4.3
When discussing estrogen replacement therapy (ERT) with a perimenopausal woman, the nurse should include the risks of a. Breast cancer b. Vaginal and urinary tract atrophy c. Osteoporosis d. Arteriosclerosis
ANS: A
A nurse in a campus health clinic is assessing the female students for risk factors associated with the future development of osteoporosis. What factors are included in this assessment? Select all that apply. 1. _____ Cigarette smoking 2. _____ Moderate exercise 3. _____ Use of street drugs 4. _____ Familial predisposition 5. _____ Inadequate intake of dietary calcium (Nugent 339)
1,4,5
The nurse is teaching an 18 year old athlete about measures to reverse amenorrhea. Which statements made indicate effective learning? A. "I will do hatha yoga daily" B. "I will increase my food intake" C. " I will perform weight training exercises" D. I will take lower back massages frequently" E " I will use oral contraceptive pills to regulate the menstrual cycle"
B,C
. A nurse is assessing a community group for dietary factors that contribute to osteoporosis. In addition to inquiring about calcium, the nurse also assesses for which other dietary components? (Select all that apply.) a. Alcohol b. Caffeine c. Fat d. Carbonated beverages e. Vitamin D
ANS: A, B, D, E Dietary components that affect the development of osteoporosis include alcohol, caffeine, high phosphorus intake, carbonated beverages, and vitamin D. Tobacco is also a contributing lifestyle factor. Fat intake does not contribute to osteoporosis.
A client has a recurrent Bartholin cyst. What is the nurse's priority action? a. Apply an ice pack to the area. b. Administer a prophylactic antibiotic. c. Obtain a fluid sample for laboratory analysis. d. Suggest moist heat such as a sitz bath.
ANS: C A major cause of an obstructed duct forming a cyst is infection. The laboratory specimen is a priority since a culture is needed in order to prescribe sensitive antibiotics. Comfort measures can then be used, such as ice packs and moist heat.
Nafarelin (Synarel) is currently used as a treatment for mild to severe endometriosis. The nurse should tell the woman taking this medication that the drug a. Stimulates the secretion of gonadotropin-releasing hormone (GnRH), thereby stimulating ovarian activity b. Should be sprayed into one nostril every other day c. Should be injected into subcutaneous tissue BID d. Can cause her to experience some hot flashes and vaginal dryness
ANS: D
Which diagnostic test is used to confirm a suspected diagnosis of breast cancer? a. Mammogram b. Ultrasound c. Core needle biopsy d. CA 15-3
ANS: C When a suspicious mammogram is noted or a lump is detected, diagnosis is confirmed by either a core needle biopsy or needle localization biopsy.
Among which group of women are breast cancer death rates the lowest? A. Hawaiian B. Puerto Rican C. Asian American D. African American
C
A client has just returned from a total abdominal hysterectomy and needs postoperative nursing care. What action can the nurse delegate to the unlicensed assistive personnel (UAP)? a. Assess heart, lung, and bowel sounds. b. Check the hemoglobin and hematocrit levels. c. Evaluate the dressing for drainage. d. Empty the urine from the urinary catheter bag.
ANS: D The UAP is able to empty the urinary output from the catheter. The nurse would assess the heart, lung, and bowel sounds; check the hemoglobin and hematocrit levels; and evaluate the drainage on the dressing.
The nurse teaches a premenopausal obese client about strategies to prevent osteoporosis. Which strategy identified by the client indicated the the teaching is effective? A. Starts a rapid, strict weight reduction diet B. Joins a tennis league and practices every day C. takes 1200 IU of vitamin D a day D. Signs up for a swimming class 3x per week
B
A client has a hysterectomy, salpingo-oophorectomy, tumor removal, and multiple abdominal biopsies for ovarian cancer. For which clinical manifestations indicating that the client may be experiencing a pulmonary embolus should the nurse assess the client? Select all that apply. A. Flushed face B. increased temperature C. Severe abdominal pain D. Decreased oxygen saturation level E. Sudden onset of shortness of breath
B,D,E
A young woman is diagnosed as having genetically related amenorrhea. What is the primary nursing intervention at this time? A. supporting her physical abilities B. discussing her altered body image C. trying to meet her emotional needs D. exploring other reproductive options for her
C
The nurse providing education regarding breast care should explain to the woman that fibrocystic changes in breasts are a. A disease of the milk ducts and glands in the breasts b. A pre-malignant disorder characterized by lumps found in the breast tissue c. Lumpiness with pain and tenderness found in varying degrees in the breast tissue of healthy women during menstrual cycles d. Lumpiness accompanied by tenderness after menses
ANS: C
With regard to endometriosis, nurses should be aware that a.It is characterized by the presence and growth of endometrial tissue inside the uterus. b.It affects 25% of all women. c.It may worsen with repeated cycles or remain asymptomatic and disappear after menopause. d.It is unlikely to affect sexual intercourse or fertility.
ANS: C
A nurse is caring for a client who is scheduled for a modified radical mastectomy. What should the nurse tell the client to expect in the immediate postoperative period? A. Portable wound drainage system B. sling to support affected arm C. high carb diet to promote healing D. large pressure dressing over incision site
A
A woman with a history of a cystocele should contact the physician if she experiences a. Involuntary loss of urine when she coughs b. Constipation c. Backache d. Urinary frequency and burning
D Urinary frequency and burning are symptoms of cystitis, a common problem associated with cystocele.
The nurse is taking the history of a 24-year-old client diagnosed with cervical cancer. What possible risk factors would the nurse assess? (Select all that apply.) a. Smoking b. Multiple sexual partners c. Poor diet d. Nulliparity e. Younger than 18 at first intercourse
ANS: A, B, C, E Smoking, multiple sexual partners, poor diet, and age less than 18 for first intercourse are all risk factors for cervical cancer. Nulliparity is a risk factor for endometrial cancer.
When assessing a woman for menopausal discomforts, the nurse expects the woman to describe the most frequently reported discomfort, which is a. Headaches b. Hot flashes c. Mood swings d. Vaginal dryness with dyspareunia
ANS: B Vasomotor instability, in the form of hat flashes or flushing, is a result of fluctuating estrogen levels and is the most common disturbance of the perimenopausal woman.
The nurse studying osteoporosis learns that which drugs can cause this disorder? (Select all that apply.) a. Antianxiety agents b. Antibiotics c. Barbiturates d. Corticosteroids e. Loop diuretics
ANS: C, D, E Several classes of drugs can cause secondary osteoporosis, including barbiturates, corticosteroids, and loop diuretics. Antianxiety agents and antibiotics are not associated with the formation of osteoporosis.
Which characteristics does the nurse observe in a client who has secondary amenorrhea? A. No uterine bleeding for 4 years after breast development B. Absence of menstrual bleeding for 3 cycles after menarche c. Absence of uterine bleeding and secondary sex D. No uterine bleeding for 1 year after attaining a sexual maturity rating of 5 on Tanner Scale
B. Absence of menstrual bleeding for three cycles after menarche Rationale: When the patient's menstrual cycle is absent three successive times after menarche, it indicates secondary amenorrhea. The absence of uterine bleeding 4 years after breast development indicates primary amenorrhea. The absence of uterine bleeding and secondary sex characteristics at the age of 16 years indicates primary amenorrhea. No uterine bleeding for 1 year after attaining a sexual maturity rating of 5 on the Tanner scale is indicative of primary amenorrhea.
A client underwent a mastectomy 24 hrs ago. Which information is most important for the nurse to include in the plan of care? A. The drainage container will be kept level with the affected arm B. The affected arm will be abducted at the shoulder with the elbow extended. C. The hand and elbow of the affected arm will be elevated above the shoulder D. The elbow and shoulder of the affected arm will be elevated, with the hand resting on the abdomen
C
A client is admitted to the PACU after abdominal hysterectomy. Which assessment should the nurse report to primary healthcare provider immediately? A. Decreased urine output B. apical pulse of 90 bpm C. increased drainage from ng tube D. serosanguineous drainage on the perineal pad
A
A client who is to undergo a mastectomy for breast cancer tells the nurse that she is worried about what she will look like. What is the most appropriate response? A. "I understand that you'd be concerned" B. "Try not to think about it" C. "everyone having this surgery feels the same way" D. "perhaps discuss this with your husband"
A
Four days after a vaginal hysterectomy a client calls the follow up service and tells the nurse that she has a yellowish green vaginal discharge. The nurse advices the client to return to the clinic for an evaluation. What does the nurse need to assess when a vaginal infection is suspected? Select all that apply. A. Abdominal pain B. urinary frequency C. Rising temperature D. decreased pulse rate E. decreased BP
A, C
The nurse is teaching a client with decreased ovarian production of estrogen due to menopause about self-management and prevention of complications. Which actions performed by the client would help to reduce the complications? Select all that apply. A. Walking for 30 min/day B. performing weight bearing activities C. Dressing warmly in cold weather D. urinating immediately after sexual intercourse E. keeping within 10 lbs of ideal body weight
A,B,D
A nurse is counseling a client who is at risk for developing osteoporosis. Which foods should the nurse recommend? Select all that apply. A. Canned tuna B. Scrambled eggs C. Chicken breasts D. Broiled beef steak E. Baked sweet potato
C,D
A client has been advised to perform weight-bearing exercises to help minimize osteoporosis. The client admits to not doing the prescribed exercises. What action by the nurse is best? a. Ask the client about fear of falling. b. Instruct the client to increase calcium. c. Suggest other exercises the client can do. d. Tell the client to try weight lifting.
ANS: A Fear of falling can limit participation in activity. The nurse should first assess if the client has this fear and then offer suggestions for dealing with it. The client may or may not need extra calcium, other exercises, or weight lifting.
A nurse is caring for four postoperative clients who each had a total abdominal hysterectomy. Which client should the nurse assess first upon initial rounding? a. Client who has had two saturated perineal pads in the last 2 hours b. Client with a temperature of 99° F and blood pressure of 115/73 mm Hg c. Client who has pain of "4" on a scale of 0 to 10 d. Client with a urinary catheter output of 150 mL in the last 3 hours
ANS: A Normal vaginal bleeding should be less than one saturated perineal pad in 4 hours. Two saturated pads in such a short time could indicate hemorrhage, which is a priority. The other clients also have needs, but the client with excessive bleeding should be assessed first.
A 70-year-old woman should be taught to report what condition to her health care provider? a. Vaginal bleeding b. Pain with intercourse c. Breasts become smaller d. Skin becomes thinner
ANS: A Vaginal bleeding after menopause should always be investigated. It is highly suggestive of endometrial cancer.
The nurse is teaching a 45-year-old woman about her fibrocystic breast condition. Which statement by the client indicates a lack of understanding? a. "This condition will become malignant over time." b. "I should refrain from using hormone replacement therapy." c. "One cup of coffee in the morning should be enough for me." d. "This condition makes it more difficult to examine my breasts."
ANS: A Fibrocystic breast condition does not increase a woman's chance of developing breast cancer. Hormone replacement therapy is not indicated since the additional estrogen may aggravate the condition. Limiting caffeine intake may give relief for tender breasts. The fibrocystic changes to the breasts make it more difficult to examine the breasts because of fibrotic changes and lumps.
What information does the nurse teach a women's group about osteoporosis? a. "For 5 years after menopause you lose 2% of bone mass yearly." b. "Men actually have higher rates of the disease but are underdiagnosed." c. "There is no way to prevent or slow osteoporosis after menopause." d. "Women and men have an equal chance of getting osteoporosis."
ANS: A For the first 5 years after menopause, women lose about 2% of their bone mass each year. Men have a slower loss of bone after the age of 75. Many treatments are now available for women to slow osteoporosis after menopause.
A client is discharged to home after a modified radical mastectomy with two drainage tubes. Which statement by the client would indicate that further teaching is needed? a. "I am glad that these tubes will fall out at home when I finally shower." b. "I should measure the drainage each day to make sure it is less than an ounce." c. "I should be careful how I lie in bed so that I will not kink the tubing." d. "If there is a foul odor from the drainage, I should contact my doctor."
ANS: A The drainage tubes (such as a Jackson-Pratt drain) lie just under the skin but need to be removed by the health care professional in about 1 to 3 weeks at an office visit. Drainage should be less than 25 mL in a day's time. The client should be aware of her positioning to prevent kinking of the tubing. A foul odor from the drainage may indicate an infection; the doctor should be contacted immediately.
The nurse is giving discharge instructions to a client who had a total abdominal hysterectomy. Which statements by the client indicate a need for further teaching? (Select all that apply.) a. "I should not have any problems driving to see my mother, who lives 3 hours away." b. "Now that I have time off from work, I can return to my exercise routine next week." c. "My granddaughter weighs 23 pounds, so I need to refrain from picking her up." d. "I will have to limit the times that I climb our stairs at home to morning and night."e. "For 1 month, I will need to refrain from sexual intercourse."
ANS: A, B Driving and sitting for extended periods of time should be avoided until the surgeon gives permission. For 2 to 6 weeks, exercise participation should also be avoided. All of the other responses demonstrate adequate knowledge for discharge. The client should not lift anything heavier than 10 pounds, should limit stair climbing, and should refrain from sexual intercourse.
The nurse is taking a history of a 68-year-old woman. What assessment findings would indicate a high risk for the development of breast cancer? (Select all that apply.) a. Age greater than 65 years b. Increased breast density c. Osteoporosis d. Multiparity e. Genetic factors
ANS: A, B, E The high risk factors for breast cancer are age greater than 65 with the risk increasing until age 80; an increase in breast density because of more glandular and connective tissue; and inherited mutations of BRCA1 and/or BRCA2 genes. Osteoporosis and multiparity are not risk factors for breast cancer. A high postmenopausal bone density and nulliparity are moderate and low increased risk factors, respectively.
A postmenopausal client is experiencing low back and pelvic pain, fatigue, and bloody vaginal discharge. What laboratory tests would the nurse expect to see ordered for this client if endometrial cancer is suspected? (Select all that apply.) a. Cancer antigen-125 (CA-125) b. White blood cell (WBC) count c. Hemoglobin and hematocrit (H&H) d. International normalized ratio (INR) e. Prothrombin time (PT)
ANS: A, C Serum tumor markers such as CA-125 assess for metastasis, especially if elevated. H&H would evaluate the possibility of anemia, a common finding with postmenopausal bleeding with endometrial cancer. WBC count is not indicated since there are no signs of infection. The INR and PT are coagulation tests to measure the time it takes for a fibrin clot to form. They are used to evaluate the extrinsic pathway of coagulation in clients receiving oral warfarin.
After a breast examination, the nurse is documenting assessment findings that indicate possible breast cancer. Which abnormal findings need to be included as part of the client's electronic medical record? (Select all that apply.) a. Peau d'orange b. Dense breast tissue c. Nipple retraction d. Mobile mass at two o'clock e. Nontender axillary nodes
ANS: A, C, D In the documentation of a breast mass, skin changes such as dimpling (peau d'orange), nipple retraction, and whether the mass is fixed or movable are charted. The location of the mass should be stated by the "face of a clock." Dense breast tissue and nontender axillary nodes are not abnormal assessment findings that may indicate breast cancer.
A 28-year-old client is diagnosed with endometriosis and is experiencing severe symptoms. Which actions by the nurse are the most appropriate at this time? (Select all that apply.) a. Reduce the pain by low-level heat. b. Discuss the high risk of infertility with this diagnosis. c. Relieve anxiety by relaxation techniques and education. d. Discuss in detail the side effects of laparoscopic surgery. e. Suggest resources such as the Endometriosis Association.
ANS: A, C, E With endometriosis, pain is the predominant symptom, with anxiety occurring because of the diagnosis. Interventions should be directed to pain and anxiety relief, such as low-level heat, relaxation techniques, and education about the pathophysiology and possible treatment of endometriosis. The nurse could suggest resources to give more information about the diagnosis. Discussion of the possibility of infertility and side effects of laparoscopic surgery is premature and may increase the anxiety.
The nurse is formulating a teaching plan according to evidence-based breast cancer screening guidelines for a 50-year-old woman with low risk factors. Which diagnostic methods should be included in the plan? (Select all that apply.) a. Annual mammogram b. Magnetic resonance imaging (MRI) c. Breast ultrasound d. Breast self-awareness e. Clinical breast examination
ANS: A, D, E Guidelines recommend a screening annual mammogram for women ages 40 years and older, breast self-awareness, and a clinical breast examination. An MRI is recommended if there are known high risk factors. A breast ultrasound is used if there are problems discovered with the initial screening or dense breast tissue.
A client has been prescribed denosumab (Prolia). What instruction about this drug is most appropriate? a. "Drink at least 8 ounces of water with it." b. "Make appointments to come get your shot." c. "Sit upright for 30 to 60 minutes after taking it." d. "Take the drug on an empty stomach."
ANS: B Denosumab is given by subcutaneous injection twice a year. The client does not need to drink 8 ounces of water with this medication as it is not taken orally. The client does not need to remain upright for 30 to 60 minutes after taking this medication, nor does the client need to take the drug on an empty stomach.
The nurse is doing preoperative teaching for a client who is scheduled for removal of cervical polyps in the office. Which statement by the client indicates a correct understanding of the procedure? a. "I hope that I do not have cancer of the cervix." b. "There should be little or no discomfort during the procedure." c. "There may be a lot of bleeding after the polyp is removed." d. "This may prevent me from having any more children."
ANS: B Polyp removal is a simple office procedure with the client feeling no pain. The other responses are incorrect. Cervical polyps are the most common benign growth of the cervix. Cautery is used to stop any bleeding, and there is no evidence that cervical polyps have a relationship to childbearing.
A client has recently been diagnosed with stage III endometrial cancer and asks the nurse for an explanation. What response by the nurse is correct about the staging of the cancer? a. "The cancer has spread to the mucosa of the bowel and bladder." b. "It has reached the vagina or lymph nodes." c. "The cancer now involves the cervix." d. "It is contained in the endometrium of the cervix."
ANS: B Stage III of endometrial cancer reaches the vagina or lymph nodes. Stage I is confined to the endometrium. Stage II involves the cervix, and stage IV spreads to the bowel or bladder mucosa and/or beyond the pelvis.
A client is scheduled to start external beam radiation therapy (EBRT) for her endometrial cancer. Which teaching by the nurse is accurate? (Select all that apply.) a. "You will need to be hospitalized during this therapy." b. "Your skin needs to be inspected daily for any breakdown." c. "It is not wise to stay out in the sun for long periods of time." d. "The perineal area may become damaged with the radiation." e. "The technician applies new site markings before each treatment."
ANS: B, C, D EBRT is usually performed in ambulatory care and does not require hospitalization. The client needs to know to evaluate the skin, especially in the perineal area, for any breakdown, and avoid sunbathing. The technician does not apply new site markings, so the client needs to avoid washing off the markings that indicate the treatment site.
A 55-year-old post-menopausal woman is assessed by the nurse with a history of dyspareunia, backache, pelvis pressure, urinary tract infections, and a frequent urinary urgency. Which condition does the nurse suspect? a. Ovarian cyst b. Rectocele c. Cystocele d. Fibroid
ANS: C Dyspareunia, backache, pelvis pressure, urinary tract infections, and urinary urgency are all symptoms of a cystocele—a protrusion of the bladder through the vaginal wall. Ovarian cysts are rare after menopause. A rectocele is associated with constipation, hemorrhoids, and fecal impaction. Fibroids are associated with heavy bleeding.
A nurse sees clients in an osteoporosis clinic. Which client should the nurse see first? a. Client taking calcium with vitamin D (Os-Cal) who reports flank pain 2 weeks ago b. Client taking ibandronate (Boniva) who cannot remember when the last dose was c. Client taking raloxifene (Evista) who reports unilateral calf swelling d. Client taking risedronate (Actonel) who reports occasional dyspepsia
ANS: C The client on raloxifene needs to be seen first because of the manifestations of deep vein thrombosis, which is an adverse effect of raloxifene. The client with flank pain may have had a kidney stone but is not acutely ill now. The client who cannot remember taking the last dose of ibandronate can be seen last. The client on risedronate may need to change medications.
A client has just returned from a right radical mastectomy. Which action by the unlicensed assistive personnel (UAP) would the nurse consider unsafe? a. Checking the amount of urine in the urine catheter collection bag b. Elevating the right arm on a pillow c. Taking the blood pressure on the right arm d. Encouraging the client to squeeze a rolled washcloth
ANS: C Health care professionals need to avoid the arm on the side of the surgery for blood pressure measurement, injections, or blood draws. Since lymph nodes are removed, lymph drainage would be compromised. The pressure from the blood pressure cuff could promote swelling. Infection could occur with injections and blood draws. Checking urine output, elevation of the affected arm on a pillow, and encouraging beginning exercises are all safe postoperative interventions.
With a history of breast cancer in the family, a 48-year-old female client is interested in learning about the modifiable risk factors for breast cancer. After the nurse explains this information, which statement made by the client indicates that more teaching is needed? a. "I am fortunate that I breast-fed each of my three children for 12 months." b. "It looks as though I need to start working out at the gym more often." c. "I am glad that we can still have wine with every evening meal." d. "When I have menopausal symptoms, I must avoid hormone replacement therapy."
ANS: C Modifiable risk factors can help prevent breast cancer. The client should lessen alcohol intake and not have wine 7 days a week. Breast-feeding, regular exercise, and avoiding hormone replacement are also strategies for breast cancer prevention.
The nurse is examining a woman's breast and notes multiple small mobile lumps. Which question would be the most appropriate for the nurse to ask? a. "When was your last mammogram at the clinic?" b. "How many cans of caffeinated soda do you drink in a day?" c. "Do the small lumps seem to change with your menstrual period?" d. "Do you have a first-degree relative who has breast cancer?"
ANS: C The most appropriate question would be one that relates to benign lesions that usually change in response to hormonal changes within a menstrual cycle. Reduction of caffeine in the diet has been shown to give relief in fibrocystic breast conditions, but research has not found that it has a significant impact. Questions related to the client's last mammogram or breast cancer history are not related to the nurse's assessment.
The nurse sees several clients with osteoporosis. For which client would bisphosphonates not be a good option? a. Client with diabetes who has a serum creatinine of 0.8 mg/dL b. Client who recently fell and has vertebral compression fractures c. Hypertensive client who takes calcium channel blockers d. Client with a spinal cord injury who cannot tolerate sitting up
ANS: D Clients on bisphosphonates must be able to sit upright for 30 to 60 minutes after taking them. The client who cannot tolerate sitting up is not a good candidate for this class of drug. Poor renal function also makes clients bad candidates for this drug, but the client with a creatinine of 0.8 mg/dL is within normal range. Diabetes and hypertension are not related unless the client also has renal disease. The client who recently fell and sustained fractures is a good candidate for this drug if the fractures are related to osteoporosis.
The nurse is caring for a postoperative client following an anterior colporrhaphy. What action can be delegated to the unlicensed assistive personnel (UAP)? a. Reviewing the hematocrit and hemoglobin results b. Teaching the client to avoid lifting her 4-year-old grandson c. Assessing the level of pain and any drainage d. Drawing a shallow hot bath for comfort measures
ANS: D The UAP is able to provide comfort through a bath. The registered nurse should review any laboratory results, complete any teaching, and assess pain and discharge.
A client has undergone a vaginal hysterectomy with a bilateral salpingo-oophorectomy. She is concerned about a loss of libido. What intervention by the nurse would be best? a. Suggest increasing vitamins and supplements daily. b. Discuss the value of a balanced diet and exercise. c. Reinforce that weight gain may be inevitable. d. Teach that estrogen cream inserted vaginally may help.
ANS: D Use of vaginal estrogen cream and gentle dilation can help with vaginal changes and loss of libido. Weight gain and masculinization are misperceptions after a vaginal hysterectomy. Vitamins, supplements, a balanced diet, and exercise are helpful for healthy living, but are not necessarily going to increase libido.
A client is diagnosed with a fibrocystic breast condition while in the hospital and is experiencing breast discomfort. What comfort measure would the nurse delegate to the unlicensed assistive personnel (UAP)? a. Aid in the draining of the cysts by needle aspiration. b. Teach the client to wear a supportive bra to bed. c. Administer diuretics to decrease breast swelling. d. Obtain a cold pack to temporarily relieve the pain.
ANS: D All of the options would be comfort measures for a client with a fibrocystic breast condition. The UAP can obtain the cold or heat therapy. Only the nurse should aid the health care provider with a needle aspiration, teach, and administer medications.
A 37-year-old Nigerian woman is at high risk for breast cancer and is considering a prophylactic mastectomy and oophorectomy. What action by the nurse is most appropriate? a. Discourage this surgery since the woman is still of childbearing age. b. Reassure the client that reconstructive surgery is as easy as breast augmentation. c. Inform the client that this surgery removes all mammary tissue and cancer risk. d. Include support people, such as the male partner, in the decision making.
ANS: D The cultural aspects of decision making need to be considered. In the Nigerian culture, the man often makes the decisions for care of the female. Women with a high risk for breast cancer can consider prophylactic surgery. If reconstructive surgery is considered, the procedure is more complex and will have more complications compared to a breast augmentation. There is a small risk that breast cancer can still develop in the remaining mammary tissue.
A nurse is performing physical assessment of four female clients who came for a general checkup. Which client is at most risk of developing breast cancer? A. Age 60, Family hx of breast cancer, 2 children, age of menopause is 45 yrs old B. Age 60, family hx of breast cancer, no children, age of menopause is 50 yrs old C. Age 60, no family hx, no children, age of menopause 50 years old
B
A woman is admitted for a hysterectomy and bilateral salpingo-oophorectomy. The nurse reviews the client's gynecologic history. Which condition of the client causes the nurse to anticipate an abdominal, rather than a vaginal, hysterectomy? A. prolapsed uterus B. large uterine fibroids C. mild dysplasia of the cervical os D. urinary incontinence
B
The nurse is reviewing the data of female clients with amenorrhea. Which client may be diagnosed with primary amenorrhea based on the given data? A. 13 year old with undeveloped secondary sexual characteristics who has not reached menarche. B. 18 year old with normally developed secondary sexual characteristics who has not reached menarche. C. 17 year old who is in her first trimester of pregnancy D. 20 year old thriathlete whos menstruation ceased 3 months ago.
B
A 28 year old woman is diagnosed as having cancer of the left breast. A simple mastectomy is performed. What should the plan of care include immediately after surgery? A. Changing the clients pressure dressing as necessary B. Inviting a member of Reach to Recovery to visit the client C. Placing the client in the semi-fowler position with the left arm elevated D. Waiting for a cessation of drainage before the client resumes any acitivity
C
A nurse is assessing a client for the potential for osteoporosis. Which factor in the client's history increases the risk for this disorder? A. Estrogen therapy B. Hypoparathyroidsism C. Prolonged immobility D. Excessive calcium intake
C
A nurse is evaluating a client's understanding regarding post op concerns after a mastectomy. Which unanticipated development near and around the incision noted by the client should be reported to her primary healthcare provider? A. persistent itching B. decreased sensation C. swelling with erythema D. irregular-appearing skin
C
An older client with a low BMI is found to have osteoporosis. What should the nurse include in the discharge plan for this client? A. encourage gradual weight gain B. monitoring for decreased urine calcium C. providing instructions relative to diet and exercise D. teach about safety factors in the use of opioids
C
When a client who has has a mastectomy return from surgery, a dressing and a portable wound drainage system to the axillary area are in place. The nurse notes excessive amount of serosanguineous drainage on the mastectomy dressing. What is the nurses next action? A. Notify surgeon B. Apply a pressure dressing C. Checking function of the drainage system D. Using additional pillows to elevate affected arm
C
A 32 year old woman is admitted to the unit with a history of fibroids and menorrhagia. Which findings does the nurse expect to encounter during assessment of the client? Select all that apply A. fluid overload B. intermittent diarrhea C. pale mucous membranes D. difficulty emptying bladder E. high hemoglobin and hematocrit levels
C,D
A nurse caring for a client who has had a hysterectomy is concerned about the client's risk for postop thrombosis. The nurse remembers that the majority of pulmonary emboli begin as DVT in what area? A. Calf B. Thoracic cavity C. Pelvis and thighs D. Extremities and abdomen
C.
A 26 year old woman whose sister recently had a lumpectomy for breast cancer calls the local women's health center for an appointment for a mammogram. What guidance should the nurse provide the client in preparation or the test? A. Do not eat for 6 hours before the test B. The room will be darkened throughout the procedure C. The first mammogram is usually performed at 50 years of age D. During the procedures, each breast will be compressed firmly between two plates
D
A 45 year old client is scheduled to undergo a hysterectomy and expresses concern because she has heard from friends that she will experience severe symptoms of menopause after surgery. What is the appropriate response? A. "You're right, but there are medicines you can take" B. "Sometimes that happens to women your age, but you dont need to worry about it" C. "You should probably talk to your surgeon, because I'm not allowed to talk about this with you" D. "Women may experience symptoms of menopause if their overies are removed with their uterus"
D
A nurse is planning care with a client for a recovery period after a laparoscopic hysterectomy and bilateral salpingo-oophorectomy. What should be included in the information regarding the changes that the client should expect after surgery? A. Depression B. weight gain C. urinary retention D. surgical menopause
D
A nurse is writing a teaching plan about osteoporosis. How would the nurse best explain what osteoporosis is? A. it is avascular necrosis B. it is caused by pathologic fractures C. it is hyperplasia of osteoblasts D. it involves a decrease in bone substance
D