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A 30-year-old woman has an appointment for a routine pelvic examination. She asks the office nurse when she should begin undergoing routine mammography. 1. If the client is asymptomatic and at low risk for breast cancer, the nurse would be correct in advising her to have a baseline mammogram at what age? [ ] 1. 35 [ ] 2. 45 [ ] 3. 50 [ ] 4. 55

1. 3. Although the American Cancer Society continues to recommend that all women have an initial baseline mammogram beginning at age 40, the U.S. Preventive Services Task Force recently indicated that routine mammograms can be delayed until age 50. The recommendation was based on statistics that indicate the risk for breast cancer between ages 40 and 50 is only 1.4%. Several studies suggest that screening for high-risk women with a family history of breast cancer should begin approximately 10 years before the age of diagnosis of the family member with breast cancer.

The office manager schedules a mandatory staff meeting for all nursing personnel. As the nurse enters the room, several documents containing the client's name, medical records number, mammogram results, and diagnosis are found unattended on the table. 10. Which nursing actions are appropriate in this situation? Select all that apply. [ ] 1. Notify housekeeping to come and dispose of the papers. [ ] 2. Toss the papers in the trash. [ ] 3. Put the papers into the shredder bin. [ ] 4. Try to determine who left the papers unattended. [ ] 5. Stack the papers neatly, placing them off to the side. [ ] 6. Notify the office manager of the breach in confidentiality.

10. 4, 6. The Health Insurance Portability and Accountability Act (HIPAA) was enacted by Congress in 1996 to protect the client's health information. This includes information such as name, address, Social Security number, phone number, medical records number, diagnosis, admission and discharge dates, and all information from past, present, and future treatments. Leaving this information unattended is considered a major HIPAA violation. The nurse who finds these violations should report them to the office manager, supervisor, or the ethics and compliance officer of that institution. Because the documents are the client's medical records and are legal documents, throwing them away or putting them into the shredder are not appropriate actions. Instead, the nurse should find out who brought the documents to the location of the meeting and remind that person that a HIPAA violation has occurred. Neatly stacking the documents to the side is immaterial at this time because potentially confidentiality has already been violated.

During a presurgical assessment, a 67-year-old woman tells the nurse that she has felt a lump in her left breast for the past 6 months. 11. If the lump has the following characteristics when the nurse palpates the breast tissue, which one is most suggestive that the lump may be cancerous? [ ] 1. The lump can be easily moved about. [ ] 2. The lump is about ½″ (1 cm). [ ] 3. The lump is irregularly shaped. [ ] 4. The lump is near the areola.

11. 3. Cancerous tumors tend to be irregularly shaped and attached firmly to surrounding tissue. Benign breast tumors tend to have a well-defined border and to be freely movable. Neither the lump's size nor the location can necessarily predict if the lump is benign or malignant. However, cancerous tumors in nulliparous women or those who have not breast-fed infants are more commonly located in the upper outer quadrant of the breast.

The physician recommends an excisional biopsy followed by an immediate modified radical mastectomy if the biopsy shows malignant cells. 12. If the client tells the nurse that she would prefer to postpone the mastectomy until the biopsy has been more thoroughly examined, which is the most appropriate initial nursing action? [ ] 1. Explain that most biopsies are accurate. [ ] 2. Advocate for her choice of treatment. [ ] 3. Discourage her from opposing the physician. [ ] 4. Recommend that she seek a second opinion.

12. 2. Competent adult clients have the right to self determination once they have all the pertinent information to make a decision. When that occurs, nurses have a duty to facilitate whatever choices the clients make. Discouraging the client from opposing the physician's recommendation promotes passivity. Even if most biopsies are accurate, some are not. Even though a second opinion may eventually prove to be appropriate, the nurse should try to facilitate communication between the client and physician; in most cases, the treatment plan can be modified to suit the client's wishes

The client's breast tumor is malignant and she undergoes a left modified radical mastectomy. 13. Which nursing interventions are most appropriate to add to the client's immediate postoperative care plan? Select all that apply. [ ] 1. Maintain the client in a dorsal recumbent position. [ ] 2. Limit oral fluid intake to no more than 2,000 mL/ day. [ ] 3. Use the right arm when assessing blood pressure. [ ] 4. Inspect the incision at least once each shift. [ ] 5. Advise the client to avoid sleeping on the affected side. [ ] 6. Ask the client to report numbness or tingling in the chest wall

13. 3, 5, 6. Because this surgery compromises the client's vascular and lymphatic circulation, blood pressures and any other invasive procedures involving an arm (I.V. sticks, blood draws, injections) are performed on the opposite upper extremity. Postmastectomy clients generally are restricted from turning or sleeping on the affected side initially so that blood and lymph circulation can still occur. A sitting position tends to promote incisional drainage. Numbness and tingling of the chest wall or the inside aspect of the arm should be reported because these findings could indicate neurologic damage. These findings may last for a year or so. Fluids usually are not restricted. It is appropriate to assess the dressing and drainage, but the incisional wound is inspected only at the time of a dressing change, which may take place several days later

14. On the basis of the location and extent of this client's surgery, which nursing assessment finding is most indicative of a postoperative complication? [ ] 1. Shallow breathing [ ] 2. Inadequate nutrition [ ] 3. Impaired bowel motility [ ] 4. Signs of skin breakdown

14. 1. After a mastectomy, the client's breathing may be compromised due to the thoracic incision and restrictive (pressure) dressing. This type of dressing prevents movement of the chest muscles and therefore reduces lung capacity until the dressing is removed. Having the client take deep breaths and encouraging coughing every 2 hours is critical to prevent such respiratory problems as atelectasis and hypostatic pneumonia. The client should be encouraged to assume her regular diet soon after surgery; therefore, her nutrition should not be compromised. The client should also begin ambulating while decreasing her pain medication, thereby helping to increase bowel motility. Her risk of pressure sores should also decrease when she begins moving.

15. The physician prescribes tamoxifen (Nolvadex) 10 mg P.O. b.i.d. for a client who underwent a modified radical mastectomy to treat her estrogen-sensitive breast cancer. The drug label indicates that there are 20 mg in each tablet. How many tablets should the nurse administer to the client? ____________________________________

15. 0.5 tablet.

16. Which activity of daily living is most therapeutic for the nurse to recommend for preserving the hospitalized client's muscle strength and joint flexibility in the arm on the operative side? [ ] 1. Feeding herself [ ] 2. Brushing her hair [ ] 3. Writing letters [ ] 4. Washing her chest

16. 2. Most mastectomy clients tend to avoid raising the arm on the operative side after surgery. If this practice is prolonged, they tend to lose their full range of motion. Using the affected arm for hair brushing requires using muscles that elevate the arm and extend the chest muscles.Although self-feeding, writing, and washing the chest are good activities, they are not as likely to exercise the muscle groups to the same extent as brushing the hair.

17. When modifying the postoperative care plan, which nursing measure should the nurse plan to include to prevent swelling of the arm on the client's operative side? [ ] 1. Applying an ice pack to the site [ ] 2. Applying warm compresses to the site [ ] 3. Keeping the arm elevated [ ] 4. Ambulating the client frequently

17. 3. In postmastectomy clients, the standard practice is to elevate the affected arm on pillows while the client is in bed, to raise the client's arm and exercise the hand muscles, and to support the client's arm in a sling while she is ambulating. Applying ice reduces swelling, and warm compresses dilate blood vessels; however, because this surgery tends to compromise the client's circulation and sensory perception, these two measures are not the most appropriate to use. Frequent ambulation of the client would be contraindicated.

Before the client's discharge, the nurse provides instructions regarding home care. 18. Which instructions should the nurse include in the client's discharge plan? Select all that apply. [ ] 1. Continue arm exercises three times per day. [ ] 2. Avoid lifting objects weighing more than 15 pounds (6.8 kg). [ ] 3. Use gloves while doing yard or house work. [ ] 4. Get at least 8 hours of sleep per night. [ ] 5. Avoid drinking caffeinated or alcoholic beverages. [ ] 6. Postpone getting a prosthesis for at least 6 months.

18. 1, 2, 3. Because most mastectomy clients are discharged fairly quickly after surgery, it is imperative that detailed discharge instructions be given to the client and that the client understands them. Arm exercises that are begun postoperatively in the hospital should be continued at home to regain full range of motion, prevent contractures, and promote blood and lymph circulation. The client should avoid lifting or carrying heavy objects weighing more than 15 pounds and should use gloves to prevent injuries that could result in infection. It is important for the client to have assistance when selecting a breast prosthesis, but most women do not postpone getting a prosthetic device and are fitted soon after surgery when healing has occurred. Although getting adequate sleep and avoiding alcohol and caffeine promote a healthy lifestyle, they do not have a bearing on the client's postoperative mastectomy home care.

19. If the client asks for information on special bras and prosthetic devices after her mastectomy, which organization is the best resource to recommend? [ ] 1. American Garment Industry [ ] 2. American Cancer Society [ ] 3. Breast Prosthetics Association [ ] 4. Organization for Mammary Cosmetics

19. 2. The American Cancer Society includes a group of trained volunteers who offer personal support and printed materials for postmastectomy clients in its program called "Reach to Recovery." None of the other associations or organizations listed exists. Some department stores hire individuals who have been certified by the American Board for Certification in Orthotics, Prosthetics & Pedorthics who may assist with fitting postmastectomy clients with an appropriate bra or prosthesis, but these employees may not be located in a commercial department store in a client's area.

The nurse asks whether the client currently practices breast self-examination (BSE), then takes the opportunity to show her the proper technique. 2. The client states that she examines her breasts in the shower and while lying down. The nurse recommends that the client should also inspect her breasts from which position? [ ] 1. Bending from the waist [ ] 2. Standing before a mirror [ ] 3. Arching the back [ ] 4. Leaning from side-to-side

2. 2. Although the American Cancer Society states that monthly breast self-examinations (BSEs) are optional, they are an important way for women to discover early breast changes. When conducting BSE, the client should inspect her breasts during a shower, when lying down, and while standing before a mirror. Ominous signs include a change in the size of one breast, dimpling of the skin, or an altered nipple appearance. A clinical breast examination performed by a physician, nurse, or physician's assistant should be performed every 3 years for women ages 20 to 39 and annually for women once they are age 40.

20. Before discharging a postmenopausal mastectomy client, which instruction concerning breast self-examination (BSE) is most correct? [ ] 1. Examine your remaining breast on awakening from sleep. [ ] 2. Examine your remaining breast on the first day of the month. [ ] 3. Examine your remaining breast after you finish your shower. [ ] 4. Examine your remaining breast before your yearly mammogram.

20. 2. Clients who have had breast cancer are at risk for cancer in the opposite breast. Therefore, they must be conscientious about performing monthly breast self-examinations (BSEs). Postmenopausal women pick an arbitrary date and perform BSE on that date each month. The time of day is not pertinent. Breasts are examined during a shower, not afterward, when it is easier for the fingers to glide over the breast tissue. BSEs are performed monthly, not once a year.

After the discharge orders have been written, the nurse walks the client down to the car. The client says to the nurse, "I sure hope the cancer hasn't spread. I don't want to have to come back here to have the other breast removed." 21. On the basis of the client's pathology report, the nurse is concerned that the cancer may have already metastasized. Identify with an X the area where breast cancer is most likely to metastasize initially.

21. Breast cancer usually spreads first to the axillary lymph nodes, the structures closest to the primary site. Distant metastasis in advanced stages of breast cancer may be found in the bones, liver, lungs, and brain.

22. A nurse has been asked to teach ovulation and menstruation to a class of secondary school students. Place the events listed below in the order in which they occur in the menstrual cycle after menstrual flow ends. Use all the options. 1. Ovum is released. 2. Progesterone decreases. 3. Endometrium begins to thicken. 4. Ovarian follicle matures. 5. Endometrium is shed. 6. Corpus luteum forms.

22. 4. Ovarian follicle matures. 3. Endometrium begins to thicken. 1. Ovum is released. 6. Corpus luteum forms. 2. Progesterone decreases. 5. Endometrium is shed.

A nurse obtains a history from a 20-year-old client who says she does not menstruate. 23. Which question is most important for the nurse to ask next? [ ] 1. "Have you ever had any menstrual periods?" [ ] 2. "Do you have any pubic hair growth?" [ ] 3. "Have you ever been sexually attracted to males?" [ ] 4. "Are there any siblings with a similar problem?"

23. 1. It is important to differentiate between primary amenorrhea, a condition in which a female has never menstruated, and secondary amenorrhea, in which menstruation has occurred but has been absent for more than 3 months. This differentiation can provide important diagnostic information. Although the other questions may be pertinent, they are not as important to know at this time.

A 16-year-old client confides to the school nurse that she has cramps that accompany the onset of menstruation. 24. Besides a mild analgesic such as ibuprofen (Motrin), which therapeutic interventions are most appropriate for the nurse to recommend? Select all that apply. [ ] 1. Obtain a prescription for an oral contraceptive. [ ] 2. Switch from menstrual pads to tampons. [ ] 3. Use local applications of heat. [ ] 4. Reduce physical activity. [ ] 5. Massage the lower abdomen when experiencing pain. [ ] 6. Lie prone while sleeping or napping.

24. 3, 4. Local applications of heat and mild analgesics are the first line of treatment for minor symptoms of dysmenorrhea, as is reducing strenuous physical activity that could worsen cramping. It would be premature to seek a prescription for an oral contraceptive at this time, although oral contraception is effective in certain cases for relieving dysmenorrhea. There is no correlation between hygieneproducts and dysmenorrhea. Massaging the lower abdomen may cause further pain due to uterine contractility.Lying on the abdomen in a prone position will not relievediscomfort.

A 34-year-old woman makes an appointment with a physician concerning her pattern of heavy menstrual bleeding. A pelvic examination is scheduled. 25. Which instruction is most appropriate if a Papanicolaou (Pap) smear will be obtained at the time of the pelvic examination? [ ] 1. Avoid douching for several days before your appointment. [ ] 2. Stop using any and all forms of contraception temporarily. [ ] 3. Drink at least 1 quart of liquid an hour before your appointment. [ ] 4. Avoid having sexual intercourse for a week before the test.

25. 1. Douching in the days preceding a Pap smear interferes with accurate test results because it removes exfoliated cells. None of the other instructions is necessary when preparing a client for a pelvic examination.

26. Before taking the client to the room where the pelvic examination will be performed, which nursing action is most appropriate? [ ] 1. Ask the client to sign a consent form. [ ] 2. Give the client an opportunity to void. [ ] 3. Offer the client a mild analgesic. [ ] 4. Help the client instill a vaginal lubricant.

26. 2.If the bladder is empty, pelvic organs are more easily palpated and the client experiences less discomfort. It is inappropriate to instill a vaginal lubricant before the examination. Analgesia is generally unnecessary. No special consent form is required for the examination

27. Which question is most important to ask to ensure valid analysis of the vaginal specimen? [ ] 1. "When did you last have sexual intercourse?" [ ] 2. "How old were you when you had your first pregnancy?" [ ] 3. "What was the date of your last menstrual period?" [ ] 4. "Have you ever used oral contraceptives?"

27. 3. The vaginal specimen obtained for a Pap smear test contains exfoliated cells from the uterus. They are examined microscopically to identify precancerous, cancerous, inflammatory, typical, and atypical cells. It is best to document the date of a client's last menstrual period to assist the pathologist in determining if the microscopic cells are appropriate for the current stage in the menstrual cycle. The presence of atypical cells can sometimes be correlated with having the Pap test performed toward the end of menses. Identifying the date of the last menstrual period may eliminate a need for additional testing. Answers to the other questions are immaterial to the results of the Pap smear

28. The nurse correctly places the client in which position when the physician is ready to perform the pelvic examination? [ ] 1. Sims' position [ ] 2. Trendelenburg's position [ ] 3. Fowler's position [ ] 4. Lithotomy position

28. 4.A supine lithotomy position is preferred for a pelvic examination. In unusual circumstances, Sims' position may be used. Neither Trendelenburg's nor Fowler's position facilitates access to the vagina

29. Before the physician performs the vaginal examination, which nursing intervention is most important? [ ] 1. Arrange to have a female nurse present during the examination. [ ] 2. Instruct the client on the dangers of cervical cancer. [ ] 3. Palpate the internal organs to obtain a baseline assessment. [ ] 4. Encourage the client to instill a vaginal lubricant.

29. 1. To reduce the claim of sexual impropriety and to make the client feel more comfortable, an important nursing consideration is to have a female nurse present during the pelvic examination. Instructing on the dangers of cervical cancer is good general information; however, it is not known if the client has cervical cancer. The physician usually completes the internal examination and documents the findings. A vaginal lubricant is not instilled before the examination, although the physician may use a lubricant on the fingers during the internal examination

3. Which breast palpation technique is most correct? [ ] 1. Examine the breast while using the heel of the hand. [ ] 2. Examine the breast while using the index finger only. [ ] 3. Examine the breast while using the index finger and thumb. [ ] 4. Examine the breast while using the pads of the fingertips.

3. 4. The pads of the four fingertips are used to feel for breast abnormalities during breast self-examination (BSE). The pads of the fingers are especially sensitive and can note lumps or changes in breast tissue.

A 20-year-old college student calls her physician's office and reports to the nurse that she is bleeding vaginally at a time other than her expected menses. 30. If the client reports all of the following data, which factor is most likely contributing to the bleeding? [ ] 1. The client has been taking an oral contraceptive for 2 months. [ ] 2. The client has just changed employment and is under unusual stress. [ ] 3. The client's sexual partner has a sexually transmitted infection. [ ] 4. The client has been using a vibrator to elicit sexualarousal.

30. 1. Breakthrough bleeding or spotting may occur in clients who take oral contraceptives with low dosages of estrogen or progesterone. Stress has been implicated in delaying menses or causing irregularity in a previously regular cycle, but it is uncommon for stress to cause midcycle bleeding. Having sexual intercourse with a partner who has a sexually transmitted infection is not smart but is not a common cause of vaginal bleeding. Using a vibrator to elicit sexual arousal typically is not the cause of bleeding or spotting. However, care must be used not to damage genital tissue

The physician requests that the client with vaginal bleeding come to the office. When the client arrives, she is accompanied by a female friend. The nurse assigns the client to an examination room, but as the client's friend follows the client into the room, the nurse stops her. The client says to the nurse, "It's OK, we're lesbians." 31. Which action by the nurse is most appropriate? [ ] 1. Allow the client's partner to stay in the examination room. [ ] 2. Ask the client's friend to remain in the waiting room. [ ] 3. Ask the physician to make the decision in this situation. [ ] 4. Suggest that the friend wait outside the examination room door.

31. 2. Regardless of sexual preference, the client should be provided with privacy when a sensitive medical history is obtained and during a physical/pelvic examination. Confidentiality must also be maintained. Therefore, asking the client's partner to wait outside in the waiting room is most appropriate for this situation

During the physical and pelvic examination by the physician, the nurse notices that the client has several tattoos on the insides of her thighs and labia and she has nipple and navel piercings. 32. Before the client leaves the office, on which topic should the nurse obtain further information? [ ] 1. The name of the person who did the tattoos and piercings [ ] 2. Whether the client is practicing safe, protected sex [ ] 3. The client's sexual experiences with members of both sexes [ ] 4. The names of all of the client's sexual partners

32. 2. To promote the client's health, the most appropriate information for the nurse to ask is regarding the practice of protected, safe sex. Although hepatitis B and human immunodeficiency virus can be spread with contaminated tattoo equipment, obtaining the name of the person who tattooed the client and questioning whether the client has sex with men as well as women is not as significant to promoting the client's health as discussing safe sex practices. Obtaining the names of sexual partners is only appropriate if the client has a sexually transmitted infection that could be potentially spread to sex partners.

A 25-year-old woman has repeated vaginal infections. The symptoms suggest that the client has candidiasis caused by the yeastlike microorganism Candida albicans (C. albicans). 33. After C. albicans is identified as the causative organism, the nurse would expect the physician to prescribe which treatment? [ ] 1. A nonprescription antifungal medication [ ] 2. A prescription oral penicillin [ ] 3. A prescription broad-spectrum antibiotic [ ] 4. A vaginal douche with a vinegar solution

33. 1.Candida albicans, a common cause of vaginitis, is usually treated with an antifungal medication. Several former prescription antifungal drugs are now available without a prescription. Over-the-counter drugs, such as miconazole (Monistat) and clotrimazole (GynLotrimin), are available in various forms, including vaginal tablets, creams, and suppositories. Oral antibiotics are not used to treat C. albicans and, in fact, are frequently the cause of the vaginitis. Irritating vaginal douches are not recommended for treatment.

34. Which instruction is best when teaching the client about inserting vaginal medication? [ ] 1. Place the applicator just inside the vaginal opening. [ ] 2. Insert the applicator while sitting on the toilet. [ ] 3. Instill the medication just before retiring for sleep. [ ] 4. Put on disposable latex gloves before applying the drug.

34. 3. Instilling the drug before bedtime aids in retaining the medication within the vagina for a substantial period of time. When this is not possible, the client is instructed to recline for 10 to 30 minutes after insertion. The applicator is inserted approximately 2″ to 4″ (5 to 10 cm) within the vagina. The best position to be in when instilling the drug is reclining in a dorsal recumbent position. Latex gloves are a matter of personal choice when self-administering vaginal medication; however, they are required when instilling the drug into someone else. Good hand washing is important in either case.

35. Which health practice is most appropriate for the nurse to teach this client? [ ] 1. Take showers rather than tub baths if possible. [ ] 2. Wipe away from the vagina after a bowel movement. [ ] 3. Use a lanolin-based soap for genital cleansing. [ ] 4. Avoid having sexual intercourse more than once a week.

35. 2. Yeasts are present in the intestinal tract and are introduced into the vagina if stool is wiped across rather than away from the vaginal opening. This is often a common etiologic factor in urinary tract infections as well. Showers versus tub baths are a matter of personal preference as long as the tub is cleaned on a routine basis. Some types of vaginal infections are spread from infected sex partners, but limiting intercourse to once a week is not likely to prevent them. Lanolin soap is no more effective than antiseptic body soaps for reducing microorganism growth.

36. What information provided by the nurse is most appropriate for the client who plans on douching twice a week? [ ] 1. Use a concentrated solution of vinegar and water. [ ] 2. Avoid frequent douching because it removes helpful microorganisms. [ ] 3. Instill no more than 16 oz of irrigant solution with each douching. [ ] 4. Discontinue the instillation if cramping occurs.

36. 2. Douching for the purpose of hygiene is unnecessary and can be harmful because it depletes helpful microorganisms that tend to prevent vaginal infections. A vinegar solution alters the pH of the vagina and makes it an inhospitable environment for microbial growth, but it is better to use a dilute solution rather than one that is concentrated. The volume of douche solutions can be more than 16 oz. The solution drains out by gravity when the vaginal capacity is reached. Cramping is not common with douching.

A 21-year-old client is recovering from acute pelvic inflammatory disease (PID). 37. When assigning a nursing assistant to this client's care, which instruction for disposing of soiled drainage pads is correct? [ ] 1. Flush all perineal pads down the toilet. [ ] 2. Put the pads in biohazard waste bags. [ ] 3. Place the pads in the client's wastebasket. [ ] 4. Enclose the soiled pads in a clean paper bag.

37. 2. Pelvic inflammatory disease (PID) refers to infection of the uterus, fallopian tubes, and other reproductive organs. It is a common and serious complication of some sexually transmitted infections (STIs), especially chlamydia and gonorrhea. It is essential to contain any and all infectious drainage from a client with PID within specially marked biohazardous infectious waste bags. Flushing absorbent pads down the toilet could cause plumbing problems. Neither an open wastebasket nor paper bags are sufficient barriers for containing the infectious microorganisms.

38. If the client asks about long-term consequences that are associated with this disorder, the nurse accurately identifies which reproductive sequela? [ ] 1. Cancer of the cervix [ ] 2. Premature labors [ ] 3. Spontaneous abortions [ ] 4. Difficulty getting pregnant

38. 4. Pelvic inflammatory disease (PID) can damage the fallopian tubes and tissues in and near the uterus and ovaries. PID can lead to serious consequences, including ectopic pregnancy, abscess formation, chronic pelvic pain, and infertility. Infertility results from the scarring of fallopian tubes, which subsequently blocks passage for both sperm and ovum. With early and aggressive treatment, the sequelae may be prevented or minimized. Cancer of the cervix, premature labor, and spontaneous abortion are not directly related to a prior incidence of PID.

A 24-year-old woman is being treated for endometriosis. A laparoscope will be used to remove ectopic tissue. 39. When the client asks where the laparoscope will be inserted, the nurse correctly identifies which structure? [ ] 1. Abdomen [ ] 2. Vagina [ ] 3. Uterine cervix [ ] 4. Uterine fundus

39. 1. The endometrium is the inside lining of the uterus. Endometriosis is tissue growth by cells that look and act like endometrial cells. However, these cells grow outside the uterus in other areas, including on or under the ovaries, behind the uterus, or on the tissues that hold the uterus in place. A laparoscope is inserted through the abdominal wall. Once inserted, the instrument is used to visualize the intra-abdominal and pelvic organs, obtain biopsies of tissue, and perform therapeutic procedures.

4. The nurse correctly informs the client that the breast self-examination (BSE) technique involves palpating each breast moving in small concentric circles, following imaginary spokes in a wheel, or moving in rows from superior to inferior areas of the breast. Besides the breast, which other body area is essential to palpate? [ ] 1. The axillae [ ] 2. The sternum [ ] 3. The clavicles [ ] 4. The ribs

4. 1. There is more than one method for performing breast self-examination (BSE). The woman may move her fingers in circles, dividing the breast into wedges like the spokes of a wheel, or in rows up and down over the breast, but the method she chooses must be done the same way for each breast. Regardless of the technique chosen, all methods include palpating from the outer margins of the breast into the axillae.

40. If the client experiences all of the following signs and symptoms after the laparoscopy, which one can the nurse attribute directly to the endoscopic procedure? [ ] 1. Nausea and vomiting [ ] 2. Shoulder discomfort [ ] 3. Urinary frequency [ ] 4. Leg cramps

40. 2. Shoulder or abdominal discomfort may be experienced for 1 to 2 days after a laparoscopy. The discomfort is caused by the bolus of carbon dioxide instilled to distend the abdominal cavity. Nausea and leg cramps are unrelated to the laparoscopic procedure. Urinary urgency may occur after removal of the retention catheter used to keep the bladder empty during the laparoscopy, but it is not a direct effect of the procedure.

A 65-year-old woman experiences painful intercourse and is concerned about possible reproductive disease. 41. On the basis of this client's age, which statement by the nurse is the best explanation for the client's discomfort? [ ] 1. The pelvic muscles are more sensitive to pressure after menopause. [ ] 2. The clitoris is unable to respond to sexual foreplay as women age. [ ] 3. The vagina hypertrophies if intercourse is infrequent. [ ] 4. The mucus-producing glands decrease with aging.

41. 4. Decreased estrogen production after menopause reduces the potential for vaginal lubrication. A dry vaginal mucous membrane is a common etiologic factor in painful intercourse after menopause. Pelvic muscles usually do not become more pressure sensitive with age. The amount of foreplay, if prolonged, can stimulate the clitoris. The vagina atrophies as a result of age-related changes.

The physician sees a 42-year-old woman for suspected fibroid tumors (myomas). 42. In addition to pressure in the pelvic region, which sign or symptom is the client most likely to reveal during a nursing history? [ ] 1. Heavy menstrual bleeding [ ] 2. Light menstrual bleeding [ ] 3. Abdominal pain at the time of ovulation [ ] 4. Breast tenderness during menstruation

42. 1. Fibroid tumors respond to estrogen stimulation. Heavy menstrual bleeding is a common complaint of clients with myomas. Myomas arise from muscle tissue in the uterus and are usually benign. If pain occurs, it usually accompanies menstruation. Irregular light menses and breast tenderness, if present, are not associated with fibroid tumors.

A pelvic ultrasound (sonogram) using a transabdominal approach is scheduled for the client. 43. When preparing the client for the sonogram, which instruction is most important for the nurse to emphasize? [ ] 1. Do not void for several hours before the test. [ ] 2. Begin fasting at midnight before the test. [ ] 3. Take a mild analgesic such as aspirin before the test. [ ] 4. Use an antiseptic soap when showering before the test.

43. 1. A full bladder is essential when performing a pelvic sonogram. Clients must consume at least a quart of water 1 hour before the examination and refrain from urinating until the examination is completed. Fasting is unnecessary. The examination is not painful, so an analgesic is unnecessary. No special skin preparation is required before the examination.

After the diagnosis of fibroid tumors is confirmed, the client is scheduled for a dilation and curettage in the ambulatory surgery department. 44. Before the client is discharged, which nursing observation is most important for the nurse to document? [ ] 1. The client can eat without nausea. [ ] 2. The client can empty her bladder. [ ] 3. The client's pelvic pain is relieved. [ ] 4. The client's perineal pad has been changed.

44. 2. All the data described are valid facts to document; however, documenting that this client has voided a sufficient amount to empty her bladder is most pertinent to the client's safety after discharge.

A client with an abnormal Pap smear has a colposcopy performed in her physician's office. 45. Before the client leaves the office, the nurse correctly instructs her to report which unusual problem associated with this procedure? [ ] 1. Excessive bleeding [ ] 2. Inability to void [ ] 3. Pressure during bowel elimination [ ] 4. Pain in the right lower quadrant

45. 1. A colposcopy is a diagnostic procedure that is performed if the woman has an abnormal Pap smear. The colposcopy examines the cervix and the tissues of the vagina and vulva by illuminating and magnifying these tissues. It is common to have slight vaginal bleeding after a colposcopy; however, excessive bleeding is unusual and should be reported. None of the other options describes a common problem following colposcopy.

The client is scheduled to undergo electrocauterization after the diagnostic tests confirm that she has an early stage of cervical cancer. 46. After the electrocauterization procedure, which discharge instruction is most appropriate? [ ] 1. "Douche in 24 hours to remove debris and blood clots." [ ] 2. "Avoid heavy lifting until you have had a follow up examination." [ ] 3. "Remain in bed as much as possible over the next 5 days." [ ] 4. "Avoid any sexual activity for 2 months."

46. 2. After electrocauterization, the client is told to avoid straining and heavy lifting because these activities may cause bleeding from the cauterized site. The physician usually reexamines the client in 2 to 4 weeks. Absolute bed rest is unnecessary, but the client should rest more than usual. Neither douching nor sexual intercourse is permitted until the physician indicates it is safe to do so, but avoiding sexual intercourse for 2 months is an unusually long time.

The nurse reviews the medical records of several clients looking for risk factors associated with cervical cancer. 47. Which finding in a client profile indicates the highest risk for cervical cancer? [ ] 1. Onset of menstruation at age 12 years [ ] 2. Spontaneous abortion at age 35 years [ ] 3. Human papillomavirus infection at age 28 years [ ] 4. Maternal history of breast cancer

47. 3. Like other sexually transmitted infections such as genital herpes, certain strains of human papillomavirus (HPV) are a risk factor for cervical cancer. HPV causes cervical dysplasia (abnormal cells), a precursor of cancer, which validates the necessity for regular Pap tests. Other risk factors include sexual intercourse before age 16, multiple sex partners, and multiple pregnancies. Menstruation beginning at age 12 years is normal. Spontaneous abortion and history of maternal breast cancer are not risk factors for cervical cancer. A vaccination for HPV is available.

A client makes an appointment with her gynecologist because she has been having vaginal bleeding between her regular menstrual periods. On the basis of the client's history and physical examination, the physician suspects cervical cancer and orders further diagnostic tests. 48. To determine the significance of the client's symptomatic bleeding, which questions are most important for the nurse to ask? Select all that apply. [ ] 1. "Has your energy level changed remarkably?" [ ] 2. "Do you have intercourse more than once a week?" [ ] 3. "How many sanitary pads do you use?" [ ] 4. "Is the bleeding light or dark red?" [ ] 5. "Do you have itching and swelling of the labia?" [ ] 6. "Have you lost weight in the past few months?"

48. 1, 3, 6. Cervical cancer is a malignancy involving the cervix (the lower portion of the uterus) or the cervical structures. The early stages of cervical cancer may be completely asymptomatic. Vaginal bleeding occurs in the advanced stages. Identifying the number of sanitary pads used helps quantify the extent of bleeding. Other symptoms of advanced cervical cancer may include anorexia; weight loss due to poor nutrition or as a consequence of the cancer; fatigue due to nutritional deficiencies or chronic vaginal bleeding; pelvic, back, or leg pain; a single swollen leg; and bone fractures. The color of the blood provides a characteristic of the blood loss, but it does not indicate the extent of bleeding. Sexual frequency does not provide clinical data that can be used to make a diagnosis. Itching and swelling of the labia are not related to cervical cancer but to sexually transmitted infectinons.

Internal radiation therapy is used to treat the client who has been diagnosed with advanced cervical cancer. An applicator containing radioactive material is inserted into the client's vagina. 49. Because the client is receiving this type of radiation therapy, which nursing interventions should the nurse include in the care plan? Select all that apply. [ ] 1. Elevate the head of the bed to 90 degrees. [ ] 2. Maintain the client on strict bed rest. [ ] 3. Place urine and feces in a closed container. [ ] 4. Weigh the client daily before breakfast. [ ] 5. Stand at a distance and talk with the client from the doorway. [ ] 6. Spend as little time as possible with the client.

49. 2, 5, 6. There are several methods used to treat cervical cancer depending on the progression of the disease. A hysterectomy may be done in the earlier stages; chemotherapy or radiation therapy or a combination of the two may be used in addition to the hysterectomy in the later stages. Internal radiation therapy is a form of treatment in which a source of radiation is put inside the client's body. Bed rest must be maintained to retain the applicator within the vagina. In fact, the head of the bed should not be raised more than 45 degrees while the radioactive applicator is in place. To provide safety for the nurse and avoid excessive exposure to radiation, the nurse should stand at a distance and talk with the client from the doorway, spending as little time in the room as possible. The client should be instructed about radiation safety precautions before the placement of the implant. Weighing the client is postponed while the radioactive applicator is in place. It is not necessary to contain urine or feces.

5. If the client chooses to perform breast self-examination (BSE), which statement demonstrates the best understanding of when BSE should be performed? [ ] 1. "I will perform a BSE on a weekly basis." [ ] 2. "I will perform a BSE every 6 months." [ ] 3. "I will perform a BSE 1 week before my period begins." [ ] 4. "I will perform a BSE 3 to 7 days after my period ends."

5. 4. Hormonal levels fluctuate each month during the menstrual cycle, which causes changes in the breast tissue. Swelling begins to decrease when the menstrual cycle starts. Premenopausal women should perform breast self-examination (BSE) every month, 3 to 7 days after the period ends. When a client is past menopause, a BSE should be performed on a selected date each month, for example, the first day of the month.

50. If the nurse finds the radioactive insert in the client's bed, which nursing action is most appropriate? [ ] 1. Return it to the nuclear medicine department. [ ] 2. Discard it in the infectious waste receptacle. [ ] 3. Reinsert it immediately. [ ] 4. Place it in a lead container.

50. 4. Displaced radioactive materials are placed in a lead container as soon as they are discovered. The nurse should avoid contact with the radioactive materials if at all possible and should call the radiation safety department or nuclear medicine department. The lead container blocks the transmission of radioactivity. The nuclear medicine department then manages the substance appropriately. Radioactive substances are never discarded. The physician, not the nurse, is responsible for reinserting the implant.

51. If the nurse must handle the radioactive implant, which action provides the best protection for the nurse? [ ] 1. Putting on sterile vinyl gloves [ ] 2. Washing hands before putting on vinyl gloves [ ] 3. Using long-handled forceps to handle the implant [ ] 4. Enclosing the implant in a glass jar

51. 3. Distance is one measure used to reduce exposure to radiation. Therefore, radioactive substances are never held with the hands. A long-handled forceps and lead container should be in the room of a client who has a radioactive implant in a body orifice. Neither washing the hands nor using a glass jar will control exposure to radiation. Rubber gloves rather than vinyl gloves provide better protection, but the radioactive substance should never be touched with the hands.

52. Which staff nurse is best suited to care for a client with a radioactive implant? [ ] 1. A male nurse with oncology nursing experience [ ] 2. A female nurse who has had a hysterectomy [ ] 3. A female nurse who has survived cancer herself [ ] 4. A male nurse whose mother died of cancer

52. 2. All the described nurses have strengths that may be helpful to this client. However, because exposure to radiation can affect male and female gametes (sex cells), it is best that a nurse for whom pregnancy is unlikely or a male nurse who has had a vasectomy should care for the client.

A 64-year-old client with uterine cancer is scheduled to undergo an abdominal hysterectomy under general anesthesia. Before the client returns from the postanesthesia care unit, the registered nurse asks the licensed practical nurse to help revise the care plan for the client who has undergone a hysterectomy. 53. Which nursing diagnosis is most appropriate for the nurse to add to the client's care plan at this time? [ ] 1. Risk for ineffective airway clearance [ ] 2. Risk for imbalanced nutrition [ ] 3. Ineffective coping [ ] 4. Impaired verbal communication

53. 1. All clients who receive general anesthesia are prone to respiratory complications. Because a clear airway and breathing are higher priorities than nutrition to maintain immediately postoperatively, Risk for ineffective airway clearance is the most appropriate addition at this time. It is too early to make the diagnosis Ineffective coping. The client should have no difficulty communicating verbally when she returns from the postanesthesia recovery room.

Postoperative orders call for applying antiembolism stockings to the client's legs after the hysterectomy. 54. Which intervention for applying antiembolism stockings is most appropriate to include in the client's care plan? [ ] 1. Have the client wear the stockings continuously, but remove and reapply them at least twice a day. [ ] 2. Have the client wear the stockings continuously during the day hours, and remove them at night. [ ] 3. Have the client wear the stockings only when getting up to ambulate. [ ] 4. Have the client wear the stockings only while in bed.

54. 1. Antiembolism stockings are frequently ordered for postoperative clients and those unable to ambulate to circulate venous blood to the heart. These clients are at high risk for developing a blood clot. Antiembolism stockings are used to reduce stasis of venous blood in the extremities that could cause a thrombus and embolus to occur. Antiembolism stockings should be worn continuously except when removed for assessment and hygiene.

55. The licensed practical nurse (LPN) realizes that the nursing assistant requires further instruction when observing her performing which actions after the client's hysterectomy? Select all that apply. [ ] 1. Frequently offering the client a variety of oral fluids [ ] 2. Helping the client ambulate in the hall [ ] 3. Raising the knee gatch on the hospital bed [ ] 4. Reporting to the physician that the client's dressing is loose [ ] 5. Massaging the calves when applying lotion [ ] 6. Changing the client's perineal pad without using gloves

55. 3, 4, 5, 6. Clients who have had abdominal surgery are prone to developing blood clots in their lower extremities. Therefore, the knees should not be elevated because doing so promotes stasis of blood flow. In addition, the client's calves should never be massaged. Gloves must be worn when dealing with blood and body fluids. Reporting to the physician that the dressing is loose is a nursing function, not one for the unlicensed assistant. All the other activities are appropriate in the care for a client recovering from a hysterectomy.

56. Before surgery a urinary catheter was inserted. Today, the physician orders that the client's catheter can be removed. Which action is most important for the nurse to perform first? [ ] 1. Clean the client's labia with soap and water. [ ] 2. Measure the urine in the drainage bag. [ ] 3. Remove the fluid from the balloon. [ ] 4. Disconnect the client's catheter and drainage bag.

56. 3. It is important to deflate the balloon first so that the catheter can be removed from the urethra. Not deflating the balloon can lead to urethral trauma and damage. Cleaning the client's perineum and measuring her urine output are essential actions, but they can be postponed until after the catheter has been removed. It is unnecessary to separate the catheter from the drainage bag. After the bag is emptied, both can be disposed of in an appropriate waste receptacle.

The client's bladder is distended after the catheter is removed even though she is urinating approximately 100 mL with each voiding. The physician instructs the nurse to recatheterize the client and measure the residual urine. 57. Which nursing action is most appropriate to carry out the medical order? [ ] 1. Catheterize the client as soon as possible. [ ] 2. Catheterize the client after her next voiding. [ ] 3. Connect the catheter to gravity drainage. [ ] 4. Use a small-gauge catheter to drain the bladder.

57. 2. To measure the volume of urine retained in the bladder, it is important to catheterize the client within 10 minutes of voiding. The size of the catheter is relative to the size of the client; however, the size is not pertinent to the purpose of the procedure. The catheter is connected to gravity drainage only if the physician orders a retention catheter based on a certain retained volume.

A 59-year-old client with ovarian cancer is receiving antineoplastic chemotherapy after undergoing a total hysterectomy. 58. To accurately determine the dosage of antineoplastic drugs, which information is essential to obtain from the client's chart? [ ] 1. Urine output for the past 24 hours [ ] 2. Body weight and height [ ] 3. Date of surgery [ ] 4. Drug allergies

58. 2. The dosages of many toxic drugs administered to adults, as well as drugs administered to children, are calculated on the basis of the client's body surface area (BSA). BSA is calculated by using both body weight and height. The other data are important to obtain but have no relationship to the dosage of the drug that will be administered.

59. Because many antineoplastic drugs affect bone marrow function, which laboratory test is most important to monitor for client safety? [ ] 1. Mean cell volume [ ] 2. Total leukocyte count [ ] 3. Differential cell count [ ] 4. Complete blood count

59. 4. Antineoplastic medications can affect the function of bone marrow, which produces the blood cells. A complete blood count provides information about all the cells that the bone marrow produces. The mean cell volume, total leukocyte count, and differential cell count are all important, but none is as comprehensively informative as a complete blood cell count.

A 35-year-old woman makes an appointment with her physician because she has felt several lumps in her right breast. She is scheduled for a mammogram. 6. When the office nurse gives the client instructions on how to prepare for the mammogram, which of the following statements offers accurate information? Select all that apply. [ ] 1. "You will need to shave your underarm hair the morning of the test." [ ] 2. "Do not wear any underarm deodorant the day of the test." [ ] 3. "Wipe each breast with an antiseptic pad before the test." [ ] 4. "Do not wear constricting clothing to the test." [ ] 5. "Avoid wearing body powder the day of the test." [ ] 6. "Refrain from applying lotion to the breasts or axillae."

6. 2, 5, 6. Underarm deodorant, body powder, lotion, or ointments on the breast can produce artifacts on the mammogram film. The artifacts may be misinterpreted as pathologic findings. The client may wear constricting clothing and a bra before and after the test, but during the mammogram, the clothing is removed from the upper part of the body and a gown is put on. Shaving underarm hair is a cultural choice; it is not a test requirement. Normal hygiene measures are appropriate, but wiping the breasts with an antiseptic before the test is unnecessary

60. When the nurse administers the parenteral form of the antineoplastic drug, which nursing action is best for preventing accidental self-absorption of the drug? [ ] 1. Use only prefilled syringes. [ ] 2. Wear disposable examination gloves. [ ] 3. Dilute the drug with saline solution. [ ] 4. Mix the drug in a closed vial.

60. 2. Examination gloves act as a barrier against contact between the drug and the nurse's skin. Regardless of the drug manufacturer's directions for preparing the drug, such as using only prefilled syringes, diluting the drug with saline solution, or mixing the drug in a closed vial, wearing gloves reduces the risk of accidentally absorbing the medication.

The client experiences almost total hair loss as antineoplastic drug therapy progresses. 61. Which statement is most accurate when discussing hair loss with the client? [ ] 1. The hair loss is permanent, but attractive wigs are available. [ ] 2. The hair loss is permanent, but hair transplantation is a possible solution. [ ] 3. The hair loss is temporary; hair may grow back in several years. [ ] 4. The hair loss is temporary; hair will regrow after chemotherapy is finished.

61. 4. The hair lost with some antineoplastic drugs returns after chemotherapy is terminated. The return of hair growth varies from client to client, but in all cases it is restored in less than 2 years. However, the new hair growth may be different in color or texture from the past hair type of the individual.

A physician prescribes an oral antibiotic for a client with prostatitis. 67. Which instruction by the nurse about the client's antibiotic use is a priority? [ ] 1. Drink a glass of milk when taking the medication. [ ] 2. Report if your urine becomes a lighter color. [ ] 3. Take the medication until it is completely gone. [ ] 4. Monitor your body temperature on a daily basis.

67. 3. Inadequate treatment leads to the development of a chronic condition. Whenever an antibiotic is prescribed, it is important to stress that the client take all the medication. Taking only a portion of the medication may not be sufficient to destroy the infectious microorganism; it can also contribute to the development of resistant strains. Drinking milk, reporting significant information, and monitoring body temperature may be important in some cases. The latter recommendations are based more on such factors as the side effects of the drug, the condition for which the drug is prescribed, and the client's physical condition.

In addition to a mild analgesic, the physician also recommends that the client use sitz baths as a comfort measure for the prostatitis. 68. Which instruction by the nurse is correct concerning the sitz bath regimen? [ ] 1. Use cool tepid water. [ ] 2. Soak for 20 minutes. [ ] 3. Add mild liquid soap to the water. [ ] 4. Massage the scrotum while bathing

68. 2. The prostate surrounds the urethra and when enlarged can induce discomfort and difficulty passing urine due to a stricture. A sitz bath soothes the area, relieving pain and possible inflammation. It is more effective if it lasts approximately 20 minutes. The water should be about 100°F (37.8°C), which is considered warm, not tepid. Soap is omitted with a sitz bath; the bath's purpose is to apply heat and relieve discomfort, not clean the area. Massaging the scrotum has no direct benefit in relieving the client's symptoms.

The physician examines a 22-year-old client who has a swollen, painful scrotum. The physician suspects epididymitis and orders a clean-catch urine specimen for a culture and sensitivity test. 69. When the nurse asks the client to repeat the instructions for collecting a clean-catch urine specimen, which statement indicates that the client needs further clarification? [ ] 1. "I must clean my penis." [ ] 2. "I must collect all the urine." [ ] 3. "I must retract the foreskin." [ ] 4. "I must use a sterile container."

69. 2. The epididymis is a tightly coiled tube in the scrotum that is used to transport sperm. An inflammation of this structure is called epididymitis. Only a small portion of urine voided in midstream (after the first release of urine is wasted) is collected in a clean-catch specimen. The procedure does require cleaning the penis, retracting the foreskin if the client is uncircumcised, and depositing the urine directly into a sterile container.

The nurse collects the woman's health history before the mammogram. 7. Which assessment findings recorded by the nurse indicate high risk factors for developing breast cancer? Select all that apply. [ ] 1. The client began menstruating before age 12. [ ] 2. The client had three full-term pregnancies. [ ] 3. The client has a sister diagnosed with breast cancer. [ ] 4. The client has very large breasts. [ ] 5. The client has had radiation treatment to the chest. [ ] 6. The client has had breast implants.

7. 1, 3, 5. Having a close blood relative with breast cancer places the client at high risk for developing this disease. The risk factor increases twofold if the relative is a first-degree female, such as a sister, mother, or daughter. Menstruating before age 12 and not having children are additional predisposing factors. Women who have had radiation therapy to the chest as treatment for cancer (such as Hodgkin's disease or non-Hodgkin's lymphoma) are at significant risk for breast cancer. According to recent research, breast implants are not found to increase the risk of breast cancer, although silicone breast implants can cause scar tissue to form in the breast. Implants make it harder to visualize breast tissue on standard mammograms. The size of the breast is not a risk factor for developing breast cancer.

70. Which suggestion by the nurse will best promote the client's comfort? [ ] 1. Using a scrotal support [ ] 2. Wearing cotton briefs [ ] 3. Buying larger underwear [ ] 4. Applying a hot compress

70. 1. Elevating and supporting the scrotum helps to relieve the discomfort of epididymitis. Analgesics are also prescribed. Wearing larger underwear or cotton briefs is a personal choice and does not inherently relieve the client's symptoms. Heat is contraindicated because it can damage sperm.

A middle-aged client with inflamed testes is being seen at a local clinic. The physician diagnoses orchitis. 71. When the nurse gathers the client data, which information is most suggestive as the cause of the client's condition? [ ] 1. The client has multiple sexual partners. [ ] 2. The client is a sexually active homosexual. [ ] 3. The client was never immunized for mumps. [ ] 4. The client had a previous sports-related scrotal injury.

71. 3. Orchitis is a painful condition of the testicles involving inflammation, swelling and, frequently, infection. Often it is the result of epididymitis that has spread to the testes. The mumps virus can infect the testes of males who have not been adequately immunized before puberty. A sexually transmitted infection would be likely if the client's testes and epididymis are co-infected, but that is not the case in this situation. Orchitis is not commonly reported in clients who have had sports-related scrotal injuries.

During a subsequent visit, when the client has recovered from the orchitis, the nurse uses the opportunity to teach him how to perform testicular self-examination. 72. Which statement by the nurse accurately explains the technique for testicular self-examination? [ ] 1. Palpate each testicle simultaneously. [ ] 2. Roll each testicle between the thumb and fingers. [ ] 3. Examine your testicles at least once yearly. [ ] 4. Perform the self-examination in a cool room.

72. 2. When performing a testicular self examination, the client should examine each testicle separately, rolling it between the thumb and fingers. It is easier to palpate the testes when the scrotum is warm, such as during or after a shower. Testicular self-examination should be performed monthly.

During a routine sports physical, the nurse notes that a 15-year-old client has an undescended testicle. 73. When the client asks how this condition will affect him sexually, which response by the nurse is most appropriate? [ ] 1. "It most likely will have little effect on your masculinity." [ ] 2. "It means that you will probably be impotent." [ ] 3. "You may notice that your breasts will enlarge later." [ ] 4. "Your sex drive will not be like that of other boys."

73. 1. As long as one testicle is descended, the testicle will most likely produce sufficient testosterone for normal secondary sexual characteristics, adequate sperm for conception, and a healthy sex drive. Impotence, the inability to achieve an erection, is not generally compromised.

A 56-year-old client has had diffi culty retracting the foreskin over the glans of his penis. He is scheduled for a circumcision. 74. Besides assessing the dressing for signs of bleeding, which other postoperative nursing assessment is a priority after this surgical procedure? [ ] 1. Checking the client's deep-breathing efforts [ ] 2. Assessing the client's ability to achieve an erection [ ] 3. Monitoring the volume of urine output [ ] 4. Monitoring the infusion of I.V. antibiotics

74. 3. The priority nursing assessments after a circumcision include checking the amount of local bleeding and the client's ability to void. Swelling can obstruct the urethra and interfere with urination. Deep breathing is a routine assessment for surgical clients who have received general anesthesia. It would be inappropriate to assess the client's erectile function at this time. I.V. antibiotics are not usually prescribed for this type of surgery.

A client with a hydrocele has the fl uid aspirated from his scrotum. The physician orders a cold application to the area. 75. When carrying out this intervention, which action is most appropriate? [ ] 1. Apply ice to the site in a sealed plastic bag. [ ] 2. Place a covered ice pack to the scrotum. [ ] 3. Position the client on a hypothermia blanket. [ ] 4. Seat the client on an ice-filled ring.

75. 2. Whenever a cold or warm device is placed on a client's body, the device is placed within some type of fabric cover. A plastic bag is not an appropriate cover. A hypothermia blanket is too large for the local effect desired. An ice-filled ring would not cover the area sufficiently to produce a local effect.

A 65-year-old client makes an appointment for a routine physical examination. 76. When the physician asks the nurse to prepare the client for a prostate examination, which position is preferred? [ ] 1. Lithotomy [ ] 2. Modified standing [ ] 3. Dorsal recumbent [ ] 4. Fowler's

76. 2. The best position for assessing the characteristics of the prostate gland is one in which the client leans forward from the waist while standing, bracing his body against the examination table for support. The rectum can be examined with the client in the lithotomy and dorsal recumbent positions, but these are not the preferred positions. A Fowler's position does not facilitate a rectal examination.

77. The nurse provides health teaching to the client about the prostate before the examination. Please place an X where the prostate gland is located.

77. The prostate gland is a walnut-sized structure that surrounds the male urethra just beneath the bladder.

A 72-year-old client with a history of benign prostatic hypertrophy (BPH) phones the nurse at his physician's office, stat ing that he has not been able to urinate in the past 16 hours. 78. In the early stages of BPH, the nurse expects the physician to monitor the progression of disease with which diagnostic test? [ ] 1. A semiannual prostate-specific antigen (PSA) test [ ] 2. An annual cystoscopy [ ] 3. A digital rectal examination [ ] 4. A retrograde pyelogram

78. 3. In the early stages of benign prostatic hypertrophy (BPH), the progression of prostatic enlargement is monitored with periodic digital rectal examinations. A prostate-specific antigen (PSA) test is no longer recommended because it has led to unnecessary treatment of prostate cancer in the past. As BPH progresses, the physician may use cystoscopy to determine the extent of the infringement on the urethra and the effects on the bladder. A retrograde pyelogram is a diagnostic test commonly used to provide information about possible damage to the upper urinary tract due to urine retention.

The physician advises the client to go to the emergency department for catheterization. 79. Because an enlarged prostate gland may be the cause for the client's urine retention, place an X on the catheter that would be best for the nurse to use in lieu of a Foley retention catheter.

79. A Coudé catheter is used in lieu of a flexible catheter to overcome urethral obstructions because it has a stiffer and pointed tip. The first catheter in the illustration is a mushroom-shaped de Pezzer catheter and the second is a wing-tipped Malecot catheter; both of these are inserted by a physician and require a stylet.

The radiologist interprets the findings on the mammogram as benign fibrocystic disease. 8. The nurse correctly informs the client that fibrocystic lesions may become larger and more tender at what time? [ ] 1. After the menstrual cycle [ ] 2. After sexual intercourse [ ] 3. Nearer to beginning menopause [ ] 4. Just before menstruation

8. 4. Fibrocystic lesions cause more discomfort before menstruation because the lesions are affected by increasing levels of estrogen. Estrogen appears to be a factor because cysts usually disappear after menopause. Many women experience relief of symptoms when menstruation occurs. Symptoms do not commonly increase with aging. Fibrocystic lesions are not affected by sexual activity.

80. Unless the physician specifies otherwise, what is the maximum volume of urine the nurse should remove with the catheter at this time? [ ] 1. 500 mL [ ] 2. 1,000 mL [ ] 3. 1,500 mL [ ] 4. 2,000 mL

80. 2. After draining 700 mL of urine, the client should feel relief. Draining any more than 1,000 mL in a short amount of time can contribute to bladder spasms or loss of bladder tone. More urine can be removed after waiting a period of time. The physician may override this rule of thumb in special circumstances.

The client is scheduled for a sonogram of his prostate. 81. When the nurse provides the client with pretest instructions, which statement is most correct? [ ] 1. "You'll need to fast from midnight the night before the test." [ ] 2. "You'll need to empty your bladder just before the test begins." [ ] 3. "You'll need to consume at least a quart of water an hour before the test." [ ] 4. "You'll need to self-administer an enema 1 hour before the test."

81. 4. When a prostate sonogram is performed, a rectal probe is inserted. The presence of stool can interfere with imaging the prostate as well as contribute to discomfort. Therefore, it is important to empty the rectum completely. The client may wish to empty his bladder as well, but that is not necessary with this test. The test does not require fasting. Water may be instilled within the sheath surrounding the rectal probe; the client is not required to consume a large volume of water.

The client undergoes a transurethral resection of the prostate (TURP) and is returned to the nursing unit with a three-way catheter for administering intermittent bladder irrigations. Because the physician is concerned about the client's renal status, urine output is calculated every 4 hours. 82. If the nurse instills 1,000 mL of irrigant in the 4-hour time frame, and there is 1,275 mL in the drainage collection bag at the end of the 4 hours, what is the total urine output?

82. 275 mL.The irrigation solution is a part of the volume that collects in the drainage bag. Therefore, to find the true urine output, the amount of instilled irrigant is subtracted from the volume in the drainage bag.

83. When a client with a transurethral resection of the prostate (TURP) complains of bladder discomfort and a feeling of urgency to void, which nursing action is best to take first? [ ] 1. Check that the urinary drainage catheter is patent. [ ] 2. Administer a prescribed analgesic as soon as possible. [ ] 3. Change the client to semi-Fowler's position. [ ] 4. Get the client out of bed to ambulate for a while.

83. 1. Obstructions in the drainage catheter are the chief cause of bladder discomfort after transurethral resection of the prostate (TURP). Therefore, the nurse should check for patency of the drainage catheter. A belladonna and opium suppository may be helpful, but this option is not the first course of action. Sitting can increase intra-abdominal pres sure and contribute to more bleeding. Ambulating may or may not improve drainage through the catheter, but it is not the first choice of actions.

91. If a culture is ordered to detect the causative organism, which body substance will the nurse collect? [ ] 1. Venous blood [ ] 2. Sterile urine [ ] 3. Ejaculated semen [ ] 4. Urethral drainage

91. 4. The most likely substance to be cultured if a client has gonorrhea is urethral drainage. However, the organism might also be cultured from swabs taken from other areas, including the rectum, pharynx, and vagina (in women). The organism causing gonorrhea is not generally found in blood or urine. It is found in semen; however, collection is complicated because producing the specimen requires masturbation and ejaculation.

A 68-year-old client with prostate cancer undergoes a suprapubic prostatectomy. He returns to the nursing unit with an indwelling catheter in his urethra and a cystostomy tube in his abdomen. 84. Which nursing order is most appropriate to add to the client's initial postoperative care plan? [ ] 1. Connect the cystostomy tube to a leg bag for drainage. [ ] 2. Secure the cystostomy tube to the client's thigh. [ ] 3. Ensure that the cystostomy tube is unclamped at all times. [ ] 4. Clamp the indwelling catheter when the cystos tomy tube is irrigated.

84. 3. In the immediate postoperative period, all urinary drainage catheters, including the cystostomy tube, are unclamped to facilitate drainage. The suprapubic cystostomy tube is clamped later when bladder retraining is begun. A cystostomy catheter is too short to attach directly to the thigh or a leg bag; it would require a separate drain age tube and urine collection bag.

85. What special instruction concerning the technique for taking vital signs is most important when assigning this task to a nursing assistant? [ ] 1. Count the client's respirations while he is resting. [ ] 2. Assess the client's pulse at the radial artery. [ ] 3. Take the client's blood pressure with an electronic machine. [ ] 4. Avoid taking a rectal temperature.

85. 4. The temperature should be taken by any route other than rectal for the first postoperative week after prostatic surgery. Inserting a rectal thermometer can result in perforation of the rectal mucosa and damage to the prostatic capsule that was left behind when the prostate was removed. All the other instructions are correct, but they are not the most important instruction to give the nursing assistant.

A radical inguinal orchiectomy is performed on a 22-year old client with testicular cancer. 86. Which comment by the client indicates that he has misinterpreted the consequences of his surgery? [ ] 1. "My beard will continue to grow." [ ] 2. "My voice will sound higher." [ ] 3. "My sperm count will be unchanged." [ ] 4. "My sex drive will be unaffected."

86. 3. Orchiectomy is the removal of the testicles when a malignancy occurs. One functioning testis ought to produce enough testosterone to sustain all of a man's secondary sex characteristics and his libido. However, after this surgery, the sperm count is reduced and the motility of the sperm is impaired.

A nurse makes an office appointment for a male teenager who thinks he may have a sexually transmitted infection. 87. To facilitate obtaining truthful information regarding this client's sexual history, which attitude is most important for the nurse to convey? [ ] 1. Sympathetic [ ] 2. Nonjudgmental [ ] 3. Encouraging [ ] 4. Optimistic

87. 2. Conveying a nonjudgmental attitude facilitates obtaining truthful information from the person who feels uncomfortable discussing sexual information. Being sympathetic, encouraging, and optimistic are all positive attributes, but none of these is as important as being nonjudgmental.

88. When obtaining a sexual history from this client, which question is most important for the nurse to ask? [ ] 1. "Have you ever had a painless sore on your penis?" [ ] 2. "Does any sex partner have similar symptoms?" [ ] 3. "At what age did you first have sexual intercourse?" [ ] 4. "When did you last have sexual intercourse?"

88. 2. Asking a person if any sex partner has similar symptoms helps to determine if the cause of the client's symptoms is a sexually transmitted infection. A painless sore is a symptom of syphilis, which is not the most common sexually transmitted infection, but may be asked if the client reports having a lesion on the penis, rectal area, mouth, or nose. The age at which a person first had sexual intercourse is unrelated to the present symptoms. Incubation periods vary among sexually transmitted infections; identifying the most recent date of sexual intercourse will not identify the time at which the infection was transmitted.

After obtaining a health and sexual history, the nurse suspects that the client has signs and symptoms of gonorrhea. 89. If the client is typical of others with gonorrhea, which statements made by the client will help to make the diagnosis? Select all that apply. [ ] 1. "I have burning when I urinate." [ ] 2. "I have a yellow drainage from my penis." [ ] 3. "I had sexual intercourse 5 days ago." [ ] 4. "I have a painless ulceration on my penis." [ ] 5. "I have little blisters on my penis and scrotum." [ ] 6. "I have extra skin growing around my penis."

89. 1, 2, 3. Gonorrhea is a common sexually transmitted infection with the highest incidence among 14- to 15-year olds. It is caused by bacteria, making it easy to treat. The bacteria enter the urethra, vagina, rectum, or throat, depending on the manner of sexual contact. Most females are asymptomatic. Males, if symptomatic, usually experience symptoms 2 to 6 days after exposure and have burning on urination; yellow, white, or green drainage from the penis; and soreness in the scrotum. Painless ulcers (chancres) on the penis are more common with syphilis. Blisters on the penis are common in herpes infections; extra skin (soft, fleshy growths) growing around the penis is common with venereal warts.

9. Although it has not been conclusively proven, the nurse explains that some women with fibrocystic disease get relief from their symptoms by eliminating which substance from their diet? [ ] 1. Alcohol [ ] 2. Caffeine [ ] 3. Saturated fat [ ] 4. Refined sugar

9. 2. Some women report that eliminating coffee, tea, cola, and chocolate reduces their breast discomfort. Limiting sodium intake, taking a warm bath, or taking an anti-inflammatory such as ibuprofen (Motrin) also helps. Objectively, however, there is no evidence that the fibrocystic lesions become smaller or disappear with any particular diet modification. Consuming a high-fat diet seems to have a relationship to developing breast cancer. Refined sugar and alcohol are not linked to breast disease.

90. The nurse discusses healthy sexual behaviors with the client. Which risk factor predisposes the client to acquiring a sexually transmitted infection? [ ] 1. Experiencing early puberty [ ] 2. Finding sex information on the Internet [ ] 3. Having multiple sex partners [ ] 4. Receiving limited sex education

90. 3. Intimate sexual contact with one or more sexual partners is the highest risk factor among the options listed for acquiring a sexually transmitted infection. Developing sexually at an early age does not necessarily affect a person's sexual choices. Internet access for children and adolescents can be informative if the site is reputable. Sex education is important, and too little accurate information does predispose individuals to making poor sexual choices. However, it is not as great a risk factor as having multiple sexual partners.

92. When collecting a specimen from the client who may have gonorrhea, which nursing action is correct? [ ] 1. Wearing latex gloves [ ] 2. Using a disinfectant [ ] 3. Asking the client to provide the specimen [ ] 4. Refrigerating the specimen immediately

92. 1. Gloves are worn as a standard precaution when collecting body substances from any client regardless of the tentative diagnosis. The hands should also be washed after glove removal. Using a disinfectant is not appropriate for any specimen collection. As long as gloves are worn, the nurse can touch the client. Cultures for the gonorrhea organism are inoculated onto a culture medium as soon as possible; therefore, refrigeration is undesirable

93. When counseling a female client with a new diagnosis of genital herpes, which statement by the nurse is accurate? [ ] 1. "Have a Pap test done at least every 6 months." [ ] 2. "Avoid having vaginal intercourse for at least 6 months." [ ] 3. "If you take your medicine, you will not infect anyone else." [ ] 4. "Your infection provides immunity for any future children."

93. 1. Women infected with the herpes simplex virus type 2 are at greater risk for developing cervical cancer. Therefore, frequent Pap smears are necessary. Men infected with the virus are at greater risk for developing prostatic cancer. Clients may have vaginal intercourse, but a condom should be used and all sex partners should be informed of the potential for infection. Drugs may decrease the frequency of outbreaks and reduce the length of time when symptoms are manifested. However, taking medication does not provide protection for others. Spontaneous abortions increase among infected pregnant women. Infants can acquire the herpes virus at the time of vaginal delivery.

94. While assessing a male client with tertiary syphilis, which finding is most characteristic of this stage of the disease? [ ] 1. Stabbing leg pain [ ] 2. Red, raised rash [ ] 3. Penile ulcer [ ] 4. Patchy hair loss

94. 1. Tertiary syphilis is the final stage in the course of untreated disease. It occurs about 25 to 30 years after the initial infection. In this stage, syphilis presents as a slow, progressive inflammatory disease. One of the manifestations of tertiary syphilis is sharp, stabbing leg pains. The client may also have other organ system damage involving the heart, brain, liver, bones, and eyes. A painless ulcer is a characteristic of primary-stage syphilis. The secondary stage of syphilis is accompanied by a red rash and patchy hair loss.

95. Which comment indicates that the client lacks a clear understanding of syphilis? [ ] 1. "I can be cured using antibiotic therapy." [ ] 2. "My sex partner should be tested for the disease." [ ] 3. "Syphilitic lesions may be present in my partner's vagina." [ ] 4. "One infection provides lifelong immunity."

95. 4. There is no lifelong immunity to syphilis. Each new incident is treated with antibiotic therapy. Antibiotic therapy destroys the microorganism and prevents further consequences from the disease. Sex partners are tested and treated if they are infected. Syphilitic lesions can appear on the penis, outside and inside the vagina, around the mouth, and even on the nipple.

A culture indicates that a client has nonspecific urethritis from Chlamydia trachomatis, a nongonococcal organism. The physician prescribes doxycycline (Vibramycin) 100 mg b.i.d. with a sufficient number of capsules for 7 days of treatment. 96. Which information given by the nurse is most appropriate to provide to the client? [ ] 1. Take the medication until the symptoms clear. [ ] 2. Refill the prescription if symptoms persist. [ ] 3. Take the medication for the full amount of time. [ ] 4. Treatment of the infection is likely to be lifelong.

96. 3. To ensure adequate treatment, the client with a sexually transmitted infection is told to continue taking the prescribed medication for the full amount of time. Symptoms may clear in a short time after initial treatment, but the organisms might not be totally destroyed. The infection may persist without adequate treatment. The need for a refill is at the discretion of the health care professional. Long-term or repeated use of an antibiotic can cause an organism to develop resistance. Aggressive and appropriate short-term treatment is adequate for the present infection. Further treatment is not required unless reinfection occurs.

97. Which nursing instruction is best to provide to the client with chlamydia to prevent a recurrence of the infection? [ ] 1. Shower or bathe after intercourse. [ ] 2. Wash your hands well using an antiseptic soap. [ ] 3. Encourage your sexual partners to be tested and treated. [ ] 4. Make sure you receive adequate nutrition and fluid intake.

97. 3. Although all of the measures listed are important health practices for preventing infections, the most important method for preventing the recurrence of a sexually transmitted infection is to eliminate the infection in other sex partners. Unless this occurs, the pathogenic organism can be retransmitted.

98. Which gynecologic symptom reported by a female client is most suggestive of trichomoniasis? [ ] 1. A series of fluid-filled vesicles on the vagina [ ] 2. Vaginal drainage that causes intense itching [ ] 3. Vaginal drainage that resembles milk curds [ ] 4. Tenderness and pressure in the lower abdomen

98. 2. Vaginal pruritus (itching) is a common problem experienced by women infected with Trichomonas vaginalis. Other clinical manifestations include yellow-brown malodorous vaginal discharge and thin vaginal secretions. Fluid-filled vesicles are associated with herpetic lesions. Vaginal drainage that seems to contain flecks of milk is characteristic of candidiasis (moniliasis). Women with gonorrhea or chlamydial infections commonly experience abdominal discomfort among other symptoms

To prevent infection with the human immunodeficiency virus (HIV), a client says he uses a condom when having intercourse. 99. When managing the care of a client with acquired immunodeficiency syndrome (AIDS), which method best evaluates the effectiveness of zidovudine (AZT) therapy? [ ] 1. Assessing the client's vital signs [ ] 2. Assessing the client's blood counts [ ] 3. Monitoring the client's blood culture reports [ ] 4. Monitoring the client's viral load tests

99. 4. Viral load tests, which include the p24 antigen and polymerase chain reaction tests, are considered to be the best marker of disease progression in acquired immunodeficiency syndrome (AIDS). They are used to guide drug therapy and follow the progression of the disease. Viral load tests and T4 cell counts are performed every 2 to 3 months once a person tests positive for human immunodeficiency virus (HIV) infection. Blood counts reveal if the cell counts are increasing, decreasing, or staying the same, but they are not as effective as the newer viral load tests. Assessing for changes in vital signs can help signal complications such as infection; however, this is not the best method for monitoring drug effectiveness. Viruses can only be cultured in living tissue. Consequently, this approach is not used except in research.