Nokea
A patient, age 41, has had a total abdominal hysterectomy and bilateral salpingo-oophorectomy for endometriosis. She asks the nurse if she will have 'hot flashes.' Knowledge of which fact will guide the nurse's response?
- A. Only the uterus was removed, and the ovaries are still producing estrogen and she will not have hot flashes.
- B. The patient is too young to have hot flashes associated with menopause.
- C. The uterus, ovaries, and fallopian tubes were removed, and she will have surgically induced menopause and may have hot flashes.
- D. The uterus and fallopian tubes were removed, and she will not experience 'hot flashes.'
Correct Answer: C
Rationale: A total abdominal hysterectomy with bilateral salpingo-oophorectomy is the removal of the uterus, fallopian tubes, and ovaries. If the ovaries are removed in these surgeries, the surgery will induce menopause and hot flashes may occur.
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The young husband of a patient who has been scheduled for a hysterectomy because of the discovery of ovarian cancer in both ovaries says to the nurse, 'Please go talk to my wife. She is real upset and says she won't be a 'woman' anymore.' Which response from the nurse is most therapeutic?
- A. Don't be concerned. All young women get upset before this kind of surgery.'
- B. Certainly, I will be glad to tell her about hormone replacement.'
- C. She will get over this feeling soon.'
- D. No matter what I may say to her, it is you that needs to listen to her concerns and assure her.'
Correct Answer: D
Rationale: Assisting patients with recognizing and clarifying fears and with developing coping strategies for those fears by listening is helpful.
A patient, age 46, is recovering from an abdominal hysterectomy. Postoperative nursing assessment findings include a urinary output of $100 \mathrm{~mL}$ in 4 hours. Which action will the nurse take?
- A. Force fluids.
- B. Report urinary retention to the charge nurse.
- C. Milk' the urinary catheter.
- D. Turn the patient onto her right side.
Correct Answer: B
Rationale: Postoperative nursing interventions for patients with abdominal hysterectomy focus on monitoring vital signs and preventing urinary retention. The patient should have an output of at least 30 mL/hr. Anything less than that should be reported.
Which situation does the diagnosis of secondary infertility refer to?
- A. Has never conceived.
- B. Is infertile because of repeated infection.
- C. Has conceived but is now unable to do so.
- D. Is over the age of 38.
Correct Answer: C
Rationale: Secondary infertility refers to a woman who has conceived in the past and now is unable to do so.
Which instruction will a nurse give a patient with genital herpes who does not have lesions at the present?
- A. Continued use of acyclovir will prevent reinfection by the virus.'
- B. Condoms should be used during all sexual activity to prevent transmission of the virus, even when lesions are not present.'
- C. Acyclovir ointment should be applied to the lesions to increase comfort and speed healing.'
- D. Recurrent genital herpes is promoted by any sexual stimulation.'
Correct Answer: B
Rationale: Sexual transmission of HSV (genital herpes, a virus) has been documented even in the absence of clinical lesions, and the use of condoms should be encouraged. Acyclovir does not cure the disease but makes the attacks less virulent.
A 25-year-old woman comes to the clinic with a yellowish-green malodorous vaginal discharge. She says it makes her itch and makes it hard to urinate. After a microscopic examination that confirms trichomoniasis, the patient is placed on metronidazole for 7 days. Which advice will the nurse give to the patient?
- A. Avoid alcohol while on metronidazole
- B. Be aware that her urine may turn blue and will stain clothing.
- C. Wear snug underwear during treatment.
- D. Be aware that she need not notify her sexual partners as trichomoniasis is not contagious.
Correct Answer: A
Rationale: Alcohol should be avoided as it can cause disorientation, cramps, and possibly convulsions.