NUR114 CH3

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NUR114 CH3
2012-10-31 08:59:10
nur114e1 Common Concerns menstral infections breast

Common Concerns
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  1. Premenstrual syndrome
    is a condition in which physical and psychologic symptoms begin during the luteal phase of the menstrual cycle and resolve at the start of menses.
  2. Endometriosis
    is the presence and growth of endometrial tissue outside the uterus. The major symptoms are dysmenorrhea, infertility, and deep pelvic dyspareunia.
  3. Sexually transmitted infections (STIs)
    may be bacterial, viral, protozoal, or parasitic.
  4. Human immunodeficiency virus (HIV),
    which is a retrovirus, is transmitted primarily through the exchange of body fluids, such as semen, blood, and vaginal secretions.

    A retrovirus is an RNA virus that is duplicated in a host cell using the reverse transcriptase enzyme to produce DNA from its RNA genome. The DNA is then incorporated into the host's genome by an integrase enzyme. The virus thereafter replicates as part of the host cell's DNA. Retroviruses are enveloped viruses that belong to the viral family Retroviridae.
  5. The most effective way to prevent mother-to-newborn HIV transmission involves
    antiretroviral drug therapy for the mother during pregnancy, labor, and birth and antiretroviral drug therapy for the newborn after birth.
  6. the most common and the fastest spreading sexuallytransmitted infection among U.S. women.
    Chlamydial infection
  7. Sexually active women younger than age 20 aremost likely to become infected with
  8. Pelvic inflammatory disease
    is an infectious process most commonly affecting the uterine tubes and uterus. More rarely, it affects the ovaries and peritoneal surfaces.
  9. In the United States, one in X women develops breast cancer.
  10. For most women with stage I or II breastcancer, the primary therapy is
    breastconserving surgery with axillary lymphnode sampling followed by radiation therapy.
  11. A simple mastectomy is
    is the removal of the breast containing thetumor.
  12. A modified radical mastectomy is
    the removal of the breast tissue, skin, andfascia of the pectoralis muscle and dissection of the axillary nodes.
  13. A radical mastectomy is A and it is B
    • A) the removal of the breast and underlying pectoralis muscles and complete axillary node dissection.
    • B) rarely preformed
  14. An effective relief measure for primary dysmenorrhea would be to:

    A. Reduce physical activity level until menstruation ceases.
    B. Decrease intake of salt and refined sugar about 1 week before menstruation is about to occur.
    C. Use barrier methods rather than the oral contraceptive pill (OCP) for birth control.
    D. Begin taking prostaglandin synthesis inhibitors on the first day of the menstrual flow.
    B. Decrease intake of salt and refined sugar about 1 week before menstruation is about to occur.

    Staying active is helpful because it facilitates menstrual flow and increases vasodilation to reduce ischemia.  Prostaglandin inhibitors should be started a few days before the onset of menstruation.  Decreasing intake of salt and refined sugar can reduce fluid retention.  OCPs are beneficial in relieving primary dysmenorrhea because they result in inhibition of ovulation and prostaglandin synthesis.
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  15. Self-care instructions for a woman following a modified radical mastectomy would include that she should:

    A. Wear clothing with snug sleeves to support her affected arm.
    B. Use depilatory creams instead of shaving the axilla of her affected arm.
    C. Expect a decrease in sensation or tingling in her affected arm as her body heals.
    D. Empty surgical drains once a day or every other day.
    C. Expect a decrease in sensation or tingling in her affected arm as her body heals.

    Loose clothing should be worn because tight clothing could impede circulation in the affected arm.  The axilla of the affected arm should not be shaved nor should depilatory creams or strong deodorants be used after this surgery.  A decrease in sensation and tingling in the affected arm and in the incision are expected for weeks to months after the surgery.  Drains should be emptied at least twice a day and more often if necessary.
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  16. When providing care to a young single woman just diagnosed with acute pelvic inflammatory disease, the nurse should:

    A. Tell her that antibiotics need to be taken until pelvic pain is relieved.
    B. Explain to the woman that infertility is a likely outcome of this type of infection.
    C. Point out that inappropriate sexual behavior caused the infection.
    D. Position the woman in a semi-Fowler position.
    D. Position the woman in a semi-Fowler position.

    Although sexual behavior may have contributed to the infection, the nurse must discuss these practices in a nonjudgmental manner and provide information about prevention measures.  The position of comfort is the semi-Fowler position. In addition, the foot of the bed could be elevated to keep the uterus in a dependent position and thus reduce discomfort.  Until treatment is complete and healing has occurred, the outcome is unknown and should not be suggested.  The nurse should emphasize that medication must be continued until follow-up assessment indicates that the infection has been treated successfully.
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  17. A causes B cases of all PID
    • A) C. trachomatis
    • B) 1/2

    • Can affect uterus (endometriosis) or
    • uterine tubes (salpingitis)
  18. The CDC-recommended medication for the treatment of chlamydia is:

    A. Doxycycline.
    B. Podofilox.
    C. Acyclovir.
    D. Penicillin.
    A. Doxycycline.

    Doxi 100mg q12hr for 7 days OR
    azithromysin 1g po taken ONCE

    Doxycycline is effective for treating chlamydia, but it should be avoided if the woman is pregnant.   

    Podofilox is a recommended treatment for nonpregnant women diagnosed with human papilloma virus infection. 

    Acyclovir is recommended for genital herpes simplex virus infection. 

    Penicillin is not a CDC-recommended medication for chlamydia; it is the preferred medication for syphilis, i.e. benzathine penisillin G 2.4M units im. For Jarisch-Herxheimer reaction, tx with analgesics and antipyretics
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  19. The viral sexually transmitted infection (STI) that affects most people in the United States today is:

    A. Human immunodeficiency virus (HIV).
    B. Herpes simplex virus type 2 (HSV-2).
    C. Human papillomavirus (HPV).
    D. Cytomegalovirus (CMV).
    C. Human papillomavirus (HPV).

    HSV-2 is a viral STI, but it is not the most prevalent viral STI.  HPV infection, an STI, is the most prevalent viral STI seen in ambulatory health care settings.  HIV is a viral STI, but it is not the most prevalent viral STI.  CMV is a viral STI, but it is not the most prevalent viral STI.
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  20. Podophyllin is
    a solution used in the treatment of human papilloma virus.
  21. Ofloxacin is
    an antibacterial treatment for gonorrhea

    • One dose:
    • ceftriaxone 125mg im
    • cefixime 400mg po
  22. Acyclovir is
    an antiviral treatment for HSV (Herpes).
  23. The recommended treatment for the prevention of human immunodeficiency virus (HIV) transmission to the fetus during pregnancy is:

    A. Ofloxacin.
    B. Zidovudine.
    C. Acyclovir.
    D. Podophyllin.
    B. Zidovudine.

    Acyclovir is an antiviral treatment for HSV (Herpes). 

    Ofloxacin is an antibacterial treatment for gonorrhea. 
    One dose:
    ceftriaxone 125mg im
    cefixime 400mg po

    Podophyllin is a solution used in the treatment of human papilloma virus. 

    Perinatal transmission of HIV has decreased significantly in the past decade as a result of prophylactic administration of the antiretroviral drug zidovudine to pregnant women in the prenatal and perinatal periods.
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  24. Fibrocystic changes in the breast most often appear in women in their 20s and 30s. The etiology is not known, but it may be an imbalance of estrogen and progesterone. The nurse who cares for this patient should be aware that treatment modalities are conservative. One proven modality that may provide relief is:

    A. Increased vitamin C supplementation.
    B. Diuretic administration.
    C. Including caffeine daily in the diet.
    D. Application of cold packs to the breast as necessary.
    B. Diuretic administration.

    Diuretic administration plus a decrease in sodium and fluid intake are recommended.  Although not supported by research, some advocate eliminating dimethylxanthines (caffeine) from the diet. Smoking should also be avoided, and alcohol consumption should be reduced.  Vitamin E supplements are recommended; however, the patient should avoid megadoses because this is a fat-soluble vitamin.  Pain relief measures include applying heat to the breast, wearing a supportive bra, and taking nonsteroidal antiinflammatory drugs.
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  25. Abnormally light or infrequent menstruation
  26. Abnormal bleeding from theuterus, particularly when it occurs at anyother than the menstrual period
  27. Abnormally profuse or excessive menstrual flow
  28. Tx of Primary dysmenorrhea
    Heat (heating pad or hot bath) minimizes cramping by increasing vasodilation and muscle relaxation  as well as minimizing uterine ischemia
  29. Cause of Primary dysmenorrhea
    Excessive release of PG (prostraglandins), specificaaly PG F2-alpha
  30. CPPD
    Cyclic Perimenstrual Pain and Discomfort includes

    • dysmenorrhea
    • PMS
    • prementrual dysphoric disorder
  31. a medically recognized mental and emotional condition in which a person experiences intense feelings of depression, discontent, and in some cases indifference to the world around them.
  32. Possible causes of amenorrhea due to hypothalamic disturbances
    May include stress  or weight loss for nonorganic reasons
  33. If non-Rx methods of managing PMS don't work after 1-2 months...
    • diuretics
    • PG inhibitors (NSAIDs)
    • progesterone and OCP
    • selective serotonin reuptake inhibitors such as Fluoxetine (Sarafem or Prozac)
  34. Tx of PMS
    Don't smoke

    • Reduce
    • sugar
    • salt
    • red meat
    • alcohol
    • caffein

    • Add
    • Diet & exercise
    • Calcium (100-1200mg daily)
    • Magnesium (300-400mg daily)
    • Vitamin B6 (100-150mg daily)
    • Evening primrose oil
  35. PMDD affects A% of women 
    A) 3%-8%

    Premenstrual Dysphoric Disorder
  36. Tx dysmenorrhea with
    • ibupropgen
    • naproxen sodium
  37. Secondary dysmenorrhea
    menstralk pain that develops later in life, typically after 25. It is associated with pelvic abnormalities, e.g. adenomyosis*, endometriosis, PID, uterine fibroids or the use of an IUD.

    Tx the underlying pathology

    * - Adenomyosis: presense of ectopic glandular tissue found in muscle. The term adenomyosis is derived from the terms adeno- (meaning gland), myo- (meaning muscle), and -osis (meaning condition). Previously named as endometriosis interna, adenomyosis actually differs from endometriosis and these two disease entities are found together in only 10% of the cases.
  38. A 6-12 month sessation of mensus after a period of menustration
    secondary amenorrhea
  39. Absense of mensus by age 16-1/2 regardless of the presense of normal growth
    primary amenorrhea
  40. Infection of internal reproductive structures and adjacent tissues usually secondary to sexually transmitted infections
    pelvic inflammatory disease (PID)
  41. Painful menstruation beginninq 2 to 6 months after menarche, related to ovulation or to organic disease such as endometriosis, pelvic inflammatory disease or uterine neoplasm
  42. Uterine fibroids occur in A% of women of reproductive age and is B in African-Ameican compared to Caucasian or Hispanic women.
    • A) 25%
    • B) higher
  43. Dyspareunia 
    is painful sexual intercourse
  44. A patient has been prescribed adjuvant tamoxifen therapy. What common side effects might she experience?

    A. Hot flashes, weight gain, and headaches
    B. Nausea, vomiting, and diarrhea
    C.  Nausea, hot flashes, and vaginal bleeding
    D. Vomiting, weight loss, and hair loss
    C.  Nausea, hot flashes, and vaginal bleeding

    Common side effects of tamoxifen therapy include hot flashes, nausea, vomiting, vaginal bleeding, menstrual irregularities, and rash.  Weight loss and hair loss are not common side effects of tamoxifen.  Diarrhea is not a common side effect of tamoxifen.  Weight gain and headaches are not common side effects of tamoxifen.
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