Nokea
A female patient tells the nurse that she thinks she has a vaginal infection because she has noted inflammation of her vulva and the presence of a frothy, yellow-green discharge. The nurse recognizes that the clinical manifestations described are typical of what vaginal infection?
- A. Trichomonas vaginalis
- B. Candidiasis
- C. Gardnerella
- D. Gonorrhea
Correct Answer: A
Rationale: The clinical manifestations indicate Trichomonas vaginalis, characterized by frothy, yellow-green discharge and vulvar inflammation, treated with metronidazole. Candidiasis produces a white, cheese-like discharge. Gardnerella is characterized by gray-white discharge. Gonorrhea often produces no symptoms.
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A patient has been diagnosed with endometriosis. When planning this patients care, the nurse should prioritize what nursing diagnosis?
- A. Anxiety related to risk of transmission
- B. Acute pain related to misplaced endometrial tissue
- C. Ineffective tissue perfusion related to hemorrhage
- D. Excess fluid volume related to abdominal distention
Correct Answer: B
Rationale: Endometriosis causes pain due to misplaced endometrial tissue, making acute pain a priority nursing diagnosis. It is not transmissible, so anxiety about transmission is irrelevant. Hemorrhage and fluid volume excess are not typical.
A public health nurse is participating in a campaign aimed at preventing cervical cancer. What strategies should the nurse include is this campaign? Select all that apply.
- A. Promotion of HPV immunization
- B. Encouraging young women to delay first intercourse
- C. Smoking cessation
- D. Vitamin D and calcium supplementation
- E. Using safer sex practices
Correct Answer: A,B,C,E
Rationale: Cervical cancer prevention includes HPV immunization, delaying first intercourse, smoking cessation, and safer sex practices to reduce HPV risk. Vitamin D and calcium supplementation are not relevant.
A student nurse is caring for a patient who has undergone a wide excision of the vulva. The student should know that what action is contraindicated in the immediate postoperative period?
- A. Placing patient in low Fowlers position
- B. Application of compression stockings
- C. Ambulation to a chair
- D. Provision of a low-residue diet
Correct Answer: C
Rationale: Sitting in a chair would place too much tension on the incision site and is contraindicated immediately post-surgery. Low Fowlers position reduces tension on the incision. Compression stockings prevent deep vein thrombosis, and a low-residue diet prevents straining during defecation.
A nurse is caring for a pregnant patient with active herpes. The teaching plan for this patient should include which of the following?
- A. Babies delivered vaginally may become infected with the virus.
- B. Recommended treatment is excision of the herpes lesions.
- C. Pain generally does not occur with a herpes outbreak during pregnancy.
- D. Pregnancy may exacerbate the mothers symptoms, but poses no risk to the infant.
Correct Answer: A
Rationale: In pregnant women with active herpes, babies delivered vaginally may become infected with the virus, posing a risk for fetal morbidity and mortality. Lesions are not controlled with excision. Itching and pain often accompany outbreaks. Pregnancy can exacerbate symptoms and poses risks to the infant if the virus is active during delivery.
The nurse is providing preoperative education for a patient diagnosed with endometriosis. A hysterectomy has been scheduled. What education topic should the nurse be sure to include for this patient?
- A. Menstrual periods will continue to occur for several months, some of them heavy.
- B. Normal activity will be permitted within 48 hours following surgery.
- C. After a hysterectomy, hormone levels remain largely unaffected.
- D. The bladder must be emptied prior to surgery and a catheter may be placed during surgery.
Correct Answer: D
Rationale: The intestinal tract and the bladder need to be empty before the patient is taken to the OR to prevent contamination and injury to the bladder or intestinal tract. The patient is informed that her periods are now over, but she may have a slightly bloody discharge for a few days. The patient is instructed to avoid straining, lifting, or driving until her surgeon permits her to resume these activities. The patients hormonal balance is upset, which usually occurs in reproductive system disturbances.