OB C-4 Assessment & Health Promotion
The uterus is a muscular pear-shaped organ that is responsible for:
- Cyclic menstruation.
- Sex hormone production.
- Sexual arousal.
The uterus is an organ for reception, implantation, retention, and nutrition of the fertilized ovum; it also is responsible for cyclic menstruation. Hormone production and fertilization occur in the ovaries. Sexual arousal is a feedback mechanism involving the hypothalamus, the pituitary gland, and the ovaries.
The hormone responsible for maturation of mammary gland tissue is:
Progesterone causes maturation of the mammary gland tissue,
specifically the lobules acinar structures. Estrogen increases the
vascularity of the breast tissue.
Prolactin is produced after birth and is released from the pituitary gland; it is produced in response to infant suckling and emptying of the breasts. Testosterone has no bearing on breast development.
Which statement about female sexual response is not accurate?
- Women and men are more alike than different in their physiologic responses to sexual arousal and orgasm.
- Vasocongestion is the congestion of blood vessels.
- The orgasmic phase is the final state of the sexual response cycle.
- Facial grimaces and spasms of hands and feet are often part of arousal.
Men and women are surprisingly alike. Arousal is characterized by increased muscular tension (myotonia). Vasocongestion causes vaginal lubrication and engorgement of the genitals. The final state of the sexual response cycle is the resolution phase after orgasm.
The nurse who provides preconception care understands that it:
- Is designed for women who have never been pregnant.
- Includes risk factor assessments for potential medical and psychologic problems but by law cannot consider finances or workplace conditions.
- Avoids teaching about safe sex to avoid political controversy.
- Could include interventions to reduce substance use and abuse.
Preconception care is designed for all women of childbearing potential. Risk factor assessment includes financial resources and environmental conditions at home and work. Health promotion can include teaching about safe sex. If assessments indicate a drug problem, treatment can be suggested or arranged.
A 62-year-old woman has not been to the clinic for an annual examination for 5 years. The recent death of her husband reminded her that she should come for a visit. Her family doctor has retired, and she is coming to see the women’s health nurse practitioner for her visit. To facilitate a positive health care experience, the nurse should:
- Remind the woman that she is long overdue for her examination and that she should come in annually.
- Listen carefully and allow extra time for this woman’s health history interview.
- Reassure the woman that a nurse practitioner is just as good as her old doctor.
- Encourage the woman to talk about the death of her husband and her fears about her own death.
The nurse has an opportunity to use reflection and empathy while listening and can ensure open and caring communication. Scheduling a longer appointment time may be necessary because older women may have longer histories or may need to talk. The comment in A is inappropriate. The client should be given positive reinforcement for coming in for her appointment even though it has been some time. A respectful and reassuring approach will ensure that women ages 50 and older will continue to seek care. The comment in C should be rephrased in a more positive manner. The nurse has an opportunity to use empathy and reflection; however, this is not the purpose of the client’s visit. If the client continues to express grief over the loss of her husband, she can be referred to an appropriate support group or counseling.
During a health history interview, a woman states that she thinks that she has “bumps” on her labia. She also states that she is not sure how to check herself. The correct response would be to:
- Reassure the woman that the examination will not reveal any problems.
- Explain the process of vulvar self-examination to the woman and reassure her that she will become familiar with normal and abnormal findings during the examination.
- Reassure the woman that “bumps” can be treated.
- Reassure her that most women have “bumps” on their labia.
During assessment and evaluation, the responsibility for self-care, health promotion, and enhancement of wellness is emphasized. The pelvic examination provides a good opportunity for the practitioner to emphasize the need for regular vulvar self-examination. Because the nurse is unsure of the cause of this client’s discomfort or the results of examination, any comments about findings or their treatment would be incorrect and inappropriate. The statement in D is not accurate and should not be used in this situation.
Which is correct concerning the performance of a Papanicolaou (Pap) test?
- The woman should not douche, use vaginal medications, or have intercourse for at least 24 hours before the test.
- It should be performed once a year beginning with the onset of puberty. Incorrect
- A lubricant such as Vaseline should be used to ease speculum insertion.
- The specimen for the Pap test should be obtained after specimens are collected for cervical infection.
Women should not douche, use vaginal medications, or have sexual intercourse for 24 hours before a Pap smear specimen is collected so as not to alter the cytology results. Also, only warm water should be used on the speculum so as not to alter the cytology results. The cytologic specimen should be obtained first. Pap tests are performed annually for sexually active women or by age 18, especially if risk factors for cervical cancer or reproductive tract infections are present. Pap tests may be performed every 3 years in low-risk women after three negative results on consecutive annual examinations.
The nurse-midwife is teaching a group of women who are pregnant about Kegel exercises. Which statement by a participant would indicate a correct understanding of the instruction?
- “I will see results only if I perform 100 Kegel exercises each day.”
- “I should hold the Kegel exercise contraction for 10 seconds and rest for 10 seconds between exercises.”
- “I should perform Kegel exercises only in the sitting position.”
- “I will perform daily Kegel exercises during the last trimester of my pregnancy to achieve the best results.”
Guidelines suggest that women perform between 30 and 80 Kegel exercises daily. The correct technique is to hold the contraction for at least 10 seconds and to rest for 10 seconds in between so the muscles can have time to recover and each contraction can be as strong as the woman can make it. The exercises are best performed in a supine position with the knees bent. Kegel exercises should be performed throughout the pregnancy to achieve the best results.
Which statements are true regarding the occurrence of obesity in the United States? (Select all that apply.)
- 25% of women in the United States are currently considered to be obese.
- Women in the age group 40 to 59 years have the highest prevalence.
- Obesity is associated with hypercholesterolemia.
- Obesity is associated with a decreased incidence of diabetes.
- Women who are obese may be more likely to have irregularities of the menstrual cycle.
2 3 5
More than 33% of women in the United States are currently considered to be obese. Obesity is associated with an increasedincidence of diabetes. The statements in B, C, and E are true according to reported evidence.