# Situation: The public health nurse of a Rural Health Unit (RHU) holds a women's health day on the prevention of noncommunicable diseases (NCDs), including cancer, for residents of a farming barangay. A 36-year-old woman arrives for her scheduled Papanicolaou (Pap) smear. Her last menstrual period ended 6 days ago. She has used no vaginal medicines or washes, but she had sexual intercourse last night. What should the nurse do?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627212  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: The public health nurse of a Rural Health Unit (RHU) holds a women's health day on the prevention of noncommunicable diseases (NCDs), including cancer, for residents of a farming barangay.

A 36-year-old woman arrives for her scheduled Papanicolaou (Pap) smear. Her last menstrual period ended 6 days ago. She has used no vaginal medicines or washes, but she had sexual intercourse last night. What should the nurse do?

## 보기

1. Proceed today, since her period ended 6 days ago
2. Reschedule the smear for at least 2 days from now **✔ 정답**
3. Reschedule the smear for after her next period
4. Proceed today and note the intercourse on the form

**정답: 2**

## 해설

Two preparation rules apply. She meets the first: she is not menstruating. She fails the second: intercourse, douching, tampons, and vaginal products are avoided for about 48 hours before the test because they can wash away or obscure cervical cells. The smear is therefore moved to a day at least 48 hours after intercourse, while she is still not menstruating.

## 심화 해설

Two preparation rules for a Pap smear
A Papanicolaou (Pap) smear depends on collecting enough clear cervical cells. Two preparation rules protect the sample. First, the woman should not be menstruating, since blood can obscure the cells. Second, she should avoid sexual intercourse, douching, tampons, and vaginal medicines or products for about 48 hours before the test, because they can wash away or obscure cervical cells. This woman meets the first rule: her period ended 6 days ago. She fails the second: she had intercourse last night. The nurse should reschedule the smear for a day at least 2 days from now, while she is still not menstruating.

Why intercourse affects the sample
Semen, lubricants, and the friction of intercourse can coat or disturb the surface cells of the cervix, and they can cause mild inflammation. The cytologist may then see too few cells, cells hidden by other material, or inflammatory changes that make interpretation difficult, leading to an unsatisfactory or misleading result. Waiting 48 hours lets the cervical surface return to its usual state so that the sample truly represents the cells.

| Preparation rule | Her status |
| --- | --- |
| Not menstruating | Met: period ended 6 days ago |
| No vaginal medicines or washes for about 48 hours | Met |
| No intercourse for about 48 hours | Not met: intercourse last night |
| Decision | Reschedule to 48 hours or more after intercourse |

Why the other actions are wrong
Proceeding today because her period ended meets only one rule and ignores the other. Rescheduling until after her next period adds unnecessary delay; she only needs 48 hours without intercourse while still not menstruating, which can easily fall before her next period. Proceeding and noting the intercourse on the form documents the problem but does not make the sample adequate. Watch out! Documentation does not replace correct preparation when the sample itself would be unreliable.

Teaching for the rescheduled visit
Before the new appointment, she should avoid intercourse, douching, tampons, and vaginal products for 48 hours, and come when she is not menstruating. The ideal time is usually the middle of the cycle, well after menstruation ends. The nurse explains the reason for rescheduling so that she does not feel turned away, confirms a specific date, and reassures her that the test itself is quick. If she cannot return easily, the nurse can discuss other screening methods available at the RHU, such as VIA or an HPV test, with their own preparation instructions.

## 임상 시나리오

Pap Smear PreparationWhen to reschedule the test
Two rules: the woman should not be menstruating, and she should avoid intercourse, douching, tampons, and vaginal products for about 48 hours.

This woman's period ended 6 days ago (met), but she had intercourse last night (not met).

Reschedule to at least 48 hours after intercourse, while she is still not menstruating, and teach the preparation rules.

CautionNoting the intercourse on the form does not make the sample adequate. Reschedule instead.

## 핵심 개념

- **Pap smear** — Collection of cervical cells for microscopic examination to detect precancerous or cancerous changes.
- **Unsatisfactory sample** — A smear with too few or obscured cells that cannot be reliably interpreted.
- **Douching** — Rinsing the vagina with water or other fluids, which can wash away cervical cells before a test.
- **Cervical cytology** — The study of cells from the cervix, the basis of the Pap smear.

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