Nokea
A 32-year-old patient has minor changes on her Pap test. Which of the following actions should the nurse take?
- A. Teach the patient about colposcopy.
- B. Teach the patient about punch biopsy.
- C. Schedule another Pap test in 4 months.
- D. Administer the human papilloma virus (HPV) vaccine.
Correct Answer: C
Rationale: Patients with minor changes on the Pap test can be followed with Pap tests every 4-6 months because these changes may revert to normal. Punch biopsy or colposcopy may be used if the Pap test shows more prominent changes. The HPV vaccine may reduce the risk for cervical cancer, but it is recommended only for ages 9 through 26.
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A patient who is trying to become pregnant asks the nurse about ways to determine when she is most likely to conceive. Which of the following information is the basis of the nurses' response?
- A. Ovulation prediction kits provide accurate information about ovulation.
- B. Ovulation is difficult to predict unless she has regular menstrual periods.
- C. She will need to bring a specimen of cervical mucus to the clinic for testing.
- D. She should take her body temperature daily and have intercourse when it drops.
Correct Answer: A
Rationale: Ovulation prediction kits indicate when luteinizing hormone (LH) levels first rise. Ovulation occurs about 28-36 hours after the first rise of LH. This information can be used to determine the best time for intercourse. Body temperature rises at ovulation. Postcoital cervical smears are used in infertility testing, but they do not predict the best time for conceiving and are not obtained by the patient. Determination of the time of ovulation can be predicted by basal body temperature charts or ovulation prediction kits and is not dependent on regular menstrual periods.
The nurse is caring for a patient with persistent menorrhagia. Which of the following parameters should the nurse monitor?
- A. Estrogen level
- B. Complete blood count (CBC)
- C. Gonadotropin-releasing hormone (GnRH) level
- D. Serial β-human chorionic gonadotropin (hCG) results
Correct Answer: B
Rationale: Because anemia is a likely complication of menorrhagia, the nurse will need to check the CBC. Estrogen and GnRH levels are checked for patients with other problems, such as infertility. Serial β-hCG levels are monitored in patients who may be pregnant, which is not likely for this patient.
A patient tells the nurse that she needs something to control the negative mood associated with premenstrual dysphoric disorder (PMDD). Which of the following medications should the nurse anticipate administering to the patient?
- A. Potassium supplement
- B. Vitamin B6
- C. Folic acid
- D. Ibuprofen
Correct Answer: B
Rationale: To improve negative mood, vitamin B6 supplementation (50 mg daily) may be used. Calcium (not potassium) and magnesium supplementation may also be effective in alleviating psychological and physiological symptoms. For anxiety, buspirone taken during the luteal phase has helped some women. Women with PMDD may benefit from antidepressants, including fluoxetine HCl (Prozac) and tricyclic antidepressants (e.g., amitriptyline). Folic acid is not given for PMDD. NSAIDs will not have an effect on negative moods.
Which of the following information should the nurse include when teaching a 51-year-old female patient who is considering the use of combined estrogen-progesterone hormone therapy (HT) during menopause?
- A. Use of estrogen-containing vaginal creams provides most of the same benefits as oral HT.
- B. Use of HT for up to 10 years to prevent symptoms such as hot flashes is generally considered safe.
- C. HT decreases osteoporosis risk and increases the risk for cardiovascular disease and breast cancer.
- D. Increased incidence of colon cancer in women taking HT requires frequent stool assessment for occult blood.
Correct Answer: C
Rationale: Data from the Women's Health Initiative indicate an increased risk for cardiovascular disease and breast cancer in women taking combination HT but a decrease in hip fractures. Vaginal creams decrease symptoms related to vaginal atrophy and dryness, but they do not offer the other benefits of HT, such as decreased hot flashes. Most women who use HT are placed on short-term treatment and are not treated for up to 10 years. The incidence of colon cancer decreases in women taking HT.
Which of the following information should the nurse include when developing a teaching plan for a patient who is premenopausal with symptoms of uterine bleeding caused by a leiomyoma?
- A. Aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to control mild to moderate pain.
- B. The tumour size is likely to increase throughout the patient's lifetime.
- C. The symptoms may decrease after the patient undergoes menopause.
- D. The patient will need frequent monitoring to detect any malignant changes.
Correct Answer: C
Rationale: Leiomyomas appear to depend on ovarian hormones and will atrophy after menopause, leading to a decrease in symptoms. Aspirin use is discouraged because the antiplatelet effects may lead to heavier uterine bleeding. The size of the tumour will shrink after menopause. Leiomyomas are benign tumours that do not undergo malignant changes.