Module 4 NUR 114 (Ch.74 IGGY), chapter 73 Medsurg Transgender, Chapter 72: Care of Patients with Male Reproductive Problems, Adult Health Exam 4

A 23-year-old female was admitted to the hospital for intravenous antibiotic treatment of pelvic inflammatory disease. The provider has ordered cefazolin (Ancef) to be administered every 8 hours. At what rate should the nurse infuse the medication if the pharmacy provides 1 g of the medication in 50 mL of 0.9% NaCl to infuse in 30 minutes? (Record your answer using a whole number.) _____ mL/hr

100 mL/hr To calculate using the dimensional analysis method: (50 mL/30 min) (60 min/1 hr) = 100 mL/hr.

A 69 yr-female comes in to the with complaints of a stiff neck, hearing loss and inability to move her right arm. The Student nurse assessing her would most likely suspect: A. Tertiary syphillis B. Secondary syphillis C. HIV D. Chlamydia

A

A person who self-identifies as the opposite gender or a gender that does not match their natal sex is described by which of the following terms? a. Transgender b. Transsexual c. Homosexual d. Gender dysphoria

A

Which client education from the nurse is need intervention on Toxic Shock Syndrome? A. During the nighttime I should try to use tampons instead of pads. B. abrupt onset high temperature and peeling of skin on hands and soles of feet are signs. C. I should wash my hands before inserting a tampon. D. Toxic Shock Syndrome can develop within 5 days after onset of menstruation.

A

A 26-year-old client with multiple sexual partners is being assessed for symptoms of dysuria and vaginal discharge. Because the results from the culture of the cervical cells are not available, the client will be treated for both Chlamydia and gonorrhea. Which explanation by the nurse is best? a. This early treatment will prevent obstruction to the fallopian tubes. b. Only azithromycin (Zithromax) is prescribed for both sexually transmitted diseases. c. The treatment will prevent aortic valve disease and aneurysms. d. Oral antibiotic treatment will prevent frequent occurrences of meningitis.

A Both gonorrhea and Chlamydia can cause pelvic inflammatory disease and scarring of the fallopian tubes, resulting in infertility problems. Azithromycin is the treatment of choice for both sexually transmitted diseases, but ceftriaxone (Rocephin) is also recommended for treatment of gonorrhea. Aortic valve disease and aneurysms usually occur with tertiary syphilis. Meningitis occurs rarely with a gonorrhea infection and is usually treated with intravenous antibiotic therapy in the hospital setting.

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

A, B, D, E The nurse should keep all clients at the office for at least 30 minutes after the administration of benzathine penicillin G. Allergic manifestations consist of rash, shortness of breath, chest tightness, and anxiety, depicting anaphylaxis and serum sickness. Heart irregularity is not seen as an allergic manifestation.

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

A dusky color of the breast flap could indicate poor tissue perfusion and a decreased capillary refill. The nurse should notify the surgeon to preserve the tissue. It is normal to have a slightly reddened incision as the skin heals. The blood pressure is within normal limits and the temperature is slightly elevated but should be monitored. DIF: Applying/Application REF: 1476

3. A transgender client is taking transdermal estrogen (Climara). What assessment finding does the nurse report immediately to the provider? a. Breast tenderness b. Headaches c. Red, swollen calf d. Swollen ankles

A red, swollen calf could be a manifestation of a deep vein thrombosis, a known side effect of estrogen. The nurse reports this finding immediately. The other manifestations are also side effects of estrogen, but do not need to be reported as a priority.

What are signs and symptoms of a fibroadenoma? Select all that apply: A. Rubbery B. Movable C. Oval D. Hard E. Firm

A, B, C

A primary care clinic sees some clients with sexually transmitted diseases. Which clients would the nurse be required to report to the local authority in every state, according to the Centers for Disease Control and Prevention? (Select all that apply.) a. Client with Chlamydia b. Woman with gonorrhea c. Man with syphilis d. Client with human immune deficiency virus e. Female with pelvic inflammatory disease

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

The nurse is providing education to a female patient on screening of cervical cancer. Which screening methods recommended by the American Cancer Society, should the nurse include? SELECT ALL THAT APPLY: a. Women should begin screening precautions at 21 years old b. Pap test should occur every 3 years for women 21-29 c. Co testing of HPV and PAP test every 5 years for women 30-65 d. Women should get screen yearly beginning at 21 years e. Women older than 65 who have had previous normal PAP results should not receive further testing.

A, B, C, E

A nurse is teaching a client with Chlamydia. What education can the nurse provide for treatment of this STI? SELECT ALL THAT APPLY: a. Finish ALL antibiotics before engaging in sexual activity b. Inform all sexual partners that may have been exposed c. This disease is not curable d. Many people who have chlamydia also have gonorrhea so it is important to test for both e. This disease is not easily spread

A, B, D

The nurse is teaching a client who is taking an oral antibiotic for treatment of a sexually transmitted disease (STD). Which statements by the client indicate a correct understanding of the treatment? (Select all that apply.) a. I need to drink at least 8 glasses of fluid each day with my antibiotic. b. I should read the instructions to see if I can take the medication with food. c. Antacids should not interfere with the effectiveness of the antibiotic. d. I need to wait 7 days after the last dose of the antibiotic to engage in intercourse. e. It should not matter if I skip a couple of doses of the antibiotic.

A, B, D When a client is being treated with an oral antibiotic for an STD, 8 to 10 glasses of fluid should be routine, medication instructions should be reviewed, and at least a week break should occur between the last dose of the antibiotic and sexual intercourse to allow for the medications full effects. Use of antacids and missing doses could decrease the effectiveness of the antibiotic.

A nurse is admitting a patient with a suspected STI. Which assessments would the nurse anticipate performing? Select all that apply: A: Sexual History B: Allergies C: Romberg Test D: Diagnostic Swabbing E: GU History

A, B, D, E

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

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

Which risk factors would the nurse teach a 23-year-old client about to prevent pelvic inflammatory disease (PID)? (Select all that apply.) a. Having multiple sexual partners b. Using an intrauterine device (IUD) c. Smoking d. Drinking two alcoholic beverages per day e. Having a history of sexually transmitted diseases (STDs)

A,B,C,E Some of the same factors that place women at risk for STDs also place women at risk for PID: sexually active women of age younger than 26 years, multiple sexual partners, use of an IUD, smoking, and a history of STDs. Alcohol consumption does not impact a womans risk for PID.

A 23-year-old female has been diagnosed with genital warts. Which action by the nurse is best? a. Encourage the client to have an annual Papanicolaou (Pap) test. b. Recommend an over-the-counter wart treatment for genital tissue. c. Report the case to the Centers for Disease Control and Prevention (CDC). d. Discuss popular options for contraception.

AAn annual Pap test is recommended (due the strong relationship between genital warts and the development of dysplasia of the cervix) until three normal Pap smears are obtained. The Pap smear can detect any malignancies of the cervix. Prescribed cream or gel such as podofilox (Condylox) is the recommended treatment, but not over-the-counter treatments. Genital warts, or condylomata acuminata, do not have to be reported to the CDC in all states. Pregnancy is not contraindicated with genital warts.

The nurse is assessing a client for reproductive health problems. What would be the priority assessments? (Select all that apply.) a. Bleeding b. Pain c. Sexual orientation d. Masses e. Discharge

ANS: A, B, D, E Bleeding, pain, masses, and discharge are common health problems that bring a client to a health care provider. Sexual orientation is not considered a health problem. Sexual activity should be assessed as part of the clients history.

1. Post transurethral resection of the prostate, a client has a three-way catheter with a continuous bladder irrigation. Over the last 12 hours, there has been 1400 mL of irrigation solution infused and 2000 mL measured in output from the drainage bag. What is the recording of the urinary output for the 12-hour period? (Record your answer using a whole number.) ____ mL

ANS: 600 mL 2000 mL from the drainage bag (including both the irrigation fluid and urine) minus the 1400 mL of irrigation fluid equals 600 mL of urine: 2000 mL 1400 mL = 600 mL.

1. A client states that she rates her pain as a 5 on a 0-to-10 scale post-mastectomy. The provider has ordered morphine 4 mg for moderate pain every 4 hours. The morphine is supplied in a solution of 8 mg/mL. How many mL will the nurse administer? ____ mL

ANS: 0.5 mL 8x = 4 x = 0.5 mL DIF: Applying/Application REF: 1481 KEY: Postoperative| pain| opioid analgesics| drug calculation MSC: Integrated Process: Nursing Process: Analysis NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

10. A 34-year-old client comes to the clinic with concerns about an enlarged left testicle and heaviness in his lower abdomen. Which diagnostic test would the nurse expect to be ordered to confirm testicular cancer? a.Alpha-fetoprotein (AFP) b.Prostate-specific antigen (PSA) c.Prostate acid phosphatase (PAP) d.C-reactive protein (CRP)

ANS: A AFP is a glycoprotein that is elevated in testicular cancer. PSA and PAP testing is used in the screening of prostate cancer. CRP is diagnostic for inflammatory conditions.

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

ANS: A Cloudy urine could indicate infection due to possible urine retention and should be a priority action. Common symptoms of benign prostatic hyperplasia are urinary hesitancy, post-void dribbling, and a weak urinary stream due to the enlarged prostate causing bladder outlet obstruction.

7. A client is diagnosed with metastatic prostate cancer. The client asks the nurse the purpose of his treatment with the luteinizing hormonereleasing hormone (LH-RH) agonist leuprolide (Lupron) and the bisphosphonate pamidronate (Aredia). Which statement by the nurse is most appropriate? a.The treatment reduces testosterone and prevents bone fractures. b.The medications prevent erectile dysfunction and increase libido. c.There is less gynecomastia and osteoporosis with this drug regimen. d.These medications both inhibit tumor progression by blocking androgens.

ANS: A Lupron, an LH-RH agonist, stimulates the pituitary gland to release luteinizing hormone (LH) to the point that the gland is depleted of LH and testosterone production is lessened. This may decrease the prostate cancer since it is hormone dependent. Lupron can cause osteoporosis, which results in the need for Aredia to prevent bone loss. Erectile dysfunction, decreased libido, and gynecomastia are side effects of the LH-RH medications. Antiandrogen drugs inhibit tumor progression by blocking androgens at the site of the prostate.

The nurse is working with a client who is recovering after a cervical biopsy. Which statement by the client indicates a need for further instruction? a. I can resume vaginal intercourse after 6 weeks. b. I should report heavy bleeding to the health care provider. c. I must not lift heavy objects for about 2 weeks. d. I will use the antiseptic rinse on a regular basis.

ANS: A The client should be instructed to keep the perineum clean and dry by using antiseptic solution rinses (as directed by her health care provider) and changing pads frequently. In addition, the client is instructed not to lift heavy objects for 2 weeks and to report excessive bleeding (more than like a normal period). She can resume intercourse in about 2 weeks, when the site has healed; she does not need to wait 6 weeks.

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

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

When scheduling an annual pelvic examination and Pap test, the client asks if she should abstain from intercourse before the test. Which is the nurses best response? a. Yes. Avoid having intercourse for 24 hours before the test. b. Yes. Avoid having intercourse for 2 hours before the test. c. No. Intercourse does not interfere with this test. d. No. Intercourse can actually enhance the test results.

ANS: A The woman should not douche, use vaginal medications or deodorants, or have sexual intercourse for at least 24 hours before the test. Such activities may prevent the accurate evaluation of smears, cultures, and cytologic data.

4. The nurse is teaching a client with benign prostatic hyperplasia (BPH). What statement indicates a lack of understanding by the client? a. There should be no problem with a glass of wine with dinner each night. b.I am so glad that I weaned myself off of coffee about a year ago. c.I need to inform my allergist that I cannot take my normal decongestant. d.My normal routine of drinking a quart of water during exercise needs to change.

ANS: A This client did not associate wine with the avoidance of alcohol, and requires additional teaching. The nurse must teach a client with BPH to avoid alcohol, caffeine, and large quantities of fluid in a short amount of time to prevent overdistention of the bladder. Decongestants also need to be avoided to lower the chance for urinary retention.

A client tells the nurse she is happy that she never had children because she has less risk of developing cancer. Which response by the nurse is best? a. Actually, your risk of breast cancer is slightly higher. b. You're right; your risk of all reproductive cancer is quite low. c. In reality, smoking is the leading risk factor for all types of cancer. d. Your risk of uterine cancer is higher because you had no children.

ANS: A Women who have never had children have a slightly higher risk of breast cancer than the general population. Smoking is a major risk factor for many, but not all, cancers. Uterine cancer is not influenced by pregnancy.

A client is in the clinic for an annual examination and questions the need for a pelvic examination and Pap smear because she had a hysterectomy many years ago. Which response by the nurse is most appropriate? a. Do you still have your cervix? b. Are you sexually active? c. We can skip it if you like. d. Lets see what the doctor says.

ANS: A Women who still have their cervix after hysterectomy still need a Pap smear according to the guidelines established for other women. Sexual activity is not relevant. Simply stating that it can be skipped does not help the woman protect her health. Asking the provider does not help the nurse further assess the client.

15. A client is placed on a medical regimen of doxorubicin (Adriamycin), cyclophosphamide (Cytoxan), and fluorouracil (5-FU) for breast cancer. Which side effect seen in the client should the nurse report to the provider immediately? a. Shortness of breath b. Nausea and vomiting c. Hair loss d. Mucositis

ANS: A Doxorubicin (Adriamycin) can cause cardiac problems with symptoms of extreme fatigue, shortness of breath, chronic cough, and edema. These need to be reported as soon as possible to the provider. Nausea, vomiting, hair loss, and mucositis are common problems associated with chemotherapy regimens. DIF: Applying/Application REF: 1477

1. The nurse is teaching a 45-year-old woman about her fibrocystic breast condition. Which statement by the client indicates a lack of understanding? a. This condition will become malignant over time. b. I should refrain from using hormone replacement therapy. c. One cup of coffee in the morning should be enough for me. d. This condition makes it more difficult to examine my breast

ANS: A Fibrocystic breast condition does not increase a womans chance of developing breast cancer. Hormone replacement therapy is not indicated since the additional estrogen may aggravate the condition. Limiting caffeine intake may give relief for tender breasts. The fibrocystic changes to the breasts make it more difficult to examine the breasts because of fibrotic changes and lumps.

A client has returned from the postanesthesia care unit after a vaginoplasty. What comfort measure does the nurse provide for this client? a. Apply ice to the perineum. b. Elevate the legs on pillows. c. Position the client on the left side. d. Raise the head of the bed.

ANS: A Ice is applied to the perineum to reduce pain and discomfort. Elevating the legs on pillows is not recommended after a lengthy procedure in the lithotomy position, which predisposes the client to venous thromboembolism. Positioning the client on the left side and raising the head of the bed are not comfort measures related to this procedure

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

ANS: A The alkaline phosphatase (normal value 30 to 120 U/L) and total calcium (normal value 9 to 10.5 mg/dL) levels are both elevated, suggesting bone metastasis. Both the hematocrit and hemoglobin are within normal limits for females. DIF: Applying/Application REF: 1470

11. A client is discharged to home after a modified radical mastectomy with two drainage tubes. Which statement by the client would indicate that further teaching is needed? a. I am glad that these tubes will fall out at home when I finally shower. b. I should measure the drainage each day to make sure it is less than an ounce. c. I should be careful how I lie in bed so that I will not kink the tubing. d. If there is a foul odor from the drainage, I should contact my docto

ANS: A The drainage tubes (such as a Jackson-Pratt drain) lie just under the skin but need to be removed by the health care professional in about 1 to 3 weeks at an office visit. Drainage should be less than 25 mL in a days time. The client should be aware of her positioning to prevent kinking of the tubing. A foul odor from the drainage may indicate an infection; the doctor should be contacted immediately. DIF: Applying/Application REF: 1474

4. A woman has been using acupuncture to treat the nausea and vomiting caused by the side effects of chemotherapy for breast cancer. Which conditions would cause the nurse to recommend against further use of acupuncture? (Select all that apply.) a. Lymphedema b. Bleeding tendencies c. Low white blood cell count d. Elevated serum calcium e. High platelet count

ANS: A, B, C Acupuncture could be unsafe for the client if there is poor drainage of the extremity with lymphedema or if there was a bleeding tendency and low white blood cell count. Coagulation would be compromised with a bleeding disorder, and the risk of infection would be high with the use of needles. An elevated serum calcium and high platelet count would not have any contraindication for acupuncture. DIF: Remembering/Knowledge REF: 1472

2. A student nurse is learning about the health care needs of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) clients. Which terms are correctly defined? (Select all that apply.) a. Gender dysphoria - Distress caused by incongruence between natal sex and gender identity b. Gender queer - A label used when gender identity does not conform to male or female c. Natal sex - The sex one is born with or is assigned to at birth d. Transgender - A person who dresses in the clothing of the opposite sex e. Transition - The time between questioning and establishing a sexual identity

ANS: A, B, C Gender dysphoria is emotional distress caused by the incongruence between natal sex (sex assigned at birth) and gender identity. Gender queer is a label sometimes used by people whose gender identity does not fit the established categories of male or female. Natal sex describes the gender a person is born with or is assigned to at birth. Transgender is an adjective to describe a person who crosses or transcends culturally defined categories of gender. Transition is the period of time when transgender individuals change from the gender role associated with their sex to a different gender role.

3. A nurse works with many transgender clients. What routine monitoring is important for the nurse to facilitate in this population? (Select all that apply.) a. Lipid profile b. Liver function tests c. Mammograms if breast tissue is present d. Prostate-specific antigen (PSA) for natal males e. Renal profile

ANS: A, B, C, D Common routine monitoring for this population includes lipid and liver panels, mammograms if any breast tissue is present, and PSA for natal males as the prostate is not removed during a vaginoplasty/penectomy. Renal profiles are not required based on treatment options for this population.

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

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

he nurse is reviewing possible complications from a phalloplasty. What factors does the nurse include? (Select all that apply.) a. Infection of donor site b. Necrosis of the neopenis c. Rectal perforation d. Urinary tract stenosis e. Vaginal infections

ANS: A, B, D Complications from phalloplasty include infection or scarring of the donor site, necrosis, and stenosis of the urinary tract. Rectal perforation can occur with vaginoplasty, as can infections.

The nurse is teaching high school girls about the female reproductive tract. Which statements by the nurse are accurate? (Select all that apply.) a. The vagina has an acidic environment. b. The cervix is where the Pap smear is taken from. c. The ovum is fertilized in the uterus. d. Ovaries produce sex steroid hormones. e. The breasts contain fat tissue.

ANS: A, B, D, E The acidic environment of the vagina helps protect against infection. The cervix is the site for Pap testing. The ovaries produce sex steroid hormones. The breasts contain fat, glandular, fibrous, and ductal tissue. Ova are fertilized in the fallopian tubes.

1. The nurse is administering finasteride (Proscar) and doxazosin (Cardura) to a 67-year-old client with benign prostatic hyperplasia. What precautions are related to the side effects of these medications? (Select all that apply.) a.Assessing for blood pressure changes when lying, sitting, and arising from the bed b.Immediately reporting any change in the alanine aminotransferase laboratory test c.Teaching the client about the possibility of increased libido with these medications d.Taking the clients pulse rate for a minute in anticipation of bradycardia e.Asking the client to report any weakness, light-headedness, or dizziness

ANS: A, B, E Both the 5-alpha-reductase inhibitor (5-ARI) and the alpha1-selective blocking agents can cause orthostatic (postural) hypotension and liver dysfunction. The 5-ARI agent (Proscar) can cause a decreased libido rather than an increased sexual drive. The alpha-blocking drug (Cardura) can cause tachycardia rather than bradycardia.

1. The nurse is taking a history of a 68-year-old woman. What assessment findings would indicate a high risk for the development of breast cancer? (Select all that apply.) a. Age greater than 65 years b. Increased breast density c. Osteoporosis d. Multiparity e. Genetic factors

ANS: A, B, E The high risk factors for breast cancer are age greater than 65 with the risk increasing until age 80; an increase in breast density because of more glandular and connective tissue; and inherited mutations of BRCA1 and/or BRCA2 genes. Osteoporosis and multiparity are not risk factors for breast cancer. A high postmenopausal bone density and nulliparity are moderate and low increased risk factors, respectively.

3. After a breast examination, the nurse is documenting assessment findings that indicate possible breast cancer. Which abnormal findings need to be included as part of the clients electronic medical record? (Select all that apply.) a. Peau dorange b. Dense breast tissue c. Nipple retraction d. Mobile mass at two oclock e. Nontender axillary nodes

ANS: A, C, D In the documentation of a breast mass, skin changes such as dimpling (peau dorange), nipple retraction, and whether the mass is fixed or movable are charted. The location of the mass should be stated by the face of a clock. Dense breast tissue and nontender axillary nodes are not abnormal assessment findings that may indicate breast cancer. DIF: Remembering/Knowledge REF: 1469

A young adult client is in the clinic for evaluation of amenorrhea lasting 3 months. She takes birth control pills but is on no other medications. Which actions by the nurse are most appropriate? (Select all that apply.) a. Instruct the client on collecting a urinalysis for a pregnancy test. b. Assess the clients urinary and bowel habits. c. Perform a physical assessment on the clients abdomen. d. Weigh the client and calculate the body mass index. e. Reassure the client that amenorrhea can occur with oral contraception.

ANS: A, D Amenorrhea can be caused by several things, but not by urinary or bowel problems. Pregnancy should always be considered, even if the woman is on birth control of any type. Too little body fat can lead to menstrual irregularities. Simply reassuring the client is not as helpful as conducting further assessment.

2. The nurse is formulating a teaching plan according to evidence-based breast cancer screening guidelines for a 50-year-old woman with low risk factors. Which diagnostic methods should be included in the plan? (Select all that apply.) a. Annual mammogram b. Magnetic resonance imaging (MRI) c. Breast ultrasound d. Breast self-awareness e. Clinical breast examination

ANS: A, D, E Guidelines recommend a screening annual mammogram for women ages 40 years and older, breast self-awareness, and a clinical breast examination. An MRI is recommended if there are known high risk factors. A breast ultrasound is used if there are problems discovered with the initial screening or dense breast tissue. DIF: Applying/Application REF: 1467

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

ANS: A, D, E, F Advanced family history of prostate cancer, age, a diet high in animal fat, and race are all risk factors for prostate cancer. Smoking and obesity are not known risk factors.

An African-American client has a prostate-specific antigen (PSA) of 12 ng/mL. Which action by the nurse is best? a. Remind the client to repeat the test in 1 year. b. Prepare the client for further diagnostic testing. c. Ask if the client ejaculated within 48 hours of the test. d. Assess the client for alcohol and tobacco use.

ANS: B A normal PSA level is less than 4 ng/mL. Elevated PSA levels, particularly those over 10 ng/mL, are associated with cancer. African Americans tend to have higher PSA levels as they age, but this level is so high that the nurse must suspect cancer and prepare the client for further diagnostic testing. The client should not wait a year to repeat the test. The client should not ejaculate for 24 hours before having blood drawn. Alcohol and tobacco use does not cause an elevation in PSA.

The nurse is preparing a teaching plan for a client who is scheduled to undergo mammography for the first time. What instruction by the nurse is accurate? a. The test should be carried out even if you are pregnant. b. Do not use deodorant on breasts or underarms before the test. c. You will not experience any discomfort because this is just an x-ray. d. The entire test should not take longer than 1 hour.

ANS: B The client should be reminded not to use creams, powders, or deodorant on breast or underarm areas before mammography because these products can show on the x-ray. The test should be rescheduled if any possibility exists that the client is pregnant. Women can experience discomfort as the breasts are compressed. The test is generally much less than an hour in duration.

The nurse is counseling a postmenopausal woman about her new stress incontinence. Which statement by the nurse is most important? a. You can try a variety of briefs and undergarments. b. It will be important to keep that area clean and dry. c. I can refer you to a good incontinence clinic. d. Unfortunately, incontinence is common in women your age.

ANS: B After menopause, the vagina becomes dry, thinner, and smoother. This atrophy places the vagina at risk for infection. The combination of this fact with the presence of urine places the woman at higher risk for infection. The nurse should teach the client good hygienic practices to reduce the likelihood of infection. Education about briefs/undergarments may be needed, and a referral to an incontinence clinic would be very helpful, but neither takes priority over preventing infection. Stating that incontinence is common is not a helpful strategy.

A 72-year-old woman is being assessed by the nurse for an annual physical. Which finding is of concern to the nurse? a. Thinning of pubic hair b. Increased size of the uterus c. Decreased size of the clitoris d. Loss of tone of the pelvic ligaments

ANS: B An increased size of the uterus is an abnormal finding and should be assessed further. Normal changes in the reproductive system related to aging include the graying and thinning of pubic hair, decreased size of the labia majora and clitoris, and loss of tone and elasticity of the pelvic ligaments and connective tissue. The uterus would normally be decreased, not increased, in size due to changes in hormonal levels and atrophy.

8. The nurse is administering sulfamethoxazole-trimethoprim (Bactrim) to a client diagnosed with bacterial prostatitis. Which finding causes the nurse to question this medication for this client? a.Urinary tract infection b.Allergy to sulfa medications c.Hematuria d.Elevated serum white blood cells

ANS: B Before administering sulfamethoxazole-trimethoprim, the nurse must assess if the client is allergic to sulfa drugs. Urinary tract infection, hematuria, and elevated serum white blood cells are common problems associated with bacterial prostatitis that require long-term antibiotic therapy.

5. A client has returned from a transurethral resection of the prostate with a continuous bladder irrigation. Which action by the nurse is a priority if bright red urinary drainage and clots are noted 5 hours after the surgery? a.Review the hemoglobin and hematocrit as ordered. b.Take vital signs and notify the surgeon immediately. c.Release the traction on the three-way catheter. d.Remind the client not to pull on the catheter.

ANS: B Bright red urinary drainage with clots may indicate arterial bleeding. Vital signs should be taken and the surgeon notified. The traction on the three-way catheter should not be released since it places pressure at the surgical site to avoid bleeding. The nurses review of hemoglobin and hematocrit and reminding the client not to pull on the catheter are good choices, but not the priority at this time.

The nurse is teaching a postmenopausal woman about nutrition. Which statement by the nurse is most appropriate? a. Be sure to eat cereal fortified with folic acid and B vitamins. b. Make sure you take a calcium supplement every day. c. Vitamin C is important for the postmenopausal woman. d. You can get all the iron you need in two daily meat servings.

ANS: B Calcium is important throughout life, but for the postmenopausal woman, it is vital to help prevent osteoporosis. Folic acid and B and C vitamins are very important for the woman taking oral contraceptives. Iron might be important for this client for other reasons but is especially important for women with heavy menstrual bleeding.

The nurse is reviewing discharge instructions with a client who has just experienced an endometrial biopsy. Which finding should be reported to the health care provider immediately? a. Mild cramping b. Slight chills and fever c. Spotting of blood on a perineal pad d. Fatigue after anesthesia

ANS: B Chills and fever could indicate an infection and should be reported immediately to the health care provider. Mild cramping, spotting, and fatigue are normal findings after an endometrial biopsy.

A postmenopausal client says that she is experiencing difficulty with vaginal dryness during intercourse and wonders what might be causing this. Which is the nurses best response? a. The less frequently you have intercourse, the drier the vaginal tissues become. b. Estrogen deficiency causes the vaginal tissues to become drier and thinner. c. Drinking at least 3 liters of water each day will make all your tissues less dry. d. Try using a water-soluble lubricant during intercourse.

ANS: B Estrogen deprivation, which occurs as a result of menopause, decreases the moisture-secreting capacity of vaginal cells, thereby making the area drier. The vaginal tissues also become thinner and the rugae become smoother. Reduced frequency of intercourse will not dry out the vaginal tissues. Drinking excess water will not make the tissues less dry. A water-soluble lubricant may make intercourse less difficult. However, the client is asking what causes the problem.

A young woman is not pregnant but has not had a menstrual period for 5 months. Which factors does the nurse explore as a possible cause of the amenorrhea? a. The clients mother having type 2 diabetes mellitus b. Running 10 to 15 miles/day c. Taking aspirin daily d. Having a diet high in protein

ANS: B Excessive exercise, with corresponding loss of body fat, is associated with insufficient estrogen levels for the maintenance of normal ovulatory and menstrual cycles. The other factors are noncontributory.

An older woman is asking the nurse about her husbands sexual functioning. Which statement by the nurse is most accurate? a. Men his age tend to have a rapid decline in sexual abilities. b. His testosterone levels will decrease only slightly until he is quite old. c. Changes in testosterone levels do not affect sexual performance. d. You are lucky your husband is healthy enough for sexual activity.

ANS: B Men experience a gradual but slight decrease in testosterone until they are in their 80s. Low testosterone levels do affect sexual performance. Stating that the woman is lucky does not give accurate information about sexual functioning.

A nurse and unlicensed assistive personnel (UAP) are helping a client during a hysterosalpingogram. Which action by the nurse is best delegated to the UAP? a. Witnessing of the consent form b. Assisting the client into a lithotomy position c. Asking about allergies to iodine or shellfish d. Assessing for pelvic or shoulder pain after the study

ANS: B The UAP would be able to position the client for the procedure. Only the nurse has the ability to witness the consent form and assess allergies and pain within the nursing scope of practice.

12. A 70-year-old client returned from a transurethral resection of the prostate 8 hours ago with a continuous bladder irrigation. The nurse reviews his laboratory results as follows: Sodium 128 mEq/L Hemoglobin 14 g/dL Hematocrit 42% Red blood cell count 4.5 What action by the nurse is the most appropriate? a.Consider starting a blood transfusion. b.Slow down the bladder irrigation if the urine is pink. c.Report the findings to the surgeon immediately. d.Take the vital signs every 15 minutes.

ANS: B The serum sodium is decreased due to large-volume bladder irrigation (normal is 136 to 145 mEq/L). By slowing the irrigation, there will be less fluid overload and sodium dilution. The hemoglobin and hematocrit values are a low normal, with a slight decrease in the red blood cell count. Therefore, a blood transfusion or frequent vital signs should not be necessary. Immediate report to the surgeon is not necessary.

A client is concerned about her irregular menstrual periods since she has increased her daily workouts at the gym to 2 hours each day. What is the nurses best response? a. Do you want to talk about the need for that much exercise? b. Exercise is healthy but can decrease body fat and cause irregular periods. c. Bingeing and purging can cause electrolyte problems in your body. d. Anorexic behavior can result in decreased estrogen levels.

ANS: B There needs to be a certain level of body fat and weight to maintain regular menstrual cycles. The client has only indicated that she has increased her workouts. There is no indication that she has anorexic or bingeing and purging behaviors.

16. A client is concerned about the risk of lymphedema after a mastectomy. Which response by the nurse is best? a. You do not need to worry about lymphedema since you did not have radiation therapy. b. A risk factor for lymphedema is infection, so wear gloves when gardening outside. c. Numbness, tingling, and swelling are common sensations after a mastectomy. d. The risk for lymphedema is a real threat and can be very self-limiting.

ANS: B Infection can create lymphedema; therefore, the client needs to be cautious with activities using the affected arm, such as gardening. Radiation therapy is just one of the factors that could cause lymphedema. Other risk factors include obesity and the presence of axillary disease. The symptoms of lymphedema are heaviness, aching, fatigue, numbness, tingling, and swelling, and are not common after the surgery. Women with lymphedema live fulfilling lives. DIF: Applying/Application REF: 1478

A client is preparing for gender reassignment surgery and will transition from male to female. The client is worried about the voice not sounding feminine enough. What action by the nurse is best? a. Ask if the client has considered vocal cord surgery to change the voice. b. Refer the client for vocal therapy with speech-language pathology. c. Teach the client that there will be no effect on the client's voice. d. Tell the client that the use of hormones will eventually change the voice

ANS: B Male-to-female clients can consult with a speech-language pathologist for vocal training to help with intonation and pitch. While vocal surgery is possible, it may not be the best first option due to cost and invasiveness. Telling the client there will be no change to the voice does not give the client information to address the concern. While the hormones this client is taking will not affect the voice, simply stating that fact does not help the client manage this issue.

6. A 68-year-old male client is embarrassed about having bilateral breast enlargement. Which statement by the nurse is the most appropriate? a. Breast cancer in men is quite rare. b. It is good that you came to be carefully evaluated. c. Gynecomastia usually comes from overeating. d. When you get older, the male breast always enlarges.

ANS: B The most appropriate statement is the one that is supportive of the client. A breast mass should be carefully evaluated for breast cancer, even if it is not common. Gynecomastia as a symptom can be related to antiandrogen agents, aging, obesity, estrogen excess, or lack of androgens. DIF: Applying/Application REF: 1463

5. The nurse is taking the history of a client who is scheduled for breast augmentation surgery. The client reveals that she took two aspirin this morning for a headache. Which action by nurse is best? a. Take the clients vital signs and record them in the chart. b. Notify the surgeon about the aspirin ingestion by the client. c. Warn the client that health insurance may not pay for the procedure. d. Teach the client about avoiding twisting above the waist after the operation.

ANS: B The surgeon must be notified immediately since the aspirin could cause increased bleeding during the procedure. Vital signs should be recorded and postoperative teaching should be completed in the preoperative time frame, but these are not the priority since the procedure may be rescheduled. The warning about the clients health insurance is not appropriate at this time. DIF: Applying/Application REF: 1463

The nurse is counseling a mother who wants her teenage daughter to have a Pap smear and pelvic examination. Which statement by the nurse is most accurate? a. If your daughter is over 18, she needs a pelvic examination and Pap smear. b. A teenager does not need this examination unless she is sexually active. c. Teach her to have her first examination by the age of 21 at the latest. d. It is not needed unless you are worried about sexually transmitted diseases.

ANS: C A woman needs to have her first pelvic examination with Pap smear by the age of 21, or within 3 years of becoming sexually active. The other statements are not accurate.

When performing an assessment of the external genitalia of an older man, the nurse observes the scrotum to have smooth skin and to be very pendulous. Which action by the nurse is most appropriate? a. Suggest to the client that he should wear an athletic supporter while awake. b. Ask the client if he has been treated for a sexually transmitted disease. c. Document the observation and continue the assessment. d. Notify the health care provider and facilitate a scrotal ultrasound.

ANS: C As the male client ages, the scrotum loses rugae and becomes increasingly pendulous. This is a normal assessment finding. No further action is needed.

The nurse is assessing a client with a history of irregular periods. Which condition does the nurse possibly correlate with this problem? a. Childhood mumps b. Past valve replacement surgery c. Diabetes mellitus d. Mild intermittent asthma

ANS: C Endocrine disorders can affect the hypothalamic-pituitary-gonadal function of both men and women. Mumps would be important to know if the client were male. Past valve replacement surgery would not be contributory. Mild intermittent asthma also would not contribute to this problem. However, a client with more severe asthma who takes steroids on a long-term basis may develop secondary diabetes.

9. A 55-year-old male client is admitted to the emergency department with symptoms of a myocardial infarction. Which question by the nurse is the most appropriate before administering nitroglycerin? a.On a scale from 0 to 10, what is the rating of your chest pain? b.Are you allergic to any food or medications? c.Have you taken any drugs like Viagra recently? d.Are you light-headed or dizzy right now?

ANS: C Phosphodiesterase-5 inhibitors such as sildenafil (Viagra) relax smooth muscles to increase blood flow to the penis for treatment of erectile dysfunction. In combination with nitroglycerin, there can be extreme hypotension with reduction of blood flow to vital organs. The other questions are appropriate but not the highest priority before administering nitroglycerin.

11. A 25-year-old client has recently been diagnosed with testicular cancer and is scheduled for radiation therapy. Which intervention by the nurse is best? a.Ask the client about his support system of friends and relatives. b.Encourage the client to verbalize his fears about sexual performance. c.Explore with the client the possibility of sperm collection. d.Provide privacy to allow time for reflection about the treatment.

ANS: C Sperm collection is a viable option for a client diagnosed with testicular cancer and should be completed before radiation therapy, chemotherapy, or radical lymph node dissection. The other options would promote psychosocial support but are not the priority intervention.

3. A 55-year-old African-American client is having a visit with his health care provider. What test should the nurse discuss with the client as an option to screen for prostate cancer, even though screening is not routinely recommended? a.Complete blood count b.Culture and sensitivity c.Prostate-specific antigen d.Cystoscopy

ANS: C The prostate-specific antigen test should be discussed as an option for prostate cancer screening. A complete blood count and culture and sensitivity laboratory test will be ordered if infection is suspected. A cystoscopy would be performed to assess the effect of a bladder neck obstruction.

A client is scheduled for an ultrasound to evaluate for possible uterine fibroids. Which instruction by the nurse is most appropriate? a. Do not eat or drink anything after midnight. b. Take these laxatives the morning of the test. c. Do not urinate an hour before the test; a full bladder will give best results. d. Have a designated driver because you will be sleepy from the anesthesia.

ANS: C The scan is noninvasive and painless. The abdominal and pelvic organs are better visualized with the bladder full during the scan. The other statements are inaccurate.

During examination of the male clients external genitalia, the nurse observes a discharge from the urethra when compressing the glans. Which is the nurses next action? a. Document the observation. b. Ask the client to turn his head and cough. c. Obtain a specimen for culture. d. Test the cremasteric reflex.

ANS: C Urethral discharge is not considered normal in a continent client and should be cultured. The other options would not help provide information about the nature of the discharge.

10. A client has just returned from a right radical mastectomy. Which action by the unlicensed assistive personnel (UAP) would the nurse consider unsafe? a. Checking the amount of urine in the urine catheter collection bag b. Elevating the right arm on a pillow c. Taking the blood pressure on the right arm d. Encouraging the client to squeeze a rolled washcloth

ANS: C Health care professionals need to avoid the arm on the side of the surgery for blood pressure measurement, injections, or blood draws. Since lymph nodes are removed, lymph drainage would be compromised. The pressure from the blood pressure cuff could promote swelling. Infection could occur with injections and blood draws. Checking urine output, elevation of the affected arm on a pillow, and encouraging beginning exercises are all safe postoperative interventions. DIF: Applying/Application REF: 1473

4. Which finding in a female client by the nurse would receive the highest priority of further diagnostics? a. Tender moveable masses throughout the breast tissue b. A 3-cm firm, defined mobile mass in the lower quadrant of the breast c. Nontender immobile mass in the upper outer quadrant of the breast d. Small, painful mass under warm reddened skin

ANS: C Malignant lesions are hard, nontender, and usually located in the upper outer quadrant of the breast and would be the priority for further diagnostic study. The other lesions are benign breast disorders. The tender moveable masses throughout the breast tissue could be a fibrocystic breast condition. A firm, defined mobile mass in the lower quadrant of the breast is a fibroadenoma, and a painful mass under warm reddened skin could be a local abscess or ductal ectasia. DIF: Applying/Application REF: 1469

7. With a history of breast cancer in the family, a 48-year-old female client is interested in learning about the modifiable risk factors for breast cancer. After the nurse explains this information, which statement made by the client indicates that more teaching is needed? a. I am fortunate that I breast-fed each of my three children for 12 months. b. It looks as though I need to start working out at the gym more often. c. I am glad that we can still have wine with every evening meal. d. When I have menopausal symptoms, I must avoid hormone replacement therapy.

ANS: C Modifiable risk factors can help prevent breast cancer. The client should lessen alcohol intake and not have wine 7 days a week. Breast-feeding, regular exercise, and avoiding hormone replacement are also strategies for breast cancer prevention. DIF: Applying/Application REF: 1465

12. What comfort measure can only be performed by a nurse, as opposed to an unlicensed assistive personnel (UAP), for a client who returned from a left modified radical mastectomy 4 hours ago? a. Placing the head of bed at 30 degrees b. Elevating the left arm on a pillow c. Administering morphine for pain at a 4 on a 0-to-10 scale d. Supporting the left arm while initially ambulating the client

ANS: C Only the nurse is authorized to administer medications, but the UAP could inform the nurse about the rating of pain by the client. The UAP could position the bed to 30 degrees and elevate the clients arm on a pillow to facilitate lymphatic fluid drainage return. The clients arm should be supported while walking at first but then allowed to hang straight by the side. The UAP could support the arm while walking the client. DIF: Applying/Application REF: 1474

9. A 35-year-old woman is diagnosed with stage III breast cancer. She seems to be extremely anxious. What action by the nurse is best? a. Encourage the client to search the Internet for information tonight. b. Ask the client if sexuality has been a problem with her partner. c. Explore the idea of a referral to a breast cancer support group. d. Assess whether there has been any mental illness in her past.

ANS: C Support for the diagnosis would be best with a referral to a breast cancer support group. The Internet may be a good source of information, but the day of diagnosis would be too soon. The nurse could assess the frequency and satisfaction of sexual relations but should not assume that there is a problem in that area. Assessment of mental illness is not an appropriate action. DIF: Applying/Application REF: 1469

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

ANS: C Tamoxifen (Nolvadex) reduces the estrogen available to breast tumors to stop or prevent growth. This drug does not block the release of luteinizing hormone to prevent the ovaries from producing estrogen; leuprolide (Lupron) does this. Chemotherapy agents such as ixabepilone (Ixempra) interfere with cancer cell division, and doxorubicin (Adriamycin) inhibits DNA synthesis in susceptible cells. DIF: Remembering/Knowledge REF: 1477

2. The nurse is examining a womans breast and notes multiple small mobile lumps. Which question would be the most appropriate for the nurse to ask? a. When was your last mammogram at the clinic? b. How many cans of caffeinated soda do you drink in a day? c. Do the small lumps seem to change with your menstrual period? d. Do you have a first-degree relative who has breast cancer?

ANS: C The most appropriate question would be one that relates to benign lesions that usually change in response to hormonal changes within a menstrual cycle. Reduction of caffeine in the diet has been shown to give relief in fibrocystic breast conditions, but research has not found that it has a significant impact. Questions related to the clients last mammogram or breast cancer history are not related to the nurses assessment. DIF: Applying/Application REF: 1462

The nurse is reviewing discharge plans with a client who is recovering from a cervical biopsy. Which statements indicate good understanding by the client? (Select all that apply.) a. I can return to work this afternoon. b. There should be no problem lifting my 2-year-old toddler when I get home. c. I cannot douche until the biopsy site is healed. d. I need to wait for about 2 weeks to have intercourse with my husband. e. If I have some bleeding, I can use a regular tampon this evening.

ANS: C, D The client should not douche, have intercourse, or use tampons until the biopsy site is healed. The client should rest for 24 hours after the procedure and should not lift heavy objects.

The nurse is conducting a reproductive assessment of a postmenopausal woman. Which assessment finding reported by the client requires immediate intervention by the nurse? a. Urinary incontinence b. Vaginal dryness c. Painful intercourse d. Returning periods

ANS: D All client reports require some action by the nurse, but the priority would be to further investigate and report the returning periods. In a postmenopausal woman, this can signal cancer.

The nurse is working with a client who is recovering after a laparoscopy. Which assessment finding is considered a priority by the nurse? a. Slight drainage from the incision site b. Grogginess after the anesthesia c. Discomfort from the catheter d. Reports of shoulder pain

ANS: D Clients should expect mild drainage or blood from the incision site. Grogginess from the anesthesia and discomfort from a catheter are also expected minor occurrences post-laparoscopy. The nurse would not be concerned about these but should intervene and treat the client with shoulder pain. Shoulder pain is referred pain from phrenic nerve irritation and can be expected.

A client who has had numerous children is having her annual examination. The nurse wishes to discuss contraception, but the client is not interested. Which action by the nurse is most appropriate? a. Provide education on the value of spacing children. b. Explain the many alternatives from which to choose. c. Ask the client how her husband feels about so many children. d. Assess the clients religious and cultural background.

ANS: D Cultural and religious backgrounds can have a great deal of influence on clients attitudes toward sexuality and reproduction. Because the client does not seem interested in the topic, the nurse should gently assess for these background influences and respect them. Providing education that the client does not want is not helpful and is disrespectful. Asking about the husbands preferences diminishes the nurse-client relationship, which should be focused on the client.

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

ANS: D Frequent visits to the bathroom during the night could cause sleep interruptions and affect the clients mood and mental status. Incontinence could cause the client to feel embarrassment and cause him to limit his activities outside the home. The social isolation could lead to clinical depression and should be treated professionally. The nurse should not give advice before exploring the clients response to his change in behavior. The statement about age has no validity.

A client is scheduled for a laparoscopy to remove endometriosis tissue. Which response by the client alerts the nurse of the need for further teaching? a. The surgeon told me that carbon dioxide would be infused into my pelvic cavity. b. There will be one or more small incisions in order to visualize all of the organs. c. There will be some shoulder pain after the procedure that may last 48 hours. d. I can return to jogging my 3-mile routine in a few days.

ANS: D No strenuous activity should occur for 7 days after the procedure. Carbon dioxide is infused into the pelvic cavity to visualize the organs. There are only one or more small incisions with this procedure. The referred shoulder pain that will occur should only last 48 hours.

The mother of an 18-year-old girl asks the nurse which screening her daughter should receive now based on evidence-based recommendations. Which suggestion by the nurse is best? a. Papanicolaou test b. Human papilloma virus (HPV) test c. Mammogram d. No screenings at this time

ANS: D Since the daughter is only 18, it is not recommended that she receive any of these screenings. Pap screenings are recommended to start at age 21. The HPV test can be done with the Pap test for women older than 30 or who had an abnormal Pap test result. A mammogram is recommended for women age 40 or older since cancers are more able to be distinguished from normal glandular tissue at that age.

6. A nurse and an unlicensed assistive personnel (UAP) are caring for a client with an open radical prostatectomy. Which comfort measure could the nurse delegate to the UAP? a.Administering an antispasmodic for bladder spasms b.Managing pain through patient-controlled analgesia c.Applying ice to a swollen scrotum and penis d.Helping the client transfer from the bed to the chair

ANS: D The UAP could aid the client in transferring from the bed to the chair and with ambulation. The nurse would be responsible for medication administration, assessment of swelling, and the application of ice if needed.

A 67-year-old male client had some serum tests performed during his annual examination. The nurse reviews his results, as follows: testosterone: 680 ng/dL; prostate-specific antigen: 10 ng/mL; prolactin: 5 ng/mL. What action by the nurse is best? a. Assess for possible galactorrhea with breast discharge. b. Note the possibility of a testicular tumor. c. Communicate to the provider that results were normal. d. Prepare the client for further diagnostic testing.

ANS: D The prostate-specific antigen is increased from the normal of 0 to 2.5, which could indicate benign prostatic hyperplasia or prostate cancer. Further testing would have to be done. The values of testosterone and prolactin are within normal range. If the prolactin were increased, there would be a possibility of galactorrhea. An increase in testosterone could indicate a possible testicular tumor.

3. A client is diagnosed with a fibrocystic breast condition while in the hospital and is experiencing breast discomfort. What comfort measure would the nurse delegate to the unlicensed assistive personnel (UAP)? a. Aid in the draining of the cysts by needle aspiration. b. Teach the client to wear a supportive bra to bed. c. Administer diuretics to decrease breast swelling. d. Obtain a cold pack to temporarily relieve the pain.

ANS: D All of the options would be comfort measures for a client with a fibrocystic breast condition. The UAP can obtain the cold or heat therapy. Only the nurse should aid the health care provider with a needle aspiration, teach, and administer medications. DIF: Applying/Application REF: 1462

8. A 37-year-old Nigerian woman is at high risk for breast cancer and is considering a prophylactic mastectomy and oophorectomy. What action by the nurse is most appropriate? a. Discourage this surgery since the woman is still of childbearing age. b. Reassure the client that reconstructive surgery is as easy as breast augmentation. c. Inform the client that this surgery removes all mammary tissue and cancer risk. d. Include support people, such as the male partner, in the decision making.

ANS: D The cultural aspects of decision making need to be considered. In the Nigerian culture, the man often makes the decisions for care of the female. Women with a high risk for breast cancer can consider prophylactic surgery. If reconstructive surgery is considered, the procedure is more complex and will have more complications compared to a breast augmentation. There is a small risk that breast cancer can still develop in the remaining mammary tissue. DIF: Applying/Application REF: 1468

A 48-year-old woman presents with greenish brown nipple discharge, edema over a mass in her right breast, and reports no family history of breast cancer. Based on these assessment findings, the most likely condition is: A.Intraductal papilloma B.Ductal ectasia C.Fibroadenoma D.Breast abscess

B

A male patient is admitted with concern for the development of breast tissue. What is the best medication to treat this condition? a. Spironolactone b. Tamoxifen c. Cephalosporin d. Orlistat

B

A patient with urinary retention associated with BPH is admitted to the emergency department. The patient has had no urine output for 13 hours, and the laboratory work shows a BUN level of 42 and a creatinine of 3. The nurse will anticipate a health care provider to order: A. Inpatient hemodialysis B. An indwelling urinary catheter C. Start an IV line for fluid administration D. Administer Furosemide (Lasix)

B

What is the leading cause of death from female reproductive cancers? A. Cervical B. Ovarian C. Endometrial D. None of the above

B

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

B Benzathine penicillin G is the evidence-based treatment for primary syphilis. The client needs to be assessed for allergies before treatment. The other questions would be helpful in the clients history of sexually transmitted diseases but not as important as knowing whether the client is allergic to penicillin.

A 19-year-old college student seeks information from the schools nurse about how to avoid sexually transmitted diseases (STDs) without abstinence as a choice. Which statement by the nurse is best? a. Urinating after intercourse will eliminate the risk of infection. b. A vaccine can prevent genital warts caused by some strains of the human papilloma virus (HPV). c. Oral contraception can prevent pregnancy and STDs. d. Good handwashing helps prevent infection associated with STDs.

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

An African-American female with blisters on the vagina is being treated with acyclovir (Zovirax) for genital herpes. She is angry at her partner for transmitting the infection. Which action by the nurse is best? a. Encourage the client to engage in sexual activity since she is on medication. b. Be sensitive to the clients feelings and refer her to a support group. c. Reinforce that the disease can no longer be spread to other partners. d. Reassure the client that sexual activity will not be painful while on acyclovir.

B The nurse needs to be sensitive and supportive of the client since infected clients may feel angry, lonely, and isolated. Allow the client to verbalize her feelings and refer her to a local support group, such as the National Herpes Resource Center. Sexual activity should not occur while the lesions are present because of discomfort and viral transmission. Genital herpes is an incurable viral disease, and the antiviral drugs minimize the infection but do not cure it. Condoms should be used to avoid the spread of the disease.

A client had a vaginoplasty under epidural anesthetic. Which action by the nurse is most important? a. Ensure that the urinary catheter is securely attached to the leg. b. Instruct the client not to try to get out of bed unassisted. c. Monitor the client's dressings and wound drainage. d. Position the Jackson-Pratt drain to the contralatera

B Epidural anesthesia will cause the client to not be able to move (or feel) the legs for several hours. It is important for client safety that adequate help is available prior to this client trying to get out of bed. Securing the catheter to the leg and monitoring dressings and drainage are important for any client after surgery. Positioning the drain to the contralateral side is not needed.

A 27 year old comes in for a hysteroscopy. The patient asks what the doctor will be examining during this process. The nurse responds with: A. Pelvic cavity B. Cervix C. Interior of the uterus and the cervical canal D. Vagina into the uterus

C

The nurse is assessing a post-operative hysterectomy patient and is most concerned with which finding? A. Pain B. Decreased urinary output C. Vaginal bleeding D. Fluid retention

C

Which of the following shows that the transgender patient (male to female) needs further education? A. "Hormone replacement therapy will not help my voice to become softer and higher pitched over time." B. "Estrogen therapy will help me to grow breasts." C. "I can stop taking hormones once I have achieved the results I want." D. "I am at a greater risk for developing clots."

C

Before marriage, a female client has a blood test drawn for syphilis. The test reveals a positive Venereal Disease Research Laboratory (VDRL) serum test. What is the advice that the nurse should give the client? a. Check with your future husband about his sexual activity. b. You must determine if you are pregnant at this time. c. Submit to a more specific treponemal test to confirm the infection. d. Agree to a benzathine penicillin G injection in multiple doses.

C False-positive reactions can occur with viral infections, hepatitis, and systemic lupus erythematosus. A health care provider can request more specific treponemal tests such a fluorescent treponemal antibody absorption or microhemagglutination assay for Treponema palladium performed by the laboratory. While it would be good to confirm sexual activity with her future husband, this inquiry could wait until after further testing is performed. Penicillin is the treatment of choice, but as a single 2.4-million-unit dose. A different regimen would be recommended if the client were pregnant.

A nurse is assessing a client who presents with a scaly rash over the palms and soles of the feet and the feeling of muscle aches and malaise. The nurse suspects syphilis. Which action by the nurse is appropriate? a. Reassure the client that this stage is not infectious unless she is pregnant. b. Assess the client for hearing loss and generalized weakness. c. Don gloves and further assess the clients lesions. d. Take a history regarding any cardiovascular symptoms.

C The client is displaying symptoms similar to secondary syphilis, with flu-like symptoms and rash due to the spirochetes circulating throughout the bloodstream. Therefore, the nurse needs to further assess the clients lesions with gloves since the client is highly contagious at this stage. Late latent syphilis is not infectious except to a fetus. Tertiary syphilis may display in the form of cardiovascular or central nervous system symptoms.

A woman is admitted to the hospital for antibiotic therapy for pelvic inflammatory disease. She is in pain, with a rating of 7 on a scale of 0 to 10. What comfort measure can the nurse delegate to the unlicensed assistive personnel (UAP)? a. Administer Tylenol #3 immediately. b. Apply a heating pad to the lower abdomen. c. Position the client in a semi-Fowlers position. d. Teach the client to increase intake of fluids.

C The client with pelvic inflammatory disease usually experiences lower abdominal tenderness. The UAP can position the client. Only the nurse can administer medications, initially apply heat to the clients abdomen, and perform teaching.

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

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

The nurse is assessing the reproductive history of a 68-year-old postmenopausal woman. Which finding is cause for immediate action by the nurse? A. Vaginal dryness B. No Papanicolaou test for 3 years C. Bleeding from the vagina D. Leakage of urine

C Vaginal bleeding is not normal for the postmenopausal woman.

The nurse is developing a teaching plan for a client who is scheduled for her first Papanicolaou test. What instruction by the nurse is the most accurate? A. "The timing of the Pap smear does not matter." B. "Sexual intercourse will not interfere with the results." C. "Results can be interpreted immediately in the office." D. "Results are best if you do not douche 24 hours before the test."

D In order to prevent false interpretation, the client must not douche, use vaginal medications or deodorants, or have sexual intercourse for at least 24 hours before the Pap smear.

While evaluating a male client for treatment of gonorrhea, which question is the most important for the nurse to ask? a. Do you have a history of sexually transmitted disease? b. When was your last sexual encounter? c. When did your symptoms begin? d. What are the names of your recent sexual partners?

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

The nurse is obtaining a health history from a 55-year old patient who has found a small lump on her breast, which questions is most relevant? A. Do you currently smoke cigarettes? B. Have you ever had any breast injuries? C. How long did you breastfeed your children? D. At what age did you start having menstrual periods?

D

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

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

A 19-year-old female is asking the nurse about the vaccine for human papilloma virus (HPV). Which statement by the nurse is accurate? a. Gardasil protects against all HPV strains. b. You are too young to receive the vaccine. c. Only females can receive the vaccine. d. This will lower your risk for cervical cancer.

D Gardasil is used to provide immunity for HPV types 6, 11, 16, and 18 that are high risk for cervical cancer and warts. The vaccine is recommended for people ages 10 to 26 years.

The nurse teaches a client with genital herpes about effective comfort measures. Which statement by the client indicates a need for further teaching by the nurse? a. I can apply warm towels or ice packs to the lesions. b. Sitz baths three times a day may help ease the pain. c. I understand there are anesthetic sprays and ointments. d. I really should try to limit urination due to the pain.

D The client should urinate frequently, not limit voiding. Voiding while in the shower or tub should lessen the discomfort. Warm compresses, ice packs, sitz baths, and anesthetic sprays and ointments are all effective comfort measures that can be used with genital herpes.

1. A nurse instructor is teaching a student nurse about the factors that have increased the number of people with sexually transmitted diseases (STDs) seen in practice. Which statement by the student indicates a lack of understanding? a. There are improved techniques to diagnose an STD used in practice. b. There is increased incidence of sexual abuse and sexual trafficking. c. Females feel safe using oral agents rather than a condom as contraception. d. The organisms causing STDs are all becoming more virulent.

D There is no evidence that the organisms that cause STDs are becoming more virulent, but a client may need to use another anti-infective if allergic or the protocol was not effective. Extensive histories are taken in the clinic of clients of all ages, as well as assessment of laboratory data such as cervical, urethral, oral, or rectal specimens and lesion samples for microbiology and virology. There are changes in sexual attitudes and practices, cultural factors, migration, and international travel. Women often think that the oral contraceptives protect them from an STD.

The nurse is teaching a transgender client about the medication goserelin (Zoladex). What action by the client indicates good understanding? a. Takes a manual blood pressure b. Administers a subcutaneous injection c. Prepares an implanted port for IV insertion d. States that the axillary area will be clothed

Goserelin is administered via subcutaneous injection. The other actions are not related to self-management while on this medication.

After a vaginoplasty, what instruction by the nurse is most important? a. "Avoid vaginal douching to prevent infection." b. "Do not have sexual intercourse for at least 6 months." c. "Use oil-based lubricants with the vaginal dilators." d. "You must dilate the vagina several times a day for months."

Self-care management for this client includes instructions to dilate the new vagina several times a day for months after the procedure, using water-based lubricant. The client also needs to douche regularly, especially after intercourse, to avoid infections. Sexual intercourse is another way to keep the vagina dilated.

2. A nurse is providing health teaching to a middle-aged male-to-female (MtF) client who has undergone gender reassignment surgery. What information is most important to this client? a. "Be sure to have an annual prostate examination." b. "Continue your normal health screenings." c. "Try to avoid being around people who are ill." d. "You should have an annual flu vaccination."

The MtF client retains the prostate, so annual screening examinations for prostate cancer remain important. The other statements are good general health teaching ideas for any client.

A transgender client taking spironolactone (Aldactone) is in the internal medicine clinic reporting heart palpitations. What action by the nurse takes priority? a. Draw blood to test serum potassium. b. Have the client lie down. c. Obtain a STAT electrocardiogram (ECG). d. Take a set of vital signs.

The nurse is teaching a transgender client about the medication goserelin (Zoladex).

1. A nurse is reviewing the chart of a new client in the family medicine clinic and notes the client is identified as "George Smith." The nurse enters the room and finds a woman in a skirt. What action by the nurse is best? a. Apologize and declare confusion about the client. b. Ask Mrs. Smith where her husband is right now. c. Ask the client about preferred forms of address. d. Explain that the chart must contain an error.

The nurse may encounter transgender clients whose outward appearance does not match their demographic data. In this case, the nurse should greet the client and ask the client to explain his or her preferred forms of address. Lengthy apologies can often create embarrassment. The nurse should not assume the client is not present in the room. The chart may or may not contain errors, but that is not related to determining how the client prefers to be addressed.