K.W. is an 18-year-old woman who comes to Planned Parenthood for a pregnancy test because a condom broke during intercourse the night before. Her last menstrual period (LMP) was 13 days ago and was normal. She always has a monthly menstrual cycle. She is extremely nervous about pregnancy because she is beginning college on a scholarship soon. She states there have been no other acts of unprotected intercourse since her LMP and declines a gynecologic examination.
K.W. asks whether she is at risk for pregnancy. How will you respond?

T.C. is a 49-year-old woman who 3 weeks ago underwent a vaginal hysterectomy and right salpingooophorectomy for abdominal pain and endometriosis. Postoperatively, she experienced an intraabdominal haemorrhage, requiring transfusion with 3 units of packed red blood cells (RBCs). After discharge, she continued to have abdominal pain, chills, and fever. She was readmitted twice: first for treatment of postoperative infection and second for evacuation of a pelvic hematoma. Despite treatment, T.C. continued to have abdominal pain, chi ll s, fever, and nausea and vomiting. T.C. has now been admitted to your unit from the postanesthesia care unit (PACU) after an exploratory laparotomy. Vital signs (VS) are 130/70, 94, 16, 99.7$^{\circ}$C F (37.6 $^{\circ}$C). Respirations are shallow and her Spo2 is 93% with oxygen at 2 l by nasal cannula. She is easily aroused and oriented to place and person. She dozes between verbal requests. She has a low-midline abdominal dressing that is dry and intact and a Jackson-Pratt drain that is fully compressed and contains a scant amount of bright red blood. Her Foley to down drain has clear yellow urine. She is receiving an IV of 1000 ml D5.4SNS at 100 ml/hr in her left forearm, with no swelling or redness. T.C. is receiving IV morphine sulphate for pain control through a patient-controlled analgesia (PCA) pump. The settings are dose 2 mg, lock-out interval 20 minutes, 4-hour maximum dose of 30 mg. When aroused, she states that her pain is an 8 on a scale of 1 to 10.
Identify factors that are affecting T.C.'s respiratory status

L.W., a 20-year-old college student, comes to the university health clinic for a pregnancy test. She has been sexually active with her boyfriend of 6 months, and her menstrual period is now "a few" weeks late. The pregnancy test result is positive. The patient begins to cry, saying, "I don't know what to do:'
What information do you need to obtain from L.W. and why?

L.W., a $20$-year-old college student, comes to the university health clinic for a pregnancy test. She has been sexually active with her boyfriend of 6 months, and her menstrual period is now $2$ weeks late. The pregnancy test is positive. The patient begins to cry, saying, “I don't know what to do.”

What options does a woman experiencing an unplanned pregnancy have?

You are working in a busy obstetrics/gynecology (OB/GYN) office, and t he last patient of the day is P.B., a 3S-year-old who is planning to get married soon. She wants to use birth control but is not sure what to choose. Her fiance is in law school, and they do not have health insurance, so she is anxious not to get pregnant right away. She asks you to review the various methods and help her explore what is best for her.
What other factors would influence the choice of a contraceptive method?

She asks you, "Could I be pregnant?" How will you respond?

T.C. is a $30$ -year-old woman who $3$ weeks ago underwent a vaginal hysterectomy and right salpingo-oophorectomy for abdominal pain and endometriosis. Postoperatively, she experienced an intraabdominal hemorrhage, and her hematocrit (Hct) dropped from ( $40.5\%$) to ( $21\%$). She was transfused with $3$ units of packed RBCs. After discharge, she continued to have abdominal pain, chills, and fever and was subsequently readmitted twice: once for treatment of postoperative infection and the second time for evacuation of a pelvic hematoma. Despite treatment, T.C. continued to have abdominal pain, chills, fever, and nausea and vomiting.

T.C. has now been admitted to your unit from the post-anesthesia care unit (PACU) after an exploratory laparotomy. Vital signs (VS) are $130/70, 94$, $16$, $99.7^{\circ} \mathrm{F}\left(37.6^{\circ} \mathrm{C}\right)$ (tympanic). She is easily aroused and oriented to place and person. She dozes between verbal requests. She has a low-midline abdominal dressing that is dry and intact and a Jackson-Pratt (JP) drain that is fully compressed and contains a scant amount of bright red blood. Her Foley to down drain has clear yellow urine. She has an IV of $1000$ mL D$5.45$NS infusing at $100$mL/hr in her left forearm, with no swelling or redness. T.C. is receiving IV morphine sulfate for pain control through a patient-controlled analgesia (PCA) pump. The settings are dose $2$mg, lock-out interval $15$ minutes, $4$-hour maximum dose of $30$mg. When aroused, she states that her pain is an $8$ on a scale of $1$ to $10$. She also has $2$ L oxygen by nasal cannula (O$_2$/NC); her Sao$_2$ by pulse oximeter is $93\%$.

Articulate a plan for assisting T.C. in maintaining adequate ventilation.

You are the nurse in a walk-in clinic. A.P. is being seen this morning for a 2-day history of diffuse, severe abdominal pain. She has complaints of nausea without vomiting; she denies vaginal bleeding or discharge. A.P. reports having unprotected sex with several partners recently, two of whom had penile discharge. Her last menstrual period ended 3 days ago. She has no known drug allergies and denies previous medical or psychiatric problems. Vital signs are 108/60, 110, 20, $100.6^{\circ}F$ ($38.1^{\circ}C$). Physical examination reveals that her abdomen is very tender. The slightest touch of her abdomen causes her to wince with pain. Bowel sounds are normal. Pelvic examination reveals purulent material pooled in t he vaginal vault, which appears to be coming from the cervix. A sample of the vaginal drainage is obtained and sent for culture. The result of a pregnancy test is negative; a rapid diagnostic test for chlamydia! infection has a positive result.
What medical interventions can you anticipate?

You are working as the triage nurse in the emergency department at a busy tertiary care center. A woman comes in complaining of very heavy vaginal bleeding and extreme pain. S.K. is single, $47$ years of age, and has been bleeding for $24$ hours, soaking a pad an hour. She works in a law firm as a paralegal and was embarrassed yesterday when she leaked around her pad and stained a chair in the conference room. She has two sexual partners currently and has been relying on condoms for birth control. She thinks her last menstrual period was $2$ months ago, but they have been irregular and she is not sure. She has had some occasional spotting during the past $6$ months. She states she is afraid of the amount of bleeding in the past $24$ hours.

Which statements indicate that S.K. understands the discharge instructions? (Select all that apply.)

• a. “I will call if I continue to have heavy bleeding, soaking a pad an hour.”
• b. “I can take three hundred twenty-five milligrams of aspirin every six hours for the cramping pain.”
• c. “If I get dizzy or feel my heart beating funny, I will come back to the ER.”
• d. “I will avoid sexual intercourse until the bleeding has completely stopped.”
• e. “I will try to eat more beans and spinach over the next several days.”

The physician comes and, after examining T.C., believes she is experiencing some internal bleeding. He takes her back to surgery where he isolates an area where the sutures have broken and cauterizes the affected vessels. T.C. returns to the unit, and her condition is quickly stabilized. The next evening you overhear T.C. and her husband saying that they are very dissatisfied with the care provided by the physician. They believe that he has mismanaged T.C.'s care. They are discussing getting an attorney. They ask you what you think.
YMr. C. says, "No one is telling us anything. My wife came in here for a simple hysterectomy. She ends up with four surgeries. She still has pain, and she is worse off than when she started. Somebody has screwed up big time. Then they have the nerve to send me a bill. This morning they demanded $185,000. I'm not paying a dime until she gets better." How are you going to respond?.

The physician comes and, after examining T.C., believes she is experiencing some internal bleeding. He takes her back to surgery where he isolates an area where the sutures have broken and cauterizes the affected vessels. T.C. returns to the unit, and her condition is quickly stabilized. The next evening you overhear T.C. and her husband saying that they are very dissatisfied with the care provided by the physician. They believe that he has mismanaged T.C.'s care. They are discussing getting an attorney. They ask you what you think.
You state, "Tell me what's going on with you right now. Maybe I can help you be more comfortable:' What would be the benefit of taking this approach?

A.P. returns to the clinic in $1$ week for her HIV test results, which are negative. Her culture results confirm the diagnosis of chlamydial infection.

You take this opportunity to review with A.P. regarding ways to reduce the risk of reinfection. How would you determine whether A.P. understood your teaching regarding safe sexual practices? She states that she will:

• a. inspect the genitalia of her partner before intercourse or other contact with perianal area.
• b. use a new application of spermicidal jelly instead of a condom before each encounter.
• c. douche with an over-the-counter solution within $8$ hours of having intercourse.
• d. not have to worry about contacting an STI if the man states he has few partners.

The physician comes and, after examining T.C., believes she is experiencing some internal bleeding. He takes her back to surgery where he isolates an area where the sutures have broken and cauterizes the affected vessels. T.C. returns to the unit, and her condition is quickly stabilized. The next evening you overhear T.C. and her husband saying that they are very dissatisfied with the care provided by the physician. They believe that he has mismanaged T.C.'s care. They are discussing getting an attorney. They ask you what you think.
What do you do and why?

L.W., a $20$-year-old college student, comes to the university health clinic for a pregnancy test. She has been sexually active with her boyfriend of 6 months, and her menstrual period is now $2$ weeks late. The pregnancy test is positive. The patient begins to cry, saying, “I don't know what to do.”

Finally, L.W. wants to know how long she has to decide.