A clinic nurse is assessing a client with a suspected diagnosis of endometriosis.
Which of the following findings in the client's medical history should the nurse identify as consistent with a diagnosis of endometriosis?

A history of pelvic inflammatory disease (PID).

An atypical Papanicolaou smear at her last clinic visit.

Dysmenorrhea that is unresponsive to NSAIDS.

Abdominal bloating starting several days before menses.

Answer and Explanation

The Correct Answer is C

Choice A rationale

While pelvic inflammatory disease can lead to infertility, it does not specifically cause endometriosis. PID involves infection of the reproductive organs, while endometriosis is the presence of endometrial tissue outside the uterus, characterized by pain and inflammation during menstruation.

Choice B rationale

An atypical Papanicolaou smear indicates abnormal cervical cells, often related to infection or precancerous changes, but is not indicative of endometriosis. Endometriosis involves ectopic endometrial tissue and does not affect cervical cell morphology directly.

Choice C rationale

Dysmenorrhea unresponsive to NSAIDs is a hallmark of endometriosis. This condition causes severe pain due to the inflammation and cyclic bleeding of ectopic endometrial tissue, often resulting in scarring and adhesions that exacerbate discomfort during menstruation.

Choice D rationale

Abdominal bloating starting before menses may be associated with premenstrual syndrome or other hormonal changes rather than endometriosis. Although some women with endometriosis report bloating, it is not a definitive diagnostic criterion compared to chronic pain and infertility.

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Correct Answer is A

Explanation

Choice A rationale

Weighing an infant's diaper for output is a task suitable for unlicensed assistive personnel (UAP) because it involves data collection rather than clinical judgment or critical thinking. The results can be recorded and reported to the nurse for further assessment and interpretation.

Choice B rationale

Assessing a post-operative dressing requires clinical judgment to identify signs of infection, dehiscence, or other complications. This task is within the scope of a licensed nurse and should not be delegated to UAP to ensure patient safety.

Choice C rationale

Calculating the Morse Fall Scale involves understanding and interpreting risk factors, which requires critical thinking and clinical judgment. It is inappropriate for delegation to UAP, as they are not trained to analyze or interpret clinical data.

Choice D rationale

Performing an assessment of a child's developmental milestones requires knowledge of growth and development patterns, as well as clinical judgment to interpret findings. This task is outside the scope of UAP and must be performed by a licensed nurse.

A. Anatomical change: Horizontal eustachian tubes; complication: otitis media; priority intervention: surgical closure of palate. B. Anatomical change: Small external ear structure; complication: hydrocephalus; priority intervention: diuretics. C. Anatomical change: Large tongue; complication: otitis externa; priority intervention: ear drops. D. Anatomical change: Opening in lip; complication: pneumonia; priority intervention: corticosteroids.

Correct Answer is A

Explanation

Choice A rationale

Horizontal eustachian tubes in children with cleft palate increase the risk of otitis media due to impaired drainage and ventilation. Surgical closure of the palate helps restore anatomical structure, reducing the incidence of middle ear infections and associated complications.

Choice B rationale

Small external ear structure is not anatomically linked to hydrocephalus, and diuretics are unrelated to managing this condition. Hydrocephalus stems from cerebrospinal fluid accumulation, not external ear anatomy, making this option inaccurate.

Choice C rationale

A large tongue may lead to airway obstruction but is not linked to otitis externa. Ear drops manage external ear infections but do not address anatomical changes associated with cleft palate, which impacts the eustachian tubes and middle ear.

Choice D rationale

An opening in the lip does not directly cause pneumonia. Pneumonia is primarily a respiratory condition influenced by infections, not lip anatomy. Corticosteroids are not standard interventions for pneumonia related to cleft palate complications.

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A clinic nurse is assessing a client with a suspected diagnosis of endometriosis.Which of the following findings in the client's medical history should the nurse identify as consistent with a diagnosis of endometriosis?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which task is most appropriate for the nurse to delegate to the unlicensed assistive personnel on a pediatric unit?

Correct Answer is A

Explanation

Identify a complication resulting from a cleft palate, the anatomical changes that lead to the complication, and the priority interventions for care.

Correct Answer is A

Explanation

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A clinic nurse is assessing a client with a suspected diagnosis of endometriosis.
Which of the following findings in the client's medical history should the nurse identify as consistent with a diagnosis of endometriosis?