Nokea
The client asks the nurse if there is a pill that can be ordered to control the symptoms of menopause. Which assessment finding is most important in determining nursing care in association with hormone replacement therapy?
- A. Presence of kyphosis
- B. Symptoms of hot flashes
- C. Family history of breast cancer
- D. History of osteoporosis
Correct Answer: C
Rationale: The risk of endometrial or breast cancer in women prescribed HRT may outweigh the benefits of relieving symptoms of menopause and preventing kyphosis or hip fractures associated with osteoporosis.
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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.
Culture of client's vaginal discharge reveals Gardnerella vaginalis. Which of the following would the nurse expect to assess?
- A. Foul foamy discharge
- B. Thick curry white discharge
- C. Fisy smelling watery discharge
- D. Yellowish white discharge
Correct Answer: C
Rationale: Gardnerella vaginalis is associated with a gray white, watery, fisy smelling vaginal discharge. The discharge associated with a Candida infection is curry white and thick, and has a strong odor. Discharge due to trichomonas vaginalis is yellow white, foamy, and has a foul odor.
A client who wishes to preserve childbearing ability asks the nurse to explain how taking oral contraceptives will work in the management of endometriosis. Which is the best response by the nurse?
- A. Symptoms of endometriosis are increased during normal menstrual cycle.
- B. Conraceptives will allow blood to be diverted to the peritoneal cavity.
- C. Trapping blood causes less pain and discomfort for clients with endometriosis.
- D. Endometriosis is usually cured with surgical menopause.
Correct Answer: A
Rationale: The use of estrogen-progestin contraceptives keeps the client in a non-bleeding phase of the menstrual cycle, therefore decreasing ectopic tissue from shedding and causing extra uterine bleeding. Blood that is trapped in the peritoneal cavity causes more pain or adhesions form. Endometriosis is cured by natural or surgical menopause but can be medically instituted for periods of time with the use of oral contraceptives.
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.
The nurse is caring for a client who has just been diagnosed with o endometriosis. The client has been hoping to have children with her partner. Which statement by the nurse is most appropriate to provide the client with support and guidance about treatment options?
- A. Treatment is essential, so you really need to make a decision pretty quickly.
- B. If it was me, I would probably choose the medication options.
- C. If might help to include your partner in any of the discussion about options.
- D. The test results are clear and another physician would tell you the same thing.
Correct Answer: C
Rationale: The nurse assists the client through the decision-making process as it applies to family planning and medical or surgical treatment. Suggesting that the client include a partner or significant other in the discussion of options would be most helpful and therapeutic. The client does not need to make a decision immediately. The nurse should not give advice or offer personal opinions to influence the client's choice. The nurse should support the client's option of seeking a second opinion.