NU 664C/ NU 664C Exam 2 (2025/2026 UPDATE) – Family Psychiatric Mental Health II | Question & Answer | 100% Verified Solutions (Regis)

…..DLDD NU 664C/ NU 664C Exam 2 (2025/2026 UPDATE) – Family Psychiatric Mental Health II | Question & Answer | 100% Verified Solutions (Regis) Q. when does menarche typically begin? Answer 2-3 years after thelarche (breast buds) Q. thelarche Answer breast buds Q. average age of menarche in the US Answer 12-13 Q. what can lead to earlier menarche? Answer high BMI Q. what regulates the menstrual cycle? Answer HPO axis Q. three characteristics of menstrual bleeding Answer frequency, volume, length Q. normal menstrual bleeding frequency Answer 24-38 days with each new cycle within 7-9 days of the last Q. normal menstrual volume Answer 5-80 ml Q. normal length of menstruation Answer 4.5-8 days Q. what happens during follicular phase Answer hypothalamus releases gonadotropin releasing hormone anterior pituitary releases FSH and LH follicles start developing estrogen increases one follicle dominates and produces more estrogen other follicles go through atresia estrogen and LH levels peak 24 hrs before ovulation ovulation occurs Q. when does the luteal phase begin Answer with ovulation Q. what happens in the luteal phase Answer shift from estrogen to progesterone dominance follicle ruptures corpus luteum forms progesterone is produced the follicle ceases growth and endometrium secretes Q. how long is luteal phase Answer 14 days (14-28) Q. how long/when is follicular phase Answer days 1-14 Q. what triggers end of luteal phase and beginning of menses? Answer drop in progesterone (and estrogen too but less important) Q. what do estrogen levels do throughout follicular and luteal phases? Answer surges with ovulation (end of follicular phase and beginning of luteal phase) Q. what happens to the egg at the end of luteal phase and how long after ovulation does this change take place? Answer corpus luteum turns into corpus albicans approx 9-11 days after ovulation Q. what phase of the uterine cycle corresponds with the follicular phase of the ovarian cycle? Answer proliferative phase same time as follicular phase Q. what is happening to endometrium during proliferative phase and why? Answer surge in estrogen thickens endometrial lining to prepare for pregnancy also forms progesterone receptors to increase endometrial blood flow Q. what phase of the uterine cycle corresponds with the luteal phase of the ovarian cycle? Answer secretory phase same time as luteal phase Q. what is the first phase of the ovarian cycle and first phase of the uterine cycle? Answer follicular phase and proliferative phase Q. what is the second phase of the ovarian cycle and second phase of the uterine cycle? Answer luteal phase and secretory phase Q. what is happening to the endometrium during secretory phase and why? Answer progesterone causes endometrium to differentiate and secrete proteins that help with embryo implantation Q. what causes menstruation, aka sloughing of the endometrium? Answer end of secretory/luteal phase, drop in progesterone*** and estrogen Q. amenorrhea Answer absence of menstrual bleeding for 3 or more usual cycles Q. oligomenorrhea Answer infrequent menstrual bleeding happening greater than every 38 days Q. polymenorrhea Answer frequent menstrual bleeding happening 21-24 days or fewer Q. hypomenorrhea Answer regular menstrual bleeding less than normal volume Q. HMB Answer heavy menstrual bleeding greater than 80 ml per cycle or lasting longer than 7 days or irregular heavy bleeding Q. IMB Answer intermenstrual bleeding bleeding at any time in between normal cycles Q. primary amenorrhea Answer no menses by age 16 Q. reasons to evaluate 14 year old with no menses Answer hirsuitism Q. reasons to evaluate 13 year old with no menses Answer no breast buds at all Q. secondary amenorrhea Answer new onset of absence of menses 3+ months for hx of regular periods 6+ months for hx of irregular periods Q. differentials for primary amenorrhea Answer flow obstruction mullerian agenesis chromosomal (turners) androgen insensitivity Q. differentials for amenorrhea normal life changes vs abnormal underlying causes pregnancy (ectopic, MAB) Answer lactation menopause Q. thyroid dysfunction (hypo or hyper) Answer pituitary dysfunction (tumor such as prolactinoma) drug related hypothalamic (ED, athleticism, weight loss more than 10%) disease/stress (celiac, depression/anxiety, diabetes) congenital syndromes (rare) primary ovarian insufficiency (menopause is usually age 51) adrenal dysfunction (tumor or PCOS) anatomic abnormalities (asherman's) Q. most important/telling part of amenorrhea visit data Answer subjective history Q. what is virilization? Answer male sex characteristics hirsutism, alopecia, acne, voice changes Q. diagnostic tests for amenorrhea Answer hCG TSH and prolactin FSH, LH, estradiol DHEA-S, 17-OHP, testosterone, cortisol, fasting BG Q. TSH that would indicate hypothyroidism Answer usually above 4 Q. prolactin level that would indicate hyperprolactinemia Answer greater than 50 Q. HPO axis lab results that would indicate ovarian insufficiency Answer elevated FSH and LH low estradiol Q. which labs are drawn for evaluation of hypothalamic-pituitary-ovarian axis (HPO axis)? Answer FSH LH estradiol Q. HPO axis lab results that would indicate hypogonadotropic hypogonadism Answer low FSH, LH, and estradiol Q. HPO axis lab results that would indicate hypothalamic amenorrhea Answer low to normal FSH, LH, and estradiol Q. typical FSH Answer 5-20 mlU/ml Q. typical LH Answer 5-20 mlU/ml typical estradiol 25-75 pg/ml when in cycle to check HPO axis labs day 2-6 of menstrual cycle with day 1 being first day of period LH:FSH ratio that may be seen with PCOS 3:1 typical total testosterone 6.0-86 ng/dl typical free testosterone 0.7-3.6 pg/ml typical DHEA-S 35-430 ug/dl suspect adrenal tumor if above 700 typical prolactin less than 25 ng/ml meds that cause hyperprolactinemia antipsychotics antidepressants opiates antihypertensive agents GI meds chronic cannabis drugs that cause irregular menses cocaine chronic cannabis what is asherman's syndrome uterine scars from multiple D&Cs what is primary dysmenorrhea cramping/pain in lower abdomen associated with menstruation without evidence of pelvic pathology what is secondary dysmenorrhea cramping/pain in lower abdomen associated with pelvic pathology... often pain occurs even in between menstrual cycles what is the patho behind dysmenorrhea prostaglandins released during menstruation causes contractions of the uterus... when the uterus contracts, ischemia occurs and pain is felt sxs that often accompany dysmenorrhea N/V, diarrhea, H/A, malaise, fatigue physical exam findings for primary dysmenorrhea usually only tender uterus if no pelvic pathology possible exam findings for secondary dysmenorrhea r/t endometriosis nodularity, thickening, or focal tenderness of uterosacral ligament cervical stenosis fixed ovaries/uterus due to adhesions ovarian fullness diagnostic testing for sexually active woman with dysmenorrhea gonorrhea, chlamydia wet mount UA, UC pelvic U/S hCG differentials for secondary dysmenorrhea before diagnosis of primary dysmenorrhea can be made pelvic infection adenomyosis fibroid (leiomyoma) IUD polyps ovarian cysts MAB pelvic adhesions ectopic UTI kidney stone IBS constipation diverticulitis cervical stenosis endometrial/ovarian carcinoma retained tampon congenital abnormalities dermoid tumors lifestyle changes to help with dysmenorrhea and why they help exercise decreases prostaglandin release, decreases endometrial proliferation, and shunts blood away from uterus decrease salty food, increase water intake and fiber with fruits and veggies... natural diuretic heat applied to abdomen to relax muscles meds for dysmenorrhea NSAIDs COCs DMPA (good for endo) Implant (good for endo) IUD (good for endo) Vitamin B and magnesium what is PALM COEIN used for? AUB classification what does PALM COEIN stand for? Polyps Adenomyosis Leiomyoma Malignancy and hyperplasia Coagulopathy Ovulation dysfunction (can be r/t HPO axis, thyroid, or PCOS) Endometrial Iatrogenic (infection, meds, IUD) Not classified at what point should adolescents expect AUB to subside and why? by the third year before this, HPO axis is immature and it is likely bleeding up until this point has been anovulatory why is AUB seen in perimenopausal women? HPO axis fluctuations r/t decline in follicular number AUB physical exam VS pelvic exam: site of bleeding, appearance of cervix, characteristics of uterus (contour, size, tenderness) initial diagnostic testing AUB wet prep KOH (trich) updated pap (cervicitis r/t HPV) hCG CBC (anemia/thrombocytopenia) coags, factor VIII, and VW gonorrhea, chlamydia (cervicitis)... herpes??? TSH (hypo or hyper) prolactin (hyperprolactinemia from meds or pituitary tumor) DHEA-S (adrenal cancer) testosterone (PCOS) U/S endometrial biopsy hysteroscopy sonohysterogram D&C who is receiving an endometrial biopsy for AUB? *women over 45 with AUB (r/o endometrial cancer) women under 45 with risk factors (obesity, chronic anovulation, tamoxifen use, lynch or cowden syndrome) meds for active HMB, hemodynamically stable low dose COC twice daily (Q12) for 5-7 days followed by once daily for remainder of pack then withdrawal bleed then continue with the next pack once daily patch or ring mirena high dose POP TXA NSAIDs what would you suspect in an adolescent who has to be hospitalized to control HMB and needs a blood transfusion? coagulation disorder!!!!!!! surgical interventions for AUB myomectomy ablation uterine artery embolization hyst The nurse reviews the use of psychotherapy with a patient diagnosed with depression. Which patient statement should indicate to the nurse that teaching was effective? A. "I will respond differently than most to the medication." B. "I may sleep too much on this medication." C. "The medication cannot help motivate me." D. "I may not be able to tolerate the medication." C A preadolescent patient has had extreme mood changes at home and has become defiant. Which factor should the nurse consider for the changes in behavior? A. Depression B. Manic episode C. Substance abose D. Transient ischemic attack C After teaching a class on depression, the nurse asks the participants to name what should be avoided when taking antidepressant medication. Which participant response should the nurse question? A. "I can continue to drink beer because it doesn't interact negatively with my medication." B. "The healthcare provider should provide me with a list of things to avoid." C. "For some medications, I will need to change the foods that I eat." D. "The things to avoid will depend upon the medication." A The nurse is planning care for a client diagnosed with major depressive disorder. Which activity should the nurse encourage the patient to do based on the diagnosis? A. Listening to music B. Watching television C. Reading a book D. Playing a card game D The nurse is discussing major depressive disorder with a colleague. Which manifestation should the nurse include in this discussion? A. Pacing B. Slowed movements C. Hand writing D. Rapid speech B A patient is prescribed an antidepressant. Which information should the nurse include when instructing the patient about this medication? A. Nutritional deficiencies occur with this medication B. Antidepressant therapy is based on trial and error C. Antidepressant therapy is not effected by neurotransmission D. A double dose is required to be effective B In seasonal affective disorder (SAD), which body function is disrupted because of a decrease in serotonin levels and an increase in melatonin? A. Neurotransmitter activity B. Circadian rhythm C. Electrical conduction D. Nerve transmission B The nursing diagnosis of Violence: Self-directed, risk for is written on a patient's plan of care. Which health problem should the nurse associate with the nursing diagnosis? A. Postpartum depression B. Dysthymic disorder C. Major depressive disorder D. Seasonal affective disorder C The nurse implements interventions for a patient with major depressive disorder demonstrating an inability to care for self. Which data should indicate to the nurse that the outcome for this problem has been achieved? A. Completes shower and brushes teeth independently B. Identifies the importance of cognitive-behavioral therapy (CBT) C. Talks to nurse about suicidal ideations D. Attends yoga class A A patient with depression asks, "How did I get this illness?" Which response by the nurse is appropriate? A. "Your brain is different than most people's." B. "Your past drug use may have contributed to this diagnosis." C. "Drinking excessively has led to this diagnosis." D. "There is most likely a history of depression in your family." D The nurse suspects psychomotor retardation in a patient experiencing depression. Which finding should the nurse use to validate this suspicion? A. Wringing hands B. Pacing C. Slow speech D. Self-blame C The nurse considers encouraging a patient to increase the intake of vitamin D. For which disorder should the nurse provide this teaching? A. Anxiety B. Schizophrenia C. Major depressive D. BipolarC C The spouse of a patient with depression asks when the medication is "going to start working." Which should the nurse include in the response to the spouse? A. Question the spouse about what response they expect B. Explain that antidepressant therapy is trial and error C. Tell the spouse to contact the healthcare provider D. Suggest that the patient change antidepressant medication B A patient is diagnosed with persistent depressive disorder. Which data should the nurse collect when completing the patient's physical assessment? A. Vital signs B. Sleep disturbances C. Anxiety D. Medication use A The nurse is assessing a patient with seasonal affective disorder (SAD). Which intervention should the nurse expect to improve the patient's emotional stability? A. Massage therapy B. Electroconvulsive therapy C. Yoga D. Phototherapy D The nurse is caring for an adolescent patient diagnosed with depression. Which assessment finding should the nurse use to support this diagnosis? A. Self-neglect B. Threats to run away C. Boredom D. Whininess A The family of an older adult patient asks why the healthcare professional has diagnosed depression in the patient. Which response should the nurse make? A. "Immobility can cause sadness." B. "Medical reasons for fatigue and lack of appetite have been ruled out." C. "Physical therapy did not help." D. "Previously prescribed medication has been ineffective." B A patient is diagnosed with seasonal affective disorder (SAD). A lack of which environmental stimulus should the nurse suspect is causing this disorder? A. Nature B. Natural light C. Moonlight D. Clean air B A patient is taking a new medications for hypertension reports feeling depressed. Which medication should the nurse suspect is causing this patient's symptoms? A. Antibioitic B. Beta blocker C. Antihistamine D. Analgesic B A patient is prescribed electroconvulsive therapy (ECT) as treatment for severe depression. Which action should the nurse take to prepare the patient for these treatments? A. Maintaining overall patient safety B. Providing muscle relaxants during the procedure C. Giving a pulse of energy D. Delivering medication prior to the procedure to help the patient sleeo A A patient with depression asks why so much time is spent on a physical assessment. Which response should the nurse make to the patient? A. "Depressive disorders can present with a wide range of symptoms." B. "Depressive disorders are characterized by a textbook set of symptoms." C. "Depressive disorders are rate and very specific." D. "Symptoms of depressive disorders are very specific and easily articulated." A A patient with los self-esteem is diagnosed with situational depression. Which intervention should the nurse include in the plan of care? A. Provide negative reinforcement when needed B. Encourage to freely discuss negative feelings C. Teach coping mechanisms D. Isolate from others C A patient is feeling depressed, doesn't want to go to work, and feels disorganized. Which action should the nurse tak eto determine if the patient is experiencing grief or depression? A. Uncover the trigger B. Suggest counseling C. Look at the medication list D. Gather health history data A The nurse explains to new colleagues that the etiology of depression is complicated. Which statement by a colleague demonstrated understanding of this information? A. "Traumatic life events have no connection to depression." B. "Hormonal imbalances have some linkage to depression." C. "Genetics has minimal connection to depression." D. "Consistent biological rhythms connect to depression." B A child id demonstrating signs of depression. Which approach should the nurse focus on first? A. Ruling out physical illness B. Evaluating dietary habits C. Evaluating sleep patterns D. Discussing behavioral issues A