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A nurse practitioner is preparing to perform a patients scheduled Pap smear and the patient asks the nurse to ensure that the speculum is well-lubricated. How should the nurse proceed with assessment?
- A. Reassure the patient that ample petroleum jelly will be used.
- B. Reassure that patient that a water-based lubricant will be used.
- C. Explain to the patient that water is the only lubricant that can be used.
- D. Explain to the patient why the speculum must be introduced dry.
Correct Answer: C
Rationale: Because lubricants may obscure cells on a Pap smear, warm water is the only lubricant that can be used to facilitate speculum insertion without compromising test results. Petroleum jelly and water-based lubricants can interfere with cell collection, and a dry speculum may cause discomfort and is not preferred.
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A nurse presenting an educational event for a local community group is addressing premenstrual syndrome (PMS). What treatment guideline should the nurse teach this group?
- A. Avoid excessive fluid intake.
- B. Increase the frequency and intensity of exercise.
- C. Limit psychosocial stressors in order to reduce symptoms.
- D. Take opioid analgesics as ordered.
Correct Answer: B
Rationale: In general, the patient is encouraged to increase or initiate an exercise program to help relieve symptoms of PMS. Increased fluid intake is recommended, not avoidance. Opioids are not used to treat PMS, and while stress reduction has general benefits, it is not specifically noted to alleviate PMS symptoms.
The nurse is being trained to perform assessment screenings for abuse on patients who come into the walk-in clinic where the nurse works. Which of the following assessment questions is most appropriate?
- A. Would you describe your relationship as healthy and functional?
- B. Have you ever been forced into sexual activity?
- C. Do you make your husband uncontrollably angry?
- D. How is conflict usually handled in your home?
Correct Answer: B
Rationale: Asking about abuse directly, such as inquiring about forced sexual activity, is effective in identifying the presence of abuse and should be included in the health history of the patients. Oblique questions that relate to the character of the relationship or conflict resolution are less useful clinically. Asking about making a partner angry is inappropriate as it implies blame and does not directly screen for abuse.
The nurse is working with a couple who have been unable to conceive despite more than 2 years of trying to get pregnant. The couple has just learned that in vitro fertilization (IVF) was unsuccessful and they are both tearful. What nursing diagnosis is most likely to apply to this couple?
- A. Hopelessness related to failed IVF
- B. Acute confusion related to reasons for failed IVF
- C. Compromised family coping related to unsuccessful IVF
- D. Moral distress related to unsuccessful IVF
Correct Answer: A
Rationale: The couple's tearful response to a failed IVF suggests hopelessness, a likely emotional reaction to the loss of a promising intervention. Acute confusion implies cognitive impairment, compromised coping is less specific, and moral distress is unrelated to the scenario.
A premenopausal patient is complaining of vaginal spotting and sharp, colicky lower abdominal pain. She informs the nurse that her period is 2 weeks late. The nurse should recognize a need for this patient to be investigated for what health problem?
- A. Trichomonas vaginalis
- B. Ectopic pregnancy
- C. Cervical cancer
- D. Fibromyalgia
Correct Answer: B
Rationale: Clinical symptoms of an ectopic pregnancy include delay in menstruation of 1 to 2 weeks, vaginal spotting, and sharp, colicky pain. These symptoms align with the patient's presentation, warranting investigation for this condition. Trichomonas vaginalis causes vaginal infection, typically with discharge, not typically associated with delayed menstruation or colicky pain. Cervical cancer may cause abnormal bleeding but is less likely to present with acute colicky pain and delayed menstruation. Fibromyalgia is unrelated to menstrual irregularities or vaginal spotting.
A 36-year-old woman comes to the clinic complaining of premenstrual syndrome (PMS) that is disrupting her quality of life. What signs and symptoms are associated with this health problem? Select all that apply.
- A. Loss of appetite
- B. Breast tenderness
- C. Depression
- D. Fluid retention
- E. Headache
Correct Answer: B,C,D,E
Rationale: Physiologic symptoms of PMS include headache, breast tenderness, and fluid retention, along with affective symptoms like depression. Loss of appetite is not a common symptom of PMS.