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WorksheetsExam 4 (OB): Common Reproductive Concerns
Total questions: 95
Worksheet time: 52mins
Which of the following is an intervention that can be implemented if a patient is experiencing dysmenorrhea?
Administering NSAIDs for analgesia
Increasing sodium intake to combat hyponatremia
Encouraging prolonged bed rest without movement to allow patient to rest
Recommending high-intensity exercise during pain episodes
Endometriosis is:
a presence of endometrial glands and stroma outside of the uterus
a type of cancer affecting the endometrium and fallopian tubes
an infectious process of the female reproductive organs, with the endometrium being the most severely affected
a hormonal endometrial disorder causing irregular/absent periods
Dysmenorrhea is:
the absence of menses
overabundance of menses
difficult and painful menses
menses after menopause
It is recommended to decrease _______ and refined _____ 7-10 days prior to menses for dysmenorrhea patients.
salt, sugar
trans fats, unsaturated fats
fiber, carbohydrates
calcium, iron
Oral _______ pills may be prescribed for dysmenorrhea.
contraceptive
antibiotic
creatinine
antihistamine
cytokinetic
What is the ONLY way to definitively diagnose endometriosis?
Ultrasound
MRI
Laparoscopy
CT scan
Endoscopy
Which endometriosis theory suggests that undifferentiated cells of the peritoneal cavity differentiate into endometrial cells during fetal development?
Celomic metaplasia theory
Implantation theory
Dissemination theory
Hormonal theory
Which endometriosis theory explains that menstrual endometrium implants on other pelvic structures?
Celomic metaplasia theory
Implantation theory
Dissemination theory
Hormonal theory
Which endometriosis theory states that endometrial tissue is transported through bloodstream or lymphatics?
Celomic metaplasia theory
Implantation theory
Dissemination theory
Hormonal theory
Estrogen and progesterone release from the ovary causes monthly buildup of ______ tissue.
endometrial
muscular
cartilaginous
epithelial
After menopause, hormone levels diminish and endometrial tissue stops proliferating, causing the symptoms of endometriosis to ______.
cease
worsen
intensify
persist
spread
Which of the following is NOT an intervention for endometriosis treatment?
Therapeutic communication
NSAIDs for analgesia
Contraceptives as prescribed
GnRH antagonist
Hysterectomy
What is the function of a GnRH agonist medication, such as Zoladex, in the treatment of endometriosis?
Suppresses pituitary gonadotropin secretion, which decreases serum FSH and LH
Stimulates estrogen production, which increases serum FSH and LH
Promotes ovulation, which increases serum FSH and LH
Enhances progesterone synthesis, which decreases serum FSH and LH
What happens to FSH and LH stimulation when a patient is treated with a GnRH agonist for endometriosis?
FSH and LH stimulation declines
FSH and LH stimulation increases
FSH and LH stimulation remains unchanged
FSH and LH stimulation fluctuates unpredictably
What is the ONLY 'cure' for endometriosis?
A) Bilateral salpingo-oophorectomy
B) Total dilation and curettage
C) Total abdominal hysterectomy
D) A and C
E) A, B, and C
Which symptom is described as pain with deep intercourse in endometriosis?
Dyspareunia
Menorrhagia
Polydipsia
Hematuria
Which symptom is described as pain with bowel movements in endometriosis?
Dyschezia
Dyspareunia
Dysuria
Menorrhagia
Which symptom of endometriosis is pain while urinating called?
Pain with micturition
Pain with dysmenorrhea
Pain with dyspareunia
Pain with pelvic heaviness
What is an endometrioma?
Buildup of endometrium in the ovary, can be cancerous
Fluid-filled cyst in the uterus, benign
Scar tissue formation in the fallopian tubes, can be cancerous
Inflammation of the cervix, can be cancerous
What is nodule formation in endometriosis?
Significant scar tissue buildup
Benign ovarian cysts
Hormonal imbalance
Infection of the uterus
How can endometriosis lead to infertility?
Embryos unable to pass from fallopian tube to uterus due to scar tissue obstruction
Embryos unable to grown in the amniotic sac due to nodule and cyst build up
Ovulation not possible due to infection secondary to endometriosis
Fertilization not possible due to endometrial dyschezia
How can endometriosis cause the formation of vaginal cysts?
Accumulation of inflammatory fluid within scar tissue
Proliferation of undifferentiated endometrial cells
Formation of bone tissue within the uterus
Development of blood clots in the fallopian tubes
What is Pelvic Inflammatory Disease (PID)?
Infective process in the female reproductive organs
Painful and difficult menses
Endometrial tissue outside of the uterus growing in the pelvic cavity
Local fibrosis of uterine tissue due to failure of excess endometrial tissue evacuation
What is the most important factor in the goal of nursing management of PID?
Prevention
Antibiotic resistance
Symptom management
Surgical intervention
Pain relief
A patient is experiencing acute pain related to PID exacerbation. How should the RN position the patient in the bed to help relive pain?
Semi-Fowlers
Prone
Supine
Left Lateral
Right-Lateral
Patients being treated for active PID _______ abstain from sexual intercourse during treatment.
should
should not
SATA: Which of the following is a sign or symptom of PID?
fever and dyspareunia
bilateral adnexal or cervical motion tenderness
bilateral lower abdominal or pelvic pain
vaginal and post-coital bleeding
mucopurulent vaginal discharge
SATA: Which of the following is a secondary complication of PID?
Infertility
Chronic pelvic pain
Ectopic pregnancy
Sepsis
Tubo-ovarian abscess
Pelvic Inflammatory Disease/PID is usually not serious, and will usually go away on its own without medical intervention.
True
False
What are the 5 P’s for obtaining a patient’s sexual history? List all five P's.
Partners, Pregnancy (Hx and/or future plans), Protection (from STIs), Practices, Past History (of STIs)
Partners, Pain, Protection (from STIs), Practices, Past History (of STIs)
Partners, Pregnancy, Protection (from STIs), Preferences, Past History (of STIs)
Partners, Pregnancy, Protection (from STIs), Practices, Personal History
SATA: Which activities should patients avoid to prevent contraction of an STI?
practices that may increase tissue damage
direct contact with lesions during intercourse
exchange of bodily fluids
increased number of sexual partners
knowing partner's sexual history
Chlamydia is often asymptomatic and is a reportable communicable disease.
True
False
Which is the most prevalent STI in the US?
Gonorrhea
Chlamydia
Syphilis
Herpes
What are the symptoms of Chlamydia in women?
Penile discharge, burning/painful urination, testicular swelling
Amenorrhea, frequent headaches, blurred vision, chest pain
Vaginal discharge, burning/painful urination, bleeding between menses
Nausea, vomiting, abdominal cramps, lochia rubra
SATA: How can syphilis enter the body?
Through ingestion of contaminated food
Through small breaks in skin or mucous membranes
Through airborne syphilitic droplets
Through insect bites
After contact with a syphilitic lesion
Syphilis can spread to the fetus via intercourse during pregnancy after the ___ month of gestational age (GA).
4th
2nd
6th
8th
Which stage of syphilis is the most infective?
A) Primary
B) Secondary
C) Tertiary
D) Latent
The primary lesion of syphilis is called a ___ and is an ulcerative, painless lesion.
Chancre
Papule
Vesicle
Pustule
How long after initial syphilis infection does a chancre appear?
1-50 days
5-90 days
2-40 weeks
6-120 months
The primary lesion of syphilis heals spontaneously within 3-6 weeks.
True
False
SATA: Which of the following is a systemic manifestation of secondary syphilis?
Recurrent Fever
Alopecia
Severe Headache
Lymphadenopathy
Maculopapular rash on palms and soles
Lesions of secondary syphilis appear ___ weeks to ___ months after the chancre is seen.
6 weeks to 6 months
2 weeks to 2 months
8 weeks to 8 months
10 weeks to 12 months
Syphilis infection will only present with systemic manifestations if the infection has progressed to the secondary stage.
True
False
If syphilis is left undiagnosed and untreated, the disease will progress to the ___ stage, also known as latent stage.
tertiary
primary
secondary
congenital
quaternary
Menstrual irregularities, greenish-yellow endocervical discharge, and vaginitis are clinical manifestations of which STI?
Gonorrhea
Syphilis
Human Papilloma Virus
HIV
Herpes virus, or HSV, has 2 subtypes: HSV1 and HSV2. Which subtype is considered a STI?
HSV1
HSV2
Both HSV1 and HSV2
Gonorrhea is often asymptomatic and is reportable as a communicable disease.
True
False
Which of the following is a manifestation of HSV1?
Fever blisters
Genital warts
Jaundice
Chickenpox
Vaginal blisters
Which of the following is a manifestation of HSV2?
Vaginal blisters
Yellow-green discharge
Cervical hemorrhage
Foul odor
Fever blisters
Painful lesions that progress from macules to papules to vesicles and typically last 4-15 days before crusting are symptoms of which STI?
HSV1
HIV
HPV
Syphilis
HSV2
Systemic symptoms of herpetic infection typically appear how many days after lesions appear?
3-4 days
1-2 days
5-6 days
7-8 days
What are the symptoms of herpes in a newborn?
Fever, malaise, headache, and photophobia
Jaundice, persistent crying, and constipation
Cough, wheezing, and chest pain
Rash, poor feeding, lethargy, and seizures
How long may herpes symptoms last in a newborn?
2-3 weeks
1-2 days
4-6 months
1 year
Are pregnant patients with a history of herpes infection allowed to have vaginal births?
Not under any circumstances, it is too dangerous for the baby.
Always, history of herpes has no bearing on the safety of vaginal births.
Yes, as long as the patient does not present with any tingling or herpetic lesions.
Not usually, these patients can only have vaginal births when they have visible lesions.
What areas should be inspected for active or healing herpes lesions in a newborn?
Vulvar, perineal, and vaginal areas
Oral cavity, scalp, and chest
Hands, feet, and back
Ears, nose, and neck
If lesions are present in a mother with herpes, what delivery method is required?
Cesarean section
Normal vaginal delivery
Forceps delivery
Vacuum extraction
SATA: Hepatitis B is transmitted through which of the following?
Semen
Vaginal Secretions
Saliva
Blood
Breastmilk
To minimize the risk of Hepatitis B transmission during delivery, the RN should ___________.
Increase number of vaginal exams
Minimize number of vaginal exams
Not do a single vaginal exam for the patient
None of the above
SATA: A healthy baby has just been delivered by a mom with an active Hepatitis B infection. What should the RN do IMMEDIATELY, before doing ANYTHING ELSE?
Remove mom's blood from the newborn
Suction fluids from the airways of the newborn
Instill eye prophylaxis into the conjunctival sac of the newborn
Administer Hep B immune globulin to the newborn IM
Administer Hep B vaccine to the newborn IM
Before any invasive procedures, including injections (LIKE IVIG AND VACCINES), what should be done to the newborn whose mother has an active Hepatitis B infection?
Bathe the newborn
Feed the newborn
Wrap the newborn in a blanket
Check the newborn's temperature
The Hepatitis B vaccine is offered shortly after birth, after the newborn has been cleaned if the parents consent. For the vaccination to be effective, it is important that the baby receives the full course of Hepatitis B vaccines. When are the 2nd and 3rd doses of the Hepatitis B vaccine given?
at 1 month and at 6 months
at 2 weeks and 10 weeks
at 6 months and 1 year
at 4 months and 8 months
at 4 weeks and 8 weeks
It is recommended to support breastfeeding after Hepatitis B treatment for the newborn.
True
False
What is the most common means for transmission of HIV in women?
Homosexual transmission
Heterosexual transmission
Blood transfusion
Sharing needles
HIV is primarily transmitted through the exchange of which of the following?
Airborne droplets
Body fluids
Contact with lesions
Acute HIV infection can manifest as esophageal sores, myalgia, hepatomegaly, and splenomegaly, among other symptoms.
True
False
SATA: Which of the following pathophysiologic process contributes to the symptoms of dysmenorrhea?
increased uterine activity
uterine ischemia
sensitization of uterine nerve terminals to prostaglandins
sensitization of uterine nerve terminals to endoperoxides
sensitization of uterine nerve terminals to cytokines
The same interventions for dysmenorrhea are also used for PMS and PMDD. However, what extra medication type is used for PMS and/or PPMD?
oral histamine 2 receptor blockers
oral contraceptives
oral CNS stimulants
oral SSRIs
SATA: Select the ways in which Pelvic Inflammatory Disease/PID can be contracted.
STI pathogens ascending into the upper genital tract
Lymphatic spread of respiratory pathogens
Lymphatic spread of enteric pathogens
STI pathogens descending into the lower genital tract
Increased lymphatic leukocyte count
SATA: Select all of the common STIs that can cause PID.
Chlamydia
Gonorrhea
Mycoplasma Genitalium
Escheria Coli
Group B Streptococcus
SATA: Select all of the common enteric/respiratory pathogens that can cause PID.
Group B Streptococcus
Staphylococcus Aureus
E. Coli
Human Immunodeficiency Virus
Chlamydia
PID can lead to damage of _______ cells of the fallopian tubes due to the infectious process.
amniotic
squamous
stratified
ciliated
endothelial
In latent syphilis, spirochetes can enter the internal organs, causing:
mild inflammation
nothing, the syphilis is latent
permanent damage
temporary excoriation
fever and chills
Manifestations of latent syphilis include cardiovascular, neurological, and musculoskeletal complications. These complications may not manifest for 10-30 _____ after initial infection.
days
weeks
months
years
SATA: What are some common BACTERIAL STIs?
Chlamydia
Syphilis
Gonorrhea
Hepatitis B
HIV
SATA: What are some common VIRAL STIs?
HPV
HSV2
Hepatitis B
Syphilis
Gonorrhea
At which prenatal visit should the RN assess for maternal HIV infection?
the first prenatal visit
the prenatal visit at 22-24 weeks GA
the prenatal visit at 35-37 weeks GA
the last prenatal visit before induction of labor
SATA: Which interventions should be AVOIDED during the labor of a mother with HIV?
Amniocentesis
Oxytocin administration
Fetal scalp electrode application
Episiotomy
Epidural administration
The medication Zidovudine is an ______ given to mothers with an active _______ infection, as well as their newborns who were delivered in a state of active maternal infection.
antibiotic, gonorrhea
antibiotic, bacterial vaginosis
antiviral, HPV
antiviral, HIV
antiviral, Hepatitis B
Breastfeeding is encouraged for mothers with an active HIV infection.
True
False
A mother with bacterial vaginosis has just given birth. Both her and her newborn are asymptomatic. Should they be treated for bacterial vaginosis infection?
Yes, they both should be treated.
Only the mom should be treated.
Only the newborn should be treated.
Treatment is not required for asymptomatic bacterial vaginosis.
Viral STIs can be cured.
True
False
Adherence to vaccinations can help to prevent the contraction of STIs.
True
False
Bacterial vaginosis is the most common form of vaginitis. Is this infection considered an STI?
Yes
No
Bacterial vaginosis during pregnancy can lead to ______ labor and birth.
post-term
preterm
life threatening
significantly delayed
SATA: Which of the following are clinical manifestations of bacterial vaginosis?
thin grayish-white or yellow discharge
foul and/or fishy vaginal odor
vaginal redness and itchiness
vaginal bleeding after intercourse
painful vaginal lesions that eventually crust over
What is the recommended antibiotic medication for the treatment of bacterial vaginosis?
Zidovudine
Metronidazole
Acyclovir
Azithromycin
Nystatin
The sexual partners of a woman with bacterial vaginosis require infection treatment.
True
False
HPV can cause condylomata acuminata, which are also known as?
genital warts
fever blisters
abnormal vaginal discharge
abnormal endometrial tissue buildup
HPV can be transmitted from the mother to the fetus during vaginal birth.
True
False
HPV is associated with _________ in adult women, and epithelial _______ in the ______ of children.
cervical/vulvar cancer, tumors, larynx
breast cancer, cysts, esophagus
cervical/vulvar cancer, fistulas, small intestine
breast cancer, nodules, mucous membranes
HPV growths most closely resemble which vegetable? (Don't hate, this is from the PowerPoint)
Carrot
Cauliflower
Cabbage
Cucumber
Gardasil-9 is a vaccine for ____ that is approved by the FDA for patients aged 9-26. Vaccination should occur ____ becoming sexually active.
HIV, before
HSV2, before
Hepatitis B, after
HSV1, after
HPV, before
SATA: A patient is requesting that the HCP remove their growths from their HPV infection. What are some methods than can be used to remove these growths?
Chemical therapy (trichloroacetic acid)
Cryotherapy
Electrocautery
Laser therapy
Pulling them off real hard
Which test, ideally completed annually, can help detect instances of HPV infection?
amniocentesis
pap smear
CBC
cervical U/S
cervical CT scan
A pregnant woman with HPV has lesions that are partially obstructing her pelvic outlet. How will this affect her delivery?
The outlet is only partially obstructed, this will not impact delivery at all.
The woman can have a vaginal delivery as long as the lesions are removed prior.
Labor and passage of the fetus will be more painful due to the decreased size of the outlet, but vaginal delivery is still possible.
The patient will require a Cesarean section for the delivery of her newborn.
