Nokea
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.
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A clinic nurse is meeting with a 38-year-old patient who states that she would like to resume using oral contraceptives, which she used for several years during her twenties. What assessment question is most likely to reveal a potential contraindication to oral contraceptive use?
- A. Have you ever had surgery?
- B. Have you ever had a sexually transmitted infection?
- C. When did you last have your blood sugar levels checked?
- D. Do you smoke?
Correct Answer: D
Rationale: Women who smoke and who are 35 years of age or older should not take oral contraceptives because of an increased risk for cardiac problems. Previous surgeries or STIs do not necessarily contraindicate use, and while blood sugar monitoring is relevant for diabetes management, smoking is the most significant risk factor in this context.
A womans current health complaints are suggestive of a diagnosis of premenstrual dysphoric disorder (PMDD). The nurse should first do which of the following?
- A. Assess the patients understanding of HT.
- B. Assess the patient for risk of suicide.
- C. Assure the patient that the problem is self-limiting.
- D. Suggest the use of St. Johns wort.
Correct Answer: B
Rationale: Severe PMDD can lead to suicidal or violent behavior, so assessing suicide risk is the priority to ensure patient safety. HT is not relevant, PMDD is not self-limiting, and suggesting herbal remedies like St. John's wort requires provider input.
A patient in her late fifties has expressed to the nurse her desire to explore hormone replacement therapy (HRT). Based on what aspect of the patients health history is HRT contraindicated?
- A. History of vaginal dryness
- B. History of hot flashes and night sweats
- C. History of vascular thrombosis
- D. Family history of osteoporosis
Correct Answer: C
Rationale: The use of HRT is contraindicated in women with a history of vascular thrombosis, active liver disease, some cases of uterine cancer, and undiagnosed vaginal bleeding. HRT is beneficial in women with a risk for osteoporosis and can relieve symptoms like vaginal dryness, hot flashes, and night sweats. A history of vascular thrombosis is a clear contraindication.
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 woman presents at the ED with sharp, colicky pain in her right abdomen that radiates to her right shoulder. She tells the nurse that she has been spotting lightly for the past few days. The patient is subsequently diagnosed with an ectopic pregnancy. What major nursing diagnosis most likely relates to this patients needs?
- A. Anxiety related to potential treatment options and health outcomes
- B. Chronic sorrow related to spontaneous abortion
- C. Chronic pain related to genitourinary trauma
- D. Impaired tissue integrity related to keloid scarring
Correct Answer: A
Rationale: A diagnosis of ectopic pregnancy is likely to cause significant anxiety due to treatment uncertainties and health risks. Chronic sorrow, chronic pain, and impaired tissue integrity (keloid scarring) are less applicable to the acute presentation of ectopic pregnancy.