ADVENTIST MEDICAL CENTER COLLEGE

BRGY. SAN MIGUEL, ILIGAN CITY

SCHOOL OF NURSING

CARE OF MOTHER, CHILD, AND ADOLSECENT – SECTION A

Related Learning Experience (Clinical: DR)
First Semester, AY 2021 – 2022

Name of Students: ___________________________________ Date: _______ Score: 40 pts

Case Scenario #1: The Nursing Role in Reproductive and Sexual Health

AN ADOLESCENT IN NEED OF SAFER SEX COUNSELING

Andrea is a 20-year-old student you see at a college health clinic.

CHIEF CONCERN:
“I can’t stand up; I have such terrible cramps every month. I don’t do anything I’m not supposed
to do like eat sour things. Either give me something that works for pain or I’ll have to get
pregnant so I don’t have periods. Maybe hope for early menopause. And while we’re talking, my
sex life isn’t great. I don’t have orgasms. Do you think my boyfriend needs Viagra?”

HISTORY OF CHIEF CONCERN:

Andrea misses at least 1 day of school every month from menstrual period pain. Menarche was
at 16 years of age. Her usual pattern is 30 days interval with 7 days duration of menses.
Cramping begins at start of menses and lasts at least 24 hours. Her last menstrual period was 2
weeks ago. She takes an over-the-counter combination (acetylsalicylic acid, acetaminophen, and
caffeine) 10 g every 4 hours for pain.
The client has been sexually active for 4 months with a monogamous 18-year-old partner.
She states she knows safer sex practices. Her boyfriend uses condoms for both safer sex and their
reproductive life planning method.

FAMILY PROFILE:
She lives with parents and one male sibling, 12 years old, in a suburban community. Her father
works as garage mechanic; her mother as a receptionist at a real estate firm. She works part-time
as a member of a “garage band.” She describes family finances as, “We’re not rich, but okay.”

1
PAST MEDICAL ILLNESSES:
She had a surgery for appendectomy at 6 years of age. She had no complications. She had
chickenpox about age 7 years. She has “bad acne” since eighth grade. She has a “sensitive
stomach” or develops nausea easily.

HISTORY OF FAMILY ILLNESSES:

Her father had a left lung lobe removed for lung cancer followed by chemotherapy 2 years ago.
There is no apparent reoccurrence to date. A maternal aunt has valvular heart disease. A paternal
aunt had severe pelvic inflammatory disease with arthritis and is now undergoing fertility studies
for fallopian tube strictures.

DAY HISTORY:
Nutrition: 24-hour dietary recall:
Breakfast: 1 cup of coffee; 2 pieces pan de sal
Lunch: Fried chicken and rice; 1 glass cola
Dinner: 2 slices bread; 1 glass milk
Snacks: 1 bowl corn chips
Sleep: The patient sleeps 8 hours per night.
Recreation: She does not participate in any organized sports or club programs; she “does the
mall” with best girlfriend two to three times per week after school.
Growth and development: She is a college sophomore. She feels her development is “normal”
except “my breasts are so small, my boyfriend has bigger ones. So big, my mother says
he’s a transvestite. Do you think I’m too small to be able to breastfeed?” She is asking if
she should be on “the pill.” She states, “My boyfriend had a urinary tract infection last
month; maybe he’s sterile now so it doesn’t matter.”

REVIEW OF SYSTEMS:
Negative but for chief concern; she wears contact lenses to correct 20/70 vision. She has no
recent hearing examination or immunizations. She has not had HPV vaccine.

2
PHYSICAL EXAMINATION:
Height: 5 ft 5 in. (50%)
Weight: 120 lb (50%)
BMI: 20
General appearance: Tall, slim, pale-appearing young adult
Head: Normocephalic; numerous black comedones on erythematous bases present on forehead
Eyes: Red reflex present; pupils equal in size; react to light and accommodate
Ears: Normal alignment; tympanic membranes pink; landmarks present; responds to whispered
words
Nose: Midline septum; nares patent
Mouth and throat: Palate intact; lower third molars partially erupted; areas tender to touch;
midline uvula; gag reflex intact; tonsil issue not reddened
Neck: Full range of motion; one node palpable in left anterior chain; midline trachea: thyroid not
enlarged
Chest: Tanner 4; one supernumerary nipple present, 3 cm below right nipple; lung sounds
normal; respiratory rate: 22 breath/min
Heart: Rate: 72 beat/min; no murmurs
Abdomen: Bowel sounds heard in all 4 quadrants; no masses; neither spleen nor liver palpable
Genitalia: Normal female
Extremities: Full range of motion; ecchymotic area 2 cm × 2 cm on left knee
Neuro: Deep tendon reflexes 2+; sensory and motor responses grossly intact; normal gait and
responses to questions
Pelvic examination: Uterus slightly anteflexed; mild cystocele present

LABORATORY REPORTS:
Hemoglobin: 8.3 g/dl

Andrea is diagnosed as having iron-deficiency anemia and dysmenorrhea. She is prescribed an

oral iron supplement and advised to use ibuprofen (Motrin or Advil) for pain relief. She was also
counseled about safer sex practices, sexual response, and the symptoms of sexually transmitted
diseases.

3
STUDY QUESTIONS:
1. Andrea was advised to use a new analgesic. She was also found to have iron-deficiency
anemia and was asked to revisit in 1 month. Based on this, which would be the priority nursing
diagnosis for Andrea? (2 pts)
A. Ineffective health maintenance related to abnormal endothelial tissue
B. Pain related to uterine cramping from menstruation
C. Fear related to possible pregnancy
D. Anxiety related to lack of knowledge about menses

Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

2. Andrea’s menstrual cycle is 30 days duration with menses for 7 days. Based on this, you
should teach Andrea which of the following? (2 pts)
A. Her pattern is normal for a late adolescent or young adult female.
B. Her cycle is abnormally long and this is what is causing the pain.
C. Her cycle is shorter than usual so normal endometrium cannot form.
d. Seven days is a long menses so, of course, she will have some pain.

Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

3. Andrea has a normal amount of menstrual flow. Excessive menstrual bleeding is termed: (2
pts)
a. Menorrhagia.
b. Dysmenorrhea.
c. Dysfunctional bleeding.
d. Metrorrhagia.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

4
4. Why is ibuprofen usually an effective drug to relieve menstrual pain? (2 pts)
A. It shortens the length of menstrual periods.
B. It does not cause painful stomach irritation.
C. It reduces inflammation as well as reducing pain.
D. It is effective and is associated with a modest risk of developing dependence
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

5. Andrea tells you she might not be ovulating. Which of the following could you tell her is the
manifestation of ovulation? (2 pts)
A. Cervical mucus becomes thin and can be stretched
B. Negative ferning pattern
C. Decrease in the basal body temperature
D. Cervical mucus is stick and pasty
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
6. Andrea asked you when will be her ovulation if her menstrual cycle is 30 days. What will be
your best response? (2 pts)
A. You will have your ovulation on the 14th day prior to your next menstrual cycle.
B. You will have your ovulation on the 15th day prior to your next menstrual cycle.
C. You will have your ovulation on the 16th day prior to your next menstrual cycle.
D. You will have your ovulation on the 17th day prior to your next menstrual cycle.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
7. Andrea was diagnosed as having a mild cystocele. This is: (2 pts)
A. An outpouching of the bladder into the vagina.
B. A displaced or tilted uterus that causes pain.
C. An abnormality of the ureters near fallopian tubes.
D. A cervical lesion that leads to spotting or bleeding.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

5
8. Andrea asked if her boyfriend needs sildenafil (Viagra). This drug is prescribed for what
health problem? (2 pts)
A. A low sperm count
B. Erectile dysfunction
C. Urethral irritation
D. Premature ejaculation
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
9. Andrea is diagnosed as having an anteflexed uterus. You should recognize what implication of
this diagnosis? (2 pts)
A. Her uterine cervix is smaller than normally.
B. Her entire uterus is tipped forward.
C. The body of her uterus bends sharply forward.
D. Her uterus is positioned in front of the bladder.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
10. Andrea’s aunt was diagnosed as having arthritis. This will interfere with: (2 pts)
A. Sexual relations.
B. Menses.
C. Orgasm
D. Self-esteem
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
11. Andrea said her boyfriend has somewhat enlarged breasts. His health record would note the
presence of: (2 pts)
A. Gynecomastia.
B. Paraphilia.
C. Adrenophilia.
D. Estrogenic suppression.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

6
12. To obtain a sexual history on Andrea, what is the best question you should begin with? (2
pts)
A. Are you sexually active?
B. Are you worried you have AIDS?
C. Have you ever been pregnant?
D. How many boyfriends have you had?
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

13. Andrea is worried she won’t be able to breastfeed because her breasts are small. Your best
advice to her would be: (2 pts)
A. “You probably won’t be able to breastfeed, but there may be hope.”
B. “The size of breasts does not greatly affect breastfeeding success.”
C. “Women with small breasts are actually best at breastfeeding.”
D. “You might want to think about implants to enlarge your breasts.”
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
14. Suppose Andrea asks you which are her fertile days during a menstrual cycle. You would
explain to her that ovulation generally occurs at what time? (2 pts)
A. Fourteen days from the beginning of her cycle
B. The midpoint of her menstrual cycle
C. Five days after the menstrual flow
D. Fourteen days before the end of the cycle
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
15. You try to locate Andrea’s uterus by abdominal palpation. The uterus is normally shaped
like: (2 pts)
A. A pear
B. An almond
C. An orange
D. A mango

7
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
16. Andrea’s boyfriend recently had a bladder infection. She asked you if this could have
interfered with sperm production. You would explain sperm are produced in the: (2 pts)
A. Epididymis coronal cells.
B. Testes seminiferous cells.
C. Van deferens prostate cells.
D. Seminal vesicles cells.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

17. Andrea said that she did experience any orgasm. What physiologic changes will occur during
an orgasm? (2 pts)
A. Arterial dilation and venous constriction in the genital area
B. Clitoris drawn forward and retracts under prepuce and penile distension
C. Vigorous contractions of muscles in the female pelvic area and ejaculatory contractions for
the male
D. External and internal genital organs return to an unaroused state
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

18. Andrea states she hopes she’ll have early menopause. What will happen to the ovarian
function during menopause? (2 pts)
A. The time when a woman no longer has menstrual cycles and the production of ova stops.
B. The time when only 1000 ova are believed to be left undeveloped
C. The point at which ovaries become fibrotic and scarred
D. The point when the fimbria becomes thinned and nonfunctional
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

8
CORRECT ORDER QUESTION: (4 pts)
Direction: Arrange in proper order. There’s no need to rationalize and write the reference.
19. Order the usual stages of a sexual response.
A. Plateau
B. Excitement
C. Resolution
D. Orgasm
Answer: ___________________________________

Assessed by:

______________________
Name of Clinical Instructor