Nokea
A patient is scheduled for an induced abortion using methotrexate with misoprostol. Before the procedure, which of the following information should the nurse discuss with the patient?
- A. Several trips to the health care provider will be required.
- B. There is a possibility that the patient may deliver a live fetus.
- C. The patient will require a general anaesthetic for the procedure.
- D. The procedure may be unsuccessful in terminating the pregnancy.
Correct Answer: A
Rationale: Takes place over 5-7 days, or longer and involves several trips to the health care provider. Risk of incomplete abortion, surgical abortion may be necessary. General anaesthesia is not needed for this procedure. It is used in patients that are 7 weeks gestation or less (within the period of the embryo), so there is no chance of delivering a live fetus. Using methotrexate with misoprostol for an induced abortion is both safe and effective.
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A patient with pelvic inflammatory disease (PID) is treated on an outpatient basis with oral antibiotics. Which of the following instructions should be included in patient teaching?
- A. Return for a follow-up appointment in 2 days.
- B. Abdominal pain may persist for several weeks.
- C. Sexual intercourse should be avoided for 1 week.
- D. Nonsteroidal anti-inflammatory drug (NSAID) use may prevent scarring of pelvic organs.
Correct Answer: A
Rationale: The patient is instructed to return for follow-up in 48-72 hours. The patient should abstain from intercourse for 3 weeks. Abdominal pain should subside with effective antibiotic therapy. Corticosteroids may help prevent inflammation and scarring, but NSAIDs will not decrease scarring.
A patient who is 58-years-old calls the health clinic and tells the nurse that she has a moderate amount of vaginal bleeding after 6 years of menopause. Which of the following procedures should the nurse anticipate teaching the patient about?
- A. Endometrial biopsy
- B. Uterine balloon therapy
- C. Laser endometrial ablation
- D. Dilation and curettage (D&C)
Correct Answer: A
Rationale: A postmenopausal woman with vaginal bleeding should be evaluated for endometrial cancer, and endometrial biopsy is the primary test for endometrial cancer. D&C will be needed only if the biopsy does not provide sufficient information to make a diagnosis. Endometrial ablation and balloon therapy are used to treat menorrhagia, which is unlikely in this patient.
The nurse has just received change-of-shift report about the following four patients. Which of the following patients should be assessed first?
- A. A patient with a possible ectopic pregnancy who is complaining of severe shoulder pain
- B. A patient in the fifteenth week of gestation who is experiencing uterine cramping and spotting
- C. A patient who has a radium implant in place to treat cervical cancer and is crying in her room
- D. A patient with ovarian cancer who is complaining of 8/10 pain after an abdominal hysterectomy
Correct Answer: A
Rationale: The patient with the ectopic pregnancy has symptoms consistent with rupture and needs immediate assessment for signs of hemorrhage and possible transfer to surgery. The other patients should also be assessed as quickly as possible but do not have symptoms of life-threatening complications.
A couple is considering the possibility of in vitro fertilization (IVF). The woman tells the nurse that they cannot afford IVF on her husband's salary, and the husband replies that if the wife would get a job, they would have enough money. Which of the following nursing diagnoses is appropriate?
- A. Decisional conflict related to insufficient support system (financial resources)
- B. Ineffective sexuality pattern related to impaired relationship with significant other
- C. Defensive coping related to uncertainty (lack of concern)
- D. Ineffective denial related to insufficient sense of control (continued infertility)
Correct Answer: C
Rationale: IVF treatments are very costly. The statements made by the couple are consistent with the diagnosis of defensive coping. No data indicate that ineffective sexuality and ineffective denial are problems. Although the couple is quarrelling about finances, the data do not provide information indicating that the finances are inadequate.
The nurse is caring for a patient who has a radium implant for treatment of cancer of the cervix. Which of the following actions should the nurse implement?
- A. Maintain the patient on complete bed rest.
- B. Use gloves when changing the patient's bed.
- C. Allow extra time for patient discussion of concerns.
- D. Flush the toilet several times after the patient voids.
Correct Answer: A
Rationale: To prevent displacement of the implant, absolute bed rest is required. Wearing of gloves when changing linens and flushing the toilet several times are not necessary because the isotope is confined to the implant. The nurse should spend minimal time in the patient's room to avoid exposure to radiation.