorrhea?

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.

d. Pain usually occurs in the suprapubic area or lower abdomen.

Which statement is accurate?

a. Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS) and more common in younger women.

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

c. Premenstrual syndrome is a complex but clearly understood condition that may include many symptoms.

d. The causes of PMS have been well established.

a. Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS) and more common in younger women.

Nurses should be aware of which in relation to endometriosis?

a. It is characterized by the presence and growth of endometrial tissue inside the uterus.

b. It is found more often in Black patients than in White or Asian patients.

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

d. It is unlikely to affect sexual intercourse or fertility.

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

Which refers to an alteration in cyclic bleeding that occurs between periods of menstruation?

a. Oligomenorrhea

b. Menorrhagia

c. Leiomyoma

d. Metrorrhagia

d. Metrorrhagia

What should a nurse be aware of with regard to abnormal uterine bleeding (AUB)?

a. Inherited blood disorders may be a cause of AUB.

b. It most often occurs in middle age.

c. Acute bleeding episodes require a dilation and curettage.

d. The most effective medical treatment involves steroids.

a. Inherited blood disorders may be a cause of AUB.

Management of primary dysmenorrhea often requires a multifaceted approach. What is the optimal pharmacological therapy for pain relief for dysmenorrhea?

a. Acetaminophen

b. Oral contraceptives (OCPs)

c. Nonsteroidal anti-inflammatory drugs (NSAIDs)

d. Aspirin

c. Nonsteroidal anti-inflammatory drugs (NSAIDs)

What are the two primary areas of risk for sexually transmitted infections (STIs)?

a. Sexual orientation and socioeconomic status

b. Age and educational level

c. Large number of sexual partners and race

d. Risky sexual behaviours and inadequate preventive health behaviours

d. Risky sexual behaviours and inadequate preventive health behaviours

When evaluating a patient for sexually transmitted infections (STIs), a nurse should be aware that which STI is on the rise in Canada?

a. Chancroid

b. Candidiasis

c. Chlamydia

d. Herpes simplex virus (HSV) type 2

c. Chlamydia

What is the viral sexually transmitted infection (STI) that affects most people in Canada today?

a. Herpes simplex virus type 2 (HSV-2)

b. Human papillomavirus (HPV)

c. Human immunodeficiency virus (HIV)

d. Cytomegalovirus (CMV)

b. Human papillomavirus (HPV)

What are the two primary functions of the ovary?

a. Normal female development and sex hormone release

b. Ovulation and internal pelvic support

c. Sexual response and ovulation

d. Ovulation and hormone production

d. Ovulation and hormone production

A patient has a thick, white, lumpy, cottage cheese-like discharge, with patches on their labia and in their vagina. The patient states symptoms of intense pruritus. A nurse would anticipate which preparation for treatment?

a. Fluconazole

b. Tetracycline

c. Clindamycin

d. Acyclovir

a. Fluconazole

What do most laboratory tests focus on to detect the human immunodeficiency virus (HIV)?

a. HIV virus

b. HIV antibodies

c. CD4 counts

d. CD8 counts

b. HIV antibodies

What would most likely be included for the care management of a woman diagnosed with acute pelvic inflammatory disease (PID)?

a. Oral antiviral therapy

b. Bedrest in a semi-Fowler position

c. Antibiotic regimen continued until symptoms subside

d. Frequent pelvic examination to monitor the progress of healing

b. Bedrest in a semi-Fowler position

On vaginal examination of a 30-year-old patient, a nurse documents the following findings: profuse, thin, greyish white vaginal discharge with a “fishy” odour; symptoms of pruritus. These findings lead the nurse to which diagnosis?

a. Bacterial vaginosis (BV)

b. Candidiasis

c. Trichomoniasis

d. Gonorrhea

a. Bacterial vaginosis (BV)

The uterus is a muscular, pear-shaped organ that is responsible for which event?

a. Cyclic menstruation

b. Sex hormone production

c. Fertilization

d. Sexual arousal

a. Cyclic menstruation

Which viral sexually transmitted infection is characterized by a primary infection followed by recurrent episodes?

a. Herpes simplex virus (HSV)-2

b. Human papillomavirus (HPV)

c. Human immunodeficiency virus (HIV)

d. Cytomegalovirus (CMV)

a. Herpes simplex virus (HSV)-2

A nurse should know that once human immunodeficiency virus (HIV) enters the body, seroconversion to HIV positivity occurs in 70% of individuals by what week?

a. 1 week

b. 4 weeks

c. 8 weeks

d. 12 weeks

d. 12 weeks

A 25-year-old female comes to the gynecologist’s office for a follow-up visit related to her abnormal Papanicolaou (Pap) smear. The test revealed that the patient has human papillomavirus (HPV). The patient asks, “What is that? Can you get rid of it?” What is the basis for the nurses’ response?

a. Provide reassurance that it can be frozen and it will fall off.

b. Explain that HPV stands for “human papillomavirus” and is a sexually transmitted infection (STI).

c. Explain that HPV is a type of early human immunodeficiency virus (HIV) and is usually fatal.

d. Explain transmission from the current partner, who needs to be tested as well.

b. Explain that HPV stands for “human papillomavirus” and is a sexually transmitted infection (STI).

Which statement about the various forms of hepatitis is accurate?

a. A vaccine exists for hepatitis C, but not for hepatitis B.

b. Hepatitis A is acquired by eating contaminated food or drinking polluted water.

c. Hepatitis B is less contagious than human immunodeficiency virus (HIV).

d. The incidence of hepatitis C is decreasing.

b. Hepatitis A is acquired by eating contaminated food or drinking polluted water.

Which is the most important aspect of a discussion related to health promotion and condom use that a nurse should be aware of?

a. Strategies to enhance condom use

b. Choice of colours and special features

c. Leaving the decision up to the male partner

d. Places to safely carry condoms

a. Strategies to enhance condom use

Which should a nurse explain when providing education regarding breast care and fibrocystic changes in breasts?

a. Fibrocystic changes are a disease of the milk ducts and glands in the breasts.

b. Fibrocystic changes are a premalignant disorder characterized by lumps found in the breast tissue.

c. Fibrocystic changes describe lumpiness with pain and tenderness in the breast tissue of healthy patients during menstrual cycles.

d. Fibrocystic changes include lumpiness accompanied by the appearance of tenderness after menses.

c. Fibrocystic changes describe lumpiness with pain and tenderness in the breast tissue of healthy patients during menstrual cycles.

When teaching a group of women about breast cancer, which fact would a nurse point out to them?

a. Risk factors identify more than 50% of women who will develop breast cancer.

b. Nearly 90% of lumps found by women are malignant.

c. One in 10 women in Canada will develop breast cancer in their lifetime.

d. The exact cause of breast cancer is unknown.

d. The exact cause of breast cancer is unknown.

Which diagnostic test is used to confirm a suspected diagnosis of breast cancer?

a. Mammogram

b. Ultrasound

c. Fine-needle aspiration (FNA)

d. CA 15-3

c. Fine-needle aspiration (FNA)

Unique longitudinal muscle fibres make the uterine myometrium ideally suited for which event?

a. Menstruation

b. Birth process

c. Ovulation

d. Fertilization

b. Birth process

Which hormone is responsible for maturation of mammary gland tissue?

a. Estrogen

b. Testosterone

c. Prolactin

d. Progesterone

d. Progesterone

Which is true of fibroadenoma?

a. Fibroadenoma is an inflammation of the milk ducts and glands behind the nipples.

b. Fibroadenoma is a thick, sticky discharge from the nipple of the affected breast.

c. Fibroadenoma is lumpiness in both breasts that develops 1 week before menstruation.

d. Fibroadenoma is a single lump in one breast that can be expected to shrink as the woman ages.

d. Fibroadenoma is a single lump in one breast that can be expected to shrink as the woman ages.

Which myometrial muscle fibres prevent menstrual blood from flowing back into the uterine tubes during menstruation?

a. Oblique

b. Circular

c. Transverse

d. Longitudinal

b. Circular

What does a patient most likely have when they experience a breast mass that is not well delineated and is nonpalpable, immobile, and nontender?

a. Fibroadenoma

b. Lipoma

c. Intraductal papilloma

d. Mammary duct ectasia

c. Intraductal papilloma

Which is a modality that may provide relief for patients with fibrocystic breast changes?

a. Diuretic administration

b. Including caffeine daily in the diet

c. Increased vitamin C supplementation

d. Application of cold packs to the breast as necessary

c. Increased vitamin C supplementation

The Jarisch-Herxheimer reaction is an acute febrile reaction associated with treatment for which sexually transmitted infection?

a. Syphilis

b. Gonorrhea

c. Herpes simplex virus type 2

d. Human immunodeficiency virus

a. Syphilis

Which both protects the pelvic structures and accommodates the growing fetus during pregnancy?

a. Perineum

b. Bony pelvis

c. Vaginal vestibule

d. Fourchette

b. Bony pelvis

Individual irregularities in the ovarian (menstrual) cycle are most often caused by

a. variations in the follicular (preovulatory) phase.

b. an intact hypothalamic-pituitary feedback mechanism.

c. a functioning corpus luteum.

d. a prolonged ischemic phase.

a. variations in the follicular (preovulatory) phase.

The transition phase during which ovarian function and hormone production decline is called

a. the climacteric.

b. menarche.

c. menopause.

d. puberty.

a. the climacteric.

The body part that both protects the pelvic structures and accommodates the growing fetus during pregnancy is the

a. perineum.

b. bony pelvis.

c. vaginal vestibule.

d. fourchette.

b. bony pelvis.

A fully matured endometrium that has reached the thickness of heavy, soft velvet describes the _____ phase of the endometrial cycle.

a. menstrual

b. proliferative

c. secretory

d. ischemic

c. secretory

The stimulated release of gonadotropin-releasing hormone and follicle-stimulating hormone is part of the

a. menstrual cycle.

b. endometrial cycle.

c. ovarian cycle.

d. hypothalamic-pituitary cycle.

d. hypothalamic-pituitary cycle.

A nurse providing care in a women’s health care setting must be aware regarding which sexually transmitted infection that can be successfully treated and cured?

a. Herpes

b. Acquired immunodeficiency syndrome (AIDS)

c. Venereal warts

d. Chlamydia

d. Chlamydia

The medication of choice for treatment of gonorrhea is

a. penicillin G.

b. tetracycline.

c. ceftriaxone.

d. acyclovir.

c. ceftriaxone.

Which communicable diseases must be reported in all provinces and territories? (Select all that apply.)

a. Gonorrhea

b. Human papillomavirus

c. Human immunodeficiency virus (HIV)

d. Herpes simplex virus 2 (HSV-2)

e. Chlamydia

f. HSV-1

g. Infectious syphilis

a. Gonorrhea, c. Human immunodeficiency virus (HIV), e. Chlamydia, g. Infectious syphilis

Which are viral sexually transmitted infections (STIs)? (Select all that apply.)

a. Herpes simplex virus (HSV)

b. Chancroid

c. Mycoplasmas

d. Human papillomavirus (HPV)

e. Trichomoniasis

f. Syphilis

g. Cytomegalovirus

a. Herpes simplex virus (HSV), d. Human papillomavirus (HPV), g. Cytomegalovirus

Which are symptoms of endometriosis? (Select all that apply.)

a. Dysmenorrhea

b. Dysuria

c. Apnea

d. Hypertension

e. Dyscrasias

a. Dysmenorrhea, b. Dysuria

There is little consensus on the management of premenstrual dysphoric disorder (PMDD). However, nurses can advise patients on several self-help modalities that often improve symptoms. A nurse knows that health teaching has been effective when the patient reports that she has adopted a number of lifestyle changes, including (Select all that apply.)

a. regular exercise.

b. improved nutrition.

c. a daily glass of wine.

d. smoking cessation.

e. oil of evening primrose.

a. regular exercise, b. improved nutrition, d. smoking cessation, e. oil of evening primrose.

Examples of sexual risk behaviours associated with exposure to a sexually transmitted infection (STI) include (Select all that apply.)

a. oral sex.

b. unprotected anal intercourse.

c. multiple sex partners.

d. dry kissing.

e. abstinence.

a. oral sex, b. unprotected anal intercourse, c. multiple sex partners.

The exact cause of breast cancer remains undetermined. Researchers have found that there are many common risk factors that increase a woman’s chance of developing a malignancy. It is essential for the nurse who provides care to women of any age to be aware of which of the following risk factors? (Select all that apply.)

a. Family history

b. Late menarche

c. Early menopause

d. Race

e. Nulliparity or first pregnancy after age 30

a. Family history, d. Race, e. Nulliparity or first pregnancy after age 30