Combo with "Advanced Health Assessment - Breast and Axilla, Anus, Rectum, Prostate" and 8 others

A 9-year-old girl is in the clinic for a sports physical. After some initial shyness she finally asks, "Am I normal? I don't seem to need a bra yet, but I have some friends who do. What if I never get breasts?" The nurse's best response would be:

"I understand that it is hard to feel different from your friends. Breasts usually develop between 8 and 10 years of age." ANS: D Page: 386 | Page: 400. Adolescent breast development usually begins between 8 and 10 years of age. The nurse should not belittle the girl's feelings by using statements like "don't worry" or by sharing personal experiences. The beginning of breast development precedes menarche by about 2 years.

Chocolate and caffeine

(methylxanthines) may cause benign breast disease, such as fibrocystic changes

Anterior Axillae

(pectoral) nodes; above the breast

What are the Health People 2020 goals?

*INcreased the proportion of mothers who breastfeen their babies *Reduce the breast cancer death rate by 20% *Increase the proportion of cancer survivors who are living 5 years or longer after diagnosis.

When does gynecomastia usually resolve?

1-2 years

What are the three positions used to reinspect a woman's breasts?

1. Arms extended overhead 2. Press hands to the hips and roll shoulders forward 3. Lean forward while seated

What are the three steps in breast/ axillae exam?

1. Inspect (characteristics of breasts & areolae and nipples 2. Reinspect in 3 positions 3. Palpate breasts and axillae in 2 positions

List the 3 steps of a breast/axillae exam

1. Inspect both breasts with patient sitting, hands at sides *check characteristics of breasts *check characteristics of areolae and nipples 2. Reinspect in 3 positions *arms overhead *hands to hips *lean forward 3. Palpate breasts and axillae *seated *supine

2 types of assessments in the breast/axillae exam

1. Inspection 2. Palpation

How do you perform the chest wall sweep during the seated palpation?

1. Place right palm at pt.'s right clavicle at sternum 2. Sweep down to the nipple, feeling for superficial lumps 3. Repeat on left side using left hand

How do you perform the bimanual digital palpation during the seated palpation?

1. Place the palm of one hand under the pt.'s right breast. 2. Walk fingers of your other hand across the breast tissue feeling for lumps while compressing the tissue against your palm 3. Repeat with other breast

What are the 7 steps for palpating breasts when patient is supine?

1. Raise 1 arm behind head 2. Palpate all quadrants and the tail of Spence 3. Depress nipple 4. Compress nipple 5. Consider findings 6. Characterize any masses 7. Transilluminate any masses

List seven parts of the supine palpation

1. Raise one arm 2. Palpate all quadrants and over the tail of Spence 3. Depress nipple 4. Compress nipple 5. Consider your findings 6. characterize any breast mass 7. transilluminate any masses

What are the 6 characteristics of breasts?

1. Size & shape 2. symmetry 3. contour 4. color & texture 5. venous patterns 6. lesions

How do you perform the lymph node palpation during the seated palpation?

1. Support pt.'s flexed left arm with your left hand 2. Examine left axilla with your right hand 3. Move your fingers down the apex to the bra line 4. Palpate medial and lateral aspects, anterior and posterior walls of the axilla, and down the inside of the upper arm to the elbow 5. Palpate supraclavicular and infraclavicular areas

What should you be looking for when reinspecting the breasts?

1. bilaterally equal 2. even contour 3. dimpling 4. retraction 5. deviation in any position

List the 2 areas to Inspect in a breast/axillae exam

1. characteristics of BREASTS 2. characteristics of Areolae & Nipples

List three parts of the seated palpation.

1. chest wall sweep 2. bimanual digital palpation 3. lymph node palpation

When noting the size and shape of a woman's breast, name 3 descriptions

1. convex 2. pendulous 3. conical

How do you characterize a breast mass?

1. dimensions 2. consistency 3. mobility

Name four axillary nodes that one would palpate during a breast exam?

1. pectoral 2. subscapular 3. central 4. brachial

List 3 things to be alert for when inspecting the skin color and texture of the breasts.

1. retractions 2. dimpling 3. peau d' orange (orange peel)

List the 6 characteristics of areolae and nipples

1. shape 2. color 3. texture 4. nipple eversion 5. nipple retraction or deviation 6. supernumerary nipples

List 5 pieces of equipment needed for the exam

1. small pillow 2. ruler 3. flashlight with transilluminator 4. glass slide cytologic fixative (if nipple discharge present)

What are the three different techniques when palpating the breasts in the supine position?

1. vertical strip technique 2. concentric circle technique 3. wedge technique

Genetic Mutation

10% of breast cancer cases are a ____ of BRCA-1 or BRCA-2

40-50; 50

18% of cases are diagnosed in women that are ____. 77% are older than___

Increased Alcohol Intake

2-5 drinks per day increased risk

How is breast dived for assessment puproses

4 quadrants. Center equals nipple. Example: Lesion at 2 o'clock 5 cm from nipple

Prenatal visits should be schedules every ____ weeks from first visit to 28 weeks, every _____ weeks to 36 weeks, every ___ week to birth? A. 1 B. 2 C. 3 D. 4

4 weeks until 28 weeks every 2 weeks until 36 weeks every 1 week until birth

When is the best time to palpate the breasts?

4-7 days after the menstrual cycle begins

Mammograms should begin at age

40

What is the best time to do a self breast exam?

4th-7th days of the menstrual cycle because the beast aren't as tender.

How long should you listen to note absent bowel sounds?

5 minutes.

Lymph Drainage from the Breast

75%; flows outward toward the axillary lymph node groups and the upward to the subclavicular and supraclavicular nodes

Benign Breast Disease

90% of breast problems, represents lots of breasts problems, including: breast pain, tenderness, swelling, lumps, discharge, and inflammation

Fibroadenoma

A common benign tumor of the glandular tissue of the breast. Usually occur as a single tumor near the nipple or in the upper outer quadrant. Asymptomatic, so they are typically found during self exam.

Paraphimosis

A condition in which the foreskin, once retracted, becomes so tight that it cannot be moved back over the glans (head of the penis)

Spermatocele

A cyst located in the epididymis. Aka testicular tumor

Chlamydia

A disease caused by a bacteria that produces a yellow discharge. Tenderness to movement of the cervix and can cause sterility if untreated.

Varicocele

A distended cord. Common cause of male infertility. Upon palpation, it may feel like a bag of worms.

Colostrum

A form of milk that is produced by the mammary glands. May leak in the month prior to childbirth

When examining the breast of a 75-year-old woman, the nurse would expect to find which of the following? A. enlarged axillary lymph nodes B. multiple large firm lumps C. a granular feel to the breast tissue D. pale areola

A granular feel to the breast tissue. In older women, secretion of estrogen and progesterone decreases, leading to atrophy of the grandular tissue and its replacement with fibrous connective tissue. This tissue feels granular. Axillary lymph nodes do not enlarge. Multiple large, firm lumps are a sign of benign breast disease (BBD), which occurs in patients 30-55 years. Areolae do not change in color.

Rectocele

A hernia that is formed when the rectum pushes into the posterior vaginal wall.

What needs further investigation to rule out breast cancer?

A new breast lump, change in existing lump, or bloody discharge from the nipples

Cyclic bilateral breast edema is

A normal occurrence caused by hormonal fluctuations associated with period

What is associated with Supernumerary Nipples?

A renal problem.

During palpation of a man's breast, what would you expect to feel?

A thin layer of fatty tissue overlying the muscle

19. The nurse should use which test to check for large amounts of fluid around the patella? A) Ballottement B) Tinel sign C) Phalen's test D) McMurray's test

A) Ballottement Ballottement of the patella is reliable when larger amounts of fluid are present. The Tinel's sign and the Phalen's test are used to check for carpal tunnel syndrome. The McMurray's test is used to test the knee for a torn meniscus. Pages: 590-591

A 55-year-old man is in the clinic for a yearly check-up. He is worried because his father died of prostate cancer. The nurse knows that which tests should be done at this time? Select all that apply. A) Blood test for prostate-specific antigen B) Urinalysis C) Transrectal ultrasound D) Digital rectal examination E) Prostate biopsy

A) Blood test for prostate-specific antigen D) Digital rectal examination Prostate cancer is typically detected by testing the blood for prostate-specific antigen (PSA) or by a digital rectal exam (DRE). It is recommended that both PSA and DRE be offered to men yearly, beginning at age 50 years. If the PSA is elevated, then further lab work or a transrectal ultrasound (TRUS) and biopsy may be recommended.

The nurse is percussing the seventh right intercostal space at the midclavicular line over the liver. Which sound should the nurse expect to hear? A) Dullness B) Tympany C) Resonance D) Hyperresonance

A) Dullness The liver is located in the right upper quadrant and would elicit a dull percussion note. REF: Page: 541

13. The nurse is checking the range of motion in a patient's knee and knows that the knee is capable of which movement(s)? A) Flexion and extension B) Supination and pronation C) Circumduction D) Inversion and eversion

A) Flexion and extension The knee is a hinge joint, permitting flexion and extension of the lower leg on a single plane. The knee is not capable of the other movements listed. Page 572

The nurse is preparing for a certification course in skin care and needs to be familiar with the various lesions that may be identified on assessment of the skin. Which of the following definitions are correct? Select all that apply. A) Petechiae: Tiny punctate hemorrhages, 1 to 3 mm, round and discrete, dark red, purple, or brown in color B) Bulla: An elevated, circumscribed lesion filled with turbid fluid (pus) C) Papule: A hypertrophic scar D) Vesicle: Also known as a friction blister E) Nodule: Solid, elevated, hard or soft, larger than 1 cm

A) Petechiae: Tiny punctate hemorrhages, 1 to 3 mm, round and discrete, dark red, purple, or brown in color D) Vesicle: Also known as a friction blister E) Nodule: Solid, elevated, hard or soft, larger than 1 cm An elevated, circumscribed lesion filled with turbid fluid (pus) is a pustule. A hypertrophic scar is a keloid. A bulla is larger than 1 cm and contains clear fluid; a papule is solid, elevated, but less than 1 cm.

The nurse is reviewing the changes that occur with menopause. Which of these are changes associated with menopause? A) Uterine and ovarian atrophy along with thinning vaginal epithelium B) Ovarian atrophy, increased vaginal secretions, and increasing clitoral size C) Cervical hypertrophy, ovarian atrophy, and increased acidity of vaginal secretions D) Vaginal mucosa fragility, increased acidity of vaginal secretions, and uterine hypertrophy

A) Uterine and ovarian atrophy along with thinning vaginal epithelium The uterus shrinks because of its decreased myometrium. The ovaries atrophy to 1 to 2 cm and are not palpable after menopause. The sacral ligaments relax, and the pelvic musculature weakens, so the uterus droops. The cervix shrinks and looks paler with a thick glistening epithelium. The vaginal epithelium atrophies, becoming thinner, drier, and itchy. The vaginal pH becomes more alkaline, and secretions are decreased. This results in a fragile mucosal surface that is at risk for bleeding and vaginitis.

12. A patient tells the nurse that she is having a hard time bringing her hand to her mouth when she eats or tries to brush her teeth. The nurse knows that for her to move her hand to her mouth, she must perform which movement? A) flexion. B) abduction. C) adduction. D) extension.

A) flexion. Flexion, or bending a limb at a joint, would be required to move the hand to the mouth. Extension is straightening a limb at a joint. Moving a limb toward the midline of the body is called adduction; abduction is moving a limb away from the midline of the body. Pages: 566-567

A nurse notices that a patient has ascites, which indicates the presence of: A) fluid. B) feces. C) flatus. D) fibroid tumors.

A) fluid. Ascites is free fluid in the peritoneal cavity, and occurs with heart failure, portal hypertension, cirrhosis, hepatitis, pancreatitis, and cancer. REF: Pages: 543-544

The nurse is caring for a black child who has been diagnosed with marasmus. The nurse would expect to find the: A) hair to be less kinky and to be a copper-red color. B) head to be larger than normal, with wide-set eyes. C) skin on the hands and feet to be scaly and tender. D) lymph nodes in the groin to be enlarged and tender.

A) hair to be less kinky and to be a copper-red color. The hair of black children with severe malnutrition (e.g., marasmus) frequently changes not only in texture but in color—the child's hair becomes less kinky and assumes a copper-red color. The other findings are not present with marasmus.

While performing an assessment of a 65-year-old man with a history of hypertension and coronary artery disease, the nurse notices the presence of pitting edema in the lower legs bilaterally. The skin is puffy and tight but of normal color. There is no increased redness or tenderness over his lower legs, and the peripheral pulses are equal and strong. In this situation, the nurse suspects that the likely cause of the edema would be: A) heart failure. B) venous thrombosis. C) a local inflammation. D) blockage of lymphatic drainage.

A) heart failure. Bilateral edema or edema that is generalized over the entire body is caused by a central problem such as heart failure or kidney failure. Unilateral edema usually has a local or peripheral cause. Page 215

15. A woman who is 8 months pregnant comments that she has noticed a change in posture and is having lower back pain. The nurse tells her that during pregnancy women have a posture shift to compensate for the enlarging fetus. This shift in posture is known as: A) lordosis. B) scoliosis. C) ankylosis. D) kyphosis.

A) lordosis. Lordosis compensates for the enlarging fetus, which would shift the center of balance forward. This shift in balance in turn creates strain on the low back muscles, felt as low back pain during late pregnancy by some women. Scoliosis is lateral curvature of portions of the spine; ankylosis is extreme flexion of the wrist, as seen with severe rheumatoid arthritis; and kyphosis is an enhanced thoracic curvature of the spine. Page 573

A woman is in the clinic for an annual gynecologic examination. The nurse should plan to begin the interview with the: A) menstrual history because it is generally nonthreatening. B) obstetric history because it is the most important information. C) urinary system history because there may be problems in this area as well. D) sexual history because it will build rapport to discuss this first.

A) menstrual history because it is generally nonthreatening. Menstrual history is usually nonthreatening; thus it is a good place to start. Obstetric, urinary, and sexual histories are also part of the interview but not necessarily the best topics with which to start.

An older man is concerned about his sexual performance. The nurse knows that in the absence of disease, a withdrawal from sexual activity later in life may be due to: A) side effects of medications. B) decreased libido with aging. C) decreased sperm production. D) decreased pleasure from sexual intercourse.

A) side effects of medications. In the absence of disease, a withdrawal from sexual activity may be due to side effects of medications such as antihypertensives, antidepressants, or sedatives. The other options are not correct.

A 75-year-old woman who has a history of diabetes and peripheral vascular disease has been trying to remove a corn on the bottom of her foot with a pair of scissors. The nurse will encourage her to stop trying to remove the corn with scissors because: A) the woman could be at increased risk for infection and lesions because of her chronic disease. B) with her diabetes, she has increased circulation to her foot and it could cause severe bleeding. C) she is 75 years old and is unable to see, so she puts herself at greater risk for self-injury with the scissors. D) with her peripheral vascular disease, her range of motion is limited and she may not be able to reach the corn safely.

A) the woman could be at increased risk for infection and lesions because of her chronic disease A personal history of diabetes and peripheral vascular disease increases a person's risk for skin lesions in the feet or ankles. The patient needs to see a professional for assistance with corn removal. Pages: 210-211

During an examination, the nurse finds that a patient has excessive dryness of the skin. The best term to describe this condition is: A) xerosis. B) pruritus. C) alopecia. D) seborrhea.

A) xerosis.

Mr. Quigley is a 56-year-old man who presents with a complaint of testicular swelling. On examination you note swelling that occurs in the epididymis as a result of a cyst. Which of the following conditions best describes these clinical findings? A. A spermatocele B. Epispadias C. Balanitis D. A hydrocele

A. A spermatocele

Which of the following occurs with endometriosis? A. Aberrant endometrial tissue growth B. Cervical polyps C. Ovarian cysts D. Red-tinged or bloody urine

A. Aberrant endometrial tissue growth

The nurse is preparing to assess for the first time the pulse of a client who has heart disease and a history of cardiac dysrhythmias. What would be the best technique for the nurse to use? A. Auscultate the apical pulse for one full minute while another nurse palpates the radial pulse B. Auscultate for 30 second and multiply by 2 to obtain an accurate heart rate C. Auscultate the apical pulse over the 2nd intercostal space in the midclavicular line D. Auscultate the apical pulse for one full minute then palpate the radial pulse during the next minute

A. Auscultate the apical pulse for one full minute while abother nurse palpates the radial pulse Rationale: The apical pulse should be auscultated for one full minute with the stethoscope at the 5th intercostal space in the midclavicular line (apex of the heart). While auscultating the apical pulse, the radial pulse should be palpated simultaneously to detect discrepancies caused by dysrhythmias. One radial pulse should be felt for each apical beat heard, but with some dysrhythmias, the radial pulsation is absent with early beats because of reduced stroke volume. Options 2 and 4 would not allow for simultaneous assessment of the apical and radial pulses. Option 3 is an incorrect location for cardiac auscultation.

The nurse would use which method of examination to assess for the presence of a bruit in the abdomen? A. Auscultation B. Percussion C. Palpitation D. Inspection

A. Auscultation Rationale: Auscultation uses the sense of hearing to identify sounds that are normal and abnormal during the assessment. A bruit is an abnormal sound of the venous/arterial system that is only detectable by listening with a stethoscope. A bruit cannot be detected by percussion or inspection. The turbulent blood flow that is heard as a bruit would be palpated as a thrill.

In which of the following ethnic groups would you expect to see the lowest incidence of osteoporosis? A. Blacks B. Whites C. Asians/Pacific Islanders D. Native Americans

A. Blacks

Mrs. Walker is a 68-year-old patient who is in very good health and comes to the clinic for a routine health assessment. Even though she is in good health, she shows signs of aging. Which is true for older adults? A. Decreased salivation leads to dry mouth. B. Gastric acid secretion increases. C. Liver size increases. D. None of the above.

A. Decreased salivation leads to dry mouth.

When taking health history, the first action the nurse should perform after the client describes the chief complaint is to: A. Document verbatim what the client has said about the problem B. Paraphrase in the nurse's own words what the problem is C. Refrain from note-taking to appear focus D. Ask the client to repeat the data to ensure reliability

A. Document verbatim what the client has said about the problem Rationale: The chief complaint offers the nurse an indication of what the problem is and how health care should proceed. The nurse can continue to probe during the interview to identify contributing factors to the client's chief complaint. The client's statements must be documented using his or her own phrases and terminology.

Prior to taking the health history, the nurse should first do which of the following? A. Establish a rapport with the client B. Offer the client a beverage of choice C. Establish that insurance coverage exists D. Ask the client to disrobe and put on a gown

A. Establish a rapport with a client Rationale: In order to gain as much insight and information from the client as possible, the nurse should establish a level of trust or rapport with the client. The client will be best able to relax and answer questions if he or she is asked in a nonthreatening manner. Offering the client food and drink is not appropriate. The nurse should not ask the client about health insurance or finances, as other personnel determine this. The client does not need to wear an examining gown to answer questions.

Ballottement of the patella is used to assess which of the following? A. Fluid in the knee B. Pain with knee flexion C. Crepitus with palpation of the knee joint D. Presence of an audible pop or click

A. Fluid in the knee

Mr. Holmes is a 54-year-old patient who comes to the clinic for an initial dermatology assessment. On examination, you note a suppurative, inflammatory skin lesion due to an infected hair follicle. Which of the following terms best describes this lesion? A. Furuncle B. Pustule C. Fissure D. Acne

A. Furuncle

A pale white cervix with a whitish gray vaginal discharge indicates? A. Gonorrhea B. Chlamydia C. Trichmoniasis d. Herpes Simplex

A. Gonorrhea

The most common cause of inflammation of bartholin glands? A. Gonorrhea B. Chlamydia C. Trichmoniasis D. Herpes Simplex

A. Gonorrhea Bartholin glands are located at 5 and 7 o'clock, large palpable bump

Which of the following physiologic processes takes place within the musculoskeletal system? A. Hematopoiesis B. Hemolysis C. Hemoptysis D. Hemianopsia

A. Hematopoiesis

Which of the following statements about hair is correct? A. In humans, hair is vestigial. B. In humans, hair is necessary to protect from cold or trauma. C. Humans have one type of hair. D. None of the above.

A. In humans, hair is vestigial.

Decreased caliber (pencil-thin stools) indicate what? A. Lower rectal stricture B. Spasmodic contraction C. Permanent stenosis D. Ambeiasis

A. Lower rectal stricture Spasmodic contraction - intermittent pencil like stools Permanent stenosis - persistent, pencil-like stools from scarring or from pressure of a malignancy Ambeiasis - small flecks of blood-stained mucus in liquid feces

Prolonged or excessive regularly occurring uterine bleeding? A. Menorrhagia B. Metrorrhagia C. Menometrohagia D. Intermenstrual bleeding

A. Menorrhagia Metorrhagia - uterine bleeding at irregular more frequent intervals Menometrorrhagia - prolonged excessive bleeding occurring at irregular or frequent intervals Intermenstrual bleeding - uterine bleeding of variable amounts occurring between periods

The shock absorber of the vertebral disks in the spine is which of the following? A. Nucleus pulposus B. Costal facet C. Vertebral bursae D. Nucleus fasciculi

A. Nucleus pulposus

Mr. Peyser is a 38-year-old patient who presents to your office for a yearly physical examination. On exam you note that the foreskin of the penis is very tight, preventing it from retracting over the glans. Which of the following conditions best describes this clinical finding? A. Phimosis B. Paraphimosis C. Spermatocele D. Epispadias

A. Phimosis

The musculoskeletal system provides which of the following functions for the human body? A. Protection and storage B. Movement and elimination C. Storage and control D. Propulsion and preservation

A. Protection and storage

What action should the nurse take to increase the likelihood of obtaining quality data when doing a complete physical assessment? A. Provide adequate lighting and a comfortably warm room for the interview and physical assessment B. Outline the process in detain to beginning the examination C. Ask all family members or significant others to wait outside the room D. Identify each piece of equipment used with the appropriate medical term

A. Provide adequate lighting and a comfortably warm room for the interview and physical assessment Rationale: A comfortable environment puts the client at ease and increases the likelihood that the nurse will be able to obtain necessary data. The family may be able to provide additional data through the assessment process (option 3). As the nurse proceeds with the more intimate components of the assessment, the family may be asked to leave. Inform the client immediately prior to assessing each system (rather than before the examination) what is entailed to facilitate understanding (option 2). Using lay terms for medical equipment (e.g., blood pressure cuff versus sphygmomanometer ) is appropriate (option 4).

When you assess an individual for the presence of a herniated nucleus pulposus, which of the following maneuvers should you ask the individual to perform? A. Raise the legs straight while keeping the knee extended. B. Bend over and attempt to touch the ground while keeping the legs straight. C. Do a knee bend. D. Abduct and adduct the legs while keeping the knee extended.

A. Raise the legs straight while keeping the knee extended.

Osteoporosis in older adults is due to which of the following factors? A. Resorption of bone at a greater rate than deposition B. Loss of water content and thinning of the intervertebral disks of the spinal column C. A redistribution of fat and subcutaneous tissue D. Loss of intervertebral cushioning resulting in an increased amount of weight-bearing on the long bones

A. Resorption of bone at a greater rate than deposition

The left upper quadrant of the abdomen contains which of the following organs? A. Stomach B. Gallbladder C. Ureter D. Ovary

A. Stomach

The nurse preparing to assess for jugular venous distention (JVD) places the client into which position? A. Supine with head of the bed elevated 30 degrees B. Supine with neck placed downward on chest C. High-fowler's with head elevated upward D. Side-lying with no pillows under the head

A. Supine with head of the bed elevated 30 degrees Rationale: To assess for jugular venous distention (which indicates fluid volume overload), the client should be lying supine with the head elevated to 30 degrees (low Fowler's). The nurse assesses the highest point of distention of the internal jugular vein in centimeters in relation to the sternal angle, the point at which the clavicles meet. The other positions listed would not aid in this physical assessment technique.

Mr. Frank, a 32-year-old patient, presents to your office with a complaint of urinary frequency. On examination you note a painless lesion with a clear base and indurated borders that is located on the glans penis. Which of the following best describes this clinical finding? A. Syphilitic chancre B. Lymphogranuloma C. Genital warts D. Herpes simplex

A. Syphilitic chancre

Jesse Carter, a student nurse, has been assigned to teach fourth-graders about hygiene. She decides that her teaching module will cover the oil-producing glands. Which of the following will Jesse include while discussing the skin's sebaceous glands? A. The sebaceous glands produce sebum, a protective oily substance that prevents water loss from the skin. B. Dry skin results from the loss of oil and is treated by moisturizers. C. Sebaceous glands are located everywhere on the skin; they are most abundant in the scalp, forehead, face, and chin. D. All of the above.

A. The sebaceous glands produce sebum, a protective oily substance that prevents water loss from the skin.

The nurse would attempt to gather which of the following information while obtaining a health history from a client? Select all that apply. A. Who lives with the client and the client's support systems B. Annual household income C. Use of vitamins and herbal supplements D. History of past illness and surgeries E. Religious preference and beliefs that might relate to healthcare issues

A. Who lives with the client and the client's support systems C. Use of vitamins and herbal supplements D. History of past illness and surgeries E. Religious preference and beliefs that might relate to healthcare issues Rationale: The nurse seeks to obtain data from the client using a holistic approach. The nurse focuses on physical, psychosocial, and spiritual concerns (options 1, 3, 4, and 5). Information regarding a client's personal finances (option 2) is not appropriate or necessary to inquire about in the interview.

Mr. Shea is a 51-year-old patient who presents with complaints of a skin lesion. On examination, you note a linear skin lesion that runs along a nerve route. Which of the following terms best describes this lesion? A. Zosteriform B. Annular C. Dermatome D. Shingles

A. Zosteriform

A hydrocele is: A. a circumscribed collection of serous fluid in the tunica vaginalis surrounding the testes. B. a meatus opening on the dorsal side of the glans or shaft. C. an acute inflammation of the testes. D. awakening in the night with a need to urinate.

A. a circumscribed collection of serous fluid in the tunica vaginalis surrounding the testes.

Epispadias is: A. a meatus opening on the dorsal side of the glans or shaft. B. a circumscribed collection of serous fluid in the tunica vaginalis surrounding the testes. C. undescended testes. D. an acute inflammation of the testes.

A. a meatus opening on the dorsal side of the glans or shaft.

The inguinal canal is: A. a narrow tunnel inferior to the inguinal ligament. B. a muscular duct continuous with the epididymis. C. a narrow tunnel superior to the inguinal ligament. D. the joining of the vas deferens and the seminal vesicle.

A. a narrow tunnel inferior to the inguinal ligament.

The corona is: A. a shoulder where the glans joins the shaft. B. a hood or flap of skin over the glans. C. a corpus spongiosum cone of erectile tissue. D. folds of thin skin on the scrotal wall.

A. a shoulder where the glans joins the shaft

The pancreas is: A. a soft, lobulated gland behind the stomach. B. a soft mass of lymphatic tissue on the postlateral wall. C. a bean-shaped, retroperitoneal gland. D. None of the above

A. a soft, lobulated gland behind the stomach.

The epididymis is: A. a sperm storage site. B. folds of thin skin on the scrotal wall. C. the joining of the vas deferens with the seminal vesicle. D. the muscle that controls the size of the scrotum.

A. a sperm storage site.

Mr. Jenkins is a 43-year-old patient who goes to the ambulatory health center with complaints of muscle pain. When testing for muscle strength, the examiner: A. applies an opposing force against the individual's actions during ROM of a joint. B. asks the individual to try to break the examiner's joint movements during ROM. C. measures the degree of muscle tension developed during active extension and flexion of a joint. D. can assume that if an individual has adequate active ROM that muscle strength is fully developed.

A. applies an opposing force against the individual's actions during ROM of a joint.

Mr. Kimbel is a 71-year-old patient who comes to the clinic with his daughter, who is concerned about a mole on her father's abdomen. You know that moles: A. are common on the abdomen. B. are uncommon on the abdomen. C. always require a biopsy. D. are no cause for concern.

A. are common on the abdomen.

Mrs. Davids is a 55-year-old patient who presents with complaints of spots in her nails. As the health care provider, you know that the components of a nail examination include: A. contour, consistency, and color. B. shape, surface, and circulation. C. clubbing, pitting, and grooving. D. texture, toughness, and translucency.

A. contour, consistency, and color.

The lateral view of the spine demonstrates two types of curvature associated with specific divisions of the spinal columns. The two types are: A. convex and concave. B. convex and ellipsoid. C. parabolic and concave. D. parabolic and ellipsoid.

A. convex and concave.

Undescended testes are called: A. cryptorchidism. B. phimosis. C. orchitis. D. a varicocele.

A. cryptorchidism.

For the spleen to be palpable, it must be: A. enlarged three times its normal size. B. enlarged twice its normal size. C. located superficially under the 11th rib. D. rotated to the left side.

A. enlarged three times its normal size.

Mr. Walker is a 56-year-old man who comes to the ambulatory health center for a routine health assessment. On examination, you note hepatomegaly, which is: A. enlargement of the liver. B. bowel protrusion through abdominal musculature. C. inflammation of the peritoneum. D. a burning sensation in the upper abdomen.

A. enlargement of the liver.

Bundles of muscle fibers that compose skeletal muscle are identified as: A. fasciculi. B. fasciculations. C. ligaments. D. tendons.

A. fasciculi.

Myoma is a(n): A. hard, painless nodule in the uterine wall. B. extrauterine endometrial nodule. C. cervical nodule. D. enlarged Skene's gland.

A. hard, painless nodule in the uterine wall.

Mrs. Gomeller is a 39-year-old patient who presents to the health clinic. After her examination, you have diagnosed Mrs. Gomeller with menorrhagia. Menorrhagia is a term that describes: A. heavy menses. B. the absence of menstruation. C. scant menstruation. D. None of the above

A. heavy menses.

Cystic fluid in the tunica vaginalis surrounding the testes is called: A. hydrocele. B. varicocele. C. orchitis. D. cryptorchidism.

A. hydrocele.

The penis: A. is composed of two corpora cavernosa and one corpus spongiosum. B. is composed of glans, shaft, and scrotum C. contains the urethra, ejaculatory duct, and testes. D. All of the above

A. is composed of two corpora cavernosa and one corpus spongiosum.

Mrs. Black is a 59-year-old patient who presents to the health center with a complaint of being postmenopausal. When providing patient education to Mrs. Black, you would explain that the postmenopausal woman: A. is more prone to vaginitis. B. is less prone to vaginitis. C. has no change in vaginitis risk. D. None of the above

A. is more prone to vaginitis.

Obstructive jaundice is indicated by what color stool? A. Light tan or gray B. Tarry black stool C. Green yellow stool D. Bluish-gray

A. light tan or gray Tarry black - upper intestinal tract bleeding

Mrs. Peterson is a 43-year-old patient who presents to the women's health clinic from her primary care provider. During the taking of her history, Mrs. Peterson complains of a heavy menstrual flow. An excessively heavy menstrual flow is called: A. menorrhagia. B. multipara. C. salpingitis. D. bloody show.

A. menorrhagia.

Heberden's and Bouchard's nodes are hard and nontender and are associated with: A. osteoarthritis. B. rheumatoid arthritis. C. Dupuytren's contracture. D. metacarpophalangeal bursitis.

A. osteoarthritis.

Dysuria is a term indicating: A. painful urination. B. clear mucous vaginal discharge. C. malodorous vaginal discharge. D. frequent urination.

A. painful urination.

A soft, lobulated gland located behind the stomach is the: A. pancreas. B. liver. C. gallbladder. D. spleen.

A. pancreas.

A flat macular hemorrhage is called a(n): A. purpura. B. ecchymosis. C. petechiae. D. hemangioma.

A. purpura.

Mrs. Wilder, a 42-year-old patient, presents to the dermatology clinic with a confluent and extensive patch of petechiae and ecchymoses; flat macular hemorrhage is called a: A. purpura. B. hemangioma. C. hematoma. D. telengiectasia.

A. purpura.

Mrs. Buckman is a 49-year-old patient who comes to the women's health clinic. On examination, you note a prolapse of the rectum and its vaginal mucosa into the vagina. This is the definition of: A. rectocele. B. menorrhagia. C. hematuria. D. nullipara.

A. rectocele.

Crepitation is an audible sound that is produced by: A. roughened articular surfaces moving over each other. B. tendons or ligaments that slip over bones during motion. C. joints that are stretched when placed in hyperflexion or hyperextension. D. an inflamed bursa.

A. roughened articular surfaces moving over each other.

Chancre is a(n): A. superficial, painless ulcer. B. aberrant growth of endometrial tissue. C. hard, painless nodule in the uterine wall. D. discoloration of the cervix.

A. superficial, painless ulcer.

The ejaculatory duct is: A. the joining of the vas deferens and the seminal vesicle. B. a muscular duct continuous with the epididymis. C. a narrow tunnel inferior to the inguinal ligament. D. a narrow tunnel superior to the inguinal ligament.

A. the joining of the vas deferens and the seminal vesicle.

A pinpoint, constricted opening at the meatus or inside along the urethra is: A. urethral stricture. B. urethritis. C. acuminate. D. progenitalis.

A. urethral stricture.

Abdominal Assessment

Abdominal Assessment

Probable signs of pregnancy?

Abdominal enlargement Uterine enlargement Palpation of fetus Balottement of fetus - shakes in uterus Hegar's sign _ softening of the isthmus Goodell's sign (softening of the cervix) Endocrine pregnancy tests

Dimpling over a mass in the breast. Normal or abnormal?

Abnormal

Fissures in tissues of vaginal opening. Normal or abnormal?

Abnormal

Lactation when the client is not pregnant or breast feeding. Normal or abnormal?

Abnormal

Thickening of the breast skin. Normal or abnormal?

Abnormal

During 1st month of pregnancy, nipples and areolae darken and enlarge. Normal or abnormal?

Abnormal (occurs during the 2nd month of pregnancy)

Clinical manifestations of noninvasive breast cancer

Abnormal mammogram with well defined margins and discharge

What is the approximate number that gynecomastia occurs in males?

About 1/3 of adolescent boys

Cryptorchidism

Absence of a testicle in the scrotal sac.

Naegele's rule is used to calculate estimated date of delivery (EDD), how is it calculated?

Add 1 year to first day of LMP - 3 months + 7 months

What two things can cause perianal irritation? One is more common in adults and the other in children.

Adults - diabetes Children - pinworms

What cultural considerations will lactose intolerance effect?

African Americans, Asina Americans, Jewish , and Mediterraneans.

What is the best time for a testicular exam?

After a hot shower because of the relaxation of the testicular.

What are the risk factors for testicular cancer?

Age 20-34, Ethnicity and culture, cryptorchidism, hx. of testicular cancer in other testicle, and family hx.

When do annual mammograms begin?

Age 40.

What are some non modifiable risk factors for breast cancer?

Age, Gender, Genetics (BRCA 1 BRCA2) History of breast cancer family and personal. Breast biopsies, race (white) breast radiation, Menarche before age 12. Menopause after age 55 Breast tissue that is dense or fatty, DES therapy

What contributes to breast healthWhat is the overall contour of the breast determined by?

Age, developmental level, race, ethnicity, work history living conditions, emotional well-being

Presumptive signs of pregnancy?

Amenorrhea Nausea, vomiting, increased salivation breast changes urinary frequency Increased basal body temperature Chadwick's sign skin changes Quickening

Para

Any woman who has given birth more than once

Where should a nurse listen to hear vascular sounds? (7)

Aorta, right renal artery, left renal artery, right illiac artery, left illac artery, right femoral artery, and left femoral artery.

What would palpation of the breasts cause?

Apprehension or embarrassment in patients; nurses will provide reassurance and privacy

Perianal area

Area between legs/urethra, vagina, anus

Invasive breast cancer

Arises from the ducts or lobules, prevalent in women ages 40 to 60

Lumps resulting from an injury

Associated with hematoma

A 70-year-old man is visiting the clinic for difficulty in passing urine. In the history he indicates he has to urinate frequently, especially at night. He has burning when he urinates and has noticed pain in his back. Given this history, what might the nurse expect to find during the physical assessment?

Asymmetric, hard, fixed prostate gland ANS: a Subjective symptoms of carcinoma of the prostate include frequency, nocturia, hematuria, weak stream, hesitancy, pain or burning on urination, and continuous pain in lower back, pelvis, and thighs. Objective symptoms of carcinoma of the prostate include a malignant neoplasm often starts as a single hard nodule on the posterior surface, producing asymmetry and a change in consistency. As it invades normal tissue, multiple hard nodules appear, or the entire gland feels stone hard and fixed.

A patient calls the clinic for instructions before having a Papanicolaou (Pap) smear. The most appropriate instructions from the nurse are: A) "If you are menstruating, please use pads to avoid placing anything into the vagina." B) "Avoid intercourse, inserting anything into the vagina, or douching within 24 hours of your appointment." C) "If you suspect that you have a vaginal infection, please gather a sample of the discharge to bring with you." D) "We would like you to use a mild saline douche before your examination. You may pick this up in our office."

B) "Avoid intercourse, inserting anything into the vagina, or douching within 24 hours of your appointment." When instructing a patient before a Papanicolaou (Pap) smear is obtained, the nurse should follow these guidelines: Do not obtain during the woman's menses or if a heavy infectious discharge is present. Instruct the woman not to douche, have intercourse, or put anything into the vagina within 24 hours before collecting the specimens. Any specimens will be obtained during the visit, not beforehand.

The nurse is watching a new graduate nurse perform auscultation of a patient's abdomen. Which statement by the new graduate shows a correct understanding of the reason auscultation precedes percussion and palpation of the abdomen? A) "We need to determine areas of tenderness before using percussion and palpation." B) "It prevents distortion of bowel sounds that might occur after percussion and palpation." C) "It allows the patient more time to relax and therefore be more comfortable with the physical examination." D) "This prevents distortion of vascular sounds such as bruits and hums that might occur after percussion and palpation."

B) "It prevents distortion of bowel sounds that might occur after percussion and palpation." Auscultation is performed first (after inspection) because percussion and palpation can increase peristalsis, which would give a false interpretation of bowel sounds. REF: Pages: 538-539

During an abdominal assessment, the nurse would consider which of these findings as normal? A) The presence of a bruit in the femoral area B) A tympanic percussion note in the umbilical region C) A palpable spleen between the ninth and eleventh ribs in the left midaxillary line D) A dull percussion note in the left upper quadrant at the midclavicular line

B) A tympanic percussion note in the umbilical region Tympany should predominate in all four quadrants of the abdomen because air in the intestines rises to the surface when the person is supine. Vascular bruits are not usually present. Normally the spleen is not palpable. Dullness would not be found in the area of lung resonance (left upper quadrant at the midclavicular line). REF: Pages: 539-540

A 22-year-old woman comes to the clinic because of a severe sunburn and states, "I was just out in the sun for a couple of minutes." The nurse begins a medication review with her, paying special attention to which medication class? A) Nonsteroidal anti-inflammatory drugs for pain B) Tetracyclines for acne C) Proton pump inhibitors for heartburn D) Thyroid replacement hormone for hypothyroidism

B) Tetracyclines for acne Drugs that may increase sunlight sensitivity and give a burn response include sulfonamides, thiazide diuretics, oral hypoglycemic agents, and tetracycline. Pages: 208-209

The nurse is listening to bowel sounds. Which of these statements is true of bowel sounds? A) They are usually loud, high-pitched, rushing, tinkling sounds. B) They are usually high-pitched, gurgling, irregular sounds. C) They sound like two pieces of leather being rubbed together. D) They originate from the movement of air and fluid through the large intestine.

B) They are usually high-pitched, gurgling, irregular sounds. Bowel sounds are high-pitched, gurgling, cascading sounds that occur irregularly from 5 to 30 times per minute. They originate from the movement of air and fluid through the small intestine. REF: Pages: 539-540

The nurse is assessing a patient who has liver disease for jaundice. Which of these assessment findings is indicative of true jaundice? A) Yellow patches in the outer sclera B) Yellow color of the sclera that extends up to the iris C) Skin that appears yellow when examined under low light D) Yellow deposits on the palms and soles of the feet where jaundice first appears

B) Yellow color of the sclera that extends up to the iris The yellow sclera of jaundice extends up to the edge of the iris. Calluses on the palms and soles of the feet often look yellow but are not classified as jaundice. Do not confuse scleral jaundice with the normal yellow subconjunctival fatty deposits that are common in the outer sclera of dark-skinned persons. Pages: 213-214

A semiconscious woman is brought to the emergency department after she was found on the floor in her kitchen. Her face, nail beds, lips, and oral mucosa are a bright cherry-red color. The nurse suspects that this coloring is due to: A) polycythemia. B) carbon monoxide poisoning. C) carotenemia. D) uremia.

B) carbon monoxide poisoning. A bright cherry-red coloring in the face, upper torso, nail beds, lips, and oral mucosa appears in cases of carbon monoxide poisoning.

The nurse keeps in mind that a thorough skin assessment is very important because the skin holds information about a person's: A) support systems. B) circulatory status. C) socioeconomic status. D) psychological wellness.

B) circulatory status. The skin holds information about the body's circulation, nutritional status, and signs of systemic diseases as well as topical data on the integument itself.

After completing an assessment of a 60-year-old man with a family history of colon cancer, the nurse discusses with him early detection measures for colon cancer. The nurse should mention the need for a(n): A) annual proctoscopy. B) colonoscopy every 10 years. C) fecal test for blood every 6 months. D) digital rectal examinations every 2 years.

B) colonoscopy every 10 years. Early detection measures for colon cancer include a digital rectal examination performed annually after age 50 years, a fecal occult blood test annually after age 50 years, sigmoidoscopy every 5 years or colonoscopy every 10 years after age 50 years; and a PSA blood test annually for men over 50 years old, except black men beginning at age 45 years (American Cancer Society, 2006).

An older patient has been diagnosed with pernicious anemia. The nurse knows that this condition could be related to: A) increased gastric acid secretion. B) decreased gastric acid secretion. C) delayed gastrointestinal emptying time. D) increased gastrointestinal emptying time.

B) decreased gastric acid secretion. Gastric acid secretion decreases with aging, and this may cause pernicious anemia (because it interferes with vitamin B12 absorption), iron deficiency anemia, and malabsorption of calcium. REF: Page: 531

The nurse knows that during an abdominal assessment, deep palpation is used to determine: A) bowel motility. B) enlarged organs. C) superficial tenderness. D) overall impression of skin surface and superficial musculature.

B) enlarged organs. With deep palpation, the nurse should notice the location, size, consistency, and mobility of any palpable organs and the presence of any abnormal enlargement, tenderness, or masses. REF: Pages: 546-547

A patient has hypoactive bowel sounds. The nurse knows that a potential cause of hypoactive bowel sounds is: A) diarrhea. B) peritonitis. C) laxative use. D) gastroenteritis.

B) peritonitis. Diminished or absent bowel sounds signal decreased motility from inflammation as seen with peritonitis, with paralytic ileus after abdominal surgery, or with late bowel obstruction. REF: Page: 561

The structure that secretes a thin, milky alkaline fluid to enhance the viability of sperm is the: A) Cowper's gland. B) prostate gland. C) median sulcus. D) bulbourethral gland.

B) prostate gland. In men, the prostate gland secretes a thin milky alkaline fluid that enhances sperm viability. The Cowper's glands (also known as bulbourethral glands) secrete a clear, viscid mucus. The median sulcus is a groove dividing the lobes of the prostate gland and does not secrete fluid.

The nurse is assessing the abdomen of a pregnant woman who is complaining of having "acid indigestion" all the time. The nurse knows that esophageal reflux during pregnancy can cause: A) diarrhea. B) pyrosis. C) dysphagia. D) constipation.

B) pyrosis.

A 40-year-old woman reports a change in mole size, accompanied by color changes, itching, burning, and bleeding over the past month. She has a dark complexion and has no family history of skin cancer, but she has had many blistering sunburns in the past. The nurse would: A) tell the patient to watch the lesion and report back in 2 months. B) refer the patient because of the suspicion of melanoma on the basis of her symptoms. C) ask additional questions regarding environmental irritants that may have caused this condition. D) suspect that this is a compound nevus, which is very common in young to middle-aged adults.

B) refer the patient because of the suspicion of melanoma on the basis of her symptoms. The ABCD danger signs of melanoma are asymmetry, border irregularity, color variation, and diameter. In addition, individuals may report a change in size, development of itching, burning, bleeding, or a new-pigmented lesion. Any of these signs raise suspicion of malignant melanoma and warrant immediate referral. Pages: 212-213

The abdomen normally moves when a person breathes until the age of ____ years. A. 4 B. 7 C. 14 D. 75

B. 7

No uterine bleeding for 6 months or longer A. Menopause B. Amenorrhea C. Polymenorrhea D. Oligomenorrhea

B. Amenorrhea Menopause no uterine bleeding for 12 months Polymenorrhea - uterine bleeding occurring at regular intervals of less than 21 days Oligomenorrhea - uterine bleeding occurring at intervals of 35 days to 6 months

Before palpating the abdomen during an assessment, the nurse should perform which of the following actions? A. Put on clean gloves B. Auscultate bowel sounds C. Elevate the client's head D. Percuss all four quadrant

B. Auscultate bowel sounds Rationale: Before palpating the abdomen, the nurse should first listen to all four quadrants for bowel sounds. Palpating and percussing the abdomen first can alter bowel sounds, making the assessment less reliable. It is unnecessary to use sterile gloves unless there is an open wound or lesion. The client should be in a supine position if tolerated by the medical condition.

Cartilage is which of the following? A. Acellular B. Avascular C. Asynchronous D. Atherosclerotic

B. Avascular

Mrs. Jones is a 32-year-old patient who is pregnant and comes to the clinic for a routine health assessment. As part of your patient education, you tell Mrs. Jones that she may feel some discomfort during the third trimester of her pregnancy. What kind of discomfort do you tell her to expect? A. Stiffer joints B. Back pain C. Osteoporosis D. Kyphosis

B. Back pain

Vaginal lubrication during intercourse is produced by: A. Skene's glands. B. Bartholin's glands. C. sebaceous glands. D. None of the above

B. Bartholin's glands.

The spinous processes that are prominent at the base of the neck are: A. T7 and T8. B. C7 and T1. C. T12 and L1. D. L3 and L4.

B. C7 and T1.

Patient sits with arms hanging free. Place your palm of your right hand at patient's right clavicle at the sternum. Sweep downward from the clavicle to the nipple. Repeat until you have covered entire right chest then repeat on left. this is called the _____ technique A. Vertical strip B. Chest wall sweep C. Bimanual digital palpitation

B. Chest wall sweep

The secondary lesion of syphilis is called? A. Syphilitic chancre B. Condyloma latum C. genital herpes

B. Condyloma latum Chancre - primary syphilis, red canker sore on vagina

The nurse selects which of the following pieces of equipment to test for a cremasteric reflex? A. Blood pressure cuff B. Cotton applicator C. Sharp end of a needle D. Percussion hammer

B. Cotton applicator Rationale: The cremasteric reflex is tested in men only. The nurse uses a cotton-tipped applicator or other smooth object to stimulate the inner thigh. The normal reaction is contraction of the cremaster muscle and elevation of the testicle on the side stimulated.

Mrs. Baker comes to your office with her 2-year-old son. On examination you note that the urinary meatus appears on the upper surface of the penis. Which of the following conditions best describes these clinical findings? A. Varicocele B. Epispadias C. Hydrocele D. Balanitis

B. Epispadias

Benign breast lump occurs as inflammatory response to local injury is? A. Duct Ectasia B. Fat necrosis C. Galactorrhea D. Paget disease

B. Fat necrosis Duct ectasia - benign condition of the subareolar ducts that produces nipple discharge Galactorrhea - lactation not associated with childbearing Paget - surface manifestation of underlying ductal carcinoma

Assessing an older adult patient's ability to engage in activities of daily living is a part of which assessment? A. Developmental B. Functional C. Cultural D. Screening

B. Functional

Which of the following would you expect to see in an individual who demonstrates genu valgum? A. Bowleg B. Knock-knee C. Pigeon-toed D. Clubfoot

B. Knock-knee

Mr. Bowers is a 39-year-old patient who presents to the clinic, and you examine the abdomen. The right upper quadrant of the abdomen contains which of the following organs? A. Spleen B. Liver C. Cecum D. Left ureter

B. Liver

A pregnant woman is most likely to demonstrate which of the following alterations in her posture, which is directly related to her pregnancy? A. Kyphosis B. Lordosis C. Scoliosis D. List

B. Lordosis

Which of the following complaints are the most common musculoskeletal concerns that prompt an individual to seek health care? A. Joint pain and myalgia B. Loss of function and joint pain C. Neuralgia and loss of function D. Neuralgia and myalgia

B. Loss of function and joint pain

The nurse would document which of the following in the medical record as objective data obtained during client assessment? A. Detailed description of pain in an extremity B. Loss of hair on lower legs bilateraly C. Report of numbness of the right hand D. Description of scalp itching, which occurs each evening

B. Loss of hair on lower legs bilateral Rationale: Subjective data is only apparent to the person affected and can be described or verified only by that person. Itching, pain, and feelings of worry are examples. In addition, the client's sensations, feelings, values, beliefs, and attitudes are regarded as subjective. Objective data is detectable by an observer or can be measured against accepted standards. Objective data can be seen, heard, felt, or smelled during physical examination.

Which of the following conditions would best utilize the assessment technique of transilluminatation? A. Palpating for inguinal hernia B. Observing for hydrocele C. Observing for phimosis D. Palpating for tender testes

B. Observing for hydrocele

Mrs. Landers is a 53-year-old patient with rheumatoid arthritis. On examination, which of the following would you expect to find due to this type of arthritis? A. Dislocation B. Painful motion C. Increased ROM D. Muscle spasms

B. Painful motion

Which of the following muscles may be congenitally absent in certain individuals? A. Palmaris shortus B. Palmaris longus C. Peroneus secondus D. Synovin membranous

B. Palmaris longus

An acute bacterial infection that presents with pain, urination sexual dysfunction, fever, chills and shakes can indicate? A. Prostatis B. Benign Prostatic Hypertrophy C. Polyps D. Prostatic carcinoma

B. Prostatis BPH - urinary obstruction, hesitancy, decreased force and caliber of stream, dribbling, incomplete emptying of the bladder, frequency, urgency, nocturia, and dysuria Polyps - Asymptomatic, rectal bleeding prostatic carcinoma - asymptomatic early then urinary obstruction can occur

To adequately inspect the external ear canal of an adult client, the nurse should do which of the following prior to inserting the otoscope? A. Require that all earrings be removed for safety purposes B. Pull the pinna up and back C. Use a cotton-tipped applicator to remove the cerumen D. Have the client lie down to promote comfort

B. Pull the pinna up and back Rationale: In order to facilitate visualization of the ear canal and tympanic membrane, the pinna should be pulled up and back for an adult client. If earrings are attached to the lobe, there should not be a safety issue; however, they may be removed if they are large in size or are causing the client discomfort during the examination. The nurse should not remove cerumen with an applicator because of the risk of pushing it further into the canal or rupturing the tympanic membrane. Generally, the ear and eye physical assessment are performed with the client sitting upright.

What type of pain is indicative of local disease? A. Anus B. Rectal C. Prostate

B. Rectal

A client who is alert and responsive was admitted directly from the physician's office with a diagnosis of "rule out acute myocardial infarction." Of the following alterations found on the initial assessment, which is of greatest concern to the nurse? A. Blood pressure supine is 138/76 B. Respirations are 28 and labored C. Temperature is 99.8 F D. There are infrequent missed apical beats

B. Respirations are 28 and labored Rationale: Using the principles of the ABCs (airway, breathing, and circulation), an alteration in respiration is always a primary concern. A disturbance in normal ventilation (rate 16-20) is occurring secondary to the medical diagnosis of myocardial infarction. The blood pressure remains in acceptable range, and the slight temperature elevation is likely related to the overall inflammatory response of the body. Infrequent abnormalities of cardiac rhythm are common and should be of concern when appearing frequently or with longer duration.

Which of the following terms describes "compact, desiccated flakes of skin from shedding of dead skin cells"? A. Crust B. Scale C. Dandruff D. Plaque

B. Scale

Mr. Sanchez is a 48-year-old patient who presents for a routine health assessment, and you examine his abdomen. The left lower quadrant contains which of the following organs? A. Pancreas B. Sigmoid colon C. Kidney D. Gallbladder

B. Sigmoid colon

When assessing a client's mental status which of the following would be key areas to include? Select all that apply. A. The client's level of attained education B. The client's appearance, facial expressions, mood, and affect C. The client's gait and balance D. The client's judgment and recent (short-term) memory E. The presence or absence of suicidal thoughts/ideation

B. The client's appearance, facial expressions, mood, and affect D. The client's judgment and recent (short-term) memory E. The presence or absence of suicidal thoughts/ideation Rationale: Four key areas of functioning to be addressed in the mental status exam are appearance, behavior (option 2), and cognition and thought processes (options 4 and 5). Educational level is unrelated to mental status. Gait and balance are assessed as part of the neurological exam.

A nurse has conducted a physical examination on a client and notes that the thyroid gland is normal. How would the nurse document this in the medical record? A. Thyroid slightly deviated to left no nodules palpated B. Thyroid Midline, smooth with no nodules palpated C. Thyroid midline with parathyroid glands easily palpated bilaterally D. Thyroid slightly deviated to the right, with pea-sized nodules at the base

B. Thyroid Midline, smooth with no nodules palpated Rationale: The thyroid should be midline, smooth, and free of nodules. The parathyroid glands are too small to be manually palpated. Any other assessment finding is considered an abnormality.

When taking a health history, the nurse should focus on which of the following? A. Completing the process in a timely manner B. Using therapeutic communication skills to identify the client's healthcare status C. Documenting objective data using the client's own words D. Attempting to have no interruptions from family members who are present

B. Using therapeutic communication skills to identify the client's healthcare status Rationale: A nurse must focus on using therapeutic communication skills, which will enhance the interview. In addition, the ability to interpret nonverbal communication is paramount in achieving the goals of history taking. The history should be done at a comfortable pace and should not be rushed. The nurse must document carefully, but it is subjective data, not objective, that is recorded using the client's own words. The client can have family in the room if they do not distract the client or nurse in the interview; in many instances family members are helpful in the process.

Pyrosis is: A. an inflammation of the peritoneum. B. a burning sensation in the upper abdomen. C. a congenital narrowing of the pyloric sphincter. D. an abnormally sunken abdominal wall.

B. a burning sensation in the upper abdomen.

A red, round, superficial ulcer with serous discharge, which is a possible sign of syphilis, is called: A. cystitis. B. a chancre. C. hypospadias. D. phimosis.

B. a chancre.

The spleen is: A. a soft, lobulated gland behind the stomach. B. a soft mass of lymphatic tissue on the posterolateral wall. C. a bean-shaped, retroperitoneal gland. D. None of the above.

B. a soft mass of lymphatic tissue on the posterolateral wall.

Splenomegaly is defined as a(n): A. outflow obstruction of the stomach. B. abnormal enlargement of the spleen. C. enlargement of the liver. D. sunken abdominal wall.

B. abnormal enlargement of the spleen.

A functional assessment is primarily concerned with gathering information related to: A. range of motion. B. activities of daily living. C. transcultural variations. D. developmental capabilities.

B. activities of daily living.

Phimosis is: A. undescended testes. B. an advanced and fixed foreskin too tight to retract over the glans. C. hard, subcutaneous plaques associated with painful bending of the erect penis. D. a prolonged, painful erection of the penis without sexual desire.

B. an advanced and fixed foreskin too tight to retract over the glans.

The term used to describe the shape of a lesion as being circular is: A. scaphoid. B. annular. C. confluent. D. zosteriform.

B. annular.

Nocturia is: A. an advanced and fixed foreskin too tight to retract over the glans. B. awakening in the night with a need to urinate. C. a circumscribed collection of serous fluid in the tunica vaginalis surrounding the testes. D. a prolonged, painful erection of the penis without sexual desire.

B. awakening in the night with a need to urinate.

Hematuria is a term used for: A. bloody discharge. B. blood in the urine. C. bleeding after intercourse. D. bloody vaginal discharge.

B. blood in the urine.

Fluid in the knee may be confirmed by performing: A. Tinel's sign. B. bulge sign. C. ROM. D. McMurray's test.

B. bulge sign.

Mrs. Hoist is a 26-year-old patient who reports to the health clinic with complaints of painful intercourse. A synonym for painful intercourse is: A. dysmenorrhea. B. dyspareunia. C. dysuria. D. None of the above

B. dyspareunia.

An STD characterized by clusters of small, painful vesicles caused by a virus is: A. chancre. B. herpes genitalis. C. orchitis. D. cystitis.

B. herpes genitalis.

The rugae: A. is a corpus spongiosum cone of erectile tissue. B. is folds of thin skin of the scrotal wall. C. controls the size of the scrotum. D. is an acute inflammation of the testes.

B. is folds of thin skin of the scrotal wall.

Mrs. Jones is a 65-year-old patient who presents with complaints of skin spots during a dermatology follow-up. As the health care provider, you note some hyperpigmentation in this aging adult. On examination, you would expect to see: A. café au lait spots and hemangioma. B. keratosis and lentigines. C. linea nigra and chloasma. D. None of the above.

B. keratosis and lentigines.

Cessation of menses is known as: A. menarche. B. menopause. C. salpingitis. D. adnexa.

B. menopause.

Borborygmi is/are: A. a midline longitudinal ridge in the abdomen. B. normal hyperperistaltic bowel sounds. C. an inflammation of the peritoneum. D. obesity.

B. normal hyperperistaltic bowel sounds.

A fecal mass in the rectum accompanying diarrhea suggestions? A. Hirschsprung B. Overflow diarrhea C. Sexual abuse

B. overflow diarrhea Hirshsprung - a consistently empty rectum in the presence of constipation is a clue Sexual abuse - presence of bruises around the anus, scars, anal tears and anal dilation

Finding mild tenderness is normal when: A. palpating the kidneys. B. palpating the sigmoid colon. C. palpating the uterus. D. None of the above.

B. palpating the sigmoid colon.

A medical emergency due to a retracted and fixed foreskin behind the glans is called: A. Peyronie disease. B. paraphimosis. C. phimosis. D. cryptorchidism.

B. paraphimosis.

Ms. McMahon is a 33-year-old patient who presents for a routine yearly health assessment. On examination you note a bright red pedunculated growth emerging from the os. This is a: A. caruncle. B. polyp. C. rectouterine pouch. D. salpingitis.

B. polyp.

The name for the hood or flap of skin over the glans is: A. varicocele. B. prepuce. C. genitalis. D. progenitalis.

B. prepuce.

Mrs. Harris is a 45-year-old patient who comes to the ambulatory health center for a yearly examination. On examination you note a cystocele. This is a: A. prolapse of the rectum into the urinary bladder. B. prolapse of the bladder into the vagina. C. membranous fold of tissue protruding from the cervical os. D. prolapse of the vagina into the bladder

B. prolapse of the bladder into the vagina.

Inflammation of the fallopian tubes is known as: A. vaginitis. B. salpingitis. C. cystocele. D. dyspareunia.

B. salpingitis.

A caruncle is a(n): A. vestibular gland located on either side of the vaginal orifice. B. small, red mass protruding from the urethral meatus. C. aberrant growth of endometrial tissue. D. hard, painless nodule in the uterine wall.

B. small, red mass protruding from the urethral meatus.

A retention cyst in the epididymis filled with milky fluid containing sperm is called a: A. varicocele. B. spermatocele. C. Peyronie's disease. D. prepuce.

B. spermatocele.

Mrs. Painter is a 62-year-old patient who comes to the clinic for a follow-up health assessment for complaints of joint tenderness. On examination you note a joint that has a boggy, soft feel to palpation. This is generally indicative of: A. rheumatoid arthritis. B. synovial thickening. C. synovial subluxation. D. crepitation.

B. synovial thickening.

Synovial joints are freely movable because: A. the ligaments holding the joint together are more elastic. B. the bones that form the joint are separated from each other and enclosed in a fluid-filled cavity. C. the muscles attached to the joint are shorter, thus giving them the ability to move in more directions. D. they are composed of cartilage, which is very soft and cushiony.

B. the bones that form the joint are separated from each other and enclosed in a fluid-filled cavity.

The cremaster is: A. a sperm storage site. B. the muscle that controls the size of the scrotum. C. a muscular duct continuous with the epididymis. D. a shoulder where the glans joins the shaft.

B. the muscle that controls the size of the scrotum.

The spermatic cord is most commonly described as: A. combining the vas deferens and seminal vesicle. B. the vas deferens approximated with other vessels. C. a muscular duct continuous with the epididymis. D. a narrow tunnel superior to the inguinal ligament.

B. the vas deferens approximated with other vessels.

Adnexa is/are: A. an absence of menstruation. B. uterine accessory organs. C. a membranous fold of tissue partly closing the vaginal orifice. D. painful intercourse.

B. uterine accessory organs.

Inflammation of the vagina is known as: A. salpingitis. B. vaginitis. C. cystocele. D. dyspareunia.

B. vaginitis.

An elevated cavity containing free fluid that is less than 1 cm in diameter is a(n): A. wheal. B. vesicle. C. bulla. D. edema.

B. vesicle.

A term for the female external genitalia is: A. vagina. B. vulva. C. clitoris. D. hymen.

B. vulva.

During an annual physical exam, a 43-year-old patient states that she doesn't perform monthly breast self-examinations (BSE). She tells the nurse that she believes that mammograms "do a much better job than I ever could to find a lump." The nurse should explain to her that:

BSEs may detect lumps that appear between mammograms. ANS:A Pages: 389-391. The monthly practice of breast self-examination, along with clinical breast examination and mammograms are complementary screening measures. Mammography can reveal cancers too small to be detected by the woman or by the most experienced examiner. However, interval lumps may become palpable between mammograms.

Bruits are heard better with the ....?

Bell

Ductal ectasia

Benign breast disease characterized by inflammation and dilation involving one or multiple subareolar ducts

Methylxanthines (caffeine) may cause

Benign breast disease such as fibrocystic changes

Intraductal papilloma

Benign tumor within 1 to 2 cm of areolar edge commonly in women 40 to 60 years old

What pattern is recommended when palpating pendulous breasts?

Bimanual palpation technique is used

Color of nipple discharge indicating pathologic condition

Bloody or blood-tinged

What controls cranial nerves 3-12 and lies below the diencephalon?

Brain Stem

What does the CNS incorporate?

Brain, Brain stem, and Cerebellum.

What is BRCA

Breast Cancer Gene

Where does the colostrum come from?

Breast Feeding.

Only Inspection

Breast assessment of infants and children

Conditions that may cause lumps or masses

Breast cancer, fibroadenoma, and fibrocystic changes

Peau d'orange appearance is highly suggestive of which of the following? A. breast cancer B. gynecomastia C. papillomas D. colostrum

Breast cancer.

What could dimpling of the skin of the breast suggest?

Breast cancer/lump

Most common initial symptom of breast cancer in males

Breast mass

Discrete, Poorly Defined Borders

Breast mass borders characteristics

Hard, Soft, Firm, Rubbery?

Breast mass consistency characteristics

Position on a Clock

Breast mass location characteristics

Does the Lump Move, Fixed to Underlying Skin or Chest Wall

Breast mass mobility characteristics

Dimpling of Tissue Around Mass

Breast mass retractions characteristics

Oval, Round, Lobed, Irregular Shape?

Breast mass shape characteristics

Width, Length, Thickness

Breast mass size characteristics

Tender During Palpation

Breast mass tenderness characteristics

Most come related symptom of breast

Breast pain

What are some common signs and symptoms related to the breasts and axillae?

Breast pain, lumps, discharge, rash, swelling, and trauma

Axillary tail

Breast tissue extending superiolaterally into the axilla

What happens to breasts in the older adult

Breasts are less firm, more pendulous, ligaments relax, smaller nipples (lose erectile ability)

Mastitis

Bresat inflammation caused by bacterial infection, frequenctly in lactating women

Women with breast cancer may report

Burning or pulling sensation and vague pain

Inflammatory tract that runs from the anus or rectum and opens onto the surface of the perianal skin or other tissue? A. Polyps B. Pruritis ani C. Anal fistula D. Pilonidal cyst

C anal fistula Polyps - occur anywhere in the intestinal tract may be malignant or benign Pruritis ani - funig in adults (common in children) - caused by parasites Pilonidal cyst - loose hairs penetrate the skin in the sacrococcygeal area becomes infected and needs draining surgically

During the interview a patient reveals that she has some vaginal discharge. She is worried that it may be a sexually transmitted infection. The nurse's most appropriate response to this would be: A) "Oh, don't worry. Some cyclic vaginal discharge is normal." B) "Have you been engaging in unprotected sexual intercourse?" C) "I'd like some information about the discharge. What color is it?" D) "Have you had any urinary incontinence associated with the discharge?"

C) "I'd like some information about the discharge. What color is it?" Ask questions that help the patient reveal more information about her symptoms in a nonthreatening manner. Assess vaginal discharge further by asking about the amount, color, and odor. Normal vaginal discharge is small, clear or cloudy, and always nonirritating.

Which statement would be most appropriate when the nurse is introducing the topic of sexual relationships during an interview? A) "Now it is time to talk about your sexual history. When did you first have intercourse?" B) "Women often feel dissatisfied with their sexual relationships. Would it be okay to discuss this now?" C) "Often women have questions about their sexual relationship and how it affects their health. Do you have any questions?" D) "Most women your age have had more than one sexual partner. How many would you say you have had?"

C) "Often women have questions about their sexual relationship and how it affects their health. Do you have any questions?" The nurse should begin with an open-ended question to assess individual needs. The nurse should include appropriate questions as a routine part of the history, because doing so communicates that the nurse accepts the individual's sexual activity and believes it is important. The nurse's comfort with discussion prompts the patient's interest and possibly relief that the topic has been introduced. This establishes a database for comparison with any future sexual activities and provides an opportunity to screen sexual problems.

A patient has had three pregnancies and two live births. The nurse would record this information as gravida _____, para _____, AB _____. A) 2; 2; 1 B) 3; 2; 0 C) 3; 2; 1 D) 3; 3; 1

C) 3; 2; 1 Gravida is number of pregnancies. Para is number of births. Abortions are interrupted pregnancies, including elective abortions and spontaneous miscarriages.

black patient is in the intensive care unit because of impending shock after an accident. The nurse would expect to find what characteristics in this patient's skin? A) Ruddy blue B) Generalized pallor C) Ashen, gray, or dull D) Patchy areas of pallor

C) Ashen, gray, or dull Pallor due to shock (decreased perfusion and vasoconstriction) in black-skinned people will cause the skin to appear ashen, gray, or dull. See Table 12-2.

14. The nurse is explaining the mechanism of the growth of long bones to a mother of a toddler. Where does lengthening of the bones occur? A) Bursa B) Calcaneus C) Epiphyses D) Tuberosities

C) Epiphyses Lengthening occurs at the epiphyses, or growth plates. The other options are not correct. Page: 573

16. A patient is complaining of pain in his joints that is worse in the morning, is better after he has moved around for awhile, and then gets worse again if he sits for long periods of time. The nurse should assess for other signs of what problem? A) Tendinitis B) Osteoarthritis C) Rheumatoid arthritis D) Intermittent claudication

C) Rheumatoid arthritis Rheumatoid arthritis is worse in the morning when arising. Movement increases most joint pain, except in rheumatoid arthritis, in which movement decreases pain. The other options are not correct. Page 574-575

The nurse has discovered decreased skin turgor in a patient and knows that this is an expected finding in which of these conditions? A) Severe obesity B) Childhood growth spurts C) Severe dehydration D) Connective tissue disorders such as scleroderma

C) Severe dehydration Decreased skin turgor is associated with severe dehydration or extreme weight loss. Page 215

A newborn infant is in the clinic for a well-baby check. The nurse observes the infant for the possibility of fluid loss because of which of these factors? A) Subcutaneous fat deposits are high in the newborn. B) Sebaceous glands are overproductive in the newborn. C) The newborn's skin is more permeable than that of the adult. D) The amount of vernix caseosa rises dramatically in the newborn.

C) The newborn's skin is more permeable than that of the adult. The newborn's skin is thin, smooth, and elastic and is relatively more permeable than that of the adult, so the infant is at greater risk for fluid loss. The subcutaneous layer in the infant is inefficient, not thick, and the sebaceous glands are present but decrease in size and production. Vernix caseosa is not produced after birth.

11. A patient is being assessed for range of joint movement. The nurse asks him to move his arm in toward the center of his body. This movement is called: A) flexion. B) abduction. C) adduction. D) extension.

C) adduction. Moving a limb toward the midline of the body is called adduction; abduction is moving a limb away from the midline of the body. Flexion is bending a limb at a joint; extension is straightening a limb at a joint. Pages: 566-567

A patient is having difficulty in swallowing medications and food. The nurse would document that this patient has: A) aphasia. B) dysphasia. C) dysphagia. D) anorexia.

C) dysphagia. Dysphagia is a condition that occurs with disorders of the throat or esophagus and results in difficulty swallowing. Aphasia and dysphasia are speech disorders. Anorexia is a loss of appetite. REF: Pages: 532-533

17. The nurse suspects that a patient has carpal tunnel syndrome and wants to perform the Phalen's test. To perform this test, the nurse should instruct the patient to: A) dorsiflex the foot. B) plantarflex the foot. C) hold both hands back to back while flexing the wrists 90 degrees for 60 seconds. D) hyperextend the wrists with the palmar surface of both hands touching and wait for 60 seconds.

C) hold both hands back to back while flexing the wrists 90 degrees for 60 seconds. For the Phalen's test, the nurse should ask the person to hold both hands back to back while flexing the wrists 90 degrees. Acute flexion of the wrist for 60 seconds produces no symptoms in the normal hand. The Phalen's test reproduces numbness and burning in a person with carpal tunnel syndrome. The other actions are not correct for testing for carpal tunnel syndrome. Page: 587

The nurse notices that a patient has had a pale, yellow, greasy stool, or steatorrhea, and recalls that this is caused by: A) occult bleeding. B) absent bile pigment. C) increased fat content. D) ingestion of bismuth preparations.

C) increased fat content. Steatorrhea (pale, yellow, greasy stool) is caused by increased fat content in the stools, as in malabsorption syndrome. Occult bleeding and ingestion of bismuth products cause black stool, and absent bile pigment causes gray, tan stool.

A patient is complaining of a sharp pain along the costovertebral angles. The nurse knows that this symptom is most often indicative of: A) ovary infection. B) liver enlargement. C) kidney inflammation. D) spleen enlargement.

C) kidney inflammation. Sharp pain along the costovertebral angles occurs with inflammation of the kidney or paranephric area. The other options are not correct. REF: Pages: 542-543

While examining a patient, the nurse observes abdominal pulsations between the xiphoid and umbilicus. The nurse would suspect that these are: A) pulsations of the renal arteries. B) pulsations of the inferior vena cava. C) normal abdominal aortic pulsations. D) increased peristalsis from a bowel obstruction.

C) normal abdominal aortic pulsations. Normally, one may see the pulsations from the aorta beneath the skin in the epigastric area, particularly in thin persons with good muscle wall relaxation. REF: Pages: 538-539

18. The nurse is assessing a 1-week-old infant and is testing his muscle strength. The nurse lifts the infant with hands under the axillae and notices that the infant starts to "slip" between the hands. The nurse should: A) suspect a fractured clavicle. B) suspect that the infant may have a deformity of the spine. C) suspect that the infant may have weakness of the shoulder muscles. D) consider this a normal finding because the musculature of an infant this age is undeveloped.

C) suspect that the infant may have weakness of the shoulder muscles. An infant who starts to "slip" between the nurse's hands shows weakness of the shoulder muscles. An infant with normal muscle strength wedges securely between the nurse's hands. The other responses are not correct. Pages: 600-601

A physician has diagnosed a patient with purpura. After leaving the room, a nursing student asks the nurse what the physician saw that led to that diagnosis. The nurse should say, "The physician is referring to: A) that blue dilation of blood vessels in a star-shaped linear pattern on the legs." B) that fiery red, star-shaped marking on the cheek that has a solid circular center." C) that confluent and extensive patch of petechiae and ecchymoses on the feet." D) those tiny little areas of hemorrhage that are less than 2 mm, round, discrete, and dark red in color."

C) that confluent and extensive patch of petechiae and ecchymoses on the feet." Purpura is a confluent and extensive patch of petechiae and ecchymoses and a flat macular hemorrhage seen in generalized disorders such as thrombocytopenia and scurvy. The blue dilation of blood vessels in a star-shaped linear pattern on the legs describes a venous lake. The fiery red, star-shaped marking on the cheek that has a solid circular center describes a spider or star angioma. The tiny little areas of hemorrhage that are less than 2 mm, round, discrete, and dark red in color describes petechiae. Pages: 239-240

The nurse is performing percussion during an abdominal assessment. Percussion notes heard during the abdominal assessment may include: A) flatness, resonance, and dullness. B) resonance, dullness, and tympany. C) tympany, hyperresonance, and dullness. D) resonance, hyperresonance, and flatness.

C) tympany, hyperresonance, and dullness. Percussion notes normally heard during the abdominal assessment may include tympany, which should predominate because air in the intestines rises to the surface when the person is supine; hyperresonance, which may be present with gaseous distention; and dullness, which may be found over a distended bladder, adipose tissue, fluid, or a mass. REF: Pages: 539-540

An increase in fluid within a bursa is manifested by which of the following characteristics? A. A decrease in the expected ROM of the joint B. Crepitus heard when putting the joint through ROM C. A bulge that appears on the opposite side of the joint after pushing on the other side D. Subluxation of the joint after flexing and extending the joint

C. A bulge that appears on the opposite side of the joint after pushing on the other side

John, a baby boy, is admitted to the transition nursery for a comprehensive physical, medications, and a bath prior to being transferred to the postpartum floor. Before you conduct the physical assessment, you review common skin variations of the newborn. Which of the following conditions requires further evaluation by the in-house neonatal nurse practitioner? A. Cutis marmorata, which is a mottling of the trunk and extremities B. Harlequin pattern, a condition that causes one side of the body to appear deep red and the other side pale, with a distinct demarcation down the midline C. A grouping of café au lait spots D. Erythema toxicum, a condition that causes punctuate macular-papular rash on cheeks, truck, back, and buttocks

C. A grouping of café au lait spots

An individual with functional scoliosis will demonstrate which of the following? A. A lateral spinal curvature that remains visible in the standing and bending position B. A lateral spinal curvature that remains at less than 20 degrees C. A lateral spinal curvature that is visible in the standing position but disappears when the individual bends over D. A lateral spinal curvature that affects either the thoracic area or the lumbar area but not both

C. A lateral spinal curvature that is visible in the standing position but disappears when the individual bends over

Casey Galen, a student nurse, conducts a dermatology in-service for nurses and students assigned to a medical surgical floor at the local hospital. Casey covers skin changes indicative of prolonged sun exposure and shows slides of precancerous lesions. Which of the following is descriptive of a precancerous keratotic lesion? A. Raised, thickened areas of pigmentation, which look crusted, scaly, and warty B. A raised, thickened, crusted area of dark pigmentation that looks "stuck on" and greasy C. A raised, rough plaque of red-tan pigmentation with a silver-white scale D. A raised, thickened, dry area of decreased pigmentation with a tightly packed set of papules

C. A raised, rough plaque of red-tan pigmentation with a silver-white scale

Functions of the skin include: A. protection, prevention, perception, and production of vitamin D. B. temperature regulation, communication, and identification. C. All of the above. D. None of the above.

C. All of the above.

A herniated nucleus pulposus will produce which of the following results when an individual performs a straight leg-raising test? A. Numbness and tingling in the foot and ankle B. Limited ROM of the hip C. Back and leg pain D. Clicking sound when the knee is extended and externally rotated

C. Back and leg pain

In order to examine the ocular mobility of a client who recently experienced a stroke, the nurse should examine which of the following cranial nerves? Select all that apply. A. Cranial Nerves I and VII B. Cranial Nerves II and V C. Cranial Nerves III and IV D. Cranial Nerve VI E. Cranial Nerve IX

C. Cranial Nerves III and IV D. Cranial Nerve VI Rationale: Evaluation of ocular motility provides information about the extraocular muscles; the orbit; cranial nerves III, IV, and VI; their brain stem connections; and the cerebral cortex. Cranial nerves I, VII, and IX, respectively, assess smell, facial movement, swallowing, and the tongue.

Which of the following statements about sweat glands is correct? A. Sweat glands are located everywhere on the skin except the palms and soles. B. Sweat glands are eccrine glands that produce a thick, milky secretion and open into the hair follicles. C. Eccrine glands mature by the time an infant is 2 months old. D. All of the above

C. Eccrine glands mature by the time an infant is 2 months old.

Fluid within the bursa that results in synovial thickening is also described by which of the following terms? A. Subluxation B. Ankylosis C. Effusion D. Effleurage

C. Effusion

Mrs. Kinder brings her infant son in for a health assessment. On examination, you note polydactyly. An infant with polydactyly would be expected to manifest which of the following? A. Digits that are webbed together B. Digits that are nonfunctional C. Extra digits D. Digits with extra joints

C. Extra digits

Mrs. Bauer comes to your office with her 12-year-old daughter with a complaint of a lump in her groin. On examination you detect a hernia. Which of the following types of hernias is more common in females? A. Direct hernia B. Indirect hernia C. Femoral hernia D. Sliding hernia

C. Femoral hernia

Bilateral breast mass/es that is single or multiple round or discoid, firm, rubbery, mobile without retractions and usually nontender and well delineated with no change during menses and occurs between 15 to 55 years are what form of breast mass? A. Cancer B. Fibrocystic C. Fibroadenoma

C. Fibroadenoma Cancer: age 30-80, usually unilateral, single masses that is irregular or stellate, hard, stonelike, fixed and retractions are often present. Usually nontender and poorly delineated irregular and no associated with menses. Firbrocystic: 20-49 years, usually bilateral, multiple or single mass, round, soft to firm, tense, mobile, no retractions, usually tender and well delineated. Associated with menses

Painful fluid-filled breast cysts are caused by ______ in the older adult? A Menopause B. Caffeine C. Hormone replacement therapy D. Age

C. Hormone replacement therapy

Which is true about a newborn's umbilical cord? A. It contains two veins. B. It contains one artery. C. It contains two arteries. D. None of the above.

C. It contains two arteries.

In which position should the nurse place the client to best inspect and palpate the Bartholin glands? A. Semi-Fowler's B. Sim's C. Lithotomy D. Prone

C. Lithotomy Rationale: The Bartholin glands are part of the female anatomy located on the posterior aspect of the vaginal orifice. Therefore, if the medical condition allows, having the client in a lithotomy position (on her back, knees flexed, legs apart, with feet supported on a surface or in stirrups) will provide the best opportunity for examination. The other responses do not allow for assessment of the female genitalia.

The breast is divided into five segments: all EXCEPT? A. Upper inner quadrant B. Upper outer quadrant C. Pectoral area D. Lower inner quadrant E. Lower outer quadrant F. Tail of spence

C. Pectoral is a muscle and not a quadrant of the breast.

Mr. Tucker is a 28-year-old patient who presents to your office with a concern that during an erection his penis is bent and painful. This clinical finding is caused by nontender, hard plaques on the surface of the penis known as: A. paraphimosis. B. phimosis. C. Peyronie disease. D. spermatocele.

C. Peyronie disease.

Mrs. Moyer comes to the ambulatory health center for a routine assessment. After her examination, you suspect rheumatoid arthritis. Which of the following characteristics differentiates rheumatoid arthritis from other MS conditions? A. Stiffness associated with RA occurs mostly at night. B. Pain associated with RA is worse at night. C. RA involves symmetric joints. D. Activity increases pain in the RA-affected joint.

C. RA involves symmetric joints.

The divisions of the spinal vertebrae include which of the following? A. Cervical, thoracic, and scaphoid B. Scapular, clavicular, and lumbar C. Thoracic, lumbar, and coccygeal D. Cervical, lumbar, and iliac

C. Thoracic, lumbar, and coccygeal

Today is your last day of an emergency room (ER) rotation. A mother brings her 3-year-old child to the ER to be examined after a fall. The child is dressed in clothing that, although clean, is worn and wrinkled. The child sits quietly without fidgeting, arms in her lap, staring at the floor; she remains silent when you try to engage her. As her mother explains the circumstances of the fall and the resulting injuries, you wonder about the possibility of physical abuse. An x-ray is ordered to rule out fracture of the left arm. Which of the following physical findings might suggest abuse? A. An x-ray depicting a simple fracture of the left arm B. A skinned knee with torn pants midway down same leg C. Three bite marks on the right upper arm/shoulder area D. None of the above

C. Three bite marks on the right upper arm/shoulder area

A strawberry red cervix with a pooling of yellow discharge is a sign of? A. Gonorrhea B. Chlamydia C. Trichmoniasis D. Herpes Simplex

C. Trichmoniasis

Mr. Turner is a 43-year-old patient who presents for a yearly physical examination. On exam you note balanitis associated with phimosis. Which individual is this most likely to occur in? A. Newborn male infants B. Diabetic men C. Uncircumcised men D. Men exposed to radiation

C. Uncircumcised men

Which of the following refers to the four layers of large, flat abdominal muscles? A. Linea alba B. Rectus abdominus C. Ventral abdominal wall D. None of the above

C. Ventral abdominal wall

Priapism is: A. a meatus opening on the dorsal side of the glans or shaft. B. an advanced and fixed foreskin too tight to retract over the glans. C. a prolonged, painful erection of the penis without sexual desire. D. a circumscribed collection of serous fluid in the tunica vaginalis surrounding the testes.

C. a prolonged, painful erection of the penis without sexual desire.

Increased deposits of subcutaneous fat on the abdomen occur in: A. toddlers. B. teenagers. C. aging adults. D. pregnant women.

C. aging adults.

A term for dislodging the thick cervical mucous plug at the end of pregnancy is: A. placenta. B. menstruation. C. bloody show. D. All of the above

C. bloody show.

Having the individual place the backs of the hands together while flexing the wrist 90 degrees assesses for the presence of: A. Dupuytren's contracture. B. wrist ganglion. C. carpal tunnel syndrome. D. Tinel's sign.

C. carpal tunnel syndrome.

The most commonly reported sexually transmitted infection in the United States is: A. gonorrhea. B. syphilis. C. chlamydia. D. HIV.

C. chlamydia.

Pyloric stenosis is defined as a(n): A. abnormal enlargement of the pyloric sphincter. B. inflammation of the pyloric sphincter. C. congenital narrowing of the pyloric sphincter. D. None of the above.

C. congenital narrowing of the pyloric sphincter.

Bloody show is the term used for: A. red-tinged or bloody urine. B. aberrant growths of endometrial tissue. C. dislodging the cervical mucous plug in labor. D. whitish or yellowish discharge from the vaginal orifice.

C. dislodging the cervical mucous plug in labor.

A healthy prostate is about 4 cm in diameter and feels? A. rubbery or boggy B.Stony hard nodular C.firm, smooth and slightly movable

C. firm, smooth, and slightly movable Rubbery or boggy = BPH Stony Hard nodular = carcinoma, prostatic calculi or chronic fibrosis

Mr. Hutchins is a 32-year-old patient who presents for follow-up examination. On examination you note painful clusters of small vesicles with surrounding erythema that erupt on the glans or foreskin. These are signs of: A. cystitis B. urethritis. C. herpes progenitalis. D. Peyronie disease.

C. herpes progenitalis.

Mrs. Bicker brings her infant son to the health clinic for a routine examination. When performing Ortolani's maneuver on the newborn infant, you feel a clunk as you abduct the infant's legs and flexed knees. The presence of a "clunk" is indicative of: A. tibial torsion. B. genu valgum. C. hip dislocation. D. talipes equinovarus.

C. hip dislocation.

Mrs. Harris brings her newborn infant to the office for a routine health assessment. On examination, you measure the equality of the infant's leg lengths, called the allis test. This assesses the presence of: A. talipes equinovarus. B. tibial torsion. C. hip dislocation. D. Colles fracture.

C. hip dislocation.

The functional unit of the skeletal system is the: A. bursa. B. articulation. C. joint. D. epiphysis.

C. joint.

Casey Galen, a student nurse, conducts a dermatology in-service for nurses and students assigned to a medical surgical floor at the local hospital. Ms. Galen stresses the impact of accumulated risk factors in skin disease and breakdown. Such factors include: A. loss of protective cushioning of the epidermal and dermal skin layers. B. decreased vascular fragility. C. lifetime of environmental trauma. D. All of the above.

C. lifetime of environmental trauma.

Mrs. Black, a 29-year-old patient who is pregnant, comes to the office with concerns about skin changes. As the health care provider, you know that some skin changes occur during pregnancy as a result of increased pigmentation, including: A. café au lait spots. B. keratosis. C. linea nigra. D. lentigines.

C. linea nigra.

Hymen is the term used for the: A. vestibular glands on either side of the vaginal orifice. B. uterine accessory organs. C. membranous fold of tissue partially closing the vaginal orifice. D. hard, painless nodules in the uterine wall.

C. membranous fold of tissue partially closing the vaginal orifice.

Linea alba is/are the: A. midline abdominal muscles extending from the rib cage to the pubic bone. B. ligament extending from the pubic bone to the anterosuperior iliac spine. C. midline tendinous seam joining the abdominal muscles. D. angle formed by the twelfth rib and the vertebral column.

C. midline tendinous seam joining the abdominal muscles.

Elevated skin lesions that are greater than 1 cm in diameter are called: A. bullae. B. papules. C. nodules. D. furuncles.

C. nodules.

Acute inflammation of the testes is: A. herpes progenitalis. B. priapism. C. orchitis. D. paraphimosis.

C. orchitis.

A solid, circumscribed palpable skin lesion, which is less than 1 cm in diameter, is a: A. nodule. B. bulla. C. papule. D. vesicle.

C. papule.

The term associated with the number of births is: A. menorrhagia. B. leukorrhea. C. para. D. Hegar's sign.

C. para.

Mr. Lee comes to the office for a routine health assessment. As part of it, you perform a screening MS exam. This consists of all the following except: A. inspection and palpation of joints integrated with each body region. B. observation of ROM as the individual proceeds through motions required for preparation for the exam and during the exam. C. testing muscle strength of the major muscle groups. D. age-specific measures.

C. testing muscle strength of the major muscle groups.

The sudden twisting of the spermatic cord causes a surgical emergency called: A. prepuce. B. spermatocele. C. torsion. D. progenitalis.

C. torsion.

The joint is the functional unit of the musculoskeletal system and is the point at which: A. the tendon is attached to the bone. B. cartilage meets bone. C. two or more bones are joined. D. the bursa is interconnected with bone.

C. two or more bones are joined.

The sloughing of necrotic inflammatory tissue that causes a deep depression in the skin that extends into the dermis is called: A. gangrene. B. dermanecrosis. C. ulceration. D. maceration.

C. ulceration.

Cryptorchidism is: A. an advanced and fixed foreskin too tight to retract over the glans. B. a circumscribed collection of serous fluid in the tunica vaginalis surrounding the testes. C. undescended testes. D. hard, subcutaneous plaques associated with painful bending of the erect penis.

C. undescended testes.

An example of a primary lesion is a(n): A. erosion. B. ulcer. C. urticaria. D. port-wine stain.

C. urticaria.

Nipple retraction and dimpling of the skin is a clinical sign of _____?

Cancer

What could thickening of the skin of the breast indicate?

Carcinoma

Serosanguineous (straw colored) nipple discharge

Carcinoma, ductal ectasia

Sanguineous (bloody) nipple discharge

Carcinoma, intraductal papilloma, ductal ectasia

A male patient presents to the clinic with a complaint of a hard, irregular, nontender mass on his chest under the areola. Upon examination, the nurse notes that the mass is immobile and suspects A. gynecomastia B. benign lesion C. paget disease D. carcinoma

Carcinoma. Gynecomastia is noninflammatory enlargement of male breast tissue. Paget disease may cause intraductal carcinoma, presenting with clear, yellow discharge and dry, scaling crusts that spread outward from the nipple to the areola.

What controls the ability to think and reason?

Cerebrum

Hormonal Fluctuations

Change in lump size, edema, pain, fullness>all in relation to mentrual cycle

What are the keys to breast inspection? (5)

Color and texture, Size and shape, Symmetry, Contour, Nipple and areola characteristics.

Another name for milk that contains antibodies and other host resistance factors and is produced by breasts?

Colostrum

Fibroadenoma

Common benign breast tumor among young women

Phimosis

Condition in which the foreskin is so tight that it cannot be retracted

What is the fifth step when palpating the breasts in the supine position?

Consider the findings. A woman's breast should feel dense, form, and elastic with no masses, lumps, or nodules.

Pain occurring in one breast

Could suggest a pathologic condition

Bacterial vaginitis

Creamy-gray to white discharge that has a fishy odor

What can be acquired related to the breast in assessment? (6)

Current health hx., past medical hx., family hx., personal hx., lifestyle/personal habits hx., and breast exams.

A 23-year-old nulliparous woman is concerned that her breasts seem to change in size all month long and they are very tender around the time she has her period. The nurse should explain to her that A. nonpregnant women usually do not have these breast changes and this is cause for concern B. breasts often change in response to stress so it is important to assess her life stressors C. cyclical breast changes are normal D. breast changes normally occur during pregnancy and she should have a pregnancy test

Cyclical breast changes are normal. Breasts often change throughout the menstrual cycle, with corresponding variations in hormonal levels.

Spermatocele

Cyst located in the epididymis

20. When assessing muscle strength, the nurse observes that a patient has complete range of motion against gravity with full resistance. What Grade should the nurse record using a 0 to 5 point scale? A) 2 B) 3 C) 4 D) 5

D) 5 Complete range of motion against gravity is normal muscle strength and is recorded as Grade 5 muscle strength. Pages: 578-579

A 22-year-old man comes to the clinic for an examination after falling off his motorcycle and landing on his left side on the handlebars. The nurse suspects that he may have injured his spleen. Which of these statements is true regarding assessment of the spleen in this situation? A) The spleen can be enlarged as a result of trauma. B) The spleen is normally felt upon routine palpation. C) If an enlarged spleen is noticed, then the nurse should palpate thoroughly to determine size. D) An enlarged spleen should not be palpated because it can rupture easily.

D) An enlarged spleen should not be palpated because it can rupture easily. If an enlarged spleen is felt, then the nurse should refer the person but should not continue to palpate it. An enlarged spleen is friable and can rupture easily with overpalpation. REF: Page: 549

The nurse is bathing an 80-year-old man and notices that his skin is wrinkled, thin, lax, and dry. This finding would be related to which factor? A) Increased vascularity of the skin in the elderly B) Increased numbers of sweat and sebaceous glands in the elderly C) An increase in elastin and a decrease in subcutaneous fat in the elderly D) An increased loss of elastin and a decrease in subcutaneous fat in the elderly

D) An increased loss of elastin and a decrease in subcutaneous fat in the elderly An accumulation of factors place the aging person at risk for skin disease and breakdown: the thinning of the skin, the decrease in vascularity and nutrients, the loss of protective cushioning of the subcutaneous layer, a lifetime of environmental trauma to skin, the social changes of aging, the increasingly sedentary lifestyle, and the chance of immobility. Page: 206

A 65-year-old man with emphysema and bronchitis has come to the clinic for a follow-up appointment. On assessment, the nurse might expect to see which assessment finding? A) Anasarca B) Scleroderma C) Pedal erythema D) Clubbing of the nails

D) Clubbing of the nails Clubbing of the nails occurs with congenital cyanotic heart disease, neoplastic, and pulmonary diseases. The other responses are assessment findings not associated with pulmonary diseases. Pages 217-218

The nurse suspects that a patient has a distended bladder. How should the nurse assess for this condition? A) Percuss and palpate in the lumbar region. B) Inspect and palpate in the epigastric region. C) Auscultate and percuss in the inguinal region. D) Percuss and palpate the midline area above the suprapubic bone.

D) Percuss and palpate the midline area above the suprapubic bone. Dull percussion sounds would be elicited over a distended bladder, and the hypogastric area would seem firm to palpation. REF: Pages: 539-540

Which structure is located in the left lower quadrant of the abdomen? A) Liver B) Duodenum C) Gallbladder D) Sigmoid colon

D) Sigmoid colon The sigmoid colon is located in the left lower quadrant of the abdomen. REF: Page: 530

The nurse is assessing for clubbing of the fingernails and would expect to find: A) a nail base that is firm and slightly tender. B) curved nails with a convex profile and ridges across the nail. C) a nail base that feels spongy with an angle of the nail base of 150 degrees. D) an angle of the nail base of 180 degrees or greater with a nail base that feels spongy.

D) an angle of the nail base of 180 degrees or greater with a nail base that feels spongy. The normal nail is firm at its base and has an angle of 160 degrees. In clubbing, the angle straightens to 180 degrees or greater and the nail base feels spongy. Pages: 217-218

The nurse is describing a scaphoid abdomen. To the horizontal plane, a scaphoid contour of the abdomen depicts a _____ profile. A) flat B) convex C) bulging D) concave

D) concave Contour describes the profile of the abdomen from the rib margin to the pubic bone; a scaphoid contour is one that is concave from a horizontal plane. See Figure 21-7. REF: Page: 536

The nurse is aware that one change that may occur in the gastrointestinal system of an aging adult is: A) increased salivation. B) increased liver size. C) increased esophageal emptying. D) decreased gastric acid secretion.

D) decreased gastric acid secretion. Gastric acid secretion decreases with aging. As one ages, salivation decreases, esophageal emptying is delayed, and liver size decreases. REF: Page: 531

A 62-year-old man states that his doctor told him that he has an "inguinal hernia." He asks the nurse to explain what a hernia is. The nurse should: A) tell him not to worry and that most men his age develop hernias. B) explain that a hernia is often the result of prenatal growth abnormalities. C) refer him to his physician for additional consultation because the physician made the initial diagnosis. D) explain that a hernia is a loop of bowel protruding through a weak spot in the abdominal muscles.

D) explain that a hernia is a loop of bowel protruding through a weak spot in the abdominal muscles. A hernia is a loop of bowel protruding through a weak spot in the musculature. The other options are not correct responses to the patient's question.

The physician comments that a patient has abdominal borborygmi. The nurse knows that this term refers to: A) a loud continuous hum. B) a peritoneal friction rub. C) hypoactive bowel sounds. D) hyperactive bowel sounds.

D) hyperactive bowel sounds. Borborygmi is the term used for hyperperistalsis when the person actually feels his or her stomach growling. REF: Pages: 539-540

A patient's abdomen is bulging and stretched in appearance. The nurse should describe this finding as: A) obese. B) herniated. C) scaphoid. D) protuberant.

D) protuberant. A protuberant abdomen is rounded, bulging, and stretched. See Figure 21-7. A scaphoid abdomen caves inward. REF: Page: 536

Which statement made by the client indicates an understanding of how the nurse will perform the Romberg test? A. "You want me to bend over so you can inspect my spine for curvature" B. "I need to touch my toes without bending my knees if possible" C. "I am going to walk five or six steps on my toes only, then on my heels only" D. "You want me to stand with my feet together and eyes close for a short time"

D. "You want me to stand with my feet together and eyes close for a short time" Rationale: The Romberg test is performed to test motor function. The client is asked to stand with feet together, arms resting at the sides and then to close the eyes. The nurse watches for the presence of swaying, which is considered normal if it is only slight. However, if the client cannot maintain foot stance, it is documented as a positive Romberg's sign.

Umbilical hernias in infants: A. appear at 2 to 3 weeks of age. B. are more prominent when the baby cries. C. disappear by the time the baby is 1 year old. D. All of the above

D. All of the above

You are conducting an in-service on aging skin for nurses and students assigned to a medical floor at the local hospital. Which of the following pieces of information is essential for your in-service to include? A. The loss of collagen increases the risk of shearing, tearing injuries. B. Thinning and flattening of the stratum corneum increases absorption of chemicals. C. Diminished vascularity and increased vascular fragility lead to senile purpura. D. All of the above

D. All of the above

Bowel sounds are: A. high pitched. B. air and fluid moving through the small intestine. C. irregular. D. All of the above.

D. All of the above.

Essential components of a patient history for dermatology disorders include: A. a previous history of skin disorders plus symptom analysis (or HPI) of current problems and allergies. B. self-care behaviors, occupation, and hobbies. C. prescribed medications, over-the-counter medications, herbs, and substance use. D. All of the above.

D. All of the above.

Jesse Carter, a student nurse, has been assigned to teach fourth-graders about hygiene. Part of her lesson will focus on the apocrine glands. Which of the following statements is true? A. The apocrine glands, a type of sweat gland, are mainly located in the axillae, anogenital area, nipples, and navel. B. These glands produce a thick, milky secretion and open into the hair follicles. C. The apocrine glands become active during puberty and decrease functioning in aging adults. D. All of the above.

D. All of the above.

Jesse Carter, a student nurse, has been assigned to teach fourth-graders about hygiene. She decides to begin the teaching module with a short lecture on the skin. Which of the following facts will Jesse include while discussing the skin's protective and adaptive properties? A. The skin regulates body temperature. Heat is stored in fat pads or released through sweating. B. The skin protects against infection. Normal skin flora fights off the invasion of microorganisms that can enter the body and cause infection. C. The skin is an organ of excretion. It removes a significant amount of metabolic wastes, which are the byproducts of cellular decomposition such as minerals and urea. D. All of the above.

D. All of the above.

Lichenification is/are: A. tightly packed sets of papules. B. thickening of the skin. C. due to prolonged, intense scratching. D. All of the above.

D. All of the above.

The right lower quadrant of the abdomen contains which of the following organs? A. Duodenum B. Liver C. Sigmoid colon D. Appendix

D. Appendix

Clue cells - irregularly shaped cells indicate what? A. Candida vulvovaginitis B. Gonorrhea C. Chlamydia D. Bacterial Vaginosis

D. Bacterial vaginosis - also positive Whiff Test with KOH wet mount Chlamydia - hyphae like fungus, linear on KOH wet mount

Mrs. Stevens is a 43-year-old patient who presents with multiple complaints and a concern that her husband was diagnosed with syphilis. Which of the following is a sign of syphilis? A. Caruncle B. Cystocele C. Polyp D. Chancre

D. Chancre

Mr. Cook is a 53-year-old patient who comes to the clinic for routine follow-up for his chronic obstructive pulmonary disease (COPD). Which of the following is indicative of COPD? A. Acrocyanosis B. Circumoral cyanosis C. Pitting of nails D. Clubbing of nails

D. Clubbing of nails

Mr. Liggett is a 42-year-old patient who presents with a painful left testicle. On examination you note abnormal dilation and tortuosity of the veins along the spermatic cord. Which of the following conditions best describes this clinical finding? A. Varicocele B. Priapism C. Hypospadias D. Epididymitis

D. Epididymitis

The rotator cuff of the body is associated with which of the following joints? A. Radiocarpal joint B. Temporomandibular joint C. Acetabular joint D. Glenohumeral joint

D. Glenohumeral joint

Some who has had more than 5 pregnancies? A. Multigravida B. Nulligravida C. Primigravida D. Grand multip

D. Grand multip Multigravida - now pregnant with her 2nd or more Nulligravida - has never been pregnant Primigravida - Pregnant for first time

Which of the following terms is used to describe the number of pregnancies? A. PAL B. Parosity C. Para D. Gravida

D. Gravida

The nurse selects which of the following as the highest priority nursing diagnosis for a 70-year-old male client with an absence of hair on the lower left leg? A. Imbalance nutrition: Less than body requirement B. Risk for infection C. Deficient fluid volume D. Impaired peripheral tissue perfusion

D. Impaired peripheral tissue perfusion Rationale: During physical assessment, the nurse inspects the client's legs for hair distribution. The most common reason for shiny skin and a complete absence of hair is poor circulation related to peripheral vascular disease (PVD). Thus the nursing diagnosis of impaired peripheral tissue perfusion applies. The other nursing diagnoses do not relate to or affect hair distribution.

The nurse would use which technique first when examining the abdomen of a client? A. Palpation B. Auscultation C. Percussion D. Inspection

D. Inspection Rationale: During inspection, the nurse scrutinizes and evaluates by sight any clues of pathology that may be present. By first performing the other assessment techniques (auscultation, percussion, and palpation), the nurse could alter the findings.

Skeletal muscle is differentiated from other types of muscle by which of the following characteristics? A. It is involuntary in its activity. B. It is semivoluntary in nature. C. It is under contractual regulation. D. It is under voluntary control.

D. It is under voluntary control.

A large amount of mucus in the fecal matter is characteristic of? A. Spasmodic contraction B. Malabsorption C. Hepatopancreatic ampulla D. Mucous colitis

D. Mucous colitis Spasmodic contraction - intermittent, pencil-like stools Malabsorption syndromes - fatty stools seen in patients with pancreatic disorders Hepatopancreatic ampulla - stolls the color of aluminum occur in tropical sprue, carcinoma. Children treated with sulfonamides for diarrhea.

Jesse Carter, a student nurse, has been assigned to teach fourth-graders about hygiene. While preparing, Jesse adds information about the sweat glands. Which of the following will Jesse include while discussing this topic? A. There are two types of sweat glands: the eccrine and the sebaceous. B. The evaporation of sweat, which is a dilute saline solution, increases body temperature. C. Eccrine glands produce sweat and are mainly located in the axillae, anogenital area, and navel. D. Newborn infants do not sweat; they use compensatory mechanisms to control body temperature.

D. Newborn infants do not sweat; they use compensatory mechanisms to control body temperature.

The liver is: A. a soft, lobulated gland behind the stomach. B. a soft mass of lymphatic tissue on the postlateral wall. C. a bean-shaped, retroperitoneal gland. D. None of the above.

D. None of the above.

What condition causes the areolae to become more deeply pigmented and their diameter to increase? A. Tanner 2 B. Lactating C. Puberty D. Pregnancy

D. Pregnancy

Breast enlargement in girls before onset of puberty? A. Mastitis B. Gynecomastia C. Paget Disease D. Premature Thelarche

D. Premature Thelarche Mastitis - inflammation and infection of the breast tissue Gynecomastia - breast enlargement in men Paget - surface manifestation of underlying ductal carcinoma

Mr. Harrison is a 28-year-old patient who presents to your office urgently with a concern of a penile erection that has not subsided. Which of the following is a prolonged penile erection that is often painful (most cases are idiopathic)? A. Paraphimosis B. Phimosis C. Spermatocele D. Priapism

D. Priapism

Paraurethral glands are also called: A. Bartholin's glands. B. Hegar's sign. C. Chadwick's sign. D. Skene's glands.

D. Skene's glands.

A 24-year-old man has scrotal pain and marked erythema. The examiner considers epididymitis. What finding is consistent with this problem? A. An uneven scrotal size and shape is observed. B. The patient has anorexia and nausea. C. The patient reports an acute onset of severe pain. D. Urinalysis shows elevated WBCs and bacteria.

D. Urinalysis shows elevated WBCs and bacteria.

Infants can produce a small amount of clear or milky white fluid from their breasts and this is called? A. Purulent discharge B. Serosanguineous discharge C. Devil's dischage D. Witch's milk

D. Witch's milk result of maternal estrogen

Mrs. Gilder is a 32-year-old patient who presents to the office for a health assessment. On examination, you note a positive Chadwick's sign. This is: A. an aberrant growth of endometrial tissue. B. a cervical mucous plug. C. the absence of menstruation. D. a bluish discoloration of the cervix.

D. a bluish discoloration of the cervix.

The vas deferens is: A. a narrow tunnel inferior to the inguinal ligament. B. a narrow tunnel superior to the inguinal ligament. C. the joining of the vas deferens with the seminal vesicle. D. a muscular duct continuous with the epididymis.

D. a muscular duct continuous with the epididymis.

A deep recess formed by the peritoneum between the rectum and the cervix is called: A. Chadwick's sign. B. a cystocele. C. a rectocele. D. a rectouterine pouch.

D. a rectouterine pouch.

During the performance of the McMurray test, the examiner hears and feels a click, which is an indication of: A. a torn cruciate ligament. B. subluxation of the knee. C. dislocation of the femoral head. D. a torn meniscus

D. a torn meniscus

Dysmenorrhea is a synonym for: A. painful intercourse. B. bowel spasms with defecation. C. cramping with urination. D. abdominal cramping and pain associated with menstruation.

D. abdominal cramping and pain associated with menstruation.

Mr. Kinder is a 59-year-old patient who comes to the clinic for follow-up after an emergency room visit. On examination of the abdomen, you note ascites. Ascites is: A. a bowel obstruction. B. a proximal part of the large intestine. C. an abnormal enlargement of the spleen. D. an abnormal accumulation of serous fluid within the peritoneal cavity.

D. an abnormal accumulation of serous fluid within the peritoneal cavity.

Orchitis is: A. a meatus opening on the dorsal side of the glans or shaft. B. hard, subcutaneous plaques associated with painful bending of the erect penis. C. a circumscribed collection of serous fluid in the tunica vaginalis surrounding the testes. D. an acute inflammation of the testes.

D. an acute inflammation of the testes.

A thin, grey-white, fishy smelling vaginal drainage is: A. gonorrhea. B. chlamydia. C. candida. D. bacterial vaginosis.

D. bacterial vaginosis.

A thickened synovial membrane is described as feeling: A. rigid. B. pliable. C. constricted. D. boggy.

D. boggy.

Mr. Verdana is a 41-year-old gentleman who presents with a complaint of skin problems. On examination you note single-chambered, superficial lesions containing free fluid > 1 cm in diameter, which are called: A. furuncles. B. vesicles. C. wheals. D. bullae.

D. bullae.

The left kidney usually: A. can be felt easily. B. can only be felt when the person breathes deeply. C. is 1 cm lower than the right kidney. D. cannot be felt.

D. cannot be felt.

Mr. Yoder is a 49-year-old patient who comes to the clinic for a physical examination for his job. On examination, you perform a Phalen's test. This is used to assess for the presence of: A. elbow joint subluxation. B. wrist ROM. C. osteoporosis. D. carpal tunnel syndrome.

D. carpal tunnel syndrome.

Leukorrhea is the term for: A. white to light yellow vaginal discharge. B. bloody vaginal discharge. C. purulent vaginal discharge. D. clear, mucoid vaginal discharge.

D. clear, mucoid vaginal discharge.

Inflammation of the urinary bladder is called: A. hypospadias. B. orchitis. C. urethritis. D. cystitis.

D. cystitis.

A scooped-out, shallow depression in the skin is called a/an: A. ulcer. B. excoriation. C. fissure. D. erosion.

D. erosion.

A congenital defect in which the urethra opens on the ventral side of the penis is known as: A. phimosis. B. urethritis. C. priapism. D. hypospadias.

D. hypospadias.

Viscera is the term given to: A. bowel obstruction. B. the midline longitudinal ridge in the abdomen. C. a proximal part of the large intestine. D. internal organs.

D. internal organs.

An elevated cavity containing thick, turbid fluid is a: A. cyst. B. vesicle. C. bulla. D. pustule.

D. pustule.

Mr. Jeffries is a 48-year-old patient who comes to the clinic for a follow-up after an emergency room visit. On examination, you note a soft mass of lymphatic tissue immediately under the diaphragm, which is the: A. gallbladder. B. liver. C. cecum. D. spleen.

D. spleen.

You are preparing the equipment that will be used to examine patients in the dermatology clinic. The equipment needed to assess the skin, its appendages and, if necessary, lesions include: A. strong direct lighting (artificial light preferred), ruler, pen light, goniometer, gloves, filtered ultraviolet light, glass slide, and KOH. B. strong direct lighting (natural daylight preferred), ruler, pen light, monometer, gloves, filtered ultraviolet light, glass slide, and KOH. C. strong direct lighting (artificial light preferred), ruler, pen light, microscope, gloves, filtered ultraviolet light, glass slide, and KOH. D. strong direct lighting (natural daylight preferred), ruler, pen light, magnifier, gloves, filtered ultraviolet light, glass slide, and KOH.

D. strong direct lighting (natural daylight preferred), ruler, pen light, magnifier, gloves, filtered ultraviolet light, glass slide, and KOH.

The shape of the spinal column and the resilient intervertebral disks facilitate: A. greater mobility of the spinal column. B. the ability to coordinate movement between the upper extremities and lower extremities. C. ease and coordination of head and neck movement. D. the ability to absorb a great deal of shock.

D. the ability to absorb a great deal of shock.

Amenorrhea is the term used for: A. painful intercourse. B. the dislodging of the cervical mucous plug. C. the bluish discoloration of the cervix. D. the absence of menstruation.

D. the absence of menstruation.

The knee joint is the articulation of three bones, which are: A. the femur, fibula, and patella. B. the femur, radius, and olecranon process. C. the fibula, tibia, and patella. D. the femur, tibia, and patella.

D. the femur, tibia, and patella.

Mrs. Griffin is a 31-year-old patient who is pregnant. She comes to the clinic complaining of "morning sickness." The cause of this ailment is: A. hormone changes. B. esophageal reflux. C. an increase in water being reabsorbed from the colon. D. unknown.

D. unknown.

Mr. Thompson is a 44-year-old patient who presents to the office with complaints of urinary burning. On examination you note an infection of the urethra. This is also known as: A. progenitalis. B. orchitis. C. prepuce. D. urethritis.

D. urethritis.

Clinical manifestations of ductal ectasia

Dark green or black sticky nipple discharge with burning or itching

A rash on both breasts

Dermatitis

Onset, Location, Duration

Determine ______ of nipple discharge

What are some diseases and illnesses of the abdomen? (6)

Diarrhea, GERD, Hiatal Hernia, Ulcers, Inflammatory disorders, and Cancer.

Pilonidal cyst

Dimpling in the sacrococcygeal area at the midline. May become abscessed or drain chronically.

There are five "D"s related to nipples, all are listed EXCEPT: Discharge Depression or inversion Dermatologic changes Deviation: compare to other side

Discoloration

Noninvasive breast cancwer

Ductal carcinoma in situ and lobular carcinoma in situ

What percussion sound should be heard over the liver?

Dullness.

When is swelling normal?

During the menstrual cycle.

What is pica?

Eating non food substances such as dirt and clay. Also associated with low blood levels of iron.

What might the lymphatic spread of breast cancer cause?

Enlarged lymph nodes, most commonly in the tail of Spence

Gynecomastia

Enlargement of male breasts

What are some inflammatory disorders for the abdomen?

Esophagitis, Gastritis, Ulcerative colitis, Crohn's Disease, Peritonits, and Hepatitis.

Atrophic vaginitis

Estrogen deficiency in postmenopausal females that result in dryness, itching, and burning.

Hormone Replacement Theraoy

Estrogen; for more than 5 years after menopause increases risk

How often should women between 50 and 74 get a mammogram?

Every 2 years

What are important factors in a testicular exam?

Examine each testicle one at a time with both hands. Normal finding - feel no pain and one testicle may e larger.

Would a supernumerary nipple be considered expected or unexpected?

Expected variation

Tail of Spence

Extension of the tissue of the breast that extends into the axilla.

African American females develop secondary sexual traits slower than European ancestry females. True or false?

False

Benign fibroadenomas is uncommon in adolescent females. True or false?

False

Breast cancer becomes decreasingly less possible with age. True or False?

False

Breast implants increase the risk of breast cancer. True or False

False

Colostrum will only appear after the birth of the infant. True or false?

False

Leiomyomas are growths outside of the uterus found in endometriosis? T/F

False Leiomyomas, fibriods - Myomas - common benign, uterine tumors Endometriosis - presence and growth of endometrial tissue outside the uterus

The first meconium stool is ordinarily passed within 3 days of delivery and indicated patency of the anus? T/F

False Meconium is passed within 24-48 hours of birth and indicates patency of anus Infants have a stool after each feeding

A sexually transmitted disease in young children which is a pinpoint red lesion on vulva is called Molluscum contagosum? T/F

False common in adults, nonsexually transmitted in young children

Montgomery tubercles are an abnormal finding on the breasts? T/F

False - a peppering of nontender, nonsuppurative Montgomery tubercles is a common expected finding

What are the subjective data collections to acquire? (4)

Family hx., Personal hx., Medications, Additional Factors: protective gear, Hep A and B vvaccine, Self Genital exam, regular clinical exams.

Functions of vagina

Female organ of copulation, birth canal, exit for menstrual flow

ACE inhibitors, antiepileptics, coumadin, accutane all may affect what in women?

Fertility or birth outcome

Positive signs of pregnancy?

Fetal Heart tone Palpation of fetal movement Visualization of fetus on ultrasound

The nurse palpates a fine, round, mobile, nontender nodule and suspects that it is A. a fibroadenoma B. a cyst C. a fibrocystic breast change D. breast cancer

Fibroadenoma. A cyst is soft to firm, often tender, round, mobile. Fibrocystic breast changes feel nodular and ropelike. Breast cancer is irregular, firm, and fixed.

What are common abnormalities?

Fibrocyctis changes, Fibroadenoma.

Multicolored (green, gray, brown) nipple discharge

Fibrocystic changes, carcinoma, infectious process, ductal ectasia

Inframammary Ridge

Firm transverse ridge along the lower edge of the breast, normal and should not be mistaken for a breast mass

Nulliparous

First born child after age 30

What are increased risks for Breast Cancer?

First degree and Second degree relatives.

Menarche

First menstrual period

Clinical manifestations of fibrocystic changes in the breast

Fluctuating size mass, subside after menopause, slightly tender, palpable

What is ascites?

Fluid accumulation w/in peritoneal space --> can lead to spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS)

Scrotal edema

Fluid in the scrotum

Hydrocele

Fluid-filled mass within the tunica vaginalis that is nontender.

What are the HealthyPeople 2020 Goals concerned with?

Foodborne illness and colorectal cancer.

Phimosis abnormality

Foreskin is tight

Breast engorgment

Found normally in patients who are pregnant or premenstrual

What controls motor control of voluntary muscles, personality, concentration, organization, problem solving?

Frontal Lobe.

Trichomoniasis

Frothy, yellow-green discharge, painful urination, vulular itching, and foul smelling.

What is BRCA 1 and BRCA 2?

Genes that put you at an increased risk for Breast Cancer. Need a blood tests to see if this is in your family.

What is the third step when palpating the breasts in the supine position?

Gently depress the nipple into the well behind the areola (the tissue should easily move inward).

What are breasts composed of?

Glandular, fibrous, and adipose tissue.

What does GFPAL mean?

Gravida (how many pregnancies) F - full term P - preterm A - spontaneous or induced abortions L - Living children

What are indications of malignant? (9)

Greater than 35, single , painless, bleeding, hard, irregular, fixed, lymph nodes, and weight loss.

Bartholin's glands

Greater vestibular glands produce mucous that promotes sperm motility/viability

Gonorrhea

Green discharge that has a foul smell. Bacterial infection and may see vaginal discharge or bleeding and abscesses in Bartholin's or Skene's glands.

What is the first step when assessing the breast in the supine position?

Have patient raise one arm behind the head and place a small pillow or folded towel under the shoulder (ideal positioning=think of pt.'s nipple pointing toward the ceiling)

When performing a breast exam on an older adult, what modifications should the nurse make if the client has limited ROM?

Have the client raise their arms to a height that does not cause discomfort.

Cystocele

Hernia that is formed when the urinary bladder is pushed into the anterior vaginal wall.

Who has the lowest incidence of breast cancer?

Hispanics and Asians

What are modifiable risk?

Hormone therapy, Obesity, Breast Feeding, Child Birth, Alcohol, Physical Inactivity, and Oral COntraceptives.

What do nurses need to teach female patients about?

How to perform SBE as part of health-related patient teaching

Gynocomastia at puberty is

Idiopathic and transient

What is the significant of Menopause and Menstrual cycles?

If menstruation starts before 12 or menopause greater than 55 there is a higher risk.

What is the fourth step when palpating the breasts in the supine position?

If patient reports any spontaneous nipple discharge, compress the nipple. If discharge occurs, obtain a specimen, using a glass slide and cytologic fixative.

Why might you hear a venous hub?

If there is a blockage to the liver.

Where would you find more masses?

In the upper outer quadrant because that is where the glandular tissue lies.

Galactorrhea

Inappropriate lactation caused by endocrine related disorders and many medications

Pronounced unilateral venous patterns in the breast could indicate what?

Increased blood flow to a malignancy

What are some common symptoms related to the abdomen? ( 12)

Indigestion, Nausea, vomiting, hematemesis, dysphagia, odynophagia, constipation, jaundice, Kidney or flank pain, anorexia, abdominal pain, change in bowel function, diarrhea, urinary or renal symptoms, and ureteral colic.

What is witch's milk?

Infants nipple has discharge because they had gotten hormones from mother.

What is Hepatitis A?

Infection through fecal-oral contaminated food, a vaccine is available.

Purulent nipple discharge

Infectious process, ductal ectasia

Orchitis

Inflammation of the testicle. Most commonly associated with the virus that causes mumps.

Vulvovaginitis

Inflammation or infection of the vulva and vagina

When palpating a woman's breasts, don't be fooled by the ____________, a ridge of form compressed tissue at the lower edge of the breast. It is not a mass!

Inframammary ridge

What is looked for concerning a mastectomy?

Inspect the scar and axilla, palpate surgical scar and chest wall with pads of two fingers in a circular motion, palpate axilla and supraclavicular lymph nodes, and ask patient to demonstrate self breast exams.

How would a nurse assess the abdominal region?

Inspection, Auscultation, Percussion, Palpation

Fornix

Intersection of vaginal canal and cervix

Invasive Breast Cancer

Invasive malignancy arising from the ducts or lobules. 40-60yoa.

Lithotomy position

Involves the individual's feet above or at the same level as the hips with the perineum positioned at the edge of an exam table.

Pregnancy can cause dark green or black stools related to what_____?

Iron preparations

Malignant indications

Irregular shape with poorly defined edges.

Why is colostrum important for infants?

It provides essential antibodies to help the baby fight off disease until its own immune system kicks in.

When teaching the SBE, the nurse should inform the woman that it is best perform the exam in which of the following times? Select all that apply A. just before the menstrual period B. just after the menstrual period C. on the 4th to 7th days of the menstrual period D. on the 10th day of the menstrual period

Just after the menstrual period, on the 4th to 7th days of the menstrual cycle. The breasts are least congested and smallest right after the menstrual period (or days 4-7 of the menstrual cycle)

Galactorrhea

Lactation not associated with childbearing

Galactorrhea

Lactation that is not associated with child birth. Occurs most commonly with endocrine disorders or medications

What carries milk to the nipple?

Lactiferous ducts

What could you offer an older adult while assessing the breasts

Large mirror, additional lighting, magnifying glass, pamphlets with large print

How do you palpate the nipple?

Last. Place the nipple between your hub and index finger.

How would a client tighten the abdominal muscles?

Lay on back and put head towards chest.

Labia

Liplike structures on either side of the vagina (majora - outer, minora - inner)

Lymphedema

Localized accumulation of lymph fluid in the interstitial spaces caused by removal of lymph nodes

Bartholin's Glands

Located posteriorly at the base of the vestibule and produce mucus, which is released into the vestibule. Also known as greater vestibular glands

What should be included in the documentation fo breast masses? (10)

Location, Size in cm, shape, consistency, mobility, tenderness, distinctness, skin, nipple, and Lympadenopathy.

Vagina

Long tubular muscular canal( extends from vaginal opening to cervix)

Infections in the breast, arm, and even the hand can cause

Lymphatic drainage into the axillary area

Dimpling, retraction, or bulging may indicate

Malignancy

Nipple retraction suggests

Malignancy

Thickening of the nipple tissue and loss of elasticity are signs consistent with

Malignancy

What detects breast cancer before palpation?

Mammography

Common drugs causing nipple discharge

Marijuana and opiods

Gynocomastia in neonates is associated with

Maternal hormones

Cremasteric reflex

May cause the testicles to migrate upward temporarily. Cold hands, a cold room, or the stimulus of touch could cause this response.

During inspection of a man's breast, how would your normally describe the size and shape?

Men's breast are usually even with the chest wall

Hard, fixed nodules or masses suggests

Metastic carcinoma or lymphoma

Clinical manifestations of galactorrhea

Milk appearing nipple discharge

Sebaceous glands in the breast

Montgomery's glands

Pain occurring bilaterally

More attributed to hormonal effects

Nabothian cysts

Mucus filled lump on the surface of the cervix

Fibrocystic changes in the breasts refers to

Multiple benign masses caused by ductal enlargment commonly seen in middle-aged women

NEURO

NEURO

Urethral stricture

Narrowing of a section of the urethra. If the meatus is only about the size of a pinpoint, this is suspected.

What conditions require further assessment for the Breast? (4)

New breast lump, lump that has changed size/shape/texture/tenderness, lump in axilla, and bloody nipple discharge.

What are considerations for Children?

Newborn bladder is above symphysis pubis, infants liver occupies more abdominal space, and less developed abdominal muscles allows for easier palpation of organs.

Breast enlargement may occur in?

Newborns as a result of the influence of maternal hormones

If breast mass is absent in male with breast cancer, another symptom may be

Nipple discharge

Deviations from normal include

Nipple edema, redness, pigment changes, ulceration, crusting, erosion, scaling, wrinkling, or cracking

What are abnormal findings?

Nipple retraction, Paget's disease, Dimpling, Peau d' orange, malignant breast tumor.

Pediculosis Pubis

Nits on roots of pubic hair that cause itching. The area is reddened and excoriated. This is also known as crabs

Syphilis

Nontender lesions appear as round or oval reddened ulcers. A solitary papule that gradually changes to a draining ulcer. Lymphadenopathy is present. Typically the lesions are firm, round and painless. It can affect the nervous system.

A client states their areolae has darkened during pregnancy. Normal or abnormal?

Normal

An increase of subcutaneous fat in a male obese client's breasts. Normal or abnormal?

Normal

Asymmetric or unsteady growth of breasts in developing females. Normal or abnormal?

Normal

Axillary lymph nodes non-palpable. Normal or abnormal?

Normal

Breast tissue enlargement during pregnancy. Normal or Abnormal?

Normal

Dry labia minor in the older adult. Normal or abnormal?

Normal

One breast is slightly larger than the other. Normal or abnormal?

Normal

Redness with breastfeeding. Normal or abnormal?

Normal

Swollen breast tissue in a newborn. Normal or abnormal?

Normal

The left testicle hangs lower than the right. Normal or abnormal?

Normal

Thin discharge from the breast of an infant. Normal or abnormal?

Normal

What are some modifable risk factors for breast cancer?

Nulliparity or late age at birth of first child (after 30) HRT, ETOH, Obesity and high-fat diets, Lack of physical activity

How should nurses describe clinical findings when examining breasts?

Nurses should divide the breast into four quadrants by imagining lines that intersect at the nipple

When does breast development occur in adolescent girls?

Occurs over a 3-year period

Inguinal hernia

Occurs when soft tissue protudes through a weak point in the abdominal muscles. Feels like a bulge or mass

Cyctocele

Occurs when the supportive tissue between a woman's bladder and vaginal wall weakens and stretches, allowing the bladder to bulge into the vagina.

Risk factors associated with anal cancer?

Older than 50 Infection with HPV Multiple sexual partners Having receptive anal intercourse Frequent anal redness, swelling and soreness Anal fistulas Cigarette smoking Immunosuppresion

Remember, inspection and palpation of a man's breast can be brief, but not ___________.

Omitted

Clinical manifestations of mastitis

One area of breast is red, edematous, tender, warm, and hard; general malaise may occur

When can nipples leak colostrum?

One month prior to child birth

Bulbourethral glands

One of two small structures about the size of peas that secrete a fluid that is released in response to sexual stimulation to provide some lubrication to the end of the penis in preparation for sexual intercourse. Aka cowper's gland

Cervical Os

Opening of the cervix

Meatus

Opening of the pee hole

Internal cervical os

Opens into the uterus

External cervical os

Opens into the vaginal canal

What medications are very important to ask about?

Oral Contraceptives. They cause enlargement, tenderness, and some cause lactation.

Peau d'Orange

Orange peel and dimpled texture and appearance.. Caused by edema from blocked lymphatics

Edema may give skin an

Orange-like texture and given peau d'orange

How long is Tanner Staging?

Over a 3 year period.

Red, scaly nipple with discharge and crusting for a long period of time

Paget's disease

Unilateral breast rash

Paget's disease

Psoas sign?

Pain when patien raises leg against counter pressure

What is an Obturator sign?

Pain when patient right knee and hip are moved and turned 80 degrees.

Common Breast and Axilllary sympotoms? (6)

Pain, Rash, Lums, Swelling, Discharge, and Trauma.

What is the concentric circle technique that is used when palpating the breasts in the supine position?

Palpate at the outer edge and spiraling in toward the nipple

What is the wedge technique that is used when palpating the breasts in the supine position?

Palpate from the center of the breast out, as if along the spokes of a wheel

What is the vertical strip technique used when palpating the breasts in the supine position?

Palpate up and down a you move across the breast

what is the next step after we inspect the breasts and areolae & nipples and then reinspect the breasts?

Palpation

The nurse should wear gloves for which of these examinations?

Palpation of the mouth and tongue ANS: C Page: 766. Gloves should be worn when the examiner is exposed to the patient's body fluids.

Skene's glands

Paraurethral glands found posterior to urethra- secrete fluids that lubricate vagina during intercourse

Unilateral nipple discharge is more commonly associated with

Pathological condition

What is the sequence for inspecting the breasts?

Patient sitting with arms at the side, arms overhead, arms pressed on the hips, leaning forward at the waist, and lying supine.

Uterus

Pear-shaped, hollow organ that holds the fetus-made up of fundus, corpus, cervix

How can the patient accentuate dimpling?

Pectoral muscle contraction

What are non modifiable risk factors for breast cancer?

Personal Hx., Race, Previous Chest Radiation, DES Exposure, Abnormal Breast Biopsy Results, Menstrual Periods, Gender, Genetics

Clear (watery) nipple discharge

Pharmalogic, carcinoma

Abnormal findings are...? (5)

Phimosis, Paraphinmosis, Blanitis, Hypospadias, and Epispadias.

Milky nipple discharge

Pituitary adenoma, pharmalogic, galactorrhea

Headaches or changes in vision along with nipple discharge may suggest

Pituitary tumor or mass

Circular Method

Place Finger pads of my middle three fingers against the outer edge of the breast, press gently in small circles around the breast until you reach the nipple, try not to lift my fingers off the breast as I move from one point to another

Wedge Method

Place finger pads of my middle three fingers on the areola, and palpate from the center of the breast outward. Return my fingers to the areola and again papate from center outward covering another section of the breast(spokelike fashion). Repeat until the entire breast has been covered

Vertical Strip Method

Place the finger pads of my middle three fingers against the top outer edge of the breast. Palpate downward, the upward working my way across the entire breast

What covers the clitoris

Prepuce

Major functions of breasts

Producing, storing, supplying milke and sexual arousal.

What is the purpose of the labia?

Protection from infection and physical injury to urethra/vagina.

What is a specific area that is needed to know

REbound tenderness at McBernie's Point is a signal for appendicitis.

What is Rovisng's sign?

REbound tenderness is tested on the opposite side that pain occurs.

How are the 4 quadrants of the abdominal listed?

RUQ,LUQ,RLQ,LLQ.

Genital warts

Rapidly growing popular lesions that can be present on the penis, testicles, groin, thighs, or in/around the anus. Can be single, grouped, raised, flat, or cauliflower-shaped. Caused by Human papillomavirus (HPV)

What is Paget's Disease and what may indicate it?

Rare form of breast cancer. Eczematous changes of the skin of the nipples/areolae that might exude fluid or scales/crust

Paget's disease

Rare type of breast cancer. Nipple may exude fluid, scale, or crust

What is Blumberg's sign?

Rebound tenderness anywhere on the abdomen; press in and release it quickly.

Obese women or women with large breast may have

Red rash with demarcated borders from candidiasis

Where is GERD from?

Reflux form the digestive acids coming up form the stomach.

What can Hypospadias and Epispadias cause?

Reproductin problems

A patient with BBD is likely to A. develop breast cancer later in life B. require hormone replacement therapy C. be a teenager D. resolve after menopause

Resolve after menopause. BBD occurs most often in patients 30-55 years and decreases or resolves after menopause. It does not predispose someone to breast cancer and is not treated with hormone-replacement therapy.

What is the percussion sound over the lungs?

Resonance

What are the 9 regions of the abdonimal?

Right hypochondriac, Epigastric, Left hypochondriac, Right lumbar, Umbilical, Left lumbar, Right inguinal, Hypogastric, Left inguinal.

Unilateral venous patterns may occur

Secondary to dilated superficial veins from increased flow to malignancy

What are some risk assessments for breast cancer?

Seeking information about gender, race/ethnicity, menstrual history, combination oral contraceptive use, history of childbirth, breastfeeding, genetic risk factors (BRCA1 and/or BRCA2), alcohol abuse, tobacco use, combined and estrogen-alone menopausal hormone therapy (MHT), abnormal breast biopsy results, personal history of breast cancer, overweight or obesity (especially after menopause), physical inactivity, previous chest radiation, family history

Peyronie's disease

Shaft of the penis is crooked during an erection

Hard, nodular shelf at the tip of the examining finger just above the prostate in males and in the cul-de-sac of females are called _____ lesions?

Shelf

List the 2 positions you should palpate the breasts and axillae?

Sitting and supine

What position does the patient start in for inspection?

Sitting.

Which of these is included in assessment of general appearance?

Skin color ANS:C Page: 764. General appearance includes items such as level of consciousness, skin color, nutritional status, posture, mobility, facial expression, mood and affect, speech, hearing, and personal hygiene. Height, weight, and vital signs are considered measurements.

Clitoris

Small long mound of erectile tissue

Genital Herpes

Small vesicles appear in clusters and are painful. The area around the vesicles is erythematous. Virus may be dormant for long periods of time.

Clincal manifestations of invasive breast cancer

Solitary, unilateral lump, discoloration, vein prominence, peau d'orange, dimpling, serosanguineous or clear nipple discharge

Intraductal Papilloma: Findings

Spontaneous blood discharge from the nipple, occasionally mass is palpated

Clinical manifestations of intraductal pailloma

Spontaneous bloody discharge

What type of cancer causes anal cancer and is associated with HPV infections?

Squamous cell carinomas

When should breast self-exams begin?

Starting at age 20

What is the position of the patient when palpating the breast

Supine

The correct position in which to place the patient to palpate the breasts is A. left lateral position with arm over head B. sitting forward with hands on hips C. supine with arm over head D. supine with arms at side

Supine with arm over head. A pillow should also be placed under the patient's shoulder on the side being assessed. The patient should be supine for the examination.

Inflammation may cause

Surface erythema and heat

Pendulous

Suspended so as to swing freely

What prevents the uterus from dropping into the vaginal canal?

Suspensory ligaments

What is gynecomastia?

Swollen male breast tissue caused by a hormone imbalance

What is the second step when assessing the breast/axillae in the supine position?

Systematically palpate all quadrants and the tail of Spence, rotating finger pads and using light, medium, and deep pressure.

Palpate systematically, pushing gently but firmly, towards the chest with your fingers rotating in a clockwise or counterclockwise position, including the ___________.

Tail of spence

Primary Prevention

Tamoxifen and raloxifen should not be used for women at low or average risk for breast cancer

Gynecomastia

Temporary breast enlargement in males. Usually resolve spontaneously.

Gynecomastia may occur in an older male secondary to A. testosterone deficiency B. lymphatic engorgement C. trauma D. decreased activity level

Testosterone deficiency. Changes in testosterone levels promote breast growth. Lymphatic engorgement does not naturally accompany aging. Trauma may cause inflammation but not gynecomastia. Decreased activity level may occur with aging, but it does not affect the breast tissue.

What are the stages of breast development called?

The Tanner Stage

What palpation method is most effective by the American Cancer Society?

The Vertical Strip Method. Use the finger pads of your first 3 fingers. Light - Medium - then Deep.

The nurse is conducting a class about breast self-examination (BSE). Which of these statements indicates proper BSE technique?

The best time to perform BSE is 4 to 7 days after the first day of the menstrual period. ANS: C Page: 398 The nurse should help each woman establish a regular schedule of self-care. The best time to conduct breast self-examination is right after the menstrual period, or the fourth through seventh day of the menstrual cycle, when the breasts are the smallest and least congested. Advise the pregnant or menopausal woman who is not having menstrual periods to select a familiar date to examine her breasts each month, for example, her birth date or the day the rent is due.

Describe the changes to the physical appearance of the female breast in the older adult?

The breast will be less firm, more pendulous, and the nipples will be smaller and flatter.

For women that do not menstruate, when is the best time for the Self Breast Exam?

The first of the month or on the same day every month.

What are the statistics for African American women developing breast cancer?

The incidence of having breast cancer is low, but the mortality rate is higher compared to Caucasian women.

What happens to breast tissues in older adults?

The ligaments begin to atrophy.

In performing a breast examination, the nurse knows that it is especially important to examine the upper outer quadrant of the breast. The reason for this is that the upper outer quadrant is:

The location of most breast tumors. ANS:B Pages: 384-385. The upper outer quadrant is the site of most breast tumors. In the upper outer quadrant, the nurse should notice the auxiliary tail of Spence, the cone-shaped breast tissue that projects up into the axilla, close to the pectoral group of auxiliary lymph nodes.

Gravida

The number of pregnancy that a woman is in.

What is important about colorectal cancer?

The risk increases with age.

What shows wide variation in the breasts?

The size and shape of the breasts

Goodell's sign

The softening of the cervix when during pregnancy, the vascularity of the cervix increases.

Supernumerary

These are accessary nipples 5-6 cm below where the nipple is supposed to be.

Ovarian, Endometrail, Colon cancer

These cancers increase risk for breast cancer

What happens to women's breasts when they become pregnant?

They experience breast changes and enlargement beginning in the first 2 months of pregnancy.

Candidiasis

Thick, cheesy white discharge and vulva and vagina are erythematous

Witch's milk

Thin discharge from breast of an infant

What is ballottement?

This is a palpation technique to assess for fluid or mass in a specific body region, (i.e. abdominal area, joints etc...)

Montgomery's Glands

Tiny sebaceous glands speckled all over areola surface

What should a nurse place a pillow under the knees of the client?

To relax the abdominal muscles.

Breast buds

Transient masses beneath areola of male

What is the 7th step when palpating the breasts in the supine position?

Transilluminate the mass to determine if it contains fluid

A firm transverse ridge of compressed tissue may be felt along the lower edge of the female breast, this is called the inframmammary ridge? T/F

True

Adolescent males may develop breast enlargement. True or False?

True

An unexplained fever should always include the rectal examination? T/F

True

Breast feeding decreases the risk for breast cancer. True or false?

True

Caucasians over 40 have higher incidence of breast cancer than any other ethnicity/race. True or false?

True

Female who have never had children or who have had their 1st child after age 30 are at greater risk for breast cancer. True or false?

True

High fat diets increase risk of breast cancer. True or False?

True

Hormone replacement therapy increases risks of breast cancer. True or False?

True

It is not uncommon for some infants to produce a thin discharge from their breasts. True or false?

True

Night shifts increase the risk of breast cancer. True or false?

True

Shrunken buttocks can suggest a chronic debilitating disease in a young child? T/F

True

Supernumerary nipples are more common in black women than in white women and appear as one or more extra nipples located along the embryonic mammary ridge? T/F

True

Fundal height at 28 weeks is halfway between the umbilicus and the xiphoid process? T/F

True 6 weeks - same as non-pregnant 8-10 weeks - larger than non-pregnant (grapefruit) 12 weeks - pubic symphysis 16 weeks - halfway between pubic symphysis and umbilicus 20 weeks - just under mother's umbilicus 28 weeks - halfway between umbilicus and xiphoid process 36 - 38 weeks at xiphoid process 39-42 weeks - drops back down (lightening)

Normal fetal heart rate is 120-160? T/F

True Heart with doppler at 12 weeks Fetoscope at 18-20 weeks

External hemorrhoids are varicose veins that orignate below the anorectal line and are covered by anal skin? T/F

True Internal hemorrhoids - originate above the anorectal junction and are covered by rectal mucosa

When you have a blocked lymph drainage system in the breast that is edematous, it may have a peau d'orange appearance? T/F

True - due to advanced or inflammatory carcinoma

Torsion of the spermatic cord

Twisting of the testicle or spermatic cord that requires immediate surgical intervention.

What is the percussion sound over the abdominal cavity?

Tympany.

Fibrocycstic breast disease

Typically seen in females in their 20's and is characterized by lumps, breast pain or tenderness, and nipple discharge. Aka benign breast disease

What is cryptorchidism?

Undescended testes

Paget's Disease

Unilateral breast rash(red, scaly nipple with discharge and crusting that lasts more that a few weeks), espically surrounding the areola

Clinical manifestations of fibroadenoma

Unilateral, small, rubbery lump Does not change premenstrually

What quadrant of the breast is cancer mostly found on?

Upper outer quadrant including the tail of spence

Serous (yellow) nipple discharge

Usually normal

What are the internal female reproductive organs?

Vagina, Uterus, Cervix, Fallopian tubes, Ovaries

Chadwicks sign

Vascular congestion that creates a blue-purple blemish or change in cervical coloration

What pattern is recommended when palpating the breasts?

Vertical

Vitamin taken to reduce breast edema and tenderness

Vitamin E

It is important to examine the upper outer quadrant of the breast because it is A. more prone to injury and calcifications B. where most breast tumors develop C. where most of the suspensory ligaments attach D. the largest quadrant of the breast

Where most breast tumors develop. Most tumors occur in this region, which is called the tail of Spence.

How would you asses the abdominal reflex?

With a pen. The umbilicus should move towards the pen.

When does breast tissue begin to enlarge in females?

With onset of puberty, 9 to 13 yrs of age. Correlated with increased estrogen and progesterone.

In what position would you inspect and palpate male breasts?

With pt. sitting and arms hanging freely at the sides.

The nurse is assisting with a self-breast examination clinic. Which of these women reflect abnormal findings during the inspection phase of breast examination?

Woman whose nipples are in different planes (deviated) ANS:A Pages: 392-393 | Page: 404. The nipples should be symmetrically placed on the same plane on the two breasts. With deviation in pointing, an underlying cancer causes fibrosis in the mammary ducts, which pulls the nipple angle toward it. The other examples are normal findings. See Table 17-3.

White

Women have the highest risk

What are a good group of landmarks for the abdominal region?

Xiphoid process, costal margin, umbilicus, pubic bone, vertebral column, midclavicular line.

Can men get breast cancer?

Yes.

Can you hear a friction rub in the case of Peritonitis?

Yes.

Should women with implants have self breast exams?

Yes.

How will you palpate the patient?

You feel for lymph nodes against the chest wall. Use right hand to palpate left.

When testing stool for occult blood, the nurse is aware that a false-positive result may occur with:

a large amount of red meat within the last 3 days. ANS:D Pages: 716-717. When testing for occult blood, a false-positive finding may occur if the person has ingested significant amounts of red meat within 3 days of the test. Absent bile pigment causes the stools to be gray or tan in color. Increased fat content causes the stool to be pale, yellow, and greasy. Increased ingestion of iron medication causes the stool to be black in color.

What are the signs and symptoms of testicular cancer? (5)

a lump or enlargement in either testicle a feeling of heaviness in the scrotum a dull ache in the abdomen or groin a sudden collection of fluid in the scrotum pain or discomfort in a testicle or the scrotum

What is Hepatitis C?

a non-vaccine preventable disease that can cause acute disease but can lead to chronic disease; Contaminated needles for drug use, blood transfusions, blood contact.

What is Hepatitis B?

a virus that causes liver disease, which is transmitted via contact with infected blood, saliva, or through intercourse.

During the breast exam, the nurse asks the client to raise her arms over her head. Why did the nurse change the client's position? a. Skin dimpling is accented in this position. b. The nurse couldn't palpate the axillae correctly. c. The client has small breasts. d. The client has large breasts.

a. Skin dimpling is accented in this position.

What abdonimal changes occur in pregnancy?

abdonminal muscles relax, rectus abdminis muscles separate, stomach rises w/growing fetus, compression of bowels causes constipation, venous pressure in lower abdomen increases and can cause hemorrhoids, appendix is displaaced upward and laterally to the right, linea nigra, umbilicus everted in late pregnancy, striae.

DCIS, LCIS: Findings

abnormal mammogram helps determine ____

Nipple Discharge

abnormal usually,during pregnancy and lactation this is normal. When palpating try to determine the orgin by gently palpating the areola look for discharge through one of the duct openings

A _____ is the termination of pregnancy before 20 weeks while a ______________ is termination after 20 weeks?

abortion stillbirth

Females

account for 99% of breast cancer cases

First Full Term Pregnancy

after age 30 increases risk

Before you Begin

always explain the procedure, inform that i will be touching her breasts, and to obtain permission

What is a Alanine aminotransferase test?

an enzyme mainly found in the liver; the best test for detecting hepatitis.

Alkaline phosphatase

an enzyme related to the bile ducts but also produced by the bones, intestines, and during pregnacy by th eplacenta (afterbirth); often increased when bile ducts are blocked.

Nipple Discharge-Male

an uncommon associated symptom of breast cancer, usually serosanguineous

Secondary Prevention

annual screening, CBE, BSE

African American Women

are more likely to die from breast cancer than any other race or ethnic group

Glandular Tissue

arranged into 15 to 20 lobes per breast, radiating around the nipple in a spoke-like pattern. The largest amount in the breast is in the upper outer quadrant of each breast. Each lobe is composed of 20 to 40 lobules, or alveoli, containing acini cells.

Sitting Position for Women with Very Large Breasts

ask client to lean foward and positon hand between the breasts, while supporting the inferior side of the breast with one hand, palpate the breast with the other hand starting at the top of the breast and slowly slide the finger pads down the breasts, repeat until all the breast tissue is covered.

A pregnant client is upset and thinks she has breast disease because she has a thick white discharge coming from her left breast. What can the nurse say or do for this client? a. Nothing. This client needs a mammogram as soon as possible. b. A thick yellow discharge from the breasts during pregnancy is normal. c. Call the physician. This information is not normal. d. Help the client understand that she might not be able to breastfeed her infant.

b. A thick yellow discharge from the breasts during pregnancy is normal.

An elderly female client wants to know when she can stop doing breast exams. What can the nurse say to this client? a. It's not really necessary at your age. b. Breast cancer can still develop when you get older. c. Probably in a month or two. d. You can stop five years after menopause.

b. Breast cancer can still develop when you get older.

A 20-year-old student comes to the student health center after discovering a small painless lump in her right breast. She is worried that she might have cancer because her mother had cervical cancer. The nurse's response to the patient is based on the knowledge that the most likely cause of the breast lump is a. fibrocystic complex. b. fibroadenoma. c. breast abscess. d. adenocarcinoma.

b. Fibroadenoma.

When assessing a patient for breast cancer risk, the nurse considers that the patient has a significant family history of breast cancer if she has a a. cousin who was diagnosed with breast cancer at age 38. b. mother who was diagnosed with breast cancer at age 42. c. sister who died from ovarian cancer at age 56. d. grandmother who died from breast cancer at age 72.

b. Mother who was diagnosed with breast cancer at age 42.

A female client tells the nurse, "I know I should examine my breasts but I just don't." What should the nurse do with this information? a. Nothing. b. Talk with the client about possible fears associated with the breast exam. c. Instruct the client on how to perform the breast exam again. d. Instruct the client on getting an annual mammogram instead.

b. Talk with the client about possible fears associated with the breast exam.

3-4 Days

before the menstrual cycle breasts may be tender, full, tense, and pain because of hormonal changes and fluid retention

Ductal Ectasia

benign breast disease, inflammation and dilation involving one or multiple subareolar ducts. Affects perimenopausal and post menopausal women

Fibroadenoma

benign breast tumor amoung young women, consists of glandular and fibrous tissue

What are Fibrocystic changes in the breast?

benign, palpable diffuse breast lumps that fluctuate with menstrual cycle. They cause breast tenderness.

What is Fibroadenoma?

benign, slow-growing breast tumor w/ epithelial and stromal components. Most common breast lesion in women <30yo.

The venous pattern in the breasts should be ___________.

bilaterally similar

Venous Patterns

bilaterally similar, may be pronounced in obese or pregnant females, unilateral may be secondary to increased blood flow to a malignancy

Pregnancy

breast change in response to luteal and placental hormones. Increase in lactiferous ducts and increase in size and number of alveoli

Thelarche

breast development

Smallest

breasts are____ during days 4-7 of the menstrual cycle

Reproductive Years

breasts undergo cyclic pattern of size change, nodularity, and tenderness during the menstural cycle

During a health history of a patient who complains of chronic constipation, the patient asks the nurse about high-fiber foods. The nurse relates that an example of a high-fiber food would be:

broccoli. ANS:A Pages: 712-713. High-fiber foods are either soluble type (i.e., beans, prunes, barley, broccoli) and insoluble type (i.e., cereals, wheat germ). The other examples are not considered high-fiber foods.

The nurse is planning a focused breast/axilla interview and wants to include a general health question. Which of the following questions would fit this criteria? a. Has your mother or sister had breast cancer? b. Have you ever had a mammogram? c. Are you still menstruating? d. Have you had any breast trauma?

c. Are you still menstruating? General health questions for the breast/axilla focused interview include a description of the breasts, changes in the breasts with menstruation, and date of the last menstrual period.

The client tells the nurse, "At times I have drainage from my right breast." What should the nurse do with this information? a. Write it in the medical record and say nothing to the client. b. Phone for a mammogram for the client immediately. c. Explain that this could be benign or it could mean something else. It needs to be further investigated. d. Nothing. It doesn't mean a thing.

c. Explain that this could be benign or it could mean something else. It needs to be further investigated.

Oral Contraceptives

can cause cyclic breast discomfort or nipple discharge

Shaving, Deodorants, Antiperspirants

can cause discomfort and a mild inflammation to the axilla

Nipple

centrally located on the breast, surrounded by the pigmented areola. composed of epithelium intertwinede with circular and longitudinal smooth muscle fibers

During an examination, a patient has just successfully completed the finger-to-nose and the rapid-alternating-movements tests and is able to run each heel down the opposite shin. The nurse will conclude that the patient's ____ function is intact.

cerebellar ANS: D Pages: 769-770. The nurse should test cerebellar function of the upper extremities by using the finger-to-nose test or rapid-alternating-movements test. The nurse should test cerebellar function of the lower extremities by asking the person to run each heel down the opposite shin.

What is the sixth step when palpating the breasts in the supine position?

characterize any breast mass by its dimensions, consistency, and mobility

During an examination, the nurse notices that a patient's legs turn white when they are raised above the patient's head. The nurse should suspect:

chronic arterial insufficiency. ANS: C Pages: 499-525. Elevational pallor (marked) indicates arterial insufficiency. See Chapter 20.

The nurse documents that a patient has coarse, thickened skin and brown discoloration over the lower legs. Pulses are present. This finding is probably the result of:

chronic venous insufficiency. ANS: D Pages: 499-525. Chronic venous insufficiency would present as firm brawny edema, coarse thickened skin, normal pulses, and brown discoloration. See Chapter 20.

Medications, Carcinoma

clear, watery nipple discharge

Palpate Nipples

client in supine position. should be soft, pliable with no masses or discharge.

note deviations in contour and symmetry

client is still seated and pushes her hands onto her hips- contracting pectoral muscles.

evaluates symmetry and bilater pull, should hang equally

client is still seated, arms still raised, have client lean foward- useful for women with very large breasts

Palpate Axillae

client relaxs both arms at her sides. Using my let hand, life one of the clients arms and supports it so that her muscles are loose and relaxed

evaluate bilateral pull on suspensory ligaments, dimpling or retractions

client remains seated and raises her arms over her head- this adds tension the the suspensory ligaments

Male Breast Exam

client seated with arms at side, nipples are areola intact, smooth, evenly pigmented and of equal color, size and shape bilaterally. Tissue feels smooth, intact, and nontender, Axillary lymph nodes are non palpated.

Nipple color ranges from _____ to _______. The nipples should _______ in color.

color ranges from pink to black; match

Unilateral Nipple Discharge

commonly associated with a pathological condition more than bilateral nipple discharge

Breast Abscess

complication that can occur with ductal ectasia

Inspect the Breast

contour-smooth, convex, and even; size-symmetry or slight asymmetry are normal

Dimpling, Retraction, Bulging

could indicate a malignancy

A client asks the nurse, "Why do I need to examine my armpits when I do my monthly breast exam?" Which of the following would be an appropriate response for the nurse to make to this client? a. This is the hardest area to feel for changes. b. Who told you that you have to do that? c. I'm not sure why that is important, but it sounds like it is. d. Breast tissue extends into the axilla.

d. Breast tissue extends into the axilla.

What are changes that occurs in older adults?

decreased saliva production and stomach acid, slowed peristalsis and gastric motility, problems swallowing, absorption, and digestion, reduced muscle mass and tone can cause constipation, fat accumulation, and liver decreases in size and function .

In Situ

decreibes an early, noninvasive stage of cancer

Milk Lines

develop embryologic development. An embryonic ridge that extends between the limb buds of what will become the axillae and the inside of the pectoral region

Lactiferous Ducts

drain milk from the lobes to the surface of the nipple

Noninvasive Breast Cancer

ductal carcinoma in situ and lobular carcinoma in situ

Pendulous breast are...

easier to visualize if she leans forward with arms on hips. Well endowed.

Peau d'orange is...

edema from blocked lymph drainage; indicates advanced cancer.

Obesity

especially after age 50 or increased weight gain as an adult increases breast cancer risk

First Degree Family Member

especially before age 50 increases risk, espically if family member is mother or sister

You should always compress the nipple to provoke discharge during the BES? T/F

false - it is no longer performed due to many benign circumstances can result in nipple discharge

Past Breast Problems?

fibrocystic disease and fibroadenoma complicate the evaluation of the breasts because the presence of cysts make it difficult to detect new masses or lumps

Other Routes for Lymph Drainage

flow through the anterior axillae, internal mammary nodes, and subdiaphragmatic nodes, and through the cross-mammary pathways to the opposite breast

Lymph System

fluid left in the interstitial spaces in absorbed by the ___ and carried through the lymph nodes

Inspect Breasts

for color, pigmentation, cascularity, surface characteristics, and lesions. Should be smooth and evenly pigmented, may be lighter than sun exposed body parts.

Axillary Tail of Spence

from the upper outer quadrant the breast tissue extends into the axilla

Female breast is composed of three types of tissue

glandular, fibrous, and subcutaneous and retromammary fat

Hispanic Women

have the lowest rate of cancer screening of any ethnic group

Breast Self Exam

helps educate and encourage health enhancing behaviors. Women should know how their breasts normally feel and be encouraged to report any breast change promptly

What are male risk factors?

high levels of estrogen/estrogen related drugs, exposure to radiation, over age 60, heavy alcohol consumption, obesity, inherited gene mutations, family hx. of breast cancer.

Increased Breast Density

higher risk of breast cancer, non modifiable

Nipple Contraction

in response to sensory, tactile, or autonomic stimuli, producing erection of the nipple and causing the lactiferous ducts to empy

Internal Mammary Nodes

in the thorax

Galactorrhea

inappropriate lactation, endocrine related disorders(pituitary tumor), systemic diseases(renal failure) and side effects of many medications(dopamine supressents, morphine, codeine)

History of Breast Cancer

increased risk for subsequent episodes

Nupillarity

increased risk, never having children

History of Proliferative Breast Disease

increased risk; history

Breast, Arm, Hand

infections may cause lymphatic drainage into the axillary area

What is Hepatitis?

inflammation of the liver

Mastitis

inflammatory of breast usually by a bacterial infection. Lactating women secondary to milk stasis or a plugged duct. Non lactating women secondary to foreign bodies or from trauma

Candidiasis

large breasted, or obese women may have this due to excessive moisture

Copper's Ligaments

layer of subcutaneous fibrous tissue and multiple fibrous bands that support the breast. They extend from the connective tissue layer and run through the breast, attaching to the underlying muscle fasia

What are indications of benign? (9)

less than 35 years old, multiple lumps, painful, no bleeding, soft/rubbery, regular/nodular, mobile, and no weight loss.

Bilateral Breast Rash

likely caused by dermatitis

Lymphedema

localized accumulation of lymph fluid in the interstitial spaces caused by removal of the lymph nodes

Fibrocystic Changes

lots of breast problems associated with multiple benign masses within the brease caused by ductal enlargement and the formation of fluid filled cysts, commonly seen amoung middle aged women.

If a unilateral inversion of the nipples has developed recently, suspect what?

malignancy

Mastectomy Scar Site

malignancy recurrence is possible. Inspect for color changes, redness, rash, irritation, visible signs of edema, thickening or lumps, and note any areas of muscle resection

Breast Palpation Abnormal Findings

masses, isolated areas of tenderness or pain and breast engorgement in clients who are not pregnant or premenstrual

Witch's Milk

maternal hormones are responsible for a small watery, whitish discharge, seen in small percent of newborns during the first few weeks of life

Transillumination

may be used to confrim the presence of fluid in superficial masses

Non Spontaneous Nipple Discharge

may result from medications or from endocrine disorders

Long Menstural History

menarche before age 12;menapause after 50 increases risk

Lactation

milk produced by the acini cells empties into the lactiferous ducts

Acini Cells

milk producing cells

Pituitary Adenoma, Medications, Galactorrhea

milky nipple discharge

Galactorrhea: Findings

milky-appearing nipple discharge, no other specific symptoms

An 85-year-old man has come in for a physical examination, and the nurse notices that he uses a cane. When documenting general appearance, the nurse should document this information under the section that covers:

mobility. ANS: B Page: 764. Use of assistive devices would be documented under the mobility section. The other responses are all other categories of the general appearance section of the health history.

Bilateral Breast Pain

more likely attributed to hormonal effects

Fibrocystic Changes, Carcinoma, Infection, Ductal Ectasia

multicolored (green, gray, brown) nipple discharge

cytologic exam

nipple discharge is considered abnormal and a specimen should be collected for possible____.

Nipple Retraction

nipple that is pointing or pulled in a different direction is suffestive of malignancy and client should be referred for further evaulation

Nipple Inversion

nipple that is recessed as opposed to protruding, can be normal(not a new finding and can be everted with manipulation) or abnormal(recent)

Gynecomastia

noninflammatory enlargement of one or both male breasts, maternal hormones, at puberty the condition is idiopathic and transient, causes in adult men- medication side effects, adrenal or testicular tumors, liver disease or renal disease

Supernumerary

normal, look similar to pink or brown moles and generally appear along the "milk line"

A patient who is visiting the clinic complains of having "stomach pains for 2 weeks" and describes his stools as being "soft and black" for about the last 10 days. He denies taking any medications. The nurse is aware that these symptoms are most indicative of:

occult blood resulting from gastrointestinal bleeding. ANS:C Page: 712. Black stools may be tarry due to occult blood (melena) from gastrointestinal bleeding or nontarry from ingestion of iron medications (not diet). Excessive fat causes the stool to become frothy; absence of bile pigment causes clay-colored stools.

Enlargement and Tenderness

of axillae lymph nodes indicated infection

Hard, Fixed Nodules

of axillae lymph nodes suggest metastic carcinoma or lymphoma

Neonates

of both genders may have slightly enlarged breast secondary to the mother's estrogen

Risk factors associated with prostate cancer?

older than 50 Black > white Nationality FH of prostate cancer Diet high in animal fat Hormones Physical inactivity

What are some risk factors for Colorectal cancer?

older than 50 Family and personal history of colorectal cancer, polyps, IBS, Gardner syndrome Personal hs of ovarian, endometrial, breast cancer Ashkenazi Jewish descent Diet high in beef and animal fats and low in fiber Obesity and smoker, physically inactive, ETOH

Fibrocystic Changes: Findings

one or more palpable masses that are round, well delineated, mobile, and tender. can be slightly tender to very painful, often fluctuate in size and tenderness with the menstrual cycle, symptoms tend to subside after menopause

Bloody Nipple Discharge

or blood-tinged is alarming and must be investigated

Palpating Axillae

palpate for areas of enlargement, masses, lymph nodes, or isolated areas of tenderness. Should not expect to feel breast lymph nodes

Quiz 5: A patient states during the interview that she noticed a new lump in the shower a few days ago. It was on her left breast near her axilla. The nurse should plan to:

palpate the unaffected breast first. ANS:B Page: 398 If the woman mentions a breast lump she has discovered herself, the nurse should examine the unaffected breast first to learn a baseline of normal consistency for this individual.

Mastectomy Palpation

paplate axillary and supraclavicular areas for lymph nodes. if client has had breast reconstruction or augmentation, perform the breast exam in the usual manner paying close attetion to scars

A patient tells the nurse that "sometimes I wake up at night and I have real trouble breathing. I have to sit up in bed to get a good breath." When documenting this information, the nurse would note:

paroxysmal nocturnal dyspnea.

While examining a 75-year-old woman, the nurse notices that the skin over her right breast is thickened and the hair follicles are exaggerated. This condition is known as:

peau d'orange. ANS:C Page: 404. This condition is known as peau d'orange. Lymphatic obstruction produces edema, which thickens the skin and exaggerates the hair follicles. The skin has a pig-skin or orange-peel look, and this condition suggests cancer.

The nurse has just recorded a positive obturator test on a patient who has abdominal pain. This test is used to confirm a(n):

perforated appendix. ANS: C Pages: 527-564. A perforated appendix irritates the obturator muscle, producing pain. See Chapter 21.

Infection, Ductal Ectasia

purulent nipple discharge

What are we inspecting for on the axillae? (4)

rash, infection, texture changes, unsual pigmentation.

Palpate Axillae

reach my fingers deep into the axilla, and slowly and firmly slide my fingers along the clients chest wall, first down the middle of the axilla, then along the anterior border of the axilla and finally along the postior border

Clinical Breast Exam

recommended every 3 years for women between ages 20-39; anually for 40yoa. Determine when last one was performed for women over 40

Vitamin E

reduce symptoms of breast edema and tenderness

Women With Mastectomy

require the same breast assessment as all other women

Lobular Carcinoma in Situ

risk factor for subsequent development of breast cancer

Peau d' Orange

roughened, tough, edema, or thickened skin. orange textured like

Describe the normal shape of areolae and nipples.

round or oval and nearly equal

Carcinoma, Intraductal Papilloma, Ductal Ectasia,

sanguineous nipple discharge

Paget's Disease is...

scaly lesions on the nipple, reddish.

Montgomery's Glands

sebaceous glands, are located within the areolar surface, aiding in lubrication of the nipple during lactation

Carcinoma, Ductal Ectasia

serosanguineous nipple discharge

usually normal

serous nipple discharge

First Position

sitting on exam table facing me, sitting erect with gown dropped to the waist- for inspection

Palpate Breast Tissue Position-Difficulty

sitting position for clients who can't lay down, young and has very small breasts, or very large breasts making palpation difficult in a supine position

Intraductal Papilloma

small benign, wartlike tumor growth in the major ducts usually within 1 or 2 cm of the areolar edge. women 40-60 years of age

Describe normal texture of areolae

smooth except for Montgomery tubercules

Describe normal texture of nipples

smooth or wrinkled

What is a normal testicular finding?

smooth, rubbery consistency of each testicle, no nodules are palpable, epididymis feels smooth and non tender.

Invasive Breast Cancer: Findings

solitary, unilateral, nontender lump, thickening or mass. as the mass grows breast may become asymmetrical, discolored, unilateral vein prominence, peau d'orange, ulceration, dimpling, puckering or retraction of the skin, lymph nodes may be palpated in the axillae

Ductal Ectasia: Findings

sticky nipple discharge that is commonly dark green or black, inflammatory s/s occur later, burning or itching of the nipple and edema in the areolar area

What is a hiatal hernia?

stomach herniates upward through the esophageal hiatus in the diaphragm

Unilateral Breast Pain

suggest a pathological condition

Headaches, Vision Changes, Nipple Discharge

suggest a pituitary tumor or mass

Palpate Breast Tissue Position

supine with a small pillow under the shoulder of the breast to be examined. Client is to place her arm over her head- this flattens the breast tissue evenly over the chest wall

onset, location, duration, characteristics, aggravating, alleviating factors, related symptoms and treatment

symptom analysis

What is the Murphy's sign?

tenderness of the liver or gallbladder.

Glandular, Fibrous, Subcutaneous and Retromammary Fat Tissue

the breasts are composed of three types of tissue

What is gynecomastia?

the enlargement of the male breast as a result of changing hormone levels.

The nurse is discussing breast self-examination with a postmenopausal woman. The best time for postmenopausal women to perform breast self-examination is:

the same day every month. ANS: A Page: 398. Postmenopausal women are no longer experiencing regular menstrual cycles but need to continue to perform breast self-examination on a monthly basis. Choosing the same day of the month is a helpful reminder to perform breast self-examination.

Prostate cancer is...

the second leading cause in men.

Palpate Axillae

thurn my hand over and examine the inner aspect of the clients upper arm

Radiation Exposure

to chest area as child or young adult for treatment of other cancer increases risk

Atrophic Changes

to female breast begin by age 40 and continue through menopause, gradually flatten

Subdiaphragmatic Nodes

toward the abdomen

Ductal carcinoma in situ

true precursor of invasive ductal carcinoma, more important, clinically detected as a lump with well defined margins or nipple discharge

Abnormal Areola

unequal bilaterally, irregular shape, lesions or changes in pigmentation

Gynecomastia: Findings

unilateral or bilateral and manifests as enlargement of the male breasthard, painless, irregular nodule often fixed to the area under the nipple

When describing breast contour, the contour should be ____________

uninterupted

Palpate Breast Tissue Technique

using finger pads of first two or three fingers on examining hand, gently, firmly and systematically palpate all four quadrants of the breast and tail of spence

Mastectomy Palpation

using finger pads, palpate the side of the mastectomy, especially around the scar, small circular motion, then use a sweeping motion to paplate entire chest area on the affected side to ensure nothing has been missed

Mastitis: Findings

usually one area of the breast, red edematous, tender, warm to the touch, and hard. axillary lymph nodes are often enlarged and tender, client usually has fever,chills, and malaise

Fibroadenoma: Findings

usually unilaterally as a small solitary, firm, rubbery, nontender lump, generally mobile and well delineated. does not change premenstrually

Breast Location

within the superficial fascia of the anterior chest wall. Extend vertically from the second to sixth ribs and laterally from the sternal margin to the midaxillary line