Which assessment findings might raise the nurse's suspicion of endometriosis in the client they are evaluating?
Unexplained weight gain
Pain during menstrual period
Pain during intercourse
Infertility
Correct Answer : B,C,D
A. Unexplained weight gain
This is incorrect because weight gain is not a characteristic symptom of endometriosis. Endometriosis primarily affects the reproductive organs and is associated with pain and infertility rather than metabolic or weight-related changes.
B. Pain during menstrual period
This is correct because dysmenorrhea (painful menstruation) is a hallmark symptom of endometriosis due to the presence of ectopic endometrial tissue responding to hormonal changes.
C. Pain during intercourse
This is correct because dyspareunia (pain during intercourse) is a common symptom of endometriosis due to the inflammatory and fibrotic changes caused by ectopic endometrial tissue.
D. Infertility
This is correct because endometriosis can lead to infertility due to scarring, adhesions, and inflammation affecting the fallopian tubes and ovaries. Many clients with endometriosis seek medical attention due to difficulty conceiving.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. During the next attempt to get pregnant
This is incorrect because waiting until the next pregnancy increases the risk of congenital rubella syndrome in future pregnancies. The vaccine should be given immediately postpartum to provide immunity.
B. Immediately after delivery
This is correct because the rubella vaccine (MMR) is a live vaccine and is contraindicated during pregnancy due to teratogenic effects. It should be given postpartum before hospital discharge to prevent future rubella infections.
C. During the third trimester of pregnancy
This is incorrect because live vaccines are contraindicated in pregnancy due to the risk of fetal infection.
D. During the first trimester of pregnancy
This is incorrect because administering a live vaccine early in pregnancy is dangerous and could cause fetal harm or congenital anomalies.
Correct Answer is C
Explanation
A. "Presence of late decelerations with each contraction during monitoring."
Late decelerations indicate uteroplacental insufficiency, which can lead to fetal hypoxia and distress. This is not a reassuring sign.
B. "Increased fetal movement between contractions."
While fetal movement is a positive sign, it is not the best indicator of fetal well-being in labor. Continuous FHR monitoring provides a better assessment.
C. "Fetal heart rate of 160 beats per minute with moderate variability."
A normal fetal heart rate (FHR) is 110–160 bpm, and moderate variability (6–25 bpm fluctuations) indicates a well-oxygenated fetus with an intact autonomic nervous system.
D. "Fetal heart rate consistently below 120 beats per minute with no accelerations."
A persistent FHR below 110 bpm (bradycardia) or minimal variability suggests possible fetal compromise.
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