8: 54, 57, 58, 59
The nurse recognizes which condition as an integumentary manifestation of chronic renal failure? Asterixis Gray-bronze skin color Tremors Seizures
Gray-bronze skin color
The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is: "As the disease progresses, you will most likely require renal replacement therapy." "Dietary changes can reverse the damage that has occurred in your kidneys." "Draining of the cysts and antibiotic therapy will cure your disease." "Genetic testing will determine the best treatment for your condition."
"As the disease progresses, you will most likely require renal replacement therapy." There is no cure for polycystic kidney disease. Medical management includes therapies to control blood pressure, urinary tract infections, and pain. Renal replacement therapy is indicated as the kidneys fail.
An elderly client, who can void only while standing and pushing upward on the vagina, is ordered a pessary. Which comment from the client indicates a need for further teaching about this device? "I will remove and clean it every day." "I will report any signs of irritation or bleeding." "I should have greater ease of emptying my bladder." "I should report any foul odor or drainage."
"I will remove and clean it every day." Pessaries should be removed, cleaned, and replaced periodically (at least every 2 months). If the client is unable to manage the pessary, then follow-up appointments should be made with the practitioner. Ill-fitting pessaries can cause irritation and erosion of tissue resulting in irritation, bleeding, or infection. The placement of the pessary should support the uterus in the pelvis and lessen urinary and pelvic symptoms.
After teaching a group of students about how to perform peritoneal dialysis, which statement would indicate to the instructor that the students need additional teaching?
"It is appropriate to warm the dialysate in a microwave."
A client has just been diagnosed with endometriosis. Which of the following would be most appropriate to provide the client with support and guidance about treatment options? "Treatment is essential, so you really need to make a decision pretty quickly." "If it was me, I would probably choose the medication options." "It might help to include your partner in any of the discussions about options." "The test results are clear and another physician would tell you the same thing."
"It might help to include your partner in any of the discussions about options."
The nurse is demonstrating the technique for performing a testicular self examination (TSE) to a group of men for a company health fair. One of the men asks the nurse at what age a man should begin performing TSE. What is the best answer by the nurse? "It should begin in adolescence." "It should begin in men over age 50." "It should be performed in high-risk males over age 30." "It should begin at age 40."
"It should begin in adolescence." Explanation: TSE should begin during adolescence.
A client reports loss of interest in sexual relations and discomfort during intercourse. Which is the best response by the nurse? "Don't worry, every woman goes through this." "These are normal, manageable symptoms of menopause." "You need to discuss this with your spouse." "Hormone replacement therapy can resolve your symptoms."
"These are normal, manageable symptoms of menopause."
The nurse weighs a patient daily and measures urinary output every hour. The nurse notices a weight gain of 1.5 kg in a 74-kg patient over 48 hours. The nurse is aware that this weight gain is equivalent to the retention of: 500 mL of fluid 1,000 mL of fluid 1,500 mL of fluid 2,000 mL of fluid
1,500 mL of fluid
Which client is most likely to develop prostate cancer according to a nurse working at a health screening at the local mall? A 35-year-old African American man A 60-year-old Asian American man A 17-year-old European American man A 56-year-old African American man
A 56-year-old African American man Explanation: Age over 40 and African American race are both risk factors for prostate cancer. Age younger than 40 and Asian heritage reduce the risk of prostate cancer.
A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be? A GFR of 90 mL/min/1.73 m2 A GFR of 30-59 mL/min/1.73 m2 A GFR of 120 mL/min/1.73 m2 A GFR of 85 mL/min/1.73 m2
A GFR of 30-59 mL/min/1.73 m2
A patient reports to the nurse that she has a sense of pelvic pressure and urinary problems such as incontinence, frequency, and urgency. The problem has gotten much worse since the birth of her third child. What does the nurse suspect the patient is experiencing? A cystocele A rectocele An enterocele A urinary tract infection
A cystocele
A woman who has been trying to conceive is diagnosed with fibroid tumors of the uterus and is scheduled to have a procedure using a laser through a hysteroscope passed through the cervix. What type of procedure will the nurse prepare the patient for? A hysteroscopic resection of myomas Laparoscopic myomectomy Laparoscopic myolysis Laparoscopic cryomyolysis
A hysteroscopic resection of myomas
A client returns to the recovery room following a mastectomy. An initial postoperative assessment is performed by the nurse. What is the nurse's priority assessment? Checking for urinary retention and the need to void. Checking the dressing, drain, and amount of drainage. Checking level of pain first upon the clients return from the operating room. Assessing the vital signs and oxygen saturation levels.
Assessing the vital signs and oxygen saturation levels. Explanation: The nurse prioritizes vital signs and breathing based on principles of ABCs.
A female client is diagnosed with breast abscess. She would like to continue to breast-feed her newborn. Which of the following would be most appropriate in this situation? Encourage the client to include protein content in the diet. Instruct the client to wear a tight-fitting bra. Reduce the frequency of removing and reapplying the dressings. Assist the client to pump the breasts to remove breast milk.
Assist the client to pump the breasts to remove breast milk. Explanation: The nurse should help the client pump the breasts and remove breast milk to prevent engorgement. Because the client has decided to continue breastfeeding, the client should wear a loose-fitting bra. Including protein content in the diet would be unrelated to the client's current situation. Frequency of dressing changes does not play a role in the intervention
Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis? Azotemia Proteinuria Hematuria Bacteremia
Azotemia The primary presenting features of acute glomerulonephritis are hematuria, edema, azotemia (excessive nitrogenous wastes in the blood), and proteinuria (>3 to 5 g/day). Bacteremia is excessive bacteria in the blood.
The presence of prerenal azotemia is a probable indicator for hospitalization for CAP. Which of the following is an initial laboratory result that would alert a nurse to this condition? Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20. BUN of 18 mg/dL. Serum creatinine of 1.2 mg/dL. Glomerular filtration rate (GFR) of 100 mL/min.
Blood urea nitrogen (BUN)-to-creatinine ratio (BUN:Cr) >20.
Assessment of a client reveals evidence of a cystocele. The nurse interprets this as which of the following? Herniation of the rectum into the vagina Protrusion of intestinal wall into the vagina Downward displacement of the cervix Bulging of the bladder into the vagina
Bulging of the bladder into the vagina
A patient admitted with electrolyte imbalance has carpopedal spasm, ECG changes, and a positive Chvostek sign. What deficit does the nurse suspect the patient has? Calcium Magnesium Phosphorus Sodium
Calcium Calcium deficit is associated with abdominal and muscle cramps, stridor, carpopedal spasm, hyperactive reflexes, tetany, positive Chvostek's or Trousseau's sign, tingling of fingers and around mouth, and ECG changes.
The nurse is collecting assessment data on a client who is reporting a vaginal discharge that is cottage cheese-like in appearance. Which pathogen is the most likely cause for this symptom? Gonococci Candida albicans Trichomonas vaginalis Gardnerella vaginalis
Candida albicans
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? Hodgkin disease Cervical cancer Colorectal cancer Cancer of the urinary tract
Cervical cancer
In which group is it most important for the client to understand the importance of an annual Papanicolaou test? Clients with a history of recurrent candidiasis Clients with a pregnancy before age 20 Clients infected with the human papillomavirus (HPV) Clients with a long history of hormonal contraceptive use
Clients infected with the human papillomavirus (HPV)
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? It lies underneath the outermost layer of the uterus. It grows within the wall of the uterine muscle. It grows below the inner uterine surface. It arises from inside or outside the surface of the uterine muscle.
It grows within the wall of the uterine muscle.
A client has a history of dysmenorrhea. During monthly menses, the client experiences incapacitating cramping and passes large clots. The client's primary care physician initiates conservative treatment. What interventions would the physician to recommend? NSAIDs ultrasonography corticosteroids oral hypoglycemia agents
NSAIDs
Which term refers to a failure of one or both or both of the testes to descend into the scrotum? Cryptorchidism Hydrocele Varicocele Phimosis
Cryptorchidism Explanation: 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.
A client who suffered hypovolemic shock during a cardiac incident has developed acute renal failure. Which is the best nursing rationale for this complication? Decrease in the blood flow through the kidneys Obstruction of urine flow from the kidneys Blood clot formed in the kidneys interfered with the flow Structural damage occurred in the nephrons of the kidneys
Decrease in the blood flow through the kidneys Acute renal failure can be caused by poor perfusion and/or decrease in circulating volume results from hypovolemic shock. Obstruction of urine flow from the kidneys through blood clot formation and structural damage can result in postrenal disorders but not indicated in this client.
The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure? Dehydration Hyperkalemia Crackles Hypertension
Dehydration
Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure?
Glomerulonephritis
The diagnosis of prostate cancer is confirmed by which of the following? Histologic exam of tissue Computed tomography Bone scan Magnetic resonance imaging
Histologic exam of tissue Explanation: The diagnosis of prostate cancer is confirmed by a histologic examination of tissue. Other tests that may be used to establish the extent of the disease include bone scans to detect metastases to the bones, and computed tomography scan to identify metastases in the pelvic lymph nodes.
A client with chronic renal failure complains of generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures? Elevated serum creatinine Hyperkalemia Hyperphosphatemia Elevated urea and nitrogen
Hyperphosphatemia
A client with chronic renal failure complains of generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures? Elevated serum creatinine Hyperkalemia Hyperphosphatemia Elevated urea and nitrogen
Hyperphosphatemia Osteodystrophy is a condition in which the bone becomes demineralized due to hypocalcemia and hyperphosphatemia. In an effort to raise blood calcium levels, the parathyroid glands secrete more parathormone. Elevated creatinine, urea, nitrogen, and potassium levels are expected in chronic renal failure and do not contribute to bone fractures.
The nurse is caring for a patient after kidney surgery. What major danger should the nurse closely monitor for? Abdominal distention owing to reflex cessation of intestinal peristalsis Hypovolemic shock caused by hemorrhage Paralytic ileus caused by manipulation of the colon during surgery Pneumonia caused by shallow breathing because of severe incisional pain
Hypovolemic shock caused by hemorrhage If bleeding goes undetected or is not detected promptly, the patient may lose significant amounts of blood and may experience hypoxemia. In addition to hypovolemic shock due to hemorrhage, this type of blood loss may precipitate a myocardial infarction or transient ischemic attack.
The client is receiving adjuvant chemotherapy for breast cancer. Which is most likely her node status and tumor size? Node negative, tumor size 0.3 cm Node negative, tumor size 0.5 cm Node negative, tumor size 1.2 cm Node negative, tumor size 0.2 cm
Node negative, tumor size 1.2 cm Explanation: Adjuvant chemotherapy is recommended for clients who have positive lymph nodes or who have invasive tumors greater that are 1 cm in size, regardless of nodal status.
The nurse teaches a premenopausal female client to perform breast self-examination (BSE) at which interval? With the onset of menstruation On day 5 to day 7, counting the first day of menses as day 1 On day 2 to day 4, counting the first day of menses as day 1 Any time during the month
On day 5 to day 7, counting the first day of menses as day 1 Explanation: BSE is best performed after menses, when less fluid is retained. Because most women notice increased tenderness, lumpiness, and fluid retention before their menstrual period, BSE is not recommended with the onset of menses. Because these symptoms generally continue through menses, BSE is not recommended during that time. BSE is best performed at a time that takes menses into account.
Following morning hygiene of an elderly client, the nurse is unable to replace the retracted foreskin of the penis. Which is the most likely outcome? Erection of the penis Unclean glans Painful swelling Nausea and vomiting
Painful swelling Explanation: Paraphimosis results in strangulation of the glans penis from inability to replace the retracted foreskin. The strangulation results in painful swelling of the glans. Erection of the penis in the presence of phimosis can cause pain but is not a result of retracted foreskin. Nausea and vomiting are not indicated with retraction of foreskin.
While caring for a client who is being treated for severe pelvic inflammatory disease (PID), which nursing action minimizes transmission of infection? Strictly adhering to the no visitation policy Implementing reverse isolation precautions Performing hand hygiene when entering the room Keeping the client in a sitting position
Performing hand hygiene when entering the room
Which of the following occurs late in chronic glomerulonephritis? Peripheral neuropathy Nosebleed Stroke Seizure
Peripheral neuropathy Peripheral neuropathy with diminished deep tendon reflexes and neurosensory changes occur late in the disease. The patient becomes confused and demonstrates a limited attention span. An additional late finding includes evidence of pericarditis with or without a pericardial friction rub. The first indication of disease may be a sudden, severe nosebleed, a stroke, or a seizure.
Which is an age-related change affecting the male reproductive system? Prostate secretion increases. Plasma testosterone levels decrease. Testes become soft. Patency increases.
Plasma testosterone levels decrease. Explanation: Changes in gonadal function include a decline in plasma testosterone levels and reduced production of progesterone. The testes become smaller and more firm.
A nurse is caring for a group of breast cancer survivors after mastectomy. Which teaching point should the nurse reinforce about activities 6 weeks after surgery? Resume light household work. Wear tight-fitting shirts for support. Brisk walking and stretching exercises can be introduced. Exercise only the unaffected side until seen by the healthcare provider.
Resume light household work. The client is instructed about postoperative activity limitation. In general, heavy lifting (more than 5 to 10 pounds) is avoided for about 4 to 6 weeks, after which light household and work-related activities are promoted to maintain muscle tone. Brisk walking, the use of stationary bikes and stepping machines, and stretching exercises may begin as soon as the client feels comfortable. Once the drain is removed, the client may begin to drive if she has full arm range of motion and is no longer taking opioid analgesic agents. General guidelines for activity focus on the gradual introduction of previous activities (e.g., bowling, weight training) once fully healed.
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client? Impaired urinary elimination Toileting self-care deficit Risk for infection Activity intolerance
Risk for infection The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body. If the client experiences repeated peritoneal infections, continuous ambulatory peritoneal dialysis may no longer be effective in clearing waste products. Impaired urinary elimination, Toileting self-care deficit, and Activity intolerance may be pertinent but are secondary to the risk of infection.
A perimenopausal woman informs the nurse that she is having irregular vaginal bleeding. What should the nurse encourage the patient to do? Stop taking her Premarin (hormonal therapy). See her gynecologist as soon as possible. Disregard this phenomenon because it is common during this life stage. Mention it to her physician during her next annual examination.
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.
The nurse is caring for a client who is ordered a sentinel lymph node biopsy. The physician explained the procedure and desired outcome. Which statement, made by the client, indicates a need for further instruction? The procedure allows for an understanding of the spread of cancer cells. The procedure allows for conservation of breast tissue. The procedure removes all cancer from the body. The procedure includes minimal surrounding tissue damage.
The procedure removes all cancer from the body. Sentinel lymph node mapping involves identifying the first (sentinel) lymph nodes through which the breast cancer cells would spread to regional lymph nodes in the axilla. Validating the lack of lymph node metastasis allows the surgeon to preserve more breast tissue, axillary tissue and chest muscle. Further instruction would be needed to explain that the sentinel lymph node biopsy does not remove cancer from the body.
A nurse is reviewing a client's medical history. Which factor indicates the client is at risk for candidiasis? Nulliparity Menopause Use of corticosteroids Use of spermicidal jelly
Use of corticosteroids
A client diagnosed with prostate cancer is to receive brachytherapy. Which of the following would the nurse include when discussing this therapy with the client? Need for daily treatments over a 7- to 8-week period Use of radioactive seeds implanted into the prostate Surgical castration to decrease the level of circulating testosterone Use of probes inserted using ultrasound to freeze the tissue
Use of radioactive seeds implanted into the prostate Explanation: Brachytherapy involves the implantation of interstitial radioactive seeds under anesthesia. External beam radiation therapy (teletherapy) involves the use of radiation treatments, usually 5 days/week over 7 to 8 weeks. Surgical castration is a type of androgen-deprivation therapy. Cryosurgery involves the insertion of transperineal probes into the prostate to freeze the tissue directly.
The nurse is interviewing a postmenopausal client during an annual gynecologic exam. Which assessment finding presents the greatest concern in the care of this client? Positive for human papillomavirus (HPV) Use of pessary Vaginal bleeding Urinary stress incontinence
Vaginal bleeding Vaginal bleeding in a client after menopause is abnormal and a predominant symptom for vaginal cancers. The incidence of vaginal cancer is higher among woman infected with HPV and those who use a pessary but neglect to remove and clean it. Urinary stress incontinence is not a significant concern.
A nurse who works in a gynecologist's office frequently cares for patients who are diagnosed with vulvovaginal candidiasis. The nurse should teach the patients how to manage and treat the most common symptom of: Vulvar pruritus. Dysuria. Vaginal pain. Dyspareunia.
Vulvar pruritus.
On discharge, a client who underwent left modified radical mastectomy expresses relief that "the cancer" has been treated. When discussing this issue with the client, the nurse should stress that she: should continue to perform breast self-examination on her right breast. is lucky that the cancer was caught in time. should schedule a follow-up appointment in 6 months. will have irregular menses.
should continue to perform breast self-examination on her right breast. Explanation: Having breast cancer on her left side puts the client more at risk for cancer on the opposite side and chest wall. Therefore, the nurse should stress the importance of monthly breast self-examinations and annual mammograms. Although the tumor was found, it was large enough to require a mastectomy, and could put the patient at risk for metastasis. Follow-up appointments should be monthly for the first few months and then scheduled at the direction of her health care provider. Modified radical mastectomy shouldn't affect the menstrual cycle.
A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience: hematuria. weight loss. increased urine output. increased blood pressure.
weight loss. Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesn't increase urine output because it doesn't correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure.
A client with end-stage renal disease is scheduled to undergo a kidney transplant using a sibling donated kidney. The client asks if immunosuppressive drugs can be avoided. Which is the best response by the nurse? "Even a perfect match does not guarantee organ success." "Immunosuppressive drugs guarantee organ success." "The doctor may decide to delay the use of immunosuppressant drugs." "Let's wait until after the surgery to discuss your treatment plan."
"Even a perfect match does not guarantee organ success."
A 32-year-old client has been diagnosed with an ovarian cyst and asks the nurse, "Should I be worried about cancer?" Which response by the nurse would be most appropriate? "Ovarian cysts are just that, cysts and not a cause for concern." "Ovarian cysts can be malignant but this is a rare occurrence." "Most cysts are benign in younger women, but it's good to have it checked out." "Since you don't have any symptoms, the chances of having cancer are really remote."
"Most cysts are benign in younger women, but it's good to have it checked out." The risk of malignancy in postmenopausal women is much greater than in premenopausal women, with almost all pelvic masses in premenopausal women being benign. However, although typically benign, the cyst should be evaluated to exclude ovarian cancer. The most appropriate response would be to provide this information to the client but also reinforce her actions to have the cyst evaluated. Telling the client that the cyst is no cause for concern or that ovarian cysts are rarely malignant ignores the client's feelings and does not address the client's concern. The absence of symptoms does not eliminate the possibility of a malignancy. Often, ovarian cancer is difficult to detect and signs and symptoms are vague and nonspecific.
A client is prescribed dutasteride (Avodart) as part of treatment for benign prostatic hyperplasia (BPH). When teaching the client about this drug, the nurse integrates knowledge of the drug's action. Which statement best reflects this? "The drug causes the smooth muscles of the bladder to relax so urine will flow more easily." "The drug interferes with testosterone, which causes the prostate to shrink in size." "The drug causes nitrous oxide to be released, leading to increased blood flow and urination." "The drug restores the balance of the normal microorganisms found in the bladder to improve urine flow."
"The drug interferes with testosterone, which causes the prostate to shrink in size." Explanation: Dutasteride is a 5-alpha-reductase inhibitor that prevents the conversion of testosterone to DHT, thereby causing a decrease in prostate size. Alpha-adrenergic blockers such as alfuzosin, terazosin, doxazosin, and tamsulosin relax the smooth muscle of the bladder neck and prostate. Nitrous oxide is released in the vasculature of the penis during sexual stimulation, leading to smooth muscle relaxation in blood vessels and resulting in increased blood flow and an erection. Phosphodiesterase-5 inhibitors increase blood flow to the penis and are used to treat erectile dysfunction. Dutasteride does not restore the normal flora of the bladder. The contents of the bladder are sterile.
A client is scheduled for a transurethral resection of the prostate (TURP). Which statement demonstrates that the expected outcome of "client demonstrates understanding of the surgical procedure and aftercare" has been met? "I'll have to stay in the hospital for about 3 to 4 days after the surgery." "I'll have a small incision on my lower abdomen after the procedure." "The surgeon is going to remove the entire prostate gland." "The surgeon is going to insert a scope through my urethra to remove a portion of the gland."
"The surgeon is going to insert a scope through my urethra to remove a portion of the gland." Explanation: TURP involves the surgical removal of the inner portion of the gland through an endoscope inserted through the urethra. There is no external skin incision. Typically, the procedure is performed in an outpatient setting but may require an overnight hospital stay.
Which statement by the client with end-stage renal disease indicates teaching by the nurse was effective? "There are few complications with renal replacement therapies." "A family member can help me perform hemodialysis in my home." "Ultrafiltration methods take much longer than hemodialysis." "A special access is created in my vein for peritoneal dialysis."
"Ultrafiltration methods take much longer than hemodialysis." Ultrafiltration methods (CVVH, CVVHD) are better tolerated by unstable clients as fluid is removed slowly, resulting in mild hemodynamic effects.
Which statement by the nurse demonstrates effective communication techniques when initiating a discussion about sex with a 25-year-old female client? "Have you had sex with more than one partner?" "Why didn't you start receiving annual Pap tests at an earlier age?" "Do you know how to properly apply a male condom?" "What questions do you have related to your sexual health?"
"What questions do you have related to your sexual health?"
A client who is scheduled for a vasectomy tells the nurse, "My partner and I will never have to worry about contraception ever again." Which response by the nurse would be most appropriate? "This seems important to you. I'm sure you must be so relieved." "You still need to use a reliable method until the physician checks your semen." "You don't have to worry about pregnancy, but your risk for a sexually transmitted infection just increased." "You might not have to worry about contraception, but remember your hormones may be affected."
"You still need to use a reliable method until the physician checks your semen." Explanation: Fertility remains for a varying time after a vasectomy until the sperm stored distally in the seminal vesicles have been evacuated. Therefore, a reliable method of contraception should be used until the urologist confirms infertility during a follow-up examination of an ejaculate specimen. Telling the client that he must be relieved provides false reassurance. The client needs to be informed about the remaining fertility. Vasectomy does not increase the risk for sexually transmitted infections; however, it does not provide protection from them. Vasectomy usually has no effect on sexual potency, erection, ejaculation, or male hormone production.
Atypical hyperplasia increases a women's risk for breast cancer about how many times compared with that of the general population? 4 2 6 8
4 Explanation: Atypical hyperplasia increases a women's risk for breast cancer about four to five times compared with that of the general population.
While caring for a patient who is treated for severe pelvic inflammatory disease (PID), the nurse insists on keeping her in a semisitting position. Which of the following is correct rationale for this positioning? Facilitation of pelvic drainage and minimize the upward extension of infection Prevention of nosocomial infections to other patients Prevention movement as it increases pain Facilitation of easy distraction of the patient
Facilitation of pelvic drainage and minimize the upward extension of infection
A patient has demonstrated interest in obtaining a penile implant. What should the patient consider prior to making this decision? Select all that apply. ADLs Social activities Expectations of the patient and his partner Financial status Occupation
ADLs Social activities Expectations of the patient and his partner Explanation: Factors to consider in choosing a penile prosthesis are the patient's activities of daily living, social activities, and the expectations of the patient and his partner.
A nurse is reviewing a female client's history, which includes the following information:Age at menarche: 14 yearsCesarean delivery: 2 pregnanciesAge at first pregnancy: 35 yearsAlcohol use: approximately 1 to 2 glasses of wine/monthThe nurse identifies which as a possible risk factor for the client to develop breast cancer? Age at menarche Cesarean deliveries Age at first pregnancy Alcohol use
Age at first pregnancy Explanation: 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.
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? All options are correct. breast cancer stroke (CVA) heart disease
All options are correct.
An older client underwent a lumpectomy for a breast lesion that was determined to be malignant. Which factors in the client's history may have increased the risk of breast cancer? All options are correct. increased age obesity not giving birth
All options are correct. Explanation: Being female, being older than 50 years of age, and having a family history of breast cancer are the most common risk factors. Additional factors include obesity, and having no children or having children after 30 years of age.
A client reports intermittent pelvic pain that does not seem to have a predictable occurrence. She recalls that these episodes began approximately 8 months ago. Following months of physical and diagnostic tests, the physician diagnoses the client with chronic pelvic pain. Which choices could be used as possible treatment options? Select all that apply. Antidepressants Analgesics Estrogen replacement Corticosteroids Oral contraceptives
Antidepressants Analgesics Oral contraceptives Chronic pelvic pain is often difficult to treat. Treatment depends on physical and diagnostic test results and may include antidepressants, analgesics, oral contraceptives, gonadotropin-releasing hormone (GnRH) agonists, exercise, and various surgical procedures. GnRH agonists decrease estrogen production. Corticosteroids are not indicated in the treatment of chronic pelvic pain.
A client with a history of chronic renal failure receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which intervention should the nurse include in the care plan? Keep the AV fistula site dry. Keep the AV fistula wrapped in gauze. Take the client's blood pressure in the left arm. Assess the AV fistula for a bruit and thrill.
Assess the AV fistula for a bruit and thrill. The nurse needs to assess the AV fistula for a bruit and thrill because if these findings aren't present, the fistula isn't functioning. The AV fistula may get wet when the client isn't being dialyzed. Immediately after a dialysis treatment, the access site should be covered with adhesive bandages, not gauze. Blood pressure readings or venipunctures shouldn't be taken in the arm with the AV fistula.
A client has been diagnosed with genital herpes. Knowing that education is an essential part of nursing care of the client with a genital herpes infection, the nurse plans to include which method(s) to minimize HIV transmission? Select all that apply. Avoiding unprotected sexual intercourse Avoiding multiple sexual partners Avoiding physical contact with others in crowded places Avoiding IV drug use Avoiding HPV vaccinations
Avoiding unprotected sexual intercourse Avoiding multiple sexual partners Avoiding IV drug use Intravenous drug use and risky sexual behaviors, which include multiple partners and unprotected sex, are factors that can put anybody at risk for HIV. Thus, the correct way to minimize HIV transmission would be to avoid these factors. HIV is not transmitted through simple physical contact. Open lesions related to HPV increase the likelihood that HIV can be transmitted; prevention includes administration of the HPV vaccine.
Which nursing assessment finding indicates that the client who has undergone renal transplant has not met expected outcomes? Diuresis Fever Absence of pain Weight loss
Fever Fever is an indicator of infection or transplant rejection.
A nurse is preparing a presentation about cervical cancer for a local woman's group. Which of the following would the nurse include as a possible risk factor for the development of cervical cancer? Sexual activity beginning at a later age Having a single sexual partner Infection with human papillomavirus (HPV) Never having been pregnant
Infection with human papillomavirus (HPV)
The client with chronic renal failure complains of intense itching. Which assessment finding would indicate the need for further nursing education? Pats skin dry after bathing Uses moisturizing creams Keeps nails trimmed short Brief, hot daily showers
Brief, hot daily showers Hot water removes more oils from the skin and can increase dryness and itching. Tepid water temperature is preferred in the management of pruritus. The use of moisturizing lotions and creams that do not contain perfumes can be helpful. Avoid scratching and keeping nails trimmed short is indicated in the management of pruritus.
Following a nephrectomy, which assessment finding is most important in determining nursing care for the client? Urine output of 35 to 40 mL/hour Pain of 3 out of 10, 1 hour after analgesic administration SpO2 at 90% with fine crackles in the lung bases Blood tinged drainage in Jackson-Pratt drainage tube
SpO2 at 90% with fine crackles in the lung bases
How can breast cancer prevention programs best serve at-risk women from lower socioeconomic backgrounds? Provide access to health insurance. Increase support services. Increase access to health care. Develop screening and educational programs.
Develop screening and educational programs. Explanation: Breast cancer prevention programs can best serve at-risk women from lower socioeconomic backgrounds by developing screening and educational programs tailored to their needs. Without increasing educational awareness and screening, access to insurance, access to health care, and support services don't help these women. According to the National Breast and Cervical Cancer Early Detection Program, research shows that without better screening and education programs, women with low incomes are three to seven times more likely to die from cancer than those with higher incomes.
A nurse is preparing a teaching plan for a client with a vulvovaginal infection. Which teaching would not be appropriate for the nurse to include? Maintain a reclining position for 30 minutes after inserting vaginal medication. Douche with a dilute vinegar solution twice a day. Wear cotton underwear that is loose-fitting and allows for air flow. Refrain from unprotected sexual intercourse with partners.
Douche with a dilute vinegar solution twice a day.
patient:No known allergiesDouching 2 to 3 times per weekUse of barrier methods for contraceptionRecent viral upper respiratory infectionEstrogen levels within acceptable parametersWhich of the following would the nurse identify as a risk factor for the patient developing a vulvovaginal infection? Douching Barrier contraception Viral upper respiratory infection Normal estrogen levels
Douching
After teaching a group of students about erectile dysfunction, the instructor determines that the teaching was successful when the students identify which of the following as true? Erectile dysfunction is unrelated to anxiety or depression. Erectile dysfunction is primarily a normal response to aging. Erectile dysfunction may be due to testosterone insufficiency. Erectile dysfunction rarely occurs in clients with diabetes mellitus.
Erectile dysfunction may be due to testosterone insufficiency. Explanation: Common causes of erectile dysfunction include neurologic disorder like spinal cord injury, perineal trauma, testosterone insufficiency, side effects of drug therapy such as antihypertensives or antidepressants, atherosclerosis, hypertension, and complications of diabetes mellitus. Erectile dysfunction may be related to anxiety or depression. It is not a normal aspect of aging.
A client is ordered continuous bladder irrigation at a rate of 60 gtt/minute. The nurse hangs a 2 L bag of sterile solution with tubing on a three-legged IV pole. She then attaches the tubing to the client's three-way urinary catheter, adjusts the flow rate, and leaves the room. Which important procedural step did the nurse fail to follow? Evaluating patency of the drainage lumen Counter-balancing the I.V. pole Attaching the infusion set to an infusion pump Collecting a urine specimen before beginning irrigation
Evaluating patency of the drainage lumen Explanation: The nurse should evaluate patency of the drainage tubing before leaving the client's room. If the lumen is obstructed, the solution infuses into the bladder but isn't eliminated through the drainage tubing, a situation that may cause client injury. Balancing the pole is important; however, the nurse would have had to address this issue immediately after hanging the 2 L bag. Using an I.V. pump isn't necessary for continuous bladder irrigation. Unless specifically ordered, obtaining a urine specimen before beginning continuous bladder irrigation isn't necessary.
Which type of biopsy would the nurse tell the client is a usual procedure for any palpable breast mass found on mammography? Stereotactic Excisional Incisional Tru-Cut core
Excisional Explanation: An excisional biopsy is the usual procedure for any palpable breast mass. Stereotactic biopsy uses computer location of the suspicious area found on biopsy, followed by core needle insertion and sampling of tissue for pathologic examination. Incisional biopsy is performed on a palpable mass when tissue sampling alone is required. A Tru-Cut core biopsy is used when a tumor is relatively large and close to the skin surface.
The client with benign prostatic hyperplasia (BPH) is considering use of medication in the management of symptoms. Which of the following drugs reduces the size of the prostate without lowering circulating levels of testosterone? Finasteride (Proscar) Tamsulosin (Flomax) Terazosin (Hytrin) Oxybutynin chloride (Ditropan)
Finasteride (Proscar) Explanation: Finasteride (Proscar) inhibits the conversion of testosterone, depriving the gland of dihydrotestosterone (more potent type of testosterone), which stimulates prostatic growth. Tamsulosin (Flomax) and terazosin (Hytrin) work by reducing the tone of smooth muscle in the bladder neck and prostate gland but have little effect on reducing prostate size. Oxybutynin chloride (Ditropan) is an antimuscarinic, antispasmodic drug used for treatment of overactive bladder.
A 28-year-old woman is learning about breast self-examination. The nurse teaches the woman that the best time of each month to examine her breasts is during the: Week before menstruation occurs. Week that menstruation occurs. First week after menstruation. Week that ovulation occurs.
First week after menstruation. Explanation: It is recommended that a woman examine the breasts during the first week after menstruation. During this period, the breasts are least likely to be tender or swollen because the secretion of estrogen, which prepares the uterus for implantation, is at its lowest level.
Culture of client's vaginal discharge reveals Gardnerella vaginalis. Which of the following would the nurse expect to assess? Foul, foamy discharge Thick, curdy, white discharge Fishy-smelling watery discharge Reddish-white discharge
Fishy-smelling watery discharge
The nurse is providing an educational presentation on toxic shock syndrome to a group of adolescents. Which preventive measure is a primary focus for this group? If using tampons, change frequently. Do not use vaginal devices for birth control. Toxin is associated with multiple sex partners. Use good personal hygiene.
If using tampons, change frequently.
The nurse is providing education regarding sexually transmitted infections. Which statement regarding herpes virus 2 (herpes genitalis) is accurate? In pregnant women with active herpes, babies delivered vaginally may become infected with the virus. Transmission of the virus requires sexual contact. The virus is very difficult to kill. Usually, the virus is killed at room temperature by drying.
In pregnant women with active herpes, babies delivered vaginally may become infected with the virus.
A pelvic examination reveals that a woman's uterus is retroflexed. Which of the following best depicts this position?
In retroflexion, the uterus bends posteriorly, as shown in option B. In retroversion, the uterus turns posteriorly as a whole unit, as shown in option A. In anteversion, the uterus tilts forward as a whole unit, as shown in option C. In anteflexion, the uterus bends anteriorly, as shown in option D.
A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia? Increase fat intake and limit carbohydrates. Eliminate fat intake and increase protein intake. Increase carbohydrates and limit protein intake. Increase protein, carbohydrates, and fat intake.
Increase carbohydrates and limit protein intake. Calories are supplied by carbohydrates and fat to prevent wasting. Protein is restricted because the breakdown products of dietary and tissue protein (urea, uric acid, and organic acids) accumulate quickly in the blood.
What is a characteristic of the intrarenal category of acute renal failure? Decreased creatinine Increased BUN High specific gravity Decreased urine sodium
Increased BUN
The nurse is assessing an older adult female who has not seen her physician in 2 years. The nurse is assisting the patient into a gown and notices that the patient has edema and pitting of the skin on the right breast. What does the nurse understand is the significance of this finding? It may result from inflammation due to mastitis while the patient is breastfeeding. This finding is not uncommon and is significant only when of recent origin. It may result from a neoplasm blocking lymphatic drainage, giving the skin an orange-peel appearance, a classic sign of advanced breast cancer. This finding is most likely related to benign cysts of the breast in the nipple area.
It may result from a neoplasm blocking lymphatic drainage, giving the skin an orange-peel appearance, a classic sign of advanced breast cancer. Explanation: Edema and pitting of the skin may result from a neoplasm blocking lymphatic drainage, giving the skin an orange peel appearance (peau d'orange)—a classic sign of advanced breast cancer.
Which statement is accurate regarding sildenafil? It can be taken twice daily for increased effect. The medication should be taken right before intercourse. Its side effects include headache, flushing, and dizziness. Sexual stimulation is not needed to produce an erection.
Its side effects include headache, flushing, and dizziness. Explanation: Side effects of sildenafil include headache, flushing, and dizziness. Is should be taken 30 minutes to 4 hours before intercourse. Taking this medication more than once a day will not have an increased effect. The client will have no erection if stimulation does not occur.
A health care provider prescribed a luteinizing hormone-releasing hormone (LHRH) agonist to suppress testicular androgen and treat prostate cancer. Which medication is the primary drug of choice? Lupron Eulexin Casodex Nilandron
Lupron Explanation: Lupon is an LHRH agonist. The other three choices are antiandrogen receptor antagonists.
The nurse is providing care to a client who has had surgery as treatment for breast cancer. The nurse would be alert for the development of which of the following? Lymphedema Fibrocystic breast disease Fibroadenoma Breast abscess
Lymphedema Explanation: Lymphedema occurs in some women after breast cancer surgery. It causes disfigurement and increases the lifetime potential for infection and poor healing. Fibrocystic breast disease and fibroadenoma are two benign breast conditions that occur usually in premenopausal woman. Breast abscess is the infectious and inflammatory breast condition that is common among breast-feeding mothers.
A nurse is preparing a presentation for a health fair about preventing breast cancer. Which of the following would the nurse include? Delaying childbearing until after age 30 Maintaining an ideal weight Opting for estrogen only replacement therapy during menopause Increasing the intake of caffeinated drinks
Maintaining an ideal weight Explanation: Maintaining an ideal weight decreases the risk of breast cancer. Having no children or having children after age 30 is associated with an increased risk for breast cancer. Some breast tumors are hormone dependent, such that estrogen (or progesterone) enhances tumor growth. Women are advised to avoid the consumption of alcohol, not caffeine, because alcohol correlates with an increased risk of breast cancer
A client is considering breast augmentation. Which of the following would the nurse recommend to the client to ensure that there are no malignancies? Mammogram Mastopexy Ultrasound Breast biopsy
Mammogram Explanation: When caring for a client considering breast augmentation, the nurse should provide her with a general guideline to have a mammogram to verify that there are no malignancies. Mastopexy involves a breast lift for drooping breasts. Ultrasound or breast biopsy would not be necessary unless there was evidence of a problem.
Which nursing assessment finding is most significant in determining the plan of care in a client with erectile dysfunction? Age Medication use Sexual history Undescended testicle
Medication use Explanation: Certain medications such as antihypertensive drugs, antidepressants, narcotics, etc. can cause sexual dysfunction in men. Impotence is not a normal part of aging. Undescended testicle is not indicative of ED. Sexual history is not indicative of ED.
The nurse is preparing a presentation for an older adult group of males at a senior center. Which of the following would the nurse expect to include when describing the effects of aging on the male reproductive system? The volume and viscosity of seminal fluid increase with age. Men retain the ability to fertilize ova irrespective of age. There is a gradual increase in sperm and testosterone production. The scrotum becomes less pendulous and becomes firm.
Men retain the ability to fertilize ova irrespective of age. Explanation: As men age, they retain the ability to fertilize ova even though there is a gradual decrease in sperm and testosterone production. Along with decreased sperm production, the volume and viscosity of seminal fluid decrease with age. A loss of muscular tone causes the scrotum to become more pendulous.
Which of the following is a term used to describe excessive menstrual bleeding? Menorrhagia Amenorrhea Dysmenorrhea Metrorrhagia
Menorrhagia Menorrhagia is excessive menstrual bleeding. Amenorrhea is the absence of menses. Dysmenorrhea is painful menses. Metrorrhagia is excessive and prolonged menstrual bleeding.
Which term is used to describe removal of breast tissue and axillary lymph node dissection leaving muscular structure intact as surgical treatment of breast cancer? Segmental mastectomy Modified radical mastectomy Total mastectomy Radical mastectomy
Modified radical mastectomy Explanation: A modified radical mastectomy leaves the pectoralis major and minor muscles intact. In a segmental mastectomy, varying amounts of breast tissue are removed, including the malignant tissue and some surrounding tissue to ensure clear margins. In a total mastectomy, breast tissue only is removed. Radical mastectomy includes removal of the pectoralis major and minor muscles in addition to breast tissue and axillary lymph node dissection.
The nurse is preparing a presentation for a men's community group about health promotion. Which of the following would the nurse include as a current recommendation for screening? Monthly testicular self-examination (TSE) Annual digital rectal examination (DRE) after age 35 years Annual prostate-specific antigen (PSA) testing after age 40 years Transrectal ultrasound every 5 years after age 50 years
Monthly testicular self-examination (TSE) Explanation: Screening typically includes monthly TSE starting in adolescence and annual DRE for men older than 50 years. PSA testing along with DRE are used to screen for prostate cancer in men with at least a 10-year life expectancy and for men at high risk, including those with a strong family history of prostate cancer and of African-American ethnicity. Transrectal ultrasound is performed in clients with abnormalities detected by DRE and in those with elevated PSA levels.
The nurse is providing instruction for testicular self-examination to a group of young adolescents. Which is the most correct examination technique? Palpate both testicles simultaneously for comparison. Palpate each testicle separately, following a warm shower. Palpate the front of the testicle first, where most tumors are found. Palpate for a soft, round shape with normal ridges on the testicles.
Palpate each testicle separately, following a warm shower. Explanation: It is best to examine and palpate each testicle following a warm shower, when the testes are relaxed and not retracted. Because one testicle is normally larger and hangs lower, comparing the two sides is not indicated. Both testes should be oval in shape, smooth, and firm without masses or tenderness. Most tumors are located on the lateral aspect of the testicles.
A nurse is teaching a client about a circumcision. Which external reproductive structure is removed by circumcision? Prepuce Glans Corpora cavernosa Mons pubis
Prepuce Explanation: In an uncircumcised male, the prepuce, sometimes referred to as the foreskin, that covers the glans is removed by circumcision. The glans is the rounded head of the penis. The corpora cavernosa is erectile tissue. The mons pubis is fatty tissue near the pubic bones.
What is a hallmark of the diagnosis of nephrotic syndrome? Hyponatremia Proteinuria Hyperalbuminemia Hypokalemia
Proteinuria Proteinuria (predominantly albumin) exceeding 3.5 g per day is the hallmark of the diagnosis of nephrotic syndrome. Hypoalbuminemia, hypernatremia, and hyperkalemia may occur.
A client is considering use of chemoprevention because she is at high risk for developing breast cancer. What can the nurse do to assist the patient with her decision? Inform the patient that medication should not be used prophylactically due to the many side effects. Inform the patient that she should take every measure available to her to prevent this disease. Provide the patient with information regarding the benefits, risks, and possible side effects. Provide the patient with information about bilateral mastectomy for the prevention of this disease.
Provide the patient with information regarding the benefits, risks, and possible side effects. Explanation: Nurses can help women who are considering chemoprevention by providing them with information about the benefits, risks, and possible side effects of both tamoxifen and raloxifene.
At a follow-up visit, the client is informed that her breast cancer has recurred. The nurse knows that which situation places the client at risk for developing bone metastases? Aggressive treatment, including surgery, radiation, and hormonal therapy Recurrence within 2 years of the original diagnosis No maternal family history of breast cancer Previous therapeutic response to chemotherapy
Recurrence within 2 years of the original diagnosis Explanation: Local recurrence may be an indicator that systemic disease will develop in the future, particularly if it occurs within 2 years of the original diagnosis. Local recurrence in the absence of systemic disease is treated aggressively with surgery, radiation, and hormonal therapy. Overall prognosis and optimal treatment are determined by a variety of factors such as the time to recurrence from the original diagnosis and treatment history.
Consuming a diet high in which of the following has been found to increase the risk for prostate cancer? Red meats Green leafy vegetables Carbohydrates Whole grains
Red meats
A nurse is caring for a client who has just had a modified radical mastectomy with immediate reconstruction. She's in her 30s and has two young children. Although she's worried about her future, she seems to be adjusting well to her diagnosis. What should the nurse do to support her coping? Tell the client's spouse or partner to be supportive while she recovers. Encourage the client to proceed with the next phase of treatment. Recommend that the client remain cheerful for the sake of her children. Refer the client to the American Cancer Society's Reach for Recovery program or another support program.
Refer the client to the American Cancer Society's Reach for Recovery program or another support program. Explanation: The client isn't withdrawn and doesn't show other signs of anxiety or depression. Therefore, the nurse can probably safely approach her about talking with others who have had similar experiences, either through Reach for Recovery or another formal support group. The nurse may educate the client's spouse or partner and listen to his concerns, but the nurse shouldn't tell the client's spouse what to do. The client must consult with her physician and make her own decisions about further treatment. The client needs to express her sadness, frustration, and fear. She can't be expected to be cheerful at all times.
The physician orders an alpha-adrenergic blocker for a client with benign prostatic hyperplasia. The nurse understands that this drug acts to achieve which of the following? Prevent urinary tract infections Relieve urinary symptoms Slow the prostatic enlargement Block testosterone conversion
Relieve urinary symptoms Explanation: Alpha-adrenergic blockers help relax the muscles in the prostate and relieve urinary symptoms. Androgen hormone inhibitors (also classified as 5-alpha reductase inhibitors) can be used to decrease symptoms and also appear to arrest the progression of prostate enlargement in some clients. These agents inhibit the conversion of testosterone into a potent androgen, causing the gland to shrink.
A patient has been diagnosed with postrenal failure. The nurse reviews the patient's electronic health record and notes a possible cause. Which of the following is the possible cause? Acute pyelonephritis Osmotic dieresis. Dysrhythmias Renal calculi
Renal calculi Postrenal ARF is the result of an obstruction that develops anywhere from the collecting ducts of the kidney to the urethra. This results from ureteral blockage, such as from bilateral renal calculi or benign prostatic hypertrophy (BPH).
Pelvic infection is most commonly caused by which of the following? Sexual transmission Surgical abortion Hysteroscopy Insertion of intrauterine device
Sexual transmission
What is used to decrease potassium level seen in acute renal failure? Sodium polystyrene sulfonate Sorbitol IV dextrose 50% Calcium supplements
Sodium polystyrene sulfonate The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.
A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment? Encourage oral fluids. Administer furosemide (Lasix) 20 mg IV Start hemodialysis after a temporary access is obtained. Start IV fluids with a normal saline solution bolus followed by a maintenance dose.
Start IV fluids with a normal saline solution bolus followed by a maintenance dose.
Which should be included as part of the home care instructions for a client with epididymitis and orchitis? Take prescribed antibiotics. Undertake lifting exercises. Apply ice to the area after scrotal swelling subsides. Resume sexual intercourse.
Take prescribed antibiotics. Explanation: Home care for a client with epididymitis and orchitis includes instructions to continue administering prescribed antibiotics, take Sitz baths, apply local heat after scrotal swelling subsides, avoid lifting, and refrain from sexual intercourse until symptoms are relieved.
A client with vaginitis complains of itching and burning of the perineum. Which suggestion would be most appropriate to relieve the client's symptoms? Use a pure vinegar douche daily. Use skin protectants containing zinc oxide. Take sitz baths frequently Avoid yogurt with active lactobacilli cultures.
Take sitz baths frequently Sitz baths are recommended to relieve the client's itching and burning, as well as relieve swelling of the vulva and perineum. Skin protectants containing zinc oxide promote healing. Using a vinegar (1to 2 tablespoons) and water (1 pint) douche daily may be used to combat the vaginitis when the client is symptomatic. Taking Lactobacillus acidophilus in capsule form or eating yogurt containing active cultures of lactobacilli can help restore normal vaginal microorganisms.
Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia. Tall, peaked T waves Shortened QRS complex Multiple spiked P waves Prolonged ST segment
Tall, peaked T waves Characteristic ECG signs of hyperkalemia are tall, tented, or peaked T waves, absent P waves, and a widened QRS complex.
A nurse who works in an oncology practice prepares patients for the side effects of adjuvant hormonal therapy to treat breast cancer. Which of the following is the hormonal agent that has an increased risk of pulmonary embolism and deep vein thrombosis? Anastrozole Exemestane Letrozole Tamoxifen
Tamoxifen Deep vein thrombosis, pulmonary embolism, and superficial phlebitis are all thromboembolic events that are adverse reactions to tamoxifen.
Students are reviewing information about the use of adjuvant hormonal therapy for breast cancer. They demonstrate understanding of this information when they identify which of the following as an example of a selective estrogen receptor modulator (SERM)? Anastrozole Letrozole Tamoxifen Exemestane
Tamoxifen Explanation: Tamoxifen is an example of a SERM. It acts by competing for estrogen-receptor binding sites. Anastrozole, letrozole, and exemestane are examples of aromatase inhibitors, drugs that block estrogen production.
A nurse is teaching a male client to perform monthly testicular self-examinations. Which point is appropriate to make? Testicular cancer is a highly curable type of cancer. Testicular cancer is very difficult to diagnose. Testicular cancer is the number one cause of cancer deaths in males. Testicular cancer is more common in older men.
Testicular cancer is a highly curable type of cancer. Explanation: 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 in men with lung cancer. Testicular cancer is found more commonly in younger, not older, men.
The nurse is providing supportive care to a client receiving hemodialysis in the management of acute renal failure. Which statement from the nurse best reflects the ability of the kidneys to recover from acute renal failure? The kidneys can improve over a period of months. Once on dialysis, the need will be permanent. Kidney function will improve with transplant. Acute renal failure tends to turn to end-stage failure.
The kidneys can improve over a period of months. The kidneys have a remarkable ability to recover from serious insult. Recovery may take 3 to 12 months. As long as recovery is continuing, there is no need to consider transplant or permanent hemodialysis. Acute renal failure can progress to chronic renal failure.
A client comes to the clinic for a routine evaluation. During the physical examination, the nurse palpates the client's breast and finds a small lump. Which of the following would lead the nurse to suspect possible breast cancer? The client reports tenderness during the palpation. The lump is mobile. The lump is soft. The lump is irregularly shaped.
The lump is irregularly shaped. Explanation: Generally, breast cancer lesions are nontender, fixed rather than mobile, and hard with irregular borders. Diffuse breast pain and tenderness with menstruation are usually associated with benign breast disease.
The client arrives at a public health clinic worried that she has breast cancer since finding a lump in her breast. When assessing the breast, which assessment finding is characteristic of fibrocystic disease? One breast is larger than the other. The lump is firm and immovable. The lump is round and movable. Nipple retractions are noted.
The lump is round and movable. Explanation: When assessing a breast with fibrocystic disease, the lumps typically are different from cancerous lumps. The characteristic breast mass of fibrocystic disease is soft to firm, circular, movable, and unlikely to cause nipple retraction. A cancerous mass is typically irregular in shape, firm, and immovable. Lumps typically do not make one breast larger than the other. Nipple retractions are suggestive of cancerous masses.
A patient is having a fine-needle biopsy (FNB) for a mass in the left breast. When the needle is inserted and the mass is no longer palpable, what does the nurse know has most likely occurred? The mass has been absorbed into the tissues of the breast. The mass may be cystic and was ruptured when the needle was inserted. The mass may not have been located correctly. The mass is not palpable because it is an inflammatory lesion.
The mass may be cystic and was ruptured when the needle was inserted. Explanation: A simple cyst often disappears on aspiration, and the fluid is usually discarded.
When developing an educational program for a group of adolescents about sexually transmitted infections (STIs), what should the nurse inform the group about the single greatest risk factor for contracting an STI? The type of contraception used The number of times the person has contact with a partner The number of sexual partners Where the patient lives
The number of sexual partners Explanation: The single greatest risk factor for contracting an STI is the number of sexual partners. As the number of partners increases, so does the risk of exposure to a person infected with an STI.
A female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client? This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually. The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days. The potential for transmission to her sexual partner will be eliminated if condoms are used every time she and her partner have sexual intercourse. The human papillomavirus (HPV), which causes condylomata acuminata, can't be transmitted during oral sex.
This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually.
The client states to the nurse that he is very anxious about having prostate cancer ever since his prostate-specific antigen (PSA) test came back elevated. The client asks, "Which diagnostic test produces definitive results if cancer is present?" The nurse is most correct to state which of the following? Transrectal ultrasonography Tissue biopsy Tumor marker studies Digital rectal exam
Tissue biopsy Explanation: Obtaining an actual piece of the tissue and analyzing it for cancer is a definitive test when cancer is found. A transrectal ultrasonography is a test to view the prostate gland from different angles. This test provides additional data on the status of the prostate gland. The tumor marker studies include the prostate-specific antigen (PSA) level. This antigen indicates a potential problem but is not definitive. PSA elevations have been noted for reasons other than cancer. A digital rectal exam provided data on the shape, size, and texture of the prostate gland.
Which is the most common type of prostate surgery? Retropubic prostatectomy Transurethral resection of the prostate Suprapubic prostatectomy Perineal prostatectomy
Transurethral resection of the prostate Explanation: Transurethral resection of the prostate, or TURP, is the most common procedure used and can be carried out through endoscopy. Suprapubic, perineal, and retropubic prostatectomies are surgical procedures for the prostate, but they are not the most common.
A client with benign prostatic hyperplasia doesn't respond to medical treatment and is admitted to the facility for prostate gland removal. Before providing preoperative and postoperative instructions to the client, the nurse asks the surgeon which prostatectomy procedure will be done. What is the most widely used procedure for prostate gland removal? Transurethral resection of the prostate (TURP) Suprapubic prostatectomy Retropubic prostatectomy Transurethral laser incision of the prostate
Transurethral resection of the prostate (TURP) Explanation: TURP is the most widely used procedure for prostate gland removal. Because it requires no incision, TURP is especially suitable for men with relatively minor prostatic enlargements and for those who are poor surgical risks. Suprapubic prostatectomy, retropubic prostatectomy, and transurethral laser incision of the prostate are less common procedures; each requires an incision.
A group of students are reviewing the anatomy and physiology of the breasts. The students demonstrate understanding of breast structure when they identify the tail of Spence as an extension of which quadrant? Upper outer Upper inner Lower outer Lower inner
Upper outer Explanation: The tail of Spence is an area of breast tissue that extends from the upper outer quadrant of the breast into the axilla. The upper and lower inner quadrants are closer to the midline. The lower outer quadrant is below the upper outer quadrant.
A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. IV fluid is being infused at 150 mL/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)?
Urine output of 250 ml/24 hours ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.
A patient is receiving chemotherapy with paclitaxel as treatment for ovarian cancer. The patient arrives at the facility for laboratory testing prior to her next dose of chemotherapy. The results are as follows:Hemoglobin: 12.9 gm/dLWhite blood cell count: 2,200 /cu mmPlatelets: 250,000 /cu mmRed blood cell count: 4,400,00/cu mmWhich result would be a cause for concern? Hemoglobin level White blood cell count Platelet count Red blood cell count
White blood cell count The patient's white blood cell count is low, revealing leukopenia and placing the patient at an increased risk for infection. The other results are within normal parameters and would not be a cause for concern.
A nurse is obtaining a male client's health history before performing a physical examination. Which information would most likely not be obtained? age of first ejaculate contraceptive practices pain during sexual intercourse premature ejaculation or other concerns of a sexual nature
age of first ejaculate Explanation: Age of first ejaculate would most likely not be asked. Premature ejaculation or other concerns of a sexual nature, pain during sexual intercourse, and contraceptive practices would most likely be included in the health history.
A health care provider recommends that a patient with breast cancer undergo a modified radical mastectomy. The nurse explains that this procedure involves removal of the entire breast: while preserving the nipple-areola complex. and the nipple-areola complex without lymph node removal. and the nipple-areola complex along with the axillary node dissection. along with lymph nodes and the underlying pectoralis major and minor muscles.
and the nipple-areola complex along with the axillary node dissection. Modified radical mastectomy is performed to treat invasive breast cancer. The procedure involves removal of the entire breast tissue, including the nipple-areola complex. In addition, a portion of the axillary lymph nodes is also removed in ALND.
A client who is 4 months postpartum reports significant left breast pain, edema, redness, and an elevated temperature. What would the physician likely order? Select all that apply. antibiotic therapy a supportive bra increased activity a breast shield. biopsy
antibiotic therapy a supportive bra Explanation: Treatment for mastitis consists of antibiotics and local application of cold compresses to relieve discomfort. The client should wear a snug bra. Adequate rest and hydration are important. Activity is neither encouraged nor restricted. The client should avoid wearing breast shields, which trap breast milk and moisture around the nipple. A biopsy would not be indicated for mastitis.
A client develops acute renal failure (ARF) after receiving IV therapy with a nephrotoxic antibiotic. Because the client's 24-hour urine output totals 240 mL, the nurse suspects that the client is at risk for: cardiac arrhythmia. paresthesia. dehydration. pruritus.
cardiac arrhythmia. As urine output decreases, the serum potassium level rises; if it rises sufficiently, hyperkalemia may occur, possibly triggering a cardiac arrhythmia. Hyperkalemia doesn't cause paresthesia (sensations of numbness and tingling). Dehydration doesn't occur during this oliguric phase of ARF, although typically it does arise during the diuretic phase. In the client with ARF, pruritus results from increased phosphates and isn't associated with hyperkalemia.
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? cyclical hormonal changes caffeine nicotine progesterone
cyclical hormonal changes Explanation: The likely cause is fibrocystic disease, which results from hormonal changes during the menstrual cycle.
The nurse cares for a client who underwent a kidney transplant. The nurse understands that rejection of a transplanted kidney within 24 hours after transplant is termed: acute rejection. hyperacute rejection. chronic rejection. simple rejection.
hyperacute rejection. After a kidney transplant, rejection and failure can occur within 24 hours (hyperacute), within 3 to 14 days (acute), or after many years. A hyperacute rejection is caused by an immediate antibody-mediated reaction that leads to generalized glomerular capillary thrombosis and necrosis. The term "simple" is not used in the categorization of types of rejection of kidney transplants.
What contributes to breast inflammation in a woman who is breastfeeding? Select all that apply. inadequate handwashing failure to alternate breasts at each feeding insufficient maternal nutrition frequently nursing an infant organisms on the mother's or infant's skin
inadequate handwashing failure to alternate breasts at each feeding organisms on the mother's or infant's skin Explanation: Breast inflammation is caused by one or more plugged lactiferous ducts or an infectious agent that enters through cracked or fissured nipples. The infectious process results from inadequate maternal handwashing or by infectious organisms on the skin of the mother or infant. Ducts can become plugged as a consequence of failure to alternate breasts at each feeding, or of infrequent nursing. Maternal nutrition is not directly related to the development of mastitis.
Glomerulonephritis is an inflammatory response in the glomerular capillary membrane, and causes disruption of the renal filtration system. Although diagnostic urinalysis can reveal glomerulonephritis, many clients with glomerulonephritis exhibit: no symptoms. fever. headache. polyuria.
no symptoms.
The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder? pH 7.20, PaCO2 36, HCO3 14- pH 7.31, PaCO2 48, HCO3 24- pH 7.47, PaCO2 45, HCO3 33- pH 7.50, PaCO2 29, HCO3 22-
pH 7.20, PaCO2 36, HCO3 14- Metabolic acidosis occurs in end-stage kidney disease (ESKD) because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3-) and to reabsorb sodium bicarbonate (HCO3-). There is also decreased excretion of phosphates and other organic acids.
A client has been diagnosed with acute glomerulonephritis. This condition causes: proteinuria. pyuria. polyuria. No option is correct.
proteinuria The disruption of membrane permeability causes red blood cells (RBCs) and protein molecules to filter from the glomeruli into Bowman's capsule and eventually become lost in the urine. Pyuria is pus in the urine. Polyuria is an increased volume of urine voided.
Twenty-four hours after undergoing kidney transplantation, a client develops a hyperacute rejection. To correct this problem, the nurse should prepare the client for: removal of the transplanted kidney. high-dose IV cyclosporine (Sandimmune) therapy. bone marrow transplant. intra-abdominal instillation of methylprednisolone sodium succinate (Solu-Medrol).
removal of the transplanted kidney. Hyperacute rejection isn't treatable; the only way to stop this reaction is to remove the transplanted organ or tissue. Although cyclosporine is used to treat acute transplant rejection, it doesn't halt hyperacute rejection. Bone marrow transplant isn't effective against hyperacute rejection of a kidney transplant. Methylprednisolone sodium succinate may be given IV to treat acute organ rejection, but it's ineffective against hyperacute rejection.
One of the roles of the nurse in caring for clients with chronic renal failure is to help them learn to minimize and manage potential complications. This would include: restricting sources of potassium. allowing liberal use of sodium. limiting iron and folic acid intake. eating protein liberally.
restricting sources of potassium. The nurse will teach the client to restrict sources of potassium, such as fresh fruits and vegetables, because hyperkalemia can cause life-threatening changes. The client will restrict sodium intake as ordered; doing so prevents fluid accumulation. Prescribed iron and folic acid supplements or Epogen should be taken; iron and folic acid supplements are needed for red blood cell (RBC) production, and Epogen stimulates the bone marrow to produce RBCs. The client will restrict protein intake to foods that are complete proteins within prescribed limits; complete proteins provide positive nitrogen balance for healing and growth.
A patient had a pessary inserted for long-term treatment of a prolapsed uterus. As part of a teaching plan, the nurse would advise the patient to: see her gynecologist to remove and clean the pessary at regular intervals. keep the insertion site clean and dry. avoid sexual intercourse. avoid climbing stairs as much as possible.
see her gynecologist to remove and clean the pessary at regular intervals.