6

Chapter 06: Reproductive System Concerns
Lowdermilk: Maternity & Women’s Health Care, 11th Edition
MULTIPLE CHOICE
1. Which condition is the least likely cause of amenorrhea in a 17-year-old client?

a. Anatomic abnormalities
b. Type 1 diabetes mellitus
c. Obesity
d. Pregnancy
ANS: C
A moderately obese adolescent (20% to 30% above ideal weight) may have early onset
menstruation. Girls who regularly exercise before menarche can have delayed onset of
menstruation to age 18 years. Anatomic abnormalities are a possible cause of amenorrhea.
Type 1 diabetes mellitus is a possible cause of amenorrhea. Pregnancy is the most common
cause of amenorrhea.
DIF: Cognitive Level: Remember REF: p. 121

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
2. When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic

intervention might be recommended?
a. Increasing the intake of red meat to replace blood loss
b. Reducing the intake of diuretic foods, such as peaches and asparagus
c. Temporarily substituting physical activity for a sedentary lifestyle
d. Using a heating pad on the abdomen to relieve cramping
ANS: D
Heat minimizes cramping by increasing vasodilation and muscle relaxation and minimizing
uterine ischemia. Dietary changes such as a low-fat vegetarian diet may be recommended for
women experiencing dysmenorrhea. Increasing the intake of diuretics, including natural
diuretics such as asparagus, cranberry juice, peaches, parsley, and watermelon, may help ease
the symptoms associated with dysmenorrhea. Exercise has been found to help relieve
menstrual discomfort through increased vasodilation and subsequent decreased ischemia.
DIF: Cognitive Level: Analyze REF: pp. 122-123 TOP: Nursing Process: Planning
MSC: Client Needs: Physiologic Integrity
3. Nafarelin (Synarel) is used to treat mild-to-severe endometriosis. What instruction or

information should the nurse provide to a client regarding nafarelin administration?
a. Nafarelin stimulates the secretion of gonadotropin-releasing hormone (GnRH),
thereby stimulating ovarian activity.
b. It should be administered by intramuscular (IM) injection.
c. Nafarelin should be administered by a subcutaneous implant.
d. It can cause the client to experience some hot flashes and vaginal dryness.
ANS: D
Nafarelin is a GnRH agonist, and its side effects are similar to those of menopause. The
hypoestrogenism effect results in hot flashes and vaginal dryness. Nafarelin is a GnRH agonist
that suppresses the secretion of GnRH. Nafarelin is administered twice daily by nasal spray
and can be intranasally administered. Leuprolide is given once per month by IM injection.
Goserelin is administered by subcutaneous implant.
DIF: Cognitive Level: Apply REF: p. 127 TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
4. While interviewing a 31-year-old woman before her routine gynecologic examination, the
nurse collects data about the client’s recent menstrual cycles. Which statement by the client
should prompt the nurse to collect further information?
a. “My menstrual flow lasts 5 to 6 days.”
b. “My flow is very heavy.”
c. “I have had a small amount of spotting midway between my periods for the past 2
months.”
d. “The length of my menstrual cycles varies from 26 to 29 days.”
ANS: B
Menorrhagia is defined as excessive menstrual bleeding, either in duration or in amount.
Heavy bleeding can have many causes. The amount of bleeding and its effect on daily
activities should be evaluated. A menstrual flow that lasts 5 to 6 days is a normal finding.
Mittlestaining, a small amount of bleeding or spotting that occurs at the time of ovulation (14
days before the onset of the next menses), is considered normal. During her reproductive
years, a woman may have physiologic variations in her menstrual cycle. Variations in the
length of a menstrual cycle are considered normal.
DIF: Cognitive Level: Understand REF: p. 131

5. A 21-year-old client complains of severe pain immediately after the commencement of her
menses. Which gynecologic condition is the most likely cause of this client’s presenting
complaint?
a. Primary dysmenorrhea
b. Secondary dysmenorrhea
c. Dyspareunia
d. Endometriosis
ANS: A
Primary dysmenorrhea, or pain during or shortly before menstruation, has a biochemical basis
and arises from the release of prostaglandins with menses. Secondary dysmenorrhea develops
after the age of 25 years and is usually associated with a pelvic pathologic condition.
Dyspareunia, or painful intercourse, is commonly associated with endometriosis.
Endometriosis is characterized by endometrial glands and stoma outside of the uterus.

6. Which symptom described by a client is characteristic of premenstrual syndrome (PMS)?

a. “I feel irritable and moody a week before my period is supposed to start.”
b. “I have lower abdominal pain beginning on the third day of my menstrual period.”
c. “I have nausea and headaches after my period starts, and they last 2 to 3 days.”
d. “I have abdominal bloating and breast pain after a couple days of my period.”
ANS: A
PMS is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal
phase of the menstrual cycle and resolve within a couple of days of the onset of menses.
Complaints of lower abdominal pain, nausea and headaches, and abdominal bloating all are
associated with PMS; however, the timing reflected is inaccurate.
DIF: Cognitive Level: Apply REF: p. 125

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
7. A client complains of severe abdominal and pelvic pain around the time of menstruation. This
pain has become progressively worse over the last 5 years. She also complains of pain during
intercourse and has tried unsuccessfully to become pregnant for the past 18 months. To which
condition are these symptoms most likely related?
a. Endometriosis
b. PMS
c. Primary dysmenorrhea
d. Secondary dysmenorrhea
ANS: A
Symptoms of endometriosis can change over time and may not reflect the extent of the
disease. Major symptoms include dysmenorrhea and deep pelvic dyspareunia (painful
intercourse). Impaired fertility may result from adhesions caused by endometriosis. Although
endometriosis may be associated with secondary dysmenorrhea, it is not a cause of primary
dysmenorrhea or PMS. In addition, this woman is complaining of dyspareunia and infertility,
which are associated with endometriosis, not with PMS or primary or secondary
dysmenorrhea.
DIF: Cognitive Level: Understand REF: pp. 126-127

8. Which menopausal discomfort would the nurse anticipate when evaluating a woman for signs
and symptoms of the climacteric?
a. Headaches
b. Hot flashes
c. Mood swings
d. Vaginal dryness with dyspareunia
ANS: B
Vasomotor instability, in the form of hot flashes or flushing, is a result of fluctuating estrogen
levels and is the most common disturbance of the perimenopausal woman. Headaches may be
associated with a decline in hormonal levels; however, headaches are not the most frequently
reported discomfort for menopausal women. Mood swings may also be associated with a
decline in hormonal levels; however, mood swings are not the most frequently reported
discomfort for menopausal women. Vaginal dryness and dyspareunia may be associated with a
decline in hormonal levels; however, both are not the most frequently reported discomforts for
menopausal women.

9. Which risk factor would the nurse recognize as being frequently associated with osteoporosis?
a. African-American race
b. Low-protein intake
c. Obesity
d. Cigarette smoking
ANS: D
Smoking is associated with earlier and greater bone loss and decreased estrogen production.
Women at risk for osteoporosis are likely to be Caucasian or Asian. Inadequate calcium intake
is a risk factor for osteoporosis. Women at risk for osteoporosis are likely to be small boned
and thin. Obese women have higher estrogen levels as a result of the conversion of androgens
in the adipose tissue. Mechanical stress from extra weight also helps preserve bone mass.

10. A perimenopausal client has arrived for her annual gynecologic examination. Which
preexisting condition would be extremely important for the nurse to identify during a
discussion regarding the risks and benefits of hormone therapy?
a. Breast cancer
b. Vaginal and urinary tract atrophy
c. Osteoporosis
d. Arteriosclerosis
ANS: A
Women with a high risk for breast cancer should be counseled against using estrogen
replacement therapy (ERT). Estrogen prevents the atrophy of vaginal and urinary tract tissue
and protects against the development of osteoporosis. Estrogen also has a favorable effect on
circulating lipids, reducing low-density lipoprotein (LDL) and total cholesterol levels and
increasing high-density lipoprotein (HDL) levels. It also has a direct antiatherosclerotic effect
on the arteries.
11. Dysfunctional uterine bleeding (DUB) is defined as excessive uterine bleeding without a
demonstrable cause. Which statement regarding this condition is most accurate?
a. DUB is most commonly caused by anovulation.
b. DUB most often occurs in middle age.
c. The diagnosis of DUB should be the first consideration for abnormal menstrual
bleeding.
d. Steroids are the most effective medical treatment for DUB.
ANS: A
Anovulation may occur because of hypothalamic dysfunction or polycystic ovary syndrome.
DUB most often occurs when the menstrual cycle is being established or when it draws to a
close at menopause. A diagnosis of DUB is made only after all other causes of abnormal
menstrual bleeding have been ruled out. The most effective medical treatment is oral or
intravenous estrogen.
DIF: Cognitive Level: Remember REF: p. 131 TOP: Nursing Process: Diagnosis
12. The female athlete triad includes which common menstrual disorder?
a. Amenorrhea
b. Dysmenorrhea
c. Menorrhagia
d. Metrorrhagia
ANS: A
The interrelatedness of disordered eating, amenorrhea, and altered bone mineral density have
been described as the female athlete triad. Dysmenorrhea is painful menstruation that begins 2
to 6 months after menarche. Menorrhagia is abnormally profuse or excessive bleeding from
the uterus. Metrorrhagia is bleeding between periods and can be caused by progestin
injections and implants.
DIF: Cognitive Level: Understand REF: p. 121 TOP: Nursing Process: Diagnosis
13. Which system responses would the nurse recognize as being unrelated to prostaglandin
(PGF2) release?
a. Systemic responses
b. Gastrointestinal system
c. Central nervous system
d. Genitourinary system
ANS: D
Systemic responses to PGF2 include backache, weakness, and sweating. Gastrointestinal
system changes include nausea, vomiting, anorexia, and diarrhea. Central nervous system
changes manifest themselves as dizziness, syncope, headache, and poor concentration; they
usually begin at the onset of menstruation and last 8 to 48 hours.

TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
14. Which statement concerning cyclic perimenstrual pain and discomfort (CPPD) is accurate?
a. Premenstrual dysphoric disorder (PMDD) is a milder form of PMS and more
common in young women.
b. Secondary dysmenorrhea is more intense and more medically significant than
primary dysmenorrhea.
c. PMS is a complex, poorly understood condition that may include any of a hundred
symptoms.
d. The causes of PMS have been well established.
ANS: C
PMS may manifest itself with one or more of a hundred physical and psychologic symptoms.
PDD is a more severe variant of PMS. Secondary dysmenorrhea is characterized by more
muted pain than the pain reported in primary dysmenorrhea; however, the medical treatment is
close to the same. The cause of PMS is unknown and may be, in fact, a collection of different
problems.
DIF: Cognitive Level: Understand REF: p. 125 TOP: Nursing Process: Diagnosis
15. To assist a client in managing the symptoms of PMS, what should the nurse recommend based
on current evidence?
a. Diet with more body-building and energy foods, such as carbohydrates
b. Herbal therapies, yoga, and massage
c. Antidepressants for symptom control
d. Discouraging the use of diuretics
ANS: B
Herbal therapies, yoga, and massage have been reported to have a beneficial effect on the
symptoms of PMS. Limiting red meat, simple carbohydrates, caffeinated beverages, and
alcohol improves the diet and may mitigate symptoms. Medication is usually begun only if
lifestyle changes fail to provide significant relief. Natural diuretics may help reduce fluid
retention.
DIF: Cognitive Level: Apply REF: pp. 125-126 TOP: Nursing Process: Planning
16. Which statement related to the condition of endometriosis is most accurate?

a. Endometriosis is characterized by the presence and growth of endometrial tissue
inside the uterus.
b. It is found more often in African-American women than in Caucasian or Asian
women.
c. Endometriosis may worsen with repeated cycles or remain asymptomatic and
disappear after menopause.
d. It is unlikely to affect sexual intercourse or fertility.
ANS: C
With endometriosis, the endometrial tissue is outside the uterus. Endometriosis is found
equally in Caucasian and African-American women and is slightly more prevalent in Asian
women. Symptoms vary among women, ranging from nonexistent to incapacitating. The
condition is seven times more prevalent in women who have a first-degree relative with
endometriosis. Women can experience painful intercourse and impaired fertility with
endometriosis.
DIF: Cognitive Level: Understand REF: pp. 126-127

17. Which alteration in cyclic bleeding best describes bleeding that occurs at any time other than
menses?
a.Oligomenorrhea
b.Menorrhagia
c.Leiomyoma
d.Metrorrhagia
ANS: D
Metrorrhagia (intermenstrual bleeding) refers to any episode or degree of bleeding that occurs
between periods. It may be caused by contraceptives that contain progesterone or by
intrauterine devices (IUDs). Oligomenorrhea is infrequent or scanty menstruation.
Menorrhagia is excessive menstruation. Leiomyoma is a common cause of excessive
bleeding.
DIF: Cognitive Level: Remember REF: p. 129 TOP: Nursing Process: Diagnosis
18. Management of primary dysmenorrhea often requires a multifaceted approach. Which

pharmacologic therapy provides optimal pain relief for this condition?
a. Acetaminophen
b. Oral contraceptive pills (OCPs)
c. Nonsteroidal antiinflammatory drugs (NSAIDs)
d. Aspirin
ANS: C
NSAIDs have the strongest research results for pain relief. If one NSAID is not effective, then
another one may provide relief. Approximately 80% of women find relief from these
prostaglandin inhibitors. Preparations containing acetaminophen are less effective for
dysmenorrhea because they lack the antiprostaglandin properties of NSAIDs. OCPs are a
reasonable choice for women who also want birth control. The benefit of OCPs is the
reduction of menstrual flow and irregularities. OCPs may be contraindicated for some women
and have a number of potential side effects. NSAIDs are the drug of choice. However, if a
woman is taking an NSAID, she should avoid taking aspirin as well.
MULTIPLE RESPONSE
1. A client has requested information regarding alternatives to hormonal therapy for menopausal
symptoms. Which current information should the nurse provide to the client? (Select all that
apply.)
a. Soy
b. Vitamin C
c. Vitamin K
d. Vitamin E
e. Vitamin A
ANS: A, D
Both soy and vitamin E have been reported to help alleviate menopausal symptoms, and both
are readily available in food sources. Vitamin E can be also be taken as a supplement.
Vitamins C, K, and A have no apparent effect on menopausal symptoms.
DIF: Cognitive Level: Understand REF: p. 139 TOP: Nursing Process: Planning
2. Which suggestions are appropriate for a client who complains of hot flashes? (Select all that
apply.)
a. Avoid caffeine.
b. Drink a glass of wine to relax.
c. Wear layered clothing.
d. Drink ice water.
e. Drink warm beverages for their calming effect.
ANS: A, C
Layered clothing allows the client to remove layers if a hot flash occurs. Ice water may help
alleviate the hot flashes. Slow, deep breathing is also beneficial. Avoid triggers such as
exercising on hot days, spicy foods, hot beverages, and alcohol.
DIF: Cognitive Level: Understand REF: p. 139 TOP: Nursing Process: Planning
3. Which medications can be taken by postmenopausal women to treat and/or prevent

osteoporosis? (Select all that apply.)
a. Calcium
b. NSAIDs
c. Fosamax
d. Actonel
e. Calcitonin
ANS: A, C, D, E
Calcium, Evista, Fosamax, Actonel, and Calcitonin can be used by postmenopausal women to
treat or prevent osteoporosis. Parathyroid hormone and estrogen may also be of value.
NSAIDs may provide pain relief; however, these medications neither prevent nor treat
osteoporosis.
DIF: Cognitive Level: Apply REF: pp. 140-142

TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
4. Which statement(s) might the nurse appropriately include when teaching a client about
calcium intake for osteoporosis? (Select all that apply.)
a. “You should try to increase your protein intake when you are taking calcium.”
b. “It is best to take calcium in one large dose.”
c. “Tums are the most soluble form of calcium.”
d. “You should take calcium with vitamin D because the vitamin D helps your body
better absorb calcium.”
e. “It’s okay to take calcium if you have had a history of kidney stones.”
ANS: C, D
Teaching the client to take calcium with vitamin D is accurate. Excessive protein should be
avoided. Calcium is best taken in divided doses to increase absorption. Calcium should be
taken with vitamin D to increase absorption. Calcium is contraindicated in women with a
history of kidney stones.
DIF: Cognitive Level: Apply REF: pp. 140-141 TOP: Nursing Process: Planning
5. Nurses are in an ideal position to educate clients who experience PMDD. What self-help
activities have been documented as helpful in alleviating the symptoms of PMDD? (Select all
that apply.)
a. Regular exercise
b. Improved nutrition
c. Daily glass of wine
d. Smoking cessation
e. Oil of evening primrose
ANS: A, B, D, E
Regular exercise, improved nutrition, smoking cessation, and oil of evening primrose are
accurate modalities that may provide significant symptom relief in 1 to 2 months. If no
improvement is realized after these changes have been made, then the client may need to
begin pharmacologic therapy. Women should decrease their alcohol and caffeinated beverage
consumption if they suffer from PMDD.
DIF: Cognitive Level: Analyze REF: p. 125 TOP: Nursing Process: Evaluation
MATCHING
Herbal preparations have long been used for the management of menstrual problems,
including dysmenorrhea, cramping and discomfort, and breast pain. For the nurse to counsel
adequately the client who elects to use this alternative modality, understanding the action of
these herbal preparations is important. Match the herbal medicine with the appropriate action.
a. Uterine antispasmodic
b. Uterotonic
c. Antiinflammatory
d. Estrogen-like luteinizing hormone suppressant
e. Decreases prolactin levels
1. Fennel, dong quai

2. Chaste tree fruit
3. Black cohosh root
4. Valerian, wild yam
5. Ginger
1. ANS: B DIF: Cognitive Level: Apply REF: p. 124

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance
NOT: Herbal medicines may be valuable in treating dysmenorrhea; however, it is essential for women
to understand that these therapies are not without potential toxicity and may cause drug interactions.
2. ANS: E DIF: Cognitive Level: Apply REF: p. 124
3. ANS: D DIF: Cognitive Level: Apply REF: p. 124
4. ANS: A DIF: Cognitive Level: Apply REF: p. 124
5. ANS: C DIF: Cognitive Level: Apply REF: p. 124

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Chapter 06: Reproductive System Concerns

Lowdermilk: Maternity & Women’s Health Care, 11th Edition

1. Which condition is the least likely cause of amenorrhea in a 17-year-old client?

DIF: Cognitive Level: Remember REF: p. 121

2. When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic

3. Nafarelin (Synarel) is used to treat mild-to-severe endometriosis. What instruction or

DIF: Cognitive Level: Understand REF: p. 131

DIF: Cognitive Level: Remember REF: p. 122

6. Which symptom described by a client is characteristic of premenstrual syndrome (PMS)?

DIF: Cognitive Level: Apply REF: p. 125

DIF: Cognitive Level: Understand REF: pp. 126-127

DIF: Cognitive Level: Understand REF: p. 133

DIF: Cognitive Level: Remember REF: p. 135

DIF: Cognitive Level: Understand REF: p. 122

16. Which statement related to the condition of endometriosis is most accurate?

DIF: Cognitive Level: Understand REF: pp. 126-127

18. Management of primary dysmenorrhea often requires a multifaceted approach. Which

3. Which medications can be taken by postmenopausal women to treat and/or prevent

DIF: Cognitive Level: Apply REF: pp. 140-142

1. Fennel, dong quai

1. ANS: B DIF: Cognitive Level: Apply REF: p. 124

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