Current Issues in Maternal-Newborn Nursing

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In some Middle Eastern and African cultures, female genital mutilation (female cutting) is a prerequisite for marriage. Women who now live in North America need care from nurses who are knowledgeable about the procedure and comfortable with the abnormal appearance of their genitalia. When caring for this patient, the nurse can formulate a diagnosis with the understanding that the patient may be at risk for which of the following? (Select all that apply.)

  • A. Infection
  • B. Laceration
  • C. Hemorrhage
  • D. Obstructed labor
Correct Answer: A

Rationale: Female genital mutilation (FGM) can lead to various short-term and long-term complications, putting the woman at risk for infection (such as urinary tract infections and pelvic infections due to poor healing and scar tissue), hemorrhage (excessive bleeding during or after the procedure or in subsequent sexual encounters), and obstructed labor (due to scarring and narrowing of the birth canal, which can lead to prolonged labor, tears, and even fistula formation). These risks highlight the importance of providing appropriate care, support, and education for women who have undergone FGM.

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What assessment finding suggests that a patient may have fibrocystic breast changes?

  • A. green-tinged nipple discharge
  • B. ongoing breast pain
  • C. firm, ropy feel of the breast tissue under the skin
  • D. peau d’orange appearance of the skin
Correct Answer: C

Rationale: Fibrocystic breast changes typically present with breast pain and a cyclic pattern of nodularity and/or lumps in the breast tissue. The characteristic assessment finding that suggests fibrocystic breast changes is the firm, ropy feel of the breast tissue under the skin. This texture is due to the presence of fibrous tissue and cysts within the breast, which can be felt during the physical examination. While nipple discharge and skin changes like peau d’orange can be associated with different breast conditions, the firm and ropy feel of the breast tissue is more specific to fibrocystic changes.

What medication would the nurse include when teaching a patient about aromatase inhibitors?

  • A. anastrozole (Arimidex)
  • B. fulvestrant (Faslodex)
  • C. tamoxifen (Novaldex)
  • D. pembrolizumab (Keytruda)
Correct Answer: A

Rationale: Aromatase inhibitors, such as anastrozole (Arimidex), are commonly used in hormone receptor-positive breast cancer treatment. They work by blocking the enzyme aromatase, which helps in the production of estrogen in postmenopausal women. By reducing estrogen levels, aromatase inhibitors help in slowing down or stopping the growth of hormone receptor-positive breast cancer cells. Therefore, when teaching a patient about aromatase inhibitors, the nurse would include information about anastrozole as it is a pertinent medication in the management of hormone receptor-positive breast cancer. Fulvestrant, tamoxifen, and pembrolizumab are not aromatase inhibitors; they work through different mechanisms in breast cancer treatment.

The nurse is formulating a nursing care plan for a postpartum patient. Which actions by the nurse indicate use of critical thinking skills when formulating the care plan? (Select all that apply.)

  • A. Using a standardized postpartum care plan
  • B. Determining priorities for each diagnosis written
  • C. Writing interventions from a nursing diagnosis book
  • D. Reflecting and suspending judgment when writing the care plan
Correct Answer: B

Rationale: B. Determining priorities for each diagnosis written: Prioritizing nursing diagnoses based on the patient's needs and condition requires critical thinking skills. The nurse must be able to identify the most urgent issues to address first in the care plan.

A 48-year-old female patient presents to the OB/GYN clinic for her annual examination. She states that she has had the following symptoms: mood swings, irregular menstrual cycles, forgetfulness, food cravings, and a decrease in libido. Which of the following does the nurse suspect the patient is experiencing?

  • A. Menopause
  • B. Perimenopause
  • C. Postmenopause
  • D. Pregnancy
Correct Answer: B

Rationale: Perimenopause is the transitional period leading to menopause that usually begins in a woman's 40s but can start earlier. During this phase, women may experience symptoms such as mood swings, irregular menstrual cycles, forgetfulness, food cravings, and a decrease in libido, as described by the patient in this case. These symptoms are caused by hormonal fluctuations as the ovaries start to produce less estrogen in preparation for menopause. Menopause occurs when a woman has not had a menstrual period for 12 consecutive months. Postmenopause, on the other hand, refers to the stage after menopause, where menopausal symptoms have generally subsided. The symptoms described by the patient are more indicative of the perimenopausal stage rather than pregnancy, as they are typical signs of hormonal changes associated with the menopausal transition.

The nurse is preparing to teach the community about risk factors for the second most common cancer of the female reproductive system. Which of the following groups of women are at higher risk for this cancer? Select all that apply.

  • A. Menopausal women with an intact uterus who receive hormonal therapy
  • B. Women who have undergone treatment for breast cancer
  • C. Women who have many pregnancies and nursed their infants
  • D. Women who smoke and have many sexual partners
Correct Answer: A

Rationale: A. Menopausal women with an intact uterus who receive hormonal therapy are at higher risk for endometrial cancer, which is the second most common cancer of the female reproductive system. Estrogen therapy without progesterone can increase the risk of endometrial cancer due to unopposed estrogen stimulation.

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