Prep-U Ch. 52 - 56

A client visits the health clinic because he has developed a painless ulcer on the penis. The urologist suspects that the client has syphilis. When reviewing the client's health history, how many days ago would the nurse expect the client to report that he had unprotected sexual intercourse that may have led to his condition?

21 days * In syphilis, the time between infection and the first occurrence of symptoms is about 21 days.

A client is receiving the Gardasil vaccine. The nurse teaches that the client will receive three doses over how many months? Fill in the blank with a number.

6 *Gardasil consists of three injections over the course of 6 months.

Following a recent history of dyspareunia and lower abdominal pain, a client has received a diagnosis of pelvic inflammatory disease (PID). When providing health education related to self-care, the nurse should address what topics? Select all that apply. A. Use of condoms to prevent infecting others B. Appropriate use of antibiotics C. Taking measures to prevent pregnancy D. The need for a Pap smear every 3 months E. The importance of weight loss in preventing symptoms

A, B * Clients with PID need to take action to avoid infecting others. Antibiotics are frequently required. Pregnancy does not necessarily need to be avoided, but there is a heightened risk of ectopic pregnancy. Weight loss does not directly alleviate symptoms. Regular follow-up is necessary, but Pap smears do not need to be performed every 3 months.

A client has just returned to the postsurgical unit from postanesthetic recovery after breast surgery for removal of a malignancy. What is the most likely major nursing diagnosis to include in this client's immediate plan of care? A. Acute pain related to tissue manipulation and incision B. Ineffective coping related to surgery C. Risk for trauma related to postsurgical injury D. Chronic sorrow related to change in body image

A. Acute pain related to tissue manipulation and incision * Although many clients experience minimal pain, it is still important to assess for this postsurgical complication. Sorrow and ineffective coping are possible, but neither is likely to be evident in the immediate postoperative period. There is minimal risk of trauma.

The history of a female patient reveals the following: - First coitus at age 16 years - First pregnancy at age 28 years - Sexual intercourse with circumcised partner - Weight appropriate for height Which of the following would alert the nurse to a possible risk factor for developing cervical cancer? A. Age at first coitus B. Age of first pregnancy C. Weight D. Sexual partner

A. Age at first coitus * Risk factors for developing cervical cancer include an early age with first coitus, early childbearing, overweight status, and sexual intercourse with uncircumcised males.

A client with challenging menopausal symptoms has discussed treatment options with the physician and now has some questions for the nurse. The client asks, "What are the potential risks of hormone replacement therapy?" What is the best answer? A. All options are correct. B. breast cancer C. stroke (CVA) D. heart disease

A. All options are correct. * In using hormonal replacement therapy, the risks of breast cancer and the seriousness of future myocardial infarction and stroke may outweigh the potential benefit of alleviating symptoms associated with menopause. The Women's Health Initiative study revealed an increase in breast cancer, blood clots, stroke, and heart disease in postmenopausal women taking HRT.

A client is being seen by an urologist for perineal pain, low back pain, fever lasting 5 days, and painful urination. The physician confirms a diagnosis of prostatitis and orders treatment. During client education, which recommendation does the nurse make? A. All options are correct. B. Avoid caffeine. C. Regularly drain the gland. D. Complete the prescribed antibiotic treatment.

A. All options are correct. * The nurse instructs the client to avoid caffeine, prolonged sitting, and constipation and regularly to drain the prostate gland through masturbation or intercourse. The nurse instructs the client to comply with antibiotic therapy and use a mild analgesic for pain.

The nurse is providing information at the local YMCA about screenings for breast and cervical cancer. The nurse should inform young women that they should begin their screenings at what time? A. Annual breast and pelvic examinations are important for all women 21 years of age or older and for those who are sexually active, regardless of age. B. Annual breast and pelvic examinations should begin at age 14 years old. C. Annual breast and pelvic examinations should begin when a woman becomes sexually active. D. Annual breast and pelvic examinations should be performed when a woman begins taking birth control.

A. Annual breast and pelvic examinations are important for all women 21 years of age or older and for those who are sexually active, regardless of age. * Annual breast and pelvic examinations are important for all women 21 years or older and for those who are sexually active, regardless of age.

Which term refers to a failure of one or both or both of the testes to descend into the scrotum? A. Cryptorchidism B. Hydrocele C. Varicocele D. Phimosis

A. Cryptorchidism * Cryptorchidism is the failure of one or both of the testes to descend into the scrotum. Hydrocele is a collection of fluid, generally in the tunica vaginalis of the testes. Varicocele is an abnormal dilation of the veins of the pampiniform venous plexus in the scrotum. Phimosis is a condition in which the foreskin is constricted so that is cannot be retracted over the glans.

The nurse is caring for a client who has been admitted to hospital for uterine bleeding after incomplete miscarriage. The nurse knows what will be included in this client's treatment? A. Dilation and curettage B. Endometrial ablation C. Ultrasonography D. Hysteroscopy

A. Dilation and curettage * Dilation and curettage (D&C) can be used as a diagnostic or therapeutic tool. The cervical canal is dilated and the endometrium is scraped. D&C can be used to gather endometrial tissue for cytologic examination, control abnormal uterine bleeding, and as a therapeutic measure for incomplete miscarriage. In this case, D&C is being used as a therapeutic intervention to control bleeding from the incomplete passage of residual tissue in the uterus. Endometrial ablation is performed in cases of severe bleeding not responsive to other therapies. Performed in an outpatient setting under general, regional, or local anesthesia, the uterus is distended with a fluid infusion. Ultrasonography is useful adjunct to the physical examination for patients with abnormal pelvic findings but is not useful as a therapeutic treatment of uterine bleeding. A hysteroscopy allows direct visualization of all parts of the uterine cavity by means of a lighted optical instrument. It is used as a diagnostic tool, not a treatment for bleeding.

The nurse is assessing a client in the emergency department who grimaces and reports swelling of the testicles, burning on urination and a green discharge from the penis. The nurse suspects the client will be diagnosed with which infection? A. Gonorrhea B. Primary syphilis C. Herpes genitalis D. Trichomoniasis

A. Gonorrhea * When symptoms of gonorrhea are present in male clients, the symptoms may include burning during urination and penile discharge. Clients with Neisseria gonorrhoeae infection also may report painful swollen testicles. The latter symptoms distinguishes this infection from the infections in the alternate options. Primary syphilis occurs 2 to 3 weeks after initial inoculation with the organism. A painless lesion at the site of infection is called a chancre. Untreated, these lesions usually resolve spontaneously within about 2 months. With herpes genitalis primary infection may begin with macules (small flat spots on skin) and papules (small circumscribed elevations) and progress to vesicles (small, serous-filled elevated spots) and ulcers. The vesicular state often appears as a blister, which later coalesces, ulcerates, and encrusts. Influenza-like symptoms may occur 3 or 4 days after the lesions appear, often with inguinal lymphadenopathy (enlarged lymph nodes in the groin). Men with trichomoniasis may notice itching or irritation inside the penis, burning after urination or ejaculation, discharge from the penis.

A 21-year-old woman has sought care because of "heavy periods" and has subsequently been diagnosed with menorrhagia. The nurse should recognize which of the following as the most likely cause of the client's health problem? A. Hormonal disturbances B. Cervical or uterine cancer C. Pelvic inflammatory disease D. A sexually transmitted infection (STI)

A. Hormonal disturbances * Menorrhagia is prolonged or excessive bleeding at the time of the regular menstrual flow. In young women, the cause is usually related to endocrine disturbance; in later life, it usually results from inflammatory disturbances, tumors of the uterus, or hormonal imbalance. STIs, pelvic inflammatory disease, and cancer are less likely causes.

A client who is postoperative day 12 and recovering at home following a laparoscopic prostatectomy has reported that he is experiencing occasional "dribbling" of urine. How should the nurse best respond to this client's concern? A. Inform the client that urinary control is likely to return gradually. B. Arrange for the client to be assessed by his urologist. C. Facilitate the insertion of an indwelling urinary catheter by the home care nurse. D. Teach the client to perform intermittent self-catheterization.

A. Inform the client that urinary control is likely to return gradually. * It is important that the client know that regaining urinary control is a gradual process; he may continue to "dribble" after being discharged from the hospital, but this should gradually diminish (usually within 1 year). At this point, medical follow-up is likely not necessary. There is no need to perform urinary catheterization.

A patient comes to the clinic with complaints of inability to sustain an erection and is prescribed a PDE-5 inhibitor, sildenafil (Viagra). What medication should the nurse caution the patient about taking with this medication? A. Isosorbide (Isordil) B. Lisinopril (Prinivil) C. Diphenhydramine (Benadryl) D. Levothyroxine (Synthroid)

A. Isosorbide (Isordil) * These agents are contraindicated in men who take organic nitrates (e.g., isosorbide [Isordil], nitroglycerin), because taken together, these medications can cause side effects such as severe hypotension (Lee, 2011; Porth & Matfin, 2009; Wein et al., 2012).

Which drug is the most effective treatment for trichomoniasis? A. Metronidazole B. Miconazole C. Clindamycin D. Clotrimazole

A. Metronidazole * The most effective treatment for trichomoniasis is metronidazole. Miconazole, clindamycin, and clotrimazole are not the most effective treatment for trichomoniasis.

The nurse is reviewing the health care provider's notes from the client who has just left the clinic. The nurse learns that a malignant breast tumor is suspected. On palpation, the mass most likely had what characteristic? A. Nontenderness B. A size of ≤ 5 mm C. Softness and a regular shape D. Mobility

A. Nontenderness * Generally, the lesions are nontender, fixed rather than mobile, and hard with irregular borders. Small size is not suggestive of malignancy.

A 15-year-old girl is brought to the clinic by her mother to see her primary provider. The mother states that her daughter has not started to develop sexually. The physical examination shows that the client has no indication of secondary sexual characteristics. What diagnosis should the nurse suspect? A. Primary amenorrhea B. Dyspareunia C. Vaginal atrophy D. Secondary dysmenorrhea

A. Primary amenorrhea * Primary amenorrhea (delayed menarche) refers to the situation in which young women older than 16 years of age have not begun to menstruate but otherwise show evidence of sexual maturation, or in which young women have not begun to menstruate and have not begun to show development of secondary sex characteristics by 14 years of age. In secondary dysmenorrhea, pelvic pathology such as endometriosis, tumor, or pelvic inflammatory disease (PID) contributes to symptoms. Dyspareunia is painful intercourse and vaginal atrophy would not contribute to the delayed onset of puberty.

A client expresses concerns about future reproduction after a surgery to correct the cancer of the testes. For this client, treatment proceeded without first collecting and storing sperm. Which alternative should the nurse suggest to the client? A. Suggest donor insemination or adoption B. Undertake herbal alternatives C. Suggest the use of sildenafil D. Reverse the surgery

A. Suggest donor insemination or adoption * For a client after a surgery to correct cancer of the testes and for whom treatment had proceeded without first collecting and storing sperm, the nurse explains other pregnancy options, such as donor insemination or adoption. Reversal of surgery is not possible for testicular cancer. In addition, undertaking herbal alternatives should not be advised by the nurse. Sildenafil would not enhance that chance of that this client could cause a woman to become pregnant.

A public health nurse is teaching a health class for the male students at the local high school. The nurse is teaching the boys to perform monthly testicular self-examinations. What point would be appropriate to emphasize? A. Testicular cancer is a highly curable type of cancer. B. Testicular cancer is very difficult to diagnose. C. Testicular cancer is the number one cause of cancer deaths in males. D. Testicular cancer is more common in older men.

A. Testicular cancer is a highly curable type of cancer. * Testicular cancer is highly curable, particularly when it's treated in its early stage. Self-examination allows early detection and facilitates the early initiation of treatment. The highest mortality rates from cancer among men are with lung cancer. Testicular cancer is found more commonly in younger men.

The nurse is assessing a client who reports stiff joints and alopecia. While taking the client's health history, the client reports having multiple sexual partners in the past 6 months and finding a lesion on her labia about 1 month before today's appointment. What should the nurse anticipate based on the signs and symptoms presented? A. The client will require treatment for the secondary stage of syphilis. B. Treatment planning for a chlamydial infection is needed. C. Pelvic inflammatory disease is the likely cause of the hair loss. D. The client will require a colposcopy to confirm any diagnosis.

A. The client will require treatment for the secondary stage of syphilis. * In the secondary stage of syphilis, generalized signs of infection may include lymphadenopathy (abnormal enlargement of lymph nodes), arthritis, meningitis (inflammation of the pia mater, arachnoid, and the subarachnoid space), hair loss, fever, malaise, and weight loss. Hair loss and arthritis are not common symptoms associated with a chlamydial infection or pelvic inflammatory disease. The information collected in the health history confirms that the client has moved past the primary stage of the infection. A colposcopy is a diagnostic procedure carried out to determine if there have been any changes in cervical cells (dysplasia). Given the client's reported health history, secondary syphilis should be further investigated first.

A 34-year-old client has been diagnosed with endometriosis. What topic should the nurse emphasize during health education? A. The importance of reporting a possible pregnancy as soon as it occurs B. The need to complete the full course of antibiotics, regardless of symptoms C. The need to have the client's partner undergo diagnostic testing as well D. Signs and symptoms of infection

A. The importance of reporting a possible pregnancy as soon as it occurs * Clients with endometriosis need to report pregnancies as soon as possible so that relevant treatment can be provided. The disease is noninfectious, so there is no need to have the partner tested or to be prescribed antibiotics.

A female client has just been diagnosed with condylomata acuminata (genital warts). What information is most appropriate for the nurse to tell this client? A. The warts may require surgical removal or cryotherapy B. The most common treatment is metronidazole, which should eradicate the problem within 7 to 10 days. C. The potential for transmission to her sexual partner will be eliminated if condoms are used every time they have sexual intercourse. D. The human papillomavirus (HPV), which causes condylomata acuminata, cannot be transmitted during oral sex.

A. The warts may require surgical removal or cryotherapy * Options for treatment of external genital warts by a primary provider include topical application of trichloroacetic acid, podophyllin (Podofin, Podocon), cryotherapy, as well as surgical removal. Because condylomata acuminata is a virus, there is no permanent cure. Because condylomata acuminata can occur on the vulva, a condom will not protect sexual partners. HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx.

During a teaching demonstration on breast self-examination (BSE), the nurse should always explain that the majority of breast cancers are found in the: A. Upper, outer quadrant. B. Lower, outer quadrant. C. Upper, inner quadrant. D. Lower, inner quadrant.

A. Upper, outer quadrant. * Breast cancers are usually found in the upper outer quadrant where the majority of breast tissue is located.

Which factor should be checked when evaluating the effectiveness of an alpha-adrenergic blocker given to a client with benign prostatic hyperplasia (BPH)? A. Voiding pattern B. Size of the prostate C. Creatinine clearance D. Serum testosterone level

A. Voiding pattern * The client's voiding pattern should be checked to evaluate the effectiveness of alpha-adrenergic blockers. These drugs relax the smooth muscle of the bladder neck and prostate, so the urinary symptoms of BPH are reduced in many clients. These drugs don't affect the size of the prostate, production or metabolism of testosterone, or renal function.

Which is the fastest spreading bacterial STI in the United States? A. chlamydia B. gonorrhea C. herpes simplex 1 D. syphilis

A. chlamydia * There were 1,307,893 reported cases of chlamydia in 2010. There were 309,341 reported cases of gonorrhea in 2010. Herpes simplex virus type 1 is not reported by law. Therefore, the data is not available. There were 13,774 reported cases of syphilis in 2010.

A client is concerned about the lumps that have developed in her breasts and is fearful of cancer. The client reports variability in the size of the lumps. What could be causing this condition? A. cyclical hormonal changes B. caffeine C. nicotine D. progesterone

A. cyclical hormonal changes * The likely cause is fibrocystic disease, which results from hormonal changes during the menstrual cycle.

While caring for a client who is being treated for severe pelvic inflammatory disease (PID), the nurse insists on keeping the client in a semi-sitting position. The nurse advises this in order to: A. facilitate pelvic drainage and minimize the upward extension of the infection. B. prevent nosocomial infections to other clients. C. prevent movement that may increase pain. D. facilitate easy distraction of the client.

A. facilitate pelvic drainage and minimize the upward extension of the infection. * While caring for a client hospitalized with PID, the nurse has to reduce the risk of the systemic spread of pathogenic microorganisms. The client must be advised to keep the upper body elevated; this facilitates pelvic drainage and minimizes the upward extension of infection.

Within the female internal reproductive structures, where is the egg most commonly fertilized? A. fallopian tubes B. cervix C. fundus D. endometrium

A. fallopian tubes * One or the other fallopian tube receives an extruded ovum every month and serves as the place where the ovum is most commonly fertilized.

A school nurse at a middle school finds that students are typically surprised to hear the role of women's breasts. What is their primary function? A. lactation B. sexual fulfillment C. sexual attraction D. All options are correct.

A. lactation * The breasts' primary function is the production of milk, a process referred to as lactation.

A couple that has been married for 5 years is unable to conceive a child. Diagnostic test results indicate that the husband has a low sperm count. What sperm count indicates infertility? A. less than 20 million sperm per milliliter B. less than15 million sperm per milliliter C. less than 30 million sperm per milliliter D. less than 10 million sperm per milliliter

A. less than 20 million sperm per milliliter * A count of fewer than 20 million spermatozoa per milliliter results in infertility.

A client is experiencing symptoms associated with menopause. What is a likely recommendation to increase the client's interest in sexual activity? A. low-dose androgens B. antidepressants C. herbal aphrodisiacs D. bisphosphates

A. low-dose androgens * Low-dose androgens are added to the hormone replacement regimen to restore an interest in sexual activity.

The nurse is caring for a couple trying to get pregnant and have not been able to for over a year. The couple asks what kind of problems a man can have that can cause infertility. What should be the nurse's response? A. "Men can have increased prolactin levels that decrease sperm viability." B. "Men can have problems that increase the temperature around their testicles and decrease the quality of their semen." C. "Men may inherit the gene that causes low sperm production." D. "Men may produce sperm that are incompatible with the shape of the egg."

B. "Men can have problems that increase the temperature around their testicles and decrease the quality of their semen." * Men may be affected by varicoceles, varicose veins around the testicle, which decrease semen quality by increasing testicular temperature. Low prolactin levels may contribute to the problem. Genetic factors are not noted to relate to male infertility. Infertility is not normally linked to sperm that are incompatible with the shape of the egg.

A client reports stress incontinence, pelvic pain, and a feeling like "something is dropping out of my vagina." The client is diagnosed as having a pelvic organ prolapse and the treatment plan includes using a pessary. Which instructions will the nurse include in client education? A. Void at least every two hours for the first week after beginning to use the pessary. B. Apply a sterile lubricant to the pessary before it is reinserted. C. Maintain bedrest for 24 to 48 hours until accustomed to the pessary. D. Maintain bedrest for 48 to 72 hours until accustomed to the pessary.

B. Apply a sterile lubricant to the pessary before it is reinserted. *A pessary should be lubricated before insertion. Bedrest and alterations to voiding are not necessary to use the device safely and effectively.

A health care provider has explained to the client that he has an inflammation of the Cowper glands. Where are the Cowper glands located? A. Within the epididymis B. Below the prostate, within the posterior aspect of the urethra C. On the inner epithelium lining the scrotum, lateral to the testes D. Medial to the vas deferens

B. Below the prostate, within the posterior aspect of the urethra * Cowper glands lie below the prostate, within the posterior aspect of the urethra. This gland empties its secretions into the urethra during ejaculation, providing lubrication. The Cowper glands do not lie within the epididymis, within the scrotum, or alongside the vas deferens.

A woman in her late 30s has been having unusually heavy menstrual periods combined with occasional urine and stool leakage over the past few weeks. Upon further enquiry, she reveals that she also has postcoital pain and bleeding. To which diagnosis will the investigation most likely lead? A. Hodgkin disease B. Cervical cancer C. Colorectal cancer D. Cancer of the urinary tract

B. Cervical cancer * The client's symptoms are those of cervical cancer. Symptoms of cervical cancer include abnormal vaginal bleeding and persistent yellowish, blood-tinged, or foul-smelling discharge. Clients may complain of postcoital pain and bleeding, bleeding between menstrual periods, and unusually heavy menstrual periods. If the cancer has progressed into the pelvic wall, the Clients may experience pain in the flank regions of the body.

A nurse practitioner is conducting a history and physical on a 42-year-old woman. One of the questions asked of someone in this age group is the type of medications that the patient's mother took during her pregnancy. The nurse is assessing for a past history of ______ use. A. Immunosuppressive agents B. Diethylstilbestrol C. Cancer drugs D. Antibiotics

B. Diethylstilbestrol * Diethylstilbestrol (DES) is a nonsteroidal estrogen that was given to pregnant women (1940-1970) to prevent pregnancy complications. After 30 years, it was found to cause vaginal cancer in daughters exposed to the drug in utero. The incidence of occurrence can be as high as 40%.

A patient is planning to use a negative-pressure (vacuum) device to maintain and sustain an erection. What should the nurse caution the patient about with the use of this device? A. Do not use the device while taking nitrates. B. Do not leave the constricting band in place for longer than 1 hour to avoid penile injury. C. Watch for erosion of the prosthesis through the skin. D. Watch for the development of infection.

B. Do not leave the constricting band in place for longer than 1 hour to avoid penile injury. * Negative-pressure (vacuum) devices may also be used to induce an erection. A plastic cylinder is placed over the flaccid penis, and negative pressure is applied. When an erection is attained, a constriction band is placed around the base of the penis to maintain the erection. To avoid penile injury, the patient is instructed not to leave the constricting band in place for longer than 1 hour.

The nurse is preparing a patient for a gynecologic examination when the patient says, "I hope the exam doesn't hurt as much as intercourse with my husband does." What should the nurse document this finding as? A. Dysmenorrhea B. Dyspareunia C. Dysuria D. Dysthymia

B. Dyspareunia * Dyspareunia (difficult or painful intercourse) can be superficial, deep, primary, or secondary and may occur at the beginning of, during, or after intercourse.

A male client reports urethral pain and a creamy yellow, bloody discharge from the penis. The nurse associates these characteristics with which of the following sexually transmitted infections? A. Candidiasis B. Gonorrhea C. Chancroid D. Trichomoniasis

B. Gonorrhea * In men, the initial symptoms of gonorrhea include urethral pain and a creamy, yellow, sometimes bloody discharge. Candidiasis, trichomoniasis, and bacterial vaginosis are vaginal infections that can be sexually transmitted, and the male partner usually is asymptomatic. Chancroid causes genital ulcers; the lesions begin as macules, progress to pustules, and then rupture.

A newly pregnant client is being assessed in an obstetric clinic. The client states that she has been experiencing intense abdominal pain and the nurse anticipates that the client will be assessed for ectopic pregnancy. In addition to ultrasonography, what diagnostic test should the nurse anticipate? A. Computed tomography B. Human chorionic gonadotropin (hCG) testing C. Estrogen and progesterone testing D. Abdominal x-ray

B. Human chorionic gonadotropin (hCG) testing * If an ectopic pregnancy is suspected, the client is assessed using ultrasound and hCG testing. CT and x-rays are contraindicated during pregnancy and estrogen and progesterone levels are not diagnostic of ectopic pregnancy.

A 42-year-old man has come to the clinic for an annual physical. The nurse notes in the client's history that his father was treated for breast cancer. What should the nurse provide to the client before he leaves the clinic? A. A referral for a mammogram B. Instructions about breast self-examination (BSE) C. A referral to a surgeon D. A referral to a support group

B. Instructions about breast self-examination (BSE) * Instructions about BSE should be provided to men if they have a family history of breast cancer, because they may have an increased risk of male breast cancer. It is not within the scope of the practice of a nurse to refer a client for a mammogram or to a surgeon; these actions are not necessary or recommended. In the absence of symptoms or a diagnosis, referral to a support group is unnecessary.

A patient is diagnosed with the most common type of uterine fibroid, an intramural fibroid. The nurse includes which information in teaching the patient about this type of fibroid? A. It lies underneath the outermost layer of the uterus. B. It grows within the wall of the uterine muscle. C. It grows below the inner uterine surface. D. It arises from inside or outside the surface of the uterine muscle.

B. It grows within the wall of the uterine muscle. * See Box 33-10 in the text.

The nurse recognizes which statement as accurately reflecting a risk factor for breast cancer? A. Onset of menses before 14 years of age B. Mother affected by cancer before 60 years of age C. Multiparity D. No alcohol consumption

B. Mother affected by cancer before 60 years of age * Risk for breast cancer increases twofold if first-degree female relatives (sister, mother, or daughter) have had breast cancer. Increased risk is associated with early menarche (i.e. menses beginning before 12 years of age). Nulliparity and later maternal age at first birth are associated with increased risk for breast cancer. Alcohol use remains controversial; however, a slightly increased risk is found in women who consume even one drink daily and doubles among women drinking three drinks daily.

Culture and sensitivity testing of a swab taken from a chancre on the penis of a 27-year-old man has confirmed the presence of Treponema pallidum. The nurse providing care for the patient should anticipate administering which of the following drugs? A. Vancomycin B. Penicillin C. Ciprofloxacin D. Azithromycin

B. Penicillin * T. pallidum is the microorganism that is responsible for syphilis, a disease that is treated in the early stages by a single dose of penicillin G benzathine.

The nurse is caring for a client with a diagnosis of vulvar cancer who has returned from the PACU after undergoing a wide excision of the vulva. How should this client's analgesic regimen be best managed? A. Analgesia should be withheld unless the client's pain becomes unbearable. B. Scheduled analgesia should be administered around-the-clock to prevent pain. C. All analgesics should be given on a PRN, rather than scheduled, basis. D. Opioid analgesics should be avoided and NSAIDs exclusively provided.

B. Scheduled analgesia should be administered around-the-clock to prevent pain. * Because of the wide excision, the client may experience severe pain and discomfort even with minimal movement. Therefore, analgesic agents are administered preventively (i.e., around the clock at designated times) to relieve pain, increase the client's comfort level, and allow mobility. Opioids are usually required.

A perimenopausal woman informs the nurse that she is having irregular vaginal bleeding. What should the nurse encourage the patient to do? A. Stop taking her Premarin (hormonal therapy). B. See her gynecologist as soon as possible. C. Disregard this phenomenon because it is common during this life stage. D. Mention it to her physician during her next annual examination.

B. See her gynecologist as soon as possible. * All women should be encouraged to have annual checkups, including a gynecologic examination. Any woman who is experiencing irregular bleeding should be evaluated promptly.

A nurse is providing patient education to a patient as part of her work in a fertility clinic. The nurse explains possible reasons for infertility. When explaining how the ovaries are involved in conception what will the nurse stress? A. Ova quickly degenerate and most are absorbed in the body before the age of 12 B. The ovaries contain all of the ova that a woman will have at birth C. Ova aggregate, causing millions to be contained in a storage site call a follicle D. Follicles produce only estrogen; the uterus produces progesterone

B. The ovaries contain all of the ova that a woman will have at birth * It would be important to explain that the woman's ova are not increased or decreased from birth to child-bearing years. The nurse will stress that all of the ova that a woman will have will be present at birth. The patient should understand that if she does not ovulate one month or for several months, it is not because she has done something to her body to cause this. Ova slowly degenerate overtime or they are released once a month until menopause is complete. Each ovum is contained in a storage site called a follicle, which produces the female sex hormones, estrogen and progesterone.

A patient who is scheduled for a gynecologic examination and Pap smear informs the nurse that she just began her menstrual cycle. What is the best response by the nurse? A. "This will have no bearing on your test today." B. "We will proceed with the examination and reschedule your Pap smear for next week." C. "We will reschedule your examination when you have finished menstruating." D. "We will do the test and take into consideration that you are menstruating."

C. "We will reschedule your examination when you have finished menstruating." * The nurse should not obtain a Papanicolaou (Pap) smear if the woman is menstruating or has other frank bleeding; the examination should be rescheduled to after her menstruation.

The nurse is discussing mammography with a female client at the clinic. The client asks at what age she should begin getting yearly mammograms. What answer should the nurse provide? A. 35 B. 40 C. 45 D. 50

C. 45 * The American Cancer Society updated its recommendations in 2015. It recommends yearly mammograms beginning at 45 years of age.

A client is diagnosed with chlamydia and is distraught. "How can I have this problem? I don't have any symptoms!" she says. The nurse teaches the client that the percentage of women with chlamydia who are asymptomatic is as high as: A. 25% B. 50% C. 75% D. 100%

C. 75% * As many as 75% of all infected women and 25% of all infected men are asymptomatic.

A nurse is reviewing a female client's history, which includes the following information: -Age at menarche: 14 years - Cesarean delivery: 2 pregnancies - Age at first pregnancy: 35 years - Alcohol use: approximately 1 to 2 glasses of wine/month The nurse identifies which as a possible risk factor for the client to develop breast cancer? A. Age at menarche B. Cesarean deliveries C. Age at first pregnancy D. Alcohol use

C. Age at first pregnancy * Risk factors for breast cancer include an early menarche (before 12 years), nulliparity, late age at first full-term pregnancy, and an alcohol intake of 2 to 5 drinks daily.

The nurse is planning health education for a client who has experienced a vaginal infection. What guidelines should the nurse include in this program regarding prevention? A. Wear tight-fitting synthetic underwear. B. Douche weekly to eradicate perineal bacteria. C. Avoid commercial feminine hygiene products, such as sprays. D. Restrict daily bathing.

C. Avoid commercial feminine hygiene products, such as sprays. *Instead of tight-fitting synthetic, nonabsorbent, heat-retaining underwear, cotton underwear is recommended to prevent vaginal infections. Douching is generally discouraged, as is the use of feminine hygiene products. Daily bathing is not restricted.

A nurse practitioner examines a patient suspected of having endometriosis. The nurse knows that although a definitive diagnosis could not be made without diagnostic treatment (transvaginal ultrasound), the most frequent symptom is: A. Dysuria. B. Low back pain. C. Chronic pelvic pain. D. Dyspareunia.

C. Chronic pelvic pain * Chronic pelvic pain is the most frequent symptom of endometriosis. Low back pain, dyspareunia, dysuria, dyschezia, dysmenorrhea, and menorrhagia are among the common complaints. The level of pain associated with endometriosis is not necessarily correlated with the stage of endometriosis.

A nurse is caring for a 33-year-old male who has come to the clinic for a physical examination. He states that he has not had a routine physical in 5 years. The health care provider's digital rectal examination (DRE) reveals "stony" hardening in the posterior lobe of the prostate gland that is not mobile. The nurse recognizes that the observation typically indicates what? A. A normal finding B. A sign of early prostate cancer C. Evidence of a more advanced lesion D. Metastatic disease

C. Evidence of a more advanced lesion *Routine repeated DRE (preferably by the same examiner) is important, because early cancer may be detected as a nodule within the gland or as an extensive hardening in the posterior lobe. The more advanced lesion is "stony hard" and fixed. This finding is not suggestive of metastatic disease.

A nurse is explaining that each breast contains 12 to 20 cone-shaped lobes. The nurse should explain that each lobe consists of what elements? A. Modified tendons and ligaments B. Connective tissue and smooth muscle C. Lobules and ducts D. Endocrine glands and sebaceous glands

C. Lobules and ducts * Each breast contains 12 to 20 cone-shaped lobes, which are made up of glandular elements (lobules and ducts) and separated by fat and fibrous tissue that binds the lobes together. These breast lobes do not consist of tendons, ligaments, endocrine glands, or smooth muscle.

A patient has undergone surgery for breast cancer and the findings of the surgery are as follows: - Invasive undifferentiated tumor - Size 2.2 cm - Axillary lymph nodes negative - High ERBB2 expression Which of these findings would suggest a favorable prognosis? A. Undifferentiated tumor B. Size C. Negative lymph nodes D. High ERBB2

C. Negative lymph nodes * The finding suggesting a favorable prognosis would be negative axillary lymph nodes. Other favorable factors would include noninvasive tumors or invasive tumors less than 1 cm in size, well-differentiated tumors, and low ERBB2 expression.

During an internal vaginal examination, the nurse practitioner notes a frothy and malodorous discharge. What bacteria does the practitioner suspect is causing this disorder? A. Candida B. Eschar C. Trichomonas D. Escherichia coli

C. Trichomonas * A Trichomonas species infection is typically malodorous and presents with a copious, often frothy yellow-green appearance. Candida species infections are characterized by either a yeast odor or none, along with a thin to thick, curd-like, white appearance. Eschar and Escherichia coli bacteria are not associated with vaginal discharges.

A client has been diagnosed with stage II breast cancer. The client tells the nurse that the physician has recommended breast conservation surgery followed by radiation. The client's husband has done some online research and is asking why his wife does not have a modified radical mastectomy "to be sure all the cancer is gone." What would be the nurse's best response? A. "Modified radical mastectomies are very hard on a client, both physically and emotionally and they really aren't necessary anymore." B. "According to current guidelines, having a modified radical mastectomy is no longer seen as beneficial." C. "Modified radical mastectomies have a poor survival rate because of the risk of cancer recurrence." D. "According to current guidelines, breast conservation combined with radiation is as effective as a modified radical mastectomy."

D. "According to current guidelines, breast conservation combined with radiation is as effective as a modified radical mastectomy." * Breast conservation along with radiation therapy in stage I and stage II breast cancer results in a survival rate equal to that of modified radical mastectomy. Mastectomies are still necessary in many cases, but are not associated with particular risk of recurrence.

The nurse is caring for a 52-year-old woman whose aunt and mother died of breast cancer. The client states, "My doctor and I talked about tamoxifen to help prevent breast cancer. Do you think it will work?" What would be the nurse's best response? A. "Yes, it's known to have a slight protective effect." B. "Yes, but studies also show an increased risk of osteoporosis." C. "You won't need to worry about getting cancer as long as you take tamoxifen." D. "Tamoxifen is known to be a highly effective protective measure."

D. "Tamoxifen is known to be a highly effective protective measure." * Tamoxifen has been shown to be a highly effective chemopreventive agent. However, it cannot reduce the risk of cancer by 100%. It also acts to prevent osteoporosis.

Which client has the highest risk of ovarian cancer? A. 30-year-old woman taking hormonal contraceptives B. 36-year-old woman who had her first child at age 22 C. 40-year-old woman with three children D. 45-year-old woman who has never been pregnant

D. 45-year-old woman who has never been pregnant * The incidence of ovarian cancer increases in women who have never been pregnant, are older than age 40, are infertile, or have menstrual irregularities. Other risk factors include a family history of breast, bowel, or endometrial cancer. The risk of ovarian cancer is reduced in women who have taken hormonal contraceptives, have had multiple births, or have had a first child at a young age.

When a female client reports profuse purulent discharge, dysuria, and bleeding, the advance practice nurse is most likely to prescribe which medication to treat this condition? A. Terconazole cream, inserted into the vagina at bedtime B. Metronidazole, administered orally twice a day for 1 week C. Tinidazole, one time for both the client and her partner D. Doxycycline for 1 week

D. Doxycycline for 1 week * Chlamydia causes a profuse purulent discharge and may be accompanied by dysuria and bleeding. The Centers for Disease Control and Prevention recommends treating chlamydia with doxycycline for 1 week or a single dose of azithromycin. Trichomonas vaginalis causes a frothy yellow-white or yellow-green vaginal discharge. Treatment for Trichomonas vaginalis is metronidazole or tinidazole. Both partners receive a one-time loading dose. Candidiasis causes a white, cheese-like discharge clinging to the vaginal epithelium. Terconazole cream inserted into the vagina with an applicator at bedtime and is the appropriate treatment for Candidiasis. Gardnerella vaginalis causes a gray-white to yellow-white discharge clinging to the external vulva and vaginal walls. Metronidazole is taken orally twice a day for 1 week to treat Gardnerella vaginalis.

A nurse is planning the postoperative care of a client who is scheduled for radical prostatectomy. What intraoperative position will place the client at particular risk for the development of deep vein thrombosis postoperatively? A. Fowler position B. Prone position C. Supine position D. Lithotomy position

D. Lithotomy position * Elastic compression stockings are applied before surgery and are particularly important for prevention of deep vein thrombosis if the client is placed in a lithotomy position during surgery. During a prostatectomy, the client is not placed in the supine, prone, or Fowler position.

A client has an STI. The nurse reviews the client's chart and sees that the client has been prescribed doxycycline. Which of the following STIs is the client most likely to have? A. Human papillomavirus (HPV) infection B. Herpes simplex virus type 2 (HSV-2) infection C. Candidiasis D. Lymphogranuloma venereum (LGV)

D. Lymphogranuloma venereum (LGV) * Because HSV-2 and HPV infections and candidiasis have nonbacterial etiologies, these infections are insensitive to antibiotics. Lymphogranuloma venereum (LGV) is an acute and chronic venereal disease caused by Chlamydia trachomatis and is consequently sensitive to antibiotics.

The nurse is providing preoperative education for a client diagnosed with endometriosis. A hysterectomy has been scheduled. What education topic should the nurse be sure to include for this client? A. Menstrual periods will continue to occur for several months, some of them heavy. B. Normal activity will be permitted within 48 hours following surgery. C. After a hysterectomy, hormone levels remain largely unaffected. D. The bladder must be emptied prior to surgery and a catheter may be placed during surgery.

D. The bladder must be emptied prior to surgery and a catheter may be placed during surgery. * The intestinal tract and the bladder need to be empty before the client is taken to the OR to prevent contamination and injury to the bladder or intestinal tract. The client is informed that her periods are now over, but she may have a slightly bloody discharge for a few days. The client is instructed to avoid straining, lifting, or driving until her surgeon permits her to resume these activities. The client's hormonal balance is upset, which usually occurs in reproductive system disturbances. The client may experience depression and heightened emotional sensitivity to people and situations.

A client newly diagnosed with breast cancer states that her health care provider suspects regional lymph node involvement and told her that there are signs of metastatic disease. The nurse learns that the client has been diagnosed with stage IV breast cancer. What is an implication of this diagnosis? A. The client is not a surgical candidate. B. The client's breast cancer is considered highly treatable. C. There is a 10% chance that the client's cancer will self-resolve. D. The client has a 15% chance of 5-year survival.

D. The client has a 15% chance of 5-year survival. * The 5-year survival rate is approximately 15% for stage IV breast cancer. Surgery is still a likely treatment, but the disease would not be considered to be "highly treatable." Self-resolution of the disease is not a possibility.

A student nurse is doing clinical hours at an OB/GYN clinic. The student is helping to develop a plan of care for a patient with gonorrhea who has presented at the clinic. The student should include which of the following in the care plan for this patient? A. The patient may benefit from oral contraceptives. B. The patient must avoid use of tampons. C. The patient is susceptible to urinary incontinence. D. The patient should also be treated for chlamydia.

D. The patient should also be treated for chlamydia. * Because of the high incidence of coinfection with chlamydia and gonorrhea, the patient should also be treated for chlamydia. Avoiding the use of tampons is part of the self-care management of a patient with possible toxic shock syndrome (TSS). The patient is not susceptible to incontinence and there is no indication for the use of oral contraceptives.

The nurse is caring for a patient with secondary syphilis. What nursing interventions would you know to institute when caring for this patient? A. Place in private room. B. Keep room door closed. C. Have personal protective equipment available. D. Wear gloves when there is a possibility of coming into contact with lesions.

D. Wear gloves when there is a possibility of coming into contact with lesions. * Lesions of primary and secondary syphilis may be highly infective. Gloves are worn when direct contact with lesions is likely, and hand hygiene is performed after gloves are removed. Isolation in a private room is not required. It is also not necessary to keep the room door closed. PPE is always available.