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.
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Which of the following information should the nurse include when teaching a 51-year-old female patient who is considering the use of combined estrogen-progesterone hormone therapy (HT) during menopause?
- A. Use of estrogen-containing vaginal creams provides most of the same benefits as oral HT.
- B. Use of HT for up to 10 years to prevent symptoms such as hot flashes is generally considered safe.
- C. HT decreases osteoporosis risk and increases the risk for cardiovascular disease and breast cancer.
- D. Increased incidence of colon cancer in women taking HT requires frequent stool assessment for occult blood.
Correct Answer: C
Rationale: Data from the Women's Health Initiative indicate an increased risk for cardiovascular disease and breast cancer in women taking combination HT but a decrease in hip fractures. Vaginal creams decrease symptoms related to vaginal atrophy and dryness, but they do not offer the other benefits of HT, such as decreased hot flashes. Most women who use HT are placed on short-term treatment and are not treated for up to 10 years. The incidence of colon cancer decreases in women taking HT.
A patient who is scheduled for a Pap test tells the nurse that she has had intercourse during the last year with several men. Which of the following information should the nurse teach to the patient?
- A. Contraceptive use
- B. Antibiotic therapy
- C. Chlamydia testing
- D. Pregnancy testing
Correct Answer: C
Rationale: Chlamydia testing is recommended annually for women with multiple sex partners. There is no indication that the patient needs teaching about contraceptives, pregnancy testing, or antibiotic therapy.
Which of the following information about a patient indicates that the nurse will need to teach the patient about endometrial biopsy?
- A. The patient has had 6 full-term pregnancies.
- B. The patient has 3-4 alcoholic drinks daily.
- C. The patient has used various oral contraceptives since she was 20 years old.
- D. The patient has a family history of hereditary nonpolyposis colorectal cancer.
Correct Answer: D
Rationale: Patients with a personal or familial history of hereditary nonpolyposis colorectal cancer are at increased risk for endometrial cancer. Alcohol addiction does not increase this risk. Multiple pregnancies and oral contraceptive use offer protection from endometrial cancer.
The nurse is caring for a patient who has been hospitalized with endometriosis. Which of the following medications should the nurse anticipate preparing for the patient?
- A. Ganirelix
- B. Cetorelix
- C. hCG
- D. Nafarelin
Correct Answer: D
Rationale: Nafarelin can be used in the treatment of endometriosis. Cetorelix and ganirelix are GnRH antagonists and used to prevent premature LH surges and premature ovulation in patients undergoing ovarian stimulation. hCG is used to stimulate ovulation.
A 32-year-old patient has minor changes on her Pap test. Which of the following actions should the nurse take?
- A. Teach the patient about colposcopy.
- B. Teach the patient about punch biopsy.
- C. Schedule another Pap test in 4 months.
- D. Administer the human papilloma virus (HPV) vaccine.
Correct Answer: C
Rationale: Patients with minor changes on the Pap test can be followed with Pap tests every 4-6 months because these changes may revert to normal. Punch biopsy or colposcopy may be used if the Pap test shows more prominent changes. The HPV vaccine may reduce the risk for cervical cancer, but it is recommended only for ages 9 through 26.
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