Nursing Care: Altered Male Reproduction
Priority Interventions for Genital Warts A community health provider is caring for a female client with genital warts. Which topic is the most important to teach the client? Schedule an annual Papanicolaou (Pap) test. Apply acyclovir cream to warts every night. Post-Exposure prophylaxis (IPEP) pills can be taken for 28 days after an exposure to prevent infection with human papillomavirus (HPV). Using a birth control pill to prevent pregnancy may worsen the condition.
A complication of HPV is the risk of developing cancer of the cervix. A Pap test is critical in detecting early malignancies of the cervix. Oral acyclovir is used to treat HSV. Podofilox or imiquimod cream are used in the treatment of HPV. Condoms should be used to prevent spread of HPV; however, using a birth control pill and condoms does not worsen the condition. PEP is used to prevent the transmission of HIV, not HPV.
Risk for Breast Cancer A health care provider is assessing four clients. Which client has the highest risk of developing breast cancer? 55-year-old woman with fibrocystic breast changes 68-year-old woman with a sister diagnosed with breast cancer 65-year-old man with a BMI of 40 60-year-old woman who does not exercise
After the age of 60, the incidence of breast cancer increases dramatically. Advanced age is the highest risk factor for females. A first-degree relative with breast cancer is a contributing factor. Obesity and a sedentary lifestyle are contributing factors but they are not significant compared with females over the age of 60 with a family history of breast cancer. Fibrocystic breast changes do not increase the risk for breast cancer
Risk for Breast Cancer A health care provider is assessing four clients. Which client has the highest risk of developing breast cancer? 65-year-old man with a BMI of 40 55-year-old woman with fibrocystic breast changes 60-year-old woman who does not exercise 68-year-old woman with a sister diagnosed with breast cancer
After the age of 60, the incidence of breast cancer increases dramatically. Advanced age is the highest risk factor for females. A first-degree relative with breast cancer is a contributing factor. Obesity and a sedentary lifestyle are contributing factors but they are not significant compared with females over the age of 60 with a family history of breast cancer. Fibrocystic breast changes do not increase the risk for breast cancer.
Recommendation Which client would it be most appropriate to recommend a prostate-specific antigen (PSA) laboratory test? A 50-year-old client who just underwent a prostatectomy A 55-year-old client whose father died of prostate cancer A 70-year-old uncircumcised client A 42-year-old client with a family history of testicular cancer
After turning 50 years old, men have a higher risk of benign prostatic hyperplasia (BPH). Therefore, screening is recommended for men over 50 years old with a family history of BPH, who are obese, and lack of physical activity. A client who just had their prostate removed would not be at risk. Those with testicular cancer would not require a prostate assessment. A circumcised penis does have a reduced incidence of prostate cancer by about 18%, but it is not a greater risk than a male client over 50 years old with a family history of BPH.
Reproductive Health Recommended Screenings The medical record states that Kimberley, a 16-year-old female client, has been sexually active for the past one year and has had two male partners. She is using combined oral contraceptives to prevent pregnancy. Which actions should the nurse include in the plan of care? Select all that apply. Screening for chlamydia and gonorrhea Shingles and pneumococcal pneumonia vaccines Human papillomavirus (HPV) and influenza vaccines Instructions on how to perform breast self-examination Papanicolaou (Pap) test and human immunodeficiency virus (HIV) test
All women should be taught and encouraged to perform breast self-examination. Papanicolaou (Pap) testing is recommended every three years between the ages of 25 and 65. Shingles and pneumococcal pneumonia vaccines are recommended for women over the age of 60 years. All women under the age of 25 who are sexually active should be screened annually for chlamydia and gonorrhea. HIV testing is recommended for all women at least once between the ages of 13 and 64. However, because this intervention was paired with the Pap test, the answer is incorrect. The HPV immunization is a series of 3 vaccines that should be started between the ages of 11 and 12. Since Kimberly's history does not indicate that she has received this vaccination, the nurse should administer the first injection. All women should receive an annual influenza vaccine.
Medications to Avoid with Benign Prostatic Hyperplasia A nurse is caring for a client who has a new diagnosis of benign prostatic hyperplasia (BPH). Which medication should the client avoid? ipratropium dutasteride tamsulosin sildenafil
Anticholinergic agents (ipratropium) are contraindicated in clients with BPH due to the risk of developing acute urinary retention. Tamsulosin, dutasteride, and sildenafil are used to treat BPH.
Exercises After Mastectomy During the immediate postoperative period after a modified radical mastectomy, which exercises for the affected arm should the health care provider recommend for the client? Raising the affected arm above the head with fingers crawling up the wall Using the affected arm to brush hair Using the affected arm to perform full passive range of motion exercises Flexing and extending the fingers on the operative side
As soon as after the surgery, the client should start flexing and extending the fingers and wrist of the affected arm with daily increases in activity. Exercises that involve raising the arm and shoulder rotation and extension should be avoided in the early postoperative period in order to prevent disruption of the wound.
Exercises After Mastectomy During the immediate postoperative period after a modified radical mastectomy, which exercises for the affected arm should the health care provider recommend for the client? Using the affected arm to perform full passive range of motion exercises Raising the affected arm above the head with fingers crawling up the wall Using the affected arm to brush hair Flexing and extending the fingers on the operative side
As soon as after the surgery, the client should start flexing and extending the fingers and wrist of the affected arm with daily increases in activity. Exercises that involve raising the arm and shoulder rotation and extension should be avoided in the early postoperative period in order to prevent disruption of the wound.
Symptoms of Benign Prostatic Hyperplasia A health care provider is caring for a middle-age male client. When reviewing the client's recent history, the provider notes symptoms of benign prostatic hyperplasia (BPH). Identify the symptoms that are indicative of this condition? Select all that apply. Frequent urinary tract infections Urinary incontinence Hematuria Weight loss Chest pain Nocturia
BPH is characterized by an enlarged prostate gland, which significantly compresses the urethra. The result of this compression is decreased urine flow, urinary retention in the bladder, and frequent urinary tract infections (UTI) caused by urinary stasis. Nocturia, frequent urination at night, is often the first sign of BPH. Urinary incontinence is also associated with BPH. Chest pain, weight loss, and hematuria are not routinely associated with BPH.
Medication Assessment The male client wants to discuss starting a prescription for sildenafil. What should the nurse address first when talking with the client? Describe the side effects of sildenafil and other erectogenic medications. Ask the client about his sexual partners and sexual history. Ask the client what medications he currently takes, including over-the-counter. Tell the client he is not a candidate for erectogenic medications.
Before prescribing a medication, current medications must be taken into consideration in order to examine drug interactions and risk/benefit. Once the medication is deemed safe, the nurse can discuss additional sexual history and then review potential side effects. Without collecting additional history, the nurse cannot state that the client is not a candidate.
Benign Prostatic Hypertrophy
Benign Prostatic Hypertrophy
Anticipated Assessment and Planning A 50-year-old male client is scheduled for his yearly exam. Which should be included in the plan of care? Assessment questions about voiding patterns and urine color Prescription for erectile function Starting testicular self-examinations (TSE) Annual prostate specific antigen (PSA) testing
Blood in the urine and increased urinary frequency can be a sign of prostate issues. Upon reaching puberty, testicular exams should be started. Prostate specific antigen (PSA) testing typically begins with male clients around 50 years old. Every client around 50-year-old has erectile dysfunction (ED), so offering a prescription would not be a standard unless additional information is collected during the visit.
Breast Disorders
Breast Disorders
Complications of Prostate Resection A client returns from surgery with continuous bladder irrigation after the removal of their prostate. The client is given some ice chips, and has an intravenous (IV) infusion at 125 mL/hour. The catheter has light pink urine draining. Almost 3 hours later, the urine output has dropped to 10 ml for the last 2 hours. The color of the urine is now red. What should be the next action taken by the nurse? Assess the bladder using a bladder scanner. Assess the blood urea nitrogen (BUN), creatinine and potassium levels. Increase the fluid rate of the bladder irrigation. Increase the IV fluid rate.
Correct answer: Assess the bladder using a bladder scanner.The nurse needs to determine if the catheter becomes occluded or the client is experiencing a decline of the renal function. Incorrect answers: Increase the fluid rate of the bladder irrigation.If the catheter is blocked, the bladder will become overdistended. Increase the IV fluid rate.This is not indicated unless it is determined that the client is dehydrated. Assess the BUN, creatinine and potassium levels.This is important, but the priority is to assess for a distended bladder first.
Care of the Client: Taking Cyclophosphamide The health care provider is caring for a client with breast cancer who is receiving cyclophosphamide. Which client statement indicates an understanding of this medication? "I will not need to take ondansetron while receiving this medication." "I can stop using condoms because I will not be able to get pregnant." "I should increase my fluid intake to 2-3 liters daily." "I should expect my stools to be black or tarry in color."
Cyclophosphamide is an antineoplastic or cytotoxic chemotherapy drug and may be hazardous to an unborn fetus. Women must be advised to avoid pregnancy. Using a barrier contraceptive method is recommended for at least one year after the last dose of cyclophosphamide. Clients should drink at least 2 to 3 liters of fluid daily to prevent hemorrhagic cystitis and report to the provider regarding any pain or burning during urination. It is also important to void frequently while taking this drug. A common side effect of this drug is nausea. Ondansetron should be taken regularly as prescribed, and the client should eat small, frequent meals to reduce nausea. Black or tarry stools indicate blood, and the client should notify the provider immediately.
Care of the Client: Taking Cyclophosphamide The health care provider is caring for a client with breast cancer who is receiving cyclophosphamide. Which client statement indicates an understanding of this medication? "I will not need to take ondansetron while receiving this medication." "I should increase my fluid intake to 2-3 liters daily." "I should expect my stools to be black or tarry in color." "I can stop using condoms because I will not be able to get pregnant."
Cyclophosphamide is an antineoplastic or cytotoxic chemotherapy drug and may be hazardous to an unborn fetus. Women must be advised to avoid pregnancy. Using a barrier contraceptive method is recommended for at least one year after the last dose of cyclophosphamide. Clients should drink at least 2 to 3 liters of fluid daily to prevent hemorrhagic cystitis and report to the provider regarding any pain or burning during urination. It is also important to void frequently while taking this drug. A common side effect of this drug is nausea. Ondansetron should be taken regularly as prescribed, and the client should eat small, frequent meals to reduce nausea. Black or tarry stools indicate blood, and the client should notify the provider immediately.
Teaching About Mammogram Screening The client is scheduled to receive a mammogram screening next week. Which statement should be included in the client teaching? "Avoid sexual intercourse the night before the procedure." "Do not apply deodorant the morning of the exam." "Do not take aspirin 24-hours prior to the mammogram." "Avoid smoking for 2 days before the exam."
Do not apply deodorant, perfume, lotion, or powder under the arms or on the breasts the day of a mammogram. Aluminum particles are difficult to distinguish from calcifications and could be mistaken for early signs of breast cancer. Aspirin, sexual intercourse, and smoking do not interfere with mammogram screening.
Therapeutic Communication and Client Decision Making Beverly, age 48, was recently diagnosed with a 2-cm breast tumor. The provider has recommended her two options: (a) a lumpectomy with radiation or (b) a modified radical mastectomy as treatment. Beverly is tearful and expresses confusion about her decision making. Beverly asks the nurse which choice is best for her. Which is the best response provided by the nurse? "You must make this decision for yourself. What does your husband think?" "A lumpectomy conserves most breast tissue, but the survival rate is poor compared to a mastectomy." "I would choose the modified radical mastectomy to ensure the entire tumor is removed." "Each choice has advantages and disadvantages. What do you know about each procedure?"
Either treatment choice is indicated for women with early-stage breast cancer. The 10-year survival rate with lumpectomy and radiation is the same as that for modified radical mastectomy. Each procedure has advantages and disadvantages which must be considered when making an informed choice. The nurse should make educational information available to the client to aid in their decision making
Therapeutic Communication and Client Decision Making Beverly, age 48, was recently diagnosed with a 2-cm breast tumor. The provider has recommended her two options: (a) a lumpectomy with radiation or (b) a modified radical mastectomy as treatment. Beverly is tearful and expresses confusion about her decision making. Beverly asks the nurse which choice is best for her. Which is the best response provided by the nurse? "Each choice has advantages and disadvantages. What do you know about each procedure?" "I would choose the modified radical mastectomy to ensure the entire tumor is removed." "You must make this decision for yourself. What does your husband think?" "A lumpectomy conserves most breast tissue, but the survival rate is poor compared to a mastectomy."
Either treatment choice is indicated for women with early-stage breast cancer. The 10-year survival rate with lumpectomy and radiation is the same as that for modified radical mastectomy. Each procedure has advantages and disadvantages which must be considered when making an informed choice. The nurse should make educational information available to the client to aid in their decision making.
Clinical Manifestations: Benign Breast Disorders A client presents at the clinic with concerns about breast tenderness and nodules. Upon examination, the health care provider notes lumps in both breasts that are round and mobile. Which question is needed for the provider to follow up? "Do the lumps in your breast become smaller and less tender after your period ends?" "When was your last mammogram?" "Do you have a family history of breast cancer?" "Do you have any discharge from your nipples?"
Fibrocystic changes of the breast occur due to hypersensitivity of the tissue to estrogen and progesterone. Symptoms are related to the menstrual cycle, occurring about 1 week before menstruation begins and subsiding about 1 week after menstruation ends. Lumps tend to be small, mobile, tender, and found in both breasts. Both malignant and benign breast disorders may produce nipple discharge. The question "Do you have any discharge from your nipples?" does not provide the information needed for the nurse to diagnose fibrocystic changes of the breast. A prior mammogram lends little information to the current health concern; therefore, the question "When was your last mammogram?" does not provide the key information to the nurse. Family history of breast cancer in a first-degree relative (mother or sister) is important information to determine cancer risk. However, the question "Do you have a family history of breast cancer?" does not provide the key information related to the client's reported symptoms
Clinical Manifestations: Benign Breast Disorders A client presents at the clinic with concerns about breast tenderness and nodules. Upon examination, the health care provider notes lumps in both breasts that are round and mobile. Which question is needed for the provider to follow up? "Do you have any discharge from your nipples?" "Do the lumps in your breast become smaller and less tender after your period ends?" "Do you have a family history of breast cancer?" "When was your last mammogram?"
Fibrocystic changes of the breast occur due to hypersensitivity of the tissue to estrogen and progesterone. Symptoms are related to the menstrual cycle, occurring about 1 week before menstruation begins and subsiding about 1 week after menstruation ends. Lumps tend to be small, mobile, tender, and found in both breasts. Both malignant and benign breast disorders may produce nipple discharge. The question "Do you have any discharge from your nipples?" does not provide the information needed for the nurse to diagnose fibrocystic changes of the breast. A prior mammogram lends little information to the current health concern; therefore, the question "When was your last mammogram?" does not provide the key information to the nurse. Family history of breast cancer in a first-degree relative (mother or sister) is important information to determine cancer risk. However, the question "Do you have a family history of breast cancer?" does not provide the key information related to the client's reported symptoms.
Benign Prostatic Hyperplasia and Prostate Cancer Jamal, a 52-year-old client, is diagnosed with benign prostatic hyperplasia (BPH). The client states, "My brother was diagnosed with prostate cancer last year. Is this the same thing?" Which response by the health care provider is most appropriate? "BPH can lead to prostate cancer, so you will be monitored closely over the next year." "BPH is an enlargement of the prostate gland that restricts the flow of urine but does not lead to cancer." "BPH is a malignant condition that will require chemotherapy and possibly surgery to remove the gland." "BPH is a benign tumor that does not spread to any other part of the body."
Hyperplasia is an increase in the number of cells. Enlargement of the prostate gland is caused by an increase in cells due to hormonal changes associated with aging. Hyperplasia is not considered a tumor. BPH does not predispose the client to developing prostate cancer.
Confidentiality and Sexually Transmitted Infections The nurse and a nursing student are caring for Tiffany, age 22, who recently tested positive for chlamydia and gonorrhea. As part of education, the nurse instructs the client to notify current and previous sexual partners of the infection. Tiffany states, "I cannot tell my boyfriend because he will know that I had sex with another partner." After the client is discharged, the nurse overhears the student on the phone telling Tiffany's boyfriend that he should come to the clinic for sexually transmitted infection (STI) testing. The nurse learns that Tiffany's boyfriend is a close acquaintance of the student nurse. Select the important information that the nurse must provide to the student. Select all that apply. As a nurse, the primary responsibility is to the client seeking care. The Health Insurance Portability and Accountability Act (HIPAA) ensures privacy of personal health information. Gonorrhea and Chlamydia must be reported to local, state, or national agencies for tracking purposes. In this situation, the nurse is obligated to inform the client's sexual partners of the potential risk for infection. Breaching confidentiality undermines the therapeutic nurse-client relationship.
Gonorrhea and chlamydia require local, state, or national reporting. Nurses have an ethical and legal obligation to maintain confidentiality of client information under HIPAA. The nurse's main obligation is to the client seeking care. Client teaching is one way to establish a relationship between the nurse and client. Sharing information about the effects of the disease, the consequences of reinfection, and the effect of the disease on others who may not know that they are infected is essential. The nurse should encourage the client to notify all partners of the diagnosis.
Nutritional Needs in Breast Cancer A health care provider is teaching a client who has breast cancer and has been receiving chemotherapy. Which of the following should be included in the instructions so the client knows the ways of increasing protein and calories in foods? Select all that apply. Top fruit with Greek yogurt and granola. Use peanut butter as a spread on crackers. Dip chicken in eggs before cooking. Sprinkle cheese on a baked potato. Use water instead of milk in soups.
High-calorie, high-protein condiments and additives such as peanut butter, Greek yogurt, eggs, and cheese should be added to all foods/meals to maintain a normal weight. Clients undergoing chemotherapy often suffer from anorexia. Eating high-calorie, high-protein foods ensures that when intake is low, calories are sufficient. Milk provides more calories than water and should be added to food when possible.
Nutritional Needs in Breast Cancer A health care provider is teaching a client who has breast cancer and has been receiving chemotherapy. Which of the following should be included in the instructions so the client knows the ways of increasing protein and calories in foods? Select all that apply. Use water instead of milk in soups. Top fruit with Greek yogurt and granola. Sprinkle cheese on a baked potato. Use peanut butter as a spread on crackers. Dip chicken in eggs before cooking.
High-calorie, high-protein condiments and additives such as peanut butter, Greek yogurt, eggs, and cheese should be added to all foods/meals to maintain a normal weight. Clients undergoing chemotherapy often suffer from anorexia. Eating high-calorie, high-protein foods ensures that when intake is low, calories are sufficient. Milk provides more calories than water and should be added to food when possible.
Prevention of Osteoporosis Cassandra, 65-year-old, recently received a bone density scan. The result was reported as normal. Today, Cassandra asks the nurse what she can do to minimize her risk of developing osteoporosis. Which response made by the client indicates a need for further teaching? "Weight-bearing exercises with low impact such as walking may slow bone loss." "High-impact aerobics and playing golf are the best activities to keep my bones healthy." "Vitamin D is necessary for calcium to be absorbed into the bones, so I should eat egg yolks and canned tuna." "I should stop smoking and consuming excessive amounts of coffee to decrease the amount of bone loss."
High-impact activities or those requiring twisting of the spine can increase the client's risk for compression fractures as the bones weaken. Low-impact weight-bearing exercises, such as walking, lifting weights, and hiking, will strengthen bones and prevent osteoporosis. Daily calcium supplements are recommended to ensure dietary intake is sufficient. Vitamin D is necessary for calcium to be absorbed from the small intestines. Good sources of vitamin D are salmon, sardines, canned tuna, egg yolks, and mushrooms. Many foods, such as cow and soy milk and orange juice are fortified with calcium and vitamin D. Smoking and excessive coffee and alcohol consumption contribute to bone loss.
Reproductive Health: Immunizations The nurse is discussing the importance of receiving the human papillomavirus (HPV) vaccine series to Elena (age of 12) and her mother. The mother asks the health care provider, "Why does my daughter need a vaccine to prevent sexually transmitted diseases while she is not sexually active?" What is the best response made by the nurse? "The HPV vaccination is unnecessary as long as Elena requires her partner to wear condoms once she is sexually active." "If you are certain Elena is not sexually active, we can delay the immunization until later in life." "HPV causes breast cancer. Since you do not have a family history of breast cancer, Elena does not need the vaccine." "We recommend starting the series now as it protects Elena before she is exposed to a cancer-causing infection.
Human papillomavirus (HPV) infections can cause genital warts and cervical cancer. Since the HPV vaccine was introduced over 12 years ago, the incidence of HPV cancers and genital warts have decreased by 86% in teenage girls. The benefits of receiving the HPV vaccine outweigh any potential risks (CDC, 2020). All girls ages 11-12 should begin the HPV vaccination series, regardless of sexual activity, to prevent the complications of HPV infections later in life. The vaccine is recommended in conjunction with the use of condoms.
Client Education: Men's Reproductive Health Risks A nurse is teaching a young, sexually active, adult male client. Which statement by the client indicates a need for further teaching? "I may not be able to get an erection if I am under a lot of stress or drinking a lot of alcohol." "I would know if I had human papillomavirus (HPV), the symptoms are obvious." "Even if the girl I am with is on birth control pills, I should still wear a condom." "I should be doing testicular self-exams to ensure that I find testicular cancer early."
In men, human papillomavirus (HPV) is usually not symptomatic, but can be spread with each sexual encounter. It is therefore important to wear a condom with any type of sexual encounter to reduce the risk of sexually transmitted infection transmission. Alcohol and stress can reduce the possibility of an erection. Doing testicular self-exams is essential to any male after puberty.
Mandatory Reporting of Sexually Transmitted Infections Which infections must be reported to public health officials? Select all that apply. Clostridium difficile Chlamydia trachomatis Human papilloma virus Hepatitis C Gonorrhea
In the United States, local, state, and national agencies require certain diseases to be reported when diagnosed (National Institutes of Health, 2020). Reporting allows for tracking of how often the disease occurs and may prevent future outbreaks. Healthcare providers, not the client, are responsible for reporting. Some diseases are reported in writing (gonorrhea), some are reported by telephone (pertussis), and some are reported as the total number of cases in a specified timeframe (varicella, influenza). Gonorrhea; hepatitis A, B, and C; and chlamydia must be reported.
Characteristics of Intraductal Papilloma Which characteristic(s) describes an intraductal papilloma? Select all that apply. More common in women ages 30 to 50 Multicolored, sticky nipple discharge Wart-like, nonpalpable growth in the mammary ducts near the nipple Associated with an increased risk of breast cancer Caused by breast trauma
Intraductal papilloma is more common in women ages 30 to 50 and is associated with a slightly increased risk of developing breast cancer. A wart-like, nonpalpable mass is found in the mammary ducts beneath the areola. The cause of intraductal papilloma is unknown and produces a serous, serosanguineous, or bloody nipple discharge. A multicolored sticky discharge is produced by mammary duct ectasia.
Characteristics of Intraductal Papilloma Which characteristic(s) describes an intraductal papilloma? Select all that apply. Wart-like, nonpalpable growth in the mammary ducts near the nipple Caused by breast trauma Multicolored, sticky nipple discharge More common in women ages 30 to 50 Associated with an increased risk of breast cancer
Intraductal papilloma is more common in women ages 30 to 50 and is associated with a slightly increased risk of developing breast cancer. A wart-like, nonpalpable mass is found in the mammary ducts beneath the areola. The cause of intraductal papilloma is unknown and produces a serous, serosanguineous, or bloody nipple discharge. A multicolored sticky discharge is produced by mammary duct ectasia.
Benign Versus Malignant Breast Disorders A nurse is caring for four clients. Which client's breast assessment should the nurse immediately report to the provider? The client with a small, firm, defined, nontender, mobile mass in the lower outer quadrant of the left breast The client with a large, round, tender, and moveable mass in the upper outer quadrant of both breasts The client with bilateral spontaneous thick, sticky, milky nipple discharge The client with an immobile, hard, nontender mass in the upper outer quadrant of the right breast
Malignant lesions are characteristically hard, irregularly-shaped, immobile, and nontender. The most common site is the upper outer quadrant of the breast. Fibrocystic lesions are typically large, round, tender, and movable, occurring in both breasts near the end of the menstrual cycle. Fibroadenoma is usually small, firm, well-defined, and mobile. Galactorrhea produces a thick, sticky, milky nipple discharge in both breasts in response to increased prolactin levels in the body. Galactorrhea is not associated with pregnancy, but is caused by a thyroid or pituitary disorder.
Benign Versus Malignant Breast Disorders A nurse is caring for four clients. Which client's breast assessment should the nurse immediately report to the provider? The client with bilateral spontaneous thick, sticky, milky nipple discharge The client with a large, round, tender, and moveable mass in the upper outer quadrant of both breasts The client with an immobile, hard, nontender mass in the upper outer quadrant of the right breast The client with a small, firm, defined, nontender, mobile mass in the lower outer quadrant of the left breast
Malignant lesions are characteristically hard, irregularly-shaped, immobile, and nontender. The most common site is the upper outer quadrant of the breast. Fibrocystic lesions are typically large, round, tender, and movable, occurring in both breasts near the end of the menstrual cycle. Fibroadenoma is usually small, firm, well-defined, and mobile. Galactorrhea produces a thick, sticky, milky nipple discharge in both breasts in response to increased prolactin levels in the body. Galactorrhea is not associated with pregnancy, but is caused by a thyroid or pituitary disorder.
Nursing Care: Altered Female Reproduction
Nursing Care: Altered Female Reproduction
Nursing Care: Altered Male Reproduction
Nursing Care: Altered Male Reproduction
Osteoporosis Risk Factors A nurse is conducting screenings at a community health fair. Which client is at greatest risk for developing osteoporosis? 65-year-old woman with a sedentary lifestyle who has smoked for 40 years 25-year-old woman with asthma who is pregnant 30-year-old woman who runs marathons 75-year-old man who has chronic obstructive pulmonary disease (COPD)
Postmenopausal women are at great risk for osteoporosis due to the declining estrogen levels. Sedentary lifestyle contributes to the risk of developing osteoporosis. Smoking leads to decreased bone mass and increasing the risk for osteoporosis. Pre-menopausal with an active healthy lifestyle are not associated with increased risk for osteoporosis. Asthma and chronic obstructive pulmonary disease (COPD) do not increase the risk for osteoporosis.
Discharge Teaching Following a Transurethral Resection of Prostate Jamal, a 52-year-old client, is being discharged today following a transurethral resection of prostate (TURP) procedure 3 days ago. Which statement indicates that the client does not understand discharge teaching? Select all that apply. "I should avoid sex for 2 weeks." "If my urine looks bloody, I should rest and drink water." "I can expect to be constipated for a few weeks, so there is no cause for concern." "If I have any pain, I should take an aspirin." "I should avoid drinking coffee every morning."
Sexual intercourse should be avoided for 2 weeks to allow for healing. Constipation must be prevented to avoid straining, which can increase the risk of bleeding. Bloody urine means the clients should immediately stop activity and drink 8 - 12 ounces of water. If bleeding persists, the client should call the health care provider. Stimulants, such as caffeine and alcohol, can irritate the bladder, leading to spasms. Aspirin thins the blood and should be avoided for pain management after a surgical procedure.
Sexually Transmitted Infections
Sexually Transmitted Infections
Characteristics of Herpes Simplex Virus Infection Select the characteristics of a herpes simplex virus (HSV) infection. Acyclovir 400 mg three times daily for 7 days will cure HSV. HSV-2 only causes genital lesions. The primary symptom of HSV is painful lesions that erupt and ulcerate. Condoms are necessary only when active lesions are present. Stress, illness, and sunburn can cause reoccurrence of genital lesions.
Stress, illness, and sunburn can precipitate recurrence of lesions that erupt and ulcerate. Both HSV-1 and HSV-2 can cause genital lesions. There is no cure for HSV. Acyclovir shortens the duration of an outbreak and may decrease recurrence. The client can actively spread the virus before lesions appear. Condoms should always be worn during sexual activity. Abstinence should be practiced when active lesions are present.
Chemoprevention for Breast Cancer Mary, a 40-year-old client at risk of breast cancer, has elected chemoprevention as an approach to reduce her risk. The provider has prescribed tamoxifen. Which statement made by the client indicates an understanding of this medication? "This medication helps prevent breast cancer by helping my body use estrogen better." "When I experience chills caused by this medication, I will need to wear heavier clothing for comfort." "I can take this medication on an empty stomach or with food." I should use an oral contraceptive containing estrogen to ensure I do not get pregnant."
Tamoxifen is an estrogen receptor blocker. One side effect of tamoxifen is hot flashes because estrogen activity is blocked. Nonhormonal or a barrier form of contraception should be used because tamoxifen may cause harm to an unborn fetus. Tamoxifen may be taken with or without food.
Chemoprevention for Breast Cancer Mary, a 40-year-old client at risk of breast cancer, has elected chemoprevention as an approach to reduce her risk. The provider has prescribed tamoxifen. Which statement made by the client indicates an understanding of this medication? I should use an oral contraceptive containing estrogen to ensure I do not get pregnant." "When I experience chills caused by this medication, I will need to wear heavier clothing for comfort." "I can take this medication on an empty stomach or with food." "This medication helps prevent breast cancer by helping my body use estrogen better."
Tamoxifen is an estrogen receptor blocker. One side effect of tamoxifen is hot flashes because estrogen activity is blocked. Nonhormonal or a barrier form of contraception should be used because tamoxifen may cause harm to an unborn fetus. Tamoxifen may be taken with or without food.
Screening for Benign Prostatic Hyperplasia Which test is recommended for routine screening of benign prostatic hyperplasia in men over 50 years of age? prostate-specific antigen (PSA) level digital rectal examination to palpate the prostate gland urinalysis with culture cystoscopy
The digital rectal exam (DRE) is performed routinely to palpate the prostate gland for enlargement. This assessment is performed by an advanced healthcare provider; not by a generalist registered nurse. If the gland is enlarged, further diagnostic testing is indicated, including a serum PSA level and urinalysis with culture.
Adverse Effects of Tamoxifen A 65-year-old female client with metastatic invasive ductal carcinoma of the breast was admitted with severe lethargy, confusion, bone pain, weakness, excessive urination, and thirst. Following a right radical mastectomy and radiation, the client was prescribed tamoxifen. Symptoms began seven days after starting the medication. Which laboratory value should be reported immediately to the health care provider? Magnesium 2 mg/dL Creatinine 2.4 mg/dL Calcium 13 mg/dL Potassium 4 mmol/L
The normal calcium level is 8.6-10.3 mg/dL. Tamoxifen can cause abnormally high levels of serum calcium, and typically develops 4-11 days after the initiation of therapy. Hypercalcemia causes the kidneys to work harder, resulting in excessive thirst and frequent urination. As calcium is leached from the bones into the bloodstream, the bones weaken, causing pain. Hypercalcemia interferes with brain function, causing confusion, lethargy, and fatigue. The creatinine level is elevated but is caused by hypercalcemia. Therefore, the calcium level should be immediately reported to the provider. The potassium and magnesium levels are within the normal range.
Adverse Effects of Tamoxifen A 65-year-old female client with metastatic invasive ductal carcinoma of the breast was admitted with severe lethargy, confusion, bone pain, weakness, excessive urination, and thirst. Following a right radical mastectomy and radiation, the client was prescribed tamoxifen. Symptoms began seven days after starting the medication. Which laboratory value should be reported immediately to the health care provider? Magnesium 2 mg/dL Creatinine 2.4 mg/dL Potassium 4 mmol/L Calcium 13 mg/dL
The normal calcium level is 8.6-10.3 mg/dL. Tamoxifen can cause abnormally high levels of serum calcium, and typically develops 4-11 days after the initiation of therapy. Hypercalcemia causes the kidneys to work harder, resulting in excessive thirst and frequent urination. As calcium is leached from the bones into the bloodstream, the bones weaken, causing pain. Hypercalcemia interferes with brain function, causing confusion, lethargy, and fatigue. The creatinine level is elevated but is caused by hypercalcemia. Therefore, the calcium level should be immediately reported to the provider. The potassium and magnesium levels are within the normal range.
Nursing's Role in Education The nurse may encounter clients with concerns related to sexuality and their decreased libido. Which basic topic is sensitive during client teaching? Ability to communicate effectively Extensive experience in dealing with clients with sexual problems Comfort with one's sexuality Knowledge about sexuality
The nurse must be accepting, empathetic, and non-judgmental to clients who disclose concerns regarding sexuality. This can happen only when the nurse has reconciled and accepted their feelings and beliefs related to sexuality. Content knowledge and experience can increase sensitivity. Nurses who can communicate effectively and teach using appropriate terminology with clients demonstrate sensitivity.
Prevention of Sexually Transmitted Infections A client presents at the clinic to discuss prevention of sexually transmitted infections and condom use. Which topic is important for the nurse to discuss with the client? Information about different condom styles Proper condom storage Strategies to enhance condom use Steps to properly use a condom
Though all topics presented are important, strategies to enhance condom use should be discussed first. Condom negotiation and communication skills are of primary importance in the prevention of sexually transmitted infections. Clients must advocate for the use of condoms with every sexual encounter.
Prevention of Sexually Transmitted Infections The Centers for Disease Control (CDC) estimates that as many as 20 million new sexually transmitted infections (STIs) occur each year (CDC, 2017). Which statement is most related to the high incidence of STIs? Organisms that cause STIs have become more virulent. Marriage is often deferred until later in life. Use of oral contraceptives rather than condoms to prevent pregnancy has increased. Organisms that cause STIs have become resistant to common antibiotics.
Though many factors contribute to the current prevalence of STIs, a major factor is the widespread use of oral conceptive pills rather than condoms to prevent pregnancy. Condoms are the only form of contraceptive that protect against STIs and pregnancy
Assessment of Clients With Sexually Transmitted Infections When assessing a young man in the health clinic, which information is most important for the health care provider to assess? How long the client has been experiencing symptoms Date of last sexual activity Prior history of sexually transmitted infections Names of sexual partners within the past 60 days
To prevent the spread of an infection, all previous sexual partners must be notified, evaluated, and treated. All other information is helpful in diagnosis and treatment, but preventing further transmission is the priority.
Risk Factors for Erectile Dysfunction Which conditions are risk factors for erectile dysfunction? Select all that apply. Hypertension Increased stress Weight loss Increased physical activity Tobacco use
Tobacco use, increased stress, and hypertension are common risk factors leading to erectile dysfunction. Weight loss and increased physical activity may help decrease erectile dysfunction.
Minimally Invasive Therapy to Treat Benign Prostatic Hyperplasia A client presents to the clinic with urinary urgency, post void dribbling, and a weak urine stream. He reports voiding up to 5 times each night. A diagnosis of benign prostatic hyperplasia (BPH) is confirmed with a digital rectal exam. After explaining all treatment options, the client elects for a minimally invasive therapy. Which treatment for BPH uses low-wave radio frequency to destroy prostate tissue? prostatic stenting transurethral electrovaporization of prostate (TUVP) transurethral microwave thermotherapy (TUMT) transurethral needle ablation (TUNA)
Transurethral needle ablation (TUNA) uses low-wave radiofrequency to heat the prostate, causing necrosis. Transurethral microwave thermotherapy (TUMT) uses microwave radiating heat to produce coagulative necrosis of the prostate. Transurethral electrovaporization (TUVP) uses electrosurgical vaporization to destroy prostate tissue. Prostatic stenting involves placing a stent in the urethra to keep it open.
What Causes Syphilis? Which organism causes syphilis? Human papilloma virus Treponema pallidum Neisseria gonorrhoeae Chlamydia trachomatis
Treponema pallidum causes syphilis. Neisseria gonorrhoeae causes gonorrhea. Chlamydia trachomatis causes chlamydia. Human papilloma virus causes genital warts
Erectile Dysfunction Assessment and Teaching A client is reviewing treatment options for erectile dysfunction (ED). The nurse provides education about the topic. Which of the following should be included in the nurse's teaching plan? Select all that apply. Encourage the use of a drainage device. Vasoactive medications can help enhance blood flow into the penile arteries. Discuss stress levels and relationship status. Vasoconstrictive medication is the preferred medication for treatment.
Vasoactive drugs along with intraurethral devices enhance blood flow into the pentile arteries. Vasoactive medications are given as a topical gel, injection, or a pellet into the urethra. Some examples include papaverine, alprostadil and phentolamine. Erectile dysfunction is common in men with diabetes. It causes early and severe hardening of the arteries. Problems with the nerves controlling erections are also often seen in men with diabetes. Some clients have performance anxiety which is often caused by stress, so assessing for mental health needs should be part of the teaching plan. A drainage device is not part of a treatment plan.
Nursing Care Following a Mastectomy The nurse is caring for a client following a modified radical mastectomy. Which nursing intervention should be included in the plan of care? Avoid arm exercises in the immediate postoperative period. Elevate the affected arm on a pillow above the heart level. Maintain an intravenous (IV) site below the antecubital area on the affected side. Place cool compresses on the affected arm.
Warm compresses should be used on the affected arm to promote vasodilation because cold compresses would cause vasoconstriction and further compromise circulation. Simple exercises for arm and shoulder on the affected side should begin prior to discharge in order to prevent contractures and muscle shortening, to maintain muscle tone, and to improve lymph and blood circulation. No blood pressure, intravenous (IV) starts, blood draws, and injections on the affected side, which may compromise circulation and contribute to lymphedema. To prevent and reduce lymphedema , the affected arm should not be dependent for long periods. Elevating the arm above the level of the heart and performing isometric exercises can reduce fluid.
Clinical Manifestations of Breast Disorders A health care provider is reviewing the medical record for a client with fibrocystic breast changes. Which finding should the provider expect? Palpable lump in the upper outer quadrant Elevated cancer antigen 125 (CA-125) and pelvic pain Dimpling of the breast with bloody nipple discharge Breast cancer 1 (BRCA1) gene mutation
When fibrosis of the breast tissue occurs, cysts are felt as multiple, smooth, well-defined nodules that are tender and movable. Cysts may be felt lumpy, rubbery, or ropelike and vary in size. Fibrocystic breast changes are benign but may increase the risk for breast cancer. The breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) gene mutations are thought to be responsible for familial breast and ovarian cancer. Cancer antigen 125 (CA-125), a serum tumor marker, is elevated in ovarian cancer. Pelvic pain, increased abdominal girth, and abnormal uterine bleeding are associated with ovarian cancer. Dimpling of the breast with bloody nippl
Clinical Manifestations of Breast Disorders A health care provider is reviewing the medical record for a client with fibrocystic breast changes. Which finding should the provider expect? Breast cancer 1 (BRCA1) gene mutation Palpable lump in the upper outer quadrant Dimpling of the breast with bloody nipple discharge Elevated cancer antigen 125 (CA-125) and pelvic pain
When fibrosis of the breast tissue occurs, cysts are felt as multiple, smooth, well-defined nodules that are tender and movable. Cysts may be felt lumpy, rubbery, or ropelike and vary in size. Fibrocystic breast changes are benign but may increase the risk for breast cancer. The breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) gene mutations are thought to be responsible for familial breast and ovarian cancer. Cancer antigen 125 (CA-125), a serum tumor marker, is elevated in ovarian cancer. Pelvic pain, increased abdominal girth, and abnormal uterine bleeding are associated with ovarian cancer. Dimpling of the breast with bloody nipple discharge is suspicious for breast cancer.
