The Stages of Reproductive Aging Workshop [STRAW] staging system was developed based upon data from multiple longitudinal cohort studies. It is considered the gold standard for characterizing reproductive aging from the reproductive years through menopause and includes criteria for the reproductive years, the menopausal transition, perimenopause, final menstrual period [FMP], and postmenopause based upon bleeding patterns, endocrine findings, and symptoms. The menopausal transition and postmenopause are further subdivided into "early" and "late" stages.
Of note, the STRAW staging criteria are not considered to represent diagnostic criteria for the menopausal transition or menopause, primarily because they include endocrine data [follicle-stimulating hormone [FSH], inhibin B, anti-müllerian hormone [AMH]] and pelvic ultrasound [antral follicle count [AFC]] as supportive criteria when determining reproductive stage.
1] Women with underlying menstrual cycle disorders — The diagnosis of menopausal transition is more difficult, and the STRAW staging system does not apply to women with underlying menstrual disorders such as polycystic ovary syndrome [PCOS] or hypothalamic amenorrhea. For women with either diagnosis who develop menopausal symptoms, measure FSH concentration for diagnostic purposes.
2] Women taking oral contraceptives — Oral estrogen-progestin contraceptives are considered to be safe in nonsmokers up to the age of menopause [average age 50 to 51 years]. Women taking them want reassurance that they are postmenopausal before stopping. However, it is difficult to determine if menopause has occurred because these women do not develop the irregular bleeding or vasomotor symptoms that are typical of the menopausal transition. In addition, because their hypothalamic-pituitary axis is suppressed by the high dose of exogenous estrogen, measurement of the serum FSH level is unreliable.
3] Post-hysterectomy or endometrial ablation — Menopause in women who have undergone hysterectomy or endometrial ablation cannot be determined using menstrual bleeding criteria. Therefore, supportive criteria, including assessment of menopausal symptoms and biochemical data, are needed. In this setting, measure FSH concentrations.Hyperthyroidism should always be considered in the differential diagnosis, as irregular menses, sweats [although different from typical hot flashes], and mood changes are all potential clinical manifestations of hyperthyroidism.
We suggest against the use of custom-compounded bioidentical hormone therapy as there is no evidence for their safety or efficacy when compared with approved and commercially available products for menopausal hormone therapy [MHT]. The term "bioidentical hormone" technically refers to a hormone with the same molecular structure as a hormone that is endogenously
produced [eg, 17-beta estradiol]. However, in popular culture, the term refers to the use of custom-compounded, multihormone regimens [pills, gels, sublingual tablets, or suppositories] with dose adjustments based upon serial hormone monitoring. The hormones most commonly compounded are estradiol, estrone, estriol, progesterone, testosterone, and dehydroepiandrosterone [DHEA].
Many postmenopausal women are turning to this approach because of safety concerns about conventional hormone
preparations. However, there are no large clinical trials that have determined the efficacy, safety, or adverse effects of these preparations
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Terms in this set [36]
A woman experiencing menopause has been placed on hormone replacement therapy [HRT] by her health care provider. What information regarding HRT should the nurse provide the client?
"Hormone replacement therapy is safe for long-term use."
"Hormone replacement therapy will assist in alleviating severe manifestations when used on a short-term basis."
"You will find that HRT will improve bone density and serum lipids.close double quote"
"You can stay on HRT as long as you need it."
b
A 34-year-old client presents to the family practice clinic with complaints of not having a menstrual period in the past 14 months. What data should the nurse obtain when performing a physical examination on the client?
Menstrual history
Weight and height
Sexual history
Drug and alcohol use
b
A 52-year-old woman complains of hot flashes, night sweats, irritability, decreased vaginal lubrication, and no menstrual period in the past 15 months. Over the past several weeks, the hot flashes and night sweats have increased in frequency, and she has noticed that she is more irritable. Laboratory values reveal
increased follicle-stimulating hormone and luteinizing hormone levels. Which intervention should the nurse initiate?
[Select all that apply.]
Instructing the client to avoid over-the-counter vaginal lubricants
Providing information about medications that might be prescribed to help with menopausal symptoms
Explaining such physiological manifestations of menopause as hot flashes and night sweats
Encouraging discussion of how menopausal symptoms are affecting sexual functioning
Asking open-ended questions about the client's body image
b c d e
The nurse is teaching a woman about the hormonal changes that occur during menopause. Which hormonal change would the nurse state is responsible for the symptoms of menopause?
Decreased luteinizing hormone
Decreased estrogen
Decreased follicle-stimulating hormone
Decreased progesterone
b
A client has been diagnosed with menopause and is complaining of increased severity of manifestations. Which treatments can be used for the treatment of menopausal symptoms?
[Select all that apply.]
Hormone replacement therapy
Gabapentin [Neurontin]
Acupuncture
Herbs
Bioidentical hormones
a c d e
The nurse is discussing menopause with a 40-year-old client. During this discussion, the nurse identified which factor that determines when perimenopause may occur?
Alcohol use
Genetics
Age of menarche
Being sexually active
b
Which psychological manifestation is not associated with perimenopause?
Loss of libido
Mood swings
Forgetfulness
Anxiety
d
What are the clinical manifestations of menopause?
[Select all that apply.]
Vaginal dryness
Headaches
Cold intolerance
Thinning hair
Hot flashes
a b d e
Which medication is used off-label to reduce the occurrence of hot flashes associated with menopause?
Raloxifene [Evista]
Triphenylethylene [Tamoxifen]
Venlafaxine [Effexor]
Levothyroxine [Synthroid]
c
Which treatment is considered an alternative or complementary therapy in managing a menopausal client?
[Select all that apply.]
Yoga
Hormone replacement therapy
Bioidentical hormones
Massage
Herbs
a c d e
A female
client presents to her healthcare provider's office with manifestations of menopause. What are the vasomotor manifestations of menopause?
[Select all that apply.]
Night sweats
Decreased body hair
Palpitations
Dizziness
Hot flashes
a c d e
Which nursing diagnosis should the nurse include when planning care for a client experiencing menopause?
[Select all that apply.]
Increased risk of low self-esteem
Altered sleep pattern
Constipation
Potential for urinary dysfunction
Impaired mood
a b d e
A client is diagnosed as perimenopausal. Which psychological manifestation is the client most likely experiencing?
Increased vaginal pH
Fatigue
Decreased skin elasticity
Irritability
b
The nurse is providing education to a client who has been diagnosed with menopause. Which health promotion intervention should the nurse discuss with the client?
[Select all that apply.]
Participating in yoga classes
Wearing tight clothing
Doing Kegel exercises
Avoiding alcohol and cigarette use
Eating a balanced diet that includes fruits, vegetables, and high-fiber foods
a c d e
A woman experiencing perimenopausal symptoms asks the nurse what she can do to help control the symptoms. What interventions should the nurse recommend?
[Select all that apply.]
Keep the bedroom cool
Avoid sexual intercourse
Dress in layers
Increase caffeine intake
Start a regular exercise routine
a c e
The nurse is providing home care instructions to a client experiencing menopause. Which activity will assist in managing mood swings?
Keeping the bedroom cool
Performing deep breathing exercises
Doing Kegel exercises
Avoiding cigarettes
b
The nurse is teaching a group of adolescents about safer and more responsible sex practices. In addition to discussing abstinence, which information is the most appropriate for the nurse to include in the session?
Responsible sex involves knowing who your partner had sex with in the immediate past.
Engaging in sex is a personal choice that you should prepare for without ever feeling pressured by another.
Having sex with someone you love shows the partner that you are committed to staying with him or her for the long term.
Safer sex includes applying spermicides on female genitalia to reduce transmission of infections before intercourse.
b
After a nurse has completed discharge teaching, which statements made by a client treated for genital herpes would indicate that discharge instructions were understood?
[Select all that apply.]
"I don't need to use a condom."
"I'm glad the medication prescribed will cause this infection to be cured."
"I understand this antiviral medication will help shorten and prevent outbreaks."
"I will notify my sex partners so they can get treatment."
"I'll try to keep my stress level down."
c d e
The nurse is caring for an adolescent client who has been diagnosed with an STI. For which problem should the nurse assess this client?
[Select all that apply.]
Deficient knowledge
Disturbed body image
Risk of altered parenting
Impaired skin integrity
Pain
a b d e
The nurse is interviewing a client newly diagnosed with syphilis. Which nursing action is most important to control the spread of the infection?
Obtaining a list of the client's sexual contacts.
Motivating the client to undergo treatment.
Reassuring the client that records are confidential.
Increasing the client's knowledge of the infection.
a
The nurse is caring for a female client with possible chlamydia. With which sign or symptom is this client most likely to present?
Urethritis
Cervicitis
No specific symptoms
Pelvic inflammatory disease
c
When educating a female client with gonorrhea, the nurse should emphasize which information is true about women with gonorrhea?
It does not lead to serious complications.
It may not cause symptoms until serious complications occur.
It can be treated but not cured.
It is often marked by symptoms of dysuria or vaginal bleeding.
b
Which information regarding safer and more responsible behavior should the nurse provide when counseling adolescent clients who have chosen to be sexually active?
[Select all that apply.]
You can choose to say 'No' to sex, even if your long-term partner says that your relationship has matured beyond the mutual masturbation stage
Latex condoms lubricated with petroleum jelly provide for comfort and additional barrier protection
Insist that your opposite sex partner use birth control to reduce the risk of HIV
Women should carry and use female condoms.
If your partner insists on having sex even though you don't want to, you should comply to show you really love him
a d
The nurse is educating a group of adolescent clients about STIs. The nurse has divided the infections into two groups: bacterial and viral. Which infection should the nurse discuss when teaching about viral STIs?
Chlamydia
Syphilis
Herpes
Gonorrhea
c
The nurse counsels a group of pregnant women about potential complications to unborn children that result from untreated sexually transmitted infections. What information will the nurse include in the presentation?
Newborns born to mothers with Human Papillomavirus [HPV] are at risk for wart formation later in life
The fetus is protected from any complication related to an untreated sexually transmitted infection if it is born by Cesarean section
There is a 75% chance of fetal anomalies if the mother has genital herpes during pregnancy
Congenital syphilis is transferred to the fetus through the placental circulation
d
Which behavior exhibits irresponsible sexual behavior?
Verbalizing how to identify the warning signs of dating violence and date rape
Examining one's own readiness to engage in intimate behavior with another
Engaging in sex with an untreated partner
Considering one's own thoughts and feelings associated with sexual behavior
c
What abnormal finding of the female genitalia is represented by painless, wartlike growths on the vulva, inner vagina, and cervix?
Pediculosis pubis
Syphilitic lesion
Human papillomavirus
Fluid-filled blisters
c
Which statements
regarding syphilis are true?
[Select all that apply.]
It has an incubation period of 10 to 90 days.
Only women are at risk for syphilis.
It spreads through the body by way of blood and lymph.
It is contracted by unprotected sex.
It is only contracted through anal sex.
a c d
The nurse is providing care in an outpatient clinic for an adolescent female who has been diagnosed with a sexually transmitted infection [STI]. When providing care, it is important for the nurse to carry out which action?
Telling the adolescent that she does not need to notify any sexual partners
Notifying the adolescent's family of the STI
Being judgmental when providing education
Encouraging the client to receive the hepatitis B vaccination
d
The community nurse is teaching a group of clients about STIs. Which client is at the greatest risk for contracting an STI?
An older adult female client, age 65
A married male client, age 50
An adolescent male client, age 17
A divorced female client, age 32
c
The nurse is caring for an adolescent client who has been diagnosed with chlamydia. Which treatment option is most appropriate for this client?
A single oral dose of metronidazole or tinidazole
A single dose of oral cefixime
Doxycycline hyclate or erythromycin for 7 days
A single dose of intramuscular ceftriaxone
c
The nurse is teaching an adolescent client about decreasing the risk of cervical cancer. Which information is most important for the nurse to include in this session?
Encouraging administration of the human papillomavirus [HPV] vaccine
Avoiding all sexual contact
Completely treating both partners when one is diagnosed with an STI
Completing all medication as prescribed
a
The nurse is educating a group of adolescents on ways to decrease the risk of contracting an STI. Which information should the nurse include in the session?
"STIs can be contracted by oral sex."
"STIs can be contracted from shared towels."
"STIs can be contracted from toilet seats."
"STIs can be contracted by sharing drinking glasses."
a
The nurse is caring for a female adolescent who has been diagnosed with gonorrhea. The client will be placed on oral antibiotic therapy. The nurse knows that the adolescent has understood the teaching when she makes which statement?
"I will need to come back to the healthcare center in 12 hours for my second dose of oral antibiotics."
"I will need to have an injection of penicillin G."
"I will need to take this one dose with food."
"I will need to take all my medication as prescribed."
d
Which teaching about reducing the risk of sexually transmitted infections [STIs] should the nurse provide to sexually active adolescent male clients?
Condoms should be used for every sexual encounter"
An initial HIV test result needs to be followed up with a retest exactly 1 month after the initial test
Natural or animal-skinned condoms feel more comfortable than latex versions
Application of petroleum jelly to the condom provides an additional barrier
a
A 24-year-old sexually active female client comes to the clinic with a complaint
of burning on urination and a vaginal discharge. Documentation on the client's chart should include which information?
[Select all that apply.]
History of unprotected sex
Allergies to any medications
History of fever or chills
Length of time since symptoms presented
Names and phone numbers of all sexual contacts
a b c d
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