Nokea
A young client has just completed the 6-month series of Gardasil vaccine. Which comment by the client would alert the nurse that is other teaching is needed?
- A. This vaccine lowers my risk for cervical cancer.
- B. Will still time need to the routine time need for cervical cancer.
- C. I am at lower risk for developing cervical warts.
- D. This vaccine will prevent human papilloma virus (HPV) from occurring.
Correct Answer: D
Rationale: Gardasil is a vaccine that protects against four types of HPV, which cause 90% of cervical cancers and 90% of cervical warts but does not protect against other strains of HPV and pre vaccination infections. Routine cervical cancer screening is recommended regardless of vaccine use.
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A client tells the nurse that she is struggling with symptoms of irritability and 'feeling crazy' around the same time each month. Which assessment data would provide the most important information needed in the development of a treatment plan for this client?
- A. Reproductive history
- B. Menstrual diary
- C. Vital signs
- D. Dietary assessment
Correct Answer: B
Rationale: Diagnosis of premenstrual disorder and/or premenstrual dysphoric disorder is based on data recorded in a menstrual diary over the time period lasting at least 2 months or more. Symptoms are absent during the period between onset of menstruation and ovulation as recorded in the diary. Reproductive history, vital signs, and dietary assessment are not significant in the diagnosis of the PMS or PMIDD.
A female client is diagnosed with carcinoma in situ of the endometrium. The nurse interprets this as which of the following?
- A. Cancer is confined to the body of the uterus.
- B. The malignancy is localized.
- C. Cancer extends outside the uterus.
- D. The malignancy involves the uterine body and cervix.
Correct Answer: B
Rationale: A localized malignancy is referred to as carcinoma in situ. Stage I endometrial cancer is confined to the body (corpus) of the uterus, stage II involves the corpus and cervix, and stage III extends outside the uterus but not the true pelvis.
The nurse is caring for a young adult client who reports excessive menstrual flow with menses lasting 10 days each month. Which treatment option does the nurse anticipate the physician will order for symptomatic relief for this client?
- A. Dilation and curettage (D and C)
- B. Hormonal contraceptives
- C. Endometrial ablation
- D. Uterine balloon therapy
Correct Answer: B
Rationale: When combination hormonal contraceptives are administered, they produce a light menstrual period and are helpful in the management of menorrhagia. Dilation and curettage can provide symptomatic relief, however, the effectiveness is limited. Endometrial ablation and uterine balloon therapy cause the endometrium to slough and are cost-effective but are only used after childbearing has completed.
The nurse is teaching a client about the use of a pessary. Which statement by the client indicates the need for additional instruction?
- A. A white or yellow vaginal discharge is expected and normal.
- B. I need to apply a sterile lubricant to the pessary before reinserting it.
- C. After removal, I should wash the pessary with warm soapy, water, rinse, and dry it.
- D. I should call the physician if I notice any discomfort with the pessary.
Correct Answer: A
Rationale: A white or yellow discharge from the vagina is not a normal finding and should be reported to the physician because it may indicate an infection. A sterile lubricant is applied to the pessary before it is reinserted. After removal, the pessary should be washed thoroughly with warm soapy water, followed by rinsing and drying. Discomfort may indicate that a pessary has been inserted incorrectly, it has moved, or that it is causing irritation. These problems should be reported to the physician.
The nurse is teaching a client with a history of recurrent vaginal infections about ways to prevent this condition. What should the nurse include in the teaching? Select all that apply.
- A. Baths daily.
- B. Wipe from back to front after bowel movements.
- C. Avoid douching more than once every 3 days.
- D. Change from a wet swimsuit as soon as possible.
- E. Wash hands and devices that are inserted into the vagina.
Correct Answer: A,D,E
Rationale: The nurse should teach the client to bathe daily with particular attention to perineal hygiene, wipe from front to back after bowel movements, avoid douching more than once a week, change from a wet bathing suit as soon as possible, and wash hands and devices that are inserted into the vagina.