Nokea
An 18-year-old visits the health clinic for a routine check-up. To determine whether a Pap test is needed, which of the following questions should the nurse ask?
- A. Do you use any illegal substances?
- B. Have you ever had sexual intercourse?
- C. How old were you when your menstrual periods started?
- D. Do you have any cramping with your menstrual periods?
Correct Answer: B
Rationale: The current Canadian Cancer Society recommendation is that a Pap test be done every 1-3 years, for women between age 21 and 69 years. The information about menstrual periods and substance abuse will not help to determine whether the patient requires a Pap test.
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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.
The nurse is counselling a healthy perimenopausal woman who prefers not to use hormone therapy (HT). Which of the following treatment options should the nurse discuss with the patient? (Select all that apply.)
- A. Reduce coffee intake.
- B. Exercise several times a week.
- C. Take black cohosh supplements.
- D. Have a glass of wine in the evening.
- E. Increase intake of dietary soy products.
Correct Answer: A,B,C,E
Rationale: Reduction in caffeine intake, use of black cohosh, increasing dietary soy intake, and exercising three to four times weekly are recommended to reduce symptoms associated with menopause. Alcohol intake in the evening may increase the sleep problems associated with menopause.
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 is caring for a patient who has undergone a radical vulvectomy for vulvar carcinoma. Which of the following nursing diagnoses is priority at this time?
- A. Bathing self-care deficit related to pain
- B. Risk for infection as evidenced by invasive procedure (contamination of the wound with urine and stool)
- C. Imbalanced nutrition: less than body requirements related to insufficient dietary intake
- D. Risk for ineffective sexual pattern as evidenced by impaired relationship with significant other (disfiguration caused by the surgery)
Correct Answer: B
Rationale: Complex and meticulous wound care is needed to prevent infection and delayed wound healing. The other nursing diagnoses may also be appropriate for the patient but are not the highest priority immediately after surgery.
The nurse is teaching a patient about ways to prevent primary dysmenorrhea. Which of the following information should the nurse provide to the patient?
- A. Avoid aerobic exercise during her menstrual period.
- B. Use cold packs on the abdomen and back for pain relief.
- C. Talk with health care provider about antidepressant therapy.
- D. Start taking nonsteroidal anti-inflammatory drugs (NSAIDs) regularly when menstrual period starts.
Correct Answer: D
Rationale: NSAIDs should be started as soon as the menstrual period begins and taken at regular intervals (every 4-8 hours) during the usual time frame in which pain occurs. Aerobic exercise may help reduce symptoms. Heat therapy, such as warm packs, is recommended for relief of pain. Antidepressant therapy is not a typical treatment for dysmenorrhea.