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A patient has returned to the post-surgical unit after vulvar surgery. What intervention should the nurse prioritize during the initial postoperative period?
- A. Placing the patient in high Fowlers position
- B. Administering sitz baths every 4 hours
- C. Monitoring the integrity of the surgical site
- D. Avoiding analgesics unless the patients pain is unbearable
Correct Answer: C
Rationale: An important intervention for the patient who has undergone vulvar surgery is to monitor closely for signs of infection in the surgical site, such as redness, purulent drainage, and fever. The patient should be placed in low Fowlers position to reduce pain by relieving tension on the incision. Sitz baths are discouraged after wide excision of the vulva because of the risk of infection. Analgesics should be administered preventively on a scheduled basis to relieve pain and increase the patients comfort level.
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The nurse is caring for a 63-year-old patient with ovarian cancer. The patient is to receive chemotherapy consisting of Taxol and Paraplatin. For what adverse effect of this treatment should the nurse monitor the patient?
- A. Leukopenia
- B. Metabolic acidosis
- C. Hyperphosphatemia
- D. Respiratory alkalosis
Correct Answer: A
Rationale: Taxol and Paraplatin commonly cause leukopenia, a manageable toxicity. Acid-base imbalances and hyperphosphatemia are not typical adverse effects of these drugs.
A patient has been diagnosed with polycystic ovary syndrome (PCOS). The nurse should encourage what health promotion activity to address the patients hormone imbalance and infertility?
- A. Kegel exercises
- B. Increased fluid intake
- C. Weight loss
- D. Topical antibiotics as ordered
Correct Answer: C
Rationale: Weight loss, even as little as 5% of body weight, can improve hormone imbalance and infertility in PCOS. Kegel exercises and fluid intake do not address PCOS. Antibiotics are irrelevant as PCOS is not infectious.
A patient diagnosed with cervical cancer will soon begin round of radiation therapy. When planning the patient's subsequent care plan, the nurse should prioritize actions with what goal?
- A. Preventing hemorrhage from bleeding
- B. Ensuring the patient knows the treatment is palliative, not curative
- C. Protecting the safety of patient, family, and staff
- D. Ensuring that patient adheres to dietary restrictions during treatment
Correct Answer: C
Rationale: Safety during radiation therapy is critical to protect patients, family, and staff from exposure. Hemorrhage is not a common risk, and the treatment may be curative. Dietary restrictions are not typically required.
A middle-aged female patient has been offered testing for HIV/AIDS upon admission to the hospital for an unrelated health problem. The nurse observes that the patient is visibly surprised and embarrassed by this offer. How should the nurse best respond?
- A. Most women with HIV dont know they have the disease. If you have it, its important we catch it early.
- B. This testing is offered to every adolescent and adult regardless of their lifestyle, appearance or history.
- C. The rationale for this testing is so that you can begin treatment as soon as testing comes back, if its positive.
- D. Youre being offered this testing because you are actually in the prime demographic for HIV infection.
Correct Answer: B
Rationale: Routine HIV screening is offered to all individuals aged 13 to 64 in healthcare settings to reduce stigma and encourage testing. This approach avoids assumptions about risk and alleviates patient anxiety.
A nurse providing prenatal care to a pregnant woman is addressing measures to reduce her postpartum risk of cystocele, rectocele, and uterine prolapse. What action should the nurse recommend?
- A. Maintenance of good perineal hygiene.
- B. Prevention of constipation.
- C. Increased fluid intake for 2 weeks postpartum.
- D. Performance of pelvic muscle exercises.
Correct Answer: D
Rationale: Kegel exercises strengthen pelvic muscles, reducing the risk of cystocele, rectocele, and uterine prolapse. Hygiene, constipation prevention, and fluid intake do not directly address pelvic muscle strength.