The 22-year-old patient is scheduled for her first gynecologic ...

[kfurse]

The 22-year-old patient is scheduled for her first gynecologic examination.
 
  What can the nurse do to make the patient more comfortable during this exam? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Have a female physician perform the exam.
  2. Show the patient what the speculum looks like.
  3. Avoid telling the patient what the exam involves.
  4. Ask the patient why she has delayed her first Pap test this long.
  5. Provide a mirror for the patient.

Question 2

The patient has undergone an ultrasound, which estimated fetal weight at 4500 g (9 pounds 14 ounces). Which statement indicates that additional teaching is needed? Because my baby is big:
 
  1. I am at risk for excessive bleeding after delivery.
  2. His blood sugars could be high after he is born.
  3. My perineum could experience trauma during the birth.
  4. His shoulders could get stuck and a collarbone broken.

[uniquea123]

Answer to Question 1

1,2,5
Rationale 1: The first pelvic examination can be a frightening experience. To reduce fear and improve the patient's sense of control, schedule the exam with a female provider.
Rationale 2: Show the patient all of the equipment to be used.
Rationale 3: To reduce fear and improve the patient's sense of control, create a trusting atmosphere by explaining everything involved in the exam.
Rationale 4: Asking why the patient has delayed her first Pap test is being judgmental, which does not foster a therapeutic relationship.
Rationale 5: Provide a mirror to increase learning about anatomy and to create a trusting atmosphere.

Answer to Question 2

2
Rationale 1: Because of the excessive size of the uterus with a macrosomic fetus, uterine atony leading to postpartum hemorrhage is a risk.
Rationale 2: Hypoglycemia, not hyperglycemia, is a potential complication experienced by a macrosomic fetus.
Rationale 3: Perineal trauma due to the large fetus is a possible complication of vaginal delivery of a macrosomic fetus.
Rationale 4: Shoulder dystocia is more common among large fetuses, and a broken clavicle could result.