MED SURGE: 50, 51, 53, 54

Which nonhormonal therapies will the nurse suggest for a healthy perimenopausal patient who prefers not to use hormone replacement therapy (HRT) (select all that apply)? a. Reduce caffeine intake. b. Exercise several times a week. c. Take black cohosh supplements. d. Drink a glass of wine in the evening. e. Increase intake of dietary soy products.

A, B, C, E Reduction in caffeine intake, use of black cohosh, increasing dietary soy intake, and exercising three to four times weekly are recommended to reduce symptoms associated with menopause. Alcohol intake in the evening may increase the sleep problems associated with menopause.

Which nursing actions can the nurse working in a women's health clinic delegate to experienced unlicensed assistive personnel (UAP) (select all that apply)? a. Call a patient with the results of an endometrial biopsy. b. Assist the health care provider with performing a Pap test. c. Draw blood for CA-125 levels for a patient with ovarian cancer. d. Question a patient about use of medications that may cause amenorrhea. e. Teach the parent of a 10-yr-old about human papilloma virus (HPV) vaccine (Gardasil).

B, C Assisting with a Pap test and drawing blood (if trained) are skills that require minimal critical thinking and judgment and can be safely delegated to UAP. Patient teaching, calling a patient who may have questions about results of diagnostic testing, and risk-factor screening all require more education and critical thinking and should be done by the registered nurse (RN).

A 22-yr-old patient tells the nurse at the health clinic that he has recently had some problems with erectile dysfunction. Which question should the nurse ask to assess for possible etiologic factors in this age group? a. "Do you use recreational drugs or drink alcohol?" b. "Do you experience an unusual amount of stress?" c. "Do you have cardiovascular or peripheral vascular disease?" d. "Do you have a history of an erection that lasted for 6 hours or more?"

A A common etiologic factor for erectile dysfunction (ED) in younger men is use of recreational drugs or alcohol. Stress, priapism, and cardiovascular illness also contribute to ED, but they are not common etiologic factors in younger men.

Which information will the nurse include in patient teaching for a 36-yr-old patient who is scheduled for stereotactic core biopsy of the breast? a. A local anesthetic will be given before the biopsy specimen is obtained. b. You will need to lie flat on your back and lie very still during the biopsy. c. A thin needle will be inserted into the lump and aspirated to remove tissue. d. You should not have anything to eat or drink for 6 hours before the procedure.

A A local anesthetic is given before stereotactic biopsy. NPO status is not needed because no sedative drugs are given. The patient is placed in the prone position. A biopsy gun is used to obtain the specimens.

The nurse will plan to teach the female patient with genital warts about the a. importance of regular Pap tests. b. increased risk for endometrial cancer. c. appropriate use of oral contraceptives. d. symptoms of pelvic inflammatory disease (PID).

A Genital warts are caused by the human papillomavirus (HPV) and increase the risk for cervical cancer. There is no indication that the patient needs teaching about PID, oral contraceptives, or endometrial cancer.

A 53-yr-old patient is scheduled for an annual physical examination. The nurse will plan to teach the patient about the purpose of a. urinalysis collection. b. uroflowmetry studies. c. prostate specific antigen (PSA) testing. d. transrectal ultrasound scanning (TRUS).

C An annual digital rectal exam (DRE) and PSA are usually recommended starting at age 50 years for men who have an average risk for prostate cancer. Urinalysis and uroflowmetry studies are done if patients have symptoms of urinary tract infection or changes in the urinary stream. TRUS may be ordered if the DRE or PSA results are abnormal.

The health care provider prescribes the following interventions for a patient with acute prostatitis caused by Escherichia coli. Which intervention should the nurse question? a. Give trimethoprim/sulfamethoxazole 1 tablet daily for 28 days. b. Administer ibuprofen 400 mg every 8 hours as needed for pain. c. Instruct patient to avoid sexual intercourse until treatment is complete. d. Catheterize the patient as needed if symptoms of urinary retention develop.

D Although acute urinary retention may occur, insertion of a catheter through an inflamed urethra is contraindicated, and the nurse will anticipate that the health care provider will need to insert a suprapubic catheter. The other actions are appropriate.

The outpatient clinic receives telephone calls from four patients. Which patient should the nurse call back first? a. A 57-yr-old patient with ductal ectasia who has sticky multicolored nipple discharge and severe nipple itching b. A 21-yr-old patient with a family history of breast cancer who wants to discuss genetic testing for the BRCA gene c. A 40-yr-old patient who still has left side chest and arm pain 2 months after a left modified radical mastectomy d. A 50-yr-old patient with stage 2 breast cancer who is receiving doxorubicin and has ankle swelling and fatigue

D Although all the patients have needs that the nurse should address, the patient who is receiving a cardiotoxic medication and has symptoms of heart failure should be assessed by the nurse first. BRCA testing may be appropriate for the 21-yr-old patient, but it does not need to be done immediately. Chest and arm pain are normal up to 3 months after mastectomy. Nipple discharge and itching is a common finding with ductal ectasia.

The nurse is admitting a patient scheduled this morning for lumpectomy and axillary lymph node dissection. Which action should the nurse take first? a. Teach the patient how to deep breathe and cough. b. Discuss options for postoperative pain management. c. Explain the postdischarge care of the axillary drains. d. Ask the patient to describe what she knows about the surgery.

D Before teaching, the nurse should assess the patient's current knowledge level. The other teaching also may be appropriate, depending on the assessment findings.

A 68-yr-old male patient tells the nurse that he is worried because he does not respond to sexual stimulation the same way he did when he was younger. Which is the nurse's best response to the patient's concern? a. "Interest in sex frequently decreases as men get older." b. "Many men need additional sexual stimulation with aging." c. "Erectile dysfunction is a common problem with older men." d. "Tell me more about how your sexual response has changed."

D The initial response by the nurse should be further assessment of the problem. The other statements by the nurse are accurate but may not respond to the patient's concerns.

The nurse will plan to teach a 67-yr-old patient who has been diagnosed with orchitis about a. pain management. b. emergency surgery. c. application of heat to the scrotum. d. aspiration of fluid from the scrotal sac.

A Orchitis is very painful, and effective pain management will be needed. Heat, aspiration, and surgery are not used to treat orchitis.

A patient diagnosed with breast cancer asks the nurse what "triple negative" means. An accurate response from the nurse about triple-negative breast cancer should include that a. the tumor is not likely to be responsive to hormone therapy. b. HER-2 receptor testing was repeated for a total of three samples. c. treatment with chemotherapy is not likely to be recommended. d. estrogen receptor testing identified the three hormones causing the cancer.

A A patient whose breast cancer tests negative for all three receptors (estrogen, progesterone, and HER-2) has triple-negative breast cancer. These cancers do not usually respond to hormone therapy or therapy for the human epidermal growth factor receptor 2 (HER-2). Chemotherapy appears to have the most success in treating triple-negative breast cancer.

A 56-yr-old patient is concerned about having a moderate amount of vaginal bleeding after 5 years of menopause. The nurse will anticipate teaching the patient about a. endometrial biopsy. c. uterine balloon therapy. b. endometrial ablation. d. dilation and curettage (D&C).

A A postmenopausal woman with vaginal bleeding should be evaluated for endometrial cancer, and endometrial biopsy is the primary test for endometrial cancer. D&C will be needed only if the biopsy does not provide sufficient information to make a diagnosis. Endometrial ablation and balloon therapy are used to treat menorrhagia, which is unlikely in this patient.

A 70-yr-old patient who has had a transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) is being discharged from the hospital today. Which patient statement indicates a need for the nurse to provide additional instruction? a. "I should call the doctor if I have incontinence at home." b. "I will avoid driving until I get approval from my doctor." c. "I should schedule yearly appointments for prostate examinations." d. "I will increase fiber and fluids in my diet to prevent constipation."

A Because incontinence is common for several weeks after a TURP, the patient does not need to call the health care provider if this occurs. The other patient statements indicate that the patient has a good understanding of post-TURP instructions.

When performing discharge teaching for a patient after a vasectomy, the nurse instructs the patient that he a. should continue to use other methods of birth control for 6 weeks. b. should not have sexual intercourse until his 6-week follow-up visit. c. may have temporary erectile dysfunction (ED) because of swelling. d. will notice a decrease in the appearance and volume of his ejaculate.

A Because it takes about 6 weeks to evacuate sperm that are distal to the vasectomy site, the patient should use contraception for 6 weeks. ED that occurs after vasectomy is psychologic in origin and not related to postoperative swelling. The patient does not need to abstain from intercourse. The appearance and volume of the ejaculate are not changed because sperm are a minor component of the ejaculate.

A patient with urinary obstruction from benign prostatic hyperplasia (BPH) tells the nurse, "My symptoms are much worse this week." Which response by the nurse is appropriate? a. "Have you taken any over-the-counter (OTC) medications recently?" b. "I will talk to the doctor about a prostate specific antigen (PSA) test." c. "Have you talked to the doctor about surgery such as transurethral resection of the prostate (TURP)?" d. "The prostate gland changes in size from day to day, and this may be making your symptoms worse."

A Because the patient's increase in symptoms has occurred abruptly, the nurse should ask about OTC medications that might cause contraction of the smooth muscle in the prostate and worsen obstruction. The prostate gland does not vary in size from day to day. A TURP may be needed, but more assessment about possible reasons for the sudden symptom change is a more appropriate first response by the nurse. PSA testing is done to differentiate BPH from prostatic cancer.

A 51-yr-old patient with a small immobile breast lump is considering having a fine-needle aspiration (FNA) biopsy. The nurse explains that an advantage to this procedure is that a. FNA is done in the outpatient clinic, and results are available in 1 to 2 days. b. only a small incision is needed, resulting in minimal breast pain and scarring. c. if the biopsy results are negative, no further diagnostic testing will be needed. d. FNA is guided by a mammogram, ensuring that cells are taken from the lesion.

A FNA is done in outpatient settings, and results are available in 24 to 48 hours. No incision is needed. FNA may be guided by ultrasound but not by mammogram. Because the immobility of the breast lump suggests cancer, further testing will be done if the FNA results are negative.

The nurse will inform a patient with cancer of the prostate that side effects of leuprolide (Lupron) may include a. flushing. c. infection. b. dizziness. d. incontinence.

A Hot flashes may occur with decreased testosterone production. Dizziness may occur with the -blockers used for benign prostatic hyperplasia. Urinary incontinence may occur after prostate surgery, but it is not an expected side effect of medication. Risk for infection is increased in patients receiving chemotherapy.

A 50-yr-old patient is diagnosed with uterine bleeding caused by a leiomyoma. Which information will the nurse include in the patient teaching plan? a. The symptoms may decrease after the patient undergoes menopause. b. The tumor size is likely to increase throughout the patient's lifetime. c. Aspirin or acetaminophen may be used to control mild to moderate pain. d. The patient will need frequent monitoring to detect any malignant changes.

A Leiomyomas appear to depend on ovarian hormones and will atrophy after menopause, leading to a decrease in symptoms. Aspirin use is discouraged because the antiplatelet effects may lead to heavier uterine bleeding. The size of the tumor will shrink after menopause. Leiomyomas are benign tumors that do not undergo malignant changes.

A patient with endometriosis asks why she is being treated with medroxyprogesterone, a medication that she thought was a contraceptive. The nurse explains that this therapy a. suppresses the menstrual cycle by mimicking pregnancy. b. relieves symptoms such as vaginal atrophy and hot flashes. c. prevents a pregnancy that could worsen the menstrual bleeding. d. leads to permanent suppression of abnormal endometrial tissues.

A Medroxyprogesterone induces a pseudopregnancy, which suppresses ovulation and causes shrinkage of endometrial tissue. Menstrual bleeding does not occur during pregnancy. Vaginal atrophy and hot flashes are caused by synthetic androgens such as danazol or gonadotropin-releasing hormone agonists such as leuprolide. Although hormonal therapies will control endometriosis while the therapy is used, endometriosis will recur once the menstrual cycle is reestablished.

A 22-yr-old patient tells the nurse that she has not had a menstrual period for the past 3 months. Which action is most important for the nurse to take? a. Obtain a urine specimen for a pregnancy test. b. Ask about any recent stressful lifestyle changes. c. Measure the patient's current height and weight. d. Question the patient about prescribed medications.

A Pregnancy should always be considered a possible cause of amenorrhea in women of childbearing age. The other actions are also appropriate, but it is important to check for pregnancy in this patient because pregnancy will require rapid implementation of actions to promote normal fetal development such as changes in lifestyle, folic acid intake, and so on.

The nurse will anticipate teaching a patient who is diagnosed with lobular carcinoma in situ (LCIS) about a. tamoxifen c. lymphatic mapping. b. lumpectomy. d. MammaPrint testing.

A Tamoxifen is used as a chemopreventive therapy in some patients with LCIS. The other diagnostic tests and therapies are not needed because LCIS does not usually require treatment.

After a 48-yr-old patient has had a modified radical mastectomy, the pathology report identifies the tumor as an estrogen-receptor positive adenocarcinoma. The nurse will plan to teach the patient about a. tamoxifen c. raloxifene (Evista). b. estradiol (Estrace). d. trastuzumab (Herceptin).

A Tamoxifen is used for estrogen-dependent breast tumors in premenopausal women. Raloxifene is used to prevent breast cancer, but it is not used postmastectomy to treat breast cancer. Estradiol will increase the growth of estrogen-dependent tumors. Trastuzumab is used to treat tumors that have the HER-2 receptor.

A patient in the emergency department reports that she has been sexually assaulted. Which action by the nurse will help to maintain the medicolegal chain of evidence? a. Labeling all specimens and other materials obtained from the patient b. Assisting the patient in filling out the application for financial compensation c. Discussing the availability of the "morning-after pill" for pregnancy prevention d. Educating the patient about baseline sexually transmitted infection (STI) testing

A The careful labeling of specimens and materials will assist in maintaining the chain of evidence. Assisting with paperwork, and discussing STIs and pregnancy prevention are interventions that might be appropriate after sexual assault, but they do not help maintain the legal chain of evidence.

A 19-yr-old patient visits the health clinic for a routine checkup. Which question should the nurse ask to determine whether a Pap test is needed? a. "Have you had sexual intercourse?" b. "Do you use any illegal substances?" c. "Do you have cramping with your periods?" d. "At what age did your menstrual periods start?"

A The current American Cancer Society recommendation is that a Pap test be done every 3 years, starting 3 years after the first sexual intercourse and no later than age 21 years. The information about menstrual periods and substance abuse will not help determine whether the patient requires a Pap test.

A patient is on the surgical unit after a radical abdominal hysterectomy. Which finding requires a report to the health care provider? a. Urine output of 125 mL in the first 8 hours after surgery b. Decreased bowel sounds in all four abdominal quadrants c. One-inch area of bloody drainage on the abdominal dressing d. Complaints of abdominal pain at the incision site with coughing

A The decreased urine output indicates possible low blood volume and further assessment is needed to assess for possible internal bleeding. Decreased bowel sounds, minor drainage on the dressing, and abdominal pain with coughing are expected after this surgery.

A patient brought to the emergency department reports being sexually assaulted. The patient is confused about where she is and she has a laceration above the right eye. Which action should the nurse take first? a. Assess the patient's neurologic status. b. Assist the patient to remove her clothing. c. Ask the patient to describe what occurred during the assault. d. Ask the sexual assault nurse examiner (SANE) to assess the patient.

A The first priority is to treat urgent medical problems associated with the sexual assault. The patient's head injury may be associated with a head trauma such as a skull fracture or subdural hematoma. Therefore her neurologic status should be assessed first. The other nursing actions are also appropriate, but they are not as high in priority as assessment and treatment for acute physiologic injury.

Several patients call the urology clinic requesting appointments with the health care provider as soon as possible. Which patient will the nurse schedule to be seen first? a. A 22-yr-old patient who has noticed a firm, nontender lump on his scrotum b. A 35-yr-old patient who is concerned that his scrotum "feels like a bag of worms" c. A 40-yr-old patient who has pelvic pain while being treated for chronic prostatitis d. A 70-yr-old patient who is reporting frequent urinary dribbling after a prostatectomy

A The patient's age and symptoms suggest possible testicular cancer. Some forms of testicular cancer can be very aggressive, so the patient should be evaluated by the health care provider as soon as possible. Varicoceles do require treatment but not emergently. Ongoing pelvic pain is common with chronic prostatitis. Urinary dribbling is a common problem after prostatectomy.

The following male patients recently arrived in the emergency department. Which one should the nurse assess first? a. A 19-yr-old patient who is complaining of severe scrotal pain b. A 60-yr-old patient with a nontender ulceration of the glans penis c. A 64-yr-old patient who has dysuria after brachytherapy for prostate cancer d. A 22-yr-old patient who has purulent urethral drainage and severe back pain

A The patient's age and symptoms suggest possible testicular torsion, which will require rapid treatment to prevent testicular necrosis. The other patients also require assessment by the nurse, but their history and symptoms indicate nonemergent problems (acute prostatitis, cancer of the penis, and radiation-associated urinary tract irritation).

A 28-yr-old patient reports anxiety, headaches with dizziness, and abdominal bloating occurring before her menstrual periods. Which action is best for the nurse to take at this time? a. Ask the patient to keep track of her symptoms in a diary for 3 months. b. Suggest that the patient try aerobic exercise to decrease her symptoms. c. Teach the patient about appropriate lifestyle changes to reduce premenstrual syndrome (PMS) symptoms. d. Advise the patient to use nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen to control symptoms.

A The patient's symptoms indicate possible PMS, but they also may be associated with other diagnoses. Having the patient keep a symptom diary for 2 or 3 months will help in confirming a diagnosis of PMS. The nurse should not implement interventions for PMS until a diagnosis is made.

The nurse is assessing the sexual-reproductive functional health pattern of a 32-yr-old woman. Which question is most useful in determining the patient's sexual orientation and related risk factors? a. "Do you have sex with men, women, or both?" b. "Which gender do you prefer to have sex with?" c. "What types of sexual activities do you prefer?" d. "Are you heterosexual, homosexual, or bisexual?"

A This question is the most simply stated and will increase the likelihood of obtaining the relevant information about sexual orientation and possible risk factors associated with sexual activity. A patient who prefers sex with women may also have intercourse at times with men. The types of sexual activities engaged in may not indicate sexual orientation. Many patients who have sex with both men and women do not identify themselves as homosexual or bisexual.

A patient who is scheduled for a lumpectomy and axillary lymph node dissection tells the nurse, "I would rather not know much about the surgery." Which response by the nurse is best? a. "Tell me what you think is important to know about the surgery." b. "It is essential that you know enough to provide informed consent." c. "Many patients do better after surgery if they have more information." d. "You can wait until after surgery for teaching about pain management."

A This response shows sensitivity to the individual patient's need for information about the surgery. The other responses are also accurate, but the nurse should tailor patient teaching to individual patient preferences.

Which topic will the nurse include in the preoperative teaching for a patient admitted for an abdominal hysterectomy? a. Purpose of ambulation and leg exercises b. Adverse effects of systemic chemotherapy c. Decrease in vaginal sensation after surgery d. Symptoms caused by the drop in estrogen level

A Venous thromboembolism is a potential complication after the surgery, and the nurse will instruct the patient about ways to prevent it. Vaginal sensation is decreased after a vaginal hysterectomy but not after abdominal hysterectomy. Most hysterectomies are not done for treatment of cancer. Unless the patient has cancer, chemotherapy and radiation will not be prescribed. Because the patient will still have her ovaries, her estrogen level will not decrease.

A 58-yr-old patient is on the medical-surgical unit after undergoing a radical vulvectomy for vulvar carcinoma. The greatest risk to the patient at this time is a. self-care deficit. c. inadequate nutrition. b. wound infection. d. ineffective sexual pattern.

B Complex and meticulous wound care is needed to prevent infection and delayed wound healing. The patient may be at risk for other problems, but they are not the greatest concerns in the immediate postoperative time period.

The health care provider prescribes finasteride (Proscar) for a patient who has benign prostatic hyperplasia (BPH). When teaching the patient about the drug, the nurse informs him that a. he should change position from lying to standing slowly to avoid dizziness. b. his interest in sexual activity may decrease while he is taking the medication. c. improvement in the obstructive symptoms should occur within about 2 weeks. d. he will need to monitor his blood pressure frequently to assess for hypertension.

B A decrease in libido is a side effect of finasteride because of the androgen suppression that occurs with the drug. Although orthostatic hypotension may occur if the patient is also taking a medication for erectile dysfunction, it should not occur with finasteride alone. Improvement in symptoms of obstruction takes about 6 months. The medication does not cause hypertension.

After scheduling a patient with a possible ovarian cyst for ultrasound, the nurse will teach the patient that she should a. expect to receive IV contrast during the procedure. b. drink several glasses of fluids before the procedure. c. experience mild abdominal cramps after the procedure. d. discontinue taking aspirin for 7 days before the procedure.

B A full bladder is needed for many ultrasound procedures, so the nurse will have the patient drink fluids before arriving for the ultrasound. The other instructions are not accurate for this procedure.

A 36-yr-old patient who has a diagnosis of fibrocystic breast changes calls the nurse in the clinic reporting symptoms. Which information is likely to change the treatment plan? a. There is yellow discharge from the patient's right nipple. b. An area on the breast is hot, pink, and tender to the touch. c. Firm, moveable lumps are in the upper outer breast quadrants. d. The lumps get more painful before the patient's menstrual period.

B An area that is hot or pink suggests an infectious process such as mastitis, which would require further assessment and treatment. Manifestations of fibrocystic breast changes include one or more palpable lumps that are often round, well delineated, and freely movable within the breast. Discomfort ranging from tenderness to pain may also occur. The lump is usually observed to increase in size and perhaps in tenderness before menstruation. Nipple discharge associated with fibrocystic breasts is often milky, watery-milky, yellow, or green.

A 31-yr-old patient who has been diagnosed with human papillomavirus (HPV) infection gives a health history that includes smoking tobacco, taking oral contraceptives, and having been treated twice for vaginal candidiasis. Which topic will the nurse include in patient teaching? a. Use of water-soluble lubricants b. Risk factors for cervical cancer c. Antifungal cream administration d. Possible difficulties with conception

B Because HPV infection and smoking are both associated with increased cervical cancer risk, the nurse should emphasize the importance of avoiding smoking. An HPV infection does not decrease vaginal lubrication, decrease the ability to conceive, or require the use of antifungal creams.

When caring for a 58-yr-old patient with persistent menorrhagia, the nurse will plan to monitor the a. estrogen level. b. complete blood count (CBC). c. gonadotropin-releasing hormone (GNRH) level. d. serial human chorionic gonadotropin (hCG) results.

B Because anemia is a likely complication of menorrhagia, the nurse will need to check the CBC. Estrogen and GNRH levels are checked for patients with other problems, such as infertility. Serial hCG levels are monitored in patients who may be pregnant, which is not likely for this patient.

A 24-yr-old woman says she wants to begin using oral contraceptives. Which information from the nursing assessment is important to report to the health care provider before a prescription is considered? a. The patient quit smoking 5 months previously. b. The patient's blood pressure is 150/86 mm Hg. c. The patient has not been vaccinated for rubella. d. The patient has chronic iron-deficiency anemia.

B Because hypertension increases the risk for morbidity and mortality in women taking oral contraceptives, the patient's blood pressure should be controlled before oral contraceptives are prescribed. The other information will not affect the choice of contraceptive.

A 58-yr-old patient with erectile dysfunction (ED) tells the nurse he is interested in using sildenafil (Viagra). Which action should the nurse take first? a. Assure the patient that ED is common with aging. b. Ask the patient about any prescription drugs he is taking. c. Tell the patient that Viagra does not always work for ED. d. Discuss the common adverse effects of erectogenic drugs.

B Because some medications can cause ED and patients using nitrates should not take sildenafil, the nurse should first assess for prescription drug use. The nurse may want to teach the patient about realistic expectations and adverse effects of sildenafil therapy, but this should not be the first action. Although ED does increase with aging, it may be secondary to medication use or cardiovascular disease.

The nurse will plan to teach a 34-yr-old patient diagnosed with stage 0 cervical cancer about a. radiation. c. chemotherapy. b. conization. d. radical hysterectomy.

B Because the carcinoma is in situ, conization can be used for treatment. Radical hysterectomy, chemotherapy, or radiation will not be needed.

A patient who was admitted to the emergency department with severe abdominal pain is diagnosed with an ectopic pregnancy. The patient begins to cry and asks the nurse to leave her alone to grieve. Which action should the nurse take next? a. Stay with the patient and encourage her to discuss her feelings. b. Explain the reason for taking vital signs every 15 to 30 minutes. c. Close the door to the patient's room and minimize disturbances. d. Provide teaching about options for termination of the pregnancy.

B Because the patient is at risk for rupture of the fallopian tube and hemorrhage, frequent monitoring of vital signs is needed. The patient has asked to be left alone, so staying with her and encouraging her to discuss her feelings are inappropriate actions. Minimizing contact with her and closing the door of the room is unsafe because of the risk for hemorrhage. Because the patient has requested time to grieve, it would be inappropriate to provide teaching about options for pregnancy termination.

Which statement by the patient indicates that the nurse's teaching about treating vaginal candidiasis was effective? a. "I will tell my partner that we cannot have intercourse for a month." b. "I should clean carefully after each urination and bowel movement." c. "I can douche with warm water if the itching continues to bother me." d. "I will insert the antifungal cream right before I get up in the morning."

B Cleaning of the perineal area will decrease itching caused by contact of the irritated tissues with urine and reduce the chance of further infection of irritated tissues by bacteria in the stool. Sexual intercourse should be avoided for 1 week. Douching will disrupt normal protective mechanisms in the vagina. The cream should be used at night so that it will remain in the vagina for longer periods of time.

Which action will the nurse include in the plan of care for a patient with right arm lymphedema? a. Avoid isometric exercise on the right arm. b. Assist with application of a compression sleeve. c. Keep the right arm at or below the level of the heart. d. Check blood pressure (BP) on both right and left arms.

B Compression of the arm assists in improving lymphatic flow toward the heart. Isometric exercises may be prescribed for lymphedema. BPs should only be done on the patient's left arm. The arm should not be placed in a dependent position.

A couple is scheduled to have a Huhner test for infertility. In preparation for the test, the nurse will instruct the couple about a. being sedated during the procedure. b. determining the estimated time of ovulation. c. experiencing shoulder pain after the procedure. d. refraining from intercourse before the appointment.

B For the Huhner test, the couple should have intercourse at the estimated time of ovulation and then arrive for the test 2 to 8 hours after intercourse. The other instructions would be used for other types of fertility testing.

A 58-yr-old woman tells the nurse, "I understand that I have stage II breast cancer and I need to decide on a surgery, but I feel overwhelmed. What do you think I should do?" Which response by the nurse is best? a. "I would have a lumpectomy, but you need to decide what is best for you." b. "Tell me what you understand about the surgical options that are available." c. "It would not be appropriate for me to make a decision about your health." d. "There is no need to make a decision rapidly; you have time to think about this."

B Inquiring about the patient's understanding shows the nurse's willingness to assist the patient with the decision-making process without imposing the nurse's values or opinions. Treatment decisions for breast cancer do need to be made relatively quickly. Imposing the nurse's opinions or showing an unwillingness to discuss the topic could cut off communication.

A 22-yr-old patient reports her concern about not having a menstrual period for the past 7 months. Which statement by the patient indicates a possible related factor to the amenorrhea? a. "I drink at least 3 glasses of nonfat milk every day." b. "I run 7 to 8 miles every day to manage my weight." c. "I am not sexually active but currently I have an IUD." d. "I was treated for a sexually transmitted infection 2 years ago."

B Intense endurance exercise can cause amenorrhea. The other statements by the patient do not suggest any urgent teaching needs.

A young patient who is trying to become pregnant asks the nurse how to determine when she is most likely to conceive. The nurse explains that a. ovulation is unpredictable unless there are regular menstrual periods. b. ovulation prediction kits can provide accurate information about ovulation. c. she will need to bring a specimen of cervical mucus to the clinic for testing. d. she should take her body temperature daily and have intercourse when it drops.

B Ovulation prediction kits indicate when luteinizing hormone (LH) levels first rise. Ovulation occurs about 28 to 36 hours after the first rise of LH. This information can be used to determine the best time for intercourse. Body temperature rises at ovulation. Postcoital cervical smears are used in infertility testing, but they do not predict the best time for conceiving and are not obtained by the patient. Determination of the time of ovulation can be predicted by basal body temperature charts or ovulation prediction kits and is not dependent on regular menstrual periods.

Which assessment finding in a 36-yr-old patient is most indicative of a need for further evaluation? a. Bilateral breast nodules that are tender with palpation b. A breast nodule that is 1 cm in size, nontender, and fixed c. A breast lump that increases in size before the menstrual period d. A breast lump that is small, mobile, with a rubbery consistency

B Painless and fixed lumps suggest breast cancer. The other findings are more suggestive of benign processes such as fibrocystic breasts and fibroadenoma.

The nurse is providing preoperative teaching about the transverse rectus abdominis musculocutaneous (TRAM) procedure to a patient. Which information will the nurse include? a. Saline-filled implants are placed under the pectoral muscles. b. Recovery from the TRAM surgery takes at least 6 to 8 weeks. c. Muscle tissue removed from the back is used to form a breast. d. TRAM flap procedures may be done in outpatient surgery centers.

B Patients take at least 6 to 8 weeks to recover from the TRAM surgery. Tissue from the abdomen is used to reconstruct the breast. The TRAM procedure can take up to 8 hours and requires postoperative hospitalization. Saline implants are used in mammoplasty.

The nurse will plan to teach the patient who is incontinent of urine following a radical retropubic prostatectomy to a. restrict oral fluid intake. b. do pelvic muscle exercises. c. perform intermittent self-catheterization. d. use belladonna and opium suppositories.

B Pelvic floor muscle training (Kegel) exercises are recommended to strengthen the pelvic floor muscles and improve urinary control. Belladonna and opium suppositories are used to reduce bladder spasms after surgery. Intermittent self-catheterization may be taught before surgery if the patient has urinary retention, but it will not be useful in reducing incontinence after surgery. The patient should have a daily oral intake of 2 to 3 L.

After a 26-yr-old patient has been treated for pelvic inflammatory disease, the nurse will plan to teach about the a. use of hormone therapy (HT). b. potential complication of infertility. c. irregularities in the menstrual cycle. d. changes in secondary sex characteristics.

B Pelvic inflammatory disease may cause scarring of the fallopian tubes and result in difficulty in fertilization or implantation of the fertilized egg. Because ovarian function is not affected, the patient will not require HT, have irregular menstrual cycles, or experience changes in secondary sex characteristics.

The nurse performing a focused examination to determine possible causes of infertility will assess for a. hydrocele. c. epididymitis. b. varicocele. d. paraphimosis.

B Persistent varicoceles are commonly associated with infertility. Hydrocele, epididymitis, and paraphimosis are not risk factors for infertility.

An 18-yr-old female patient who has been admitted to the emergency department after a motor vehicle crash is scheduled for chest and abdominal x-rays. Which information may alter the plans for the x-rays? a. Report of abdominal pain b. Positive result of hCG test c. Blood pressure of 172/88 mm Hg d. Temperature of 102.1°F (38.9°C)

B Positive hCG testing indicates that the patient is pregnant and that abdominal x-rays should be avoided if possible. The other information is also important to report promptly, but it will not affect whether the x-rays should be done.

The nurse in a health clinic receives requests for appointments from several patients. Which patient should be seen by the health care provider first? a. A 48-yr-old patient who has perineal pain and a temperature of 100.4° F b. A 58-yr-old patient who has a painful erection that has lasted more than 6 hours c. A 38-yr-old patient who reports that he had difficulty maintaining an erection twice last week d. A 68-yr-old patient who has pink urine after a transurethral resection of the prostate (TURP) 3 days ago

B Priapism can cause complications such as necrosis or hydronephrosis, and this patient should be treated immediately. The other patients do not require immediate action to prevent serious complications.

Which patient statement indicates that the nurse's teaching about tamoxifen has been effective? a. "I can expect to have leg cramps." b. "I will call if I have any eye problems." c. "I should contact you if I have hot flashes." d. "I will be taking the medication for 6 to 12 months."

B Retinopathy, cataracts, and decreased visual acuity should be immediately reported because it is likely that the tamoxifen will be discontinued or decreased. Tamoxifen treatment generally lasts 5 years. Hot flashes are an expected side effect of tamoxifen. Leg cramps may be a sign of deep vein thrombosis, and the patient should immediately notify the health care provider if pain occurs.

Which information should the nurse include in teaching a patient who is scheduled for external beam radiation to the breast? a. The radiation therapy will take a week to complete. b. Careful skin care in the radiated area will be necessary. c. Visitors are restricted until the radiation therapy is completed. d. Wigs may be used until the hair regrows after radiation therapy.

B Skin care will be needed because of the damage caused to the skin by the radiation. External beam radiation is done over a 5- to 6-week period. Scalp hair loss does not occur with breast radiation therapy. Because the patient does not have radioactive implants, no visitor restrictions are necessary.

The nurse in the clinic notes elevated prostate specific antigen (PSA) levels in the laboratory results of these patients. Which patient's PSA result is not expected to be elevated? a. A 38-yr-old patient who is being treated for acute prostatitis b. A 48-yr-old patient whose father died of metastatic prostate cancer c. A 52-yr-old patient who goes on long bicycle rides every weekend d. A 75-yr-old patient who uses saw palmetto to treat benign prostatic hyperplasia (BPH)

B The family history of prostate cancer and elevation of PSA indicate that further evaluation of the patient for prostate cancer is needed. Elevations in PSA for the other patients are not unusual.

The nurse notes bilateral enlargement of the breasts during examination of a 62-yr-old male patient. Which action should the nurse take first? a. Refer the patient for mammography. b. Question the patient about current medications. c. Explain that this is temporary due to hormonal changes. d. Teach the patient how to palpate the breast tissue for lumps.

B The first action should be further assessment. Because gynecomastia is a possible side effect of drug therapy, asking about the current drug regimen is appropriate. The other actions may be needed, depending on the data that are obtained with further assessment.

A 27-yr-old patient who has testicular cancer is being admitted for a unilateral orchiectomy. The patient does not talk to his wife and speaks to the nurse only to answer the admission questions. Which action is appropriate for the nurse to take? a. Teach the patient and the wife that impotence is unlikely after unilateral orchiectomy. b. Ask the patient if he has any questions or concerns about the diagnosis and treatment. c. Inform the patient's wife that concerns about sexual function are common with this diagnosis. d. Document the patient's lack of communication on the health record and continue preoperative care.

B The initial action by the nurse should be assessment for any anxiety or questions about the surgery or postoperative care. The nurse should address the patient, not the spouse, when discussing the diagnosis and any possible concerns. Without further assessment of patient concerns, the nurse should not offer teaching about complications after orchiectomy. Documentation of the patient's lack of interaction is not an adequate nursing action in this situation.

A patient who has benign prostatic hyperplasia (BPH) with urinary retention is admitted to the hospital with elevated blood urea nitrogen (BUN) and creatinine. Which prescribed therapy should the nurse implement first? a. Infuse normal saline at 50 mL/hr. b. Insert a urinary retention catheter. c. Draw blood for a complete blood count. d. Schedule pelvic magnetic resonance imaging

B The patient data indicate that the patient may have acute kidney injury caused by the BPH. The initial therapy will be to insert a catheter. The other actions are also appropriate, but they can be implemented after the acute urinary retention is resolved.

A patient with pelvic inflammatory disease (PID) is being treated with oral antibiotics as an outpatient. Which instruction will be included in patient teaching? a. Abdominal pain may persist for several weeks. b. Return for a follow-up appointment in 2 to 3 days. c. Instruct a male partner to use a condom during sexual intercourse for the next week. d. Nonsteroidal antiinflammatory drug (NSAID) use may prevent pelvic organ scarring

B The patient is instructed to return for follow-up in 48 to 72 hours. The patient should abstain from intercourse for 3 weeks. Abdominal pain should subside with effective antibiotic therapy. Corticosteroids may help prevent inflammation and scarring, but NSAIDs will not decrease scarring.

The nurse provides discharge teaching for a 61-yr-old patient who has had a left modified radical mastectomy and lymph node dissection. Which statement by the patient indicates that teaching has been successful? a. "I will need to use my right arm and to rest the left one." b. "I will avoid reaching over the stove with my left hand." c. "I will keep my left arm in a sling until the incision is healed." d. "I will stop the left arm exercises if moving the arm is painful."

B The patient should avoid any activity that might injure the left arm, such as reaching over a burner. If the left arm exercises are painful, analgesics should be used and the exercises continued in order to restore strength and range of motion. The left arm should be elevated at or above heart level and should be used to improve range of motion and function.

A healthy 24-yr-old patient who has been vaccinated against human papillomavirus (HPV) has a normal Pap test result. Which information will the nurse include in patient teaching when calling the patient with the results of the Pap test? a. You can wait until after age 30 before having another Pap test. b. Pap testing is recommended every 3 years for women your age. c. No further Pap testing is needed until you decide to become pregnant. d. Yearly Pap testing is suggested for women with multiple sexual partners.

B Women ages 21 to 29 years should get a Pap test every 3 years.

A 33-yr-old patient has a saline breast implant inserted in the outpatient surgery area. Which instruction will the nurse include in the discharge teaching? a. Take aspirin every 4 hours to reduce inflammation. b. Check wound drains for excessive blood or a foul odor. c. Wear a loose-fitting bra to decrease irritation of the sutures. d. Resume normal activities 2 to 3 days after the mammoplasty.

B The patient should be taught drain care because the drains will be in place for 2 or 3 days after surgery. Normal activities can be resumed after 2 to 3 weeks. A bra that provides good support is typically ordered. Aspirin will decrease coagulation and is typically not given after surgery.

A patient undergoes an anterior and posterior (A&P) colporrhaphy for repair of a cystocele and rectocele. Which nursing action will be included in the postoperative care plan? a. Encourage a high-fiber diet. b. Perform urinary catheter care. c. Repack the vagina with gauze daily. d. Teach the patient to insert a pessary.

B The patient will have a retention catheter for several days after surgery to keep the bladder empty and decrease strain on the suture. A pessary will not be needed after the surgery. Vaginal wound packing is not usually used after an A&P repair. A low-residue diet will be ordered after posterior colporrhaphy.

The nurse will plan to teach the patient scheduled for photovaporization of the prostate (PVP) a. that urine will appear bloody for several days. b. how to care for an indwelling urinary catheter. c. that symptom improvement takes 2 to 3 weeks. d. about complications associated with urethral stenting.

B The patient will have an indwelling catheter for 24 to 48 hours and will need teaching about catheter care. There is minimal bleeding with this procedure. Symptom improvement is almost immediate after PVP. Stent placement is not included in the procedure.

A patient tells the nurse that he decided to seek treatment for erectile dysfunction (ED) because his wife "is losing patience with the situation." The nurse's follow-up questions should focus on the man's identified concern with a. low self-esteem. c. increased anxiety. b. role performance. d. infrequent intercourse.

B The patient's statement indicates that the relationship with his wife is his primary concern. Although anxiety, low self-esteem, and ineffective sexuality patterns may also be concerns, the patient information suggests that addressing the role performance problem will lead to the best outcome for this patient.

A 34-yr-old patient who is discussing contraceptive options with the nurse says, "I want to have children but not for a few years." Which response by the nurse is accurate? a. "If you do not become pregnant within the next few years, you never will." b. "Women often have more difficulty becoming pregnant after about age 35." c. "Stop taking oral contraceptives several years before you want to have a child." d. "You have many more years of fertility left, so there is no rush to have children."

B The probability of successfully becoming pregnant decreases after age 35 years, although some patients may have no difficulty in becoming pregnant. Oral contraceptives do not need to be withdrawn for several years for a woman to become pregnant. Although the patient may be fertile for many years, it would be inaccurate to indicate that there is no concern about fertility as she becomes older. Although the risk for infertility increases after age 35 years, not all patients have difficulty in conceiving.

Which information will the nurse plan to include when teaching a young adult who has a family history of testicular cancer about testicular self-examination? a. Testicular self-examination should be done at least weekly. b. Testicular self-examination should be done in a warm room. c. The only structure normally felt in the scrotal sac is the testis. d. Call the health care provider if one testis is larger than the other.

B The testes will hang lower in the scrotum when the temperature is warm (e.g., during a shower), and it will be easier to palpate. The epididymis is also normally palpable in the scrotum. One testis is normally larger. Men at high risk should perform testicular self-examination monthly.

When caring for a patient with continuous bladder irrigation after having transurethral resection of the prostate, which action could the nurse delegate to unlicensed assistive personnel (UAP)? a. Teach the patient how to perform Kegel exercises. b. Report any complaints of pain or spasms to the nurse. c. Monitor for increases in bleeding or presence of clots. d. Increase the flow rate of the irrigation if clots are noted.

B UAP education and role includes reporting patient concerns to supervising nurses. Patient teaching, assessments for complications, and actions such as bladder irrigation require more education and should be done by licensed nursing staff.

Which nursing assessment finding in a patient who recently started taking hormone replacement therapy (HRT) requires discussion with the health care provider about a change in therapy? a. Breast tenderness c. Weight gain of 3 lb b. Left calf swelling d. Intermittent spotting

B Unilateral calf swelling may indicate deep vein thrombosis caused by the changes in coagulation associated with HRT and would indicate that the HRT should be discontinued. Breast tenderness, weight gain, and intermittent spotting are common side effects of HRT and do not indicate a need for a change in therapy.

A patient is scheduled for an induced abortion using instillation of hypertonic saline solution. Which information will the nurse plan to discuss with the patient before the procedure? a. The patient will require a general anesthetic. b. The expulsion of the fetus may take 1 to 2 days. c. There is a possibility that the patient may deliver a live fetus. d. The procedure may be unsuccessful in terminating the pregnancy.

B Uterine contractions take 12 to 36 hours to begin after the hypertonic saline is instilled. Because the saline is feticidal, the nurse does not need to discuss any possibility of a live delivery or that the pregnancy termination will not be successful. General anesthesia is not needed for this procedure.

A 32-yr-old patient has oral contraceptives prescribed for endometriosis. The nurse will teach the patient to a. expect to experience side effects such as facial hair. b. take the medication every day for the next 9 months. c. take calcium supplements to prevent developing osteoporosis during therapy. d. use a second method of contraception to ensure that she will not become pregnant.

B When oral contraceptives are prescribed to treat endometriosis, the patient should take the medications continuously for 9 months. Facial hair is a side effect of synthetic androgens. The patient does not need to use additional contraceptive methods. The hormones in oral contraceptives will protect against osteoporosis.

A 53-yr-old woman who is experiencing menopause is discussing the use of hormone therapy (HT) with the nurse. Which information about the risk of breast cancer will the nurse provide? a. HT is a safe therapy for menopausal symptoms if there is no family history of BRCA genes. b. HT does not appear to increase the risk for breast cancer unless there are other risk factors. c. The patient and her health care provider must weigh the benefits of HT against the risks of breast cancer. d. Natural herbs are as effective as estrogen in relieving symptoms without increasing the risk of breast cancer.

C Because HT has been linked to increased risk for breast cancer, the patient and health care provider must determine whether or not to use HT. Breast cancer incidence is increased in women using HT, independent of other risk factors. HT increases the risk for both non-BRCA-associated cancer and BRCA-related cancers. Alternative therapies can be used but are not consistent in relieving menopausal symptoms.

A 19-yr-old patient calls the school clinic and tells the nurse, "My menstrual period is very heavy this time. I have to change my tampon every 4 hours." Which action should the nurse take next? a. Tell the patient that her flow is not unusually heavy. b. Schedule the patient for an appointment later that day. c. Ask the patient how heavy her usual menstrual flow is. d. Have the patient call again if the heavy flow continues.

C Because a heavy menstrual flow is usually indicated by saturating a pad or tampon in 1 to 2 hours, the nurse should first assess how heavy the patient's usual flow is. There is no need to schedule the patient for an appointment that day. The patient may need to call again, but this is not the first action that the nurse should take. Telling the patient that she does not have a heavy flow implies that the patient's concern is not important.

A patient has an induced abortion with suction curettage at an ambulatory surgical center. Which instructions will the nurse include when discharging the patient? a. "Avoid contraceptives until your reexamination." b. "Heavy vaginal bleeding is expected for 2 weeks." c. "Abstain from sexual intercourse for the next 2 weeks." d. "Irregular menstrual periods are expected for a few months."

C Because infection is a possible complication of this procedure, the patient is advised to avoid intercourse until the reexamination in 2 weeks. Patients may be started on contraceptives on the day of the procedure. The patient should call the doctor if heavy vaginal bleeding occurs. No change in the regularity of the menstrual periods is expected.

The nurse is providing teaching by telephone to a patient who is scheduled for a pelvic examination and Pap test next week. The nurse instructs the patient that she should a. not have sexual intercourse the day before the Pap test. b. shower, but not take a tub bath, before the examination. c. avoid douching for at least 24 hours before the examination. d. schedule to have the Pap test just after her menstrual period.

C Because the results of a Pap test may be affected by douching, the patient should not douche before the examination. The examination may be scheduled without regard to the menstrual period. The patient may shower or bathe before the examination. Sexual intercourse does not affect the results of the examination or Pap test.

Which information will the nurse include when teaching a patient who has developed a small vesicovaginal fistula 2 weeks into the postpartum period? a. Take stool softeners to prevent fecal contamination of the vagina. b. Limit oral fluid intake to minimize the quantity of urinary drainage. c. Change the perineal pad frequently to prevent perineal skin breakdown. d. Call the health care provider immediately if urine drains from the vagina.

C Because urine will leak from the vagina, the patient should plan to use perineal pads and change them frequently. A high fluid intake is recommended to decrease the risk for urinary tract infections. Fecal contamination is not a concern with vesicovaginal fistulas.

A patient who is scheduled for a routine gynecologic examination tells the nurse that she has had intercourse during the past year with several men. The nurse will plan to teach about the reason for a. contraceptive use. c. Chlamydia testing. b. antibiotic therapy. d. pregnancy testing.

C Chlamydia testing is recommended annually for women with multiple sex partners. There is no indication that the patient needs teaching about contraceptives, pregnancy testing, or antibiotic therapy.

Which finding from the nurse's physical assessment of a 42-yr-old male patient should be reported to the health care provider? a. One testis hangs lower than the other. b. Genital hair distribution is diamond shaped. c. Clear discharge is present at the penile meatus. d. Inguinal lymph nodes are nonpalpable bilaterally.

C Clear penile discharge may be indicative of a sexually transmitted infection (STI). The other findings are normal and do not need to be reported.

The nurse taking a focused health history for a patient with possible testicular cancer will ask the patient about a history of a. testicular torsion. b. testicular trauma. c. undescended testicles. d. sexually transmitted infection (STI).

C Cryptorchidism is a risk factor for testicular cancer if it is not corrected before puberty. STI, testicular torsion, and testicular trauma are risk factors for other testicular conditions but not for testicular cancer.

A patient is considering the use of combined estrogen-progesterone hormone replacement therapy (HRT) during menopause. Which information will the nurse include during their discussion? a. Use of estrogen-containing vaginal creams provides the same benefits as oral HRT. b. Increased risk of colon cancer in women taking HRT requires frequent colonoscopy. c. HRT decreases osteoporosis risk and increases the risk for cardiovascular disease and breast cancer. d. Use of HRT for up to 10 years to prevent symptoms such as hot flashes is generally considered safe.

C Data from the Women's Health Initiative indicate an increased risk for cardiovascular disease and breast cancer in women taking combination HRT but a decrease in hip fractures. Vaginal creams decrease symptoms related to vaginal atrophy and dryness, but they do not offer the other benefits of HRT, such as decreased hot flashes. Most women who use HRT are placed on short-term treatment and are not treated for up to 10 years. The incidence of colon cancer decreases in women taking HRT.

The nurse is caring for a patient with breast cancer who is receiving chemotherapy with doxorubicin and cyclophosphamide. Which assessment finding is most important to communicate to the health care provider? a. The patient complains of fatigue. b. The patient eats only 25% of meals. c. The patient's apical pulse is irregular. d. The patient's white blood cell (WBC) count is 5000/µL.

C Doxorubicin can cause cardiac toxicity. The dysrhythmia should be reported because it may indicate a need for a change in therapy. Anorexia, fatigue, and a low-normal WBC count are expected effects of chemotherapy.

A patient who has been recently diagnosed with benign prostatic hyperplasia (BPH) tells the nurse that he does not want to have a transurethral resection of the prostate (TURP) because it might affect his ability to have sexual intercourse. Which action should the nurse take? a. Discuss alternative methods of sexual expression. b. Teach about medication for erectile dysfunction (ED). c. Clarify that TURP does not commonly affect erection. d. Offer reassurance that fertility is not affected by TURP.

C ED is not a concern with TURP, although retrograde ejaculation is likely, and the nurse should discuss this with the patient. Erectile function is not usually affected by a TURP, so the patient will not need information about penile implants or reassurance that other forms of sexual expression may be used. Because the patient has not asked about fertility, reassurance about sperm production does not address his concerns.

During a well-woman physical examination, a 43-yr-old patient asks about her risk for breast cancer. Which question is most pertinent for the nurse to ask? a. "Do you currently smoke tobacco?" b. "Have you ever had a breast injury?" c. "At what age did you start having menstrual periods?" d. "Is there a family history of fibrocystic breast changes?"

C Early menarche and late menopause are risk factors for breast cancer because of the prolonged exposure to estrogen that occurs. Cigarette smoking, breast trauma, and fibrocystic breast changes are not associated with increased breast cancer risk.

Which information will the nurse teach a patient who has chronic prostatitis? a. Ibuprofen (Motrin) should provide good pain control. b. Prescribed antibiotics should be taken for 7 to 10 days. c. Intercourse or masturbation will help relieve symptoms. d. Cold packs used every 4 hours will decrease inflammation.

C Ejaculation helps drain the prostate and relieve pain. Warm baths are recommended to reduce pain. Nonsteroidal antiinflammatory drugs (NSAIDs) are frequently prescribed but usually do not offer adequate pain relief. Antibiotics for chronic prostatitis are taken for 4 to 12 weeks.

Which question should the nurse ask when assessing a 60-yr-old patient who has a history of benign prostatic hyperplasia (BPH)? a. "Have you noticed any unusual discharge from your penis?" b. "Has there been any change in your sex life in the past year?" c. "Has there been a decrease in the force of your urinary stream?" d. "Have you been experiencing any difficulty in achieving an erection?"

C Enlargement of the prostate blocks the urethra, leading to urinary changes such as a decrease in the force of the urinary stream. The other questions address possible problems with infection or sexual difficulties, but they would not be helpful in determining whether there were functional changes caused by BPH.

A patient tells the nurse that she would like a prescription for oral contraceptives to control her premenstrual dysphoric disorder (PMD-D) symptoms. Which patient information that contraindicates oral contraceptives should be communicated to the health care provider? a. Bilateral breast tenderness c. History of migraine headaches b. Frequent abdominal bloating d. Previous spontaneous abortion

C Oral contraceptives are contraindicated in patients with a history of migraine headaches. The other patient information would not prevent the patient from receiving oral contraceptives.

A patient requests a prescription for birth control pills to control severe abdominal cramping and headaches during her menstrual periods. Which action should the nurse take first? a. Determine whether the patient is sexually active. b. Teach about the side effects of oral contraceptives. c. Take the patient's personal and family health history. d. Suggest nonsteroidal antiinflammatory drugs (NSAIDs).

C Oral contraceptives may be appropriate to control this patient's symptoms, but the patient's health history may indicate contraindications to oral contraceptive use. Because the patient is requesting contraceptives for management of dysmenorrhea, whether she is sexually active is irrelevant. Because the patient is asking for birth control pills, responding that she should try NSAIDs is nontherapeutic. The patient does not need teaching about oral contraceptive side effects at this time.

Which action by the unlicensed assistive personnel (UAP) who are assisting with the care of male patients with reproductive problems indicates that the nurse should provide more teaching? a. The UAP apply a cold pack to the scrotum for a patient with mumps orchitis. b. The UAP help a patient who has had a prostatectomy to put on antiembolism hose. c. The UAP leave the foreskin pulled back after cleaning the glans of a patient who has a retention catheter. d. The UAP encourage a high oral fluid intake for patient who had transurethral resection of the prostate yesterday.

C Paraphimosis can be caused by failing to replace the foreskin back over the glans after cleaning. The other actions by UAP are appropriate.

Which patient in the women's health clinic will the nurse expect to teach about an endometrial biopsy? a. A 55-yr-old patient who has 3 to 4 alcoholic drinks each day b. A 35-yr-old patient who has used oral contraceptives for 15 years c. A 25-yr-old patient who has a family history of hereditary nonpolyposis colorectal cancer d. A 45-yr-old patient who has had six previous full-term pregnancies and two spontaneous abortions

C Patients with a personal or familial history of hereditary nonpolyposis colorectal cancer are at increased risk for endometrial cancer. Alcohol addiction does not increase this risk. Multiple pregnancies and oral contraceptive use offer protection from endometrial cancer.

Which action should the nurse take when a 35-yr-old patient has a Pap test result of minor cellular changes? a. Teach the patient about colposcopy. b. Teach the patient about punch biopsy. c. Schedule another Pap test in 4 months. d. Administer human papillomavirus (HPV) vaccine.

C Patients with minor changes on the Pap test can be followed with Pap tests every 4 to 6 months because these changes may revert to normal. Punch biopsy or colposcopy may be used if the Pap test shows more prominent changes. The HPV vaccine may reduce the risk for cervical cancer, but it is recommended only for ages 9 through 26 years.

A 49-yr-old man who has type 2 diabetes, high blood pressure, hyperlipidemia, and gastroesophageal reflux tells the nurse that he has had recent difficulty in achieving an erection. Which of the following drugs from his current medications list may cause erectile dysfunction (ED)? a. Ranitidine (Zantac) c. Propranolol (Inderal) b. Atorvastatin (Lipitor) d. Metformin (Glucophage)

C Some antihypertensives may cause ED, and the nurse should anticipate a change in antihypertensive therapy. The other medications will not affect erectile function.

The nurse is obtaining the pertinent health history for a man who is being evaluated for infertility. Which question focuses on a possible cause of infertility? a. "Are you circumcised?" b. "Have you had surgery for phimosis?" c. "Do you use medications to improve muscle mass?" d. "Is there a history of prostate cancer in your family?"

C Testosterone or testosterone-like medications may adversely affect sperm count. The other information will be obtained in the health history but does not affect the patient's fertility.

To determine the severity of the symptoms for a patient with benign prostatic hyperplasia (BPH), the nurse will ask the patient about a. blood in the urine. c. force of urinary stream. b. lower back or hip pain. d. erectile dysfunction (ED).

C The American Urological Association Symptom Index for a patient with BPH asks questions about the force and frequency of urination, nocturia, and so on. Blood in the urine, ED, and back or hip pain are not typical symptoms of BPH.

The nurse is caring for a patient with pelvic inflammatory disease (PID) requiring hospitalization. Which nursing intervention will be included in the plan of care? a. Monitor liver function tests. b. Use cold packs PRN for pelvic pain. c. Elevate the head of the bed at least 30 degrees. d. Teach the patient how to perform Kegel exercises.

C The head of the bed should be elevated to at least 30 degrees to promote drainage of the pelvic cavity and prevent abscess formation higher in the abdomen. Although a possible complication of PID is acute perihepatitis, liver function test results will remain normal. There is no indication for increased fluid intake. Application of heat is used to reduce pain. Kegel exercises are not helpful in PID.

A 47-yr-old patient asks whether she is going into menopause if she has not had a menstrual period for 3 months. Which response by the nurse is appropriate? a. "Have you thought about using hormone replacement therapy?" b. "Most women feel a little depressed about entering menopause." c. "What was your menstrual pattern before your periods stopped?" d. "Because you are in your mid-40s, it is likely that you are menopausal."

C The initial response by the nurse should be to assess the patient's baseline menstrual pattern. Although many women do enter menopause in the mid-40s, more information about this patient is needed before telling her that it is likely she is menopausal. Although hormone therapy may be prescribed, further assessment of the patient is needed before discussing therapies for menopause. Because the response to menopause is very individual, the nurse should not assume that the patient is experiencing any adverse emotional reactions.

Which nursing action should be included in the plan of care for a patient returning to the surgical unit after a left modified radical mastectomy with dissection of axillary lymph nodes? a. Obtain a permanent breast prosthesis before the patient is discharged from the hospital. b. Teach the patient to use the ordered patient-controlled analgesia (PCA) every 10 minutes. c. Post a sign at the bedside warning against venipunctures or blood pressures in the left arm. d. Insist that the patient examine the surgical incision when the initial dressings are removed.

C The patient is at risk for lymphedema and infection if blood pressures or venipuncture are done on the right arm. The patient is taught to use the PCA as needed for pain control rather than at a set time. The nurse allows the patient to examine the incision and participate in care when the patient feels ready. Permanent breast prostheses are usually obtained about 6 weeks after surgery.

A nursing diagnosis that is likely to be appropriate for a 67-yr-old patient who has just been diagnosed with stage III ovarian cancer is a. sexual dysfunction related to loss of vaginal sensation. b. risk for infection related to impaired immune function. c. anxiety related to cancer diagnosis and need for treatment decisions. d. situational low self-esteem related to guilt about delaying medical care.

C The patient with stage III ovarian cancer is likely to be anxious about the poor prognosis and about the need to make decisions about the multiple treatments that may be used. Decreased vaginal sensation does not occur with ovarian cancer. The patient may develop immune dysfunction when she receives chemotherapy, but she is not currently at risk. It is unlikely that the patient has delayed seeking medical care because the symptoms of ovarian cancer are vague and occur late in the course of the cancer.

The nurse has just received change-of-shift report about the following four patients. Which patient should be assessed first? a. A patient with a cervical radium implant in place who is crying in her room b. A patient who is complaining of 5/10 pain after an abdominal hysterectomy c. A patient with a possible ectopic pregnancy who is complaining of shoulder pain d. A patient in the fifteenth week of gestation who has uterine cramping and spotting

C The patient with the ectopic pregnancy has symptoms consistent with rupture and needs immediate assessment for signs of hemorrhage and possible transfer to surgery. The other patients should also be assessed as quickly as possible but do not have symptoms of life-threatening complications.

The following patients call the outpatient clinic. Which phone call should the nurse return first? a. A 44-yr-old patient who has bloody discharge after a hysteroscopy earlier today b. A 64-yr-old patient who is experiencing shoulder pain after a laparoscopy yesterday c. A 34-yr-old patient who is short of breath after having a pelvic CT with contrast dye d. A 54-yr-old patient who has severe breast tenderness following a needle aspiration breast biopsy

C The patient's dyspnea suggests a delayed reaction to the iodine dye used for the CT scan. The other patient's symptoms are not unusual after the procedures they had done.

A female patient tells the nurse that she has been having nightmares and acute anxiety around men since being sexually assaulted 3 months ago. The most appropriate nursing diagnosis for the patient is a. anxiety related to effects of being raped. b. sleep deprivation related to frightening dreams. c. rape-trauma syndrome related to rape experience. d. ineffective coping related to inability to resolve incident.

C The patient's symptoms are most consistent with the nursing diagnosis of rape-trauma syndrome. The nursing diagnoses of sleep deprivation, ineffective coping, and anxiety address some aspects of the patient's symptoms but do not address the problem as completely as the rape-trauma syndrome diagnosis.

The plan of care for a patient immediately after a perineal radical prostatectomy will include decreasing the risk for infection related to a. urinary incontinence. c. fecal wound contamination. b. prolonged urinary stasis. d. suprapubic catheter placement.

C The perineal approach increases the risk for infection because the incision is located close to the anus, and contamination with feces is possible. Urinary stasis and incontinence do not occur because the patient has a retention catheter in place for 1 to 2 weeks. A urethral catheter is used after the surgery.

The nurse in the infertility clinic is explaining in vitro fertilization (IVF) to a couple. The woman tells the nurse that they cannot afford IVF on her husband's salary. The man replies that if his wife worked outside the home, they would have enough money. Which nursing diagnosis is appropriate? a. Decisional conflict related to inadequate financial resources b. Ineffective sexuality patterns related to psychological stress c. Defensive coping related to anxiety about lack of conception d. Ineffective denial related to frustration about continued infertility

C The statements made by the couple are consistent with the diagnosis of defensive coping. No data indicate that ineffective sexuality and ineffective denial are problems. Although the couple is quarreling about finances, the data do not provide information indicating that the finances are inadequate.

A patient newly diagnosed with stage I breast cancer is discussing treatment options with the nurse. Which statement by the patient indicates that additional teaching may be needed? a. "There are several options that I can consider for treating the cancer." b. "I will probably need radiation to the breast after having the surgery." c. "Mastectomy is the best choice to decrease the chance of cancer recurrence." d. "I can probably have reconstructive surgery at the same time as a mastectomy."

C The survival rates with lumpectomy and radiation or modified radical mastectomy are comparable. The other patient statements indicate a good understanding of stage I breast cancer treatment.

A patient in the sexually transmitted infection clinic has a positive Venereal Disease Research Laboratory (VDRL) test, but no chancre is visible on assessment. The nurse will plan to send specimens for a. Gram stain. b. cytologic studies. c. rapid plasma reagin (RPR) agglutination. d. fluorescent treponemal antibody absorption (FTA-Abs).

D Because false positives are common with VDRL and RPR testing, FTA-Abs testing is recommended to confirm a diagnosis of syphilis. Gram staining is used for other sexually transmitted infections (STIs) such as gonorrhea and Chlamydia and cytologic studies are used to detect abnormal cells (e.g., neoplastic cells).

A patient who has a large cystocele was admitted 10 hours ago but has not yet voided. If the patient reports no urge to void, which action should the nurse take first? a. Insert a straight catheter per the PRN order. b. Encourage the patient to increase oral fluids. c. Notify the health care provider of the inability to void. d. Use an ultrasound scanner to check for urinary retention.

D Because urinary retention is common with a large cystocele, the nurse's first action should be to use an ultrasound bladder scanner to check for the presence of urine in the bladder. The other actions may be appropriate, depending on the findings with the bladder scanner.

A patient has just been instructed in the treatment for a Chlamydia trachomatis vaginal infection. Which patient statement indicates that the nurse's teaching has been effective? a. "I can purchase an over-the-counter medication to treat this infection." b. "The symptoms are due to the overgrowth of normal vaginal bacteria." c. "The medication will need to be inserted once daily with an applicator." d. "Both my partner and I will need to take the medication for a full week."

D Chlamydia is a sexually transmitted bacterial infection that requires treatment of both partners with antibiotics for 7 days. The other statements are true for the treatment of Candida albicans infection.

The nurse explains to a patient being prepared for colposcopy with a cervical biopsy that the procedure a. involves dilation of the cervix and biopsy of the tissue lining the uterus. b. will take place in a same-day surgery center so that local anesthesia can be used. c. requires that the patient have nothing to eat or drink for 6 hours before the procedure. d. is similar to a speculum examination of the cervix and should result in little discomfort.

D Colposcopy involves visualization of the cervix with a binocular microscope and is similar to a speculum examination. Anesthesia is not required and fasting is not necessary. A cervical biopsy may cause a minimal amount of pain.

The nurse will anticipate that a 61-yr-old patient who has an enlarged prostate detected by digital rectal examination (DRE) and an elevated prostate specific antigen (PSA) level will need teaching about a. cystourethroscopy. b. uroflowmetry studies. c. magnetic resonance imaging (MRI). d. transrectal ultrasonography (TRUS).

D In a patient with an abnormal DRE and elevated PSA, transrectal ultrasound is used to visualize the prostate for biopsy. Uroflowmetry studies help determine the extent of urine blockage and treatment, but there is no indication that this is a problem for this patient. Cystoscopy may be used before prostatectomy but will not be done until after the TRUS and biopsy. MRI is used to determine whether prostatic cancer has metastasized but would not be ordered at this stage of the diagnostic process.

A 49-yr-old patient tells the nurse that she is postmenopausal but has recently had occasional spotting. Which initial response by the nurse is appropriate? a. "A frequent cause of spotting is endometrial cancer." b. "How long has it been since your last menstrual period?" c. "Breakthrough bleeding is not unusual in women your age." d. "Are you using prescription hormone replacement therapy?"

D In postmenopausal women, a common cause of spotting is hormone replacement therapy. Because breakthrough bleeding may be a sign of problems such as cancer or infection, the nurse would not imply that this is normal. The length of time since the last menstrual period is not relevant to the patient's symptoms. Although endometrial cancer may cause spotting, this information is not appropriate as an initial response.

A patient has had left-sided lumpectomy (breast-conservation surgery) and an axillary lymph node dissection. Which nursing intervention is appropriate to delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Teaching the patient how to avoid injury to the left arm b. Assessing the patient's range of motion for the left arm c. Evaluating the patient's understanding of instructions about drain care d. Administering an analgesic 30 minutes before scheduled arm exercises

D LPN/LVN education and scope of practice include administration and evaluation of the effects of analgesics. Assessment, teaching, and evaluation of a patient's understanding of instructions are more complex tasks that are more appropriate to RN level education and scope of practice.

When the nurse is working in the women's health care clinic, which action is appropriate to take? a. Teach a healthy 30-yr-old patient about the need for an annual mammogram. b. Discuss scheduling an annual clinical breast examination with a 22-year-old patient. c. Explain to a 60-yr-old patient that mammography frequency can be reduced to every 3 years. d. Teach a 28-yr-old patient with a BRCA-1 mutation about magnetic resonance imaging (MRI).

D MRI (in addition to mammography) is recommended for women who are at high risk for breast cancer. A woman should have a clinical breast examination about every 3 years for women in their 20s and 30s and every year for women age 40 years and older. Annual mammograms are recommended for women older than 40 years of age.

A 19-yr-old patient has been diagnosed with primary dysmenorrhea. How will the nurse suggest that the patient manage discomfort? a. Avoid aerobic exercise during her menstrual period. b. Use cold packs on the abdomen and back for pain relief. c. Talk with her health care provider about beginning antidepressant therapy. d. Take nonsteroidal antiinflammatory drugs (NSAIDs) when her period starts.

D NSAIDs should be started as soon as the menstrual period begins and taken at regular intervals during the usual time frame when pain occurs. Aerobic exercise may help reduce symptoms. Heat therapy, such as warm packs, is recommended for relief of pain. Antidepressant therapy is not a typical treatment for dysmenorrhea.

A patient was recently diagnosed with polycystic ovary syndrome. It is most important for the nurse to teach the patient a. reasons for a total hysterectomy. b. how to decrease facial hair growth. c. ways to reduce the occurrence of acne. d. methods to maintain appropriate weight.

D Obesity exacerbates the problems associated with polycystic ovary syndrome, such as insulin resistance and type 2 diabetes. The nurse should also address the problems of acne and hirsutism, but these symptoms are lower priority because they do not have long-term health consequences. Although some patients do require total hysterectomy, it is usually performed only after other therapies have been unsuccessful.

The nurse will plan to teach a 51-yr-old man who is scheduled for an annual physical examination about a(n) a. increased risk for testicular cancer. b. possible changes in erectile function. c. normal decreases in testosterone level. d. prostate specific antigen (PSA) testing.

D PSA testing may be recommended annually for men, starting at age 50. There is no indication that the other patient teaching topics are appropriate for this patient.

A patient who has been diagnosed with stage 2 prostate cancer chooses the option of active surveillance. The nurse will plan to a. vaccinate the patient with sipuleucel-T (Provenge). b. provide the patient with information about cryotherapy. c. teach the patient about placement of intraurethral stents. d. schedule the patient for annual prostate-specific antigen testing.

D Patients who opt for active surveillance need to have annual digital rectal examinations and prostate-specific antigen testing. Vaccination with sipuleucel-T, cryotherapy, and stent placement are options for patients who choose to have active treatment for prostate cancer.

The nurse teaching a young women's community service group about breast self-examination (BSE) will include that a. BSE will reduce the risk of dying from breast cancer. b. BSE should be done daily while taking a bath or shower. c. annual mammograms should be scheduled in addition to BSE. d. performing BSE after the menstrual period is more comfortable.

D Performing BSE at the end of the menstrual period will reduce the breast tenderness associated with the procedure. The evidence is not clear that BSE reduces mortality from breast cancer. BSE should be done monthly. Annual mammograms are not routinely scheduled for women younger than age 40 years, and newer guidelines suggest delaying them until age 50.

To prevent pregnancy in a patient who has been sexually assaulted, the nurse in the emergency department will plan to teach the patient about the use of a. mifepristone . c. methotrexate with misoprostol. b. dilation and evacuation. d. levonorgestrel (Plan-B One-Step).

D Plan B One-Step reduces the risk of pregnancy when taken within 72 hours of intercourse. The other methods are used for therapeutic abortion but not for pregnancy prevention after unprotected intercourse.

After a transurethral resection of the prostate (TURP), a 64-yr-old patient with continuous bladder irrigation complains of painful bladder spasms. The nurse observes clots in the urine. Which action should the nurse take first? a. Increase the flow rate of the bladder irrigation. b. Administer the prescribed IV morphine sulfate. c. Give the patient the prescribed belladonna and opium suppository. d. Manually instill and then withdraw 50 mL of saline into the catheter.

D The assessment suggests that obstruction by a clot is causing the bladder spasms, and the nurse's first action should be to irrigate the catheter manually and to try to remove the clots. IV morphine will not decrease the spasm, although pain may be reduced. Increasing the flow rate of the irrigation will further distend the bladder and may increase spasms. The belladonna and opium suppository will decrease bladder spasms but will not remove the obstructing blood clot.

A woman calls the clinic because she is having an unusually heavy menstrual flow. She tells the nurse that she has saturated three tampons in the past 2 hours. The nurse estimates that the amount of blood loss over the past 2 hours is _____ mL. a. 20 to 30 c. 40 to 60 b. 30 to 40 d. 60 to 90

D The average tampon absorbs 20 to 30 mL.

Which assessment information collected by the nurse may present a contraindication to a testosterone replacement therapy (TRT)? a. The patient has noticed a decrease in energy level for a few years. b. The patient's symptoms have increased steadily over the past few years. c. The patient has been using sildenafil (Viagra) several times every week. d. The patient has had a gradual decrease in the force of his urinary stream.

D The decrease in urinary stream may indicate benign prostatic hyperplasia (BPH) or prostate cancer, which are contraindications to the use of testosterone replacement therapy (TRT). The other patient data indicate that TRT may be a helpful therapy for the patient.

When caring for a patient who has a radium implant for treatment of cervical cancer, the nurse will a. assist the patient to ambulate every 2 to 3 hours. b. use gloves and gown when changing the patient's bed. c. flush the toilet several times right after the patient voids. d. encourage the patient to discuss any concerns by telephone.

D The nurse should spend minimal time in the patient's room to avoid exposure to radiation. The patient and nurse can have longer conversations by telephone between the patient room and nursing station. To prevent displacement of the implant, absolute bed rest is required. Wearing of gloves and gown when changing linens and flushing the toilet several times are not necessary because the isotope is confined to the implant.

The nurse in the women's health clinic has four patients who are waiting to be seen. Which patient should the nurse see first? a. A 22-yr-old patient with persistent red-brown vaginal drainage 3 days after having balloon thermotherapy b. A 42-yr-old patient with secondary amenorrhea who says that her last menstrual cycle was 3 months ago c. A 35-yr-old patient with heavy spotting after having a progestin-containing IUD (Mirena) inserted a month ago d. A 19-yr-old patient with menorrhagia who has been using superabsorbent tampons and has fever with weakness

D The patient's history and clinical manifestations suggest possible toxic shock syndrome, which will require rapid intervention. The symptoms for the other patients are consistent with their diagnoses and do not indicate life-threatening complications.

Which information about continuous bladder irrigation will the nurse teach to a patient who is being admitted for a transurethral resection of the prostate (TURP)? a. Bladder irrigation decreases the risk of postoperative bleeding. b. Hydration and urine output are maintained by bladder irrigation. c. Antibiotics are infused continuously through the bladder irrigation. d. Bladder irrigation prevents obstruction of the catheter after surgery.

D The purpose of bladder irrigation is to remove clots from the bladder and prevent obstruction of the catheter by clots. The irrigation does not decrease bleeding or improve hydration. Antibiotics are given by the IV route, not through the bladder irrigation.

The nurse will teach a patient with metastatic breast cancer who has a new prescription for trastuzumab (Herceptin) that a. hot flashes may occur with the medication. b. serum electrolyte levels will be drawn monthly. c. the patient will need frequent eye examinations. d. the patient should call if she notices ankle swelling.

D Trastuzumab can lead to ventricular dysfunction, so the patient is taught to self-monitor for symptoms of heart failure. There is no need to monitor serum electrolyte levels. Hot flashes or changes in visual acuity may occur with tamoxifen, but not with trastuzumab.