Nokea
A patient arrives to the clinic 2 hours late for her prenatal appointment. This is the third time she has been late. What is the nurse’s best action in response to this patient’s tardiness?
- A. Ask the patient if she has a way to tell the time.
- B. Ask the patient if she is deliberately being late for her appointments.
- C. Determine if the patient wants this baby and if this is her way of acting out.
- D. Determine if the patient arrives after the start time for other types of appointments.
Correct Answer: C
Rationale: The nurse's best action in response to the patient's tardiness is to determine if the patient wants this baby and if this is her way of acting out. Tardiness to prenatal appointments can sometimes indicate underlying issues such as ambivalence towards the pregnancy or emotional distress. By addressing the patient's motivation for being consistently late, the nurse can better understand and support her needs. This approach allows for a more patient-centered and compassionate response, aiming to address any possible concerns or challenges the patient may be facing.
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A nurse is working in the area of labor and birth. Her assignment is to take care of a gravida 1 para 0 woman who presents in early labor at term. Vaginal exam reflects the following: 2 cm, cervix posterior, –1 station, and vertex with membranes intact. The patient asks the nurse if she can break her water so that her labor can go faster. The nurse’s response, based on the ethical principle of nonmaleficence, is which of the following?
- A. Tell the patient that she will have to wait until she has progressed further on the vaginal exam and then she will perform an amniotomy.
- B. Have the patient write down her request and then call the physician for an order to implement the amniotomy.
- C. Instruct the patient that only a physician or certified midwife can perform this procedure.
- D. Give the patient an enema to stimulate labor.
Correct Answer: A
Rationale: The correct response based on the ethical principle of nonmaleficence, which refers to the duty to do no harm, is to tell the patient that she will have to wait until she has progressed further on the vaginal exam and then perform an amniotomy. In this scenario, breaking the patient's water prematurely could introduce risks and potential harm without clear medical necessity. Performing an amniotomy too early could increase the risk of infection or cause umbilical cord prolapse, which can be harmful to both the mother and the baby. Therefore, it is important for the nurse to wait until the patient has progressed further in labor before considering an amniotomy.
What medication would the nurse include when teaching a patient about aromatase inhibitors?
- A. anastrozole (Arimidex)
- B. fulvestrant (Faslodex)
- C. tamoxifen (Novaldex)
- D. pembrolizumab (Keytruda)
Correct Answer: A
Rationale: Aromatase inhibitors, such as anastrozole (Arimidex), are commonly used in hormone receptor-positive breast cancer treatment. They work by blocking the enzyme aromatase, which helps in the production of estrogen in postmenopausal women. By reducing estrogen levels, aromatase inhibitors help in slowing down or stopping the growth of hormone receptor-positive breast cancer cells. Therefore, when teaching a patient about aromatase inhibitors, the nurse would include information about anastrozole as it is a pertinent medication in the management of hormone receptor-positive breast cancer. Fulvestrant, tamoxifen, and pembrolizumab are not aromatase inhibitors; they work through different mechanisms in breast cancer treatment.
When reviewing a new patient’s birth plan, the nurse notices that the patient will be bringing a doula to the hospital during labor. What does the nurse think that this means?
- A. The patient will have her grandmother as a support person.
- B. The patient will bring a paid, trained labor support person with her during labor.
- C. The patient will have a special video she will play during labor to assist with relaxation.
- D. The patient will have a bag that contains all the approved equipment that may help with the labor process.
Correct Answer: B
Rationale: A doula is a trained labor support person who provides physical, emotional, and informational support to the mother before, during, and after childbirth. They are not typically a family member like a grandmother (option A) and do not involve playing a special video (option C) or bringing a bag of equipment (option D). The presence of a doula can help improve birth outcomes, provide continuous support, and enhance the birthing experience for the mother.
The nurse is preparing to teach the community about risk factors for the second most common cancer of the female reproductive system. Which of the following groups of women are at higher risk for this cancer? Select all that apply.
- A. Menopausal women with an intact uterus who receive hormonal therapy
- B. Women who have undergone treatment for breast cancer
- C. Women who have many pregnancies and nursed their infants
- D. Women who smoke and have many sexual partners
Correct Answer: A
Rationale: A. Menopausal women with an intact uterus who receive hormonal therapy are at higher risk for endometrial cancer, which is the second most common cancer of the female reproductive system. Estrogen therapy without progesterone can increase the risk of endometrial cancer due to unopposed estrogen stimulation.
The nurse is providing care to a 72-year-old female patient. While providing care, the nurse instructs the patient to slowly rise from a sitting or prone position. What is the pathophysiological reason for this instruction?
- A. The patient is at higher risk for fractures due to postmenopausal osteoporosis.
- B. The patient is at higher risk for hypotension due to decreased baroreceptor sensitivity.
- C. The patient is at higher risk for falls due to decreased muscle strength and balance
- D. The patient is at higher risk for adverse drug reactions due to decreased hepatic function
Correct Answer: B
Rationale: As people age, their baroreceptor sensitivity decreases, making them more prone to orthostatic hypotension, especially when changing positions quickly. Orthostatic hypotension is a significant concern in the elderly population as it can lead to falls and injuries. By instructing the patient to rise slowly from a sitting or prone position, the nurse is helping to prevent a rapid drop in blood pressure that can occur with sudden position changes. This precaution is particularly important in elderly patients to minimize the risk of falls and subsequent injuries.