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The nurse is caring for a patient who has an induced abortion with suction curettage at an ambulatory surgical centre. Which of the following instructions should the nurse include when discharging the patient?
- A. Heavy vaginal bleeding is expected for about 2 weeks.
- B. You should abstain from sexual intercourse for 2 weeks.
- C. Irregular menstrual periods are expected for the next few months.
- D. Use of contraceptives should be avoided until your reexamination.
Correct Answer: B
Rationale: Because infection is a possible complication of this procedure, the patient is advised to avoid intercourse until the reexamination in 2 weeks. Patients may be started on contraceptives on the day of the procedure. The patient should call the doctor if heavy vaginal bleeding occurs. No change in the regularity of the menstrual periods is expected.
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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 who had an anterior and posterior (A&P) colporrhaphy for repair of a cystocele and rectocele. Which of the following nursing actions should be included in the postoperative care plan?
- A. Teach the patient correct pessary use.
- B. Perform in-dwelling catheter care daily.
- C. Repack the vaginal wound daily with gauze.
- D. Provide patient teaching about a high fibre diet.
Correct Answer: B
Rationale: The patient will have an in-dwelling catheter for several days after surgery to keep the bladder empty and decrease strain on the suture. A pessary will not be needed after the surgery. Vaginal wound packing is not usually used after an A&P repair. A low-residue diet will be ordered after posterior colporrhaphy.
A patient is diagnosed with vaginal candidiasis and an antifungal vaginal cream is prescribed. Which of the following patient statements indicate that the nurse's teaching about the treatment plan has been effective?
- A. I will tell my husband that we cannot have sex for the next month.
- B. I should clean carefully after each urination and bowel movement.
- C. I can douche daily with warm water if the itching continues to bother me.
- D. I will insert the cream using the applicator before I get up in the morning.
Correct Answer: B
Rationale: Cleaning of the perineal area will decrease itching caused by contact of the irritated tissues with urine and reduce the chance of further infection of irritated tissues by bacteria in the stool. Sexual intercourse should be avoided for 1 week. Douching will disrupt normal protective mechanisms in the vagina. The cream should be used at night so that it will remain in the vagina for longer.
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.
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.