Scenario:
A nurse is caring for a 32-year-old female client who was recently diagnosed with endometriosis. The client is in the clinic for a follow-up visit after beginning nafarelin treatment.
Setting: Clinic
Which of the following manifestations reported by the client should the nurse identify as a therapeutic effect of the nafarelin? (Select all that apply.)
CNS manifestations
Pain level during sexual intercourse
Nasal mucosa changes
Breast changes
Missed previous month's menstrual cycle
Dermatological manifestations
Correct Answer : B,E
Choice A rationale: CNS manifestations such as headaches are not a therapeutic effect of nafarelin. These are side effects of the medication. Nafarelin, a gonadotropin-releasing hormone (GnRH) agonist, works by reducing the production of estrogen in the body. This can lead to a variety of side effects, including headaches. While these side effects can be bothersome, they do not indicate that the medication is effectively treating the endometriosis.
Choice B rationale: The reduction in pain level during sexual intercourse, or dyspareunia, is a therapeutic effect of nafarelin. Endometriosis can cause painful sexual intercourse, and one of the goals of treatment with nafarelin is to reduce this pain. The client’s report of decreased dyspareunia suggests that the nafarelin is effectively treating the endometriosis.
Choice C rationale: Changes in the nasal mucosa, such as irritation, are not a therapeutic effect of nafarelin. These are side effects of the medication. Nafarelin is administered intranasally, which can lead to irritation of the nasal mucosa. While this side effect can be bothersome, it does not indicate that the medication is effectively treating the endometriosis.
Choice D rationale: Changes in breast size are not a therapeutic effect of nafarelin. These are side effects of the medication. Nafarelin can cause a variety of side effects, including changes in breast size. While this side effect can be bothersome, it does not indicate that the medication is effectively treating the endometriosis.
Choice E rationale: The absence of menstruation, or amenorrhea, is a therapeutic effect of nafarelin. Nafarelin works by reducing the production of estrogen in the body, which can lead to a temporary halt in menstruation. This is a therapeutic effect as it can help to reduce the pain and other symptoms associated with endometriosis.
Choice F rationale: Dermatological manifestations such as increased acne are not a therapeutic effect of nafarelin. These are side effects of the medication. Nafarelin can cause a variety of side effects, including increased acne. While this side effect can be bothersome, it does not indicate that the medication is effectively treating the endometriosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Urinary retention refers to the inability to empty the bladder completely. While it can cause discomfort and bloating, it does not typically result in dark amber, cloudy urine with an unpleasant odor.
Choice B rationale
Urinary incontinence is the loss of bladder control, leading to the involuntary leakage of urine. It does not cause the urine to become dark amber, cloudy, or have an unpleasant odor.
Choice C rationale
A urinary tract infection (UTI) is an infection in any part of the urinary system — kidneys, bladder, urethra. Most UTIs are caused by bacteria, but they can also be caused by viruses or fungi. Symptoms of a UTI often include cloudy, dark, or strong-smelling urine.
Choice D rationale
Urinary frequency refers to needing to urinate more often than usual. It can be a symptom of many different issues, including a UTI, but on its own, it does not cause the urine to become dark amber, cloudy, or have an unpleasant odor.
Correct Answer is A
Explanation
Choice A rationale
The patient has the right to withdraw their informed consent at any time, even after signing the consent form. This is a fundamental principle of patient autonomy and respect for the individual’s rights. The nurse should respect the patient’s decision and notify the surgeon that the patient wishes to withdraw informed consent for the procedure. This allows the healthcare team to reassess the situation, provide further information if necessary, and make appropriate adjustments to the care plan.
Choice B rationale
While informing the surgical team to cancel the surgery might be a subsequent step, it is not the immediate action the nurse should take. The first action should be to respect the patient’s autonomy and communicate their decision to the surgeon.
Choice C rationale
Proceeding with the preparation of the patient for the surgical procedure against their expressed wishes would be a violation of the patient’s rights. It is essential to respect the patient’s autonomy and their right to make decisions about their own healthcare.
Choice D rationale
Reminding the patient that a signed informed consent form is a legally binding document is incorrect. Informed consent is not a contract, and the patient has the right to withdraw consent at any time. The purpose of informed consent is to ensure that the patient understands the procedure, its risks and benefits, and alternatives, and makes an informed decision.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.