Nokea
Which of the following information should the nurse include when teaching a 51-year-old female patient who is considering the use of combined estrogen-progesterone hormone therapy (HT) during menopause?
- A. Use of estrogen-containing vaginal creams provides most of the same benefits as oral HT.
- B. Use of HT for up to 10 years to prevent symptoms such as hot flashes is generally considered safe.
- C. HT decreases osteoporosis risk and increases the risk for cardiovascular disease and breast cancer.
- D. Increased incidence of colon cancer in women taking HT requires frequent stool assessment for occult blood.
Correct Answer: C
Rationale: Data from the Women's Health Initiative indicate an increased risk for cardiovascular disease and breast cancer in women taking combination HT but a decrease in hip fractures. Vaginal creams decrease symptoms related to vaginal atrophy and dryness, but they do not offer the other benefits of HT, such as decreased hot flashes. Most women who use HT are placed on short-term treatment and are not treated for up to 10 years. The incidence of colon cancer decreases in women taking HT.
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A 32-year-old patient has minor changes on her Pap test. Which of the following actions should the nurse take?
- A. Teach the patient about colposcopy.
- B. Teach the patient about punch biopsy.
- C. Schedule another Pap test in 4 months.
- D. Administer the human papilloma virus (HPV) vaccine.
Correct Answer: C
Rationale: Patients with minor changes on the Pap test can be followed with Pap tests every 4-6 months because these changes may revert to normal. Punch biopsy or colposcopy may be used if the Pap test shows more prominent changes. The HPV vaccine may reduce the risk for cervical cancer, but it is recommended only for ages 9 through 26.
A couple is considering the possibility of in vitro fertilization (IVF). The woman tells the nurse that they cannot afford IVF on her husband's salary, and the husband replies that if the wife would get a job, they would have enough money. Which of the following nursing diagnoses is appropriate?
- A. Decisional conflict related to insufficient support system (financial resources)
- B. Ineffective sexuality pattern related to impaired relationship with significant other
- C. Defensive coping related to uncertainty (lack of concern)
- D. Ineffective denial related to insufficient sense of control (continued infertility)
Correct Answer: C
Rationale: IVF treatments are very costly. The statements made by the couple are consistent with the diagnosis of defensive coping. No data indicate that ineffective sexuality and ineffective denial are problems. Although the couple is quarrelling about finances, the data do not provide information indicating that the finances are inadequate.
The nurse is caring for a patient who has been hospitalized with endometriosis. Which of the following medications should the nurse anticipate preparing for the patient?
- A. Ganirelix
- B. Cetorelix
- C. hCG
- D. Nafarelin
Correct Answer: D
Rationale: Nafarelin can be used in the treatment of endometriosis. Cetorelix and ganirelix are GnRH antagonists and used to prevent premature LH surges and premature ovulation in patients undergoing ovarian stimulation. hCG is used to stimulate ovulation.
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.
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.