Nokea
The nurse is caring for an older-adult patient who is recently diagnosed with stage III ovarian cancer. Which of the following nursing diagnoses is best for this patient?
- A. Sexual dysfunction related to insufficient knowledge about sexual function (loss of vaginal sensation)
- B. Risk for infection as evidenced by immunosuppression
- C. Situational low self-esteem related to unrealistic self-expectations
- D. Anxiety related to threat to current status (cancer diagnosis and need to make treatment decisions)
Correct Answer: D
Rationale: The patient with stage III ovarian cancer is likely to be anxious about the poor prognosis and about the need to make decisions about the multiple treatments that may be used. Decreased vaginal sensation does not occur with ovarian cancer. The patient may develop immune dysfunction when she receives chemotherapy, but she is not currently at risk. It is unlikely that the patient has delayed seeking medical care because the symptoms of ovarian cancer are vague and occur late in the course of the cancer.
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A 33-year-old female patient who uses oral contraceptives tells the nurse, 'I want to have children in a few years.' Which of the following responses by the nurse is best?
- A. You may have more difficulty becoming pregnant after about age 35.
- B. You have many years of fertility left, so there is no rush to have children.
- C. You should plan to stop taking oral contraceptives several years before you want to become pregnant.
- D. If you do not have children within the next few years, it will be very difficult for you to become pregnant.
Correct Answer: A
Rationale: The probability of successfully becoming pregnant decreases after age 35 although some patients may have no difficulty in becoming pregnant, this probability further decreases after age 40. Oral contraceptives do not need to be withdrawn for several years for a woman to become pregnant. Although the patient may be fertile for many years, it would be inaccurate to indicate that there is no concern about infertility as she becomes older. Although the risk for infertility increases after age 35, not all patients have difficulty in conceiving.
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 planning an educational session at a local community centre related to health promotion during menopause. Which of the following information should the nurse include related to management of hot flashes?
- A. Limit daily calcium intake
- B. Vitamin E daily supplement
- C. Have a glass of wine before bedtime
- D. Daily rigorous exercise in the evening
Correct Answer: B
Rationale: Daily intake of vitamin E in doses up to 800 IU may help reduce hot flashes in some women. Changing sleep patterns may be helped by avoiding alcohol and controlling hot flashes. A regular moderate program (three to four times per week) of aerobic and weight-bearing exercises is appropriate but it has no effect on hot flashes.
A patient requests a prescription for birth control pills to decrease abdominal cramping and headaches during her menstrual periods. Which of the following actions should the nurse take first?
- A. Determine whether the patient is sexually active.
- B. Suggest that the patient use nonsteroidal anti-inflammatory drugs (NSAIDs) for symptom relief.
- C. Take a personal and family health history from the patient.
- D. Teach the patient about the adverse effects of oral contraceptives.
Correct Answer: C
Rationale: Oral contraceptives may be appropriate to control this patient's symptoms, but the patient's health history may reveal contraindications to oral contraceptive use. Because the patient is requesting contraceptives for management of dysmenorrhea, whether she is sexually active is irrelevant. Since the patient is asking for birth control pills, responding that she should try NSAIDs is nontherapeutic. The patient does not need teaching about oral contraceptive adverse effects at this time.
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.