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The nurse is caring for a patient who has been diagnosed with human papilloma virus (HPV) infection and who smokes cigarettes, uses oral contraceptives, and has a history of candidiasis. Which of the following topics should the nurse include in the teaching plan?
- A. Use of water-soluble lubricants
- B. Antifungal cream administration
- C. Importance of smoking cessation
- D. Possible difficulties with conception
Correct Answer: C
Rationale: Because smoking and HPV infection are both associated with increased cervical cancer risk, the nurse should emphasize the importance of avoiding smoking. An HPV infection does not decrease vaginal lubrication, decrease ability to conceive, or require the use of antifungal creams.
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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.
A patient tells the nurse that she needs something to control the negative mood associated with premenstrual dysphoric disorder (PMDD). Which of the following medications should the nurse anticipate administering to the patient?
- A. Potassium supplement
- B. Vitamin B6
- C. Folic acid
- D. Ibuprofen
Correct Answer: B
Rationale: To improve negative mood, vitamin B6 supplementation (50 mg daily) may be used. Calcium (not potassium) and magnesium supplementation may also be effective in alleviating psychological and physiological symptoms. For anxiety, buspirone taken during the luteal phase has helped some women. Women with PMDD may benefit from antidepressants, including fluoxetine HCl (Prozac) and tricyclic antidepressants (e.g., amitriptyline). Folic acid is not given for PMDD. NSAIDs will not have an effect on negative moods.
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.
The nurse is teaching a patient about ways to prevent primary dysmenorrhea. Which of the following information should the nurse provide to the patient?
- A. Avoid aerobic exercise during her menstrual period.
- B. Use cold packs on the abdomen and back for pain relief.
- C. Talk with health care provider about antidepressant therapy.
- D. Start taking nonsteroidal anti-inflammatory drugs (NSAIDs) regularly when menstrual period starts.
Correct Answer: D
Rationale: NSAIDs should be started as soon as the menstrual period begins and taken at regular intervals (every 4-8 hours) during the usual time frame in which pain occurs. Aerobic exercise may help reduce symptoms. Heat therapy, such as warm packs, is recommended for relief of pain. Antidepressant therapy is not a typical treatment for dysmenorrhea.
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.