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The nurse is reviewing discharge instructions with a client who has just experienced an endometrial biopsy. Which finding should be reported to the health care provider immediately?
- A. Mild cramping
- B. Slight chills and fever
- C. Bleeding of blood on a perineal pad
- D. Fatigue after anesthesia
Correct Answer: B
Rationale: Chills and fever could indicate an infection and should be reported immediately to the health care provider. Mild cramping, spotting, and fatigue are normal findings after an endometrial biopsy.
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The nurse is assessing the reproductive history of a 68-year-old postmenopausal woman. Which finding is cause for immediate action by the nurse?
- A. Vaginal dryness
- B. Need for a Papaniccolous test if none for 3 years
- C. Vaginal bleeding
- D. Leakage of urine
Correct Answer: C
Rationale: Vaginal bleeding is not normal for the postmenopausal woman and requires immediate action to investigate potential serious conditions such as endometrial cancer. Vaginal dryness and leakage of urine are common findings in adults of this age range. Pap tests may not be needed for women over 65 who have had regular cervical cancer screening with normal results.
A 72-year-old woman is being assessed by the nurse for an annual physical. Which finding is of concern to the nurse?
- A. Mild vaginal dryness
- B. Occasional urinary incontinence
- C. Vaginal bleeding
- D. History of regular Pap smears
Correct Answer: C
Rationale: Vaginal bleeding in a 72-year-old postmenopausal woman is concerning and requires further investigation, as it may indicate serious conditions such as endometrial cancer. Mild vaginal dryness and occasional urinary incontinence are common in this age group, and a history of regular Pap smears is a positive finding.
A client is concerned about her irregular menstrual periods since she has increased her daily workouts at the gym to 2 hours each day. What is the nurse's best response?
- A. Do you want to talk about the need for that much exercise?
- B. Exercise is healthy but can decrease body fat and cause irregular periods.
- C. You should stop exercising to restore regular periods.
- D. Irregular periods are not related to exercise.
Correct Answer: B
Rationale: A certain level of body fat is necessary to maintain regular menstrual cycles. Increased exercise can reduce body fat, potentially leading to irregular periods. This response educates the client on the relationship between exercise, body fat, and menstrual irregularities.
The nurse is reviewing discharge plans with a client who is recovering from a cervical biopsy. Which statements indicate good understanding by the client? (Select all that apply).
- A. I can return to work this afternoon.
- B. There should be no problem lifting my 2-year-old toddler when I get home.
- C. I should not douche until the biopsy site is healed.
- D. I need to wait for about 2 weeks to have intercourse with my husband.
- E. If I have some bleeding I can use a regular tampon this evening."
Correct Answer: C,D
Rationale: The client should not douche, have intercourse, or use tampons until the biopsy site is healed, which typically takes about 2 weeks. Returning to work the same afternoon and lifting heavy objects like a toddler are not recommended, as the client should rest for 24 hours and avoid heavy lifting to promote healing. Using a tampon could introduce infection or disrupt healing.
The nurse is developing a teaching plan for a client who is scheduled for her first Papaniccolous test. What instructions by the nurse is the most important?
- A. The timing of the Pap smear does not matter.
- B. Sexual intercourse will not interfere with the results.
- C. Results can be interpreted immediately at the office.
- D. Results are best if you do not douche 24 hours before the test.
Correct Answer: D
Rationale: In order to prevent false interpretation, the client must not douche or have sexual intercourse for at least 24 hours before the Pap smear. Timing is important, with the test scheduled between the client's menstrual periods so that the menstrual flow does not interfere with laboratory analysis. The specimens are placed on a glass slide and sent to the laboratory for examination and cannot be interpreted immediately.