Nokea
With regard to an obstetric litigation case, a nurse working in labor and birth is found to be negligent. Which intervention performed by the nurse indicates that a breach of duty has occurred?
- A. The nurse did not document fetal heart tones (FHR) during the second stage of labor.
- B. The patient was only provided ice chips during the labor period, which lasted 8 hours.
- C. The nurse allowed the patient to use the bathroom rather than a bedpan during the first stage of labor.
- D. The nurse asked family members to leave the room when she prepared to do a pelvic exam on the patient.
Correct Answer: A
Rationale: In an obstetric setting, failure to document fetal heart tones (FHR) during the second stage of labor is a critical breach of duty by the nurse. Monitoring FHR is essential to assess fetal well-being and detect any signs of distress or complications during labor. Neglecting to document this important vital sign could result in delayed recognition of fetal distress, potentially leading to adverse outcomes for the baby and the mother. Therefore, this intervention indicates negligence on the part of the nurse in this scenario.
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The nurse is assessing a 33-year-old female patient who comes to the family practice clinic with complaints of excessive menstrual bleeding with bleeding between periods for the past 6 months. The health care provider has performed an endometrial biopsy and has discontinued the patient's oral contraceptives. What is the rationale for this treatment?
- A. This condition is often associated with use of oral contraceptives and may subside upon discontinuation.
- B. This condition is often associated with type 2 diabetes and must be controlled with a different type of birth control.
- C. This condition is often associated with hyperplasia of the endometrial tissue, which is exacerbated with oral contraceptives.
- D. This condition is often associated with ovarian cysts, which are exacerbated with the use of oral contraceptives.
Correct Answer: C
Rationale: The correct rationale for discontinuing the oral contraceptives in a patient with excessive menstrual bleeding and bleeding between periods is that this condition is often associated with hyperplasia of the endometrial tissue, which can be exacerbated with the use of oral contraceptives. Endometrial hyperplasia is a condition characterized by the abnormal thickening of the lining of the uterus, which can lead to heavy or prolonged menstrual bleeding. Estrogen contained in oral contraceptives can contribute to this thickening of the endometrial tissue, potentially worsening the patient's symptoms. By discontinuing the oral contraceptives, the provider aims to reduce the estrogen levels in the body, which may help alleviate the symptoms associated with endometrial hyperplasia. An endometrial biopsy is also important in this case to further investigate the underlying cause of the abnormal bleeding.
The nurse is providing care to the 35-year-old female patient at the family practice clinic who is in the office for her annual physical examination. Which tests should the nurse recommend are the most appropriate for this patient? Select all that apply.
- A. Papanicolaou test every 5 years
- B. Mammogram every 2 years
- C. DEXA screen every 2 years
- D. HPV every 5 years
Correct Answer: A
Rationale: A. Papanicolaou test (Pap smear) every 5 years - This test is recommended for cervical cancer screening in women aged 30-65 years old. It helps in early detection and prevention of cervical cancer.
What information is important for the nurse to include in planning for the care of a woman who has had a vaginal hysterectomy?
- A. Expect to be fully recovered in 4 to 6 weeks.
- B. Expect no changes in her hormone levels.
- C. Expect surgical menopause.
- D. Take tub baths to aid in healing.
Correct Answer: B
Rationale: Unless the ovaries were also removed, hormonal levels should not change. The woman should expect vaginal discharge for 4 to 6 weeks. Full recovery varies from woman to woman, depending on risk factors and individual healing.
What is the most common reproductive tract cancer associated with pregnancy?
- A. Cervical
- B. Uterine
- C. Ovarian
- D. Fallopian tube
Correct Answer: A
Rationale: The incidence of cervical cancer concurrent with pregnancy is reported to be 1 in 2000 pregnancies, making it the most common reproductive tract cancer associated with pregnancy.
Dysfunctional uterine bleeding (DUB) is defined as excessive uterine bleeding without a demonstrable cause. Which statement regarding this condition is most accurate?
- A. DUB is most commonly caused by anovulation
- B. DUB most often occurs in middle age
- C. The diagnosis of DUB should be the first consideration for abnormal menstrual bleeding
- D. Steroids are the most effective medical treatment for DUB
Correct Answer: A
Rationale: Anovulation is the most common cause of DUB especially in women at the beginning or end of their reproductive years. Other causes should be ruled out before diagnosing DUB.