Nokea
The nurse has just received change-of-shift report about the following four patients. Which of the following patients should be assessed first?
- A. A patient with a possible ectopic pregnancy who is complaining of severe shoulder pain
- B. A patient in the fifteenth week of gestation who is experiencing uterine cramping and spotting
- C. A patient who has a radium implant in place to treat cervical cancer and is crying in her room
- D. A patient with ovarian cancer who is complaining of 8/10 pain after an abdominal hysterectomy
Correct Answer: A
Rationale: The patient with the ectopic pregnancy has symptoms consistent with rupture and needs immediate assessment for signs of hemorrhage and possible transfer to surgery. The other patients should also be assessed as quickly as possible but do not have symptoms of life-threatening complications.
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The nurse is caring for a patient recently diagnosed with polycystic ovary syndrome. Which of the following information is most important for the nurse to teach the patient?
- A. Reasons for a total hysterectomy
- B. How to decrease facial hair growth
- C. Ways to reduce the occurrence of acne
- D. Methods to maintain appropriate weight
Correct Answer: D
Rationale: Obesity exacerbates the problems associated with polycystic ovary syndrome, such as insulin resistance and type 2 diabetes. The nurse will also address the problems of acne and hirsutism, but these symptoms are lower priority because they do not have long-term health consequences. Although some patients do require total hysterectomy, this is usually performed only after other therapies have been unsuccessful.
The nurse is admitting a patient with increasing abdominal pain who is diagnosed with an ectopic pregnancy. The patient begins to cry and asks the nurse to leave her alone to grieve. Which of the following actions should the nurse take next?
- A. Stay with the patient and encourage her to discuss her feelings.
- B. Explain the reason for taking vital signs every 15-30 minutes.
- C. Close the door to the patient's room and minimize disturbances.
- D. Provide teaching about options for termination of the pregnancy.
Correct Answer: B
Rationale: Because the patient is at risk for rupture of the fallopian tube and hemorrhage, frequent monitoring of vital signs is needed. The patient has asked to be left alone, so staying with her and encouraging her to discuss her feelings are inappropriate actions. Minimizing contact with her and closing the door of the room is unsafe because of the risk for hemorrhage. Since the patient has requested time to grieve, it would be inappropriate to provide teaching about options for pregnancy termination.
The nurse is admitting a patient with multiple uterine leiomyomas for an abdominal hysterectomy. Which of the following topics should the nurse include in patient teaching?
- A. Leg exercises and the purpose of frequent ambulation
- B. Temporary decrease in vaginal sensation after surgery
- C. Adverse effects of systemic chemotherapy or radiation
- D. Symptoms caused by the sudden drop in estrogen level
Correct Answer: A
Rationale: Venous thromboembolism (VTE) is a potential complication after the surgery, and the nurse will instruct the patient about ways to prevent it. Vaginal sensation is decreased after a vaginal hysterectomy but not after abdominal hysterectomy. Leiomyomas are benign tumours, so chemotherapy and radiation will not be prescribed. Because the patient will still have her ovaries, the estrogen level will not decrease.
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 caring for a patient with persistent menorrhagia. Which of the following parameters should the nurse monitor?
- A. Estrogen level
- B. Complete blood count (CBC)
- C. Gonadotropin-releasing hormone (GnRH) level
- D. Serial β-human chorionic gonadotropin (hCG) results
Correct Answer: B
Rationale: Because anemia is a likely complication of menorrhagia, the nurse will need to check the CBC. Estrogen and GnRH levels are checked for patients with other problems, such as infertility. Serial β-hCG levels are monitored in patients who may be pregnant, which is not likely for this patient.