Unit 4: Chapters 56, 57, 58

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

A (Feedback: Although many patients experience minimal pain, it is still important to assess for this postsurgical complication. Sorrow and ineffective coping are possible, but neither is likely to be evident in the immediate postoperative period. There is minimal risk of trauma.)

A woman presents at the ED with sharp, colicky pain in her right abdomen that radiates to her right shoulder. She tells the nurse that she has been spotting lightly for the past few days. The patient is subsequently diagnosed with an ectopic pregnancy. What major nursing diagnosis most likely relates to this patients needs? A) Anxiety related to potential treatment options and health outcomes B) Chronic sorrow related to spontaneous abortion C) Chronic pain related to genitourinary trauma D) Impaired tissue integrity related to keloid scarring

A (Feedback: It is highly likely that the woman diagnosed with an ectopic pregnancy will experience intense anxiety. Pain and sorrow are also plausible, but are unlikely to become chronic. Impaired tissue integrity and keloid scarring are atypical.)

While taking a health history on a 20-year-old female patient, the nurse ascertains that this patient is taking miconazole (Monistat). The nurse is justified in presuming that this patient has what medical condition? A) Bacterial vaginosis B) Human papillomavirus (HPV) C) Candidiasis D) Toxic shock syndrome (TSS)

C (Feedback: Candidiasis is a fungal or yeast infection caused by strains of Candida. Miconazole (Monistat) is an antifungal medication used in the treatment of candidiasis. This agent is inserted into the vagina with an applicator at bedtime and may be applied to the vulvar area for pruritus. HPV, bacterial vaginosis, and TSS are not treated by Monistat.)

A community health nurse is leading a health education session addressing menopause and other aspects of women's health. What dietary supplements should the nurse recommend to prevent morbidity associated with osteoporotic fractures? A) Vitamin B12 and vitamin C B) Vitamin A and potassium C) Vitamin B6 and phosphorus D) Calcium and vitamin D

D (Feedback: Calcium and vitamin D supplementation may be helpful in reducing bone loss and preventing the morbidity associated with osteoporotic fractures. Phosphorus, potassium, vitamin B12, vitamin C, and vitamin B6 do not address this risk.)

A patient has herpes simplex 2 viral infection (HSV2). The nurse recognizes that which of the following should be included in teaching the patient? A) The virus causes cold sores of the lips. B) The virus may be cured with antibiotics. C) The virus, when active, may not be contracted during intercourse. D) Treatment is aimed at relieving symptoms.

D (Feedback: HSV-2 causes genital herpes and is known to ascend the peripheral sensory nerves and remain inactive after infection, becoming active in times of stress. The virus is not curable, but treatment is aimed at controlling symptoms. HSV1 causes cold sores, and varicella zoster causes shingles.)

The nurse is caring for a 52-year-old woman whose aunt and mother died of breast cancer. The patient states, My doctor and I talked about Tamoxifen to help prevent breast cancer. Do you think it will work? What would be the nurses best response? A) Yes, its known to have a slight protective effect. B) Yes, but studies also show an increased risk of osteoporosis. C) You wont need to worry about getting cancer as long as you take Tamoxifen. D) Tamoxifen is known to be a highly effective protective measure.

D (Feedback: Tamoxifen has been shown to be a highly effective chemo-preventive agent. However, it cannot reduce the risk of cancer by 100%. It also acts to prevent osteoporosis)

During the nurses assessment of a female patient, the patient reveals that she experienced sexual abuse when she was a young woman. What is the nurses most appropriate response to this disclosure? A) Reassure her that this information will be kept a secret. B) Begin the process of intensive psychotherapy. C) Encourage the patient to phone 911. D) Facilitate appropriate resources and referrals.

D (Feedback: The nurses primary roles in light of this disclosure are to provide empathy and to arrange for appropriate resources and referrals. There is no need to phone 911 and psychotherapy is beyond the nurses scope of practice. The patients confidentiality will be respected, but this does not mean that the nurse can promise to keep it a secret.)

The nurse is caring for a 63-year-old patient with ovarian cancer. The patient is to receive chemotherapy consisting of Taxol and Paraplatin. For what adverse effect of this treatment should the nurse monitor the patient? A) Leukopenia B) Metabolic acidosis C) Hyperphosphatemia D) Respiratory alkalosis

A (Feedback: Chemotherapy is usually administered IV on an outpatient basis using a combination of platinum and taxane agents. Paclitaxel (Taxol) plus carboplatin (Paraplatin) are most often used because of their excellent clinical benefits and manageable toxicity. Leukopenia, neurotoxicity, and fever may occur. Acid/base imbalances and elevated phosphate levels are not anticipated.)

A nurse is teaching a group of women about the potential benefits of breast self-examination (BSE). The nurse should teach the women that effective BSE is dependent on what factor? A) Women's knowledge of how their breasts normally look and feel B) The rapport that exists between the woman and her primary care provider C) Synchronizing women's routines around BSE with the performance of mammograms D) Women's knowledge of the pathophysiology of breast cancer

A (Feedback: Current practice emphasizes the importance of breast self-awareness, which is a woman's attentiveness to the normal appearance and feel of her breasts. BSE does not need to be synchronized with the performance of mammograms. Rapport between the patient and the care provider is beneficial, but does not necessarily determine the effectiveness of BSE. The woman does not need to understand the pathophysiology of breast cancer to perform BSE effectively.)

A couple has come to the infertility clinic because they have been unable to get pregnant even though they have been trying for over a year. Diagnostic tests are planned for the woman to ascertain if ovulation is regular and whether her endometrium is adequately supported for implantation. What test would the nurse expect to have ordered for this woman? A) Serum progesterone B) Abdominal CT C) Oocyte viability test D) Urine testosterone

A (Feedback: Diagnostic studies performed to determine if ovulation is regular and whether the progestational endometrium is adequate for implantation may include a serum progesterone level and an ovulation index. None of the other listed tests is used to investigate infertility.)

A patient has just been told she needs to have an incisional biopsy of a right breast mass. During preoperative teaching, how could the nurse best assess this patient for specific educational, physical, or psychosocial needs she might have? A) By encouraging her to verbalize her questions and concerns B) By discussing the possible findings of the biopsy C) By discussing possible treatment options if the diagnosis is cancer D) By reviewing her medical history

A (Feedback: During the preoperative visit, the nurse assesses the patient for any specific educational, physical, or psychosocial needs that she may have. This can be accomplished by encouraging her to verbalize her fears, concerns, and questions. Reviewing her medical history may be beneficial, but it is not the best way to ascertain her needs. Discussing possible findings of the biopsy and possible treatment options is the responsibility of the treating physician.)

An adolescent is brought to the clinic by her mother because of abnormal uterine bleeding. The nurse should understand that the most likely cause of this dysfunctional bleeding pattern is what? A) Lack of ovulation B) Chronic vaginitis C) A sexually transmitted infection D) Ectopic pregnancy

A (Feedback: Dysfunctional uterine bleeding can occur at any age, but is most common at opposite ends of the reproductive life span. It is usually secondary to anovulation (lack of ovulation) and is common in adolescents. It is not suggestive of vaginitis, an STI, or ectopic pregnancy.)

The nurse is caring for a patient who has just been told that her ovarian cancer is terminal and that no curative options remain. What would be the priority nursing care for this patient at this time? A) Provide emotional support to the patient and her family. B) Implement distraction and relaxation techniques. C) Offer to inform the patients family of this diagnosis. D) Teach the patient about the importance of maintaining a positive attitude.

A (Feedback: Emotional support is an integral part of nursing care at this point in the disease progression. It is not normally appropriate for the nurse to inform the family of the patients diagnosis. It may be inappropriate and simplistic to focus on distraction, relaxation, and positive thinking.)

A school nurse is presenting information on human development and sexuality. When describing the role of hormones in sexual development, which hormone does the nurse teach the class is the most important one for developing and maintaining the female reproductive organs? A) Estrogen B) Progesterone C) Androgens D) Follicle-stimulating hormone

A (Feedback: Estrogens are responsible for developing and maintaining the female reproductive organs. Progesterone is the most important hormone for conditioning the endometrium in preparation for implantation of the fertilized ovum. Androgens, secreted by the ovaries in small amounts, are involved in the early development of the follicle and affect the female libido. Follicle-stimulating hormone is responsible for stimulating the ovaries to secrete estrogen.)

The nurse is reviewing the physicians notes from the patient who has just left the clinic. The nurse learns that the physician suspects a malignant breast tumor. On palpation, the mass most likely had what characteristic? A) Non-tenderness B) A size of 5 mm C) Softness and a regular shape D) Mobility

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

A patient comes to the free clinic complaining of a gray-white discharge that clings to her external vulva and vaginal walls. A nurse practitioner assesses the patient and diagnoses Gardnerella vaginalis. What would be the most appropriate nursing action at this time? A) Advise the patient that this is an overgrowth of normal vaginal flora. B) Discuss the effect of this diagnosis on the patients fertility. C) Document the vaginal discharge as normal. D) Administer acyclovir as ordered.

A (Feedback: Gray-white discharge that clings to the external vulva and vaginal walls is indicative of an overgrowth of Gardnerella vaginalis. The patients discharge is not a normal assessment finding. Antiviral medications are ineffective because of the bacterial etiology. This diagnosis is unlikely to have a long-term bearing on the patients fertility.)

A female patient with HIV has just been diagnosed with condylomata acuminata (genital warts). What information is most appropriate for the nurse to tell this patient? A) This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) test annually. B) The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days. C) The potential for transmission to her sexual partner will be eliminated if condoms are used every time they have sexual intercourse D) The human papillomavirus (HPV), which causes condylomata acuminata, cannot be transmitted during oral sex.

A (Feedback: HIV-positive women have a higher rate of HPV. Infections with HPV and HIV together increase the risk of malignant transformation and cervical cancer. Thus, women with HIV infection should have frequent Pap smears. Because condylomata acuminata is a virus, there is no permanent cure. Because condylomata acuminata can occur on the vulva, a condom will not protect sexual partners. HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx.)

A patient has had a total mastectomy with immediate reconstruction. The patient asks the nurse when she can take a shower. What should the nurse respond? A) Not until the drain is removed B) On the second postoperative day C) Now, if you wash gently with soap and water D) Seven days after your surgery

A (Feedback: If immediate reconstruction has been performed, showering may be contraindicated until the drain is removed.)

A patient who is in the first trimester of pregnancy has experienced an incomplete abortion. The obstetric nurse should prepare the patient for what possible intervention? A) Dilation and evacuation B) Several days of bed rest C) Administration of hydromorphone D) IV administration of clomiphene

A (Feedback: If only some of the tissue is passed, the abortion is referred to as incomplete. An emptying or evacuation procedure (D&C, or dilation and evacuation [D&E]) or administration of oral misoprostol (Cytotec) is usually required to remove the remaining tissue. Bed rest will not necessarily result in the passing of all the tissue. Clomiphene and hydromorphone are of no therapeutic benefit.)

A nurse is caring for a pregnant patient with active herpes. The teaching plan for this patient should include which of the following? A) Babies delivered vaginally may become infected with the virus. B) Recommended treatment is excision of the herpes lesions. C) Pain generally does not occur with a herpes outbreak during pregnancy. D) Pregnancy may exacerbate the mothers symptoms, but poses no risk to the infant.

A (Feedback: In pregnant women with active herpes, babies delivered vaginally may become infected with the virus. There is a risk for fetal morbidity and mortality if this occurs. Lesions are not controlled with excision. Itching and pain accompany the process as the infected area becomes red and swollen. Aspirin and other analgesics are usually effective in controlling the pain.)

A patient who came to the clinic after finding a mass in her breast is scheduled for a diagnostic breast biopsy. During the nurses admission assessment, the nurse observes that the patient is distracted and tense. What is it important for the nurse to do? A) Acknowledge the fear the patient is likely experiencing. B) Describe the support groups that exist in the community. C) Assess the patients stress management skills. D) Document a nursing diagnosis of ineffective coping.

A (Feedback: In the breast cancer diagnostic phase it is appropriate to acknowledge the patients feelings of fear, concern, and apprehension. This must precede interventions such as referrals, if appropriate. Assessment of stress management skills made be necessary, but the nurse should begin by acknowledging the patients feelings. Fear is not necessarily indicative of ineffective coping.)

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

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

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

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

A patient who has had a lumpectomy calls the clinic to talk to the nurse. The patient tells the nurse that she has developed a tender area on her breast that is red and warm and looks like someone drew a line with a red marker. What would the nurse suspect is the woman's problem? A) Mondor disease B) Deep vein thrombosis (DVT) of the breast C) Recurrent malignancy D) An area of fat necrosis

A (Feedback: Superficial thrombophlebitis of the breast (Mondor disease) is an uncommon condition that is usually associated with pregnancy, trauma, or breast surgery. Pain and redness occur as a result of a superficial thrombophlebitis in the vein that drains the outer part of the breast. The mass is usually linear, tender, and erythematous. Fat necrosis is a condition of the breast that is often associated with a history of trauma. The scenario described does not indicate a recurrent malignancy. DVTs of the breast do not occur.)

A female patient tells the nurse that she thinks she has a vaginal infection because she has noted inflammation of her vulva and the presence of a frothy, yellow-green discharge. The nurse recognizes that the clinical manifestations described are typical of what vaginal infection? A) Trichomonas vaginalis B) Candidiasis C) Gardnerella D) Gonorrhea

A (Feedback: The clinical manifestations indicate T. vaginalis, which is treated with metronidazole in the form of oral tablets. Candidiasis produces a white, cheese-like discharge. Gardnerella is characterized by gray-white to yellow-white discharge clinging to external vulva and vaginal walls. Gonorrhea often produces no symptoms.)

The nurse is working with a patient who expects to begin menopause in the next few years. What educational topic should the nurse prioritize when caring for a healthy woman approaching menopause? A) Patient teaching and counseling regarding healthy lifestyles B) Referrals to local support groups C) Nutritional counseling regarding osteoporosis prevention D) Drug therapy options

A (Feedback: The individual womans evaluation of herself and her worth, now and in the future, is likely to affect her emotional reaction to menopause. Patient teaching and counseling regarding healthy lifestyles, health promotion, and health screening are of paramount importance. This broad goal of fostering healthy lifestyles transcends individual topics such as drug treatment, support groups, and osteoporosis prevention.)

A patient with trichomoniasis comes to the walk-in clinic. In developing a care plan for this patient the nurse would know to include what as an important aspect of treating this patient? A) Both partners will be treated with metronidazole (Flagyl). B) Constipation and menstrual difficulties may occur. C) The patient should perform Kegel exercises 30 to 80 times daily. D) Care will involve hormone therapy to control the pain

A (Feedback: The most effective treatment for trichomoniasis is metronidazole (Flagyl). Both partners receive a onetime loading dose or a smaller dose three times a day for 1 week. In pelvic inflammatory disease, menstrual difficulties and constipation may occur. Kegel exercises are prescribed to help strengthen weakened muscles associated with cystocele and other structural deficits. Hormone therapy does not address the etiology of trichomoniasis.)

You are caring for a patient who has been diagnosed with genital herpes. When preparing a teaching plan for this patient, what general guidelines should be taught? A) Thorough handwashing is essential. B) Sun bathing assists in eradicating the virus. C) Lesions should be massaged with ointment. D) Self-infection cannot occur from touching lesions during a breakout.

A (Feedback: The risk of reinfection and spread of infection to others or to other structures of the body can be reduced by handwashing, use of barrier methods with sexual contact, and adherence to prescribed medication regimens. The lesions should be allowed to dry. Touching of lesions during an outbreak should be avoided; if touched, appropriate hygiene practices must be followed)

A nurse practitioner is examining a patient who presented at the free clinic with vulvar pruritus. For which assessment finding would the practitioner look that may indicate the patient has an infection caused by Candida albicans? A) Cottage cheese-like discharge B) Yellow-green discharge C) Gray-white discharge D) Watery discharge with a fishy odor

A (Feedback: The symptoms of C. albicans include itching and a scant white discharge that has the consistency of cottage cheese. Yellow-green discharge is a sign of T. vaginalis. Gray-white discharge and a fishy odor are signs of G. vaginalis.)

A patient is to undergo an ultrasound-guided core biopsy. The patient tells the nurse that a friend of hers had a stereotactic core biopsy. She wants to understand the differences between the two procedures. What would be the nurses best response? A) An ultrasound-guided core biopsy is faster, less expensive, and does not use radiation. B) An ultrasound-guided core biopsy is a little more expensive, but it doesn't use radiation and it is faster. C) An ultrasound-guided core biopsy is a little more expensive, and it also uses radiation but it is faster. D) An ultrasound-guided core biopsy takes more time, and it also uses radiation, but it is less expensive.

A (Feedback: Ultrasound-guided core biopsy does not use radiation and is also faster and less expensive than stereotactic core biopsy.)

A public health nurse is participating in a campaign aimed at preventing cervical cancer. What strategies should the nurse include is this campaign? Select all that apply. A) Promotion of HPV immunization B) Encouraging young women to delay first intercourse C) Smoking cessation D) Vitamin D and calcium supplementation E) Using safer sex practices

A, B, C, E (Feedback: Preventive measures relevant to cervical cancer include regular pelvic examinations and Pap tests for all women, especially older women past childbearing age. Preventive counseling should encourage delaying first intercourse, avoiding HPV infection, participating in safer sex only, smoking cessation, and receiving HPV immunization. Calcium and vitamin D supplementation are not relevant.)

By initiating an assessment about sexual concerns what does the nurse convey to the patient? Select all that apply. A) That sexual issues are valid health issues B) That it is safe to talk about sexual issues C) That sexual issues are only a minor aspect a persons identity D) That changes or problems in sexual functioning should be discussed E) That changes or problems in sexual functioning are highly atypical

A, B, D (Feedback: By initiating an assessment about sexual concerns, the nurse communicates to the patient that issues about changes or problems in sexual functioning are valid and significant health issues. The nurse communicates that it is safe to talk about sexual issues and that changes or challenges in sexual function are not unusual.)

The nurse is assessing a 53-year-old woman who has been experiencing dysmenorrhea. What questions should the nurse include in an assessment of the patients menstrual history? Select all that apply. A) Do you ever experience bleeding after intercourse? B) How long is your typical cycle? C) Did you have any sexually transmitted infections in early adulthood? D) When did your mother and sisters get their first periods? E) Do you experience cramps or pain during your cycle?

A, B, E (Feedback: Menstrual history addresses such factors as the length of cycles, duration and amount of flow, presence of cramps or pain, and bleeding between periods or after intercourse. Family members menarche and prior STIs are not likely to affect the patients current cycles.)

A 42 year-old patient tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. She says that she is afraid that she has cancer. Which assessment finding would most strongly suggest that this patients lump is cancerous? A) Eversion of the right nipple and mobile mass B) A nonmobile mass with irregular edges C) A mobile mass that is soft and easily delineated D) Nonpalpable right axillary lymph nodes

B (Feedback: Breast cancer tumors are typically fixed, hard, and poorly delineated with irregular edges. A mobile mass that is soft and easily delineated is most commonly a fluid-filled benign cyst. Axillary lymph nodes may or may not be palpable on initial detection of a cancerous mass. Nipple retraction, not eversion, may be a sign of cancer.)

A patient with ovarian cancer is admitted to the hospital for surgery and the nurse is completing the patients health history. What clinical manifestation would the nurse expect to assess? A) Fish-like vaginal odor B) Increased abdominal girth C) Fever and chills D) Lower abdominal pelvic pain

B (Feedback: Clinical manifestations of ovarian cancer include enlargement of the abdomen from an accumulation of fluid. Flatulence and feeling full after a light meal are significant symptoms. In bacterial vaginosis, a fish-like odor, which is noticeable after sexual intercourse or during menstruation, occurs as a result of a rise in the vaginal ph. Fever, chills, and abdominal pelvic pain are atypical.)

A premenopausal patient is complaining of vaginal spotting and sharp, colicky lower abdominal pain. She informs the nurse that her period is 2 weeks late. The nurse should recognize a need for this patient to be investigated for what health problem? A) Trichomonas vaginalis B) Ectopic pregnancy C) Cervical cancer D) Fibromyalgia

B (Feedback: Clinical symptoms of an ectopic pregnancy include delay in menstruation of 1 to 2 weeks, vaginal spotting, and sharp, colicky pain. Trichomonas vaginalis causes a vaginal infection. Cervical cancer and fibromyalgia do not affect menstruation.)

A patient calls the clinic and tells the nurse she has thick white, curd-like discharge from her vagina. How should the nurse best interpret this preliminary data? A) The drainage is physiologic and normal. B) The patient may have a Candida species infection. C) The patient needs a Pap smear as soon as possible. D) The patient may have a Trichomonas infection.

B (Feedback: Drainage caused by Candida is typically curd-like and white. Trichomonas infections usually cause copious, frothy yellowish-green discharge. There is no immediate need for a Pap smear, as malignancy is an unlikely cause.)

A nurse is examining a patient who has been diagnosed with a fibroadenoma. The nurse should recognize what implication of this patients diagnosis? A) The patient will be scheduled for radiation therapy. B) The patient might be referred for a biopsy. C) The patients breast mass is considered an age-related change. D) The patients diagnosis is likely related to her use of oral contraceptives.

B (Feedback: Fibroadenomas are firm, round, movable, benign tumors. These masses are nontender and are sometimes removed for biopsy and definitive diagnosis. They are not considered to be an age-related change, even though they are benign. Radiation therapy is unnecessary and fibroadenomas do not result from oral contraceptive use.)

A 60-year-old man presents at the clinic complaining that his breasts are tender and enlarging. The patient is subsequently diagnosed with gynecomastia. The patient should be assessed for the possibility of what causative factor? A) Age-related physiologic changes B) Medication adverse effects C) Poor nutrition D) Fluid overload

B (Feedback: Gynecomastia can also occur in older men and usually presents as a firm, tender mass underneath the areola. In these patients, gynecomastia may be diffuse and related to the use of certain medications. It is unrelated to fluid overload or nutrition and is not considered an age-related change.)

When teaching patients about the risk factors of cervical cancer, what would the nurse identify as the most important risk factor? A) Late childbearing B) Human papillomavirus (HPV) C) Postmenopausal bleeding D) Tobacco use

B (Feedback: HPV is the most salient risk factor for cervical cancer, exceeding the risks posed by smoking, late childbearing, and postmenopausal bleeding.)

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

B (Feedback: If an ectopic pregnancy is suspected, the patient is assessed using ultrasound and hCG testing. CT and x-rays are contraindicated during pregnancy and estrogen and progesterone levels are not diagnostic of ectopic pregnancy.)

A patient is post-operative day 1 following a vaginal hysterectomy. The nurse notes an increase in the patients abdominal girth and the patient complains of bloating. What is the nurses most appropriate action? A) Provide the patient with an unsweetened, carbonated beverage. B) Apply warm compresses to the patients lower abdomen. C) Provide an ice pack to apply to the perineum and suprapubic region. D) Assist the patient into a prone position.

B (Feedback: If the patient has abdominal distention or flatus, a rectal tube and application of heat to the abdomen may be prescribed. Ice and carbonated beverages are not recommended and prone positioning would be uncomfortable.)

A woman's current health complaints are suggestive of a diagnosis of premenstrual dysphoric disorder (PMDD). The nurse should first do which of the following? A) Assess the patients understanding of HT. B) Assess the patient for risk of suicide. C) Assure the patient that the problem is self-limiting. D) Suggest the use of St. Johns wort.

B (Feedback: If the patient has severe symptoms of PMS or PMDD, the nurse assesses her for suicidal, uncontrollable, and violent behavior. The problem can escalate and is not necessarily self-limiting. HT is not a relevant intervention and the nurse should not recommend herbal supplements without input from the primary care provider.)

A nurse presenting an educational event for a local community group is addressing premenstrual syndrome (PMS). What treatment guideline should the nurse teach this group? A) Avoid excessive fluid intake. B) Increase the frequency and intensity of exercise. C) Limit psychosocial stressors in order to reduce symptoms. D) Take opioid analgesics as ordered.

B (Feedback: In general, the patient is encouraged to increase or initiate an exercise program to help relieve symptoms of PMS. Fluid intake should be increased. Opioids are not used to treat PMS. Stress reduction has multiple benefits, but it is not noted to alleviate the symptoms of PMS.)

A patient at high risk for breast cancer is scheduled for an incisional biopsy in the outpatient surgery department. When the nurse is providing preoperative education, the patient asks why an incisional biopsy is being done instead of just removing the mass. What would be the nurses best response? A) An incisional biopsy is performed because its known to be less painful and more accurate than other forms of testing. B) An incisional biopsy is performed to confirm a diagnosis and so that special studies can be done that will help determine the best treatment. C) An incisional biopsy is performed to assess the potential for recovery from a mastectomy. D) An incisional biopsy is performed on patients who are younger than the age of 40 and who are otherwise healthy.

B (Feedback: Incisional biopsy surgically removes a portion of a mass. This is performed to confirm a diagnosis and to conduct special studies that will aid in determining treatment. Incisional biopsies cannot always remove the whole mass, nor is it always beneficial to the patient to do so. The procedure is not chosen because of the potential for pain, the possibility of recovery from mastectomy, or the patients age.)

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

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

A 45-year-old woman comes into the health clinic for her annual check-up. She mentions to the nurse that she has noticed dimpling of the right breast that has occurred in a few months. What assessment would be most appropriate for the nurse to make? A) Evaluate the patients milk production. B) Palpate the area for a breast mass. C) Assess the patients knowledge of breast cancer. D) Assure the patient that this likely an age-related change.

B (Feedback: It would be most important for the nurse to palpate the breast to determine the presence of a mass and to refer the patient to her primary care provider. 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. Evaluation of milk production is required in lactating women. There is no indication of lactation in the scenario. The patients knowledge of breast cancer is relevant, but is not a time-dependent priority. This finding is not an age-related change.)

The nurse is performing a comprehensive health history of a patient who is in her 50s. The nurse should identify what risk factor that may increase this patients risk for breast cancer? A) The patient breastfed each of her children. B) The patient gave birth to her first child at age 38. C) The patient experienced perimenopausal symptoms starting at age 46. D) The patient experienced menarche at age 13.

B (Feedback: Late age at first pregnancy is a risk factor for breast cancer. None of the other listed aspects of the patients health history is considered to be a risk factor for breast cancer.)

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

B (Feedback: Men may be affected by varicoceles, varicose veins around the testicle, which decrease semen quality by increasing testicular temperature. Low prolactin levels may contribute to the problem. Genetic factors are not noted to relate to male infertility. Infertility is not normally linked to sperm that are incompatible with the shape of the egg.)

A 52-year-old woman has just been told she has breast cancer and is scheduled for a modified mastectomy the following week. The nurse caring for this patient knows that she is anxious and fearful about the upcoming procedure and the newly diagnosed malignancy. How can the nurse most likely alleviate this patients fears? A) Provide written material on the procedure that has been scheduled for the patient. B) Provide the patient with relevant information about expected recovery. C) Give the patient current information on breast cancer survival rates. D) Offer the patient alternative treatment options.

B (Feedback: Providing the patient with realistic expectations about the healing process and expected recovery can help alleviate fears. Offering the patient alternative treatment options is not within the nurses normal scope of practice. Addressing survival rates may or may not be beneficial for the patient. Written material is rarely sufficient to meet patients needs.)

A patient has been diagnosed with endometriosis. When planning this patients care, the nurse should prioritize what nursing diagnosis? A) Anxiety related to risk of transmission B) Acute pain related to misplaced endometrial tissue C) Ineffective tissue perfusion related to hemorrhage D) Excess fluid volume related to abdominal distention

B (Feedback: Symptoms of endometriosis vary but include dysmenorrhea, dyspareunia, and pelvic discomfort or pain. Dyschezia (pain with bowel movements) and radiation of pain to the back or leg may occur. Ineffective tissue perfusion is not associated with endometriosis and there is no plausible risk of fluid overload. Endometriosis is not transmittable.)

A new patient has come to the clinic seeking an appropriate method of birth control. What would the nurse teach this patient about a diaphragm? A) One size fits all females. B) The diaphragm may be cleaned with soap and water after use. C) A diaphragm eliminates the need for spermicidal jelly. D) The diaphragm should be removed 1 hour following intercourse

B (Feedback: The diaphragm may be cleaned with soap and water after use. It must be left in 6 hours after intercourse and should be used with spermicidal jelly. There are different sizes of diaphragms and the patient needs to be fitted by the health care practitioner.)

A 31-year-old patient has returned to the post-surgical unit following a hysterectomy. The patients care plan addresses the risk of hemorrhage. How should the nurse best monitor the patients postoperative blood loss? A) Have the patient void and have bowel movements using a commode rather than toilet. B) Count and inspect each perineal pad that the patient uses. C) Swab the patients perineum for the presence of blood at least once per shift. D) Leave the patients perineum open to air to facilitate inspection.

B (Feedback: To detect bleeding, the nurse counts the perineal pads used or checks the incision site, assesses the extent of saturation with blood, and monitors vital signs. The perineum is not swabbed and there is no reason to prohibit the use of the toilet. Absorbent pads are applied to the perineum; it is not open to air.)

A patient with a genital herpes exacerbation has a nursing diagnosis of acute pain related to the genital lesions. What nursing intervention best addresses this diagnosis? A) Cover the lesions with a topical antibiotic. B) Keep the lesions clean and dry. C) Apply a topical NSAID to the lesions. D) Remain on bed rest until the lesions resolve.

B (Feedback: To reduce pain, the lesions should be kept clean and proper hygiene practices maintained. Topical ointments are avoided and antibiotics are irrelevant due to the viral etiology. Activity should be maintained as tolerated.)

A patient comes to the clinic complaining of a tender, inflamed vulva. Testing does not reveal the presence of any known causative microorganism. What aspect of this patients current health status may account for the patients symptoms of vulvitis? A) The patient is morbidly obese. B) The patient has type 1 diabetes. C) The patient has chronic kidney disease. D) The patient has numerous allergies.

B (Feedback: Vulvitis, an inflammation of the vulva, may occur as a result of other disorders, such as diabetes, dermatologic problems, or poor hygiene. Obesity, kidney disease, and allergies are less likely causes than diabetes.)

A 14-year-old is brought to the clinic by her mother. The mother explains to the nurse that her daughter has just started using tampons, but is not yet sexually active. The mother states I am very concerned because my daughter is having a lot of stabbing pain and burning. What might the nurse suspect is the problem with the 14-year-old? A) Vulvitis B) Vulvodynia C) Vaginitis D) Bartholins cyst

B (Feedback: Vulvodynia is a chronic vulvar pain syndrome. Symptoms may include burning, stinging, irritation, or stabbing pain and may follow the initial use of tampons or first sexual experience. Vulvitis is an inflammation of the vulva that is normally infectious. Bartholin's cyst results from the obstruction of a duct in one of the paired vestibular glands located in the posterior third of the vulva, near the vestibule)

A patient is being discharged home from the ambulatory surgery center after an incisional biopsy of a mass in her left breast. What are the criteria for discharging this patient home? Select all that apply. A) Patient must understand when she can begin ambulating B) Patient must have someone to accompany her home C) Patient must understand activity restrictions D) Patient must understand care of the biopsy site E) Patient must understand when she can safely remove her urinary catheter

B, C, D (Feedback: Prior to discharge from the ambulatory surgical center or the office, the patient must be able to tolerate fluids, ambulate, and void. The patient must have somebody to accompany her home and would not be discharged with urinary catheter in place.)

A woman aged 48 years comes to the clinic because she has discovered a lump in her breast. After diagnostic testing, the woman receives a diagnosis of breast cancer. The woman asks the nurse when her teenage daughters should begin mammography. What is the nurses best advice? A) Age 28 B) Age 35 C) Age 38 D) Age 48

C (Feedback: A general guideline is to begin screening 5 to 10 years earlier than the age at which the youngest family member developed breast cancer, but not before age 25 years. In families with a history of breast cancer, a downward shift in age of diagnosis of about 10 years is seen. Because their mother developed breast cancer at age 48 years, the daughters should begin mammography at age 38 to 43 years.)

A patient has just been diagnosed with breast cancer and the nurse is performing a patient interview. In assessing this patients ability to cope with this diagnosis, what would be an appropriate question for the nurse to ask this patient? A) What is your level of education? B) Are you feeling alright these days? C) Is there someone you trust to help you make treatment choices? D) Are you concerned about receiving this diagnosis?

C (Feedback: A trusted ally to assist in making treatment choices is beneficial to the patients coping ability. It is condescending and inappropriate to ask if the patient is feeling alright these days or is concerned about the diagnosis. The patients education level is irrelevant.)

A patient has returned to the post-surgical unit after vulvar surgery. What intervention should the nurse prioritize during the initial postoperative period? A) Placing the patient in high Fowlers position B) Administering sitz baths every 4 hours C) Monitoring the integrity of the surgical site D) Avoiding analgesics unless the patients pain is unbearable

C (Feedback: An important intervention for the patient who has undergone vulvar surgery is to monitor closely for signs of infection in the surgical site, such as redness, purulent drainage, and fever. The patient should be placed in low Fowlers position to reduce pain by relieving tension on the incision. Sitz baths are discouraged after of wide excision of the vulva because of the risk of infection. Analgesics should be administered preventively on a scheduled basis to relieve pain and increase the patients comfort level.)

The nurse is taking the sexual history of an adolescent who has come into the free clinic. What question best assesses the patients need for further information? A) Are you involved in an intimate relationship at this time? B) How many sexual partners have you had? C) What questions or concerns do you have about your sexual health? D) Have you ever been diagnosed with a sexually transmitted infection?

C (Feedback: An open-ended question related to the patients need for further information should be included while obtaining a sexual history. None of the other listed questions are open-ended.)

A nurse practitioner is preparing to perform a patients scheduled Pap smear and the patient asks the nurse to ensure that the speculum is well-lubricated. How should the nurse proceed with assessment? A) Reassure the patient that ample petroleum jelly will be used. B) Reassure that patient that a water-based lubricant will be used. C) Explain to the patient that water is the only lubricant that can be used. D) Explain to the patient why the speculum must be introduced dry.

C (Feedback: Because lubricants may obscure cells on a Pap smear, warm water is the only lubricant that can be used)

A patient diagnosed with cervical cancer will soon begin a round of radiation therapy. When planning the patients subsequent care, the nurse should prioritize actions with what goal? A) Preventing hemorrhage B) Ensuring the patient knows the treatment is palliative, not curative C) Protecting the safety of the patient, family, and staff D) Ensuring that the patient adheres to dietary restrictions during treatment

C (Feedback: Care must be taken to protect the safety of patients, family members, and staff during radiation therapy. Hemorrhage is not a common complication of radiation therapy and the treatment can be curative. Dietary restrictions are not normally necessary during treatment.)

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

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

A 23-year-old woman comes to the free clinic stating I think I have a lump in my breast. Do I have cancer? The nurse instructs the patient that a diagnosis of breast cancer is confirmed by what? A) Supervised breast self-examination B) Mammography C) Fine-needle aspiration D) Chest x-ray

C (Feedback: Fine-needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis, although false/negative and false/positive findings are possibilities. A breast self-examination, if done regularly, is the most reliable method for detecting breast lumps early, but is not diagnostic of cancer. Mammography is used to detect tumors that are too small to palpate. Chest x-rays can be used to pinpoint rib metastasis. Neither test is considered diagnostic of breast cancer, however.)

The nurse is caring for a patient who has just had a radical mastectomy and axillary node dissection. When providing patient education regarding rehabilitation, what should the nurse recommend? A) Avoid exercise of the arm for next 2 months. B) Keep cuticles clipped neatly. C) Avoid lifting objects heavier than 10 pounds. D) Use a sling until healing is complete.

C (Feedback: Following an axillary dissection, the patient should avoid lifting objects greater than 5 to 10 pounds, cutting the cuticles, and undergoing venipuncture on the affected side. Exercises of the hand and arm are encouraged and the use of a sling is not necessary.)

A couple with a diagnosis of ovarian failure discusses their infertility options with their physician. The nurse should recognize which of the following as the treatment of choice for a patient with ovarian failure? A) Intracytoplasmic sperm injection B) Artificial insemination C) Gamete intrafallopian transfer D) In vitro fertilization

C (Feedback: Gamete intrafallopian transfer (GIFT), a variation of IVF, is the treatment of choice for patients with ovarian failure. In intracytoplasmic sperm injection (ICSI), an ovum is retrieved as described previously, and a single sperm is injected through the zona pellucida, through the egg membrane, and into the cytoplasm of the oocyte. The fertilized egg is then transferred back to the donor. ICSI is the treatment of choice in severe male factor infertility. IVF involves ovarian stimulation, egg retrieval, fertilization, and embryo transfer. Artificial insemination is the deposit of semen into the female genital tract by artificial means.)

A 51-year-old woman is experiencing perimenopausal symptoms and expresses confusion around the possible use of hormone therapy (HT). She explains that her mother and aunts used HT and she is unsure why few of her peers have been prescribed this treatment. What should the nurse explain to the patient? A) Large, long-term health studies have revealed that HT is minimally effective. B) HT has been largely replaced by other nonpharmacologic interventions. C) Research has shown that significant health risks are associated with HT. D) HT has been shown to exacerbate symptoms of menopause in a minority of women.

C (Feedback: HT is effective, but has been associated with serious adverse effects. However, it does not exacerbate the symptoms of menopause. Nonpharmacologic interventions that address perimenopausal symptoms have not yet been identified.)

When reviewing the electronic health record of a female patient, the nurse reads that the patient has a history of adenomyosis. The nurse should be aware that this patient experiences symptoms resulting from what pathophysiologic process? A) Loss of muscle tone in the vaginal wall B) Excessive synthesis and release of unopposed estrogen C) Invasion of the uterine wall by endometrial tissue D) Proliferation of tumors in the uterine wall

C (Feedback: In adenomyosis, the tissue that lines the endometrium invades the uterine wall. This disease is not characterized by loss of muscle tone, the presence of tumors, or excessive estrogen.)

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

C (Feedback: Instead of tight-fitting synthetic, nonabsorbent, heat-retaining underwear, cotton underwear is recommended to prevent vaginal infections. Douching is generally discouraged, as is the use of feminine hygiene products. Daily bathing is not restricted.)

A patient has been diagnosed with polycystic ovary syndrome (PCOS). The nurse should encourage what health promotion activity to address the patients hormone imbalance and infertility? A) Kegel exercises B) Increased fluid intake C) Weight loss D) Topical antibiotics as ordered

C (Feedback: Lifestyle modification is critical in the treatment of PCOS, and weight management is part of the treatment plan. As little as a weight loss of 5% of total body weight can help with hormone imbalance and infertility. Antibiotics are irrelevant, as PCOS does not have an infectious etiology. Fluid intake and Kegel exercises do not influence the course of the disease.)

A 30-year-old patient has come to the clinic for her yearly examination. The patient asks the nurse about ovarian cancer. What should the nurse state when describing risk factors for ovarian cancer? A) Use of oral contraceptives increases the risk of ovarian cancer. B) Most cases of ovarian cancer are attributed to tobacco use. C) Most cases of ovarian cancer are considered to be random, with no obvious causation. D) The majority of women who get ovarian cancer have a family history of the disease.

C (Feedback: Most cases of ovarian cancer are random, with only 5% to 10% of ovarian cancers having a familial connection. Contraceptives and tobacco have not been identified as major risk factors.)

During a recent visit to the clinic a woman presents with erythema of the nipple and areola on the right breast. She states this started several weeks ago and she was fearful of what would be found. The nurse should promptly refer the patient to her primary care provider because the patients signs and symptoms are suggestive of what health problem? A) Peau d'orange B) Nipple inversion C) Pagets disease D) Acute mastitis

C (Feedback: Pagets disease presents with erythema of the nipple and areola. Peau d'orange, which is associated with breast cancer, is caused by interference with lymphatic drainage, but does not cause these specific signs. Nipple inversion is considered normal if long-standing; if it is associated with fibrosis and is a recent development, malignancy is suspected. Acute mastitis is associated with lactation, but it may occur at any age.)

A 45-year-old woman has just undergone a radical hysterectomy for invasive cervical cancer. Prior to the surgery the physician explained to the patient that after the surgery a source of radiation would be placed near the tumor site to aid in reducing recurrence. What is the placement of the source of radiation called? A) Internal beam radiation B) Trachelectomy C) Brachytherapy D) External radiation

C (Feedback: Radiation, which is often part of the treatment to reduce recurrent disease, may be delivered by an external beam or by brachytherapy (method by which the radiation source is placed near the tumor) or both.)

A student nurse is caring for a patient who has undergone a wide excision of the vulva. The student should know that what action is contraindicated in the immediate postoperative period? A) Placing patient in low Fowlers position B) Application of compression stockings C) Ambulation to a chair D) Provision of a low-residue diet

C (Feedback: Sitting in a chair would not be recommended immediately in the postoperative period. This would place too much tension on the incision site. A low Fowlers position or, occasionally, a pillow placed under the knees, will reduce pain by relieving tension on the incision. Application of compression stocking would prevent a deep vein thrombosis from occurring. A low-residue diet would be ordered to prevent straining on defecation and wound contamination.)

The nurse is utilizing the PLISSIT model of sexual health assessment during an interaction with a new patient. According to this model, the nurse should begin with what action? A) Conducting a preliminary assessment B) Addressing the patients psychosocial status C) Asking the patients permission to discuss sexuality D) Assessing for physiologic problems

C (Feedback: The PLISSIT model of sexual assessment begins with permission and subsequently includes limited information, specific suggestions, and intensive therapy.)

A woman scheduled for a simple mastectomy in one week is having her preoperative education provided by the clinic nurse. What educational intervention will be of primary importance to prevent hemorrhage in the postoperative period? A) Limit her intake of green leafy vegetables. B) Increase her water intake to 8 glasses per day. C) Stop taking aspirin. D) Have nothing by mouth for 6 hours before surgery.

C (Feedback: The nurse should instruct the patient to stop taking aspirin due to its anticoagulant effect. Limiting green leafy vegetables will decrease vitamin K and marginally increase bleeding. Increasing fluid intake or being NPO before surgery will have no effect on bleeding.)

When planning discharge teaching with a patient who has undergone a total mastectomy with axillary dissection, the nurse knows to instruct the patient that she should report what sign or symptom to the physician immediately? A) Fatigue B) Temperature greater than 98.5F C) Sudden cessation of output from the drainage device D) Gradual decline in output from the drain

C (Feedback: The patient should report sudden cessation of output from the drainage device, which could indicate an occlusion. Gradual decline in output is expected. A temperature of 100.4F or greater should also be reported to rule out postoperative infection, but a temperature of 98.5F is not problematic. Fatigue is expected during the recovery period.)

A patient is being discharged home after a hysterectomy. When providing discharge education for this patient, the nurse has cautioned the patient against sitting for long periods. This advice addresses the patients risk of what surgical complication? A) Pudendal nerve damage B) Fatigue C) Venous thromboembolism D) Hemorrhage

C (Feedback: The patient should resume activities gradually. This does not mean sitting for long periods, because doing so may cause blood to pool in the pelvis, increasing the risk of thromboembolism. Sitting for long periods after a hysterectomy does not cause postoperative nerve damage; it does not increase the fatigue factor after surgery or the risk of hemorrhage.)

The nurse leading an educational session is describing self-examination of the breast. The nurse tells the women's group to raise their arms and inspect their breasts in a mirror. A member of the women's group asks the nurse why raising her arms is necessary. What is the nurses best response? A) It helps to spread out the fat that makes up your breast. B) It allows you to simultaneously assess for pain. C) It will help to observe for dimpling more closely. D) This is what the American Cancer Society recommends.

C (Feedback: The primary reason for raising the arms is to detect any dimpling. To elicit skin dimpling or retraction that may otherwise go undetected, the examiner instructs the patient to raise both arms overhead. Citing American Cancer Society recommendations does not address the woman's question. The purpose of raising the arms is not to elicit pain or to redistribute adipose tissue.)

The school nurse is presenting a class on female reproductive health. The nurse should describe what aspect of Pap smears? A) The test may be performed at any time during the patients menstrual cycle. B) The smear should be done every 2 years. C) The test can detect early evidence of cervical cancer. D) False/positive Pap smear results occur mostly from not douching before the examination.

C (Feedback: The test should be performed when the patient is not menstruating. Douching washes away cellular material. The test detects cervical cancer, and false/negative Pap smear results occur mostly from sampling errors or improper technique. For most women, a Pap smear should be done annually.)

A patient in her late fifties has expressed to the nurse her desire to explore hormone replacement therapy (HRT). Based on what aspect of the patients health history is HRT contraindicated? A) History of vaginal dryness B) History of hot flashes and night sweats C) History of vascular thrombosis D) Family history of osteoporosis

C (Feedback: The use of HRT is contraindicated in women with a history of vascular thrombosis, active liver disease, some cases of uterine cancer, and undiagnosed vaginal bleeding. HRT is beneficial in women with a risk for osteoporosis. Vaginal dryness, hot flashes, and night sweats are symptoms of menopause that may be relieved with HRT.)

The nurse is assessing a patient who believes that she has recently begun menopause. What principle should inform the nurses interactions with this patient? A) The nurse should express empathy for the patients difficult health situation. B) The nurse should begin by assuring the patient that her health will be much better in a few years. C) The nurse must carefully assess the patients feelings and beliefs surrounding menopause. D) The nurse should encourage the patient to celebrate this life milestone and its accompanying benefits.

C (Feedback: Women have widely varying views on menopause and the nurse must ascertain these. It is wrong to presume either a positive or negative view of this transition without first performing assessment.)

A 48-year-old woman presenting for care is seeking information about hormone therapy (HT) for the treatment of her perimenopausal symptoms. The patients need for relief from hot flashes and other symptoms will be weighed carefully against the increased risks of what complications of HT? Select all that apply. A) Anaphylaxis B) Osteoporosis C) Breast cancer D) Cardiovascular disease E) Venous thromboembolism

C, D, E (Feedback: Although HT decreases hot flashes and reduces the risk of osteoporotic fractures as well as colorectal cancer, studies have shown that it increases the risk of breast cancer, heart attack, stroke, and blood clots. There is no significant risk of anaphylaxis.)

The nurse notes that a patient has a history of fibroids and is aware that this term refers to a benign tumor of the uterus. What is a more appropriate term for a fibroid? A) Bartholin's cyst B) Dermoid cyst C) Hydatidiform mole D) Leiomyoma

D (Feedback: A leiomyoma is a usually benign tumor of the uterus, commonly referred to as a fibroid. A Bartholin's cyst is a cyst in a paired vestibular band in the vulva, whereas a dermoid cyst is a benign tumor that is thought to arise from parts of the ovum and normally disappears with maturation. A hydatidiform mole is a type of gestational neoplasm.)

A 25-year-old patient diagnosed with invasive cervical cancer expresses a desire to have children. What procedure might the physician offer as treatment? A) Radical hysterectomy B) Radical culposcopy C) Radical trabeculectomy D) Radical trachelectomy

D (Feedback: A procedure called a radical trachelectomy is an alternative to hysterectomy in women with invasive cervical cancer who are young and want to have children. In this procedure, the cervix is gripped with retractors and pulled down into the vagina until it is visible. The affected tissue is excised while the rest of the cervix and uterus remain intact. A drawstring suture is used to close the cervix. For a woman who wants to have children, a radical hysterectomy would not provide the option of children. A radical culposcopy and a radical trabeculectomy are simple distracters for this question.)

A patient with genital herpes is having an acute exacerbation. What medication would the nurse expect to be ordered to suppress the symptoms and shorten the course of the infection? A) Clotrimazole (Gyne-Lotrimin) B) Metronidazole (Flagyl) C) Podophyllin (Podofin) D) Acyclovir (Zovirax)

D (Feedback: Acyclovir (Zovirax) is an antiviral agent that can suppress the symptoms of genital herpes and shorten the course of the infection. It is effective at reducing the duration of lesions and preventing recurrences. Clotrimazole is used in the treatment of yeast infections. Metronidazole is the most effective treatment for trichomoniasis. Posophyllin is used to treat external genital warts. Acyclovir is used in the treatment of genital herpes.)

The nurse is teaching breast self-examination (BSE) to a group of women. The nurse should recommend that the women perform BSE at what time? A) At the time of menses B) At any convenient time, regardless of cycles C) Weekly D) Between days 5 and 7 after menses

D (Feedback: BSE is best performed after menses, on day 5 to day 7, counting the first day of menses as day 1. Monthly performance is recommended.)

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

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

A 35-year-old mother of three young children has been diagnosed with stage II breast cancer. After discussing treatment options with her physician, the woman goes home to talk to her husband, later calling the nurse for clarification of some points. The patient tells the nurse that the physician has recommended breast conservation surgery followed by radiation. The patients husband has done some online research and is asking why his wife does not have a modified radical mastectomy to be sure all the cancer is gone. What would be the nurses best response? A) Modified radical mastectomies are very hard on a patient, both physically and emotionally and they really aren't necessary anymore. B) According to current guidelines, having a modified radical mastectomy is no longer seen as beneficial. C) Modified radical mastectomies have a poor survival rate because of the risk of cancer recurrence. D) According to current guidelines, breast conservation combined with radiation is as effective as a modified radical mastectomy.

D (Feedback: Breast conservation along with radiation therapy in stage I and stage II breast cancer results in a survival rate equal to that of modified radical mastectomy. Mastectomies are still necessary in many cases, but are not associated with particular risk of recurrence.)

A woman is considering breast reduction mammoplasty. When weighing the potential risks and benefits of this surgical procedure, the nurse should confirm that the patient is aware of what potential consequence? A) Chronic breast pain B) Unclear mammography results C) Increased risk of breast cancer D) Decreased nipple sensation

D (Feedback: During the preoperative consultation, the patient should be informed of a possibility that sensory changes of the nipple (e.g., numbness) may occur. There is no consequent increase in breast cancer risk and it does not affect future mammography results. Chronic pain is not an expected complication.)

A 51-year-old woman has come to the OB/GYN clinic for her annual physical. She tells the nurse that she has been experiencing severe hot flashes, but that she is reluctant to begin hormone therapy (HT). What potential solution should the nurse discuss with the patient? A) Sodium restriction B) Adopting a vegan diet C) Massage therapy D) Vitamin supplements

D (Feedback: For some women, vitamins B6 and E have proven beneficial for the treatment of hot flashes. Sodium restriction, vegan diet, and massage have not been noted to relieve this symptom of perimenopause.)

A woman calls the clinic and tells the nurse she has had bloody drainage from her right nipple. The nurse makes an appointment for this patient, expecting the physician or practitioner to order what diagnostic test on this patient? A) Breast ultrasound B) Radiography C) Positron emission testing (PET) D) Galactography

D (Feedback: Galactography is a diagnostic procedure that involves injection of less than 1 mL of radiopaque material through a cannula inserted into the ductal opening on the areola, which is followed by mammography. It is performed to evaluate an abnormality within the duct when the patient has bloody nipple discharge on expression, spontaneous nipple discharge, or a solitary dilated duct noted on mammography. X-ray, PET, and ultrasound are not typically used for this purpose.)

A nurse has assessed that a patient is not yet willing to view her mastectomy site. How should the nurse best assist the patient is developing a positive body image? A) Ask the woman to describe the current appearance of her breast. B) Help the patient to understand that many women have gone through the same unpleasant experience. C) Explain to the patient that her body image does not have to depend on her physical appearance. D) Provide the patient with encouragement in an empathic and thoughtful manner

D (Feedback: Gentle encouragement can help the patient progress toward accepting the change in her appearance. The nurse should not downplay the significance of physical appearance. Explaining that others have had similar experiences may or may not benefit the patient. Asking the patient to describe the appearance of her breast is likely to exacerbate the woman's reluctance to do so.)

The nurse is working with a couple who is being evaluated for infertility. What nursing intervention would be most appropriate for this couples likely needs? A) Educating them about parenting techniques in order to foster hope B) Educating them about the benefits of child-free living C) Choosing the most appropriate reproductive technology D) Referring them to appropriate community resources

D (Feedback: Nursing interventions appropriate when working with couples during infertility evaluations include referring the couple to appropriate resources when necessary. It would likely be considered offensive and insensitive to focus the couple on parenting skills or the benefits of child-free living. Choosing particular reproductive technologies is beyond the nurses scope of practice.)

A patient states that PMS that is significantly disrupting her quality of life and that conservative management has failed to produce relief. What pharmacologic treatment may benefit this patient? A) An opioid analgesic B) A calcium channel blocker C) A monoamine oxidase inhibitor (MAOI) D) A selective serotonin reuptake inhibitor (SSRI)

D (Feedback: Pharmacologic remedies for PMS include selective serotonin reuptake inhibitors. MAOIs are not used for this purpose. Calcium channel blockers and opioids would not lead to symptom relief.)

A 27-year-old primipara presents to the ED with vaginal bleeding and suspected contractions. The woman relates that she is 14 weeks pregnant and she thinks she is losing her baby. Diagnostic testing confirms a spontaneous abortion. What nursing action would be a priority at this time? A) Leave the patient alone so she can grieve in private. B) Teach the patient that this will not affect her future chance of conception. C) Take the patient off the obstetric floor so she will not hear a baby cry. D) Provide opportunities for the patient to talk and express her emotions.

D (Feedback: Providing opportunities for the patient to talk and express her emotions is helpful and also provides clues for the nurse in planning more specific care. The patient may or may not want to be alone, but the nurse should first determine her wishes. It would be inappropriate to refer to future pregnancies during this acute time of loss. It would not be necessary or practical to remove the patient from the unit.)

A woman is being treated for a tumor of the left breast. If the patient and her physician opt for prophylactic treatment, the nurse should prepare the woman for what intervention? A) More aggressive chemotherapy B) Left mastectomy C) Radiation therapy D) Bilateral mastectomy

D (Feedback: Right mastectomy would be considered a prophylactic measure to reduce the risk of cancer in the patients unaffected breast. None of the other listed interventions would be categorized as being prophylactic rather than curative.)

The nurse is teaching a patient preventative measures regarding vaginal infections. The nurse should include which of the following as an important risk factor? A) High estrogen levels B) Late menarche C) Nonpregnant state D) Frequent douching

D (Feedback: Risk factors associated with vulvovaginal infections include pregnancy, pre-menarche, low estrogen levels, and frequent douching.)

A nurse providing prenatal care to a pregnant woman is addressing measures to reduce her postpartum risk of cystocele, rectocele, and uterine prolapse. What action should the nurse recommend? A) Maintenance of good perineal hygiene B) Prevention of constipation C) Increased fluid intake for 2 weeks postpartum D) Performance of pelvic muscle exercises

D (Feedback: Some disorders related to relaxed pelvic muscles (cystocele, rectocele, and uterine prolapse) may be prevented. During pregnancy, early visits to the primary provider permit early detection of problems. During the postpartum period, the woman can be taught to perform pelvic muscle exercises, commonly known as Kegel exercises, to increase muscle mass and strengthen the muscles that support the uterus and then to continue them as a preventive action. Fluid intake, prevention of constipation, and hygiene do not reduce this risk.)

A 17-year-old girl has come to the free clinic for her annual examination. She tells the nurse she uses tampons and asks how long she may safely leave her tampon in place. What is the nurses best response? A) You may leave the tampon in overnight. B) The tampon should be changed at least twice per day. C) Tampons are dangerous and, ideally, you should not be using them. D) Tampons need to be changed every 4 to 6 hours.

D (Feedback: Tampons should not be used for more than 4 to 6 hours, nor should super-absorbent tampons be used because of the association with toxic shock syndrome. If used appropriately, it is acceptable and safe for the patient to use tampons.)

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

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

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

D (Feedback: The intestinal tract and the bladder need to be empty before the patient is taken to the OR to prevent contamination and injury to the bladder or intestinal tract. The patient is informed that her periods are now over, but she may have a slightly bloody discharge for a few days. The patient is instructed to avoid straining, lifting, or driving until her surgeon permits her to resume these activities. The patients hormonal balance is upset, which usually occurs in reproductive system disturbances. The patient may experience depression and heightened emotional sensitivity to people and situations.)

A patient in her 30s has two young children and has just had a modified radical mastectomy with immediate reconstruction. The patient shares with the nurse that she is somewhat worried about her future, but she appears to be adjusting well to her diagnosis and surgery. What nursing intervention is most appropriate to support this patients coping? A) Encourage the patients spouse or partner to be supportive while she recovers. B) Encourage the patient to proceed with the next phase of treatment. C) Recommend that the patient remain optimistic for the sake of her children. D) Arrange a referral to a community-based support program.

D (Feedback: The patient is not exhibiting clear signs of anxiety or depression. Therefore, the nurse can probably safely approach her about talking with others who have had similar experiences. The nurse may educate the patients spouse or partner to listen for concerns, but the nurse should not tell the patients spouse what to do. The patient must consult with her physician and make her own decisions about further treatment. The patient needs to express her sadness, frustration, and fear. She cannot be expected to be optimistic at all times)

A 27-year-old female patient is diagnosed with invasive cervical cancer and is told she needs to have a hysterectomy. One of the nursing diagnoses for this patient is disturbed body image related to perception of femininity. What intervention would be most appropriate for this patient? A) Reassure the patient that she will still be able to have children. B) Reassure the patient that she does not have to have sex to be feminine. C) Reassure the patient that you know how she is feeling and that you feel her anxiety and pain. D) Reassure the patient that she will still be able to have intercourse with sexual satisfaction and orgasm.

D (Feedback: The patient needs reassurance that she will still have a vagina and that she can experience sexual intercourse after temporary postoperative abstinence while tissues heal. Information that sexual satisfaction and orgasm arise from clitoral stimulation rather than from the uterus reassures many women. Most women note some change in sexual feelings after hysterectomy, but they vary in intensity. In some cases, the vagina is shortened by surgery, and this may affect sensitivity or comfort. It would be inappropriate to reassure the patient that she will still be able to have children; there is no reason to reassure the patient about not being able to have sex. There is no way you can know how the patient is feeling and it would be inappropriate to say so.)

A patient has presented for her annual mammogram. The patient voices concerns related to exposure to radiation. What should the nurse teach the patient about a mammogram? A) It does not use radiation. B) Radiation levels are safe as long as mammograms are performed only once per year. C) The negative effects of radiation do not accumulate until late in life. D) Radiation from a mammogram is equivalent to an hour of sunlight.

D (Feedback: The radiation exposure of mammogram is equivalent to about 1 hour of exposure to sunlight. Consequently, the benefits of mammography far outweigh any risks associated with the procedure. Negative consequences are insignificant, and do not accumulate later in life.)

A female patient who has cognitive and physical disabilities has come into the clinic for a routine check- up. When planning this patients assessment, what action should the nurse take? A) Ensure that a chaperone is available to be present during the assessment. B) Limit the length and scope of the health assessment. C) Avoid health promotion or disease prevention education. D) Avoid equating the patient with her disabilities.

D (Feedback: When working with women who have disabilities, it is important that the nurse avoid equating the woman with her disability; the nurse must make an effort to understand that the patient and the disability are not synonymous. A chaperone is not necessarily required and there may or may not be a need to abbreviate the assessment. The nurse should provide education as needed.)

A clinic nurse is meeting with a 38-year-old patient who states that she would like to resume using oral contraceptives, which she used for several years during her twenties. What assessment question is most likely to reveal a potential contraindication to oral contraceptive use? A) Have you ever had surgery? B) Have you ever had a sexually transmitted infection? C) When did you last have your blood sugar levels checked? D) Do you smoke?

D (Feedback: Women who smoke and who are 35 years of age or older should not take oral contraceptives because of an increased risk for cardiac problems. Previous surgeries, STIs, and blood sugar instability do not necessarily contraindicate the use of oral contraceptives.)

For which of the following population groups would an annual clinical breast examination be recommended? A) Women over age 21 B) Women over age 25 C) Women over age 40 D) All post-pubescent females with a family history of breast cancer

C (Feedback: Annual clinical breast examination is recommended for women aged 40 years and older. Younger women may have examinations less frequently)

The nurse is working with a couple who have been unable to conceive despite more than 2 years of trying to get pregnant. The couple has just learned that in vitro fertilization (IVF) was unsuccessful and they are both tearful. What nursing diagnosis is most likely to apply to this couple? A) Hopelessness related to failed IVF B) Acute confusion related to reasons for failed IVF C) Compromised family coping related to unsuccessful IVF D) Moral distress related to unsuccessful IVF

A (Feedback: Although further assessment is undoubtedly necessary, it is likely that the couple will be experiencing hopelessness at the news that a potentially promising intervention has failed. Acute confusion denotes a cognitive deficit, not a sense of despair. Sadness at this news is not necessarily suggestive of impaired coping. Moral distress is unlikely because this is not a situation involving morality.)

A nurse is collecting assessment data from a premenopausal patient who states that she does not have menses. What term should the nurse use to document the absence of menstrual flow? A) Amenorrhea B) Dysmenorrhea C) Menorrhagia D) Metrorrhagia

A (Feedback: Amenorrhea refers to absence of menstrual flow, whereas dysmenorrhea is painful menstruation. Menorrhagia, also called hypermenorrhea, is defined as prolonged or excessive bleeding at the time of the regular menstrual flow. Metrorrhagia refers to vaginal bleeding between regular menstrual periods.)

A patient has been referred to the breast clinic after her most recent mammogram revealed the presence of a lump. The lump is found to be a small, well-defined nodule in the right breast. The oncology nurse should recognize the likelihood of what treatment? A) Lumpectomy and radiation B) Partial mastectomy and radiation C) Partial mastectomy and chemotherapy D) Total mastectomy and chemotherapy

A (Feedback: Treatment for breast cancer depends on the disease stage and type, the patients age and menopausal status, and the disfiguring effects of the surgery. For this patient, lumpectomy is the most likely option because the nodule is well-defined. The patient usually undergoes radiation therapy afterward. Because a lumpectomy is possible, mastectomy would not be the treatment of choice.)

A new mother who is breastfeeding calls the clinic to speak to a nurse. The patient is complaining of pain in her left breast and describes her breast as feeling doughy. The nurse tells her to come into the clinic and be checked. The patient is diagnosed with acute mastitis and placed on antibiotics. What comfort measure should the nurse recommend? A) Apply cold compresses as ordered. B) Avoid wearing a bra until the infection clears. C) Avoid washing the breasts. D) Perform gentle massage to stimulate neutrophil migration.

A (Feedback: Treatment of mastitis consists of antibiotics and local application of cold compresses to relieve discomfort. A broad-spectrum antibiotic agent may be prescribed for 7 to 10 days. The patient should wear a snug bra and perform personal hygiene carefully. Massage is not recommended.)

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

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

The nurse is planning the sexual assessment of a new adolescent patient. The nurse should include what assessment components? Select all that apply. A) Physical examination findings B) Laboratory results C) Health history D) Interpersonal skills E) Understanding of menopause

A, B, C (Feedback: A sexual assessment includes both subjective and objective data. Health and sexual histories, physical examination findings, and laboratory results are all part of the database. A sexual assessment would not normally include the patients interpersonal skills. It is not likely to necessary to assess an adolescents understanding of menopause.)

A patient has been discharged home after a total mastectomy without reconstruction. The patient lives alone and has a home health referral. When the home care nurse performs the first scheduled visit this patient, what should the nurse assess? Select all that apply. A) Adherence to the exercise plan B) Overall psychological functioning C) Integrity of surgical drains D) Understanding of cancer E) Use of the breast prosthesis

A, B, C (Feedback: Patients who have difficulty managing their postoperative care at home may benefit from a home health care referral. The home care nurse assesses the patients incision and surgical drain(s), adequacy of pain management, adherence to the exercise plan, and overall physical and psychological functioning. It is unnecessary to assess the patients understanding of cancer at this stage of recovery. Prostheses may be considered later in the recovery process.)

The nurse is being trained to perform assessment screenings for abuse on patients who come into the walk-in clinic where the nurse works. Which of the following assessment questions is most appropriate? A) Would you describe your relationship as healthy and functional? B) Have you ever been forced into sexual activity? C) Do you make your husband uncontrollably angry? D) How is conflict usually handled in your home?

B (Feedback: Asking about abuse directly is effective in identifying the presence of abuse and should be included in the health history of all women. Oblique questions that relate to the character of the relationship or conflict resolution are less useful clinically. Asking about making a partner angry is not an appropriate way to screen for family violence because it does not directly address the problem.)

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

B (Feedback: Because of the wide excision, the patient may experience severe pain and discomfort even with minimal movement. Therefore, analgesic agents are administered preventively (i.e., around the clock at designated times) to relieve pain, increase the patients comfort level, and allow mobility. Opioids are usually required.)

A middle-aged female patient has been offered testing for HIV/AIDS upon admission to the hospital for an unrelated health problem. The nurse observes that the patient is visibly surprised and embarrassed by this offer. How should the nurse best respond? A) Most women with HIV don't know they have the disease. If you have it, its important we catch it early. B) This testing is offered to every adolescent and adult regardless of their lifestyle, appearance or history. C) The rationale for this testing is so that you can begin treatment as soon as testing comes back, if its positive. D) You're being offered this testing because you are actually in the prime demographic for HIV infection.

B (Feedback: Because patients may be reluctant to discuss risk-taking behavior, routine screening should be offered to all women between the ages of 13 to 64 years in all health care settings. Assuring a woman that the offer of testing is not related to a heightened risk may alleviate her anxiety. Middle-aged women are not the prime demographic for HIV infection. The nurse should avoid causing fear by immediately discussing treatment or the fact that many patients are unaware of their diagnosis.)

A 36-year-old woman comes to the clinic complaining of premenstrual syndrome (PMS) that is disrupting her quality of life. What signs and symptoms are associated with this health problem? Select all that apply. A) Loss of appetite B) Breast tenderness C) Depression D) Fluid retention E) Headache

B, C, D, E (Feedback: Physiologic symptoms of PMS include headache, breast tenderness, and fluid retention as well as affective symptoms, such as depression. Loss of appetite is not noted to be among the most common symptoms.)