When providing care to a young single woman just diagnosed with acute pelvic inflammatory disease, the nurse should:
point out that inappropriate sexual behavior caused the infection.
position the woman in a semi-Fowler position.
tell her that antibiotics need to be taken until pelvic pain is relieved.
explain to the woman that infertility is a likely outcome of this type of infection.
The Correct Answer is B
Choice A reason: Pointing out that inappropriate sexual behavior caused the infection is not helpful, as it may make the woman feel guilty, ashamed, or defensive. The nurse should avoid blaming or judging the woman and focus on providing education and support.
Choice B reason: Positioning the patient in a semi-Fowler position (head of the bed elevated 30–45 degrees) helps promote drainage of pelvic exudate and reduces the risk of abscess formation or further spread of infection. This is a key nursing intervention for patients with acute pelvic inflammatory disease (PID).
Choice C reason: Telling her that antibiotics need to be taken until pelvic pain is relieved is incorrect, as it may lead to incomplete treatment and recurrence of the infection. The nurse should instruct the woman to take the full course of antibiotics as prescribed, regardless of the symptoms.
Choice D reason: While infertility is a potential complication of PID, it is not a guaranteed outcome. The nurse should provide accurate information about risks but avoid causing unnecessary alarm. The focus should be on prompt treatment and prevention of complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Cerebral compression is the cause of early decelerations, as it reflects the fetal head compression during uterine contractions. Early decelerations are decreases in the FHR that begin and end with the onset and end of a contraction, respectively. They are symmetrical and mirror the shape of the contraction. Early decelerations are normal and benign, as they indicate that the fetus is responding to the increased intracranial pressure and maintaining adequate oxygenation.
Choice B reason: Cord compression is not the cause of early decelerations but of variable decelerations. Variable decelerations are abrupt and irregular decreases in the FHR that vary in onset, duration, and depth. They are usually caused by the umbilical cord being compressed or occluded by the fetal body, the maternal pelvis, or the uterine contractions. Variable decelerations can indicate fetal distress or hypoxia, especially if they are severe, frequent, or prolonged.
Choice C reason: Uteroplacental insufficiency is not the cause of early decelerations, but of late decelerations. Late decelerations are decreases in the FHR that begin after the peak of a contraction and return to the baseline after the contraction ends. They are symmetrical and have a gradual onset and recovery. They are usually caused by the reduced blood flow and oxygen delivery to the placenta and the fetus due to maternal or fetal factors. Late decelerations can indicate fetal distress or hypoxia, and require immediate intervention.
Choice D reason: Spontaneous rupture of membranes is not the cause of early decelerations, but it can be a risk factor for cord compression and variable decelerations. Spontaneous rupture of membranes is the breaking of the amniotic sac and the release of the amniotic fluid, which usually occurs during labor or shortly before it. Spontaneous rupture of membranes can cause the umbilical cord to prolapse or slip into the vagina, where it can be compressed or kinked by the fetal head or the contractions.
Correct Answer is B
Explanation
Choice A reason: Braxton Hicks contractions are irregular, painless uterine contractions that occur throughout pregnancy. They are a probable sign of pregnancy, not a positive sign.
Choice B reason: Fetal movement palpated by the nurse-midwife is a positive sign of pregnancy, as it confirms the presence of a living fetus in the uterus. It can be detected as early as 16 to 20 weeks of gestation.
Choice C reason: A positive pregnancy test is a probable sign of pregnancy, as it indicates the presence of human chorionic gonadotropin (hCG) in the urine or blood. However, it is not a definitive sign, as other conditions can cause elevated hCG levels.
Choice D reason: Quickening is the first perception of fetal movement by the mother, which usually occurs between 16 and 20 weeks of gestation. It is a presumptive sign of pregnancy, not a positive sign.
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