CHAPTER 53 - FEMALE REPRODUCTIVE PROBLEMS EXAM REVIEW LATEST UPDATE 2022

CHAPTER 53 - FEMALE REPRODUCTIVE PROBLEMS EXAM REVIEW LATEST UPDATE 2022 A patient is scheduled for an induced abortion using instillation of hypertonic saline solution. Which information will the nurse plan to discuss with the patient before the procedure? a. The patient will require a general anesthetic. b. The expulsion of the fetus may take 1 to 2 days. c. There is a possibility that the patient may deliver a live fetus. d. The procedure may be unsuccessful in terminating the pregnancy. - Answer: b. The expulsion of the fetus may take 1 to 2 days. Rationale: Uterine contractions take 12 to 36 hours to begin after the hypertonic saline is instilled. Because the saline is feticidal, the nurse does not need to discuss any possibility of a live delivery or that the pregnancy termination will not be successful. General anesthesia is not needed for this procedure. A patient reports anxiety, headaches with dizziness, and abdominal bloating occurring before her menstrual periods. Which action should the nurse take first? a. Ask the patient to keep track of her symptoms in a diary for 3 months. b. Suggest that the patient try aerobic exercise to decrease her symptoms. c. Teach the patient about lifestyle changes to reduce premenstrual syndrome (PMS) symptoms. d. Recommend nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen to control symptoms. - Answer: a. Ask the patient to keep track of her symptoms in a diary for 3 months. Rationale: The patient's symptoms indicate possible PMS, but they also may be associated with other diagnoses. Having the patient keep a symptom diary for 2 or 3 months will help in confirming a diagnosis of PMS. The nurse should not implement interventions for PMS until a diagnosis is made. A patient who was admitted to the emergency department with severe abdominal pain is diagnosed with an ectopic pregnancy. The patient begins to cry and asks the nurse to leave her alone to grieve. Which action should the nurse take next? a. Stay with the patient and encourage her to discuss her feelings. b. Explain the reason for taking vital signs every 15 to 30 minutes. c. Close the door to the patient's room and minimize disturbances. d. Provide teaching about options for termination of the pregnancy. - Answer: b. Explain the reason for taking vital signs every 15 to 30 minutes. Rationale: Because the patient is at risk for rupture of the fallopian tube and hemorrhage, frequent monitoring of vital signs is needed. The patient has asked to be left alone, so staying with her and encouraging her to discuss her feelings are inappropriate actions. Minimizing contact with her and closing the door of the room is unsafe because of the risk for hemorrhage. Because the patient has requested time to grieve, it would be inappropriate to provide teaching about options for pregnancy termination. A patient is considering the use of combined estrogen-progesterone hormone replacement therapy (HRT) during menopause. Which information will the nurse include during their discussion? a. Use of estrogen-containing vaginal creams provides the same benefits as oral HRT. b. Increased risk of colon cancer in women taking HRT requires frequent colonoscopy. c. HRT decreases osteoporosis risk and increases the risk for cardiovascular disease and breast cancer. d. Use of HRT for up to 10 years to prevent symptoms such as hot flashes is generally considered safe. - Answer: c. HRT decreases osteoporosis risk and increases the risk for cardiovascular disease and breast cancer. Rationale: Data from the Women's Health Initiative indicate an increased risk for cardiovascular disease and breast cancer in women taking combination HRT but a decrease in hip fractures. Vaginal creams decrease symptoms related to vaginal atrophy and dryness, but they do not offer the other benefits of HRT, such as decreased hot flashes. Most women who use HRT are placed on short-term treatment and are not treated for up to 10 years. The incidence of colon cancer decreases in women taking HRT. Which statement by the patient indicates that the nurse's teaching about treating vaginal candidiasis was effective? a. "I will tell my partner that we cannot have intercourse for a month." b. "I should clean carefully after each urination and bowel movement." c. "I can douche with warm water if the itching continues to bother me." d. "I will insert the antifungal cream right before I get up in the morning." - Answer: b. "I should clean carefully after each urination and bowel movement." Rationale: Cleaning of the perineal area will decrease itching caused by contact of the irritated tissues with urine and reduce the chance of further infection of irritated tissues by bacteria in the stool. Sexual intercourse should be avoided for 1 week. Douching will disrupt normal protective mechanisms in the vagina. The cream should be used at night so that it will remain in the vagina for longer periods of time. The nurse is caring for a patient with pelvic inflammatory disease (PID) requiring hospitalization. Which nursing intervention will be included in the plan of care? a. Monitor liver function tests. b. Use cold packs PRN for pelvic pain. c. Elevate the head of the bed at least 30 degrees. d. Teach the patient how to perform Kegel exercises. - Answer: c. Elevate the head of the bed at least 30 degrees. Rationale: The head of the bed should be elevated to at least 30 degrees to promote drainage of the pelvic cavity and prevent abscess formation higher in the abdomen. Although a possible complication of PID is acute perihepatitis, liver function test results will remain normal. There is no indication for increased fluid intake. Application of heat is used to reduce pain. Kegel exercises are not helpful in PID. A 32-yr-old patient has oral contraceptives prescribed for endometriosis. What instruction should the nurse give this patient? a. Expect to experience side effects such as facial hair. b. Take the medication every day for the next 9 months. c. Take calcium supplements to prevent developing osteoporosis during therapy. d. Use a second method of contraception to ensure that she will not become pregnant. - Answer: b. Take the medication every day for the next 9 months. Rationale: When oral contraceptives are prescribed to treat endometriosis, the patient should take the medications continuously for 9 months. Facial hair is a side effect of synthetic androgens. The patient does not need to use additional contraceptive methods. The hormones in oral contraceptives will protect against osteoporosis. A patient with endometriosis asks why she is being treated with a contraceptive. What information should the nurse explain about this therapy? a. It suppresses the menstrual cycle by mimicking pregnancy. b. It relieves symptoms such as vaginal atrophy and hot flashes. c. It prevents a pregnancy that could worsen the menstrual bleeding. d. It leads to permanent suppression of abnormal endometrial tissues. - Answer: a. It suppresses the menstrual cycle by mimicking pregnancy. Rationale: Medroxyprogesterone induces a pseudopregnancy, which suppresses ovulation and causes shrinkage of endometrial tissue. Menstrual bleeding does not occur during pregnancy. Vaginal atrophy and hot flashes are caused by synthetic androgens such as danazol or gonadotropin-releasing hormone agonists such as leuprolide. Although hormonal therapies will control endometriosis while the therapy is used, endometriosis will recur once the menstrual cycle is reestablished. A 56-yr-old patient is concerned about having a moderate amount of vaginal bleeding after 5 years of menopause. What topic should the nurse plan to discuss with this patient? CONTINUES...