ch 47, 73, 74

A client has experienced a stroke resulting in damage to Wernicke's area. Which clinical manifestation does the nurse monitor for? a. Inability to comprehend spoken words b. Communication with rote speech only c. Slurred speech d. Inability to make sounds

A The client with damage to Wernicke's area cannot understand spoken or written words. If the client speaks, the language is meaningless, with the client using made-up words. Damage to Wernicke's area does not cause slurred speech, nor will the client communicate with habitual speech only.

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

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

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

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

The nurse is caring for a client who has a moderate head injury. The client's sister asks, "Will my brother return to his normal functioning level when his brain heals?" How does the nurse respond? a. "You should expect a full recovery in all ways by the time of discharge." b. "Usually, someone with this type of injury returns to baseline within 6 months." c. "Your brother may experience many changes in personality and cognitive abilities." d. "Learning complex new skills may be more difficult, but you can expect other functions to return to normal."

C Those with moderate to severe head injuries are never the same as before the injury. They can experience changes in cognition such as memory loss, difficulty learning new information, and limited concentration. Personality alterations such as outbursts of temper and depression also may occur. The other responses do not correctly answer the question and can give false hope.

The nurse is teaching bladder training to a client who is incontinent after a stroke. Which instruction does the nurse include in this client's teaching? a. "Decrease your oral intake of fluids to 1 liter per day." b. "Use a Foley catheter at night to prevent accidents." c. "Plan to use the commode every 2 hours during the day." d. "Hold your bladder as long as possible to restore bladder tone."

C To begin a bladder training program, teach the client to use the commode, bedpan, or urinal every 2 hours. If used frequently enough, this will prevent accidents and establish a routine. Fluid intake should be restricted at night, and a Foley catheter should be used only for urine retention. The client should empty his or her bladder when the urge occurs and should not hold the bladder.

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

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

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

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

A client is admitted for evaluation of a cerebral tumor. Which clinical manifestations does the nurse assess this client for? Select all that apply a. Hemiplegia b. Aphasia c. Hearing loss d. Behavior changes e. Nystagmus

A, B, D If the tumor affects the cerebral hemispheres, hemiplegia, aphasia, and behavioral changes are common. Hearing loss and nystagmus are found with brainstem lesions.

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

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

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

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

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

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

The nurse is obtaining a health history for a client admitted to the hospital after experiencing a brain attack. Which disorder does the nurse identify as a predisposing factor for an embolic stroke? a. Seizures b. Psychotropic drug use c. Atrial fibrillation d. Cerebral aneurysm

C Clients with a history of hypertension, heart disease, atrial fibrillation, diabetes, obesity, and hypercoagulopathy are at risk for embolic stroke. The other disorders are not risk factors for an embolic stroke.

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

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

A client who has a severe head injury is placed in a drug-induced coma. The client's husband states, "I do not understand. Why are you putting her into a coma?" How does the nurse respond? a. "These drugs will prevent her from experiencing pain when positioning or suctioning is required." b. "This medication will help her remain cooperative and calm during the painful treatments." c. "This medication will decrease the activity of her brain so that additional damage does not occur." d. "This medication will prevent her from having a seizure and will reduce the need for monitoring intracranial pressure."

C When intracranial pressure cannot be controlled by other means, clients may be placed in a barbiturate coma to decrease cerebral metabolic demands, decrease formation of vasogenic edema, and produce a more uniform blood supply to the brain. The other responses do not correctly explain the reason for a medication-induced coma. Pain medication should be administered when the client is comatose.

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

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

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

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

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

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

The nurse is assessing a client who had a stroke in the right cerebral hemisphere. Which neurologic deficit does the nurse assess for in this client? a. Impaired proprioception b. Aphasia c. Agraphia d. Impaired olfaction

A A stroke to the right cerebral hemisphere causes impaired visual and spatial awareness. The client may present with impaired proprioception and may be disoriented as to time and place. The right cerebral hemisphere does not control speech, smell, or the client's ability to write.

The nurse is preparing to administer a prescribed dose of intravenous dexamethasone (Decadron) to a client after craniotomy. The pharmacy supplies dexamethasone 40 mcg in 20 mL normal saline to be administered over 15 minutes. The nurse sets the IV pump at a rate of _____ mL/hr.

80 20 mL/15 min = x mL/60 min 15x = 1200 x = 80 mL/hr

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

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

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

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

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

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

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

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

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

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

The nurse is caring for a client who is disoriented as the result of a stroke. Which action does the nurse implement to help orient this client? a. Ask the family to bring in pictures familiar to the client. b. Turn on the television to a 24-hour news station. c. Maintain a calm and quite environment by minimizing visitors. d. Provide auditory and visual stimulation simultaneously.

A For the client with disorientation, the nurse can request that the family bring in pictures or objects that are familiar to the client. The nurse explains what the object or picture represents in simple terms. These stimuli can be presented several times daily. Visitors can also be familiar stimuli to reorient the client. Too much stimuli and constant stimuli can lead to further confusion.

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

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

The nurse notes that the left arm of a client who has experienced a brain attack is in a contracted, fixed position. Which complication of this position does the nurse monitor for in this client? a. Shoulder subluxation b. Flaccid hemiparesis c. Pathologic fracture d. Neglect syndrome

A Hypertonia causing contracture or flaccidity can predispose the client to subluxation of the shoulder. Contractures are stiff and immobile—not flaccid. Contractures are not caused by fractures or neglect syndrome.

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

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

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

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

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

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

The nurse is preparing to administer prescribed mannitol (Osmitrol) to a client with a severe head injury. Which precaution does the nurse take before administering this medication? a. Draw up the medication using a filtered needle. b. Have injectable naloxone (Narcan) prepared and ready at the bedside. c. Prepare to hyperventilate the client before drug administration. d. Discontinue a barbiturate-induced coma before drug administration.

A Mannitol (Osmitrol) must be drawn up using a filtered needle to eliminate microscopic crystals. Narcan does not reverse the effects of mannitol. Hyperventilation does not affect administration of this drug, and clients can be given mannitol while in a barbiturate-induced coma.

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

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

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

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

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

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

A client who first experienced symptoms related to a confirmed thrombotic stroke 2 hours ago is brought to the intensive care unit. Which prescribed medication does the nurse prepare to administer? a. Tissue plasminogen activator b. Heparin sodium c. Gabapentin (Neurontin) d. Warfarin (Coumadin)

A The client who has had a thrombotic stroke has a 3-hour time frame from the onset of symptoms to receive recombinant tissue plasminogen activator (rt-PA) to dissolve the cerebral artery occlusion and re-establish blood flow. Clients must meet eligibility criteria for administration of this therapy. The other medications do not assist in the re-establishment of blood flow for a client with a confirmed thrombotic stroke.

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

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

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

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

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

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

A client with aphasia presents to the emergency department with a suspected brain attack. Which clinical manifestation leads the nurse to suspect that this client has had a thrombotic stroke? a. Two episodes of speech difficulties in the last month b. Sudden loss of motor coordination c. A grand mal seizure 2 months ago d. Chest pain and nuchal rigidity

A Thrombotic stroke is characterized by a gradual onset of symptoms that often are preceded by transient ischemic attacks (TIAs), causing a focal neurologic dysfunction. Two episodes of speech difficulties would correlate with TIAs. The other manifestations are not related to a thrombotic stroke.

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

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

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

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

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

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

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

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

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

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

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

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

The nurse is caring for a client who has experienced a stroke. Which nursing intervention for nutrition does the nurse implement to prevent complications from cranial nerve IX impairment? a. Turn the client's plate around halfway through the meal. b. Place the client in high Fowler's position. c. Order a clear liquid diet for the client. d. Verbalize the placement of food on the client's plate.

B Cranial nerve IX, the glossopharyngeal nerve, controls the gag reflex. Clients with impairment of this nerve are at great risk for aspiration. The client should be in high Fowler's position and should drink thickened liquids if swallowing difficulties are present. The client would not have vision problems. Turning the plate around would not prevent a complication, nor would limiting the client's diet to clear liquids.

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

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

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

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

The nurse is assessing a client who was recently diagnosed with a meningioma. Which statement indicates that the client correctly understands the diagnosis? a. "This is the worst type of brain tumor, and surgery is not an option." b. "My tumor can be removed, but I can still have damage because of pressure in my brain." c. "Even after the surgery, I will need chemotherapy to decrease the spread of the tumor." d. "Radiation is never used on brain tumors because of possible nerve damage."

B Meningiomas arise from the coverings of the brain (the meninges) and are the most common type of benign tumor. This tumor is encapsulated, globular, and well demarcated, and causes compression and displacement of nearby brain tissue. Although complete removal of the tumor is possible, it tends to recur and causes irreversible damage to the brain. The tumor is not treated by chemotherapy or radiation.

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

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

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

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

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

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

The nurse assesses periorbital edema and ecchymosis around both eyes of a client who is 6 hours postoperative for craniotomy. Which intervention does the nurse implement for this client? a. Position the client with the head of the bed flat. b. Apply an ice pack to the affected area. c. Assess arterial blood pressure. d. Notify the health care provider.

B Periorbital edema and ecchymosis are expected after a craniotomy. The nurse should attempt to increase the client's comfort by reducing the swelling with application of ice. The provider does not need to be notified. Lowering the head of the bed and assessing blood pressure will not decrease inflammation.

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

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

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

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

A client who had a brain attack was admitted to the intensive care unit yesterday. The nurse observes that the client is becoming lethargic and is unable to articulate words when speaking. What does the nurse do next? a. Check the client's blood pressure and apical heart rate. b. Elevate the back rest to 30 degrees and notify the health care provider. c. Place the client in a supine position with a flat back rest, and observe. d. Assess the client's white blood cell count and differential.

B The client is experiencing signs of increased intracranial pressure (ICP). Raising the head of the bed would help decrease ICP. The health care provider should then be notified immediately so that other interventions to reduce ICP can be instituted. Assessing vital signs and white blood cell count is not the priority at this time.

The nurse is caring for a client admitted to the intensive care unit after incurring a basilar skull fracture. Which complication of this injury does the nurse monitor for? a. Aspiration b. Hemorrhage c. Pulmonary embolus d. Myocardial infarction

B This type of fracture may cause hemorrhage from damage to the internal carotid artery. The other problems are not complications of this injury.

The nurse is caring for a client who is immobile from a recent stroke. Which intervention does the nurse implement to prevent complications in this client? a. Position the client with the unaffected side down. b. Apply sequential compression stockings. c. Instruct the client to turn the head from side to side. d. Teach the client to touch and use both sides of the body.

B To avoid complications of immobility, such as deep vein thrombosis, the nurse applies sequential compression stockings or pneumatic compression boots. Efforts are made to mobilize the client as much as possible, and the client should be repositioned frequently. The other interventions will not prevent complications of immobility.

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

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

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

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

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

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

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

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

A client who had a stroke is receiving clopidogrel (Plavix). Which adverse effect does the nurse monitor for in this client? a. Repeated syncope b. New-onset confusion c. Spontaneous ecchymosis d. Abdominal distention

C Clopidogrel (Plavix) is an antiplatelet medication that can cause bleeding, bruising, and liver dysfunction. The nurse should be alert for signs of bleeding, such as ecchymosis, bleeding gums, and tarry stools. Plavix does not cause syncope, confusion, or abdominal distention.

The nurse is planning the discharge of a client who has sustained a moderate head injury and is experiencing personality and behavior changes. The client's wife states, "I am concerned about how different he is. What can I do to help with the transition back to our home?" How does the nurse respond? a. "Be firm and let him know when his behavior is unacceptable." b. "Minimizing the number of visitors will help stabilize his personality." c. "Developing a routine will help provide him with a structured environment." d. "He will return to his normal emotional functioning in 6 to 12 months."

C Developing a home routine that provides structure and repetition is recommended because clients with personality and behavior problems respond best to this type of environment. The client's personality and emotional functioning will never return to normal. The client may be aggressive, and family members must be aware of potential client reactions.

The nurse is caring for a client who had a stroke. Which nursing intervention does the nurse implement during the first 72 hours to prevent complications? a. Administer prescribed analgesics to promote pain relief. b. Cluster nursing procedures together to avoid fatiguing the client. c. Monitor neurologic and vital signs closely to identify early changes in status. d. Position with the head of the bed flat to enhance cerebral perfusion.

C Early detection of neurologic, blood pressure, and heart rhythm changes offers an opportunity to intervene in a timely fashion. Evidence is not yet sufficient to recommend a specific back rest elevation after stroke. Analgesics are often held during the first 72 hours to ensure that the client's neurologic status is not altered by pain medications. Preventing fatigue is not a priority in the first 72 hours.

A client who has a head injury is transported to the emergency department. Which assessment does the emergency department nurse perform immediately? a. Pupil response b. Motor function c. Respiratory status d. Short-term memory

C Respiratory derangements (e.g., hypoxemia, hypercarbia, alterations in pH) can contribute to secondary brain injury in this scenario. Therefore, the important priority is assessment of respiratory status so that secondary brain injury conditions are avoided. The other assessments should be performed after effective respiratory functions have been established.

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

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

A client who has had a stroke with left-sided hemiparesis has been referred to a rehabilitation center. The client asks, "Why do I need rehabilitation?" How does the nurse respond? a. "Rehabilitation will reverse any physical deficits caused by the stroke." b. "If you do not have rehabilitation, you may never walk again." c. "Rehabilitation will help you function at the highest level possible." d. "Your doctor knows best and has ordered this treatment for you."

C The goal of rehabilitation is to maximize the client's abilities in all aspects of life. The other responses do not answer the client's question appropriately.

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

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

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

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

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

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

A client who had a stroke combs her hair only on the right side of her head and washes only the right side of her face. How does the nurse interpret these actions? a. Poor left-sided motor control b. Paralysis or contractures on the right side c. Limited visual perception of the left fields d. Unawareness of the existence of her left side

D Clients who have experienced a right hemisphere stroke often have neglect syndrome, in which they are unaware of the existence of the paralyzed side, or the left side. This injury would not have an effect on the client's sight. This is not related to poor motor control or paralysis.

The nurse is caring for an 80-year-old client who presented to the emergency department in a coma. Which question does the nurse ask the client's family to help determine whether the coma is related to a brain attack? a. "How many hours does your mother usually sleep at night?" b. "Did your mother complain recently of weakness in her lower extremities?" c. "Is any history of seizures known among your mother's immediate family?" d. "Does your mother drink any alcohol or take any medications?"

D Conditions such as drug or alcohol intoxication, as well as hypoxemia and metabolic disturbances, can cause profound changes in level of consciousness (LOC) when accompanied by a brain attack. Alcohol abuse and medication toxicity can be especially problematic in older adults. The other manifestations are related to a stroke but would not increase the client's risk of coma.

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

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

A client with a head injury is being given midazolam (Versed) while on mechanical ventilation. Which action does the nurse implement for this client? a. Monitor for seizures. b. Assess for urinary output. c. Provide a clear liquid diet. d. Administer an analgesic.

D Midazolam (Versed) is a benzodiazepine agent and has no analgesic effect. It should be given with pain medication. This medication does not increase the risk of seizures and does not decrease urinary output. Clients should not be fed when being mechanically ventilated.

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

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

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

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

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

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

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

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

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

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

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

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