Nokea
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.
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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.
A 48-year-old woman presenting for care is seeking information about hormone therapy (HT) for the treatment of her perimenopausal symptoms. The patients need for relief from hot flashes and other symptoms will be weighed carefully against the increased risks of what complications of HT? Select all that apply.
- A. Anaphylaxis
- B. Osteoporosis
- C. Breast cancer
- D. Cardiovascular disease
- E. Venous thromboembolism
Correct Answer: C,D,E
Rationale: HT increases the risk of breast cancer, cardiovascular disease (e.g., heart attack, stroke), and venous thromboembolism, which must be considered against benefits like hot flash relief. HT reduces osteoporosis risk, and anaphylaxis is not a significant concern.
During the nurses assessment of a female patient, the patient reveals that she experienced sexual abuse when she was a young woman. What is the nurses most appropriate response to this disclosure?
- A. Reassure her that this information will be kept a secret.
- B. Begin the process of intensive psychotherapy.
- C. Encourage the patient to phone 911.
- D. Facilitate appropriate resources and referrals.
Correct Answer: D
Rationale: The nurse's primary roles in response to a disclosure of past sexual abuse are to provide empathy and arrange for appropriate resources and referrals, such as counseling or support services. Promising secrecy is inappropriate as confidentiality has limits, psychotherapy is beyond the nurse's scope, and calling 911 is unnecessary for a past event.
An adolescent is brought to the clinic by her mother because of abnormal uterine bleeding. The nurse should understand that the most likely cause of this dysfunctional bleeding pattern is what?
- A. Lack of ovulation
- B. Chronic vaginitis
- C. A sexually transmitted infection
- D. Ectopic pregnancy
Correct Answer: A
Rationale: Dysfunctional uterine bleeding is most common in adolescents due to anovulation (lack of ovulation), which disrupts normal hormonal cycles. Vaginitis, STIs, and ectopic pregnancy are less likely causes of abnormal bleeding in this age group.
A patient calls the clinic and tells the nurse she has thick white, curd-like discharge from her vagina. How should the nurse best interpret this preliminary data?
- A. The drainage is physiologic and normal.
- B. The patient may have a Candida species infection.
- C. The patient needs a Pap smear as soon as possible.
- D. The patient may have a Trichomonas infection.
Correct Answer: B
Rationale: Drainage caused by Candida is typically curd-like and white, matching the patient's description. Trichomonas infections usually cause copious, frothy yellowish-green discharge. A Pap smear is not indicated as the primary response, as malignancy is unlikely. The discharge is not physiologic or normal.