CM exam 9

A nurse is providing education to a new 55-year-old African-American client about screening for prostate cancer. What action by the nurse is most appropriate? a. Inform the client that recommendations vary, so screening is a personal choice. b. Let the client know that as an African American, he should be screened annually. c. Teach the client that he is in a high risk group and should discuss screening. d. Give the client written information that discourages screening until age 70

ANS C Clients in certain high risk groups should discuss screening for prostate cancer with their primary health care providers at age 45. High risk groups include African Americans and men with a first-degree relative who was diagnosed with prostate cancer before the age of 65. This new client will be encouraged to discuss screening even though he is past the age of initial discussion. Recommendations do vary somewhat, but he is in a recognized high risk group. The nurse would not say that he "should" be screened annually. Screening is not recommended for men over the age of 70.

The nurse is conducting a history on a male client to determine the severity of symptoms associated with prostate enlargement. Which finding is cause for prompt action by the nurse? a. Hematuria b. Urinary hesitancy c. Postvoid dribbling d. Weak urinary stream

ANS: A Hematuria, especially at the start or end of the urine stream, could indicate infection due to possible urine retention and would cause the nurse to act promptly. Common symptoms of benign prostatic hyperplasia are urinary hesitancy, postvoid dribbling, and a weak urinary stream due to the enlarged prostate causing bladder outlet obstruction.

A nurse has taken an informed consent to a woman who is having a transvaginal repair of a prolapsed uterus. What client statement indicates a need for more information? a. "The mesh they use may become infected." b. "I may still need to do my Kegel exercises." c. "I will watch for any signs of infection." d. "I know how to use the incentive spirometer."

ANS: A Mesh is not used in the transvaginal approach as it has been discontinued in this country. The other statements show good understanding

The nurse is teaching a client with benign prostatic hyperplasia (BPH). What statement indicates the client needs further information? a. "There should be no problem with drinking wine with dinner each night." b. "I am so glad that I weaned myself off of coffee about a year ago." c. "I need to inform my allergist that I cannot take my normal antihistamine." d. "My routine of drinking a quart (liter) of water first thing in the morning needs to change."

ANS: A Caffeine and alcohol have diuretic effects and so the nurse would teach about avoiding or limiting their intake. The statement about drinking wine indicates a need for further instruction. Antihistamines can cause urinary retention. Clients are taught to avoid drinking large quantities of fluid at one time

A 24 year-old female has been diagnosed with genital warts. Which action by the nurse is best? a. Encourage the client to complete STI screening. b. Recommend an over-the-counter wart treatment for genital tissue. c. Report the case to the Centers for Infection Control and Prevention (CDC). d. Discuss popular options for contraception.

ANS: A Clients with HPV should be fully screened for other STIs since co-infection is common. Over the counter treatments should not be applied to genital tissue. HPV is not reportable. Contraception is not related.

A client is placed on a medical regimen of doxorubicin (Adriamycin), cyclophosphamide, and fluorouracil for breast cancer. Which side effect seen in the client would the nurse report to the primary health care provider immediately? a. Shortness of breath b. Nausea and vomiting c. Hair loss d. Mucositis

ANS: A Doxorubicin can cause cardiotoxicity with symptoms of extreme fatigue, shortness of breath, chronic cough, and edema. These need to be reported as soon as possible to the primary health care provider. Nausea, vomiting, hair loss, and mucositis are common problems associated with chemotherapy regimens.

The nurse is teaching a 45-year-old woman about her fibrocystic breast changes. Which statement by the client indicates a lack of understanding? a. "This condition will become malignant over time." b. "I understand that hormone-based drugs have serious adverse effects." 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 changes do not increase a woman's chance of developing breast cancer. Hormone-based drugs can be used in severe cases to suppress the over-secretion of estrogen. Serious adverse effects include thrombotic events and an increased risk for uterine cancer. 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

The nurse is conducting a history on a male client to determine the severity of symptoms associated with prostate enlargement. Which finding is cause for prompt action by the nurse? a. Hematuria b. Urinary hesitancy c. Postvoid dribbling d. Weak urinary stream

ANS: A Hematuria, especially at the start or end of the urine stream, could indicate infection due to possible urine retention and would cause the nurse to act promptly. Common symptoms of benign prostatic hyperplasia are urinary hesitancy, postvoid dribbling, and a weak urinary stream due to the enlarged prostate causing bladder outlet obstruction

A nurse receives hand-off report on four postoperative clients who each had total hysterectomies. Which client would the nurse assess first upon initial rounding? a. Vaginal hysterectomy: two saturated perineal pads in 2 hours b. Abdominal: temperature of 99° F (37.2° C), blood pressure of 116/74 mm Hg c. Vaginal: opened incisional edges and moderate bleeding d. Abdominal: urinary catheter output of 150 mL in the last 3 hours

ANS: A Normal vaginal bleeding after a vaginal hysterectomy 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 client with the slight temperature elevation needs to be assessed for possible infection, but not as the priority. A vaginal hysterectomy would not result in an incision the nurse could observe separating. The urinary output is normal.

The nurse has educated a community group of risk factors for ovarian cancer. Which statement by a participant shows the need for reviewing the information? a. "This is a disease of young women." b. "Never being pregnant increases my risk." c. "Difficulty conceiving is a risk factor." d. "Having endometriosis is one of the risks."

ANS: A Ovarian cancer usually strikes women who are middle age or older. Nulliparity, difficulty conceiving, and endometriosis all increase risk and are correct statements.

The nurse is educating a client on the prevention of toxic shock syndrome (TSS). Which statement by the client indicates a lack of understanding? a. "I need to change my tampon every 8 hours during the day." b. "At night, I should use a feminine pad rather than a tampon." c. "If I don't use tampons, I should not get TSS." d. "It is best if I wash my hands before inserting the tampon."

ANS: A Tampons need to be changed every 3 to 6 hours to avoid infection by such organisms as Staphylococcus aureus. All of the other responses are correct: use of feminine pads at night, not using tampons at all, and washing hands before tampon insertion are all strategies to prevent TSS

A woman diagnosed with breast cancer had these laboratory tests performed at an office visit: Alkaline phosphatase 125 U/L (2.2 mckat/L) Total calcium 12 mg/dL (3 mmol/L) Hematocrit 39% (0.39) Hemoglobin 14 g/dL (140 mmol/L) Which test results indicate to the nurse that some further diagnostics are needed? a. Elevated alkaline phosphatase and calcium suggests bone involvement. b. Only alkaline phosphatase is decreased, suggesting liver metastasis. c. Hematocrit and hemoglobin are decreased, indicating anemia. d. The elevated hematocrit and hemoglobin indicate dehydration

ANS: A The alkaline phosphatase (normal value 30 to 120 U/L [0.5 to 2.0 mckat/L]) and total calcium (normal value 9 to 10.5 mg/dL [2.25 to 2.63 mmol/L]) levels are both elevated, suggesting bone metastasis. Both the hematocrit and hemoglobin are within normal limits for females.

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 (30 mL)." 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 will contact my primary health care provider."

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 30 mL for three consecutive days. 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 primary health care would be contacted immediately

The nurse is teaching an uncircumcised 65-year-old client about self-management of a urinary catheter in preparation for discharge to his home. What statement indicates the client needs more information? a. "I have to wash the outside of the catheter once a day with soap and water. b. "I should take extra time to clean the catheter site by pushing the foreskin back." c. "The drainage bag needs to be changed at least once a week and as needed." d. "I should pour a solution of vinegar and water through the tubing and bag."

ANS: A The first few inches (centimeters) of the catheter must be washed daily starting at the penis and washing outward with soap and water. The other options are correct for self-management of a urinary catheter in the home setting

A client comes to the clinic with concerns about an enlarged left testicle and heaviness in his lower abdomen. Which diagnostic test would the nurse expect to be ordered? a. Alpha-fetoprotein (AFP) b. Prostate-specific antigen (PSA) c. Serum acid phosphatase (PAP) d. C-reactive protein (CRP)

ANS: A These are symptoms of possible testicular cancer. AFP is a tumor marker that is elevated in testicular cancer. PSA and PAP testing is used in testing for prostate cancer and its metastasis. CRP is diagnostic for inflammatory conditions.

A client with multiple sexual partners has been assessed for symptoms of dysuria and green, malodorous vaginal discharge. The nurse administers and injection of ceftriaxone and gives the client a prescription for doxycycline. The client asks why two drugs are needed. What answer by the nurse is best? a. "It is very common to be infected with both gonorrhea and chlamydia." b. "Giving two medications increases the chance of curing the infection." c. "Some people are not affected by the injection and need more medication." d. "This will prevent you from needing a 3-month follow-up test."

ANS: A This client has signs of gonorrhea. Co-infection with gonorrhea and chlamydia is common, so the client being treated for gonorrhea also needs treatment for chlamydia with oral antibiotics. It is fairly accurate to say two medications increases the chance of cure, but does not really explain the situation. Giving the client two medications is not because some people are not affected by the injection nor is it to prevent needing a 3-month follow-up test. Testing for re-infection with chlamydia is recommended by the CDC.

A client has recurrent vulvovaginitis. Which statements by the client indicate a need for further teaching? (Select all that apply.) a. "I can take a long, hot bath to relieve itching." b. "I need to take all of my antibiotics as prescribed." c. "I should avoid having sex until my infection is gone." d. "I should not douche or use feminine hygiene sprays." e. "I should use antibacterial soap to clean the area." f. "I should switch to wearing only cotton underwear."

ANS: A, B?, E Clients should avoid hot water baths as they may increase the itching and infection. They may take warm or tepid sitz baths for 30 minutes several times a day to relieve itching. Clients should cleanse the inner labia mucosa with water, not soap, during a bath or shower. All of the other options are correct

The nurse is giving discharge instructions to a client who had a total abdominal hysterectomy with a vaginal repair. 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 lb (10.5 kg) so I need to refrain from picking her up." d. "I will have to limit the number of times that I climb our stairs at home to fewer than five times a day." e. "I need to refrain from sexual intercourse for 4 to 6 weeks." f. "When I do resume intercourse, I will use a water-based lubricant and go slowly."

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 lb (4.5 kg), should limit stair climbing, and should refrain from sexual intercourse. When intercourse is resumed, the client should use water-based lubricant and proceed slowly as the vaginal walls are tighter. This may temporarily cause some pain.

A primary care clinic sees some clients with sexually transmitted infections. Which diseases would the nurse be required to report to the local authority? (Select all that apply.) a. Chlamydia b. Gonorrhea c. Syphilis d. Human immune deficiency virus e. Pelvic inflammatory disease f. Human papilloma virus

ANS: A, B, C, D Chlamydia, gonorrhea, syphilis, human immune deficiency virus (HIV), and acquired immune deficiency syndrome (AIDS) are all reportable to local authorities in every state. Pelvic inflammatory disease and HPV do not need to be reported.

A client has pelvic inflammatory disease (PID). What complications does the nurse monitor the client for? (Select all that apply.) a. Chronic pelvic pain b. Infertility c. Ectopic pregnancy d. Tubo-ovarian abscess e. Peri-hepatitis f. Pancreatitis

ANS: A, B, C, D, E Possible complications of PID include chronic pelvic pain, infertility, ectopic pregnancy, tubo-ovarian abscess, peri-hepatitis, inflammation of the liver capsule, and inflammation of the peritoneal surfaces of the anterior right upper quadrant.

A client came to the clinic with erectile dysfunction. What are some possible causes of this condition that the nurse could discuss with the client during history taking? (Select all that apply.) a. Recent prostatectomy b. Long-term hypertension c. Diabetes mellitus d. Hour-long exercise sessions e. Consumption of beer each night f. Taking long hot baths

ANS: A, B, C, E Organic erectile dysfunction can be caused by surgical procedures, vascular diseases such as hypertension and its treatment, diabetes mellitus, and alcohol consumption. There is no evidence that exercise or hot baths are related to this problem.

The nurse is teaching a client who is taking an oral antibiotic for treatment of a sexually transmitted infection (STI). Which statements by the client indicate a correct understanding of the treatment? (Select all that apply.) a. "I need to drink at least eight glasses of fluid each day with my antibiotic." b. "I should read the instructions to see if I can take the medication with food." c. "Antacids should not interfere with the effectiveness of the antibiotic." d. "I need to wait 7 days after this injection to engage in intercourse." e. "It should not matter if I skip a couple of doses of the antibiotic."

ANS: A, B, D When a client is being treated with an oral antibiotic for an STI, 8 to 10 glasses of fluid should be routine, medication instructions should be reviewed, and at least a week break should occur between the antibiotic and sexual intercourse to allow for the medication's full effects if the medication was given in a single dose. Use of antacids and missing doses could decrease the effectiveness of the antibiotic.

A nurse wants to reduce the risk potential for transmission of chlamydia and gonorrhea with a client diagnosed with both infections. Which items should be included in the client's teaching plan? (Select all that apply.) a. Expedited partner therapy b. Abstinence until therapy is completed c. Use of intrauterine devices d. Proper use of condoms e. Rescreening for infection f. Use of oral contraception

ANS: A, B, D, E As part of client/partner education, the nurse should explain the expedited partner therapy (practice of treating both sexual partners by providing medication to the client for the partner). The nurse should also emphasize the need for abstinence from sexual intercourse until treatment is finished, proper use of condoms, and rescreening for reinfection 3 to 12 months after treatment. The use of an intrauterine device and oral contraception is not part of the plan.

A client being treated for syphilis visits the office with a possible allergic reaction to benzathine penicillin G. Which abnormal findings would the nurse expect to document? (Select all that apply.) a. Red rash b. Shortness of breath c. Heart irregularity d. Chest tightness e. Anxiety f. Confusion

ANS: A, B, D, E The nurse should keep all clients at the office for at least 30 minutes after the administration of benzathine penicillin G. Allergic signs and symptoms consist of rash, shortness of breath, chest tightness, and anxiety. Heart irregularity and confusion are not seen as an allergic manifestation.

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 f. Early menarche

ANS: A, B, E, F Risk factors for breast cancer include advancing age, family and genetic history, early menarche, late menopause, postmenopausal obesity, physical inactivity, combined hormonal therapies, alcohol consumption, and lack of breast feeding.

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 births c. Poor diet d. Nulliparity e. Younger than 18 at first intercourse f. Infections with HPV

ANS: A, B, F Smoking, multiple births, and infection with HPV are all risk factors for cervical cancer. Nulliparity is a risk factor for endometrial cancer. Poor diet could lead to decreased immunity, which is a risk, but is not directly related. Giving birth before the age of 17 is a risk factor

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 2 o'clock e. Nontender axillary nodes f. Skin ulceration

ANS: A, C, D, F 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." Skin ulceration is also a common sign. 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 uterine leiomyoma and is experiencing severe symptoms. Which actions by the nurse are the most appropriate at this time? (Select all that apply.) a. Teach nonpharmacologic comfort measures. 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. Review complete blood count for possible iron deficiency anemia.

ANS: A, C, E With uterine leiomyomas or fibroids, heavy bleeding is the predominant symptom, with anxiety occurring because of fears of cancer or infertility. Interventions would be directed to the heavy bleeding and anxiety relief, such as relaxation techniques and education about the pathophysiology and possible treatment of the fibroids. While many women do not experience pain with this condition, some do, so the nurse would teach nonpharmacologic comfort measures. 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

A woman is interested in alternative and complementary treatments for the nausea and vomiting caused by the side effects of chemotherapy for breast cancer. Which therapies wound the nurse suggest? (Select all that apply.) a. Acupuncture b. Chiropractic c. Journaling d. Aromatherapy e. Shiatsu f. Black cohosh

ANS: A, D, E Alternative and complementary measures are chosen by many women. For nausea and vomiting, the best choices would be acupuncture, aromatherapy, and shiatsu. Chiropractic treatments would help pain. Journaling would be beneficial for fear and anxiety. Black cohosh is frequently used for hot flashes.

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 would 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 f. Self-breast examination

ANS: A, D, E Guidelines from the American Cancer Society include annual mammograms for low risk women starting at the age of 45 and continuing through the age of 54. At 55, women can continue annual mammography or change to every 2 years. MRI and ultrasound are done for abnormal findings or for high risk women. Breast self-awareness is important so women can detect changes early. Current data shows that SBE is not a valuable screening tool. Asymptomatic women 40 and older should have a clinical breast exam annually

A client is interested in learning about the risk factors for prostate cancer. Which factors does the nurse include in the teaching? (Select all that apply.) a. First-degree relative with prostate cancer b. Smoking c. Obesity d. Advanced age e. Eating too much red meat f. Race

ANS: A, D, E?, F Risk factors for prostate cancer include having a first-degree relative with the disease, advanced age, and African-American race. Smoking, obesity, and eating too much red meat are not considered risk factors. Research is exploring the relationship with diet.

A client has a positive HSV-2 test but is asymptomatic. What action by the nurse is best? a. Encourage the client to have frequent STI screening. b. Teach the client ways to prevent getting STIs. c. Provide the same education as if the client were symptomatic. d. Inform the client that partner notification is unnecessary.

ANS: B

A new nurse care for several client after radical prostatectomies for prostate cancer. What action by the nurse indicates a need to review care measures for this type of client? a. Delegates emptying and recording contents of the drainage devices. b. Administers a suppository to the client who reports constipation. c. Removes the sequential compression stockings on ambulatory clients. d. Discusses long-term complications such as erectile dysfunction

ANS: B After a radical prostatectomy, the nurse would not provide a rectal suppository for constipation. All rectal treatments are contraindicated. The nurse would delegate emptying and recording drainage, remove the sequential pressure devices when clients begin ambulating, and discuss long-term complications of the operation.

A new nurse care for several client after radical prostatectomies for prostate cancer. What action by the nurse indicates a need to review care measures for this type of client? a. Delegates emptying and recording contents of the drainage devices. b. Administers a suppository to the client who reports constipation. c. Removes the sequential compression stockings on ambulatory clients. d. Discusses long-term complications such as erectile dysfunction.

ANS: B After a radical prostatectomy, the nurse would not provide a rectal suppository for constipation. All rectal treatments are contraindicated. The nurse would delegate emptying and recording drainage, remove the sequential pressure devices when clients begin ambulating, and discuss long-term complications of the operation.

The nurse has provided postvasectomy discharge instructions to the client. What statement by the client demonstrates good understanding? a. "We can have unprotected intercourse as soon as I have healed." b. "An ice pack to my scrotum will help with the swelling." c. "I need to report signs of infection, swelling, or bruising right away." d. "The stitches can be removed here in the office in 7 to 10 days."

ANS: B After vasectomy, clients are instructed to use birth control until the 3-month semen analysis shows that the procedure has worked, to use an ice pack intermittently for 24 to 48 hours, that swelling and bruising are normal, and the bandage can be removed in 48 hours. There are no sutures to be removed.

A male client is diagnosed with primary syphilis. Which question by the nurse is a priority at this time? a. "Have you been using latex condoms?" b. "Are you allergic to penicillin?" c. "When was your last sexual encounter?" d. "Do you have a history of sexually transmitted infections?

ANS: B Benzathine penicillin G is the evidence-based treatment for primary, secondary, and early latent syphilis. The client needs to be assessed for allergies before treatment. The other questions would be helpful in the client's history of sexually transmitted infections but not as important as knowing whether the client is allergic to penicillin.

A client has returned from a transurethral resection of the prostate with a continuous bladder irrigation. Five hours after the operation, the nurse notes the drainage is bright red with clots. What action should the nurse take first? a. Review the most recent hemoglobin and hematocrit. b. Take vital signs and begin immediate irrigation with sterile water. c. Notify the primary health care provider immediately. d. Remind the client not to pull on the catheter.

ANS: B Bright red urinary drainage with clots may indicate arterial bleeding. The nurse would notify the primary health care provider immediately and begin irritating the catheter with sterile normal saline (not sterile water). The nurse can delegate the vital signs. The nurse would review hemoglobin and hematocrit and would remind the client not to pull on the catheter for all clients with bladder irrigation. But for this client who may be bleeding the nurse would take further action to address the problem

A client with metastatic prostate cancer has been prescribed leuprolide, a bisphosphonate, and flutamide. Which statement by the client warrants further investigation by the nurse? a. "I go for a short walk each day, even when I am very tired." b. "My wife has noticed my eyes looking a little yellow." c. "I ordered some looser shirts to hide my enlarging breasts." d. "Now I understand my wife's hot flashes with menopause."

ANS: B Flutamide is an antiandrogen drug that can cause liver toxicity. The nurse would follow up on the statement that the client's eyes may be looking a little yellow which could indicate the onset of this adverse effect. Leuprolide can cause osteoporosis, hot flashes, and gynecomastia. The statements regarding weight-bearing exercise, enlarging breasts, and hot flashes are not cause for concern

A college student seeks information from the school's nurse about how to avoid sexually transmitted infections (STIs) without abstinence as a choice. Which statement by the nurse is best? a. "Urinating after intercourse will eliminate the risk of infection." b. "A vaccine can prevent genital warts caused by some strains of the human papilloma virus (HPV)." c. "Oral contraception can prevent pregnancy and STIs." d. "Good handwashing helps prevent infection associated with STIs."

ANS: B Gardasil and Gardasil 9 are used to provide immunity for HPV types 6, 11, 16, and 18 and others that are high risk for cervical cancer and genital warts. While there is some truth that urination after intercourse may decrease the risk of infection by flushing out organisms, it does not eliminate the risk of contaminating bacteria traveling up the urethra or from skin-to-skin contact. The other statements are not accurate.

A client is concerned about the risk of lymphedema after a mastectomy. Which response by the nurse is best? a. "You do not need to worry about lymphedema since you did not have radiation therapy." b. "Be careful not to injure that arm or get any infection in that arm." c. "Numbness, tingling, and swelling are common sensations after a mastectomy." d. "The risk for lymphedema is a real threat and can be very self-limiting."

ANS: B Injury and infection are risk factors for lymphedema; therefore, the client needs to be cautious with activities using the affected arm. Radiation therapy is just one of the factors that could cause lymphedema. Other risk factors include obesity and presence of axillary disease. The symptoms of lymphedema are heaviness, aching, fatigue, numbness, tingling, and swelling, and are not common after the surgery. Women with lymphedema live fulfilling lives.

A nurse is caring for a woman who had hysteroscopic surgery for uterine leiomyomas. On initial assessment, the nurse notes the following: pulse: 114 beats/min, respiratory rate: 20 breaths/minute, crackles in bilateral lung bases. What action by the nurse takes priority? a. Assess the client for pain. b. Call the Rapid Response Team. c. Obtain an oxygen saturation. d. Delegate a temperature

ANS: B The fluid that is used during this procedure to distend the uterine cavity can be absorbed, leading to fluid overload. This client has signs of fluid overload which can be critical. The nurse would notify the Rapid Response Team first, then perform the other actions.

A client is admitted to the emergency department with toxic shock syndrome. Which action by the nurse is the most important? a. Administer IV fluids to maintain fluid and electrolyte balance. b. Remove the tampon as the source of infection. c. Collect a blood specimen for culture and sensitivity. d. Transfuse the client to manage low blood count

ANS: B The source of infection should be removed first. All of the other answers are possible interventions depending on the client's symptoms and vital signs, but removing the tampon is the priority.

A client has recently been diagnosed with type II endometrial cancer and will be treated with brachytherapy. What statement by the client indicates a need for further education on this treatment? a. "Each treatment will take only 20 to 30 minutes." b. "I have to be alone in the room during treatment so I don't expose others." c. "I can get up and walk around or read in a chair during the treatments." d. "I need to report any heavy vaginal bleeding or severe diarrhea.

ANS: B Type II endometrial cancer is likely to invade the uterine wall and metastasize. Treatment with brachytherapy is intended to prevent recurrence. During the treatment, which lasts 20 to 30 minutes each, the woman must remain on bedrest to avoid dislodging the radioactive source. The source emits radiation while it is in place, so the woman is in the treatment room by herself. Once it is removed, she has no restrictions on being around others. She would need to report any heavy vaginal bleeding or severe diarrhea

The nurse is teaching a client about side effects and adverse reactions of a PDE5 inhibitor. What information does the nurse include? (Select all that apply.) a. Refrain from eating citrus fruit within 24 hours of taking the medication. b. Stop using this drug if your primary health care provider prescribes a nitrate. c. Do not drink alcohol before having sexual intercourse. d. Muscle cramps, nausea, and vomiting are possible if you take more than 1 pill a day. e. Take this medication within 30 to 60 minutes of having sexual intercourse. f. Change positions slowly especially if you also take an anti-hypertensive drug.

ANS: B, C, D, F A PDE5 inhibitor is used to treat erectile dysfunction. The client should avoid grapefruit or grapefruit juice while taking these drugs. Taking a PDE5 inhibitor along with a nitrate can cause a profound drop in blood pressure. Alcohol may interfere with the ability to have an erection. Muscle cramps, nausea, and vomiting are possible side effects if more than 1 pill a day are taken. Each medication has its own directions for how soon to take it before intercourse, from 15 minutes to 2 hours. Any PDE5 drug can lower blood pressure so the nurse alerts the client of safety precautions

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." f. "You will not be radioactive or pose any danger to anyone else."

ANS: B, C, D, F 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.

The nurse is doing home care teaching for a client who has undergone cryotherapy. Which statements by the client indicate a correct understanding of the instructions? (Select all that apply.) a. "I can resume my weight-lifting exercise class tomorrow." b. "I should not use tampons, douche, or have sexual activity." c. "I should shower rather than take a tub bath." d. "There may be a lot of bleeding for a few days." e. "There should be little or no discomfort."

ANS: B, C, E Cryotherapy involves freezing of cervical cancer cells and is often painless. Clients are restricted from heavy lifting. They may have a heavy watery discharge for several weeks, but should report any heavy bleeding, foul-smelling drainage, or a fever. The other options are correct

A client with genital herpes has painful blisters on her vulva. After teaching the client self-care measures, which statement indicates the need for further education? a. "Pouring water over my genitals will decrease the pain of urinating." b. "I will wash my hands carefully after applying ointment." c. "When I don't have lesions, I am not contagious to my sexual partner." d. "I should increase my fluid intake when I have open lesions."

ANS: C A client with genital herpes can still spread the disease when asymptomatic through viral shedding. The client is taught to use condoms with all sexual activity. Pouring water over the genitals (or urinating in the shower) will help decrease the pain of urine passing over open lesions. Good handwashing is important. Open lesions can lead to fluid loss so the client is taught to increase fluid intake.

A nurse is providing education to a new 55-year-old African-American client about screening for prostate cancer. What action by the nurse is most appropriate? a. Inform the client that recommendations vary, so screening is a personal choice. b. Let the client know that as an African American, he should be screened annually. c. Teach the client that he is in a high risk group and should discuss screening. d. Give the client written information that discourages screening until age 70.

ANS: C Clients in certain high risk groups should discuss screening for prostate cancer with their primary health care providers at age 45. High risk groups include African Americans and men with a first-degree relative who was diagnosed with prostate cancer before the age of 65. This new client will be encouraged to discuss screening even though he is past the age of initial discussion. Recommendations do vary somewhat, but he is in a recognized high risk group. The nurse would not say that he "should" be screened annually. Screening is not recommended for men over the age of 70.

The nurse is working with a male client who has gynecomastia. What action by the nurse is most appropriate? a. Teach the client to perform self-breast examination. b. Review the plan for chemotherapy after surgery. c. Educate him on the side effects of tamoxifen. d. Assess his usual daily alcohol intake.

ANS: C Gynecomastia is enlarged breast tissue in men. It is from an enlarged ridge of glandular breast tissue and is benign. The client does not need to perform SBE nor will he undergo chemotherapy. Tamoxifen is one drug used to treat the condition, so the nurse would educate the client on the medication. Alcohol is not related.

A 25-year-old woman is concerned about contracting HPV. What information by the nurse is most appropriate? a. "HPV is a benign infection that usually clears up on its own." b. "You are too old to receive the HPV vaccination." c. "We can provide HPV testing along with your Pap smear." d. "HPV is not a common sexually transmitted disease."

ANS: C HPV DNA testing can be done at the same time as the pap smear. Most women have HPV infection during their lives; however, it is not always benign. Two types, 16 and 18 are responsible for about 70% of cervical cancers. The vaccination with Gardasil 9 can be given up to age 45.

A client returned from a transurethral resection of the prostate 8 hours ago with a continuous bladder irrigation. The client reports headache and dizziness. What action by the nurse is most appropriate? a. Consider starting a blood transfusion. b. Slow the bladder irrigation down. c. Report the findings to the surgeon immediately. d. Take the vital signs every 15 minutes.

ANS: C Headache, dizziness, and shortness of breath are symptoms of possible TURP syndrome in which the irrigation fluid is absorbed, putting strain on the client's heart. The nurse notifies the primary health care provider immediately as the client may need intensive care monitoring. There is no data indicating the client needs a blood transfusion, plus that would add even more fluid in the system. The irrigant may need to be slowed but that is not the first action the nurse would take. Vital signs do need to be taken frequently in this situation, but the nurse notifies the primary health care provider first.

A client has just returned from a right radical mastectomy. Which action by the assistive personnel (AP) would require the nurse consider to intervene? a. Checking the amount of urine in the 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.

Which finding in a female client by the nurse would receive the highest priority for further diagnostics? a. Tender moveable masses throughout the breast tissue b. Nipple discharge without a palpable mass c. Nontender fixed mass in the upper outer quadrant of the breast d. Small, painful mass under warm reddened skin and nipple discharge

ANS: C Malignant lesions are fixed, hard and irregularly shaped and this lesion would be the priority for further diagnostic study. The other lesions are benign breast disorders. The client with nipple discharge but no palpable mass most likely has intraductal papilloma. The client who has nipple discharge but also has a mass under warm, red, edematous skin most likely has ductal ectasia

A nurse has taught a female client about the modifiable risk factors for breast cancer. 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, maintaining a normal weight, and avoiding hormone replacement are also strategies for breast cancer prevention.

The nurse is teaching a client who is undergoing brachytherapy about what to immediately report to her primary health care provider . Which signs and symptoms would be included in this teaching? (Select all that apply.) a. Constipation for 3 days b. Temperature of 99° F (37.2° C) c. Abdominal pain d. Visible blood in the urine e. Heavy vaginal bleeding f. Urinary retention

ANS: C, D, E Health teaching for a client having brachytherapy would emphasize reporting abdominal pain, visible blood in the urine, and heavy vaginal bleeding. Severe diarrhea (not constipation), urethral burning, extreme fatigue, and a fever over 100° F (37.7° C) would also be reported.

The nurse is providing preoperative education to a client prior to having an orchiectomy for testicular cancer. What statement by the client indicates the need to review the information? a. "I can still function sexually without one of my testes." b. "I will investigate sperm banking before the operation." c. "There should be no effect on my ability to reproduce." d. "Testicular self-exam will be important on the remaining testis."

ANS: C Oligospermia and azoospermia are common in clients with testicular function and can affect reproduction. The statement that there will be no effect on reproduction requires the nurse to review the information with the client. Sperm banking is an option prior to treatment to store sperm for future use. Normal sexual function is possible with one testis. Self-examination of the remaining testis is important for early detection of another tumor

The nurse is providing preoperative education to a client prior to having an orchiectomy for testicular cancer. What statement by the client indicates the need to review the information? a. "I can still function sexually without one of my testes." b. "I will investigate sperm banking before the operation." c. "There should be no effect on my ability to reproduce." d. "Testicular self-exam will be important on the remaining testis."

ANS: C Oligospermia and azoospermia are common in clients with testicular function and can affect reproduction. The statement that there will be no effect on reproduction requires the nurse to review the information with the client. Sperm banking is an option prior to treatment to store sperm for future use. Normal sexual function is possible with one testis. Self-examination of the remaining testis is important for early detection of another tumor.

A client is starting hormonal therapy with tamoxifen to lower the risk for breast cancer. What information needs to be explained by the nurse regarding the action of this drug? a. It blocks the release of luteinizing hormone. b. It interferes with cancer cell division. c. It selectively blocks estrogen in the breast. d. It inhibits DNA synthesis in rapidly dividing cells.

ANS: C Tamoxifen reduces the estrogen available to breast tumors to stop or prevent growth. This drug does not block the release of luteinizing hormone to prevent the ovaries from producing estrogen; leuprolide does this. Chemotherapy agents interfere with cancer cell division. Newer research supports treatment with tamoxifen for 10 years to prevent recurrence.

A nurse is assessing a client who presents with a scaly rash over the palms and soles of the feet and the feeling of muscle aches and malaise. Which action by the nurse is most appropriate? a. Reassure the client that these lesions are not infectious. b. Assess the client for hearing loss and generalized weakness. c. Don gloves and further assess the client's lesions. d. Take a history regarding any cardiovascular symptoms.

ANS: C The client is displaying symptoms similar to secondary syphilis, with flulike symptoms and rash due to the spirochetes circulating throughout the bloodstream. Therefore, the nurse needs to further assess the client's lesions with gloves since the client is highly contagious at this stage. Tertiary syphilis may display in the form of cardiovascular or central nervous system symptoms. Neurosyphilis can appear at any time, in any state, and can include hearing loss.

A woman is admitted to the hospital for antibiotic therapy for pelvic inflammatory disease. She is in pain, with a rating of 7 on a scale of 0-10. What comfort measure can the nurse delegate to assistive personnel (AP)? a. Administer acetaminophen with codeine. b. Apply an ice pack to the lower abdomen. c. Position the client in a semi-Fowler position. d. Teach the client to increase intake of fluids.

ANS: C The client with pelvic inflammatory disease usually experiences lower abdominal tenderness. The AP can position the client. Only the nurse can administer medications and perform teaching. A heating pad, not an ice pack, is used for comfort.

The nurse is examining a woman's breast and notes multiple small mobile lumps. Which question would be 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 changes, 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.

A female client returned to the clinic with a yellow vaginal discharge after being treated for Chlamydia infection 3 weeks ago. Which statement by the client alerts the nurse that there may be a recurrence of the infection? a. "I did practice abstinence while taking the medication." b. "I took doxycycline two times a day for a week." c. "I never told my boyfriend about the infection." d. "I did drink wine when taking the medication for Chlamydia."

ANS: C There is a good possibility that the boyfriend reinfected the client after the medication regimen was finished. Both the client and the boyfriend need to be treated. The other statements were in compliance with the recommendations of abstinence and the usual medication regimen with doxycycline. Wine should not interfere with the treatment.

A client presents to the emergency department reporting vomiting, severe lower abdominal pain, and a tender mass above one testis. What action by the nurse is most important? a. Have the client rate pain using the 0-10 scale. b. Prepare to administer an IV opioid analgesic. c. Determine when he last ate or drank anything. d. Assess risk factors for testicular cancer.

ANS: C This client has signs and symptoms of testicular torsion, which is a surgical emergency. For client safety, the nurse assesses last oral intake. Rating the pain is an important intervention too but is not related to safety. The client cannot have opioids prior to signing a surgical consent. The client does not have signs and symptoms of testicular cancer

A client has been treated for syphilis with IM penicillin. The next day the client calls the clinic to report fever, chills, achy muscles, and a worsening rash. What statement by the nurse is most appropriate? a. "You must be allergic to penicillin; over the counter antihistamines will help." b. "Please go to the nearest emergency department if you develop shortness of breath." c. "You can take acetaminophen or ibuprofen for the pain and achiness." d. "I think you should come in to the clinic either today or tomorrow and be checked."

ANS: C This client has signs of a Jarisch-Herxheimer reaction which is caused when the organisms' cell walls are disrupted and cellular contents are released rapidly. It is usually self-limiting and benign. Antipyretics and mild analgesics treat the symptoms. The client does not need to monitor for shortness of breath, come in to the clinic, or get antihistamines for an allergic reaction

A client with pelvic inflammatory disease is seen by the nurse 72 hours after starting oral antibiotics. Which finding leads the nurse to take immediate action? a. Feelings of anger that her partner infected her b. Loose stools over the last 2 days c. Anorexia and nausea d. Chills and a temperature of 101° F (38.3° C)

ANS: D Chills and fever could indicate a persistent infection and the immediate need to alter the dose or type of antibiotic. Anger is a normal reaction to a sexually transmitted infection and the pain of pelvic inflammatory disease. Gastrointestinal symptoms are common side effects of antibiotics but not an immediate cause for intervention.

A 30-year-old male client is asking the nurse about the vaccine for human papilloma virus (HPV). Which statement by the nurse is accurate? a. "Gardasil protects against all HPV strains." b. "You are too old to receive the vaccine." c. "Only females can receive the vaccine." d. "You will only need 1 dose of the vaccine."

ANS: D ? Gardasil is used to provide immunity for HPV types 6, 11, 16, and 18 and Gardasil 9 protects against 5 more strains. The vaccine is recommended for people aged 9 to 26 years of age, but Gardasil 9 can be given up to age 45. Both males and females can get the vaccine. Depending on the timing and type of vaccine, either 2 to 3 doses are required

During dressing changes, the nurse assesses a client who had breast reconstruction. Which finding would cause the nurse to take immediate action? a. Slightly reddened incisional area b. Blood pressure of 128/75 mm Hg c. Temperature of 99° F (37.2° C) d. Dusky color of the breast flap

ANS: D A dusky color of the breast flap could indicate poor tissue perfusion. The nurse would notify the primary health care provider to preserve the tissue. It is normal to have a slightly reddened incision as the skin heals. The blood pressure is within normal limits and the temperature is slightly elevated but would be monitored.

The outpatient clinic nurse has assessed a woman who reports a month-long history of feeling full, urinary frequency, and bloating. What action by the nurse is best? a. Obtain a clean catch urine specimen. b. Instruct the client on a 3-day diet history. c. Facilitate having a pelvic ultrasound. d. Teach the woman about CA-125 test

ANS: D Evidence shows that women with ovarian cancer often have recognizable, early signs such as abdominal bloating, urinary frequency or urgency, feeling full or difficulty eating, and pelvic pain. The nurse should "think ovarian" and facilitate the client having a CA-125 blood test, which is a cancer antigen test. The other actions may or may not be needed, but with these symptoms, the client needs to be evaluated for ovarian cancer.

A client is diagnosed with benign prostatic hyperplasia and seems sad and irritable. After assessing the client's behavior, which statement by the nurse would be the most appropriate? a. "The urine incontinence should not prevent you from socializing." b. "You seem depressed and should seek more pleasant things to do." c. "It is common for men at your age to have changes in mood." d. "Nocturia could cause interruption of your sleep and cause changes in mood."

ANS: D Frequent visits to the bathroom during the night could cause sleep interruptions and affect the client's mood and mental status. Telling the client his symptoms should not lead to less socialization is patronizing. Instructing the client to seek more pleasant things to do also is patronizing. Neither statement has any information the client could find useful. The statement about age has no validity and again does not offer useful information

A client is diagnosed with benign prostatic hyperplasia and seems sad and irritable. After assessing the client's behavior, which statement by the nurse would be the most appropriate? a. "The urine incontinence should not prevent you from socializing." b. "You seem depressed and should seek more pleasant things to do." c. "It is common for men at your age to have changes in mood." d. "Nocturia could cause interruption of your sleep and cause changes in mood."

ANS: D Frequent visits to the bathroom during the night could cause sleep interruptions and affect the client's mood and mental status. Telling the client his symptoms should not lead to less socialization is patronizing. Instructing the client to seek more pleasant things to do also is patronizing. Neither statement has any information the client could find useful. The statement about age has no validity and again does not offer useful information.

While evaluating a client for treatment of gonorrhea, which question is the most important for the nurse to ask? a. "Do you have a history of sexually transmitted infection?" b. "When was your last sexual encounter?" c. "When did your symptoms begin?" d. "Can you remember your partners and contact them to get treated?"

ANS: D Sexual partners, as well as the client, should be tested and treated for gonorrhea. Asking about sexually transmitted infection history, last sexual encounter, and onset of symptoms would be helpful with the history taking, but the priority is treating the client's sexual partners to limit the spread of the infection.

The nurse is caring for a postoperative client following an anterior colporrhaphy. What action can be delegated to the assistive personnel (AP)? 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 AP is able to provide comfort through a bath. The registered nurse would review any laboratory results, complete any teaching, and assess pain and discharge.

A younger woman from an unfamiliar culture 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. Offer to 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 some cultures, the man often makes the decisions for care of the female. The woman may want to make the decision with other support people or by herself. The nurse must maintain sensitivity to cultural, religious, and personal beliefs when it comes to this personal decision. 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 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.