Nokea
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.
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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 a large cystocele and has not voided since admission 8 hours previously. Which of the following actions should the nurse take first?
- A. Insert a straight catheter per the PRN order.
- B. Encourage the patient to increase oral fluids.
- C. Notify the health care provider of the inability to void.
- D. Assess for urinary retention.
Correct Answer: D
Rationale: Since urinary retention is common with a large cystocele, the nurse's first action should be to assess for the presence of urine in the bladder. The other actions may be appropriate, depending on the findings of the physical assessment.
The nurse is caring for a patient who tells the nurse that she has noticed increasing headaches with dizziness, abdominal bloating, and unexplained anxiety occurring before her menstrual periods. Which of the following actions is best for the nurse to take at this time?
- A. Ask the patient to write down her symptoms in a diary for 3 months.
- B. Suggest that the patient try aerobic exercise to decrease her symptoms.
- C. Teach the patient about appropriate lifestyle changes to reduce premenstrual syndrome (PMS) symptoms.
- D. Advise the patient to use nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen to control symptoms.
Correct Answer: A
Rationale: The patient's symptoms indicate possible PMS, but they may also be associated with other diagnoses. Having the patient keep a symptom diary for 2 or 3 months will help in confirming a diagnosis of PMS. The nurse should not implement interventions for PMS until a diagnosis is made.
The nurse is caring for a patient who is diagnosed with stage 0 cervical cancer using a punch biopsy. Which of the following treatments should the nurse include in the teaching plan?
- A. Radiation
- B. Conization
- C. Chemotherapy
- D. Radical hysterectomy
Correct Answer: B
Rationale: Because the carcinoma is in situ, conization can be used for treatment. Radical hysterectomy, chemotherapy, or radiation will not be needed.
A couple is considering the possibility of in vitro fertilization (IVF). The woman tells the nurse that they cannot afford IVF on her husband's salary, and the husband replies that if the wife would get a job, they would have enough money. Which of the following nursing diagnoses is appropriate?
- A. Decisional conflict related to insufficient support system (financial resources)
- B. Ineffective sexuality pattern related to impaired relationship with significant other
- C. Defensive coping related to uncertainty (lack of concern)
- D. Ineffective denial related to insufficient sense of control (continued infertility)
Correct Answer: C
Rationale: IVF treatments are very costly. The statements made by the couple are consistent with the diagnosis of defensive coping. No data indicate that ineffective sexuality and ineffective denial are problems. Although the couple is quarrelling about finances, the data do not provide information indicating that the finances are inadequate.