Papanicolaou Test (Pap Smear)

Notes

Definition
  • The Papanicolaou test (Pap smear) is a widely known cystologic test for early detection of cervical cancer. The can also be used to detect cancerous cells of the breast, lung, stomach, and renal system. A physician or specifically trained nurse scrapes secretions from the patient’s cervic and spreads them on a slide, which is sent to the laboratory for cystologic analysis.
  • An alternative method is to use the ThinPrep preservative solution rather than a slide. The ThinPrep was introduced in 1996 and allows testing for malignancy cells from the cervix and shows the cell maturity, metabolic activity, and morphology variations.
  • The American Cancer Society recommends a Pap test every 3 years for women between ages 20 and 40 who aren’t in a high-risk category and who have had negative results from three previous Pap tests. Yearly tests (or tests at physician-recommended intervals) are advised for women older than age 40, for those in a high risk category, and for those who had a positive test previously. If a Pap test is positive or suggest malignancy, cervical biopsy can confirm the diagnosis.
Purpose
  • To detect malignant cells.
  • To detect inflammatory changes in tissue.
  • To assess response to chemotherapy and radiation therapy.
  • To detect viral, fungal, and occasionally, parasitic invasions.
Procedure
Patient Preparation
  1. Instruct the patient to avoid intercourse for 24 hours, douching for 48 hours, and vaginal creams or medication for 1 week.
  2. Just before the test, instruct the patient to empty her bladder.
  3. During the procedure, she might experience a slight discomfort but no pain from the speculum; however, she may feel some pain when the cervix is scraped.
  4. Explain the procedure takes only 5 to 10 minutes to perform.
  5. Instruct the patient to disrobe from the waist down and to drape herself.
  6. Ask her to lie on the examining table and to place her heels in the stirrups.
  7. Tell her to slide her buttocks to the edge of the table.papsmear
Implementation
  1. The patient is assisted into the lithotomy position with her feet in the stirrups.
  2. An unlubricated speculum is inserted into the vagina.
  3. The cervix is located.
  4. Secretions from the cervix and material from the endocervical canal are collected with an endocervical brush and wooden spatula.
  5. Specimens are spread on slides and immediately immersed in fixative or sprayed with a fixative.
  6. Specimens are appropriately labeled with date of last menses, collection site, and method.
  7. If vaginal or vulval lesions are present, scrapings taken directly from the lesion are preferred.
  8. The slides are preserved immediately.
Nursing Interventions
  1. Help the patient up and ask her to dress when the examination is completed.
  2. Supply the patient with a sanitary napkin if cervical bleeding occurs.
  3. Tell the patient when to return for her next Pap test.
Interpretation
Normal Results
  • No malignant cells or abnormalities are present.Pap-smear-1
Abnormal Results
  • Cells with relatively large nuclei, only small amounts of cytoplasm, abnormal nuclear chromatin patterns, and marked variation in size, shape, and staining properties, with prominent nucleoli, suggest malignancy.
  • Atypical but nonmalignant cells suggest a benign abnormality.
  • Atypical cells may suggest dysplasia.
Interfering Factors
  • Douching within 24 hours of testing.
  • Excessive use of lubricating jelly on the slide.
  • Collection of specimen during menstruation
  • Delay in fixing the specimens
  • Consistency of specimen too thin or too thick.
Precautions
  • Preserve the slides immediately after the specimen is collected.
  • Preserve the ThinPrep solution by immediately placing the lid back on the container, as exposure to air or light can cause distortion of cells.
Complications
  • Bleeding

Exam

Welcome to your Papanicolaou Test (Pap Smear) Practice Exam! This exam is carefully curated to help you consolidate your knowledge and gain deeper understanding on the topic.

 

Exam Details

  • Number of Questions: 10 items
  • Mode: Practice Mode

Exam Instructions

  1. Practice Mode: This mode aims to facilitate effective learning and review.
  2. Instant Feedback: After each question, the correct answer along with an explanation will be revealed. This is to help you understand the reasoning behind the correct answer, helping to reinforce your learning.
  3. Time Limit: There is no time limit for this exam. Take your time to understand each question and the corresponding choices.

Tips For Success

  • Read each question carefully. Take your time and don't rush.
  • Understand the rationale behind each answer. This will not only help you during this exam, but also assist in reinforcing your learning.
  • Don't be discouraged by incorrect answers. Use them as an opportunity to learn and improve.
  • Take breaks if you need them. It's not a race, and your understanding is what's most important.
  • Keep a positive attitude and believe in your ability to succeed.

Remember, this exam is not just a test of your knowledge, but also an opportunity to enhance your understanding and skills. Enjoy the learning journey!

 

Click 'Start Exam' when you're ready to begin. Best of luck!

💡 Hint

Consider the factors that might influence the accuracy of a Pap test.

1 / 10

1. Nurse Avery is helping a client schedule her annual pelvic exam and Pap test. The client asks whether she should avoid intercourse before the test. What is the best response from Nurse Avery?

💡 Hint

Consider that dysplasia involves changes at the cellular level that can affect cell appearance and arrangement.

2 / 10

2. Nurse Adams is speaking with a patient who had an abnormal result on her Pap test and asks about the meaning of the term "dysplasia." What definition should Nurse Adams provide?

💡 Hint

Think about the roles of different parts of the female reproductive system, particularly where fertilization and implantation typically occur.

3 / 10

3. Nurse Sophie is teaching a group of high school girls about the female reproductive system. Which of the following statements are accurate?

💡 Hint

Consider the screening recommendations for young women, especially the age at which certain cancer detection methods are generally advised to begin.

4 / 10

4. Nurse Lee is educating a 25-year-old patient on early cancer detection methods. Which method is the least likely to be recommended by Nurse Lee?

💡 Hint

Consider the relationship between HPV and the risk of developing cervical cancer, as well as the limitations of treatments and preventive measures.

5 / 10

5. Nurse Jenna is educating a female client who has just been diagnosed with condylomata acuminata (genital warts). Which information is most appropriate to share with this client?

💡 Hint

Consider the relationship between HPV and cervical cancer risk, as well as the limitations of condoms and transmission methods for HPV.

6 / 10

6. Nurse Harper is educating a patient who has just been diagnosed with condylomata acuminata (genital warts). What information is most appropriate to share with this patient?

💡 Hint

Higher classification numbers in Pap smear results typically indicate more severe cellular abnormalities.

7 / 10

7. Nurse Rodriguez is reviewing the results of a Pap smear that are reported as class 5. How should the nurse interpret this finding?

💡 Hint

The necessity of a Pap smear often depends on whether the cervix is still present after a hysterectomy.

8 / 10

8. Nurse Lopez is speaking with a client who questions the need for a pelvic exam and Pap smear because she had a hysterectomy years ago. What is the most appropriate response from Nurse Lopez?

💡 Hint

Consider the recommended guidelines for the age at which women should begin routine Pap smears and pelvic exams.

9 / 10

9. Nurse Morgan is counseling a mother who is considering scheduling a Pap smear and pelvic exam for her teenage daughter. What is the most accurate statement Nurse Morgan can provide?

💡 Hint

Consider the screening test that is specifically advised for detecting cervical changes in younger women.

10 / 10

10. Nurse Lawson is discussing recommended health screening diagnostic tests with a 35-year-old woman. Which of the following tests is recommended for women aged 19-39 years?