A nurse is reviewing the medical record of a client who has dysmenorrhea.
Which of the following should the nurse identify as a potential cause of this condition?
Polycystic ovarian syndrome (PCOS).
Lynch syndrome.
Endometriosis.
Use of combined oral contraceptives (COCs).
The Correct Answer is C
Choice A rationale
Polycystic ovarian syndrome is characterized by hormonal imbalances, irregular menstrual cycles, and excess androgen levels. While it can cause pelvic discomfort or heavy bleeding, it is not the classic cause of secondary dysmenorrhea. Instead, PCOS is frequently associated with anovulation and metabolic issues rather than the specific painful uterine contractions or structural obstructions found in conditions like endometriosis. It typically results in oligomenorrhea or amenorrhea rather than consistent painful menstruation.
Choice B rationale
Lynch syndrome is a hereditary condition that significantly increases the risk of various cancers, particularly colorectal and endometrial cancer. While individuals with Lynch syndrome require close monitoring of the reproductive tract, the syndrome itself is a genetic predisposition to malignancy rather than a direct cause of dysmenorrhea. Painful menstruation is usually a result of structural or inflammatory processes within the pelvic cavity rather than the presence of DNA mismatch repair mutations.
Choice C rationale
Endometriosis is a common cause of secondary dysmenorrhea where endometrial-like tissue grows outside the uterine cavity. This ectopic tissue responds to hormonal changes during the menstrual cycle, leading to internal bleeding, inflammation, and the formation of painful adhesions and scar tissue. The resulting inflammatory environment and prostaglandin release during menstruation cause intense pelvic pain that often exceeds the discomfort of primary dysmenorrhea. It is a leading structural cause of chronic pelvic pain.
Choice D rationale
Combined oral contraceptives are actually a primary treatment for dysmenorrhea rather than a cause. COCs work by suppressing ovulation and thinning the endometrial lining, which significantly reduces the production of prostaglandins. Prostaglandins are the primary chemical mediators responsible for uterine contractions and pain during menses. By lowering these levels, COCs effectively decrease the severity of menstrual cramps and flow, making them a therapeutic option rather than an etiological factor for the condition.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Not all over-the-counter medications are safe for the developing fetus, and this statement indicates a need for further teaching. Many common drugs, such as nonsteroidal anti-inflammatory drugs like ibuprofen, can cause serious issues like the premature closure of the ductus arteriosus in the third trimester. Every medication, including herbal supplements and vitamins, must be reviewed by a healthcare provider to ensure they do not have teratogenic effects or cause fetal physiological distress.
Choice B rationale
Working as a baggage screener at the airport may involve exposure to ionizing radiation, which is a known teratogen capable of causing birth defects, microcephaly, or childhood cancers. This statement shows an understanding that environmental and occupational hazards can impact fetal development. Pregnant individuals should minimize exposure to radiation and certain chemicals. Employers are generally required to provide safety data and accommodations to protect the health of the pregnant worker and the fetus.
Choice C rationale
While a maternal infection like strep throat requires treatment with pregnancy-safe antibiotics to prevent complications like rheumatic fever in the mother, the Streptococcus pyogenes bacteria itself is not typically associated with congenital birth defects. This differs from TORCH infections, such as rubella or cytomegalovirus, which are directly linked to structural abnormalities. The client's concern is valid regarding general health, but strep throat is not a primary cause of teratogenic malformations in the developing baby.
Choice D rationale
Limiting alcohol use to a few drinks a week is an incorrect understanding because there is no known safe amount of alcohol consumption during pregnancy. Alcohol is a potent teratogen that crosses the placenta freely, potentially leading to Fetal Alcohol Spectrum Disorders. These disorders can cause permanent cognitive impairment, growth restriction, and distinct facial dysmorphology. The only safe recommendation for a pregnant client is total abstinence from alcohol to ensure the best developmental outcomes.
Correct Answer is A
Explanation
Choice A rationale
The umbilical cord normally contains one umbilical vein and two umbilical arteries. The umbilical vein is responsible for carrying oxygenated, nutrient-rich blood from the placenta to the fetal liver and systemic circulation. This structure is central to fetal survival as it is the only source of oxygen for the developing fetus. In the cord, it is surrounded by Wharton's jelly, which provides structural support and prevents compression of the vessel during fetal movements.
Choice B rationale
This statement is incorrect because the ductus venosus is a fetal vascular shunt that allows oxygenated blood from the umbilical vein to bypass the liver and enter the inferior vena cava. The structure located between the pulmonary artery and the descending aorta is actually the ductus arteriosus. The ductus arteriosus serves to divert blood away from the non-functional fetal lungs. The ductus venosus ensures that highly oxygenated blood reaches the fetal heart and brain quickly.
Choice C rationale
The placenta is a temporary organ embedded in the maternal uterine wall, not inside the fetal heart. The structure located between the left and right atrium is the foramen ovale. The foramen ovale is an anatomical opening that allows blood to flow directly from the right atrium to the left atrium, bypassing the pulmonary circulation. The placenta facilitates the exchange of gases, nutrients, and waste products between the maternal and fetal blood through the umbilical vessels.
Choice D rationale
The ductus arteriosus is a blood vessel in the fetus connecting the pulmonary artery to the proximal descending aorta. It is not located on the uterine wall. The placenta is the structure that attaches to the uterine wall to facilitate maternal-fetal exchange. The ductus arteriosus is a critical component of the fetal circulatory system that normally closes shortly after birth in response to increased oxygen tension and decreased prostaglandin levels, becoming the ligamentum arteriosum.
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