Reproductive System ATI-Med/Surg
An older adult client is having an annual physical exam at a provider's office. Which of the following client findings indicates additional follow-up is needed in regard to the prostate gland? (Select all that apply.) A. Prostate-specific antigen (PSA) is 7.1 ng/mL. B. A digital rectal exam (DRE) reveals an enlarged prostate that is smooth and firm. C. The client reports a weak urine stream. D. The client reports urinating once during the night. E. Smegma is present below the glands of the penis.
A. CORRECT: Although the PSA level typically is elevated in an older adult male, a PSA level of greater than 4 ng/mL warrants additional follow-up. B. INCORRECT: A prostate that is enlarged and smooth is an expected finding in an older adult male. C. CORRECT: A weak urine stream is a clinical manifestation of benign prostatic hyperplasia and warrants follow-up. D. INCORRECT: Urinating once during the night is an expected finding for an older adult male. E. INCORRECT: Smegma is a normal secretion that can accumulate beneath the glans penis.
A nurse is assisting with discharge of a client who has had an anterior and posterior colporrhaphy. Which of the following instructions should the nurse provide? A. "Do not bend over for at least 6 weeks." B. "You can lift objects as heavy as 10 pounds." C. "Do not engage in intercourse for at least 6 weeks." D. "You may have foul-smelling draining within the first week after surgery."
A. CORRECT: Clients who have fibrocystic breast condition typically have breast pain and rubbery lumps in the upper outer quadrant of the breasts. B. INCORRECT: BRCA1 gene mutation is a risk factor for breast cancer. C. INCORRECT: An elevated CA-125 is a finding associated with ovarian cancer. D. INCORRECT: Peau d'orange dimpling of the breast is a finding associated with breast cancer.
A nurse in a provider's office is reviewing information with a client who has dysfunctional uterine bleeding (DUB). Which of the following statements by the client indicate understanding of the information? (Select all that apply.) A. "My heavy bleeding may be due to a hormonal imbalance." B. "If I do not ovulate, my menstrual flow will be lighter." C. "Oral contraceptives are contraindicated for women who have heavy uterine bleeding like mine." D. "My doctor may perform a D&C to find out what's causing my abnormal bleeding." E. "My condition is more common in women who are in their 30s."
A. CORRECT: DUB can be caused by a progesterone deficiency. B. INCORRECT: Anovulation is associated with a deficiency in estrogen and progesterone, which contributes to DUB. C. INCORRECT: DUB occurs when progesterone levels are low. Contraceptives that contain progestin can be used to treat the condition. D. CORRECT: When the provider performs a dilatation and curettage, endometrium scraped from the uterine wall is sent to the laboratory for evaluation. E. INCORRECT: DUB is more common in young women who are just starting to menstruate and in women who are nearing menopause.
A nurse is reviewing the medical record of a client who has premenstrual syndrome (PMS). Which of the following medications are used to treat premenstrual syndrome? (Select all that apply.) A. Fluoxetine (Prozac) B. Spironolactone (Aldactone) C. Ethinyl estradiol/drospirenone (Yasmin) D. Ferrous sulfate (Feosol) E. Methylergonovine (Methergine)
A. CORRECT: Fluoxetine, an SSRI, is used to treat the emotional symptoms of PMS, such as irritability and mood swings, and has an added effect of treating physical symptoms. B. CORRECT: Spironolactone is a diuretic and can reduce bloating and weight gain associated with PMS. C. CORRECT: Oral contraceptives that contain drospirenone reduce the symptoms of PMS. D. INCORRECT: Oral iron supplements, such as ferrous sulfate, are used to treat anemia associated with dysfunctional uterine bleeding. E. INCORRECT: Methylergonovine is used to treat postpartum hemorrhage.
A nurse is instructing a client how to perform Kegel exercises. Which of the following instructions should the nurse include? (Select all that apply.) A. Perform a set of exercises four times a daily. B. Contract the circumvaginal and/or perirectal muscles. C. Gradually increase the contraction period to 10 seconds. D. Follow each contraction with at least a 10-second relaxation period. E. Perform while sitting, lying, and standing. F. Tighten abdominal muscles during contractions.
A. CORRECT: The client should perform a set of exercises at least four times a day. B. CORRECT: The client should contract her circumvaginal and perirectal muscles as if trying to stop the flow of urine or passing flatus. C. CORRECT: The client should hold the contraction for 10 seconds. She might need to gradually increase the contraction period to reach this goal. D. CORRECT: The client should follow each contraction with a period of relaxation of 10 to 15 seconds. E. CORRECT: The client should perform the exercises in all three positions. F. INCORRECT: The client should relax her other muscles, such as those in her abdomen and her thighs.
A nurse is reviewing postoperative information with a client who is scheduled for a transurethral resection of the prostate (TURP). Which of the following information should the nurse include in the discussion? A. "You may have a continuous sensation of needing to void even though you have a catheter." B. "You will be on bed rest for the first 2 days after the procedure." C. "You will be instructed to limit your fluid intake after the procedure." D. "Your urine should be clear yellow the evening after the surgery."
A. CORRECT: To reduce the risk of postoperative bleeding, the client will have a catheter with a large balloon that places pressure on the internal sphincter of the bladder. Pressure on the sphincter causes a continuous sensation of needing to void. B. INCORRECT: The client is ambulated early in the postoperative period to reduce the risk of deep‑vein thrombosis and other complications that occur due to immobility. C. INCORRECT: The client is encouraged to increase his fluid intake unless contraindicated by another condition. A liberal fluid intake reduces the risks of urinary tract infection and dysuria. D. INCORRECT: The client's urine is expected to be pink the first 24 hr after surgery.
A nurse in a provider's office is reviewing information with an older adult client who is to have prostate‑specific antigen (PSA) and a digital rectal exam (DRE). Use the ATI Active Learning Template: Diagnostic Procedure to complete this item to include the following: A. Description of the procedures and the order in which they are performed. B. Nursing Actions: Identify two factors that place the client at risk for prostate cancer.
A. Description of the procedures and the order in which they are performed ●● PSA: A blood sample is taken to measure a specific protein produced by the prostate gland that is present in the bloodstream. The PSA is performed first because examination of the prostate (DRE) irritates the prostate and can cause the PSA to rise. ●● DRE: With the client leaning over the exam table, placed on his side, or in the lithotomy position, the examiner uses a gloved, lubricated finger to palpate the prostate through the rectal wall to identify any abnormalities in size, shape, and consistency. B. Nursing Actions ●● African American descent ●● Family history of prostate cancer
A nurse is reviewing information with a client who is scheduled for a transrectal ultrasound (TRUS). Which of the following information should the nurse include? A. "This procedure will determine whether you have prostate cancer." B. "The provider will insert a finger into your anus during the procedure." C. "Sound waves will be used to create a picture of your prostate." D. "An anesthetic will be used during the procedure."
A. INCORRECT: A biopsy is used to make the diagnosis of prostate cancer. B. INCORRECT: A rectal probe transducer is inserted into the client's rectum when a TRUS is performed. C. CORRECT: A TRUS creates an image of the prostate using sound waves. D. INCORRECT: Anesthesia is not used for this procedure.
A nurse is reinforcing education about menstruation with an adolescent female client. Which of the following statements should the nurse include? (Select all that apply.) A. "The average age of onset of menstruation for girls in the U.S. is 11." B. "The range for a typical menstrual cycle is between 21 and 42 days." C. "The first day of the menstrual cycle begins with the last day of the menstrual period." D. "Ovulation typically occurs around the 14th day of the menstrual cycle." E. "It is not unusual for a menstrual period to last as long as 7 days."
A. INCORRECT: Although some females experience the onset of menstruation as early as age 11, the average age is 13. B. CORRECT: Although a typical menstrual cycle is 28 days, a range of 21 to 42 days is considered a regular menstrual cycle. C. INCORRECT: The first day of the menstrual cycle begins with the first day of the menstrual period. D. CORRECT: The first half of the menstrual cycle is the follicular phase, and the second half of the menstrual cycle is the luteal phase. Ovulation typically occurs around the middle of the cycle, or day 14 in a 28-day menstrual cycle. E. CORRECT: A menstrual period typically lasts from 4 to 7 days.
A nurse in a provider's office is obtaining a history from a client who is being evaluated for benign prostatic hyperplasia (BPH). Which of the following findings are indicative of this condition? (Select all that apply.) A. Backache B. Frequent urinary tract infections C. Weight loss D. Hematuria E. Urinary incontinence
A. INCORRECT: Backache occurs in the presence of prostate cancer that has spread to other areas of the body. B. CORRECT: In the presence of BPH, pressure on urinary structures leads to urinary stasis, which in turn promotes the occurrence of urinary tract infections. C. INCORRECT: Weight loss occurs in the presence of prostate cancer. D. CORRECT: Painless hematuria occurs in the presence of BPH. E. CORRECT: Overflow incontinence occurs in the presence of BPH due to an increased volume of residual urine.
A client who is menopausal asks the nurse about use of herbal therapy to treat hot flashes. Which of the following herbal supplements should the nurse recommend? A. Ginger root B. Black cohosh C. Saw palmetto D. Kava
A. INCORRECT: Ginger root is used to treat nausea and vomiting. B. CORRECT: The action of black cohosh is unknown. However, research studies indicate it is useful in the treatment of menopausal symptoms, including hot flashes. C. INCORRECT: Saw palmetto is used to treat benign prostate hyperplasia. D. INCORRECT: Kava is used to treat anxiety. However, it can cause severe liver damage, and its use is not recommended.
A nurse is providing support to a client who has a recent diagnosis of endometriosis. The nurse should reinforce with the client that which of the following conditions is a complication of endometriosis? A. Insulin resistance B. Infertility C. Vaginitis D. Pelvic inflammatory disease
A. INCORRECT: Insulin resistance is a complication of polycystic ovary syndrome. B. CORRECT: Infertility is a complication of endometriosis because endometrial tissue overgrowth can block the fallopian tubes. C. INCORRECT: Vaginitis is typically caused by an infection. D. INCORRECT: Pelvic inflammatory disease is caused by an infection of the pelvic organs.
A nurse is caring for a client who has a new diagnosis of benign prostatic hyperplasia (BPH). The nurse should anticipate a prescription for which of the following medications? A. Oxybutynin (Ditropan) B. Diphenhydramine C. Ipratropium (Atrovent) D. Tamsulosin (Flomax)
A. INCORRECT: Oxybutynin is an anticholinergic medication that is used to treat overactive bladder. Anticholinergic medications are contraindicated for a client who has BPH. Oxybutynin causes urinary retention. B. INCORRECT: Diphenhydramine is an antihistamine and is contraindicated for a client who has BPH. Diphenhydramine causes urinary retention. C. INCORRECT: Ipratropium is an anticholinergic used to treat asthma and other respiratory conditions. Anticholinergic medications are contraindicated for a client who has BPH. Ipratropium causes urinary retention. D. CORRECT: Tamsulosin is an alpha-adrenergic receptor antagonist that relaxes the bladder outlet and the prostate gland, which improves urinary flow.
A nurse is collecting data from a client admitted for an anterior colporrhaphy. The nurse should recognize that which of the following client statements validates the need for this type of surgery? A. "I have to push the feces out of a pouch in my vagina with my fingers." B. "I have pain and bleeding when I have a bowel movement." C. "I have had frequent urinary tract infections." D. "I am embarrassed by uncontrollable flatus."
A. INCORRECT: Pouching of feces is a physiological alteration associated with a rectocele. The surgical procedure for a rectocele is posterior colporrhaphy. B. INCORRECT: Pain and bleeding with a bowel movement is a physiological alteration associated with a rectocele. The surgery for a rectocele is a posterior colporrhaphy. C. CORRECT: Due to urinary stasis associated with a cystocele, this finding is consistent with a cystocele. The surgery for a cystocele is an anterior colporrhaphy. D. INCORRECT: Uncontrollable flatus is a physiological alteration associated with a rectocele. The surgery for a rectocele is a posterior colporrhaphy.
A nurse is reviewing instructions with a client before a mammogram. Which of the following should the nurse instruct the client to avoid prior to the procedure? A. Multivitamin B. Deodorant C. Sexual intercourse D. Exercise
A. INCORRECT: Taking a multivitamin does not alter the accuracy of a mammogram. B. CORRECT: Applying deodorant or powder can alter the accuracy of a mammogram by causing a shadow to appear. C. INCORRECT: Having sexual intercourse does not alter the accuracy of a mammogram. D. INCORRECT: Exercising does not alter the accuracy of a mammogram.
A nurse in a clinic is reviewing the facility's testing process and procedures for human immune deficiency virus (HIV) with a new employee. Which of the following information should the nurse include in the review? A. In the presence of HIV, the enzyme immunoassay (EIA) test is typically reactive within 72 hr after the client is infected. B. The Western blot assay is used to confirm the diagnosis of HIV. C. The polymerase chain reaction (PRC) test is used to confirm the diagnosis of HIV. D. In the presence of HIV the enzyme immunoassay (EIA) test is typically reactive within 48 hr after the client is infected.
A. INCORRECT: The EIA test is typically reactive 3 weeks to 3 months after the infection occurs, but it can be delayed for as long as 36 months. B. CORRECT: Confirming HIV is a two-step process. If the EIA is positive, a second test, the Western blot assay, is done. C. INCORRECT: The PRC test is used to confirm the diagnosis of genital herpes. D. INCORRECT: The EIA test is typically reactive 3 weeks to 3 months after the infection occurs, but it can be delayed for as long as 36 months.
A nurse in a provider's office is reviewing a client's laboratory results. The client's rapid plasma regain (RPR) is positive. Which of the following tests confirm the diagnosis of syphilis? A. Venereal disease research laboratory (VDRL) B. D-dimer C. Treponema pallidum particle agglutination assay D. Sickledex
A. INCORRECT: The VDRL is another screening test for syphilis. B. INCORRECT: The D-dimer is a test used measure fibrin and is used to diagnose disseminated intravascular coagulation. C. CORRECT: The treponema pallidum particle agglutination assay is used to confirm the diagnosis of syphilis. D. INCORRECT: The sickledex is used to diagnose sickle cell anemia.
A nurse is assisting with discharge of a client who has had an anterior and posterior colporrhaphy. Which of the following instructions should the nurse provide? A. "Do not bend over for at least 6 weeks." B. "You can lift objects as heavy as 10 pounds." C. "Do not engage in intercourse for at least 6 weeks." D. "You may have foul-smelling draining within the first week after surgery."
A. INCORRECT: The client does not have a restriction regarding bending over. B. INCORRECT: The client should not lift an object that weighs more than 5 lb. C. CORRECT: The client should refrain from intercourse to allow time for the surgical site to heal, which is typically about 6 weeks. D. INCORRECT: Foul-smelling draining is a sign of infection, which should be reported to the provider.
A nurse is preparing a client for her first Papanicolaou (Pap) test. Which of the following statements is appropriate for the nurse to make? A. "You should urinate immediately after the procedure is over." B. "You will not feel any discomfort." C. "You may experience some bleeding after the procedure." D. "You will need to hold your breath during the procedure."
A. INCORRECT: The client is instructed to urinate immediately before the procedure. B. INCORRECT: The client can experience discomfort when the provider obtains the cervical sample. C. CORRECT: The client can experience a small amount of vaginal bleeding due to scraping of the cervix. D. INCORRECT: The client should use relaxation techniques such as taking deep breaths during the procedure.
A nurse is reinforcing discharge instructions with a client who is postoperative from a TURP. Which of the following instructions should the nurse include? (Select all that apply.) A. Avoid sexual intercourse for 3 months after the surgery. B. If urine appears bloody, stop activity and rest. C. Avoid drinking caffeinated beverages. D. Take a stool softener once a day. E. Treat pain with ibuprofen (Motrin).
A. INCORRECT: The client should follow the provider's instructions, which typically includes avoidance of sexual intercourse for 2 to 6 weeks after the surgery. B. CORRECT: Excessive activity can cause recurrence of bleeding. The client should rest to promote reclotting at the incisional site. C. CORRECT: Caffeine is a bladder stimulant and should be avoided. D. CORRECT: The client should take a stool softener to keep the stool soft and thus prevent the complication of bleeding at the time of a bowel movement. E. INCORRECT: The client should avoid taking nonsteroidal anti-inflammatory medications because they can cause bleeding.
A nurse is reinforcing instructions for a client who is scheduled for a cervical biopsy. Which of the following should the nurse include in the instructions? (Select all that apply.) A. "The procedure is painless." B. "Avoid heavy lifting for approximately 2 weeks after the procedure." C. "Heavy bleeding is common during the first 12 hours after the procedure." D. "Plan to rest for the first 72 hours after the procedure." E. "Avoid the use of tampons for 2 weeks after the procedure."
A. INCORRECT: Typically, the client will experience temporary discomfort and cramping when the specimen is obtained. B. CORRECT: The client should avoid heavy lifting until the cervix has healed, which is approximately 2 weeks. C. INCORRECT: Some bleeding is common after a cervical biopsy, but excessive bleeding is a complication and should be reported to the provider. D. INCORRECT: The client should plan to rest for the first 24 hr after the procedure. E. CORRECT: The client should not use tampons until the cervix has healed, which is approximately 2 weeks.
A nurse is reinforcing teaching with a client who has a new prescription for finasteride (Proscar) about the medication. Use the ATI Active Learning Template: Medication to complete this item to include the following sections: A. Therapeutic Uses: Identify the therapeutic use of this medication for this client. B. Client Education: Identify four instructions the nurse should include.
A. Therapeutic Uses ●● Finasteride inhibits 5-alpha reductase and enzyme, which converts testosterone to dihydrotesterone. Production of testosterone in the prostate gland is reduced, which in turn reduces the size of prostate tissue. B. Client Education ●● The medication must be taken on a long-term basis. It can take as long as 1 year before the effects of the medication are evident. ●● Impotence and a decreased libido are possible adverse effects. ●● Report breast enlargement to the provider. ●● Finasteride is teratogenic to the male fetus. The medication can be absorbed through the skin. Pregnant women should not be in contact with tablets.
A nurse is preparing to review teaching with a client on medications used to treat fibrocystic breast condition. Use the ATI Active Learning Template: Medication to complete this item. Include the following section: Therapeutic Uses - Identify three classes of medications that are used to treat the condition, and provide a brief description of the purpose of the medications in treating fibrocystic breast condition.
Using the ATI Active Learning Template: Medication ●● Therapeutic Uses ◯◯ Analgesics, such as acetaminophen (Tylenol) or ibuprofen (Motrin), are used to relieve pain. ◯◯ Oral contraceptives suppress estrogen/progesterone secretion. ◯◯ Diuretics decrease breast engorgement. ◯◯ Androgen/anabolic steroids (danazol) suppress ovarian function. ◯◯ Vitamin E reduces pain.