Chapter 55: Comprehensive Overview of Women’s Reproductive Health

A woman is taking a combination oral contraceptive and asks the nurse why

progestin is necessary. The nurse will explain that progestin helps prevent

pregnancy by which method?

a. Altering the quantity and viscosity of cervical mucus

b. Inhibiting proliferative and secretory changes in the endometrium

c. Increasing motility of muscles and cilia in the fallopian tubes

d. Stimulating a surge in luteinizing hormone (LH)

ANS: A

Progestin alters the quantity and viscosity of cervical mucus, making it thick and hostile

to spermpenetration. Estrogen inhibits proliferative and secretory changes in the

endometrium. Progestin decreases muscle and ciliary motility and decreases the LH

surge

A woman will begin taking a combination oral contraceptive (COC) that has a higher

estrogenicactivity than her previous COC. When teaching this woman about the new

product, the nurse will explain that she may experience which effect(s)?

a. Cyclic breast changes and chloasma

b. Decreased dysmenorrhea and menorrhagia

c. Decreased libido

d. Weight gain and fatigue

ANS: A

Increased estrogenic activity may include side effects such as cyclic breast

changes and chloasma as well as increased dysmenorrhea and menorrhagia.

Increased progestin causesdecreased libido, weight gain, and fatigue.

A woman who has recently begun taking a combination oral contraceptive calls the

clinic toreport breakthrough bleeding. The nurse will

a. advise her to use a back-up method of contraception.

b. counsel her to continue taking the contraceptive as prescribed.

c. recommend discussing an alternative contraceptive with her provider.

d. suggest that she perform a home pregnancy test to rule out pregnancy.

ANS: B

Breakthrough bleeding is more common at the start of COC use, and there is no

evidence that anepisode of bleeding is associated with a decrease in the COC's

effectiveness as long as the patient continues to take the pill as prescribed. She does

not need to use back-up contraception. Unless the bleeding continues and is

problematic, there is no need to change products. A pregnancy test is not indicated.

A young woman who is taking an oral contraceptive combination product containing

drospirenone and ethinyl estradiol for contraception tells the nurse that her provider

has told herit will help to treat her acne. The nurse explains that this is because this

product is

a. high in progestin.

b. low in androgenic activity.

c. low in estrogen.

d. triphasic.

ANS: B

Products with low androgenic activity help to reduce acne.

A woman who is taking a combined oral contraceptive (COC) that contains 21 days of

active pills and 7 days of inert pills reports having headaches accompanying withdrawal

bleeding everymonth. The nurse will

a. counsel her to take ibuprofen to counter these side effects.

b. tell her to stop her oral contraceptive immediately.

c. recommend she use an alternative form of contraception.

d. suggest she ask her provider about changing to a product that

allows forcontinuous oral administration of active contraceptive

pills

ANS: D

Withdrawal bleeding can be eliminated altogether by continuous oral administration

of activepills. The patient may discuss this approach with her provider to see if this

will help with her headaches.

A woman who is using an etonogestrel/ethinyl estradiol vaginal ring for contraception

calls to report that the ring has slipped out while sleeping. The patient is not sure how

long the product was dislodged. The nurse will instruct the patient to rinse the ring with

lukewarm water, reinsertthe ring, and

a. abstain from sexual intercourse for 24 h.

b. replace it with a new ring as soon as possible.

c. take an oral contraceptive product for 2 weeks.

d. use a back-up method of contraception for 7 days.

ANS: D

If the vaginal ring slips out, it should be rinsed off and reinserted. If it has been out

longer than 3h, the woman should be counseled to use a back-up method of

contraception until it has been in place for 7 days.

A 35-year-old woman asks the nurse about oral contraceptives. The nurse learns that

the patient smokes and has a family history of venous thromboembolism (VTE). The

nurse will suggest thatthe patient

a. discuss a progestin-only oral contraceptive with her provider.

b. may want to consider having a tubal ligation.

c. use a transdermal contraceptive product.

d. will not be a candidate for oral contraceptive product

ANS: A

Patients who smoke or who have an increased risk of VTE may be candidates for

progestin-onlyproducts. A 35-year-old woman may still want children in the future, so

recommending a tubal ligation is not indicated. Transdermal products contain estrogen

and carry the same risks as COCs.

A woman comes to the clinic for a depot medroxyprogesterone injection. The nurse

reviews her medical record and notes that it has been 6 months since her last injection.

What action will the nurse perform?

a. Administer depot medroxyprogesterone 150 mg IM.

b. Give depot medroxyprogesterone 300 mg IM.

c. Perform a pregnancy test.

d. Suggest she wait until she has had a period.

ANS: C

Women should receive depot medroxyprogesterone injections every 12-14 weeks.

Patients who are late for injections will need to rule out pregnancy before receiving the

next injection. Patientswho are eligible receive 150 mg IM. It is not correct to give a

higher dose

A 45-year-old woman reports cessation of menses for the past 6 months and asks the

nurse if sheneeds to continue using contraception. The nurse will tell her

a. that she may discontinue using contraception.

b. that she most likely has premature ovarian failure.

c. to begin hormone therapy to prevent menopausal symptoms.

d. to continue using contraception for at least 6 more months.

ANS: D

Women should use contraception until menstruation has ceased for 1 year if they do not

wish to become pregnant. Premature ovarian failure occurs when menstruation stops

before age 40 years.It is not necessary to treat menopausal symptoms until they occur.

A 45-year-old woman who has not had a period for 15 months reports severe hot

flashes and poor sleep. The nurse reviews information about hormone replacement

therapy and tells thiswoman that hormone therapy

a. is very safe and may be used freely to treat menopausal symptoms.

b. may be used indefinitely to treat menopausal symptoms.

c. should be used at the lowest dose possible for less than 5 years.

d. will be necessary to prevent osteoporosis caused by estrogen depletion.

ANS: C

Women should use hormone therapy at the lowest dose possible for a period of less

than 5 years.It carries risks for breast cancer and cardiovascular disease and cannot be

used indefinitely.

Hormone therapy can help slow osteoporosis, but it does not prevent osteoporosis

and is notrecommended for this use.

The parent of a 16-year-old female tells the nurse that the child has not had a

menstrual period despite having breast and pubic hair development. The nurse

recognizes this as characteristic ofwhich condition?

a. Dysmenorrhea

b. Hypothyroidism

c. Primary amenorrhea

d. Secondary amenorrhea

ANS: C

Females who have never had a period have primary amenorrhea, which is defined as

no mensesby age 14 without secondary sex characteristics, or no menses by age 16

with secondary sex characteristics. Dysmenorrhea refers to painful cramping with

periods. Hypothyroidism can contribute to secondary amenorrhea, which is

characterized by cessation of periods for at least 6months once menses have begun.

A young woman reports not having a period for 7 months. Which test will the

provider likelyorder first to evaluate the cause of amenorrhea in this patient?

a. Pelvic ultrasound

b. Pregnancy test

c. Progestational challenge test

d. Serum insulin levels

ANS: B

When secondary amenorrhea occurs, pregnancy must be ruled out prior to performing

other tests.A progestational challenge test will be performed if the patient is not

pregnant. If polycystic ovarian syndrome is suspected, serum insulin levels and possibly

a pelvic ultrasound will be performed.

A woman is diagnosed with polycystic ovarian disease (PCOS) after being unable to

conceive.Which of the following is considered the treatment of choice for ovulation

induction for this patient?

a. Metformin

b. Clomiphene citrate

c. Depot medroxyprogesterone

d. Letrozole

ANS: D

For women who are attempting to conceive, and weight loss has not restored ovulation,

new studies have shown that letrozole, an aromatase inhibitor, is now the first-line

ovulation induction agent over clomiphene citrate for women with PCOS, though it is an

off-label use. Clomiphene citrate can still be used, but studies have shown that it is less

effective for live birth rates than letrozole. Metformin has been used with clomiphene

citrate, though current guidelinesrecommend against the use of metformin in obese

women with PCOS, except in women with glucose intolerance not corrected with

lifestyle changes. Depot medroxyprogesterone is used forcontraception and would not

be indicated.

A 30-year-old woman describes having periods every 30 days, lasting 8 days,

with heavybleeding. The nurse understands that these are signs of which

condition?

a. Menometrorrhagia

b. Menorrhagia

c. Menorrhea

d. Metrorrhagia

ANS: B

Menorrhagia is defined as regular uterine bleeding lasting more than 7 days with heavy

bleeding.Metrorrhagia is irregular uterine bleeding lasting more than 7 days with heavy

bleeding.

Menorrhea is normal uterine bleeding. Menometrorrhagia is a combination of

menorrhagia andmetrorrhagia.

A woman who has menorrhagia is prescribed ibuprofen, and she asks the nurse

how a painmedication can decrease uterine bleeding. The nurse will explain that

this is most likely explained by ibuprofen's effects on

a. estrogen levels.

b. platelet aggregation.

c. prostaglandin production.

d. uterine endometrium.

ANS: C

Ibuprofen blocks prostaglandin production, which decreases uterine bleeding and

cramps. Ibuprofen does not affect estrogen levels. Its effects on platelet aggregation

can impair clotting.It does not have effects on the uterine endometrium

A woman who is infertile has taken 2.5 mg of letrozole daily for 5 days starting on day 3

of her cycle and has not ovulated. The nurse will anticipate that the provider will perform

which action?

a. Begin gonadotropin therapy.

b. Increase the dose to 5 mg daily for 5 days of her next cycle.

c. Order clomiphene citrate to be given throughout her next cycle.

d. Repeat the 2.5 mg of letrozole for 2 more cycles

ANS: B

If the first round of letrozole is not successful, the provider may increase the dose 5 mg

on subsequent cycles. Dosing of up to 5 cycles is used. Gonadotropin may be used if

other approaches prove unsuccessful. It is not correct to administer the drug

throughout the cycle or tocontinue with the initial dose.

The nurse performs a history on a woman who will begin taking clomiphene citrate

to induceovulation. Which aspect of this patient's history is of concern?

a. Anovulation

b. Dysmenorrhea

c. Sexually transmitted infection

d. Uterine fibroids

ANS: D

Patients with a history of uterine fibroids should not take clomiphene.

Anovulation is theindication for clomiphene. Dysmenorrhea and sexually

transmitted infections are not contraindications.