Chapters 73 & 74

Which statement made by a woman who is being discharged after a hysterectomy indicates understanding and acceptance? a. "I wish I had delayed this surgery so that I could have had one more child." b. "I will diet to prevent the weight gain most women have after hysterectomy." c. "Now that my uterus will be gone, I'll probably develop stress incontinence." d. "My husband and I hope to have more sex because I won't have so much bleeding."

: D Discontent with loss of fertility and misconceptions about the effects of hysterectomy are common contributors to psychological or adjustment problems following hysterectomy. Positive attitudes and family support decrease the risk for psychological problems. Wanting to delay the surgery for childbearing indicates unresolved grief for fertility. Gaining weight and developing incontinence are misconceptions about the operation.

When performing a clinical breast examination on a client, the nurse palpates a thickened area where the skin folds under the breast. Which is the nurse's best action? a.Proceed with the examination. b.Determine whether the thickness is bilateral. c.Ask how long the thickness has been present. d.Change the client's position and re-assess.

A A thickened area where the skin folds under the breast is the inframammary ridge, a normal anatomic finding. Clients should be taught to identify this ridge and not confuse it with the presence of a lump or abnormal tissue thickening. Because this is a normal finding, no concern is necessary about whether it is present bilaterally or occurs in a different position, or how long the finding has been notable.

A client has returned to the nursing unit after a total abdominal hysterectomy. The nurse auscultates the client's abdomen and does not hear bowel sounds. Which is the nurse's priority intervention? a. Document the finding in the chart. b. Position the client on the right side. c. Irrigate the nasogastric tube. d. Measure abdominal girth.

A Absence of bowel sounds for 1 to 2 days after abdominal surgery is an expected finding that should be documented. No intervention specific to this finding is needed.

A client is scheduled to have a hysteroscopic myomectomy. Which statement by the client indicates that she understands the procedure? a. "I will need to deliver future children by cesarean section." b. "I need to schedule this during the last part of my cycle." c. "My uterus will be removed through tiny incisions." d. "This operation will make me infertile."

A Because of the risk for uterine rupture after this procedure, future deliveries will be done by cesarean section. The procedure is done during the early part of the menstrual cycle to limit blood loss and reduce the possibility of interrupting a pregnancy. This operation is a uterus-sparing procedure. The woman will not be infertile after the myomectomy.

A client has advanced breast cancer and bone metastasis. Which problem does the nurse consider the priority? a.Pain b.Mobility problems c.Risk for infection d.Malnutrition

A Bone metastasis can cause intense continuous pain that disrupts the client's activities and sleep and reduces the client's quality of life. This problem should be managed ahead of all other problems. Although the client may also be experiencing impaired mobility and risks for infection and malnutrition, none of these problems will be as disruptive as acute pain. The pain must become manageable before the other problems can be addressed.

A client is in the clinic reporting stress incontinence. Which other assessment is the priority for the nurse to perform? a. Ask the client about vaginal discharge or bleeding. b. Have the client perform a 24-hour fluid recall. c. Inquire about fever, chills, and burning on urination. d. Obtain the client's reproductive history.

A Gynecologic problems are often accompanied by urinary symptoms. Because women are often hesitant or embarrassed to discuss gynecologic problems, the nurse should specifically assess for them in clients reporting urinary issues. The other assessments are important as well but are not the priority.

A client had a uterine artery embolization and has just returned to the nursing unit. She is asking when she can get up to go to the bathroom. Which question does the nurse ask during hand-off report? a. "Was a vascular closure device used?" b. "What was her estimated blood loss?" c. "Is there an order for a catheter?" d. "When was the client's last sedation?"

A If a vascular closure device was used after the procedure, the client can get up in about 2 hours. If a closure device was not used, the client needs to be on bedrest for 4 hours. Although all questions are important during hand-off report, the question specific for activity restrictions is the one that asks about the vascular closure device.

A client had a mastectomy nearly a year ago and is distressed over continued tingling and burning in the ipsilateral arm. What orders does the nurse prepare to implement? a.Teach the client about gabapentin (Neurontin). b.Demonstrate the use of heat therapy to the axilla. c.Discuss ways to prevent constipation with pain meds. d.Reassure the client that this will disappear shortly.

A Injury to nerves causes paresthesias such as burning, tingling, "pins and needles," and numbness after a mastectomy. These sensations are usually gone by the end of a year. Because this client's symptoms are distressing and have lasted so long, the nurse should anticipate an order for Neurontin. Narcotic pain medications will not be helpful or needed. Heat therapy may or may not be helpful, and reassuring the client at this point will sound unbelievable.

A client had a mastectomy with reconstruction, and several axillary nodes were dissected. Which statement by the client indicates good understanding of discharge instructions? a. "I must be careful not to injure the arm or hand on the side of my surgery." b. "I'm glad that lymphedema is no longer a problem, as it was in my mother's day." c. "I will have a hard time waiting for a whole year to see how my breast will look." d. "I need to pull my drains out by inch each day until they are totally out."

A Lymphedema is a complication following mastectomy, especially if lymph nodes have been removed. The client must use measures to prevent this from occurring for the rest of her life. Preventing injury is one way of preventing lymphedema. Breast reconstruction should look optimal in 3 to 6 months. The health care provider will remove drains at a postoperative appointment.

A client had a total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node dissection 2 days ago. The nurse finds the client short of breath, tachycardic, and anxious. What intervention takes priority? a. Assess oxygen saturation and apply oxygen if needed. b. Have the client cough and deep breathe or use the spirometer. c. Call respiratory therapy to provide a nebulizer treatment. d. Prepare to administer furosemide (Lasix) IV push

A Pulmonary embolism is a risk of major abdominal surgery. The client is exhibiting signs of pulmonary embolism. The nurse should first assess and treat oxygenation problems, then notify the Rapid Response Team. Pulmonary hygiene will not be aggressive enough to help this client. No indications suggest that the client needs a nebulizer treatment. Lasix is not warranted.

A client recently had a mammogram. Which statement by the client indicates a need for clarification regarding the importance or purpose of this procedure? a."Now that I have had a mammogram, my risk for getting breast cancer is reduced." b."I will still do a breast self-examination monthly even after the mammogram." c."Yearly mammograms can reduce my risk of dying from breast cancer." d."The amount of radiation exposure from a mammogram is very low."

A Regular or yearly mammography does not decrease the incidence of breast cancer. It only assists in early detection and diagnosis and decreases the mortality rate from breast cancer. The client should be instructed that the mammogram uses a very small amount of radiation in the test, and that consistent scheduling of a mammogram, along with a breast self-examination performed at least monthly, can reduce the client's risk of dying from breast cancer.

A client with a history of breast cancer is admitted through the emergency department with shortness of breath, weakness, fatigue, and new lower extremity edema. The client's oxygen saturation is 88%. After stabilizing the client, which action by the nurse is most important? a. Obtain a list of the client's medications. b. Orient her to her room and surroundings. c. Place the client on intake and output. d. Assess the client's family cardiac history.

A Some chemotherapeutic drugs, such as doxorubicin (Adriamycin) and trastuzumab (Herceptin), are known to be cardiotoxic. Although all other actions are appropriate, the nurse (and the provider) must know the medications the client is on, with specific emphasis on assessing for causative agents.

A client has undergone cryosurgery for stage I cervical cancer. Which precaution or action does the nurse teach this client? a. "Use sanitary napkins to manage discharge for the next several weeks." b. "Avoid sexual intercourse or becoming pregnant for the next 12 months." c. "If you should become pregnant, you will be at increased risk for preterm labor." d. "Your next menstrual cycle will be delayed because of this procedure."

A The effects of cryosurgery include a heavy, watery vaginal discharge for 3 to 6 weeks after the procedure. Clients are cautioned to avoid the use of tampons and intercourse during this time to reduce the risk for infection. The other statements are inaccurate.

A woman reports cyclical abdominal pain, and her pelvic examination reveals tender nodules in the posterior vagina. The nurse plans to educate the woman about which treatment? a. Medroxyprogesterone (Depo-Provera) b. Radiation therapy c. Doxycycline (Vibramycin) d. Endometrial ablation

A This client has manifestations of endometriosis, and menstrual cycle control is a common therapy. Oral contraceptives or injectables such as Depo-Provera are often used. Radiation therapy is used for cancer. Doxycycline is an antibiotic used for bacterial infection. Endometrial ablation is a treatment used for dysfunctional uterine bleeding.

A client is recovering from a hysteroscopic myomectomy. The nurse assesses the client and finds the following: 2+ bilateral pedal edema; pulse, 108 beats/min; and respiratory rate, 28 breaths/min. Which action by the nurse takes priority? a. Assess lung sounds and oxygen saturation. b. Call for an immediate electrocardiogram (ECG). c. Notify the health care provider as soon as possible. d. Review the client's intake and output pattern.

A This client has signs of fluid overload, which is a possible complication of hysteroscopic surgery. The nurse should assess the client's oxygenation status, then should notify the provider or call the Rapid Response Team. An ECG may be ordered but is not the priority, nor is reviewing intake and output patterns. Although the provider does need to be notified, the nurse needs further assessment data to report.

The nurse is teaching a woman's group about gynecologic cancers. Which does the nurse teach are risk factors? (Select all that apply.) a. Nulliparity b. Multiple sex partners c. Obesity d. Smoking e. Delayed first intercourse

A, B, C, D Nulliparity, smoking, and obesity are risk factors for uterine cancer. Risk factors for cervical cancer include multiple sex partners, obesity, and smoking. Early age at first intercourse (before 18) is a risk factor for cervical cancer

Which factors are considered to be indicative of a moderately increased risk of a client's developing breast cancer? (Select all that apply.) a. High postmenopausal bone density b. Ionizing radiation c. Family history of one first-degree relative d. Genetic factors e. First child born after age 30 f. Biopsy-confirmed atypical hyperplasia

A, B, C, F Factors considered to be indicative of a moderately increased risk of a client's developing breast cancer include high postmenopausal bone density, ionizing radiation, family history of one first-degree relative, and biopsy-confirmed atypical hyperplasia. Female gender and genetic factors are indicative of high increased risk. The first child born after age 30 is indicative of low increased risk of developing breast cancer.

A 48-year-old woman reports to the nurse about new "flooding" with her periods. Which other complaint is the nurse prepared to investigate more thoroughly? a. Hot flashes and sweating episodes b. Fatigue during typical activity c. More frequent periods than usual d. Abdominal cramping with periods

B A description of "flooding" during the menstrual cycle indicates heavy bleeding, which may be due to dysfunctional uterine bleeding (DUB). DUB usually occurs at the beginning or at the end of a woman's reproductive years. Because this woman is 48, she might be entering the perimenopausal period. Fatigue during usual activities can indicate anemia. Hot flashes with sweating are a manifestation of menopause. More frequent menstrual bleeding also occurs in DUB. Abdominal cramping may be normal for this client.

Which statement made by a client about breast cancer indicates correct understanding of the disease? a."Breast cancer is the leading cause of cancer deaths among women in the United States." b."Breast cancer is the leading type of cancer among women in North America." c."Late onset of menses and early menopause increase the risk for breast cancer." d."Breast cancer decreases with age, and very old women have virtually no risk."

B Breast cancer is the second most common form of cancer diagnosed in women (after skin cancer) and is the second leading cause of cancer deaths in women in the United States (after lung cancer). The incidence of breast cancer increases with age. Early onset of menses and late menopause increase the risk for breast cancer.

A woman had returned to the nursing unit after a total abdominal hysterectomy. After settling the client and performing a thorough assessment including vital signs, which action by the nurse is most important? a. Consult with physical therapy about ambulating the client. b. Obtain and apply sequential compression devices. c. Order the client's next-day chest x-ray and laboratory work. d. Assist the client to order light food items for dinner.

B Care of a client post-abdominal hysterectomy includes measures to prevent deep vein thrombosis and pulmonary embolism. The client needs sequential compression devices ordered and applied. The other actions might be needed, but they are not the priority.

Which action does the nurse teach the client to prevent toxic shock syndrome? a. "Use a barrier method of contraception." b. "Wash your hands before inserting a tampon." c. "Avoid intercourse with more than one partner." d. "Empty your bladder immediately after intercourse."

B Certain strains of Staphylococcus aureus, commonly found on skin surfaces, produce a toxin that can enter the bloodstream through the vaginal mucosa. Handwashing before tampon insertion reduces the chance that the organism will enter the vagina.

A woman has been told she has cervical polyps. Which statement by the client indicates a good understanding of the teaching the nurse provided? a. "I hope my polyp doesn't turn cancerous like colon polyps can." b. "These can be removed easily in the doctor's office with little pain." c. "I will need to have more frequent screening for cervical cancer." d. "I will need to finish all my medication before having sex again."

B Cervical polyps are benign growths. They can be removed easily in the physician's office with little to no pain. The other statements are inaccurate: Polyps are not related to cancer or to sexually transmitted diseases.

A woman has endometriosis and is visibly upset. She tells the nurse that she just got married and wants to have children but is distressed because now she will be infertile. Which response by the nurse is most appropriate? a. "Treatment for endometriosis often causes infertility; I can refer you to a support group." b. "Endometriosis is more common in infertile women, but not all treatments cause infertility." c. "You shouldn't worry about fertility until after we know that this didn't cause cancer." d. "Unfortunately, you will have to take birth control pills for the rest of your life."

B Endometriosis is more common among infertile women than in the general population. However, treatments can be chosen on the basis of symptoms, extent of the disease, and the woman's desire to remain fertile. Menstrual cycle control with hormones is often a choice and would not leave the woman infertile. Endometriosis only rarely causes cancer. The woman would not have to take birth control pills for the rest of her life.

A client has recently undergone an anterior colporrhaphy. Which is the most important discharge instruction that the nurse can provide? a. "Avoid sexual intercourse for 2 weeks." b. "Call us for fever and pain that does not improve." c. "Sutures will need to be removed in 2 weeks." d. "An ice pack on your incision will help the pain."

B Fever and pain may indicate an infection and should be reported. Sexual activity is restricted for 6 weeks. Sutures will absorb or fall out. Discomfort can be lessened with heat, not cold, therapy.

Which exercise plan or activity does the nurse teach the client for the first postoperative day after a modified radical mastectomy? a."Perform no movement or exercise today. Keep the arm supported and the elbow flexed, and as close to your body as possible." b."Without moving your shoulder, straighten your elbow three times hourly and squeeze a rubber ball with your fingers." c."Face the wall and extend your arm straight out to the wall. Walk your fingers as far above your head as your arm will reach, and then walk them back down." d."Hold your operative arm straight out from the shoulder to the side. Use your nonoperative arm to pull the operative arm completely straight above your head."

B Mild exercise begins on the first postoperative day. Exercises should not put stress on the incision and do not involve the shoulder at this point. Full extension of the elbow, with support, is important, as is using grip maneuvers for the hand on the affected side. Total immobility is not recommended. The other two exercises can be performed a few days after the operation.

A client asks how soon after a mastectomy she can engage in sexual activity. Which is the nurse's best response? a."When do you want to resume sexual activity?" b."Most surgeons say to wait several weeks after the operation." c."As soon as the incision has healed completely." d."You shouldn't worry about sexuality right now."

B Most surgeons prefer that the client wait 4 to 6 weeks postoperatively before resuming sexual activity, although this very personal advice should be individualized. Asking the client when she wants to resume sexual activity places the burden on her to make a tentative decision. Until the incision is healed, clients should be taught how to protect the incision and avoid contact with the surgical site during intercourse. Telling the client not to worry about sexuality is dismissing and disrespectful.

Why are the death rates from ovarian cancer so high? a. The causative oncovirus is resistant to chemotherapy and to radiation. b. No symptoms are obvious during the early stages of this disorder. c. Radiation therapy is ineffective because the ovaries are located deep in the pelvis. d. Ovarian cancer occurs mostly in women over the age of 70 who have other health problems.

B Ovarian cancer is poorly detected in its early stages, when the chances for cure or control are better. The other statements are inaccurate.

A client had a mastectomy and axillary node dissection. The nurse empties sanguineous drainage from the client's incisional Jackson-Pratt drain on the first postoperative day. Which other action regarding the drain is of high priority for the nurse? a.Flushing the tubing with urokinase to ensure patency b.Compressing and closing the drain to ensure suction c.Advancing the tubing inch from the insertion site d.Clamping the drain for 2 hours and releasing it for 2 hours

B The Jackson-Pratt drain removes fluid from the wound through closed suction. The drain must be compressed and closed to create suction as it slowly re-expands. The drain should never be flushed with urokinase, tubing should not be advanced, and the drain should not be clamped and released for 2 hours.

Which client does the nurse encourage to seek genetic counseling regarding her risk for BRCA1 or BCRA2 gene mutation-related breast cancer? a.Woman whose father had lung cancer and mother had leukemia b.Woman whose sister has breast cancer and mother has ovarian cancer c.Woman whose fraternal twin sister has breast cancer d.Older woman who has bilateral benign breast disease

B The best-defined increased genetic risk for breast cancer is related to mutations in the BRCA1 or BRCA2 gene. Families in which either of these genes is mutated have higher rates of breast and ovarian cancer in first-degree relatives. Being older is the primary risk factor for developing breast cancer but is not related to the genetic component; neither is benign breast disease. Lung cancer and leukemia are not genetically related to breast cancer. Having a twin with breast cancer does increase the genetic risk, but not as much as having two first-degree relatives with related cancers.

A client is experiencing lymphedema in the arm on the operative side after a modified radical mastectomy. Which statement indicates correct understanding of managing this problem? a."I will reduce my intake of salt and water." b."I will elevate my arm on a pillow at night." c."I will try to drink at least 3 liters of water each day." d."I will wear long sleeves to prevent sun exposure."

B The formation of edema is aggravated by having the arm in a position dependent to the heart. Elevating the arm as much as possible assists gravity to promote better venous and lymph return. This will be a more effective intervention than salt reduction or drinking large amounts of water. Preventing sun exposure will have no effect on the lymphedema.

The nurse is assessing a client with a history of ductal ectasia. Which signs and symptoms supporting this diagnosis does the nurse correlate with this condition? (Select all that apply.) a. A soft mass on palpation b. Greenish-brown nipple discharge c. Enlarged axillary nodes d. A mass with regular borders e. Redness and edema over the site of the mass f. Mass tenderness on palpation

B, C, E, F The benign condition, ductal ectasia, is caused by dilation and thickening of collecting ducts in the subareolar area. It results in activation of the inflammatory response when the ducts fill with cellular debris. Clinical manifestations of this condition include development of a hard mass with irregular borders that is tender on palpation. A greenish-brown nipple discharge, enlarged axillary nodes, and redness and edema over the site of the mass are also noted. Palpation of a soft mass or a mass with regular borders is not applicable to ductal ectasia.

Which intervention is essential for the nurse to perform for a client who had a total abdominal hysterectomy? a. Instruct the client on a low-fat diet. b. Monitor for the onset of menopause. c. Assess for problems with intercourse. d. Teach exercises to prevent incontinence.

C A hysterectomy and the accompanying menopause can lead to vaginal changes. Pain or difficulty with intercourse can occur, and the client should be reassured that gentle dilation will overcome this problem. Sexuality concerns should always be assessed in clients, particularly after they undergo procedures that can alter sexuality. The client would not necessarily need a low-fat diet, and the onset of menopause occurs with surgery. The client will not necessarily have incontinence.

A client had a posterior colporrhaphy. Which statement by the client indicates an adequate understanding of discharge instructions? a. "I'll eat a high-fiber diet so I won't get constipated again." b. "I'll expect my periods to decrease within the next 6 months." c. "I'll need to eat a low-residue diet." d. "I'll call the surgeon if I saturate more than one pad in 4 hours."

C A posterior colporrhaphy is a treatment for a rectocele. After-care instructions include a low-residue (fiber) diet and stool softeners to decrease stool numbers and straining. A high-fiber diet is used when rectoceles are managed medically. The repair will have no effect on vaginal bleeding or on the number of periods.

Which symptom experienced by a woman in her 20s alerts the nurse to the possibility of endometriosis? a. Bleeding between periods b. Cessation of menstruation c. Premenstrual tension headache d. Pain before the onset of menstrual flow

D Pain is the most common symptom of endometriosis. The peak of pain usually occurs just before the menstrual flow.

A client has just been diagnosed with fibrocystic breast disease. She asks what this means in terms of her health. Which is the nurse's best response? a."This increases your risk for breast cancer, so schedule yearly mammograms." b."This will increase as you age, especially if you have never been pregnant." c."This will diminish with menopause if you don't take replacement hormones." d."This is genetic and you should teach your daughters about it."

C Although the cause of fibrocystic breast changes is unknown, the condition seems to be related to normal fluctuations in estrogen levels during the menstrual cycle. Symptoms usually resolve after menopause in the absence of estrogen supplementation. The presence of fibrocystic breast changes does not necessarily increase the client's risk for breast cancer, will not necessarily increase with age, and does not routinely have a genetic component.

A client is being treated with anastrozole (Arimidex) for breast cancer. The nurse is developing a plan of care for the client. Which intervention is the highest priority? a. Teach the client to weigh herself each day at the same time. b. Instruct the client to keep a symptom journal for menopausal symptoms. c. Monitor the client closely for evidence of osteoporosis. d. Review the client's dietary habits to prevent weight gain.

C Arimidex is an aromatase inhibitor. A major side effect of the aromatase inhibitors is loss of bone density. Fluid retention, menopausal symptoms, and weight gain are not primary side effects of Arimidex or other aromatase inhibitors.

A woman is asking about monthly breast self-examination (BSE). What information does the nurse provide to the client? a. "It is a valuable tool for finding breast lumps early." b. "After menopause, it is no longer useful." c. "BSE should be combined with other assessments." d. "Women in their 30s should begin monthly BSE."

C BSE can be presented as an option for breast self-awareness. However, BSE is no better than awareness of normal breast findings. It is best when combined with clinical breast examinations and mammography. Women of all ages can practice BSE.

A woman has had recurrent Bartholin cysts. Which intervention is most appropriate for the nurse to add to the client's care plan? a. Assess the woman for sexually transmitted diseases (STDs). b. Prepare a family diagram to investigate a familial pattern. c. Teach the woman about surgical marsupialization. d. Instruct the woman to wear only cotton underwear.

C Bartholin cysts tend to recur and can be treated with surgical marsupialization, the creation of a pouch as a new opening for the cysts, so it does not become obstructed again. The woman should have already been screened for STDs, Bartholin cysts are not genetic in nature, and wearing cotton underwear will not prevent them from occurring.

For which problem are Kegel exercises recommended? a. Cyst b. Fistula c. Cystocele d. Rectocele

C Kegel exercises, alternately tightening and relaxing the pelvic floor muscles, can strengthen muscles sufficiently to support the bladder and reduce the discomfort that accompanies a cystocele. They are not used for treatment for a cyst or fistula. A rectocele, another type of pelvic organ prolapse, is managed by promoting bowel elimination.

A client with a family history of breast cancer tells the nurse that she has made several recent lifestyle changes. Which question by the nurse about these practices is most important? a. "Are you a vegetarian?" b. "Do you drink green tea?" c. "What supplements do you use?" d. "Do you smoke cigarettes?"

C Soy supplements in high amounts should be avoided by women who have breast cancer or who are at high risk for breast cancer. Dietary soy, eaten in normal amounts, does not appear to present the same risk. The other activities do not have the same risk as taking large quantities of soy supplements.

A client is postoperative from a left-sided mastectomy. She says that the incision and the inner side of her arm from the armpit to the elbow are numb. Which is the nurse's best action? a.Teach the client to avoid lifting heavy objects. b.Measure the circumference of the client's left arm. c.Reassure the client that this is an expected finding. d.Notify the surgeon as soon as possible.

C The nerves supplying the skin in the area were injured during surgery, decreasing sensation to the area. These problems frequently resolve over time. Teaching the client to avoid lifting heavy objects or measuring the circumference of the arm will not improve sensation to the client's arm. The surgeon does not need to be notified about normal findings.

A young woman calls the clinic to report a fever and a funny rash with peeling skin on the palms of her hands and the soles of her feet. Which action by the nurse is most appropriate? a. Make an appointment for her to be seen the next day at the clinic. b. Instruct her to take warm baths with oatmeal added to the water. c. Tell her to go to the emergency department immediately. d. Have her take acetaminophen (Tylenol) every 4 hours and drink fluids.

C These signs are consistent with toxic shock syndrome, a potentially life-threatening bacterial infection often associated with tampon use in menstruating women. The client requires immediate medical attention and should go to the nearest emergency department. Waiting until the next day, taking warm baths, and using symptom control measures such as Tylenol and fluids only lead to delay in obtaining necessary care.

The clinic nurse is preparing a client for a physical and breast examination. The nurse notes the client's breast appears as shown in the photograph below. Which action by the nurse takes priority? a. Continue preparations and note the finding in the client's chart. b. Ask the client how long this problem has been present. c. Alert the health care provider and prepare to order a mammogram. d. Question the client about routine drug and alcohol intake.

C This finding (dimpling of the skin) is suspicious for infiltrating ductal carcinoma. The nurse should alert the provider and prepare to order a mammogram for the client. In addition, the nurse should be prepared to refer the client to a breast specialist. The nurse does need to continue preparing the client and document the finding, but this is not as important as the mammogram and referral. Assessment can continue before, during, or after the examination, but is also not as vital as facilitating further diagnostic testing.

A client with pelvic organ prolapse has chosen treatment with a vaginal mesh. Which action by the nurse before the procedure is most important? a. Administering the preoperative sedative medication b. Giving the woman the manufacturer's labeling information c. Ensuring that the woman has a ride home after she recovers d. Witnessing the client signature on the informed consent

D All activities are important before surgery. However, the priority before any operation is to obtain informed consent. The nurse's main responsibilities regarding informed consent including having the client sign the form and witnessing the signature.

A woman is receiving radiation via brachytherapy for endometrial cancer. Which statement by the woman indicates a need for further education about the procedure? a. "I can go about my usual activities between sessions." b. "I might experience more fatigue than usual during therapy." c. "I should report any fever over 100 degrees to my doctor." d. "I must stay away from my young grandchildren for 6 weeks."

D Brachytherapy is provided mostly on an outpatient basis, and the client does not have restrictions placed on her interactions with her family during this time. The radiologist inserts an applicator into the woman's uterus through which the radioactive isotope is placed for treatment. After the treatment, the isotope and the applicator are removed. The other statements show good understanding of brachytherapy.

Which clinical manifestation in a client with invasive cervical cancer alerts the nurse to the possibility of metastasis? a. Amenorrhea b. Weight gain c. Breast tenderness d. Swelling of one leg

D Leg pain or unilateral swelling of a leg is a symptom of disease progression as the tumor enlarges, or of recurrent disease.

Which comment made by a client with breast cancer indicates correct understanding regarding cancer causes and prevention? a."I will prevent recurrence of my cancer by eating a low-fat diet from now on." b."If I had breast-fed my children, this would not have happened to me." c."I hope this doesn't increase my risk for bone cancer or lung cancer." d."I will have regular mammograms on my other breast to detect cancer early."

D Regular mammography can help detect breast cancer at an early stage. Women who have had breast cancer have a greater risk of developing cancer in the other breast. The other statements are inaccurate.

A client receiving tamoxifen (Tamofen) asks how this therapy helps fight breast cancer. Which is the nurse's best response? a."This agent decreases estrogen levels. so the cancer stops growing." b."The drug causes you to secrete testosterone, which limits cancer growth." c."Tamoxifen kills estrogen-secreting cells and growth of blood vessels to cancer cells." d."It blocks estrogen receptors, and this limits cancer cell growth."

D Tamoxifen is an estrogen antagonist-agonist. Its use in breast cancer is limited to cancers that express the estrogen receptor. Tamoxifen binds to estrogen receptors, inhibiting the binding of estrogen to receptors, thereby "starving" the cancer cells of an essential growth factor. The drug does not decrease circulating levels of estrogen, does not cause testosterone to be secreted instead of estrogen, and does not kill off estrogen-secreting cells.

A client has large breasts. Which health problem is she most likely to develop? a. Breast tenderness b. Breast cancer c. Chest pain d. Back pain

D The added weight of large breasts and the altered center of gravity increase spinal pull and contribute to back pain. She is not at risk for developing increased breast tenderness, cancer, or chest pain.

A client is crying because her endometrial cancer is scheduled to be treated with chemotherapy agents that will cause hair loss. Which is the most appropriate response from the nurse? a. "You should prepare yourself for total hair loss all over your body." b. "You can start shopping for wigs and scarves now so you'll have them available." c. "Why not shave your hair off now so that you can have it made into a wig?" d. "Would you like me to put you in touch with a former client so that you can talk?"

D The client should be given the opportunity to talk with someone who has undergone treatment with chemotherapy that causes hair loss. It would be ineffective for the nurse to suggest that the client should simply start shopping for wigs/scarves or shave her head. This would prevent the client from making her own decision. It would be incorrect for the nurse to tell the client that total body hair loss will occur. This may not happen. It depends completely on the agent given.

A client who has discovered a lump in her breast becomes tearful when scheduling a mammogram. Which is the nurse's best response? a."All lumps are considered cancerous until proven otherwise." b."Unless you have a relative with breast cancer, this lump is probably benign." c."Diagnosing cancer at this early stage is most likely to result in a cure." d."Many women have breast lumps, and most of the lumps are benign."

D The finding of a breast lump or mass is a frightening experience. Clients should be reassured, until they can be seen or testing is done, that 90% of all breast lumps or masses are benign. It is inaccurate for the nurse to state that all lumps are considered cancerous until proven benign, or that the lump is probably benign unless the client has a relative with breast cancer. Diagnosing cancer at an early stage results in cure more often than when the cancer is in later stages, but such a comment before diagnosis will only scare the client more.

A client is undergoing treatment for breast cancer and asks the nurse about "natural" treatments for her chemotherapy-induced nausea. Which is the most appropriate response by the nurse? a. "Anything you can take will interfere with your chemotherapy." b. "I don't know of any recommended complementary treatments for nausea." c. "Black cohosh and flaxseed are good for combating nausea." d. "Ginger has been used for nausea; would you consider taking it?"

D Up to 80% of women with breast cancer have used complementary therapies. Ginger, along with acupuncture, aromatherapy, hypnosis, progressive muscle relaxation, and shiatsu, has been used for nausea. Black cohosh and flaxseed are used for hot flashes. The client should check with her provider and other credible sources regarding any desired therapies to ensure that they won't interfere with the chemotherapy. Even if the nurse doesn't know of specific therapies, it is never appropriate to just say, "I don't know." The nurse should investigate for the client.

When the history of a female client is taken, which client statement does the nurse refer to the health care provider? a. "I had a fibroadenoma of the breast when I was 22 years old." b. "I had my first child when I was 26 years old and my second child when I was 32." c. "I stopped using oral contraceptives when I was no longer sexually active." d. "I had my menopause 2 years ago and have started to have vaginal bleeding again."

D Vaginal bleeding that occurs after menopause can indicate cancer and should be promptly evaluated. The other statements by the client would not be cause for alarm and would not need to be reported to the provider.

The client has been diagnosed with possible vulvovaginitis pending the outcome of laboratory tests. What information does the nurse teach the client? a. "Use sanitary pads, not tampons, when you have your period." b. "Limit douching to once a month or so, after your period." c. "Scrub your vulvar area with antibacterial soap when you bathe." d. "Wear only cotton underwear and wear looser jeans or slacks."

D Vulvovaginitis occurs as a result of imbalances in the hormones and florae of the vulva and/or vagina. Several causative factors are known, and self-care includes wearing cotton underwear and not wearing tight-fitting jeans or pants. Using tampons will not prevent it. Douching and washing the area with antibacterial soap should be avoided.