Nursing - 309 Exam 2
A patient who is very upset asks the nurse, "My doctor says I have endometriosis. What does it mean?" What is the nurse's best response?
"A special type of tissue, called endometrial tissue, is outside of your uterus."
A patient reports the sensations of feeling "something is falling out." along with painful intercourse, backache, and a feeling of heaviness/pressure in the pelvis. Which question does the nurse ask to assess for a cystocele?
"Are you having urinary frequency or urgency?"
The nurse is teaching a group of women about prevention of toxic shock syndrome. What preventive measures does the nurse include?
"Avoid the use of superabsorbent tampons." "Use sanitary napkins at night." "Avoid using internal contraceptives."
Patient tells the nurse that he has cut back on drinking fluids to reduce his symptoms of BPH The nurse responds
"Decreasing fluid intake may increase your risk of developing a urinary tract infection."
After a hysterosalpingo-oophorectomy, a client wants to know whether it would be wise for her to take hormones right away to prevent symptoms of menopause. What is the nurse's MOST appropriate action?
"Discuss this with your health care provider, because it is important to know your concerns."
A 20 year old woman is being evaluated for possible toxic shock syndrome. What question would the nurse ask?
"Do you use internal contraceptives?"
The nurse is taking a history on a patient with probable gynecologic cancer. Which clinical manifestation is a sign of metastasis?
Dysuria.
A pt is prescribed the luteinizing hormone releasing hormone (LH - RH) agonist leuprolide (Lupron) for treatment of a prostate tumor. What possible side effect of this med does the nurse advise the pt about?
ED
The nurse is teaching a pt who is taking finasteride (Proscar), an 5-alpha reductase inhibitior (5-ARI). What medication side effects does the nurse include in the teaching?
ED Dizziness Decreased libido
A client past menopause undergoes an anterior posterior colporrhaphy. What should the discharge teaching include?
Eating a high fiber diet.
The nurse is interviewing a patient to determine the presence of lower UTI symptoms associated with BPH. Which questions would the nurse ask?
"Do you have difficulty starting and continuing urination?" "Do you have reduced force and size of the urinary stream?" "Have you noticed postvoid dribbling or leaking?" "How many times do you have to get up and urinate during the night?" "Have you noticed blood at the start or at the end of voiding?"
The patient reports itching, change in vaginal discharge, and an odor. The nurse suspects that the patient has vulvovaginitis. Based on knowledge about the common causes of vulvovaginitis, which question would the nurse ask?
"Have you recently been taking antibiotics?"
The nurse hears in shift report that the pt had a transurethral needle ablation. Which question would the nurse ask the patient to determine if the procedure achieved the intended therapeutic goal?
"Have your problems with urination been resolved?
A 22 year old patient reports abdominal pain that stems to start several days before her menstrual period. What questions does the nurse ask in order to obtain a thorough menstrual history?
"How old were you when you started menstruation?" "Typically, how long does your period last?" "How would you describe your menstrual flow?"
A client is in skin traction while awaiting surgery for repair of a fractured femur. The client reports leg discomfort and asks the nurse to release the traction. Which is the nurse's BEST INITIAL response?
"I can't because the eights are needed to keep the bone aligned."
A patient had an anterior colporrhaphy and is returning to the clinic for the follow up appointment. Which patient statement indicates that the procedure has achieved the desired therapeutic outcome?
"I have good control over my urination."
During morning care, a patient with a below the knee amputation asks the UAP about prostheses. How will you instruct the UAP to respond?
"I'll ask the nurse to come in and discuss this with you."
A young patient had a great toe amputated because of severe injury. The patient is depressed and withdrawn after the physician tells him that the amputation will affect balance and gait. What is the nurse's best response?
"When the doctor was explaining things to you, what were you thinking about?"
A patient with a right above the knee amputation asks you why he has phantom limb pain. What is your best response?
"Phantom limb pain is not explained or predicted by any one theory."
An older pt's wife is very upset because "my husband was just told that he had prostate cancer. He feels fine now, but the dr told him to watch and wait. Why are we just watching? What are we watching for?" What is the nurse's best response?
"Prostate cancer is slow growing. Your husband needs regular DRE and PSA testing and here is a list of symptoms to watch for."
What is an important health teaching point for a patient with TJA?
"Protect the joint."
A client is diagnosed with uterine fibroids, and the health care provider advises a hysterectomy. The client expresses concern about having a hysterectomy at age 45 because she has heard from friends that she will undergo severe symptoms of menopause after surgery. What is the nurse's MOST appropriate response?
"Some women may experience symptoms of menopause if their ovaries are removed with their uterus."
A pt needs surgical intervention for an enlarged prostate, but also needs to maintain his anticoag therapy. Which brochure would be the most appropriate to prepare for the pt?
"Talking to your dr about Holmium Laser Enucleation of the Prostate (Ho-LEP)"
The nurse is giving instructions to a patient who is undergoing brachytherapy for cervical cancer. What information does the nurse include?
"You are not radioactive between treatments." "Report any blood in the urine or severe diarrhea immediately." "You will be on bedrest during the treatment session."
A patient is reluctant to consider hip surgery because of fear of blood transfusion reaction. What is the nurse's BEST response?
"You could donate your own blood for several weeks before surgery."
The nurse is talking to a 35 yo African American man about PSA testing. The pt tells the nurse that his father and older brother with diagnosed with prostate cancer in their 50s. What should the nurse tell the pt?
"Your genetic and racial risk factors suggest testing should begin at 40"
What information should be included when teaching a patient about using tamsulosin (Flomax)?
"change positions slowly, such as when standing up."
A patient has had a posterior colporrhaphy. What is included in the nursing care of this patient?
Administer pain medication before a bowel movement. Instruct to avoid straining during a bowel movement. Provide sitz baths. Promote a low residue (low fiber) diet.
Postoperative care for total knee replacement may include which technique?
Continuous passive motion used immediately or several days post operatively. Ice packs or cold packs to the incisional area. The use of CPM machine in the daytime and an immobilizer at night.
A patient is undergoing large volume bladder irrigation. During and after the procedure, the nurse observes the pt for confusion, muscle weakness, and increased GI motility related to which potentially adverse effect of large volume irrigation?
Hyponatremia
The pt has a continuous bladder irrigation via a 3 way urinary catheter. At 7 am the urine drainage bag was emptied and 1000 mL of irrigation fluid was started. At 11 am, 350 mL of irrigation fluid was administered through the catheter. The urinary drainage bag contains 600 mL. How many mL of urine has the pt produced in the past 4 hours?
250 mL
A patient with a fever, myalgia, sore throat, and sunburn like rash is admitted with the diagnosis of toxic shock syndrome. What additional clinical manifestation should the nurse assess for?
Hypotension.
A patient with cancer has also been diagnosed with uterine leiomyomas. Which procedure does the nurse prepare the patient for?
Hysterectomy.
Patient has BPH. Which information about this condition is important to consider?
It predisposes to hydronephrosis
Which woman is at greatest risk for dysfunctional uterine bleeding?
45 year old attorney with a stressful life.
Which woman is at greatest risk for developing pelvic organ prolapse?
48 year old obese mother of four children
The pt is prescribed trimethoprim/sulfamethoxazole (Bactrim, Septra) for prostatitis. Which lab result indicate the med is having the desired therapeutic effects?
Normalization of WBC
Which man has the highest risk for prostate cancer?
A 75 yo African American man whose brother had prostate cancer.
Client pulls out urinary catheter. What should the nurse do first?
Notify the health care provider
The nurse is giving discharge teaching to a patient who had a transvaginal repair for pelvic organ prolapse using a surgical mesh. What does the nurse include?
Abstain from sexual intercourse for 6 weeks.
Patients with which condition meet the criteria for having a TURP?
Acute urinary retention, hydronephrosis, hematuria
Postoperative total hip replacement patients can develop numerous complications. Which interventions are most important in preventing complications?
Adequate diet and fluid intake. Getting out of bed on the first post operative day. Frequent assessment of the patient's pain.
What types of examinations are done to reveal the presence of uterine enlargement related to fibroids?
Abdominal examination Vaginal examination Rectal examination Transvaginal ultrasound with saline infusion
The nurse is caring for a patient with open reduction and internal fixation (ORIF) for a hip fracture. Because the patient is at risk for hip dislocation, the nurse ensures that the hip is maintained in which position?
Abduction
Seven warning signs of Gynecologic Cancer
Abnormal bleeding Pelvic Pain Urinary/Gastro disturbances abdominal swelling changes in vulva/vagina low back pain.
Nursing care of a client with a fractured hip should include the assessment of pedal pulses. The nurse should assess for which important characteristics of the pedal pulses?
Amplitude and symmetry.
After an abdominal hysterectomy the client returns to the unit with an indwelling catheter. The nurse identifies that the urine in the client's collection bag has become increasingly sanguineous. What complication does a nurse suspect?
An incisional nick in the bladder.
What information would the nurse give to a sexually active 22 year old woman about conventional Papanicolaou (Pap) smear testing?
Annual screening is recommended.
The nurse is caring for a pt who had minimally invasive sx (MIS) for testicular cancer. The nurse is also caring for a pt who had an open radical retroperitoneal lymph node dissection for testicular cancer. The nurse anticipates that the second pt has more of risk for which condition?
Paralytic Ileus
The nurse is caring for a patient with a radioactive implant in the uterus. Which instruction will the nurse give to unlicensed assistive personnel (UAP)?
Patient is on bedrest and excessive movement is restricted.
An older adult pt had a TURP at 8 am. At 3 pm, the nurse assesses the pt. Which finding does the nurse report to the HCP?
Patient keeps moving and ketchup like output is noted
Adlea is a refined capsaicin product. What is the advantage of infusing this drug directly into the surgical joint during knee surgery?
Patients experience less acute post operative pain.
A patient is admitted to the same day surgery unit following a meniscectomy. What does post operative care for this patient include?
Perform neurovascular checks every hour for the first few hours and then every 4 hours. Check the surgical dressing for bleeding. Teach about signs and symptoms of infection.
The nurse is giving discharge instructions to patient who had a TURP. What does the nurse include in the instructions?
Reassurance that loss of control of urination or dribbling of urine is temporary.
A client at the women's health clinic tells the nurse she has endometriosis. What factors associated with endometriosis does the nurse anticipate the client will report?
Rectal pressure. Abdominal pain.
Rectocele
Rectum is displace, bulging of posterior wall.
A nurse is caring for a client with a fracture of the head of the femur. The health care provider places the client in a buck extension. What explanation does the nurse give the client for why the traction is being used?
Reduces muscle spasms.
What should the nurse do to control edema of the residual limb 1 week after a client has an above the knee amputation?
Rewrap the elastic bandage as necessary.
The nurse is teaching a patient who is being discharged after having a total abdominal hysterectomy. Which conditions does the nurse tell the patient to immediately report to the surgeon?
Vaginal drainage that becomes thicker or foul smelling. Temperature over 100 F Burning during urination.
A patient is admitted with toxic shock syndrome. What organism is frequently associated with this syndrome when it occurs as a menstrually related infection?
Staphylococcus aureus.
A nurse is caring for a client who has had an open reduction internal fixation of a fractured hip. Which nursing assessment of the affected leg is most important after this surgery?
Toes for mobility.
A patient is receiving external radiation therpay for treatment of endometrial cancer. What task does the nurse delegate to the UAP?
Assist the patient to ambulate if she feels fatigue or tiredness.
A pt is diagnosed with prostatitis. Which intervention does the nurse use to alleviate the discomfort associated with this condition?
Assist with comfort measures such as sitz baths for pain
You observe a student nurse who is caring for a client who has an intracavitary radioactive implant in place to treat cervical cancer. Which action by the student requires that you intervene immediately?
Assisting the client to the beside commode for a bowel movement.
The nurse is providing care for a patient scheduled for a THA. Which medications should the patient receive before surgery?
Anti-hypertensive tablet orally.
A client with a third degree uterine prolapse is scheduled for a vaginoplasty. What should the nurse anticipate the surgeon will order?
Apply moist compresses to the uterus
A patient with swelling in the perineal area is diagnosed with Bartholin cyst. Nonsurgical management is recommended. What does the nurse instruct the patient to do?
Apply moist heat to the vulva (sitz baths or hot wet packs).
The patient has returned from the post anesthesia care unit after TJR. Which interventions will the nurse use to prevent venous thromboembolism?
Apply sequential compression devices (SCDs). Administer subcutaneous enoxaparin (Lovenox) as ordered. Teach the patient to perform leg exercises such as flexion and dorsiflexion.
The nurse sees that the patient is taking tamsulosin (Flomax). Which question would the nurse ask to determine if the med is achieving the desired therapeutic effect?
Are you having any trouble passing urine?
A young patient has been diagnosed with testicular cancer. He and his wife had been trying to conceive a child for several months. What information does the nurse give the couple about sperm storage?
Arrangements for sperm storage should be made as soon as possible after diagnosis
A patient had a total abdominal hysteretomy. Which patient behavior is the best indicator that she is coping and adapting successfully?
Ask questions about the wound care, but seems reluctant to do self care.
The nurse's neighbor comes running over because her husband "cut his finger off with a power saw." After calling for help, what is the first priority action when the nurse gets to the neighbor's house?
Assess for airway or breathing problems.
A patient tells the nurse taht she was told that she had a "chocolate" cyst. Which assessment is the nurse most likely to perform?
Assess onset and description of pain.
A patient with uterine leiomyomas reports a feeling of pelvic pressure, constipation, and urinary retention. She says, "I can't button my pants anymore." What does the nurse assess for to further evaluate the patient's symptoms?
Assess the abdomen for distention or enlargement.
When educating a patient about total joint arthroplasty (TJA), what does the nurse do first?
Assesses the patient's knowledge about TJA.
Following a uterine embolization using a vascular closure device, what patient care would the nurse provide?
Assist the patient to ambulate 2 hours after the procedure. Assess the patient's pain level and administer analgesics as needed. Raise the head of the bed.
A pt has undergone eternal beam radiation (EBRT) for palliative treatment of prostate cancer. What suggestions does the nurse make to help the pt manage acute radiation cystitis secondary to EBRT?
Avoid consumption of caffeine drinks
The nurse teaches a patient with BPH to follow which instructions?
Avoid diuretics, avoid sex, avoid caffeine, avoid drinking large amounts of fluid in a short time
A patient who had a total abdominal hysterectomy is anxious to resume her activities because she has young children at home. What postprocedure information does the nurse provide to the patient?
Avoid sitting for prolonged periods. Do not lift anything heavier than 5 to 10 pounds. When sitting, do not cross the legs.
What self management strategy would the nurse recommend to a a patient to prevent vulvovaginitis?
Avoid wearing tight fitting clothing
A pt who has testicular cancer is likely to have which common problem?
Azoospermia
A client has an anterior and posterior surgical repair of a cystocele and rectocele and returns from the PACU with an indwelling catheter in place. What should the nurse tell the client about the PRIMARY reasons for the catheter?
Discomfort is minimized. Urinary retention is prevented. Pressure on the suture line is relieved.
The nurse is caring for several patients who had total abdominal hysterectomies. All patients are coming to the clinic for their 6 week follow up appointment. Which patient demeanor is the strongest indicator that there is a need for psychological referral?
Disheveled and lackluster, and displays a lack of interest in questions.
The nurse is designing a teaching plan for a pt with an enlarged prostate and obstructive symptoms. What does the nurse teach the pt to avoid?
Diuretics
The nurse is preparing an educational session for a patient who is scheduled to undego hip replacement. Which potential complications does the nurse make the patient aware of?
Venous thromboembolism. Hip dislocation. Neurovascular compromise. Infection.
When should the nurse begin the process of rehabilitation when a client is scheduled for an amputation?
Before the surgery.
The nurse is preparing patient teaching for several young women who will undergo surgical procedures for gynecologic problems. Which surgical procedure is most likely to induce menopausal symptoms?
Bilateral Salpingo-oophorectomy
What are common sites of metastasis for prostate cancer?
Bones of the pelvis Liver Lungs
An older patient is discharged to home following an orthopedic injury. Which mobilization device is usually preferred for older patients who need additional support for balance?
Walker
A patient who has sustained a traumatic amputation of the left leg expresses concern about working and taking care of his family after his injury. What resources does the nurse recommend to help the patient adjust to his lost limb?
Chaplain. Medical Social Worker. National Amputation Foundation.
The nurse is teaching a pt who had an open retroperitoneal lymph node dissection. What instructions does the nurse give to the patient?
Do not drive a car for several weeks Perform monthly testicular self exams on the remaining testes Have follow up diagnostic testing for atleast 3 years after the surgery.
The nurse sees that a patient has been advised by the health care provider to apply lindane to the affected area. What is a self care measure for this patient to ensure that the symptoms do not return after using the medication?
Wash clothes, linens, and disinfect the home environment.
It is important to monitor which lab tests for patients on anticoagulant therapy with LMWH after TJA?
CBC. Platelet count.
Tumor marker for Ovarian/Endometrial cancer
Ca-125
In recalling dietary intake for a recent 24 hour period, a female patient describes eating eggs, whole milk, and bacon for breakfast; fried chicken and french fries for lunch. This type of diet places her at increased risk for which disorder?
Cancer of the Ovaries.
The nurse encourages a teenage patient to receive the HPV vaccine (Gardasil) because it protects against which type of Cancer?
Cervical Cancer
Young women who have intercourse as teenagers and/or have multiple sex partners are at high risk for which disease?
Cervical Cancer
The nurse is interviewing an older adult with a history of osteoporosis who reports falling and catching her weight on her outstretched dominant hand. This patient is most likely to have sustained what type of fracture?
Colles' wrist fracture.
Three days after undergoing a pelvic exenteration procedure, a client reports dizziness after experiencing a sudden "giving" sensation along her abdominal incision. You find that the wound edges are open and loops of intestine are protruding. Which action should you take first?
Cover the wound with saline soaked dressings.
A nurse provides discharge teaching for a client who had a total hip replacement. Which activities to avoid identified by the client indicate an understanding of the teach?
Crossing the legs. Sitting in a low chair.
A patient has undergone a total hysterectomy with vaginal repair. The nurse advises her about careful intercourse and which OTC product to decrease sexual discomfort related to intercourse?
Water based lubricants.
The patient is a middle aged man with a history of uncontrolled diabetes. His right foot is a dark brownish purple color and there is no palpable dorsalis pedis or posterior tibial pulse. The nurse prepares the patient for which diagnostic test.
Doppler ultrasound.
Which assessment finding would indicate urinary retention?
Dullness heard on percussion below the umbilicus.
A client with urinary retention, BPH, and delirium related to urosepsis. The HCP orders a catheter to be placed. What nursing action is most important for the patient's safety?
Determine if any unsafe behavior pattern exists.
A client had an above the knee amputation of the left leg because of trauma from a motor vehicle collision. The health care provider orders ambulation with crutches until the residual limb is healed and the client can be fitted with a prosthesis. What should be the nurse's FIRST intervention?
Determine if the client has ever used crutches before.
The pain a patient experiences from a bone fracture results from which processes?
Edema. Muscle spasms.
A nurse is caring for a client in the evening after the client has had a below the knee amputation. What action should be implemented by the nurse?
Elevate the foot of the bed.
The nurse is caring for a pt who had an open radical prostatectomy. During the assessment, the nurse notes that the penis and scrotum are swollen. What does the nurse do next?
Elevate the scrotum and penis, intermittently apply ice to the area for 24-48 hours
Lab indicators for testicular cancer
Elevated AFP, LDH, presence of HCG
The nurse is reviewing the lab results for a pt with prostate cancer. Which lab results suggests metastasis to the bone?
Elevated serum alkaline phosphatase
The pt had several diagnostic tests to evaluate report of LUTS. Which finding suggests that the pt may have kidney disease?
Elevated serum creatinine
A patient receiving chemotherapy treatments reports fatigue, loss of energy, and experiencing an "emotional crisis every day and my hair is falling out." What does the nurse do first to help the patient adapt to body changes?
Encourage the patient to ventilate feelings.
Which interventions does the nurse implement to improve mobility for a patient who has undergone a THR?
Encourage use of assistive devices such as a walker when ambulating. Instruct in the use of a raised toilet seat.
A nurse is caring for a client who had a total hip replacement. What nursing action should be incorporated into the plan of care to prevent thrombus formation?
Encouraging the client to perform ankle exercises.
The home health nurse is reviewing the patient's medication list and sees that the patient was given doxorubicin (Adriamycin) at the hospital. What gynecologic diagnosis would the nurse expect to see as part of the patient's history?
Endometrial Cancer
What disease is strongly associated with prolonged exposure to estrogen without the protective effects of progesterone?
Endometrial Cancer
A patient has excessive bleeding from uterine fibroids. Which therapy stops the blood flow to the fibroids?
Endometrial ablation.
An obese 57 year old patient describes excessive menstrual bleeding that occurs approximately every 10 days. The nurse educates the patient for which diagnostic test that is used to evaluate for endometrial cancer?
Endometrial biopsy
Which is most important for the nurse to do when providing care to a client who has had a transurethral resection of the prostate?
Ensure patency of the indwelling catheter.
A patient is receiving low molecular weight heparin therapy to prevent post operative deep vein thrombosis (DVT). Which routine assessments are most important for this patient during anticoagulation therapy?
Ensure that anti-embolic stockings or sequential compression devices are in use. Monitor complete blood count (CBC) and platelets counts. Check stools for occult blood. Monitor the surgical site for bleeding.
A nurse is caring for a client who had a total hip replacement. What is the priority assessment when monitoring the client for hemorrhage?
Examining the bedding under the client
What should be included in the nurse's instructions to help a client prepare for walking with crutches?
Exercises with or without weights to strengthen the muscles of the upper extremities.
A nurse receives a change of shift report for a client who had a total hip replacement 24 hours ago. After reviewing the client's clinical record and completing a physical assessment, which complication should the nurse conclude that the client is experiencing?
Fat embolism
The pt is diagnosed with acute bacterial prostatitis. What assessment findings does the nurse expect to find?
Fever Chills Dysuria Urethral Discharge
The nurse is teaching a pt at risk for prostate cancer about food sources of omega 3 fatty acids. Which food does the nurse suggest?
Fish
On the first postoperative day after a total hip replacement, a client asks for assistance onto the bedpan. What should the nurse instruct the client to do?
Flex the knee on the unoperated leg and pull on the trapeze to lift the pelvis.
The care plan for a client with a fractured hip includes nursing actions to prevent which type of contracture?
Flexion of the hip.
Which crutch gait should the nurse teach the client wearing a prosthesis after a single leg amputation?
Four point.
A patient who underwent a right above the knee amputation 4 days ago also has a diagnosis of depression. Which order would you clarify with the health care provider.
Give fluoxetine (Prozac) 40 mg once a day.
The nurse is caring for an older pt who had a urinary catheter inserted after a TURP. The pt is intermittently confused, and pics at the IV tubing and the catheter. What should the nurse try first?
Give the pt a familiar object to hold, such as a family picture.
Which nursing intervention is best to prevent increased pain in a patient experiencing phantom limb pain?
Handle the residual limb carefully when assessing the site or changing the dressing.
A 15 old adolescent tells a school nurse, "I have persistent pain during my periods." What should the nurse encourage her do to?
Have a gynecologic examination.
The nurse notes that the pt has just started taking an alpha blocker med to treat BPH. What instruction, related to the med side effects, will the nurse give to the UAP who will assist the pt with ADLs?
Have him sit up slowly and pause before standing
A patient is diagnosed with uterine leiomyomas. What does the nurse expect to see in the documentation for this patient as the chief presenting symptom?
Heavy vaginal bleeding.
During the first 24 hours after prostatectomy, what is the priority assessment in the nursing care plan?
Hemorrhage
The nurse is caring for a patient who had hysteroscopic surgery. The patient reports severe lower abdominal pain, she appears pale, and has trouble focusing on the nurse's questions about pain. Vital signs show: T 98.6, P 120/min, R 24/min, BP 103/60. Which complication does the nurse suspect?
Hemorrhage
Which additional manifestations would the nurse expect in clients with Benign Prostatic Hyperplasia?
Hesitancy when starting the urine stream. Decrease in the size and force of urine stream. Frequent urination, including nocturia.
A pt reports having uncomfortable and unsettling episodes of hot flashes after receiving hormonal therapy for a prostate tumor. To alleviate this symptom, which prescription med does the nurse assist the pt in obtaining?
Hormonal inhibitor drug such as megestrol acetate (Megace)
The nurse is teaching a pt who had an open radical prostatectomy about how to manage the common potential long term complications. What does the nurse teach the pt?
How to perform Kegal perineal exercises
An older pt reports that he has an enlarged prostate with chronic urinary retention, but declines to seek treatment because "it's been that way for a long time." The nurse would encourage a follow up appointment to prevent which complication of this chronic condition?
Hydronephrosis
A client has a total knee replacement, and a continuous passive motion device is being used. The nurse concludes that the teaching was effective when the client states, "The goal of this therapy to--"
Improve joint flexion."
The nurse is preparing an educational program for student nurses on the orthopedic unit. Which three signs of hip dislocation would be included in this offering?
Increased pain. Leg rotation. Shortening of affected leg.
Which are contraindications for TJA?
Infection. Advanced osteoporosis. Severe inflammation.
How does a continuous peripheral nerve blockage (CPNB) device work?
Infuses a local anesthetic into the surgical site.
A client who underwent an abdominal hysterectomy 3 days ago reports burning with urination. Her urine output during the previous shift was 210 mL, and her temperature is 101.3 F. Which of these actions prescribed by the health care provider will you implement first.
Insert a straight catheter PRN for output of less than 300 mL/8 hr.
The nurse is preparing to assess an obese patient who reports subjective symptoms and urinary patterns associated with BPH. Which technique does the nurse use to perform the physical assessment?
Instruct pt to void and then use bladder scanner.
A client is admitted with a fracture of the neck of the femur. In what position should the nurse maintain the client's affected extremity?
Internal rotation with extension of the knee and hip.
Which assessment tool is commonly used to ask patients about the effect of urinary symptoms on their quality of life?
International Prostate Symptom Score
The nruse notes bright red blood with numerous clots in the urinary drainage bag for a patient who had a TURP. After notifying the surgeon, what does the nurse do next?
Irrigate the catheter with normal saline per protocol.
AN older adult patient has skin traction in place for a hip fracture. What is the main purpose of this type of traction?
It decreases painful muscle spasms.
What instructions should the nurse provide when the client is allowed out of bed after an above the knee amputation?
Keep the hip in extension and alignment.
A pt had a TURP and has a thre way urinary catheter taped to the left thigh. What does the nurse instruct about the position of the left leg?
Keep the leg straight
What are the common serum tumor markers that confirm a diagnosis of testicular cancer?
LDH, AFP, hCG
A client who has a diagnosis of endometriosis is concerned about the side effect of hot flashes from her prescribed medication. She tells the nurse that her mother found them very uncomfortable during her menopause. Which medication causes this side effect?
Leuprolide (Lupron)
A client has an amputation of a lower limb. What instructions should the nurse give the client to prevent a hip flexion contracture?
Lie on the abdomen 30 minutes four times daily.
A pt had a transrectal ultrasound with biopsy earlier in the day. What urine characteristics does the nurse expect to see?
Light pink urine
What does the patient need to know about using finasteride Proscar?
Liver function studies need to be monitored frequently. Most clients see significant change in BPH symptoms in 4 months. The medication should not be handled by women or children. Clients have experience breast tenderness and nipple discharge.
A nurse is caring for a client who developed aseptic necrosis after a fracture of the head of the femur. The nurse understands that aseptic necrosis is associated with which factor?
Loss of blood supply to the head of the femur.
Waht does a nurse expect to be the PRIORITY concern of a 28 year old woman who is to undergo a laparoscopic bilateral salpingo oophorectomy?
Loss of childbearing potential.
For a patient with endometriosis, which supplement might offer relief of the muscle cramping?
Magnesium
What is the best diagnostic test to determine musculoskeletal and soft tissue damage?
Magnetic resonance imaging. (MRI)
The pt has an indwelling catheter in place following a TURP. Wha instructions will the nurse give to the UAP with regards to the catheter?
Maintain traction of the catheter.
What signs/symptoms does the nurse assess in a patient with dysfunctional uterine bleeding?
Male hair pattern. Thyroid enlargement. Abdominal pain. Abdominal masses.
A patient reports dramatic changes in color and temperature of the skin over the left foot with intense burning pain, sensitive skin, excessive sweating, and edema. The physician makes a preliminary medical diagnosis of complex regional pain syndrome. What is the priority for nursing care?
Management of pain.
The nurse is performing an assessment on a pt with organic ED. What are the possible causes of this condition?
Meds for HTN Thyroid disorders Diabetes Mellitus
Which interventions can the nurse use to prevent or manage infections in patients who have undergone total joint replacement?
Use aseptic technique for wound care and emptying of drains. Wash hands thoroughly when caring for patients. Culture drainage fluid if a change is observed. Report excessive inflammation or drainage to the provider.
What is the priority nursing care most commonly seen preoperatively and postoperatively in a patient with leiomyomas?
Monitoring for bleeding.
A patient injured a lower extremity and has been placed in a running traction. What instructions does the nurse give to the UAP?
Moving the patient or the bed during care can alter the countertraction.
Client has indwelling urinary catheter. What is the most important action for the nurse to implement when irrigating the bladder?
Use sterile equipment.
After an above the knee amputation of a leg, a client reports pain in the foot that is no longer there. What should the nurse include about phantom limb pain in a discussion with the client?
Nerve endings in the limb are still intact and react to stimuli.
A pt reports having ED and is seeking a prescription for sildenafil (Viagra). Because of the potential for drug-drug interactions, the nurse asks the pt specifically if he is taking which type of drugs?
Nitrates
Grade II Uterine Prolapse
Uterus bulges into vagina, but the cervix does not protrude.
For patients who have TJAs, the risk of DVT is high. Which statements are true?
Older adults are at high risk for DVT and compromised circulation. Patients with a history of DVT are at high risk for recurrence. Leg exercises must be started in the immediate post operative period.
A client has surgery to repair a fractured right hip. Where should the nurse stand when assisting the client to ambulate?
On the client's left side.
A current treatment of nonemergent dysfunctional uterine bleeding includes which medication?
Oral or patch contraceptives
Which position should a nurse avoid placing a client who had surgery for a total hip replacement?
Orthopneic
Which factor carries the greatest risk for hip fracture?
Osteoporosis
The nurse is teaching a pt diagnosed with ED about the common treatment and therapies. Which topics does the nurse include?
PDE-5 inhibitors, Intraurethral applications, vacuum devices, penile implants
An older pt is scheduled for an annual physical including a PSA and a digital rectal examination (DRE). How are these two test scheduled for the pt?
PSA is drawn before the DRE is performed
A middle aged male patient has a tight cast on his left lower leg. An early assessment variable requiring further evaluation for compartment syndrome would be:
Pain more intense than that of the injury itself.
A nurse is assessing a client who is being admitted for surgical repair of a rectocele. What signs or symptoms does the nurse expect the client to report?
Painful intercourse. Bearing down sensations.
Which classic symptom is indicative of invasive gynecologic cancer in an older patient?
Painless vaginal bleeding
A nurse is teaching crutch walking to a client who had arthroscopic surgery of the knee. On which part of the body should the nurse instruct the client to place weight?
Palms of the hands
Which is an example of the principles of body mechanics that the nurse uses when caring for immobilized clients?
Placing the feet apart to increase the stability of the body.
A 36 year old patient is diagnosed with dysfunctional uterine bleeding. During the pelvic exam, the health care provider determines that the bleeding is acute and heavy. What is the nurse's priority action?
Prepare to administer combination hormonal therapy.
The surgical procedure for stage I disease of endometrial cancer involves removal of which components?
Uterus. Fallopian tubes. Ovaries.
A nurse is caring for a client with a below the knee amputation. What should the nurse encourage the client to do to prepare the residual limb for a prosthesis?
Press the end of the residual limb against a pillow periodically.
What is the primary treatment for dysfunctional uterine bleeding in perimenopausal women?
Progestin or combination hormone therapy.
The nurse is caring for a patient with an above the knee amputation (AKA). In order to prevent hip flexion contractures, how does the nurse position the patient?
Prone position every 3 to 4 hours for 20 to 30 minute periods.
The nurse is reviewing the lab results from a pt being evaluated for LUTS. What does an elevated prostate specific antigen (PSA) level and serum acid phosphatase level in this pt indicate?
Prostate Cancer
Patient has prostate cancer. Which serum level should both the nurse and the client monitor?
Prostate specific antigen
For pre operative care of a patient scheduled for TJA. What does the nurse plan to do?
Provide written or videotaped information about the procedure. Assess the patient's understanding of the procedure. Assess and include the patient's support people or family. Include interdisciplinary providers, if possible.
The pt had a TURP several days ago and the urinary catheter was removed 6 hours ago. Which sign/symptom must be resolved before the pt is discharged?
Pt has not voided since catheter was removed.
A client with a fractured hip is placed in traction until surgery can be performed. What should the nurse explain is the purpose of the traction?
Relieve muscle spasm and pain.
You are working in the ED when a client with possible toxic shock syndrome is admitted. Which prescribed intervention will you implement first?
Remove the client's tampon.
The nurse is giving instructions to the UAP about hygienic care for an older adult patient who is uncircumsized. What does the nurse instruct the UAP to do?
Replaced the foreskin over the penis after bathing.
A pt had a transrectal ultrasound with a biopsy. After this procedure, what does the nurse instruct the pt to do?
Report fever, chills, bloody urine, and any difficulty voiding Avoid strenuous physical activity
The nurse is giving discharge teaching to a woman who had a local cervical ablation. What information would be included?
Report heavy vaginal bleeding or foul smelling drainage. Showering is permitted, but no tub baths. Avoid lifting heavy objects for 3 weeks.
A client that has prostate cancer attempts to urinate frequently, but voids in very small amounts. What is the most likely causative factor?
Retention.
You are working on the PACU caring for a 32 year old client who has just arrived after undergoing dilation and curetagge to evaluate infertility. Which assessment finding should be immediately communicated to the surgeon?
Sharp, continuous, level 8 out of 10 abdominal pain.
Which clinical indicator should the nurse expect to identify when assessing a client with a fracture of the neck of the femur?
Shortening of the affected extremity with external rotation.
The nurse assesses a postoperative TKR patient for neurovascular compromise. Which assessments must the nurse document?
Skin color and temperature. Presence or absence of distal peripheral pulses. Capillary refill of operative leg. Comparison of operative leg to nonoperative leg.
After an open reduction and internal fixation of a fractured hip. What assessments of the client's affected leg should the nurse make?
Skin temperature. Sensation in the toes. Presence of pedal pulse.
A patient had loop electrosurgical excision procedure (LEEP) for treatment and diagnosis of cervical cancer. In the discharge instructions, what does the nurse tell the patient to expect after the procedure?
Spotting
A nurse is caring for a client who had an open reduction and internal fixation of a femoral neck fracture. The client has an order for ambulation with slight weight bearing on the affected extremity. During the physical assessment the nurse identifies that the client has kyphosis and strong upper arm strength. What assistive devise does the nurse expect the health care provider to order for this client?
Standard walker
Following a meniscectomy, the nurse assists a patient to immediately start performing which exercises?
Straight leg raises on both legs.
When a client is in the right side lying position after the insertion of a left hip prosthesis, the nurse ensures that the client has a pillow placed between the thighs and that the entire length of the upper leg is supported. What does this pillow prevent?
Strain on the operative site.
When taking the health history of a client who is admitted for repair of a cystocele and rectocele, the nurse should expect the client to report the occurrence of
Stress incontinence and low abdominal pressure.
To prevent a DVT, several types of anti coagulant medications can be ordered. Which is the most commonly used drug during hospitalization?
Subcutaneous LMWH
Patient with a continuous bladder irrigation. What is the most important nursing action?
Subtracting irrigant from output to determine urine volume.
Which sign or symptom is associated with advanced prostate cancer?
Swollen groin lymph nodes
What is the primary factor for the low survival rates for patients who are diagnosed with ovarian cancer?
Symptoms are mild and vague, therefore the cancer is often not detected until its late stage.
Which type of surgery is most commonly used to treat BPH?
TURP
The nurse is teaching self care management to a 39 year old woman who had an abdominal hysterectomy. Which point would be emphasized to avoid complications of this surgery?
Take temperature twice a day for the first 3 days after surgery.
A pt is receiving internal radiation therapy (brachytherapy ) and has had a low dose radiation seed implanted directly into the prostate gland. What nursing implication is related to this therapy?
Teach the patient that fatigue is common, but should pass after several months
A client experiences a traumatic amputation of a leg in a motor vehicle accident. Which nursing intervention INITIALLY should receive the lowest priority?
Teaching residual limb care.
The advanced practice nurse is performing a testicular exam on a young Caucasian male patient. The practitioner finds a lump, which the pt reports as painless. This finding is considered the most common manifestation of which disease or disorder?
Testicular Cancer
An 86 year old woman had an anterior and posterior colporrhaphy (A & P repair) several days ago. Her retention catheter was removed 8 hours ago. Which assessment finding requires that you act most rapidly?
The abdomen is firm and tender to palpation above the symphysis pubis.
You are assessing a long term care client with a history of BPH Which patient information requires prompt action?
The bladder is paplable above the symphysis pubis. The client is restless.
The nurse is reviewing PSA results for a pt who had a prostatectomy for prostate cancer several weeks ago. The PSA level is 40 ng/mL. How does the nurse interpret this data?
The cancer is most likely reoccuring
Which principle should the nurse consider when assisting a client with crutches to learn the four point gait?
The client must be able to bear weight on both legs.
When assessing a client with cervical cancer who had a total abdominal hysterectomy yesterday, you obtain the following data. Which information has the most immediate implications for planning of the client's care?
The client's right calf is swollen, and she reports calf tenderness.
The advanced practice nurse is preparing to examine a patient's prostate gland. Before the exam, what does the nurse tell the patient?
The gland will be massaged to obtain a fluid sample for possible prostatitis.
A client is ready to walk with crutches after knee surgery. Which crutch walking technique will the nurse most likely have to reinforce after the client returns from physical therapy?
Three-point
The charge nurse is assigning the nursing care of a patient who had a left below the knee amputation 1 day ago to an experienced LPN, who will function under your supervision. What will you tell the LPN is the major focus for the patient's care today?
To monitor for signs of sufficient tissue perfusion.
Diagnosis of Endometrial and Ovarian Cancers
Transvaginal Ultrasound
A patient has had a pelvic examination and needs an additional diagnostic test for possible uterine leiomyomas. The nurse prepares the patient for which first choice diagnostic test?
Transvaginal ultrasound
Which diagnostic tests are considered the gold standard tests for determining the presence of endometrial thickening and cancer?
Transvaginal ultrasound. Endometrial biopsy.
What should the nurse do to promote early and efficient ambulation after a client has a midthigh amputation?
Turn the client to the prone position routinely.
What potential complication does a nurse anticipate when admitting a client with the diagnosis of severe procidentia (prolapse of the uterus)?
Ulcerations
A client has a total hip replacement. Which clinical indicators of pulmonary embolism indicate that the plan to prevent postoperative thrombus formation has been ineffective?
Unilateral chest pain. Sudden onset of shortness of breath.
A pt has an enlarged prostate. Which procedure does the nurse anticipate that the HCP will order to test for bladder obstruction?
Urodynamic pressure flow study
The nurse applies bandages to a patient's residual limb in order to help shape and shrink the limb for a prosthesis. What is the proper technique for the nurse to use?
Use a figure eight wrapping method to prevent restriction of blood flow.
A client has a total hip arthroplasty. What should the nurse do when caring for this client after surgery?
Use a pillow to keep the legs abducted.
To reduce a hip fracture, the client is placed in traction before surgery for an open reduction and internal fixation. Because the client keeps slipping down in bed, increased countertraction is ordered. How does the nurse increase the countertraction?
Use a slight Trendelenburg position.
A client with a fractured hip is helped from the bed to a chair after surgery. The nurse instructs the client to bear most of the weight on the unaffected leg before sitting in a chair. What should the nurse explain is the benefit of bearing most of the weight on the unaffected?
Will help maintain the strength of the unaffected limb
An excited group of teenagers brings a friend to the ED who severed a finger while playing sports. The bleeding from the site is well controlled and the patient is alert and stable. What does the nurse do with the severed finger?
Wrap it in dry gauze, place it in a waterproof bag, and put the bag in ice water.
A patient with crush injuries to his lower extremities is at high risk for
acute kidney injury
Most common case of endometrial cancer
adenocarcinoma (80%)
pedunculated leiomyomas
attached to pedicle to outside of uterus, may break off and attach to other organs
Grade III Uterine Prolapse
body of uterus protrudes through entrance of vagina.
After a radical prostatectomy, a client is ready to be discharged. what should be delegated to an LPN?
check patient temperature daily.
Best nursing action to prevent infection from a urinary catheter
cleansing around the meatus routinely
leiomyomas are caused by
excessive growth of smooth muscle cells
Dysfunctional Uterine Bleeding assessment
excessive uterine bleeding - greater than 80 mL blood loss per cycle. longer than 21 days of bleeding.
bilateral salpingo-oophorectomy
fallopian tubes and ovaries are removed
African American Woman are more susceptible to
leiomyoma (fibroid)
subserosal leiomyomas
protrude through outer surface of uterine wall
The nurse is teaching a pt about self care following a radical prostatectomy. What does the nurse include in the health teaching?
teach how to care for the indwelling catheter and manifestations of an infection Walk short distances Maintain an upright position and do not walk bent or flexed Shower rather than soak in a bath for the first 2-3 weeks
Myomectomy
the removal of leiomyomas from the uterus with a laser
A patient tells the nurse that he was diagnosed with BPH. Based on this medical diagnosis, which symptom is the patient most likely to report?
trouble passing urine
Cryptochidism
undescended testes
Cystocele
urinary bladder is displaced downward. Bulging of anterior wall
Devices to support pelvic organ prolapse
vaginal pessary
Which pre operative tests are performed for a patient scheduled to undergo a total hip arthroplasty (THA)?
x-ray of operative hip. Computed tomography (CT) of operative hip. Magnetic resonance imaging (MRI) of operative hip.
