NSG 170 Test 3

Sexual Counseling

Since many patients affected by erectile dysfunction are uncomfortable discussing their issues, sexual counseling is recommended to assess and address the patient's psychosocial status. Sexual counseling should be initiated prior to beginning medical treatment for erectile dysfunction. Since sexual dysfunction affects relationships, the patient's partner should be included during counseling sessions.

Penile Implants

Since these surgical procedures are highly invasive and may cause complications, penile implants are indicated for patients experiencing severe erectile dysfunction. Complications related to penile implants include mechanical failure, infection, and erosion. Semi-rigid or inflatable penile prostheses are implanted into the corporeal bodies to sustain an erection firm enough for intercourse.

Vacuum Constriction Devices

Vacuum constriction devices pull blood into the corporeal body to produce an erection. Examples of vacuum constriction devices that retain venous blood for maintaining an erection include a penile ring or constrictive band.

Medical Conditions: Erectile Dysfunction

Various medical conditions may cause erectile dysfunction. Middle-age men are particularly affected. Erectile dysfunction may be related to medical conditions such as diabetes, hypertension, and peripheral vascular disease (refer to the Picmonic on "Peripheral Arterial Disease").

Estrogen Receptor Modulators

raloxifene (Evista) prevention and treatment of osteoporosis in postmenopause increases bone mineral density without stimulating the endometrium; modulates effects of endogenous estrogen at specific receptor sites adverse effects: venous thromboembolism, hot flashes, skin rash, nausea, vomiting, vaginal bleeding, depression, light-headedness

Which of the following combination contraceptives has been approved for extended continuous use? A. Seasonale B. Triphasil C. Ortho Evra D. Mirena

A. Seasonale rationale: Seasonale is one of the several FDA approved long-term oral contraceptives that is packaged to provide 84 days of continuous protection. off-label use (not approved by FDA). Triphasil should be left in 3 weeks and then removed for 1 week. Ortho Evra (transdermal patch) is not approved for continuous use; placed on skin for 3 weeks and removed for 1 week. Mirena (implantable device) is not a combination contraceptive and only releases progesterone; can be left in for 5 years.

Therapeutic Management: Acute Lymphoblastic Leukemia (ALL) child

Chemotherapy divided into three stages & determined by age, risk category, and subtype induction stage: rapid removal of blasts from blood and bone and remission (oral steroids, IV vincristine, IM L-asparaginase, daunomycin [high risk]) consolidation stage: kills blasts that may be inactive but still present, strengthens remission (high-dose methotrexate, 6-mercaptopurine) maintenance stage: lasts 2-3 yrs, eliminates all residual blasts (low dose: 6-mercaptopurine, weekly methotrexate, intermittent IV vincristine, oral steroids) *CNS prophylaxis: reduces risk of developing CNS disease, given at all stages

Cancer: Child vs. Adult

Child arise from primitive embryonal and neuroectodermal tissues most common CA is leukemia warning signs: changes in blood cell production (fatigue, pallor, frequent/severe infection, easy bruising) or compression, infiltration, or obstruction by tumor (bone/abd. pain, swelling, unusual discharge) areas: blood, lymph, brain, bone, kidney, muscle Adult arise from epithelial cells (organs) areas: breast, lung, prostate, bowel, bladder 80% preventable less responsive to treatments

Augmentation mammoplasty

Creating larger breast by placing an implant Subpectoral (under pectoralis muscle; preferred) Subglandular (under breast tissue) Pt. Education: wear supportive bra 24 hrs per day for 2 wks; avoid vigorous exercise FDA: women 22 yrs +

The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia (ALL)." What will confirm this diagnosis? A. Complete white blood count B. Lethargy, bruising, and pallor C. History of leukemia in twin D. Bone marrow aspiration

D. Bone marrow aspiration rationale: Bone marrow aspiration and biopsy are diagnostic. An abnormal white blood count and symptoms of lethargy, bruising, and pallor only create suspicion of leukemia; a twin may or may not be affected.

Risk factors: breast cancer

Female 55 years + Hx of breast cancer Family hx of breast cancer (mother/sister/daughter = two fold); increased risk if relative is premenopausal at dx BRCA 1 & BRCA2 Early menarche Late menopause Nulliparity (no full term pregnancy) Late age at first full term pregnancy Long term use of estrogen & progesterone hormone therapy Exposure to radiation during adolescence and early adulthood (e.g. mantel radiation for Hodgkin lymphoma) Atypical ductal or lobular hyperplasia/lobular carcinoma Obesity (more fat tissue = increased estrogen levels at menopause) 2-5 alcoholic drinks daily long term smoking before first pregnancy working night shifts lower socioeconomic status

Effects of chemotherapy-induced menopause & hormonal treatments

Hot flashes Vaginal dryness UTI Weight gain Decreased sex drive Long term cardiac effects & neuropathy Impaired cognitive function (chemo brain) Risk of osteoporosis * hormone therapy contradicted

Neoplastic polyps

adenocarcinomas

Lynch syndrome (hereditary non-polyposis colorectal cancer HNPCC)

- fam hx of colorectum, stomach, uterine, ovarian, urinary epithelium, or small bowel cancer - early onset age

Risk factors of colorectal cancer

Family hx: Lynch Syndrome or FAP High alcohol consumption (2+ drinks qd men, 1+ drinks qd women) High fat and protien diet with low fiber Hx: genital cancer, breast cancer, inflammatory bowel disease, type 2 diabetes increased age male gender overweight/obese hx of colon cancer or adenomatous polyps race: Black or Ashkenazi Jew

Long term psychosocial effects: breast cancer

Fear of recurrence Mood changes Vulnerability Uncertainty Feelings of loss Body image Self concept Emotional distress r/t role change & family response Finances & employment Depression Anxiety

Risk factors: Acute Lymphoblastic Leukemia (ALL) child

2-5 years old white children male down syndrome, Schwachman syndrome, ataxia-telangiectasia x-ray exposure in utero previous radiation-treated CA

lymphedema

Chronic swelling r/t impaired lymphatic circulation * caused by axillary lymph nose dissection (ALND)

A client is diagnosed with erectile dysfunction. He asks what effect sildenafil (Viagra) has because he is taking nitroglycerin for chest pain. What is the best explanation for why nitrates are contraindicated with sildenafil? A. "The combination can cause a severe decrease in blood pressure." B. "Taking the drugs together can lead to prostate cancer." C. "Nitroglycerine decreases the effect of sildenafil for erectile dysfunction." D. "Nitroglycerine and sildenafil will diminish the effectiveness of chest pain relief."

A. "The combination can cause a severe decrease in blood pressure." rationale: Nitrates and phosphodiesterase enzyme type 5 inhibitors decrease blood pressure, and the combined effect can produce profound, life-threatening hypotension. The other options do not accurately describe the risk posed by concurrent use of the two medications.

A patient with erectile dysfunction is receiving an injection directly into the cavernosum. The nurse identifies this drug as: A. Alprostadil B. Danazol C. Sildenafil D. Vardenafil

A. Alprostadil rationale: Alprostadil is injected directly into the corpus cavernosum. Danazol is not used to treat erectile dysfunction. Sildenafil is administered orally. Vardenafil is administered orally.

A 74-year-old male client is seeking testosterone supplement for low libido and erectile dysfunction. Which tests should the nurse inform the client will likely be recommended prior to starting testosterone therapy? Select all that apply. A. Testosterone level B. Prostate specific antigen (PSA) C. Lipid profile D. Sperm count E. Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels

A. B. C. rationale: Given the client's age, routine treatment with testosterone is not recommended. The client's testosterone level would need to be known, as treatment is not recommended unless the testosterone is less than 300 ng/dL (10.4 nmol/L). The client's prostate health would need to be known, and thus the prostate specific antigen level is part of this screening process. Finally, side effects of replacement therapy may include reduced high-density lipoprotein cholesterol levels; therefore, the health care provider would want to establish a baseline as part of the risk versus benefit assessment. Sperm count is not relevant unless the client wishes to conceive a child, and LH and FSH levels are not needed for the treatment in a client of this age.

A client who is taking an estrogen reports swelling and weight gain. The nurse notes some peripheral edema. Which nursing diagnosis would the nurse identify as the priority? A. Fluid volume excess B. Imbalanced nutrition, less than body requirements C. Acute pain D. Ineffective peripheral tissue perfusion

A. Fluid volume excess rationale: The client is experiencing fluid retention, which makes this nursing diagnosis appropriate. B. This nursing diagnosis would be appropriate if the client was experiencing a decreased intake due to nausea and vomiting. Acute pain would be appropriate if the patient was experiencing headache or abdominal cramping. C. This nursing diagnosis would be appropriate if the patient was experiencing signs and symptoms of a thromboembolic disorder.

A client has developed priapism. For which outcome is this client at risk? A. Impotence B. Cancer of the penis C. Swelling of the testicles D. Premature ejaculation

A. Impotence rationale: Priapism is an involuntary, prolonged (>4 hours), abnormal, and painful erection that continues beyond, or is unrelated to, sexual stimulation. The prolonged erection can result in ischemia and fibrosis of the erectile tissue with significant risk of subsequent impotence. The other results will not occur.

The client is experiencing severe signs of urinary obstruction. The client has an existing diagnosis of benign prostatic hyperplasia (BPH). Which treatment option will the health care provider most likely recommend? A. Transurethral prostatectomy B. Insertion of a urinary catheter C. Radiation treatment of the prostate D. Injecting the prostate with a chemotherapy drug

A. Transurethral prostatectomy rationale: Transurethral prostatectomy (TURP) is the most commonly used treatment for BPH. Late complications of TURP include erectile dysfunction, incontinence, and bladder neck contractures. Immediate complications of TURP include the inability to urinate, postoperative hemorrhage or clot retention, and urinary tract infection. A catheter would provide only short-term relief and predispose the client to infection. Radiation would be a palliative measure. The condition is not malignant and does not require chemotherapy.

A postmenopausal woman presents to the clinic with painless vaginal bleeding. The health care provider wants to assess for endometrial cancer. The nurse would anticipate the health care provider prescribing which procedure first? A. a transvaginal ultrasound B. an endometrial biopsy C. a hysterectomy D. chemotherapy and radiation

A. a transvaginal ultrasound rationale: Abnormal and painless vaginal bleeding is a major initial symptom of endometrial cancer. A transvaginal ultrasound can be used to evaluate the endometrial cavity and measure the thickness of the endometrial lining. If the endometrium measures less than 4 mm, then the client is at low risk for malignancy. A biopsy is not indicted when endometrial thickness is 4 mm in a postmenopausal client with bleeding, thereby avoiding invasive measures.

A nurse is reviewing the history and physical examination of a client diagnosed with secondary dysmenorrhea for possible associated causes. Which etiology would the nurse need to keep in mind as being the most common? A. endometriosis B. multigravida status C. hormonal imbalance D. perimenopause

A. endometriosis rationale: Secondary dysmenorrhea is painful menstruation due to pelvic or uterine pathology. Endometriosis is the most common cause of secondary dysmenorrhea. Other recognized causes include adenomyosis, fibroids, pelvic infection, an intrauterine device, cervical stenosis, or congenital uterine or vaginal abnormalities.

A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication? A. Urine output of 400 ml in 8 hours B. Serum potassium level of 2.6 mEq/L C. Blood pressure of 120/64 to 130/72 mm Hg D. Sodium level of 142 mEq/L

B. Serum potassium level of 2.6 mEq/L rationale: Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include a serum potassium level below 3.5 mEq/L, decreased urine output (less than 40 ml/hour), and abnormally low blood pressure. Urine output of 400 ml in 8 hours, serum sodium level of 142 mEq/L, and a blood pressure of 120/64 to 130/72 mm Hg aren't abnormal findings.

Which client would the nurse identify as being at highest risk for the development of testicular cancer? A. A 45-year-old white male with a history of hypertension B. A 25-year-old male with a history of cryptorchidism C. A 39-year-old African American male who is HIV-negative D. A 75-year-old white male with erectile dysfunction

B. A 25-year-old male with a history of cryptorchidism rationale: Testicular cancer is most common in between 15 and 34 years of age and is the leading cause of cancer deaths in men between 25 to 34 years of age. Its incidence is higher in Caucasians and men with a history of cryptorchidism. Other clients at risk are those with a family history of the disease, those who are HIV-positive or have developed AIDS, and those who already have had cancer in one testicle.

Mark, age 42, is prescribed sildenafil for the treatment of pulmonary hypertension. The nurse caring for Mark would explain that sildenafil works by what mechanism? A. Decreasing the function of the right ventricle B. Causing vasodilation in the pulmonary vascular bed C. Increasing systemic vascular resistance D. Decreasing arterial blood flow

B. Causing vasodilation in the pulmonary vascular bed rationale: When sildenafil is used to treat pulmonary arterial hypertension, it stabilizes patients clinically as well as improves their exercise capacity and the function of the right ventricle. The drug causes vasodilation of the pulmonary vascular bed and, to a lesser degree, vasodilation in the systemic circulation.

A client has been given a prescription for sildenafil (Viagra) for treatment of erectile dysfunction. The nurse will instruct the client to take this medication at what time prior to the onset of sexual intercourse? A. 2 hours B. 90 minutes C. 30 minutes D. 5 minutes

C. 30 minutes rationale: The client should take sildenafil approximately 20 to 60 minutes prior to the time of the desired erection.

Fertility Drugs

Clomiphene (Clomid) treatment of ovarian failure in patients with normal liver function and normal endogenous estrogens; off label use; treatment of male sterility binds to estrogen receptors, decreasing the number of available receptors, increases FSH and LH which leads to ovarian stimulation adverse effects: vasomotor flushing, visual changes, abdominal discomfort, distention and bloating, N/V, ovarian enlargement, breast tenderness, ovarian overstimulation, multiple gestation

Lab & Diagnostic Tests: Acute Lymphoblastic Leukemia (ALL) child

Complete blood count (CBC): low h/h, RBC, platelet. WBC can be elevated, normal or decreased Peripheral blood smear: blasts Bone marrow aspiration: greater than 25% lymphoblasts. also used for immunotyping and cytogenic analysis to classify leukemia. Lumbar puncture: CNS infiltration Liver function test and BUN/creatine levels: abnormal = prevent treatment with some chemotherapies Chest radiography: pneumonia/mediastinal mass

Risk factors: lymphedema

Concomitant radiation therapy Increased age Concomitant infection Pre-existing cardiovascular conditions Obesity

Considerations for Pregnancy & Breast Cancer

Dx during gestation or within 1 year of childbirth Breast tissues more tender/swollen = difficultly detecting masses; stop breast feeding if mass is detected Ultrasound preferred method for diagnosing Indicated = mammography c shielding, fine needle aspiration (FNA), biopsy Surgical = modified radical mastectomy; breast conversion if dx in 3rd trimester Radiation = C section as soon as fetus is matured, radiation therapy after delivery Termination of pregnancy = aggressive cancer early in gestation

Drug-Induced Erectile Dysfunction

Erectile dysfunction may be a side effect of various medications. Medications include antihypertensives, tricyclic antidepressants, beta blockers, and diuretics. Alcohol, nicotine, and recreational drugs may decrease the patient's sperm count and contribute to erectile dysfunction. Instead of discussing low libido or erectile dysfunction with a healthcare provider, the patient may decide to stop taking their medications in order to avoid problems with sexual functioning. If drug-induced erectile dysfunction occurs, notify the healthcare provider for medication alternatives.

Age-Related Changes: Erectile Dysfunction

Erectile dysfunction may be associated with age-related changes, such as testosterone deficiency. Age-related changes in males include an increase in prostate size, decrease in sperm production, and decrease in testicular size and firmness. These symptoms of decreased testosterone production lead to low libido and erectile dysfunction.

Mastopexy

Improves shape of & lifts breast Pt. Education: wear supportive bra 24 hrs per day for 2 wks; avoid vigorous exercise

Intraurethral Devices

In combination with vasoactive drugs, intraurethral devices enhance blood flow into the penile arteries. Vasoactive medications are administered as a topical gel, intracavernosal self-injection, or insertion of a pellet into the urethra using a medicated urethral system for erection (MUSE) device. Examples of vasoactive medications include papaverine, alprostadil (Caverject), and phentolamine (Vasomax).

Long-term effects after surgery: breast cancer

Lymphedema (after axillary lymph node dissection ALND) Pain Sensory disturbances

Fertility risks with chemotherapy

Morbidity of reproductive function Risk of early menopause Decreased ovarian reserve * physiologic age of ovaries 10 years older than actual age

Clinical manifestations: Breast Cancer

Nontender lump Abnormal nipple discharge Rash around nipple Nipple retraction, dimpling of skin, change in nipple position Nipple pain, scaliness, ulceration, skin irritation * may have no manifestations

Risk factors for hyperplasia

Overweight older than 45 years hx of nulliparity and infertility family hx of colon cancer

Clinical Manifestations: lymphedema

Painful swelling of arm Shoulder pain Transient edema

Phosphodiesterase Type 5 (PDE5) Inhibitors

Phosphodiesterase type 5 (PDE5) inhibitors are indicated for patients with erectile dysfunction. The medications increase blood flow to the corpus cavernosum by relaxing smooth muscles. Examples of PDE5 inhibitors include sildenafil, tadalafil, vardenafil, and avanafil. Since they both cause significant hypotension, avoid concurrent administration of PDE5 inhibitors with nitrate drugs.

Psychological Causes: Erectile Dysfunction

Psychological issues may lead to erectile dysfunction. Fear of failure to perform causes stress and anxiety. Stress, depression, and anxiety affects the patient's ability to sustain an erection.

Prevention of lymphedema

Pt. Education on lifetime hand/arm injury prevention Contact provider if lymphedema is suspected Consult rehabilitation specialist for compression sleeve & manual lymph drainage

Male Breast Cancer

Risk factors: BRCA2 & BRCA1 mutations, Klinefelter syndrome (chromosomal conditions c decreased testosterone) Clinical manifestation: early detection uncommon; painless lump in later stages Treatment: total mastectomy c sentinel lymph node biopsy (SLNB) or ALND * (hormone receptor positive) ER+ = tamoxifen (treatment)

Infection prevention: breast cancer

avoid deodorants until incision heals *the rest are common infection prevention protocols

colorectal cancer

cancer of the colon and rectum

clinical manifestations: left sided lesions (symptoms of obstruction)

abdominal pain and cramping narrowing of stools constipation distention

Female Diagnostic Evaluation: Cone Biopsy and LEEP

abnormal changes or if lesion extends into canal (endocervical findings) = cone biopsy performed loop electrosurgical excision procedure (LEEP) removes abnormal cervical tissue ; rest for 24hrs post op and leave any vaginal packing in place until removed report excessive bleeding

Female Diagnostic Evaluation: Endometrial (Aspiration) Biopsy

obtains endometrial tissue and is indicated in cases of midlife irregular bleeding, postmenopausal bleeding, or irregular bleeding while taken HT/tamoxifen contradicted in pregnancy sligh discomfort; tenaculum stabilizes uterus then Pipelle is inserted to aspirate. findings: normal endometrial tissue, hyperplasia, endometrial CA

A couple reports that their condom broke while they were having sexual intercourse last night. What would you advise to prevent pregnancy? a. Inject a spermicidal agent into the woman's vagina immediately. b. Obtain emergency contraceptives and take them immediately. c. Douche with a solution of vinegar and hot water tonight. d. Take a strong laxative now and again at bedtime.

b. Obtain emergency contraceptives and take them immediately. rationale: If EC is taken within 72 hours after unprotected sexual intercourse, pregnancy will be prevented by inhibiting implantation. The next morning would still afford time to take EC and not become pregnant.

Prognosis: Acute Lymphoblastic Leukemia (ALL) child

based on WBC count at dx, type of cytogenetic factors, age at dx, and extent of extramedullary involvement. higher WBC = worse prognosis WBC less than 50,000 between 1-9 yrs = better prognosis

Prevention: breast cancer

breast feeding 1 year regular, moderate exercise maintaining healthy body weight extra virgin olive oil in diet *high risk prevention* consultation c breast specialist long term surveillance chemoprevention: tamoxifen & raloxifene (Elisa); anastrozole (Arimidex); exemestane (Aromasin) prophylactic mastectomy

clinical manifestations of colorectal cancer

change in bowel habits, hematochezia, unexplained anemia, anorexia, weight loss, fatigue

Female Diagnostic Evaluation: Colposcopy & Cervical biopsy

colposcope: instrument with magnifying lens that visualizes cervix and obtains sample of abnormal tissues. abnormal findings: leukoplakia, acetowhite tissue, punctation, mosaicism, atypical vascular patterns. precancerous cells in biopsy = cryotherapy, laser therapy, cone biopsy

Female Diagnostic Evaluation: Cryotherapy and Laser Therapy

cryotherapy = freezing cervical tissue with nitrous oxide - results in cramping and feelings of faintness (vasovagal response); watery discharge for a few weeks *excessive bleeding/pain/fever = call provider

What comment by a woman would indicate that a diaphragm is not the best contraceptive device for her? a. "My husband says it is my job to keep from getting pregnant." b. "I have a hard time remembering to take my vitamins daily." c. "Hormones cause cancer and I don't want to take them." d. "I am not comfortable touching myself down there."

d. "I am not comfortable touching myself down there." rationale: this vaginal barrier is a dome-shaped rubber cup with a flexible rim that needs to be inserted into the woman's vagina before intercourse. The dome covers the cervix and sperimicidal jelly is applied to the rim.

laparoscopic surgery benefits

decreased length of stay decreased post-op. complications increased pain control earlier progression to normal diet

Female Diagnostic Evaluation: Cytologic Test for Cancer (Pap Smear)

detects cervical cancer atypical cells = HPV testing atypical cells and no high risk HPV types = next Pap smear performed in 1 year repeat Pap smear have atypical squamous cells c high-risk HPV types = colposcopy precancerous lesions = repeated in 4-6 months and colposcopy

Female Diagnostic Evaluation: Dilation and Curettage (D&C)

diagnostic: identifies cause of irregular bleeding therapeutic: temporarily stops irregular bleeding secure endometrial/endocervical tissue for cytologic examination, to control abnormal bleeding, and therapeutic measure for incomplete abortion void before procedure, no vaginal penetration for 2 weeks

Risk factors for altered male health

digital rectal examination frequency testicular self-examination frequency contraceptives exposure to chemicals sexual history Hx of STI Hx discharge from penis difficulty urination history of erectile dysfunction, pain with intercouse

clinical manifestations: right sided lesions

dull abdominal pain melena

Red Blood Cell Production: Child

embryo = 8 wks gestation, blood cells form in liver, lymphoid produced by spleen after birth = kidneys produce EPO hormone

Treatment: Acute Myelogenous Leukemia (AML) child

empiric broad-spectrum antibiotics and prophylatic platelet infusions chemotherapy after remission Hematopoietic stem cell transplantation (HSCT) depending on subtype Leukapheresis = hyperleukocytosis (MEDICAL EMERGENCY)

Sex Hormones: Estrogen

estradiol (Estrace) : used to pallaiation of signs and symptoms of menopause, inoperable breast cancer, and prostate cancer affect the release of follicle stimulating hormone (FSH) and luteinizing hormone (LH); capillary dialation, fluid retention, conserve calcium and phosphorus and encourage bone formation. adverse effects: corneal changes, photosensitivity, peripheral edema, chloasma, hepatic adenoma, nausea, vomiting, abd. cramps, bloating, breakthrough bleeding, change in menstrual flow, dysmenorrhea, premenstrual-like syndrome

Iron: Child

fetus: receives from placenta (preterm = increased risk of anemia) infant: physiologic anemia 2-6 months r/t rapid growth and increase in blood volume. must ingest iron from breast milk or iron fortified formula adolescence: iron intake must increase r/t rapid growth

Clinical manifestations: Acute Lymphoblastic Leukemia (ALL) child

fever petechia, purpura, unusual bruising (r/t decreased platelets) adventitious breath sounds (r/t pneumonia) enlarged lymph nodes enlarged liver/spleen tenderness of abd.

Risk Factors: Acute Myelogenous Leukemia (AML) child

hispanic race previous chemotherapy down sydrome, faconi anemia, neurofibromatosis type I, schwahcman syndrome, bloom syndrome, familial monosomy 7

Pharmacologic therapy: Tamoxifen citrate

hormone therapy bind to estrogen receptor sites used in advance breast cancer adjuvant = early stage preventive = high risk women increases risk of endometrial CA and thromboembolic events side effects: hot flashes, vaginal problems, irregular menses, moos disturbances, rashes

Prostatitis

inflammation of the prostate gland manifestations: sudden onset of fever, dysuria, perineal prostatic pain, frequency, urgency, hesitancy, nocturia med management bacteria = antiobiotic (trimethoprim-sulfmethozaole [Bactrim]) normal urinalysis & afebrile = inflammatory agents alpha-adrenergic therapy (tamusolin [Flomax]) = bladder & prostate relaxation nsg management admn. anitbiotics agents analgesic agents sitz baths

Sex hormones: Progestin

norethindrone acetate (Aygestin) treats amenorrhea, abnormal uterine bleeding, treatment of endometriosis inhibits LH and FSH secretion preventing ovulation; inhibits uterine contractions adverse effects: venous thromboembolism, loss of vision, diplopia, migraine, rash, acne, chloasma, alopecia, breakthrough bleeding, spotting, amenorrhea, fluid retention, edema, increased weight.

Complications: Acute Myelogenous Leukemia (AML) child

less responsive to treatment toxicity is more common prolonged hospitalization in induction phase WBC above 100,000 = hyperleukocytosis (symptoms hypoxia, hemorrhage, lung/brain infarction) MEDICAL EMERGCENY

Patho: Acute Lymphoblastic Leukemia (ALL) child

lymphoblast take over blood forming tissues and deprive normal cells of nutrients. lymphoblast = fragile, immature & lack infection fighting capabilities clinical manifestations: fatigue, weight loss/growth arrest, muscle wasting, anemia, thrombocytopenia, neutropenia, join/bone pain, lymphadenopathy, hepatosplenomegaly, vomiting, headache, seizures, coma, vision alterations, cranial nerve palsies

non-neoplastic polyps

mucosal and hyperplastic

benign prostatic hyperplasia (BPH)

noncancerous enlargement or hypertrophy of the prostate; the most common pathologic condition in older men patho: elevated estrogen levels in men and prostate tissue becomes more responsive to estrogen and less to DHT risk factors: smoking, heavy alcohol consumption, obesity, reduced activity, hypertension, heart disease, diabetes, western diet clinical manifestations: urinary frequency, urgency, nocturia, hesitancy, decreased & intermittent force stream and sensation incomplete bladder emptying, dribbling, UTI pharm treatment: alpha-adrenergic blockers , antiandrogen agents, phytotherapuetic agents

Complex hyperplasia

overgrowth of cells with abnormal features risk factor for uterine cancer treated with progesterone

Simple Hyperplasia

overgrowth of uterine lining treated with progesterone

Clinical Manifestations: Acute Myelogenous Leukemia (AML) child

pallor salmon colored/blue-gray papular lesions subcutaneous rubbery nodules lymphadenopathy headache, visual disturbances, signs of increased ICP Bone marrow aspiration greater than 20% blast cells

Long-term effects of radiation: Breast Cancer

pneumonitis, rib fractures, heart disease, breast fibrosis/necrosis *rare

Chemotherapy-induced amenorrhea (CIA)

progressive depletion of ovarian follicles & granulosa cells = oligomenorrhea & ovarian failure

testicular self-examination

roll testes gently in a horizontal plane between thumb and fingers while holding head of penis high. then do the same but on a vertical plane locate the epididymis or the top and back of the testicle it is normal for one testicle to be larger than the other

prevention of colorectal cancer

smoking cessation lifestyle changes adults 50-59 with a risk of cardiovascular disease = daily/alternate day aspirin

Pharmacologic therapy: Chemotherapy

standard for breast CA with axillary node see notes for regimens NSG management antiemetic agents + optimal dose schedule = decreased N/V decrease mucositis = rinsing c normal saline or sodium bicarbonate; avoid spicy foods, soft tooth brush hematopoietic growth factors: granulocyte colony stimulating factors, erythropoietin growth factor emotional support Side effects N/V, bone marrow suppression, taste changes, alopecia, mucositis, neuropathy, skin changes, fatigue

Pharmacologic therapy: Trastuzumab

targeted drugs (antineoplastic) targets and inactivates HER-2/neu slows/inhibits tumor growth\ spares normal cells trastuzumab + anthracycline = risk for cardiotoxicity

clinical manifestations: rectal lesions

tenesmus constipation feeling of incomplete evacuation diarrhea hematochezia

Familial adenomatous polyposis (FAP)

the most common hereditary polyp disease. patient's develop hundreds of colonic polyps

Hemoglobin: Child

three types: Hgb A, Hgb F, Hgb A2 (after 6 months = Hgb A) Hgb F: short cell life, high quantities, increased risk for anemia and O2 carrying capacity

The nurse informs the client that a diaphragm is an example of which type of contraception? A. chemical barrier B. mechanical barrier C. transdermal D. intrauterine

B. mechanical barrier rationale: The diaphragm is an example of a mechanical barrier. It is a circular rubber disk placed over the cervix before intercourse.

A couple in their mid-30s are at their primary care provider's office because they have been unable to conceive for 3 years. They already have one child who is 4 years of age. The care provider explains to them that they are dealing with what kind of infertility? A. primary infertility B. secondary infertility C. tertiary infertility D. There is no name for different kinds of infertility.

B. secondary infertility rationale: There are two main types of infertility: primary and secondary. A couple who has never been able to conceive has primary infertility, whereas a couple who has been able to conceive in the past but is currently unable to do so has secondary infertility.

The nurse is teaching the client about consolidation. What statement should be included in the teaching plan? A. "Consolidation therapy is administered to reduce the chance of leukemia recurrence." B. "Consolidation occurs as a side effect of chemotherapy." C. "Consolidation of the lungs is an expected effect of induction therapy." D. "Consolidation is the term used when a client does not tolerate chemotherapy."

A. "Consolidation therapy is administered to reduce the chance of leukemia recurrence." rationale: Consolidation therapy is administered to eliminate residual leukemia cells that are not clinically detectable and reduce the chance for recurrence. It is also termed post-remission therapy. It is not a side effect of chemotherapy, but the administration of chemotherapy.

A 9-year-old child with leukemia is scheduled to undergo an allogenic hematopoietic stem cell transplant. When teaching the child and parents, what information would the nurse include? A. "We'll need to have a match to a donor." B. "The risk for rejection is much less with this type of transplant." C. "You won't need to receive the high doses of chemotherapy before the transplant." D. "You'll need to have an incision in your hip area to instill the cells.

A. "We'll need to have a match to a donor." rationale: An allogenic hematopoietic stem cell transplantation (HSCT) refers to transplantation using stem cells from another individual that are harvested from the bone marrow, peripheral blood, or umbilical cord blood. With this type of transplant, human leukocyte antibody (HLA) matching must occur. Therefore, the lesser the degree of HLA matching in the donor, the higher the risk for graft rejection and graft-versus-host disease (GVHD). Regardless of the type of transplant, a period of purging of abnormal cells in the child is necessary and accomplished through high-dose chemotherapy or irradiation. The procedure is accomplished by intravenously infusing hematopoietic stem cells into the child.

A nurse is counseling a 17-year-old girl on the importance of contraception. The girl states that she is not really concerned about getting pregnant; she says that she will deal with the consequences if and when it happens. Which points should the nurse emphasize with the client regarding the risks of unintended pregnancies? Select all that apply. A. The woman is less likely to seek prenatal care. B. The woman is less likely to breastfeed. C. The woman is less likely to protect her fetus from harmful substances. D. The woman is less likely to complete high school or college. E. The woman is more likely to require public assistance. F. The woman is more likely to have a baby with birth defects.

A. B. C. D. E. rationale: It is important for the health of children that as many pregnancies as possible be intended; when a pregnancy is unintended or mistimed, both short-term and long-term consequences can result. Among the many consequences are all of the answers listed above, except for an increased likelihood of having a baby with birth defects.

A nurse is describing the advantages and disadvantages associated with tamoxifen therapy as a means of breast cancer prevention. The nurse would identify that the drug has a beneficial effect on which of the following? A. Bone mineral density B. High density lipoprotein levels C. Risk for endometrial cancer D. Cataract formation

A. Bone mineral density rationale: Besides reducing the risk of breast cancer, tamoxifen preserves bone mineral density, thus preventing osteoporosis. It also lowers the low-density lipoprotein cholesterol levels, although it is still unknown if it decreases the incidence of myocardial infarction in women. Tamoxifen can have detrimental effects. It increases the incidences of endometrial cancer, deep vein thrombosis, pulmonary embolism, and cataracts.

A nurse cares for an adult client with chronic lymphocytic leukemia (CLL). Which statements regarding the disease will the nurse include in the teaching? Select all that apply. A. "This type of leukemia primarily impacts older adults." B. ''This type of leukemia does not appear to have familial predisposition." C. "This type of leukemia is rarely seen in certain ethnicities." D. "This type of leukemia primarily impacts pediatric adults." E. "This type of leukemia is rarely aggressive."

A. C. rationale: Chronic lymphocytic leukemia (CLL) is a common malignancy of older adults and primarily impacts older adults and has a strong familial predisposition. This type of leukemia rarely impacts Native Americans and infrequently individuals of Asian descent. While many clients will have a normal life expectancy, others will have a very short life expectancy due to the aggressive nature of the disease.

The nurse is caring for a client with chronic myeloid leukemia (CML) who is taking imatinib mesylate. In what phase of the leukemia does the nurse understand that this medication is most useful to induce remission? A. Chronic B. Transformation C. Accelerated D. Blast crisis

A. Chronic rationale: Advances in understanding the pathology of CML at a molecular level have led to dramatic changes in treatment. An oral formulation of a tyrosine kinase inhibitor, imatinib mesylate (Gleevec), works by blocking signals within the leukemia cells that express the BCR-ABL protein, thus preventing a series of chemical reactions that cause the cell to grow and divide. Imatinib therapy appears to be most useful in the chronic phase of the illness. It can induce complete remission at the cellular and even molecular level.

A client's bone marrow study report reveals the findings of blast cells in the bone marrow. What does the nurse interpret this as indicating? A. Leukemia B. Hodgkin disease C. Non-Hodgkin disease D. Neutropenia

A. Leukemia rationale: The finding of blast cells in the bone marrow is indicative of leukemia.

When collecting a client's history the client states that he is receiving treatment to maintain remission from leukemia. What does the nurse document that the client is receiving? A. Maintenance therapy B. Induction therapy C. Intensification therapy D. Lysis therapy

A. Maintenance therapy rationale: When a client receives therapy to maintain remission, it is documented and referred to as maintenance therapy.

A patient asks the nurse if there are any available nonsurgical options to terminate a pregnancy if she is only 2 weeks pregnant. What information should the nurse provide to the patient about a medication that blocks progesterone? A. Mifepristone (RU-486, Mifeprex) is used only in early pregnancy to terminate a pregnancy nonsurgically. B. Methotrexate is used only in early pregnancy to terminate a pregnancy nonsurgically. C. Clomiphene (Clomid) is used only in early pregnancy to terminate a pregnancy nonsurgically. D. Birth control pills can be used to terminate the pregnancy.

A. Mifepristone (RU-486, Mifeprex) is used only in early pregnancy to terminate a pregnancy nonsurgically. rationale: Mifepristone (Mifeprex), formerly known as RU-486, is a medication used only in early pregnancy (up to 49 days from the last menstrual period) to induce abortion. It works by blocking progesterone.

A nurse is preparing a presentation for a health fair on the topic of vasectomy. Which information should the nurse point out in the presentation? A. Relatively easy procedure with few complications B. Regular sperm counts are not essential C. Procedure is effective immediately D. Birth control measures are not required

A. Relatively easy procedure with few complications rationale: The nurse should inform the individuals that vasectomy is a relatively easy procedure with few complications. Regular sperm counts following a vasectomy are important, as it will take approximately a month for the remaining sperm to exit the body. The client should use birth control measures until his sperm count remains at zero for 6 weeks.

Which oncologic emergency involves the failure in the negative feedback mechanism that normally regulates the release of antidiuretic hormone (ADH)? A. Syndrome of inappropriate antidiuretic hormone release (SIADH) B. Cardiac tamponade C. Disseminated intravascular coagulation (DIC) D. Tumor lysis syndrome

A. Syndrome of inappropriate antidiuretic hormone release (SIADH) rationale: SIADH is a result of the failure in the negative feedback mechanism that normally regulates the release of antidiuretic hormone (ADH). Cardiac tamponade is an accumulation of fluid in the pericardial space. DIC is a complex disorder of coagulation and fibrinolysis, which results in thrombosis and bleeding. Tumor lysis syndrome is a rapidly developing oncologic emergency that results from the rapid release of intracellular contents as a result of radiation- or chemotherapy-induced cell destruction of large or rapidly growing cancers such as leukemia.

A postmenopausal woman with breast cancer will most likely be treated with which anti-estrogen drug? A. Tamoxifen B. Bleomycin C. Cyclophosphamide D. Cisplatin

A. Tamoxifen rationale: Anti-estrogens are first-line therapy for treating breast cancer in postmenopausal women. Tamoxifen is the most widely recognized anti-estrogen.

A nurse should monitor a client receiving oxytocin for which adverse effects? A. cardiac arrhythmias B. hypotension C. headache D. dizziness

A. cardiac arrhythmias rationale: A nurse should monitor a client receiving oxytocin for the following adverse effects: fetal bradycardia, uterine rupture, uterine hypertonicity, nausea, vomiting, cardiac arrhythmias, and anaphylactic reactions. Hypotension, headache, and dizziness are not adverse reactions of oxytocin. Hypotension can be seen with uterine rupture due to hypovolemia, along with dizziness due to low blood pressure. Headache can be seen with the use of hormone medications such as birth control.

A female patient is taking oral cyclophosphamide therapy for breast cancer. Because of possible adverse effects of the drug, the nurse will instruct the patient to: A. drink a lot of water. B. limit fluid intake. C. take the medication at bedtime. D. increase the protein in her diet.

A. drink a lot of water rationale: An adverse effect of this drug is the incidence of hemorrhagic cystitis. The nurse should encourage the patient to drink at least 2 liters of fluid a day and, in high-dose therapy, administer the uroprotectant agent mesna. Therapy should include prehydrating the patient orally and intravenously with at least 2 liters of normal saline solution. Potassium and magnesium additives may be indicated. The nurse will monitor urine output vigilantly to ensure an output of at least half of the intake. Taking the medication at bedtime and increasing protein in her diet are not associated with limiting the possible adverse effects of the drug.

A nurse is instructing a client on birth control methods. The client asks about the cervical mucus method. When should the nurse tell the client she is fertile in relation to her mucus? A. when it is thin, watery, and copious B. when it is thick C. Cervical mucus is not a reliable indicator. D. when it does not stretch

A. when it is thin, watery, and copious rationale: The cervical mucus method relies on the changes that occur naturally with ovulation. Before ovulation, cervical mucus is thick and does not stretch when pulled. With ovulation, the mucus becomes thin, copious, watery, transparent, and stretchy.

A nurse is providing breast cancer education at a community facility. The American Cancer Society recommends that women get mammograms: A. yearly starting at age 45. B. after the birth of the first child and every 2 years thereafter. C. after the first menstrual period and annually thereafter. D. every 3 years between ages 20 and 44 and annually thereafter.

A. yearly starting at age 45. The American Cancer Society recommends a mammogram yearly for women age 40 and older. It's recommended that women between ages 20 and 44 have a professional breast examination (not a mammogram) every 3 years.

Gynecomastia

Abnormal development of breast tissue in males * adolescent cases = r/t hormones secreted by testes; resolves 1-2 years *older adult cases = r/t medications (Zantac), feminizing testicular tumors, infection of testes, liver disease; firm tender mass under areola *idiopathic (unknown cause) = testicular examination/ultrasound * surgical removal = small incision around areola

An older adult female comes in to the clinic for her yearly gynecologic appointment and informs the nurse that she is having pain when having intercourse with her spouse. The client has been postmenopausal for at least 5 years. What is the nurse's best response? A. "That is really a shame since you won't be able to enjoy sex anymore." B. "This is caused by a decrease in estrogen levels, but there are things that you may be able to use to help." C. "The cause of this is an increase in progesterone levels and you will have to take hormone replacement to control this." D. "This is caused by the superficial layer of the endometrium shedding."

B. "This is caused by a decrease in estrogen levels, but there are things that you may be able to use to help." rationale: Decreased estrogen stimulation after menopause causes the vaginal mucosa to become thin and dry, often resulting in dyspareunia, atrophic vaginitis, and occasional vaginal bleeding. Low-dose estrogen suppositories may be used and the client should be encouraged to use a water-soluble vaginal lubricant. This does not mean that the client will no longer be able to have —or enjoy—sex. It is not caused by increased progesterone levels.

The nurse is explaining the procedure of bone marrow aspiration to a 6-year-old child with leukemia. What explanation would be best to give to the child? A. "You will need to lie still afterward to prevent a headache." B. "You may feel pressure on your hip during the procedure." C. "You will have to lie on your back and hold your breath." D. "The numbing medicine on your skin will keep you from having pain."

B. "You may feel pressure on your hip during the procedure." rationale: The bone marrow aspiration is performed on the iliac crest if the child is older and on the femur if the child is an infant. Bone marrow aspiration requires hard pressure to allow the needle to puncture the bone. A lidocaine/prilocaine cream is applied to the skin anywhere from 1 to 3 hours prior to the procedure to help numb the site where the needle will be inserted. Bone marrow aspirations and biopsies are usually performed with conscious sedation. If the child is an infant or there are special circumstances the procedure may be performed under anesthesia. The child is placed on the side for the procedure so the health care provider has better access to the iliac crest. The child will need to rest after the procedure to prevent bleeding, but is not required to lay flat on the back. Children who have had a lumbar puncture may need to lie on the back and are at risk for a headache.

A couple is considered infertile after how many months of trying to conceive? a. 6 months b. 12 months c. 18 months d. 24 months

B. 12 months rationale: the definition of infertility is the inability of a couple to conceive after 12 months of unprotected sexual intercourse.

The primary care provider has prescribed estrogen replacement therapy (ERT) for a menopausal woman who has been diagnosed with pelvic organ prolapse (POP). The client asks the nurse why she needs to be on hormones. Which would be the nurse's best response? A. Hormone replacement will decrease blood perfusion and the elasticity of the vaginal wall. B. Hormone replacement will increase blood perfusion and the elasticity of the vaginal wall. C. Hormone replacement will increase the blood perfusion and decrease the elasticity of the vaginal wall. D. Hormone replacement will decrease blood perfusion and increase the elasticity of the vaginal wall.

B. Hormone replacement will increase blood perfusion and the elasticity of the vaginal wall. rationale: Hormone replacement therapy may improve the tone and vascularity of the supporting tissue in perimenopausal and menopausal women by increasing blood perfusion and the elasticity of the vaginal wall.

The nurse is caring for a client with leukemia who is having difficulty with blood clotting after having several transfusions with packed red blood cells. What does the nurse anticipate infusing for this client to assist with controlling the bleeding? A. Whole blood B. Platelets C. Ringer's lactate solution D. Albumin

B. Platelets rationale: Thrombocytes, or platelets, are circulating cell fragments of the large megakaryocytes that are derived from the myeloid stem cell. They function to form the platelet plug to help control bleeding after injury to a vessel wall. Their cytoplasmic granules release mediators required for the blood coagulation process. Thrombocytes have a membrane but no nucleus, cannot replicate, and, if not used, last approximately 10 days in the circulation before the phagocytic cells of the spleen remove them.

Which of the following activities will increase a woman's risk of cardiovascular disease if she is taking oral contraceptives? A. Eating a high-fiber diet B. Smoking cigarettes C. Taking daily multivitamins D. Drinking alcohol

B. Smoking cigarettes rationale: smoking causes vasoconstriction of the blood vessels, increasing peripheral vascular resistance and elevating blood pressure.

A woman uses a diaphragm for contraception. The nurse would instruct her to return to the clinic to have her diaphragm fit checked after which occurrence? A. cervical infection B. a weight gain of 10 lb (4.5 kg) C. a vaginal infection D. six months of nonuse

B. a weight gain of 10 lb (4.5 kg) rationale: A substantial weight gain or weight loss of 10 pounds (4.5 kilograms) or more may shift the relationship of pelvic organs enough that the diaphragm no longer fits correctly.

A 20-year-old woman has been prescribed estrogen. As with all women taking estrogen, the nurse will carefully monitor the client for: A. a decrease in secondary sexual characteristics. B. cardiovascular complications. C. early epiphyseal closure. D. decreased libido.

B. cardiovascular complications. rationale: Women taking estrogen are at an increased risk of cardiovascular complications, along with ovarian and breast cancer. Early epiphyseal closure is a condition the nurse would watch for in a prepubescent girl who takes estrogen. Diminished libido and lack of secondary sexual characteristics are not identified adverse effects of estrogen.

Which definition best explains the term "subfertility/infertility"? A. failure to achieve pregnancy after 6 months of unprotected intercourse B. failure to achieve pregnancy after 1 year of unprotected intercourse C. inability to achieve pregnancy because of a known factor that prevents conception D. inability to achieve pregnancy following a previous viable pregnancy

B. failure to achieve pregnancy after 1 year of unprotected intercourse

A young woman comes to the free clinic asking for oral contraceptive pills. Which factor best indicates that another type of contraception would be better for this client? A. cost of the pills B. history of noncompliance with medications C. age of her partner D. frequency of sexual encounters

B. history of noncompliance with medications

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia? A. Implement neutropenic precautions. B. Eliminate direct contact with others who are infectious. C. Apply prolonged pressure to needle sites or other sources of external bleeding. D. Monitor temperature at least once per shift.

C. Apply prolonged pressure to needle sites or other sources of external bleeding. rationale: For a client with leukemia, the nurse should apply prolonged pressure to needle sites or other sources of external bleeding. Reduced platelet production results in a delayed clotting process and increases the potential for hemorrhage. Implementing neutropenic precautions and eliminating direct contact with others are interventions to address the risk for infection.

A client is receiving adjuvant chemotherapy for breast cancer. Which is most likely her node status and tumor size? A. Node negative, tumor size 0.3 cm B. Node negative, tumor size 0.5 cm C. Node negative, tumor size 1.2 cm D. Node negative, tumor size 0.2 cm

C. Node negative, tumor size 1.2 cm rationale: Adjuvant chemotherapy is recommended for clients who have positive lymph nodes or who have invasive tumors greater than 1 cm in size, regardless of nodal status.

Estropipate is sometimes administered to postmenopausal women to prevent which condition? A. Endometriosis B. Dysfunctional uterine bleeding C. Osteoporosis D. Uterine cancer

C. Osteoporosis rationale: Estropipate and other estrogens are sometimes prescribed to postmenopausal women to prevent or treat osteoporosis associated with hormone deficiency. However, given the potentially significant risks associated with hormone replacement therapy, this use is not currently considered a first-line treatment.

Nursing students are reviewing information about natural family planning methods in preparation for a quiz the next day. The students demonstrate a need for additional study when they identify which of the following as an example? A. Basal body temperature B. Symptothermal method C. Spermicide D. Calendar method

C. Spermicide rationale: Spermicides are considered a barrier method of contraception. Natural family planning methods include the calendar, basal body temperature, symptothermal, and ovulation methods.

The nurse is caring for a child with leukemia. Which nursing intervention would be the highest priority for this child? A. encouraging the child to share feelings B. grouping nursing care C. following guidelines for protective isolation D. providing age-appropriate activities

C. following guidelines for protective isolation rationale: The child with leukemia is susceptible to infection, especially during chemotherapy. Infections such as meningitis, septicemia, and pneumonia are the most common causes of death. To protect the child from infectious organisms, follow standard guidelines for protective isolation. Grouping nursing care to provide rest is important, but not the highest priority. Encouraging the child to share feelings and providing age-appropriate activities are important, but psychological issues are a lower priority than physical.

A breast cancer client has just learned that her tumor clinical stage is T3, N2, M0. After the physician leaves, the client asks the nurse to explain this to her again. The nurse will use which statement in his or her answer? Your: A. tumor is very small and has zero number of mitoses. B. tumor has metastasized to at least three distal sites and you have cancer in your lymph nodes. C. tumor is large and at least two lymph nodes are positive for cancer cells. D. extent of disease is unknown, but it looks like your cancer has stayed intact and not spread to the bloodstream.

C. tumor is large and at least two lymph nodes are positive for cancer cells. rationale: Tumor staging groups clients according to the extent and spread of the disease, using the TNM (tumor, node, and metastasis) system. In the TNM system, T1, T2, T3, and T4 describe tumor size, N0, N1, N2, and N3, lymph node involvement; and M0 or M1, the absence or presence of metastasis.

A 24-year-old woman has come to the clinic with an infection and has been prescribed penicillin. The nursing assessment reveals that she is taking oral contraceptives. The nurse will instruct her to: A. include adequate proteins and vitamins in her diet. B. stop using oral contraceptives and focus on the penicillin therapy. C. use an additional form of birth control while taking penicillin. D. abstain from intercourse for at least 48 hours after taking penicillin.

C. use an additional form of birth control while taking penicillin. rationale: A patient who takes penicillin should use another form of birth control in addition to oral contraceptives because the penicillin may reduce their effectiveness. The patient need not abstain from intercourse; changing her protein and vitamin intake would also not be necessary

A couple wants to start a family. They are concerned that their child will be at risk for cystic fibrosis because they each have a cousin with cystic fibrosis. They are seeing a nurse practitioner for preconceptual counseling. What would the nurse practitioner tell them about cystic fibrosis? A. It is an autosomal dominant disorder. B. It is passed by mitochondrial inheritance. C. It is an X-linked inherited disorder. D. It is an autosomal recessive disorder.

D. It is an autosomal recessive disorder. rationale: Cystic fibrosis is autosomal recessive. Nurses also consider other issues when assessing the risk for genetic conditions in couples and families. For example, when obtaining a preconception or prenatal family history, the nurse asks if the prospective parents have common ancestors. This is important to know because people who are related have more genes in common than those who are unrelated, thus increasing their chance for having children with autosomal recessive inherited condition such as cystic fibrosis. Mitochondrial inheritance occurs with defects in energy conversion and affects the nervous system, kidney, muscle, and liver. X-linked inheritance, which has been inherited from a mutant allele of the mother, affects males. Autosomal dominant is an X-linked dominant genetic disease.

A client was admitted to the hospital with a pathologic pelvic fracture. The client informs the nurse that he has been having a strange pain in the pelvic area for a couple of weeks that was getting worse with activity prior to the fracture. What does the nurse suspect may be occurring based on these symptoms? A. Hemolytic anemia B. Polycythemia vera C. Leukemia D. Multiple myeloma

D. Multiple myeloma rationale: The first symptom usually is vague pain in the pelvis, spine, or ribs. As the disease progresses, the pain becomes more severe and localized. The pain intensifies with activity and is relieved by rest. When tumors replace bone marrow, pathologic fractures develop. Hemolytic anemia does not result in pathologic fractures nor does polycythemia vera or leukemia.

A client comes to the clinic for a routine evaluation. During the physical examination, the nurse palpates the client's breast and finds a small lump. Which of the following would lead the nurse to suspect possible breast cancer? A. The client reports tenderness during the palpation. B. The lump is mobile. C. The lump is soft. D. The lump is irregularly shaped.

D. The lump is irregularly shaped. rationale: Generally, breast cancer lesions are nontender, fixed rather than mobile, and hard with irregular borders. Diffuse breast pain and tenderness with menstruation are usually associated with benign breast disease.

Which of the following measures prevents osteoporosis? A. Supplementing with iron B. Sleeping 8 hours nightly C. Eating lean meats only D. Walking daily

D. Walking daily rationale: weight bearing exercise prevents osteoporosis.

Reduction mammoplasty

Performed to reduce breast size (breast hypertrophy = excessively large breast) Drains remain 2-5 days Risk of impaired breast feeding Weight gain = enlargement of breast Pt. Education: wear supportive bra 24 hrs per day for 2 wks; avoid vigorous exercise

Nursing Management: Both ALL and AML Leukemia child

Reducing Pain: distraction techniques, mild analgesic (acetaminophen); ELMA creams prior to venipuncture, port access, lumbar puncture, bone marrow aspiration; applying heat or cold; narcotic analgesics for severe pain Preventing Infection Restoring healthy oral mucosa Preventing Injury Promoting Physical Mobility Alleviating Nausea and Vomiting Decreasing Fatigue Promoting Comfort Promoting Adequate nutrition Preventing/Managing Constipation Managing Diarrhea Promoting Skin Integrity Educating Parents about effective Health Maintenance Relieving Anxiety Promoting Effective Child & Family Coping Promoting Body Image Promoting Self Esteem Supporting the Grieving Family

Patho: Acute Myelogenous Leukemia (AML) child

affects myeloid cell progenitors/precursors in bone marrow resulting in malignant calls. 8 subtypes depending on myeloid lineage involved and degree of cell differentation