NCLEX Review: CH 33

A client has had a right modified radical mastectomy and axillary lymph node dissection. The nurse is teaching the client about measures to reduce the risk of complications. The client demonstrates understanding of the instructions when she states which of the following? a) "I can lift with my right arm objects that weigh as much as 15 pounds." b) "I need to use an electric shaver when shaving my right armpit." c) "Anytime I need blood drawn, they should get the sample from my right arm." d) "I should tell my manucurist that it is okay to trim the cuticles on my right hand."

b)

A nurse is preparing a presentation for a health fair about preventing breast cancer. Which of the following would the nurse include? a) Opting for estrogen only replacement therapy during menopause b) Maintaining an ideal weight c) Delaying childbearing until after age 30 d) Increasing the intake of caffeinated drinks

b)

A nurse is reviewing a female patient's history, which includes the following information: Age at menarche: 14 years Cesarean delivery: 2 pregnancies Age at first pregnancy: 35 years Alcohol use: approximately 1 to 2 glasses of wine/month The nurse identifies which of the following as a possible risk factor for developing breast cancer? a) Alcohol use b) Age at first pregnancy c) Age at menarche d) Cesarean deliveries

b)

Assessment of a client reveals evidence of a cystocele. The nurse interprets this as which of the following? a) Downward displacement of the cervix b) Bulging of the bladder into the vagina c) Herniation of the rectum into the vagina d) Protrusion of intestinal wall into the vagina

b)

Students are reviewing information about the use of adjuvant hormonal therapy for breast cancer. They demonstrate understanding of this information when they identify which of the following as an example of a selective estrogen receptor modulator (SERM)? a) Exemestane b) Tamoxifen c) Letrozole d) Anastrozole

b)

The nurse is providing care to a client who has had surgery as treatment for breast cancer. The nurse would be alert for the development of which of the following? a) Breast abscess b) Lymphedema c) Fibrocystic breast disease d) Fibroadenoma

b)

While obtaining the history, a client reports that her mother was treated with diethylstilbestrol (DES) during her pregnancy. The nurse determines that this client is at risk for which of the following? a) Breast cancer b) Cervical cancer c) Vulvar cancer d) Endometrial cancer

b) Cervical cancer affects the lowest portion of the uterus and is associated with the risk factor of being born to mothers treated with DES during their pregnancy. DES is not a risk factor associated with vulvar or breast cancers. Endometrial cancer occurs in women who take estrogens without the addition of progesterone for 5 or more years during and after menopause

A nurse who works in an oncology practice prepares patients for the side effects of adjuvant hormonal therapy to treat breast cancer. Which of the following is the hormonal agent that has an increased risk of pulmonary embolism and deep vein thrombosis? a) Anastrozole b) Letrozole c) Tamoxifen d) Exemestane

c)

A woman with a 3-cm breast tumor is scheduled for a lumpectomy followed by 5 to 7 weeks of radiation therapy. The patient asks the nurse if this procedure would cure her. What is the nurse's best response? a) "No, but this combination of treatment has shown a 10-year remission rate." b) "No, but recurrences can be treated with a mastectomy." c) "Lumpectomy, followed by radiation, has the same predicted long-term survival rates as a mastectomy." d) "Yes, without regional node involvement, lumpectomy, followed by radiation, is curative."

c)

Which of the following would be inconsistent as a risk factor for breast cancer? a) Increased age b) Late menopause c) Multiparity d) Family history of breast cancer

c)

A client has undergone a total abdominal hysterectomy and bilateral salpingo-oopherectomy as treatment for endometrial cancer. When providing postoperative care to this client the nurse would be alert for signs and symptoms of which of the following? a) Neurotoxicity b) Leukopenia c) Bladder dysfunction d) Clotting deficiencies

c) After a total abdominal hysterectomy and bilateral salpingo-oopherectomy, the client is at risk for several complications, especially bladder dysfunction because the surgical site is close to the bladder. Leukopenia and neurotoxicity are adverse effects of chemotherapy agents such as paclitaxel and carboplatin used to treat ovarian cancer. Deep vein thrombosis, not clotting deficiencies are a potential complication after this type of surgery.

A nurse is speaking to a local women's group about the various types of cancer affecting the female reproductive tract. The nurse explains that ovarian cancer is the leading cause of death from gynecologic malignancies based on the understanding that this type of cancer does which of the following? a) Arises from extremely rare types of cells that are resistant to treatment b) Is closely associated with highly resistant sexually transmitted infections c) Typically manifests with vague symptoms resulting in late diagnosis d) Spreads more easily than other female reproductive cancers

c) Tumors of the ovary have been lethal largely because they present with nonspecific symptoms and therefore, frequently are far advanced and inoperable by the time they are diagnosed. Ease of spread and types of cells involved are not reasons underlying the fatal nature of this type of cancer. Ovarian cancer is not associated with sexually transmitted infections. Cervical cancer is linked to human papilloma virus infection.

Hematoma and seroma formation are complications of breast surgery. Which of the following is the indicator that should be reported to the surgeon? a) Bruising of the skin b) Pain at the site c) Tightness of the skin d) Gross swelling

d)

A 25-year-old woman has just been told that she has endometriosis. What would be the appropriate nursing intervention? 1) Assess her knowledge of the disease and explain treatment options. 2) Educate her that she will be unable to have children and will probably need a hysterectomy. 3) Educate the woman that she probably increased her risk for this disease by prolonged use of tampons. 4) Educate the woman that she is at no increased risk and that this is a benign disease.

1)

A nurse explains to a 30-year-old woman during her annual exam that the American Cancer Society currently recommends that women have an annual mammogram after what age? 1) 40 2) 50 3) 60 4) 30

1)

A 65-year-old female is admitted to the GYN unit with complaints of low pelvic pain and low back pain. To arrive at a tentative nursing diagnosis related to endometrial cancer, the nurse should focus her questions on which of the following? 1) Post-menopausal bleeding 2) Vaginal itching 3) Dysuria 4) Constipation

1) The main and most common symptom of endometrial cancer is post-menopausal bleeding, which occurs early in the disease, making diagnosis and treatment possible.

During a pelvic exam a 42-year-old woman was told she has a uterine fibroid approximately 3 cm in size. She is teary and worried about this fibroid since she had no idea it was there. Which of the following should the nurse not tell her? 1) If the fibroid does not cause any symptoms, there is no reason to remove it. 2) Fibroids can grow with estrogen stimulation and shrink after menopause. 3) A uterine fibroid is a cancerous lesion that requires a hysterectomy. 4) A uterine fibroid is a common benign growth of the uterus.

3)

A 62-year-old patient tells the nurse she is experiencing some slight vaginal bleeding. She wonders if this is normal since she went through menopause 10 years ago. The nurse should educate this woman: 1) to keep track of her bleeding. If it becomes heavier, she should go to her health care provider for evaluation. 2) that she needs some hormones to correct the bleeding. 3) that she needs to see her health care provider as soon as possible. This is an abnormal symptom. 4) not to be concerned because the bleeding is minima

3) Bleeding in the postmenopause may indicate endometrial cancer and needs immediate evaluation.

A 25-year-old woman has just been told that she has a 2 x 3 cm fibroadenoma in her left breast. What information should the nurse provide to this client? 1) A fibroadenoma can be treated by chemotherapeutic agents. 2) A fibroadenoma is usually a precursor to breast cancer and must be surgically removed. 3) A fibroadenoma is cause by trauma to the breast. 4) A fibroadenoma is a benign breast tumor and is common in women her age.

4)

A 76-year-old patient is receiving tamoxifen (Nolvadex) for breast cancer. To which of the following would the nurse give priority during tamoxifen therapy? 1) Monitor for drug-to-drug interactions. 2) Monitor for signs of dehydration and nausea. 3) Monitor for occasional headache and limb pain. 4) Monitor for menstrual irregularity and vaginal discharge.

4)

A Pap smear screens for which of the following? 1) Ovarian cancer 2) Vaginal cancer 3) Uterine cancer 4) Cervical cancer

4)

Which of the following is a characteristic of a breast cancer mass? a) Firm, hard, embedded in surrounding tissue b) Occurs as disseminated masses c) Tender upon palpation d) Symmetrical mass

a)

A nurse caring for a postmastectomy patient should not perform which of the following on the operative side? Select all that apply. a) Blood pressure b) Injections c) Blood draws d) Intravenous sticks e) Pulse check

a) b) c) d)

A 67-year-old client underwent a lumpectomy for a breast lesion determined to be malignant. Which of the following are factors in the client's history that may have increased her risk of breast cancer? a) All options are correct b) Not giving birth c) Increased age d) Obesity

a)

A client who has had a left total mastectomy is about to view her surgical site for the first time. Which of the following would be most appropriate for the nurse to say? a) "Do you feel like you're ready to look at your incision now?" b) "You need to look at the incision so you can heal emotionally." c) "Did you have reconstructive surgery when they removed your breast?" d) "Don't be afraid. Everybody feels the same way."

a)

A nurse is reviewing a client's history for possible risk factors associated with breast cancer. Which of the following would the nurse identify as increasing the client's risk? a) First full-term pregnancy at age 34 years b) Menopause at age 50 years c) One of three living children born prematurely d) Menarche at age 14 years

a)

A patient reports to the nurse that she has a sense of pelvic pressure and urinary problems such as incontinence, frequency, and urgency. The problem has gotten much worse since the birth of her third child. What does the nurse suspect the patient is experiencing? a) A cystocele b) A rectocele c) An enterocele d) A urinary tract infection

a)

The earliest and the most common symptom of endometrial cancer is: a) Bleeding b) Loss of weight c) Pain d) Symptoms of pressure on the bladder

a)

The nurse is discussing mammography with a female patient at the clinic. The patient asks at what age she should begin getting yearly mammograms. What answer should the nurse provide to the patient? a) 40 b) 55 c) 35 d) 50

a)

A client with vaginitis complains of itching and burning of the perineum. Which suggestion would be most appropriate to relieve the client's symptoms? a) Use skin protectants containing zinc oxide. b) Take sitz baths frequently c) Use a pure vinegar douche daily. d) Avoid yogurt with active lactobacilli cultures.

b)