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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.
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The nurse is caring for a patient who has a radium implant for treatment of cancer of the cervix. Which of the following actions should the nurse implement?
- A. Maintain the patient on complete bed rest.
- B. Use gloves when changing the patient's bed.
- C. Allow extra time for patient discussion of concerns.
- D. Flush the toilet several times after the patient voids.
Correct Answer: A
Rationale: To prevent displacement of the implant, absolute bed rest is required. Wearing of gloves when changing linens and flushing the toilet several times are not necessary because the isotope is confined to the implant. The nurse should spend minimal time in the patient's room to avoid exposure to radiation.
Which of the following information should the nurse include when developing a teaching plan for a patient who is premenopausal with symptoms of uterine bleeding caused by a leiomyoma?
- A. Aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to control mild to moderate pain.
- B. The tumour size is likely to increase throughout the patient's lifetime.
- C. The symptoms may decrease after the patient undergoes menopause.
- D. The patient will need frequent monitoring to detect any malignant changes.
Correct Answer: C
Rationale: Leiomyomas appear to depend on ovarian hormones and will atrophy after menopause, leading to a decrease in symptoms. Aspirin use is discouraged because the antiplatelet effects may lead to heavier uterine bleeding. The size of the tumour will shrink after menopause. Leiomyomas are benign tumours that do not undergo malignant changes.
The nurse is counselling a healthy perimenopausal woman who prefers not to use hormone therapy (HT). Which of the following treatment options should the nurse discuss with the patient? (Select all that apply.)
- A. Reduce coffee intake.
- B. Exercise several times a week.
- C. Take black cohosh supplements.
- D. Have a glass of wine in the evening.
- E. Increase intake of dietary soy products.
Correct Answer: A,B,C,E
Rationale: Reduction in caffeine intake, use of black cohosh, increasing dietary soy intake, and exercising three to four times weekly are recommended to reduce symptoms associated with menopause. Alcohol intake in the evening may increase the sleep problems associated with menopause.
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.
The nurse is caring for a patient with pelvic inflammatory disease (PID) requiring hospitalization. Which of the following nursing interventions should be included in the plan of care?
- A. Monitor liver function tests.
- B. Use cold packs PRN for pelvic pain.
- C. Teach the patient how to perform Kegel exercises.
- D. Elevate the head of the bed to at least 30 degrees.
Correct Answer: D
Rationale: The head of the bed should be elevated to at least 30 degrees to promote drainage of the pelvic cavity and prevent abscess formation higher in the abdomen. Although a possible complication of PID is acute perihepatitis, liver function tests will remain normal. There is no indication for increased fluid intake. Application of heat is used to reduce pain. Kegel exercises are not helpful in PID.