Evolve endrocrine/sexuality

A client with newly diagnosed gynecologic cancer is being discharged home. Which health care team member does the nurse contact to coordinate nursing care at home for this client? a. Case manager b. Primary Health care provider c. Hospice d. Social services

A

The RN has just received change-of-shift report on the medical-surgical unit. Which client will need to be assessed first? Client with Hashimoto's thyroiditis and a large goiter Client with hypothyroidism and an apical pulse of 51 beats/min Client with parathyroid adenoma and flank pain due to a kidney stone Client who had a parathyroidectomy yesterday and has muscle twitching Correct

A client who is 1 day postoperative for parathyroidectomy and has muscle twitching is showing signs of hypocalcemia and is at risk for seizures. Rapid assessment and intervention are needed. Clients with Hashimoto's thyroiditis are usually stable; this client does not need to be assessed first. Although an apical pulse of 51 is considered bradycardia, a low heart rate is a symptom of hypothyroidism. A client with a kidney stone will be uncomfortable and should be asked about pain medication as soon as possible, but this client does not need to be assessed first.

A 42-year-old woman with an intramural leiomyoma (myomas or fibroids) has been taking estrogen replacement therapy for menopausal symptoms. What does the nurse tell her about estrogen replacement therapy and how it relates to her fibroids? a. "Estrogen will help shrink your fibroids." b. "Increasing the amount of estrogen you are taking will be necessary." c. "The fibroids may continue to grow." d. "Your estrogen dosage will not change."

C

What task does the RN delegate to unlicensed assistive personnel (UAP) working on the medical-surgical unit? a. Inserting a catheter in a client who has a history of uterine prolapse b. Giving report to a receiving nurse about a client who is being transferred c. Assisting with a sitz bath for a client with ulcerative vulvitis d. Providing discharge teaching for a client who is scheduled for brachytherapy

C

Which client history places a woman at highest risk for developing endometrial (uterine) cancer? a. Multiparity, human papilloma virus (HPV), smoking, and African-American ethnicity b. Nulliparity, endometriosis, diabetes mellitus, first pregnancy at older than 20 years c. Nulliparity, smoking, uterine polyps, hypertension d. Oral contraceptive use, smoking, localized pain in the thigh

C

The nurse is performing discharge teaching for a client who is recovering from a total abdominal hysterectomy (TAH). Which client statement indicates a need for clarification? a. "I cannot jog for 2 to 6 weeks." b. "I must take my temperature twice a day for the first few days after surgery." c. "I will need to find a new form of birth control." d. "I will no longer have menstrual periods."

C

The nurse is teaching a client how to prevent vaginal inflammation and itching. What information does the nurse include? a. Wear snug-fitting latex undergarments to prevent chafing. b. Cleanse the inner labia daily with soap and water. c. Do not have unprotected sex with multiple partners. d. Monthly douching may help reduce symptoms.

C

The nurse is providing teaching to the client with hepatitis C. Which information is essential to include?

When ribavirin is taken, contraception must be used

Which statement by the client with cirrhosis indicates that further instruction is needed about the disease?

"My liver is scarred, but the cells can regenerate themselves and repair the damage."

A client has a urinary catheter and continuous bladder irrigation after a transurethral resection of the prostate this morning. The amount of bladder irrigation solution that has infused over the past 12 hours is 1000 mL. The amount of fluid in the urinary drainage bag is 1725 mL. The nurse records that the client has had ____ mL urinary output in the past 12 hours. (Ignatavicius & Workman, p.1505)

725 mL (Ignatavicius & Workman, p.1505)

An 18-year-old female is diagnosed with possible toxic shock syndrome (TSS) and has these vital signs: T 103.2°F (39.6°C), P 124 beats/min, R 36 breaths/min, BP 84/30 mm Hg. Which primary health care provider request does the nurse implement first? a. Administer O2 at 6 L/min. b. Give cefazolin (Ancef) 500 mg IV. c. Infuse normal saline IV at 500 mL/hr. d. Obtain blood cultures × 2 sites.

A

The nursing team consists of an RN, an LPN/LVN, and a nursing assistant. Which client should be assigned to the RN?

A client with end-stage cirrhosis who needs teaching about a low-sodium diet

The nurse is reviewing laboratory results on a 34-year-old client who is suspected of having endometrial (uterine) cancer. Which laboratory tests does the nurse expect to see? (Select All That Apply) a. Alpha-fetoprotein (AFP) test b. Cancer antigen (CA)-125 test c. Human chorionic gonadotropin (hCG) level d. Complete Blood Count (CBC) e. Serum electrolytes f. Hereditary nonpolyposis colon cancer (HNPCC) test

A, B, C, D, F

The nurse is teaching a client how to adapt to physical and psychological changes after surgery for ovarian cancer. What is included in the teaching plan? (Select All That Apply) a. Encouraging the use of support groups and counseling b. Encouraging the expression of grief and fears c. Offering vaginal dilators d. Refraining from sexual intercourse for 6 weeks after surgery. e. Suggesting the use of oil-based lubricants

A, B, D

Which gynecologic clients does the charge nurse assign to an LPN/LVN? (Select All That Apply) a. A 23-year-old who is nauseated after her laparotomy and needs to receive antiemetic drugs b. A 34-year-old who had a total hysterectomy for invasive cervical cancer and has a blood pressure (BP) of 88/54 mm Hg c. A 42-year-old who had an abdominal hysterectomy whose primary health care provider wants to remove sutures at her bedside d. A 48-year-old who is receiving IV chemotherapy to treat stage II cervical cancer e. A 52-year-old who just returned to the unit following a total abdominal hysterectomy

A, C

Decreased estriol levels in a pregnant client are frequently associated with which condition? A. An impending miscarriage B. Impending birth of multiples (twins, etc.) C. Infertility problems D. Normal pregnancy

ANS: A Decreased levels of estradiol, total estrogens, and estriol in women indicate possible amenorrhea, climacteric, impending miscarriage, or hypothalamic disorders. Decreased estriol levels in the pregnant client do not indicate impending birth of multiples or infertility.

The nurse is caring for clients in the outpatient clinic. Which of these phone calls should the nurse return first?

From the client with severe ascites who has a temperature of 101.4° F (38° C)

The prostate-specific antigen (PSA) test is used in screening for prostate cancer. Which statement is true regarding this test? A. The PSA test can be used to monitor the disease after prostate cancer treatment. B. PSA levels less than 7.5 ng/mL may be considered normal. C. Elevated PSA levels are diagnostic for prostate cancer. D. Younger men, particularly African Americans, often have a higher normal PSA.

ANS: A The PSA test is used to screen for prostate cancer and to monitor the disease after cancer treatment. PSA levels less than 2.5 ng/mL may be considered normal, although there is no agreement on that value and how it is affected by age. Elevated PSA levels may be associated with prostate cancer. Older men, particularly African-American men, often have a higher normal PSA, especially as they age.

The nurse is educating an 18-year-old girl about the Papanicolaou (Pap) test. Which client statement indicates that further teaching is needed? A. "I can have sexual intercourse the night before the test." B. "It is recommended that women up to age 30 have an annual Pap test." C. "Pap smears help detect precancerous and cancerous cells." D. "The specimen will be sent to a laboratory for evaluation."

ANS: A The client should not have sexual intercourse for at least 24 hours before the test. Annual screening is recommended to 30 years of age with the conventional Pap test. After age 30 and three or more consecutive negative test results, Pap tests may be performed less frequently until 70 years of age. The Pap smear is a cytologic study that is effective in detecting precancerous and cancerous cells in the cervix. The specimen-containing slides from a Pap smear are sent to a laboratory for evaluation.

A client scheduled for a hysterosalpingogram is interviewed by the nurse. What interview information is critical for the nurse to report to the health care provider before the procedure? A. Allergy to shellfish B. Abortion 2 months ago C. Menstrual period that ended 3 days ago D. Administration of a rectal suppository 4 hours ago

ANS: A The contrast medium used during hysterosalpingography is iodine-based, so the client will need premedication with an antihistamine and/or corticosteroid before the procedure. Obstetric history, menstrual history, and recent medications are communicated to the provider, but do not require any change in the procedure. Two months between an abortion and this procedure is adequate. This test is done just at the completion of menses so that it would not interrupt a pregnancy, should there be one, in the uterus or the fallopian tube.

The nurse is conducting a reproductive assessment of a young adult client. What assessment questions does the nurse ask? (Select all that apply.) A. "Have you had any sexually transmitted diseases?" B. "How would you describe yourself?" C. "If you engage in sexual activities, do you practice 'safe' sex?" D. "What changes would you like to see in your appearance?" E. "When did you first start menstruating?"

ANS: A, B, C, E Asking the client about a history of sexually transmitted diseases is a question included in the health perception/health management pattern for performing a reproductive assessment. If the answer is "yes," the nurse continues with "When?" and "What type?" Asking the client to describe him- or herself is also included in the self-perception/self-concept pattern. The nurse follows with "Do you feel good or not-so-good about yourself?" It is important to note, if the client is sexually active, that he or she practices (and understands) "safe" sex. This might include the use of condoms, being tested for human immunodeficiency virus, and other measures to keep from acquiring sexually transmitted diseases. The age of onset of menses in women is important to note. Either early or late onset may indicate a problem or the increased likelihood for one to develop. Although the nurse might inquire whether a client has experienced changes in his or her body appearance or function, asking about changes the client might want to see is not important in doing a reproductive assessment.

A newly graduated RN is orienting to a same-day surgery unit. Which client does the charge nurse assign to the new graduate? A. A 25-year-old with infertility having a laparoscopy under general anesthesia B. A 32-year-old with a breast lump scheduled for a needle biopsy under local anesthesia. C. A 40-year-old with possible cervical cancer having a laser excision conization D. A 66-year-old with prostatic enlargement scheduled for a transrectal needle biopsy

ANS: B A needle biopsy of the breast has the least risk for possible complications and the least complex client teaching of the listed procedures. A laparoscopy under general anesthesia, laser excision conization, and transrectal needle biopsy are all procedures that will require complex client teaching and postoperative monitoring.

A client with possible prostate cancer has a transrectal ultrasound and needle biopsy. The next day, which client statement is of greatest concern to the nurse? A. "I am really worried about the test results." B. "I feel like I have a fever and my back aches." C. "I had some bright-red spotting after the procedure." D. "I haven't had a bowel movement since the biopsy."

ANS: B Low back pain and fever are indications of infection, a potentially life-threatening complication. Worrying about test results, some bright-red spotting, and having no bowel movement since the biopsy are not abnormal for a client who had a transrectal biopsy.

A client with pelvic pain is admitted to the same-day surgery unit for a laparoscopic procedure. Which nursing action does the RN delegate to unlicensed assistive personnel (UAP)? A. Educating the client about analgesic use for referred pain B. Inserting a retention catheter using sterile technique C. Taking the client's admission blood pressure and heart rate D. Teaching the client about postoperative activity restrictions

ANS: C Although most of the admission assessment and history will be completed by the RN, the admission vital signs can be delegated to UAP. Client teaching is a higher-level skill and should be done by the RN. Catheter insertion is also a higher-level skill and should be done by the RN, unless the UAP has had specialized training to perform this skill safely.

A middle-aged client is scheduled for her first mammogram. What does the nurse tell the client before the test? A. "A mammogram will x-ray the hard tissue of your breasts." B. "Do not eat anything for 12 hours before having your mammogram." C. "You should not wear deodorant the day of your mammogram." D. "You will not feel any discomfort during the mammography procedure."

ANS: C Deodorant may not be worn before a mammogram because it can show up on the x-ray. Mammography is an x-ray of the soft tissue of the breast. Dietary restrictions are not necessary before a mammogram. The client may experience some temporary discomfort when the breast is compressed during positioning and the test itself.

The nurse is teaching a group of young women about the risks for developing cervical cancer. What cancer risk is included in the content of the nurse's presentation? A. Eating a diet that is high in fat content. B. Having more than six pregnancies C. Starting to have sexual intercourse at a very early age D. Using a diaphragm with spermicidal jelly as a contraceptive device

ANS: C Having intercourse at a very early age and /or multiple sex partners places a woman at high risk for the development of cervical cancer. Eating a diet that is high in fat content, the number of pregnancies, and using a diaphragm have not been identified as increasing the risk for cervical cancer.

The nurse is obtaining a personal health history on a 24-year-old male whose male partner is present. How does the nurse approach questions about his sexual practices? A. Defer questions about his sexual practices to the health care provider. B. Direct questions about sexual and reproductive practices to both the client and his partner. C. Respect the client's choice to answer or refuse to answer questions about sexual practices. D. Skip the assessment questions about his sexual and reproductive practices.

ANS: C Respecting the client's choice to answer or not answer questions about sexual practices is an important part of the process of taking the sexual/reproductive history. The nurse must be sensitive about knowing when to ask and when to permit the client his or her privacy. Deferring questions about sexual practices to the health care provider or skipping questions is missing potentially important data; the nurse must establish trust with the client and then proceed with data collection. The nurse is collecting data on the client only, not on the partner or the client's relationship with his partner; directing questions to both of them could be very uncomfortable.

The human papilloma virus (HPV) test may be collected at the same time as the Papanicolaou (Pap) test for screening. Which finding indicates the highest risk for development of cervical cancer? A. Normal Pap results and no HPV infection B. Abnormal Pap results and no HPV infection C. Abnormal Pap results and positive HPV test D. Normal Pap results and positive HPV results

ANS: C The HPV test can identify many high-risk types of HPV infection associated with the development of cervical cancer and can be done at the same time as the Pap test for women older than 30 years and for women of any age who have had an abnormal Pap test result. Women with an abnormal Pap result and a positive HPV test are at higher risk if not treated. Women who have normal Pap test results and no HPV infection are at very low risk for developing cervical cancer.

An older client tells the nurse about vaginal dryness. What does the nurse suggest? A. "Be sure to tell your health care provider about this." B. "I think that you should have additional pelvic examinations." C. "Let me teach you how to do Kegel exercises." D. "Products such as water-soluble lubricants are helpful with this problem."

ANS: D Information about vaginal estrogen therapy and water-soluble lubricants should be provided to the older woman with vaginal dryness. There is no need to inform the health care provider because vaginal dryness is normal with aging. Additional pelvic examinations are not indicated for this client. Kegel exercises are used for clients with incontinence.

A 68-year-old client has recently undergone a prostate biopsy. Which symptom would indicate immediate referral to the health care provider? A. Slight rectal bleeding B. Small amount of blood in the toilet after urinating C. Mild pain and soreness at the site D. Temperature of 101.6° F (38.7° C)

ANS: D Rarely, sepsis can develop after a prostate biopsy. Clients should contact their health care provider immediately if they experience fever, pain when urinating, or penile discharge. Expected findings may include slight soreness, light rectal bleeding, and blood in the urine or stools for a few days. Semen may be red or rust-colored for several weeks.

A 12-year-old girl says to the nurse, "I've had my first period, so can I have a baby now?" How does the nurse respond? A. "A boy's sperm must unite with your egg to make a baby." B. "Technically yes you can; but how can you take care of a baby?" C. "Yes, you can." D. "You are physically able to, but let's discuss becoming a parent."

ANS: D Telling the client that she is able to have a baby and encouraging her to discuss it address the physiologic, psychological, and developmental facts related to the client's question. Telling the client that a boy's sperm must unite with her egg addresses physiologic facts but does not relate to the psychological issues involved with pregnancy and parenthood. Asking the client how she will take care of a baby projects the nurse's own values; it is accusative and could place the girl on the defensive. Simply telling the client that she is able to have a baby is too simple and uninformative.

The certified nurse-midwife (CNM) completes a cervical biopsy on a client and performs postprocedure teaching. What does the CNM tell the client? A. "Do not have intercourse for 24 hours after the procedure." B. "Rest for at least 6 hours after the procedure." C. "There is no limit on weight lifting; do what you normally do." D. "Use the antiseptic solution rinses to clean your perineum."

ANS: D The client must keep the perineum clean and dry by using antiseptic solution rinses as directed by the health care provider, and should change pads frequently. The client should not have intercourse or lift heavy objects for about 2 weeks after the procedure. The client should rest for 24 hours after the procedure.

The RN working at the college health clinic is caring for a sexually active 19-year-old female who is having a routine checkup. What information is of greatest concern to the nurse? A. Report of irregular menstrual periods B. Left breast is slightly smaller than the right breast C. No history of rubella vaccination or infection D. Bruising on the vulvar and inner thigh areas

ANS: D Vulvar and inner thigh bruising may indicate that the client is involved in an abusive relationship; this assessment information requires further follow-up by the nurse and health care provider. Irregular periods, disparity in the size of the client's breasts, and the lack of history on rubella status may require further investigation, but are not as high a priority as the possibility that the client may be in danger.

A 32-year-old client has small uterine fibroids and is considering options for treatment. To assist the woman to make a decision about whether to have magnetic resonance-guided focused ultrasound or uterine artery embolization, what will the nurse determine? a. If the woman has had one or more children b. Whether the woman wants to preserve her fertility and desires to have children. c. The age of onset of the woman's first menstrual period d. The woman's risk for uterine cancer

B

A client had a total abdominal hysterectomy 2 days ago and is to be discharged on antibiotics. What does the nurse include in her discharge teaching about antibiotics? a. "After your first day at home, you can stop them if you do not have a fever." b. "It is important to take them as directed until they are all gone." c. "Stop the antibiotic if you feel nauseated because it will lose its effectiveness." d. "You will need to take the drug until your incision heals."

B

Which action does the postanesthesia care unit (PACU) nurse perform first when caring for a client who has just arrived after a total thyroidectomy? Assess the wound dressing for bleeding. Give morphine sulfate 4 to 8 mg IV for pain. Monitor oxygen saturation using pulse oximetry. Correct Support the head and neck with sandbags.

Airway assessment and management is always the first priority with every client. This is especially important for a client who has had surgery that involves potential bleeding and edema near the trachea. Assessing the wound dressing for bleeding is a high priority, although this is not the first priority. Pain control and supporting the head and neck with sandbags are important priorities, but can be addressed after airway assessment.

When assessing a client for hepatic cancer, the nurse anticipates finding an elevation in which of these?

Alpha-fetoprotein

A client has gynecologic cancer. Which client statement demonstrates a correct understanding of her treatment options? a. "Chemotherapy will be used to shrink my cancer before I have my operation." b. "External beam radiation therapy (EBRT) may be used after my cancer surgery." c. "Brachytherapy is given on an outclient basis for 4 to 6 weeks before surgery." d. "The purpose of brachytherapy will be to dissolve the cancer."

B

A client who had an anterior colporrhaphy is being discharged. What does the nurse tell the client before her discharge? a. "Avoid lifting more than 25 pounds (11.3 kg)." b. "Do not have sexual intercourse for at least 2 weeks." c. "Return to the clinic in 6 weeks for suture removal." d. "Take a hot bath or use a moist heating pad for discomfort."

D

A client is being discharged after a total abdominal hysterectomy (TAH). What principle guides the nurse in planning discharge care and teaching? a. Clients in their childbearing years generally adapt better. b. No special home equipment will be necessary for the client. c. Psychological reactions would be evident by discharge. d. The client can resume normal activities upon discharge.

B

The nurse asks the client with liver disease to raise the arms to shoulder level and dorsiflex the hands. A few moments later, the hand begins to flap upward and downward. How does the nurse correctly document this in the medical record?

Asterixis

The nurse is teaching care principles to a client who plans uterus-sparing surgery to remove uterine fibroids. Which client statement indicates that further teaching is needed? a. "I will be able to return to my usual activities in about 2 weeks." b. "It is important to avoid having sexual intercourse for 3 weeks after surgery." c. "Probably I will be able to go home on the day of the surgery." d. "Fewer complications occur with this procedure than with hysterectomies."

B

The nurse is discussing transvaginal repair for pelvic organ prolapse (POP) using surgical vaginal mesh with a client who plans to have the procedure. What teaching does the nurse include? (Select All That Apply) a. Incisional care instructions b. Manufacturer's labeling and information c. Signs and symptoms of infection d. Statements from women who have had successful outcomes e. When to contact the surgeon after the procedure

B, C, E

It is essential that the nurse should monitor the client returning from hepatic artery embolization for hepatic cancer for which of these?

Bleeding

A client is scheduled for a total hysterectomy with a laparoscopic vaginal approach after a diagnosis of microinvasive cervical cancer. What psychological and/or social changes does the nurse expect this client to experience? a. Because the surgery does not affect a visible site, altered body image issues are not as common. b. The client will be actively involved in her own care in the immediate postoperative period. c. Sexual counseling may be needed, especially if the client has doubts about her ability to feel like a woman and engage in sexual activities. d. The client would demonstrate reality testing and would experience a grief reaction immediately after her surgery.

C

The nurse is preparing the room for the client returning from a thyroidectomy. Which items are important for the nurse to have available for this client? (Select all that apply.) Calcium gluconate Correct Emergency tracheotomy kit Correct Furosemide (Lasix) Hypertonic saline Oxygen Correct Suction Correct

Calcium gluconate should be available at the bedside to treat hypocalcemia and tetany that might occur if the parathyroid glands have been injured during the surgery. Equipment for an emergency tracheotomy must be kept at the bedside in the event that hemorrhage or edema should occlude the airway. Respiratory distress can result from swelling or damage to the laryngeal nerve leading to spasm, so it is important that the nurse work with respiratory therapy to have oxygen ready at the bedside for the client on admission. Because of the potential for increased secretions, it is important that a working suction device is present at the bedside for admission of the client from the operating room. Furosemide might be useful in the postoperative client to assist with urine output; however, this is not of added importance for this client. Hypertonic saline would not be of benefit to this client as the client is not hyponatremic.

A client with thyroid cancer has just received 131I ablative therapy. Which statement by the client indicates a need for further teaching? "I cannot share my toothpaste with anyone." "I must flush the toilet three times after I use it." "I need to wash my clothes separately from everyone else's clothes." "I'm ready to hold my newborn grandson now." Correct

Clients undergoing 131I therapy should avoid close contact with pregnant women, infants, and young children for 1 week after treatment. Clients should remain at least 1 meter (39 inches, or roughly 3 feet) away, and limit exposure to less than 1 hour per day. Some radioactivity will remain in the client's salivary glands for up to 1 week after treatment. Care should be taken to avoid exposing others to the saliva. Flushing the toilet three times after use will ensure that all urine has been diluted and removed. Clothing needs to be washed separately and the washing machine then needs to be run empty for a full cycle before it is used to wash the clothing of others.

When caring for a client awaiting liver transplantation, the nurse recognizes that the client will be excluded from the procedure if which of these is present?

Colon cancer with metastasis to the liver

After receiving change-of-shift report about these four clients, which client does the nurse attend to first? a) Client with acute adrenal insufficiency who has a blood glucose of 36 mg/dL b) Client with diabetes insipidus who has a dose of desmopressin (DDAVP) due c) Client with hyperaldosteronism who has a serum potassium of 3.4 mEq/L d) Client with pituitary adenoma who is reporting a severe headache

Correct Answer: a A glucose level of 36 mg/dL is considered an emergency; this client must be assessed and treated immediately. Although it is important to maintain medications on schedule, the client requiring a dose of desmopressin is not the first client who needs to be seen. A serum potassium of 3.4 mEq/L in the client with hyperaldosteronism may be considered normal (or slightly hypokalemic), based on specific hospital levels. The client reporting a severe headache needs to be evaluated as soon as possible after the client with acute adrenal insufficiency. As an initial measure, the RN could delegate obtaining vital signs to unlicensed assistive personnel.

A client with iatrogenic Cushing's syndrome is a resident in a long-term care facility. Which nursing action included in the client's care would be best to delegate to unlicensed assistive personnel (UAP)? a) Assist with personal hygiene and skin care. b) Develop a plan of care to minimize risk for infection. c) Instruct the client on the reasons to avoid overeating. d) Monitor for signs and symptoms of fluid retention.

Correct Answer: a Assisting a client with bathing and skin care is included in UAP scope of practice. It is not within their scope of practice to develop a plan of care, although they will play a very important role in following the plan of care. Client teaching requires a broad education and should not be delegated to UAP. Monitoring for signs and symptoms of fluid retention is part of client assessment, which requires a higher level of education and clinical judgment.

A client has been admitted to the medical intensive care unit with a diagnosis of diabetes insipidus (DI) secondary to lithium overdose. Which medication is used to treat the DI? a) Desmopressin (DDAVP) b) Dopamine hydrochloride (Intropin) c) Prednisone d) Tolvaptan (Samsca)

Correct Answer: a Desmopressin is the drug of choice for treatment of severe DI. It may be administered orally, nasally, or by intramuscular or intravenous routes. Dopamine hydrochloride is a naturally occurring catecholamine and inotropic vasopressor; it would not be used to treat DI. Prednisone would not be used to treat DI. Tolvaptan is a selective competitive arginine vasopressin receptor 2 antagonist and is not used with DI.

A client with diabetes insipidus (DI) has dry lips and mucous membranes and poor skin turgor. Which intervention does the nurse provide first? a) Force fluids b) Offer lip balm c) Perform a 24-hour urine test d) Withhold desmopressin acetate (DDAVP)

Correct Answer: a Dry lips and mucous membranes and poor skin turgor are indications of dehydration, which can occur with DI. This is a serious condition that must be treated rapidly. Encouraging fluids is the initial step, provided the client is able to tolerate oral intake. Lip balm may make the client more comfortable, but does not address the problem of dehydration. A 24-hour urine test will identify loss of electrolytes and adrenal androgen metabolites, but will not correct the dehydration that this client is experiencing. Desmopressin acetate is a synthetic form of antidiuretic hormone that is given to reduce urine production; it improves DI and should not be withheld.

A client with pheochromocytoma is admitted for surgery. What does the nurse do for the admitting assessment? a) Avoids palpating the abdomen b) Monitors for pulmonary edema with a chest x-ray c) Obtains a 24-hour urine specimen on admission d) Places the client in a room with a roommate for distraction

Correct Answer: a The abdomen must not be palpated in a client with pheochromocytoma because this action could cause a sudden release of catecholamines and severe hypertension. The tumor on the adrenal gland causes sympathetic hyperactivity, increasing blood pressure and heart rate, not pulmonary edema. A 24-hour urine collection will already have been completed to determine the diagnosis of pheochromocytoma. A client diagnosed with a pheochromocytoma may feel anxious as part of the disease process; providing a roommate for distraction will not reduce the client's anxiety.

The nurse is teaching a client about how to monitor therapy effectiveness for syndrome of inappropriate antidiuretic hormone. What does the nurse tell the client to look for? a) Daily weight gain of less than 2 pounds b) Dry mucous membranes c) Increasing heart rate d) Muscle spasms

Correct Answer: a The client must monitor daily weights because this assesses the degree of fluid restriction needed. A weight gain of 2 pounds or more daily or a gradual increase over several days is cause for concern. Dry mucous membranes are a sign of dehydration and an indication that therapy is not effective. An increased heart rate indicates increased fluid retention or dehydration and hypovolemia, and either condition is an indication that therapy is not effective. Muscle spasms are associated with hyponatremia and are an indication of a change in the client's neurologic status. Untreated hyponatremia can lead to seizures and coma.

A client with syndrome of inappropriate antidiuretic hormone is admitted with a serum sodium level of 105 mEq/L. Which request by the health care provider does the nurse address first? a) Administer infusion of 150 mL of 3% NaCl over 3 hours. b) Draw blood for hemoglobin and hematocrit. c) Insert retention catheter and monitor urine output. d) Weigh the client on admission and daily thereafter.

Correct Answer: a The client with a sodium level of 105 mEq/L is at high risk for seizures and coma. The priority intervention is to increase the sodium level to a more normal range. Ideally, 3% NaCl should be infused through a central line or with a small needle through a large vein to prevent irritation. Monitoring laboratory values for fluid balance and monitoring urine output are important, but are not the top priority. Monitoring client weight will help in the assessment of fluid balance; however, this is also not the top priority.

A client presents to the emergency department with a history of adrenal insufficiency. The following laboratory values are obtained: Na+ 130 mEq/L, K+ 5.6 mEq/L, and glucose 72 mg/dL. Which is the first request that the nurse anticipates? a) Administer insulin and dextrose in normal saline to shift potassium into cells. b) Give spironolactone (Aldactone) 100 mg orally. c) Initiate histamine2 (H2) blocker therapy with ranitidine for ulcer prophylaxis. d) Obtain arterial blood gases to assess for peaked T waves.

Correct Answer: a This client is hyperkalemic. The nurse should anticipate a request to administer 20 to 50 units of insulin with 20 to 50 mg of dextrose in normal saline as an IV infusion to shift potassium into the cells. Spironolactone is a potassium-sparing diuretic that helps the body keep potassium, which the client does not need. Although H2 blocker therapy would be appropriate for this client, it is not the first priority. Arterial blood gases are not used to assess for peaked T waves associated with hyperkalemia; an electrocardiogram needs to be obtained instead.

The client is taking fludrocortisone (Florinef) for adrenal hypofunction. The nurse instructs the client to report which symptom while taking this drug? a) Anxiety b) Headache c) Nausea d) Weight loss

Correct Answer: b A side effect of fludrocortisone is hypertension. New onset of headache should be reported, and the client's blood pressure should be monitored. Anxiety is not a side effect of fludrocortisone and is not associated with adrenal hypofunction. Nausea is associated with adrenal hypofunction; it is not a side effect of fludrocortisone. Sodium-related fluid retention and weight gain, not loss, are possible with fludrocortisone therapy.

A client presents to the emergency department with acute adrenal insufficiency and the following vital signs: P 118 beats/min, R 18 breaths/min, BP 84/44 mm Hg, pulse oximetry 98%, and T 98.8° F oral. Which nursing intervention is the highest priority for this client? a) Administering furosemide (Lasix) b) Providing isotonic fluids c) Replacing potassium losses d) Restricting sodium

Correct Answer: b Providing isotonic fluid is the priority intervention because this client's vital signs indicate volume loss that may be caused by nausea and vomiting and may accompany acute adrenal insufficiency. Isotonic fluids will be needed to administer IV medications such as hydrocortisone. Furosemide is a loop diuretic, which this client does not need. Potassium is normally increased in acute adrenal insufficiency, but potassium may have been lost if the client has had diarrhea; laboratory work will have to be obtained. Any restrictions, including sodium, should not be started without obtaining laboratory values to establish the client's baseline.

A client has undergone a transsphenoidal hypophysectomy. Which intervention does the nurse implement to avoid increasing intracranial pressure (ICP) in the client? a) Encourages the client to cough and deep-breathe b) Instructs the client not to strain during a bowel movement c) Instructs the client to blow the nose for postnasal drip d) Places the client in the Trendelenburg position

Correct Answer: b Straining during a bowel movement increases ICP and must be avoided. Laxatives may be given and fluid intake encouraged to help with this. Although deep breathing is encouraged, the client must avoid coughing early after surgery because this increases pressure in the incision area and may lead to a cerebrospinal fluid (CSF) leak. If the client has postnasal drip, he or she must inform the nurse and not blow the nose; postnasal drip may indicate leakage of CSF. The head of the bed must be elevated after surgery.

A client diagnosed with hyperpituitarism resulting from a prolactin-secreting tumor has been prescribed bromocriptine mesylate (Parlodel). As a dopamine agonist, what effect does this drug have by stimulating dopamine receptors in the brain? a) Decreases the risk for cerebrovascular disease b) Increases the risk for depression c) Inhibits the release of some pituitary hormones d) Stimulates the release of some pituitary hormones

Correct Answer: c Bromocriptine mesylate inhibits the release of both prolactin and growth hormone. It does not decrease the risk for cerebrovascular disease leading to stroke. Increased risk for depression is not associated with the use of bromocriptine mesylate; however, hallucinations have been reported as a side effect. Bromocriptine mesylate does not stimulate the release of any hormones.

Which client does the nurse identify as being at highest risk for acute adrenal insufficiency resulting from corticosteroid use? a) Client with hematemesis, upper epigastric pain for the past 3 days not relieved with food, and melena b) Client with right upper quadrant pain unrelieved for the past 2 days, dark-brown urine, and clay-colored stools c) Client with shortness of breath and chest tightness, nasal flaring, audible wheezing, and oxygen saturation of 85% for the second time this week d) Client with three emergency department visits in the past month for edema, shortness of breath, weight gain, and jugular venous distention

Correct Answer: c Corticosteroids may be used to treat signs and symptoms of asthma, such as shortness of breath and chest tightness, nasal flaring, audible wheezing, and oxygen saturation of 85%. This places the client at risk for adrenal insufficiency. Corticosteroids are not used to treat signs and symptoms of GI bleeding or peptic ulcer disease (hematemesis, upper epigastric pain for the past 3 days not relieved with food, and melena), gallbladder disease (right upper quadrant pain unrelieved for the past 2 days, dark brown urine, and clay-colored stools), or congestive heart failure (edema, shortness of breath, weight gain, and jugular venous distention).

These data are obtained by the RN who is assessing a client who had a transsphenoidal hypophysectomy yesterday. What information has the most immediate implications for the client's care? a) Dry lips and oral mucosa on examination b) Nasal drainage that tests negative for glucose c) Client report of a headache and stiff neck d) Urine specific gravity of 1.016

Correct Answer: c Headache and stiff neck (nuchal rigidity) are symptoms of meningitis that have immediate implications for the client's care. Dry lips and mouth are not unusual after surgery. Frequent oral rinses and the use of dental floss should be encouraged because the client cannot brush the teeth. Any nasal drainage should test negative for glucose; nasal drainage that tests positive for glucose indicates the presence of a cerebrospinal fluid leak. A urine specific gravity of 1.016 is within normal limits.

Which laboratory result indicates that fluid restrictions have been effective in treating syndrome of inappropriate antidiuretic hormone (SIADH)? a) Decreased hematocrit b) Decreased serum osmolality c) Increased serum sodium d) Increased urine specific gravity

Correct Answer: c Increased serum sodium due to fluid restriction indicates effective therapy. Hemoconcentration is a result of hypovolemic hyponatremia caused by SIADH and diabetes insipidus. Plasma osmolality is decreased as a result of SIADH. Urine specific gravity is decreased with diabetes insipidus and is increased with SIADH.

The nurse is providing discharge instructions to a client on spironolactone (Aldactone) therapy. Which comment by the client indicates a need for further teaching? a) "I must call the provider if I am more tired than usual." b) "I need to increase my salt intake." c) "I should eat a banana every day." d) "This drug will not control my heart rate."

Correct Answer: c Spironolactone increases potassium levels, so potassium supplements and foods rich in potassium, such as bananas, should be avoided to prevent hyperkalemia. While taking spironolactone, symptoms of hyponatremia such as drowsiness and lethargy must be reported; the client may need increased dietary sodium. Spironolactone will not have an effect on the client's heart rate.

A client with Cushing's disease begins to laugh loudly and inappropriately, causing the family in the room to be uncomfortable. What is the nurse's best response? a) "Don't mind this. The disease is causing this." b) "I need to check the client's cortisol level." c) "The disease can sometimes affect emotional responses." d) "Medication is available to help with this."

Correct Answer: c The client may have neurotic or psychotic behavior as a result of high blood cortisol levels. Being honest with the family helps them to understand what is happening. Telling the family not to mind the laughter and that the disease is causing it is vague and minimizes the family's concern. This is the perfect opportunity for the nurse to educate the family about the disease. Cushing's disease is the hypersecretion of cortisol, which is abnormally elevated in this disease and, because the diagnosis has already been made, blood levels do not need to be redrawn. Telling the family that medication is available to help with inappropriate laughing does not assist them in understanding the cause of or the reason for the client's behavior.

The nurse is caring for a client with hypercortisolism. The nurse begins to feel the onset of a cold but still has 4 hours left in the shift. What does the nurse do? a) Asks another nurse to care for the client b) Monitors the client for cold-like symptoms c) Refuses to care for the client d) Wears a facemask when caring for the client

Correct Answer: d A client with hypercortisolism will be immune-suppressed. Anyone with a suspected upper respiratory infection who must enter the client's room must wear a mask to prevent the spread of infection. Although asking another nurse to care for the client might be an option in some facilities, it is not generally realistic or practical. The nurse, not the client, feels the onset of the cold, so monitoring the client for cold-like symptoms is part of good client care for a client with hypercortisolism. Refusing to care for the client after starting care would be considered abandonment.

The charge nurse is making client assignments for the medical-surgical unit. Which client will be best to assign to an RN who has floated from the pediatric unit? a) Client in Addisonian crisis who is receiving IV hydrocortisone b) Client admitted with syndrome of inappropriate antidiuretic hormone (SIADH) secondary to lung cancer c) Client being discharged after a unilateral adrenalectomy to remove an adrenal tumor d) Client with Cushing's syndrome who has elevated blood glucose and requires frequent administration of insulin

Correct Answer: d An RN who works with pediatric clients would be familiar with glucose monitoring and insulin administration. A client in Addisonian crisis would best be monitored by an RN from the medical-surgical floor. Although the float RN could complete the admission history, the client with SIADH secondary to lung cancer might require teaching and orientation to the unit that a nurse more familiar with that area would be better able to provide. Discharge teaching specific to adrenalectomy should be provided by the RN who is regularly assigned to the medical-surgical floor and is more familiar with taking care of postoperative adult clients with endocrine disorders.

A 52-year-old client has been diagnosed with endometrial (uterine) cancer. She says to the nurse, "I was told that my cancer is stage II. What does that mean?" How does the nurse respond? a. "It means that your cancer remains confined to your uterus." b. "The spread of your cancer is beyond your pelvic area." c. "The cancer is in your vagina or lymph node areas." d. "Your cancer has spread from your uterus to your cervix."

D

A client is referred to a home health agency after a transsphenoidal hypophysectomy. Which action does the RN case manager delegate to the home health aide who will see the client daily? a) Document symptoms of incisional infection or meningitis. b) Give over-the-counter laxatives if the client is constipated. c) Set up medications as prescribed for the day. d) Test any nasal drainage for the presence of glucose.

Correct Answer: d Cerebrospinal fluid (CSF) will test positive using a glucose "dipstick." Nasal drainage that is positive for glucose after a transsphenoidal hypophysectomy would indicate a CSF leak that would require immediate notification of the health care provider. Home health aides can be taught the correct technique to perform this procedure. Assessing for symptoms of infection and documenting them in the record, medication administration, and setting up medication are not within the scope of practice of the home health aide.

How does the drug desmopressin (DDAVP) decrease urine output in a client with diabetes insipidus (DI)? a) Blocks reabsorption of sodium b) Increases blood pressure c) Increases cardiac output d) Works as an antidiuretic hormone (ADH) in the kidneys

Correct Answer: d Desmopressin is a synthetic form of ADH that binds to kidney receptors and enhances reabsorption of water, thus reducing urine output. Desmopressin does not have any effect on sodium reabsorption. It may cause a slight increase or a transient decrease in blood pressure, but this does not affect urine output. Desmopressin does not increase cardiac output.

A client with a possible adrenal gland tumor is admitted for testing and treatment. Which nursing action is most appropriate for the charge nurse to delegate to the nursing assistant? a) Assess skin turgor and mucous membranes for hydration status. b) Discuss the dietary restrictions needed for 24-hour urine testing. c) Plan ways to control the environment that will avoid stimulating the client. d) Remind the client to avoid drinking coffee and changing position suddenly.

Correct Answer: d Drinking caffeinated beverages and changing position suddenly are not safe for a client with a potential adrenal gland tumor because of the effects of catecholamines. Reminding the client about previous instructions is an appropriate role for a nursing assistant who may observe the client doing potentially risky activities. Client assessment, client teaching, and environment planning are higher-level skills that require the experience and responsibility of the RN, and are not within the scope of practice of the nursing assistant.

A client with Cushing's disease says that she has lost 1 pound. What does the nurse do next? a) Auscultates the lungs for crackles b) Checks urine for specific gravity c) Forces fluids d) Weighs the client

Correct Answer: d Fluid retention with weight gain is more of a problem than weight loss in clients with Cushing's disease. Weighing the client with Cushing's disease is part of the nurse's assessment. Crackles in the lungs indicate possible fluid retention, which would cause weight gain, not weight loss. Urine specific gravity will help assess hydration status, but this would not be the next step in the client's assessment. Forcing fluids is not appropriate because usually excess water and sodium reabsorption cause fluid retention in the client with Cushing's disease.

Four women phone the gynecology clinic about having new-onset vaginal bleeding. Which call does the RN decide to return first? a. A 23-year-old using medroxyprogesterone acetate (Depo-Provera) b. A 34-year-old with a history of multiple leiomyomas c. A 48-year-old who had an endocervical curettage yesterday d. A 62-year-old with no previous gynecologic problems

D

The nurse is caring for a female client with uterine leiomyoma. What is the most likely problem this client will experience as a result of this condition? a. Pain b. Constipation c. Infection d. Bleeding

D

Which client does the RN assess first after receiving change-of-shift report? a. A 45-year-old with a history of hypothyroidism who is scheduled for a hysterectomy and bladder suspension b. A 48-year-old who is reporting abdominal pain and light vaginal spotting after an endometrial biopsy c. A 50-year-old who is receiving morphine through a client-controlled analgesia (PCA) device after a hysterectomy and who rates her pain at a level 3 (0-to-10 scale) d. A 54-year-old with an anterior and posterior colporrhaphy who has an elevated heart rate and an oral temperature of 101.2°F (38.4°C)

D

The nurse is teaching a local young women's group about health promotion and maintenance measures for prevention of gynecologic cancers. Which preventive factors does the nurse stress? (Select All That Apply) a. Annual endometrial biopsy b. Annual human papilloma virus (HPV) vaccination c. Annual Papanicolaou (Pap) test d. Safe sex practices e. Well-balanced diet

D, E

In caring for the client who has undergone paracentesis, which changes in the client's status should be promptly reported to the provider?

Decreased blood pressure, increased heart rate

A client recently admitted with hyperparathyroidism has a very high urine output. Of these actions, what does the nurse do next? Calls the health care provider Monitors intake and output Correct Performs an immediate cardiac assessment Slows the rate of IV fluids

Diuretic and hydration therapies are used most often for reducing serum calcium levels in clients with hyperparathyroidism. Usually, a diuretic that increases kidney excretion of calcium is used together with IV saline in large volumes to promote renal calcium excretion. The health care provider does not need to be notified in this situation, given the information available in the question. Cardiac assessment is part of the nurse's routine evaluation of the client. Slowing the rate of IV fluids is contraindicated because the client will become dehydrated due to the use of diuretics to increase kidney excretion of calcium.

Which activity by the nurse will best relieve symptoms associated with ascites?

Elevating the head of the bed

Which is important for the nurse to include in the plan of care for a client who is to undergo paracentesis later today?

Have the client void before the procedure is performed.

A client had a parathyroidectomy 18 hours ago. Which finding requires immediate attention? Edema at the surgical site Hoarseness Correct Pain on moving the head Sore throat

Hoarseness or stridor is an indication of respiratory distress and requires immediate attention. Edema at the surgical site of any surgery is an expected finding. Pain when the client moves the head or attempts to lift the head off the bed is an expected finding after a parathyroidectomy. Any time a client has been intubated for surgery, a sore throat is a common occurrence in the postoperative period. This is especially true for clients who have had surgery involving the neck.

What effect can starting a dose of levothyroxine sodium (Synthroid) too high or increasing a dose too rapidly have on a client? Bradycardia and decreased level of consciousness Decreased respiratory rate Hypotension and shock Hypertension and heart failure Correct

Hypertension and heart failure are possible if the levothyroxine sodium dose is started too high or raised too rapidly, because levothyroxine would essentially put the client into a hyperthyroid state. The client would be tachycardic, not bradycardic. The client may have an increased respiratory rate. Shock may develop, but only as a late effect and as the result of "pump failure."

The nurse reviews the vital signs of a client diagnosed with Graves' disease and sees that the client's temperature is up to 99.6° F. After notifying the health care provider, what does the nurse do next? Administers acetaminophen Alerts the Rapid Response Team Asks any visitors to leave Assesses the client's cardiac status completely Correct

If the client's temperature has increased by even 1°, the nurse's first action is to notify the provider. Continuous cardiac monitoring should be the next step. Administering a nonsalicylate antipyretic such as acetaminophen is appropriate, but is not a priority action for this client. Alerting the Rapid Response Team is not needed at this time. Asking visitors to leave would not be the next action, and if visitors are providing comfort to the client, this would be contraindicated.

When providing dietary teaching to the client with hepatitis, the nurse includes which information?

Increased carbohydrates and moderate protein

A client being treated for hyperthyroidism calls the home health nurse and mentions that his heart rate is slower than usual. What is the nurse's best response? Advise the client to go to a calming environment. Ask whether the client has increased cold sensitivity or weight gain. Correct Instruct the client to see his health care provider immediately. Tell the client to check his pulse again and call back later.

Increased sensitivity to cold and weight gain are symptoms of hypothyroidism, indicating an overcorrection by the medication. The client must be assessed further because he may require a lower dose of medication. A calming environment will not have any effect on the client's heart rate. The client will want to notify the health care provider about the change in heart rate. If other symptoms such as chest pain, shortness of breath, or confusion accompany the slower heart rate, then the client should see the health care provider immediately. If the client was concerned enough to call because his heart rate was slower than usual, the nurse needs to stay on the phone with the client while he re-checks his pulse. This time could also be spent providing education about normal ranges for that client.

The client is scheduled to undergo a liver transplantation. Which nursing intervention is most likely to prevent the complications of bile leakage and abscess formation?

Keep the T-tube in a dependent position.

When caring for the client with hepatic encephalopathy, in which situation does the nurse question the use of neomycin (Mycifradin)?

Kidney failure

A client has been diagnosed with hypothyroidism. What medication is usually prescribed to treat this disorder? Atenolol (Tenormin) Levothyroxine sodium (Synthroid) Correct Methimazole (Tapazole) Propylthiouracil

Levothyroxine is a synthetic form of thyroxine (T4) that is used to treat hypothyroidism. Atenolol is a beta blocker that is used to treat cardiovascular disease. Methimazole and propylthiouracil are used to treat hyperthyroidism.

A client with hypothyroidism is being discharged. Which environmental change may the client experience in the home? Frequent home care Handrails in the bath Increased thermostat setting Correct Strict infection-control measures

Manifestations of hypothyroidism include cold intolerance. Increased thermostat settings or additional clothing may be necessary. A client with a diagnosis of hypothyroidism can be safely managed at home with adequate discharge teaching regarding medications and instructions on when to notify the health care provider or home health nurse. In general, hypothyroidism does not cause mobility issues. Activity intolerance and fatigue may be an issue, however. A client with hypothyroidism is not immune-compromised or contagious, so no environmental changes need to be made to the home.

An older client with an elevated serum calcium level is receiving IV furosemide (Lasix) and an infusion of normal saline at 150 mL/hr. Which nursing action can the RN delegate to unlicensed assistive personnel (UAP)? Ask the client about any numbness or tingling. Check for bone deformities in the client's back. Measure the client's intake and output hourly. Correct Monitor the client for shortness of breath.

Measuring intake and output is a commonly delegated nursing action that is within the UAP scope of practice. Numbness and tingling is part of the client assessment that needs to be completed by a licensed nurse. Bony deformities can be due to pathologic fractures; physical assessment is a complex task that cannot be delegated. An older client receiving an IV at 150 mL/hr is at risk for congestive heart failure; careful monitoring for shortness of breath is the responsibility of the RN.

Which type of thyroid cancer often occurs as part of multiple endocrine neoplasia (MEN) type II? Anaplastic Follicular Medullary Correct Papillary

Medullary carcinoma commonly occurs as part of MEN type II, which is a familial endocrine disorder. Anaplastic carcinoma is an aggressive tumor that invades surrounding tissue. Follicular carcinoma occurs more frequently in older clients and may metastasize to bone and lung. Papillary carcinoma is the most common type of thyroid cancer. It is slow growing and, if the tumor is confined to the thyroid gland, the outlook for a cure is good with surgical management.

When providing community education, the nurse emphasizes that which group should receive immunization for hepatitis B?

Men who prefer sex with men

A client is taking methimazole (Tapazole) for hyperthyroidism and would like to know how soon this medication will begin working. What is the nurse's best response? "You should see effects of this medication immediately." "You should see effects of this medication within 1 week." "You should see full effects from this medication within 1 to 2 days." "You should see some effects of this medication within 2 weeks." Correct

Methimazole is an iodine preparation that decreases blood flow through the thyroid gland. This action reduces the production and release of thyroid hormone. The client should see some effects within 2 weeks; however, it may take several more weeks before metabolism returns to normal. Although onset of action is 30 to 40 minutes after an oral dose, the client will not see effects immediately. Effects will take longer than 1 week to become apparent when methimazole is used. Methimazole needs to be taken every 8 hours for an extended period of time. Levels of triiodothyronine (T3) and thyroxine (T4) will be monitored and dosages adjusted as levels fall.

When providing discharge teaching to the client with cirrhosis, it is essential for the nurse to emphasize avoidance of which of these?

Nonsteroidal anti-inflammatory drugs

A client with a history of esophageal varices has just been admitted to the emergency department after vomiting a large quantity of blood. Which action should the nurse take first?

Obtain pulse and blood pressure.

Which problem for the client with cirrhosis takes priority?

Potential for injury related to hemorrhage

What teaching does the home care nurse give the client and family to prevent spread of hepatitis C?

Prohibit members of the household from sharing toothbrushes.

When caring for a client with Laennec's cirrhosis, which of these does the nurse expect to find on assessment? Select all that apply

Prolonged partial thromboplastin time (PTT) Icterus of skin Swollen abdomen

The nurse administers lactulose (Cephulac) to the client with cirrhosis for which purpose?

Promotes gastrointestinal excretion of ammonia

The health care worker believes that he may have been exposed to hepatitis A. Which intervention is the highest priority to prevent him from developing the disease?

Requesting injection of immunoglobulin

How does the home care nurse best modify the home environment to manage side effects of lactulose?

Requests a bedside commode for the client

When assessing a client with hepatitis B, the nurse anticipates finding which of these? Select all that apply.

Tea-colored urine Right upper quadrant tenderness Itching

Family members of a client diagnosed with hyperthyroidism are alarmed at the client's frequent mood swings. What is the nurse's response? "How does that make you feel?" "The mood swings should diminish with treatment." Correct "The medications will make the mood swings disappear completely." "Your family member is sick. You must be patient."

Telling the family that the client's mood swings should diminish over time with treatment will provide information to the family, as well as reassurance. Asking how the family feels is important; however, the response should focus on the client. Any medications or treatment may not completely remove the mood swings associated with hyperthyroidism. The family is aware that the client is sick; telling them to be patient introduces guilt and does not address the family's concerns.

A client is being discharged with propylthiouracil (PTU). Which statement by the client indicates a need for further teaching by the nurse? "I can return to my job at the nursing home." Correct "I must call if my urine is dark." "I must faithfully take the drug every 8 hours." "I need to report weight gain."

The client should avoid large crowds and people who are ill because PTU reduces blood cell counts and the immune response, which increases the risk for infection. The client does not, however, need to remain completely at home. Dark urine may indicate liver toxicity or failure, and the client must notify the provider immediately. Taking PTU regularly at the same time each day provides better drug levels and ensures better drug action. The client must notify the provider of weight gain because this may indicate hypothyroidism; a lower drug dose may be required.

The nurse manager for the medical-surgical unit is making staff assignments. Which client will be most appropriate to assign to a newly graduated RN who has completed a 6-week unit orientation? Client with chronic hypothyroidism and dementia who takes levothyroxine (Synthroid) daily Correct Client with follicular thyroid cancer who has vocal hoarseness and difficulty swallowing Client with Graves' disease who is experiencing increasing anxiety and diaphoresis Client with hyperparathyroidism who has just arrived on the unit after a parathyroidectomy

The client with chronic hypothyroidism and dementia is the most stable of the clients described and would be most appropriate to assign to an inexperienced RN. A client with vocal hoarseness and difficulty swallowing is at higher risk for complications and requires close observation by a more experienced nurse. Increasing anxiety and diaphoresis in a client with Graves' disease can be an indication of impending thyroid storm, which is an emergency; this is not a situation to be managed by a newly graduated RN. A client who has just arrived on the unit after a parathyroidectomy requires close observation for bleeding and airway compromise and requires assessment by an experienced nurse.

A client has hyperparathyroidism. Which incident witnessed by the nurse requires the nurse's intervention? The client eating a morning meal of cereal and fruit The physical therapist walking with the client in the hallway Unlicensed assistive personnel pulling the client up in bed by the shoulders Correct Visitors talking with the client about going home

The client with hyperparathyroidism is at risk for pathologic fracture. All members of the health care team must move the client carefully. A lift sheet should be used to re-position the client. The client with hyperparathyroidism is not restricted from eating and should maintain a balanced diet. The client can benefit from moderate exercise and physical therapy, and is not restricted from having visitors.

A client admitted with hyperthyroidism is fidgeting with the bedcovers and talking extremely fast. What does the nurse do next? Calls the provider Encourages the client to rest Correct Immediately assesses cardiac status Tells the client to slow down

The client with hyperthyroidism often has wide mood swings, irritability, decreased attention span, and manic behavior. The nurse should accept the client's behavior and provide a calm, quiet, and comfortable environment. Because the client's behavior is expected, there is no need to call the provider. Monitoring the client's cardiac status is part of the nurse's routine assessment. Telling the client to slow down is unsupportive and unrealistic.

Following paracentesis, during which 2500 mL of fluid has been removed, which assessment finding is most important to communicate to the physician?

The client's heart rate is 122.

A client who has just been notified that the breast biopsy indicates a malignancy tells the nurse, "I just don't know how this could have happened to me." Which response by the nurse is best? a) "Tell me what you mean when you say you don't know how this could have happened to you." Correct b) "Do you have a family history that might make you more likely to develop breast cancer?" c) "Would you like me to help you find more information about how breast cancer develops?" d) "Many risk factors for breast cancer have been identified, so it is difficult to determine what might have caused it." (Chp. 70, elsevier resources)

The client's statement that he or she does not know how this could have happened may indicate shock and denial or a request for more information. To provide appropriate care, further assessment is needed about the client's psychosocial status. The first action by the nurse in this situation is to obtain more data by asking open-ended questions. The nurse needs to further assess the client's emotional status before asking about family history of cancer or obtaining information for the client. (Chp. 70, elsevier resources)

The nurse is teaching a client about thyroid replacement therapy. Which statement by the client indicates a need for further teaching? "I should have more energy with this medication." "I should take it every morning." "If I continue to lose weight, I may need an increased dose." Correct "If I gain weight and feel tired, I may need an increased dose."

Weight loss indicates a need for a decreased dose, not an increased dose. One of the symptoms of hypothyroidism is lack of energy; thyroid replacement therapy should help the client have more energy. The correct time to take thyroid replacement therapy is in the morning. If the client is gaining weight and continues to feel tired, that is an indication that the dose may need to be increased.

The nurse is orienting a new unlicensed assistive personnel (UAP) to the clinic. One of the clients has self-identified as transgender. The UAP states "I don't want to say the wrong thing. What do I call him or her?" What is the nurse's best response? a) "Ask how the client would like to be addressed." b) "Just call the client by his or her name." c) "Just be polite and it won't matter." d) "Look at the client's driver's license and use that." (Chp. 73, elsevier resources)

a) "Ask how the client would like to be addressed." Asking a client how he or she would like to be addressed shows respect and does not make assumptions. A client's given name and sex as listed on a driver's license may not be how the client chooses to be addressed. Being polite is a given, but may make the client uncomfortable if it is not how he or she prefers to be recognized. (Chp. 73, elsevier resources)

A male-to-female client wishes to discuss breast augmentation surgery. What statement by the client indicates the need for further education by the nurse? a) "Fat can be used instead of implants for a more natural look." b) "I may take hormones for about a year before my surgery." c) "If I take hormones, I will have to get a mammogram." d) "The surgeons will use either silicone or saline implants." (Chp. 73, elsevier resources)

a) "Fat can be used instead of implants for a more natural look." The options for breast augmentation include saline and silicone; fat injections are not used as a substitute for implants. The use of feminizing hormones for 12 months may yield better results postoperatively but is not mandatory. If hormones are used, once breast tissue enlarges, mammograms should be obtained on a regular basis. (Chp. 73, elsevier resources)

The nurse is teaching post-mastectomy exercises to a client. Which statement made by the client indicates that teaching has been effective? a) "For the pulley exercise, I'll drape a 6-foot-long rope over a shower curtain rod or over the top of a door." b) "In rope turning, I'll hold the rope with my arms flexed." c) "In rope turning, I'll start by making large circles." d) "With hand wall climbing, I'll walk my hands up the wall and back down until they are at waist level." (Chp. 70, elsevier resources)

a) "For the pulley exercise, I'll drape a 6-foot-long rope over a shower curtain rod or over the top of a door." To perform the pulley exercise properly, the client should drape a 6-foot-long rope over a sturdy structure. In rope turning, the client holds the end of the rope and steps back from the door until the arm is almost straight out in front. The client starts with small circles and gradually increases to larger circles as the client becomes more flexible. With hand wall climbing, the client walks the hands up the wall and then back down until they are at shoulder level. (Chp. 70, elsevier resources)

Which routes are used for testosterone administration? (Select all that apply.) a) Buccal b) Intramuscular c) Intravenous d) Oral e) Transdermal (Chp. 73, elsevier resources)

a) Buccal b) Intramuscular d) Oral e) Transdermal Testosterone is available in a variety of preparations and can be administered via all routes except intravenously. (Chp. 73, elsevier resources)

The nurse is completing discharge teaching for a client who has been prescribed finasteride (Proscar). What statement by the client indicates that reinforcement is required? a) "I will need to have my potassium checked regularly." b) "I may feel dizzy, and have cold sweats and chills." c) "My symptoms should get better over time or I should contact my doctor." d) "This medication is not an estrogen drug." (Chp. 73, elsevier resources)

a) "I will need to have my potassium checked regularly." Although laboratory work will be monitored while taking hormone therapy, this medication does not specifically affect potassium. Dizziness, cold sweats, and chills are associated with finasteride, but these effects tend to decrease over time. If the effects do not diminish, the client should be encouraged to contact the provider. Finasteride is a 5-alpha reductase inhibitor, not an estrogen. (Chp. 73, elsevier resources)

A client is preparing to be discharged home after her gender reassignment surgery. What are the key points that the nurse will include in her discharge teaching? (Select all that apply.) a) "The drain will be removed in about 3 to 5 days." b) "You will need to douche routinely to prevent infection." c) "Place the stents or dilators several times a day." d) "Do not engage in sexual intercourse for at least 6 weeks." e) "When you insert the dilators, remember to use petroleum jelly." (Chp. 73, elsevier resources)

a) "The drain will be removed in about 3 to 5 days." b) "You will need to douche routinely to prevent infection." c) "Place the stents or dilators several times a day." The Jackson-Pratt drain will be removed in approximately 3 to 5 days when the drainage is less than 15 to 20 mL/24 hours. Douching routinely with a vinegar and water solution will help prevent infection. Stents or dilators will need to be inserted using a water-based lubricant (not petroleum jelly) several times per day and left in place for 30 to 45 minutes. This will need to continue for several months. Sexual intercourse is also important to keep the vagina dilated. In general, there is no need to refrain from sexual intercourse unless directed by the surgeon. (Chp. 73, elsevier resources)

The nurse is reviewing options and providing education for a client who is experiencing gender dysphoria. What statement by the client indicates that further discussion with the health care team and education is needed? a) "To avoid scrutiny at the pharmacy, I'll buy my hormones on the Internet." b) "I could live as the other sex full time if I want to." c) "Surgery is an option to change my breasts and face." d) "Talking to a psychotherapist might help me understand my identity and strengthen my coping skills." (Chp. 73, elsevier resources)

a) "To avoid scrutiny at the pharmacy, I'll buy my hormones on the Internet." The use of hormones to feminize or masculinize the body is an option for a client experiencing gender dysphoria; however, their use is prescribed and monitored by health care providers. Frequently endocrinologists are part of the multidisciplinary team. Products purchased via the Internet are from an uncontrolled source and may be hazardous. Individuals experiencing gender dysphoria may live either full- or part-time as the other gender. If the client desires a more permanent change, surgery is an option. Psychotherapy or counseling can provide an outlet to help improve self-image and strengthen coping mechanisms. (Chp. 73, elsevier resources)

A client has undergone transurethral resection of the prostate (TURP). Which interventions does the nurse incorporate in this client's postoperative care? (Select all that apply.) a) Administer antispasmodic medications. b) Encourage the client to urinate around the catheter if pressure is felt. c) Perform intermittent urinary catheterization every 4 to 6 hours. d) Place the client in a supine position with his knees flexed. e) Assist the client to mobilize as soon as permitted. (Chp 72, elsevier resources)

a) Administer antispasmodic medications. e) Assist the client to mobilize as soon as permitted. Antispasmodic drugs can be administered to decrease the bladder spasms that may occur due to catheter use. Assisting the client to a chair as soon as permitted postoperatively will help to decrease the risk of complications from immobility. An indwelling catheter and continuous bladder irrigation are in place for about 24 hours after TURP. The client should not try to void around the catheter, which causes the bladder muscles to contract and may result in painful spasms. Intermittent urinary catheterization is not necessary. Typically, the catheter is taped to the client's thigh, so he should keep his leg straight. (Chp 72, elsevier resources)

The RN working in the hospital emergency department is assigned to care for these four clients. Which client does the nurse attend to first? a) Adolescent with an erection for "10 or 11 hours" who is reporting severe pain b) Young adult with a swollen, painful scrotum who has a recent history of mumps infection c) Middle-aged adult discharged 2 days ago after a transurethral resection of the prostate who has increased hematuria d) Older adult with a history of benign prostatic hyperplasia and palpable bladder distention (Chp 72, elsevier resources)

a) Adolescent with an erection for "10 or 11 hours" who is reporting severe pain The client who has had an erection for "10 or 11 hours" has symptoms of priapism, which is considered a urologic emergency because the circulation to the penis may be compromised and the client may not be able to void with an erect penis. The client with a swollen, painful scrotum; the client with hematuria; and the client with a history of benign prostatic hyperplasia do not require the nurse's immediate attention since these are not medical emergencies. (Chp 72, elsevier resources)

A client with prostate cancer asks the nurse for more information and counseling. Which resources does the nurse suggest? (Select all that apply.) a) American Cancer Society's Man to Man program b) Us TOO International c) American Prostate Cancer Society d) National Prostate Cancer Coalition e) Client's church, synagogue, or place of worship (Chp 72, elsevier resources)

a) American Cancer Society's Man to Man program b) Us TOO International d) National Prostate Cancer Coalition e) Client's church, synagogue, or place of worship The American Cancer Society's Man to Man program helps the client and partner cope with prostate cancer by providing one-on-one education, personal visits, education presentations, and the opportunity to engage in open and candid discussions. Us TOO International is a prostate cancer support group that is sponsored by the Prostate Cancer Education and Support Network. The National Prostate Cancer Coalition provides prostate cancer information. The client's church, synagogue, or place of worship is a community support service that may be important for many clients. There is no such organization as the American Prostate Cancer Society. (Chp 72, elsevier resources)

After returning from transurethral resection of the prostate, the client's urine in the continuous bladder irrigation system is a burgundy color. Which client needs does the nurse anticipate after the surgeon sees the client? (Select all that apply.) a) Antispasmodic drugs b) Emergency surgery c) Forced fluids d) Increased intermittent irrigation e) Monitoring for anemia (Chp 72, elsevier resources)

a) Antispasmodic drugs e) Monitoring for anemia Although not a common occurrence, bleeding may occur in the postoperative period. Venous bleeding is more common than arterial bleeding. The surgeon may apply traction on the catheter for a few hours to control the venous bleeding. Traction on the catheter is uncomfortable and increases the risk for bladder spasms, so analgesics or antispasmodics are usually prescribed. Hemoglobin and hematocrit should be monitored and trended for indications of anemia. Emergency surgery and increased intermittent irrigation would be indicated for an arterial bleed, which would be a brighter red color. Forced fluids are indicated after the catheter is removed. (Chp 72, elsevier resources)

A male-to-female client has a body mass index of 29 and is planning to have transvaginal surgery. The nurse is aware that this client is at higher risk for which complications? (Select all that apply.) a) Atelectasis b) Difficulty ambulating c) Ileus formation d) Nausea/vomiting e) Wound infection (Chp. 73, elsevier resources)

a) Atelectasis b) Difficulty ambulating e) Wound infection Individuals are considered overweight if they have a body mass index over 24.9. Overweight clients who have had transvaginal surgery are at higher risk for difficulty with ventilation leading to atelectasis, difficulty with ambulating, and wound infection. Nausea/vomiting is a risk after any surgery with general anesthesia. Ileus is a risk with abdominal surgery. (Chp. 73, elsevier resources)

A client with benign prostatic hyperplasia is being discharged with alpha-adrenergic blockers. Which information is important for the nurse to include when teaching the client about this type of pharmacologic management? (Select all that apply.) a) Avoid drugs used to treat erection problems. b) Be careful when changing positions. c) Keep all appointments for follow-up laboratory testing. d) Hearing tests will need to be conducted periodically. e) Take the medication in the afternoon. (Chp 72, elsevier resources)

a) Avoid drugs used to treat erection problems. b) Be careful when changing positions. c) Keep all appointments for follow-up laboratory testing. Drugs used to treat erectile dysfunction can worsen side effects, such as hypotension. Alpha-adrenergic blockers may cause orthostatic hypotension and can cause liver damage, so it is important to keep appointments for follow-up laboratory testing. These drugs do not affect hearing. Alpha-adrenergic blockers should be taken in the evening to decrease the risk of problems related to hypotension. (Chp 72, elsevier resources)

A client is struggling with body image after breast cancer surgery. Which behavior indicates to the nurse that the client is maladaptive? a) Avoiding eye contact with staff b) Saying, "I feel like less of a woman" c) Requesting a temporary prosthesis immediately d) Saying, "This is the ugliest scar ever" (Chp. 70, elsevier resources)

a) Avoiding eye contact with staff Avoiding eye contact may be an indication of decreased self-image. The client stating that she feels like less of a woman or that her scar is ugly illustrates an expected emotional state; by verbalizing her frustration, the client suggests a willingness to discuss and express feelings. Requesting a prosthesis can be a sign of healing and working through body image changes. (Chp. 70, elsevier resources)

When is the best time for the nurse to begin discharge planning and a community-based plan of care for a client with prostate cancer? a) Before surgery b) After surgery c) 2 days before being discharged d) The day of discharge (Chp 72, elsevier resources)

a) Before surgery Planning should begin as early as possible, on admission and before surgery. After surgery is not the correct time to begin planning. Planning should begin earlier than 2 days before discharge. (Chp 72, elsevier resources)

A male-to-female client is beginning estrogen therapy. Which data obtained from the client's history are of particular concern to the nurse? (Select all that apply.) a) Body mass index of 32 b) Client has a twin sibling c) One pack-per-day smoker d) History of environmental allergies e) Takes multiple medications for blood pressure control (Chp. 73, elsevier resources)

a) Body mass index of 32 c) One pack-per-day smoker e) Takes multiple medications for blood pressure control Estrogen therapy is associated with various health risks, including venous thromboembolism, hypertension, and elevated glucose levels. A client who is already hypertensive by history should be evaluated carefully before estrogen therapy is started. Smoking and obesity increase the risk of complications; a body mass index over 30 is considered obese. Being a twin is not a cause for concern. There is no correlation between environmental allergies and estrogen therapy. (Chp. 73, elsevier resources)

A client is beginning testosterone therapy and asks the nurse what effects are to be expected. What physical changes does the nurse tell the client to anticipate? (Select all that apply.) a) Breast atrophy b) Decreased libido c) Deepening voice d) Development of penile tissue (Chp. 73, elsevier resources)

a) Breast atrophy c) Deepening voice e) Menstruation cessation Testosterone will cause breast and uterine tissue to atrophy. The clitoris will also atrophy. The client's voice will become deeper with testosterone therapy. Menstruation will also cease; however, it is important for the nurse to advise the client that these effects may take up to 1 year to occur. Libido will increase with testosterone therapy. A penis will not develop; this will require surgical intervention if the client desires. (Chp. 73, elsevier resources)

A client wants to know what complications may occur after a phalloplasty. About which complications does the nurse inform the client? (Select all that apply.) a) Dissatisfaction with results b) Donor graft site scarring c) Penile necrosis d) Prostate cancer e) Urinary tract stenosis (Chp. 73, elsevier resources)

a) Dissatisfaction with results b) Donor graft site scarring c) Penile necrosis e) Urinary tract stenosis Phalloplasty is one of the most difficult reconstructive genital surgeries to perform, and many female-to-male (FtM) clients do not choose to have phalloplasty surgery due to its low success/satisfaction rate. Donor graft scarring and urinary tract stenosis are possible. Although not a common occurrence, necrosis of the neopenis may occur. FtM clients do not have a prostate gland. (Chp. 73, elsevier resources)

A young adult with testicular cancer is admitted for unilateral orchiectomy and retroperitoneal lymph node dissection. Which nursing action is best for the nurse to delegate to unlicensed assistive personnel (UAP)? a) Encourage the client to cough and deep-breathe after surgery. b) Discuss reproductive options with the client and significant other. c) Teach about the availability of a gel-filled silicone testicular prosthesis. d) Evaluate the client's understanding of chemotherapy and radiation treatment. (Chp 72, elsevier resources)

a) Encourage the client to cough and deep-breathe after surgery. Although teaching about routine postoperative client actions such as coughing and deep-breathing should be done by licensed nurses, reminding clients to perform these activities can be delegated to UAP. Client education and evaluation are more complex skills that should be done by licensed nurses. (Chp 72, elsevier resources)

A client is receiving chemotherapy treatment for breast cancer and asks for additional support for managing the associated nausea and vomiting. Which complementary therapy does the nurse suggest? a) Ginger b) Journaling c) Meditation d) Yoga (Chp. 70, elsevier resources)

a) Ginger It has long been believed that ginger helps alleviate nausea and vomiting. Current studies are being done on the effect of ginger on chemotherapy-induced nausea. Journaling is good for reducing anxiety, stress, and fear. Meditation helps reduce stress, improve mood, improve quality of sleep, and reduce fatigue. Yoga has been shown to improve physical functioning, reduce fatigue, improve sleep, and improve one's overall quality of life. (Chp. 70, elsevier resources)

Which statement about breast reconstruction surgery is correct? a) Many women want breast reconstruction using their own tissue immediately after mastectomy. b) Placement of saline- or gel-filled prostheses is not recommended because of the nature of the surgery. c) Reconstruction of the nipple-areola complex is the first stage in the reconstruction of the breast. d) The surgeon should offer the option of breast reconstruction surgery once healing has occurred after a mastectomy. (Chp. 70, elsevier resources)

a) Many women want breast reconstruction using their own tissue immediately after mastectomy. Many women want autogenous reconstruction after mastectomy. Saline- or gel-filled prostheses are recommended as breast expanders in breast augmentation surgery, not for reconstructive surgery. Reconstruction of the nipple-areola complex is the last stage in breast reconstruction surgery. Breast reconstruction surgery should be discussed before mastectomy takes place. (Chp. 70, elsevier resources)

A client who is transitioning from female to male asks the nurse what options are available to make his voice "more real to who he is." What options does the nurse discuss with this client? (Select all that apply.) a) Masculinizing hormones such as testosterone b) Voice specialist to help with pitch and intonation c) Surgery to alter the vocal cords d) Adaptation to current vocal pattern e) Human growth hormone Testosterone will cause the voice to deepen, although not immediately. Voice and communication therapists can help a client develop certain voice characteristics such as pitch and intonation. Surgery would not be undertaken on the vocal cords to alter the voice. Telling a client to "learn to adapt" to his vocal pattern is negating his feelings. Human growth hormone is not indicated for gender dysphoria. (Chp. 73, elsevier resources)

a) Masculinizing hormones such as testosterone b) Voice specialist to help with pitch and intonation Testosterone will cause the voice to deepen, although not immediately. Voice and communication therapists can help a client develop certain voice characteristics such as pitch and intonation. Surgery would not be undertaken on the vocal cords to alter the voice. Telling a client to "learn to adapt" to his vocal pattern is negating his feelings. Human growth hormone is not indicated for gender dysphoria. (Chp. 73, elsevier resources)

Which client has the highest risk for breast cancer? a) Older adult woman with high breast density b) Nullipara older adult woman c) Obese older adult male with gynecomastia d) Middle-aged woman with high breast density (Chp. 70, elsevier resources)

a) Older adult woman with high breast density People at high increased risk for breast cancer include women age 65 years and older with high breast density. Nullipara women are at low increased risk for breast cancer. Men are not at high increased risk for breast cancer, but obesity can cause gynecomastia. Being middle-aged does not indicate a high increased risk for breast cancer. (Chp. 70, elsevier resources)

The nurse is caring for a client with erectile dysfunction who has not had success with other treatment modalities. The nurse anticipates that the health care provider will recommend which treatment for this client? a) Penile implants b) Penile injections c) Transurethral suppository d) Vacuum constriction device (Chp 72, elsevier resources)

a) Penile implants Penile implants (prostheses), which require surgery, are used when other modalities fail. Devices include semi-rigid, flexible, or hydraulic inflatable and multi-component or one-piece instruments. Penile injections are tried before using the option of last resort. Transurethral suppository is tried before using the option of last resort. A vacuum constriction device is easy to use, and is often the first option that is tried. (Chp 72, elsevier resources)

The nurse is completing preoperative teaching for a client who is having a phalloplasty. Which statement by the client indicates further education is necessary? a) "Fat may be needed to make my penis bigger." b) "I will get my implant during the last surgery." c) "They will take skin flaps to make my penis." d) "This is going to take several surgeries to complete." (Chp. 73, elsevier resources)

b) "I will get my implant during the last surgery." The penile implant will not be placed until several months after all of the surgeries have been completed and the incisions are healed. Skin flaps may be taken from the back, radial forearm, or anterior lateral thigh to create the penis, and fat grafts may be needed to increase its circumference. Phalloplasties are one of the most difficult types of genital surgeries and are usually done in stages. (Chp. 73, elsevier resources)

A client is beginning transdermal estrogen (Climara) therapy. Which statement by the client indicates the need for additional health teaching by the nurse? a) "I should monitor my blood pressure while I am taking this medicine." b) "I will need to change out the patch once a month." c) "My blood work will be checked regularly." d) "This medicine will increase my risk of blood clots." (Chp. 73, elsevier resources)

b) "I will need to change out the patch once a month." The transdermal estrogen patch (Climara) is typically dosed as two 0.1-mg patches that are changed twice weekly. If the patch were only changed once a month, the dose would likely be insufficient. Estrogen therapy may cause hypertension, so blood pressure should be regularly monitored, as well as glucose and lipids, since estrogens may elevate triglyceride levels. The risk of venous thromboembolism is markedly increased with the use of estrogens. (Chp. 73, elsevier resources)

A male-to-female client and her partner come to the preoperative appointment. "My partner has some questions. He wants to know about my new vagina. What will it be made of?" What is the nurse's best response? a) "The neovagina is made from silicone." b) "It is made with inverted penile tissue." c) "It will be made from parts of the scrotum." d) "The surgeon uses skin grafts to create the neovagina." (Chp. 73, elsevier resources)

b) "It is made with inverted penile tissue." In a vaginoplasty, the neovagina (new vagina) is created from inverted penile tissue or a colon graft. Silicone is used during breast augmentation surgery. Tissue taken from the scrotum and skin grafts may be utilized to create a clitoris or labia. (Chp. 73, elsevier resources)

A client with prostate cancer asks why he must have surgery instead of radiation, even if his cancer is the least-invasive type. What is the nurse's best response? a) "It is because your cancer growth is large." b) "Surgery is the most common intervention to cure the disease." c) "Surgery slows the spread of cancer." d) "The surgery is to promote urination." (Chp 72, elsevier resources)

b) "Surgery is the most common intervention to cure the disease." Because some localized prostate cancers are resistant to radiation, surgery is the most common intervention for a cure. The size of the tumor is not likely to be why the client is having surgery. A bilateral orchiectomy (removal of both testicles) is palliative surgery that slows the spread of cancer by removing the main source of testosterone. A transurethral resection of the prostate is done to promote urination for clients with advanced disease; it is not used as a curative treatment. (Chp 72, elsevier resources)

A client has been prescribed goserelin (Zoladex). The nurse is reviewing discharge teaching with the client. Which statement by the client indicates a need for further teaching? a) "I must call 9-1-1 right away if I have chest pain." b) "This medicine goes deep into my muscle." c) "I will be careful when I dispose of my needles." d) "I'll want to keep an eye on my heart rate and follow up with my health care provider." (Chp. 73, elsevier resources)

b) "This medicine goes deep into my muscle." Goserelin (Zoladex) is a gonadotropin-releasing hormone agonist often used to block the effects of testosterone in male-to-female clients. Goserelin is administered subcutaneously. Tachycardia and dysrhythmias are major side effects of goserelin, and between 1% and 5% of clients sustain a myocardial infarction. Proper administration technique and sharps disposal should be taught before the client is given the first prescription. The nurse should teach the client how to correctly monitor pulse, and the parameters that should be reported to the health care provider. (Chp. 73, elsevier resources)

A client presents to the clinic to discuss options for treatment for gender dysphoria. He states "I'm confused and I need to talk to somebody, but I don't know what to do and who to talk to. I don't want my parents to know. Can you help me?" What is the nurse's priority response? a) "I'll tell the doctor you want to talk to him." b) "What you say here will be confidential." c) "Let's see if we can get a therapist to see you." d) "It depends on what kind of insurance you have." (Chp. 73, elsevier resources)

b) "What you say here will be confidential." It is most important to reassure the client that, as long as there is no evidence of abuse or concern of immediate self-harm, discussions with health care providers are confidential. Collaborating with other members of the health care team, including the physician and therapists, is important to provide comprehensive care, but the client must first be reassured of confidentiality; otherwise the client may not be communicative. Insurance coverage is not the top priority in client care. (Chp. 73, elsevier resources)

Periodic laboratory tests will be monitored for a female-to-male client who is taking testosterone. Which laboratory tests does the nurse tell the client to anticipate will be monitored? (Select all that apply.) a) Arterial blood gases (ABGs) b) Blood glucose c) Blood urea nitrogen (BUN)/creatinine d) Lipid profile e) Liver profile (Chp. 73, elsevier resources)

b) Blood glucose d) Lipid profile e) Liver profile Testosterone therapy may cause an increase in blood glucose and liver enzymes as well as a decrease in high-density lipids and an increase in low-density lipids. ABGs will not be affected and will not routinely be monitored. The BUN and creatinine may or may not be monitored as part of routine blood chemistries with testosterone therapy. (Chp. 73, elsevier resources)

A client has been diagnosed with breast cancer. Which client-chosen treatment option requires the nurse to discuss with the client the necessity of considering additional therapy? a) Chemotherapy b) Complementary and alternative medicine (CAM) c) Hormonal therapy d) Neoadjuvant therapy (Chp. 70, elsevier resources)

b) Complementary and alternative medicine (CAM) No proven benefit has been found with using CAM alone as a cure for breast cancer. The nurse must ensure that the client's choices can be safely integrated with conventional treatment for breast cancer. Chemotherapy is usually used for stage II or higher breast cancer and may or may not be used as a single treatment option. The purpose of hormonal therapy is to reduce the estrogen available to breast tumors to stop or prevent their growth; it may or may not be used with other treatment options. A large tumor is sometimes treated with chemotherapy, called neoadjuvant therapy, to shrink the tumor before it is surgically removed; an advantage of this therapy is that cancers can be removed by lumpectomy rather than mastectomy. (Chp. 70, elsevier resources)

A transwoman presents to her provider's office reporting difficulty sleeping, anxiety, and hypervigilance. She states "I just can't stop thinking about what they did to me last New Year's Eve at work. They slashed my tires. They took my purse. I see it over and over." What is the nurse's best action? a) Ask if the client has been abusing drugs or alcohol. b) Consult with the health care provider for referral to a counselor. c) Document the statements and proceed with the remainder of the assessment. d) Look for signs of self-harm. Incorrect (Chp. 73, elsevier resources)

b) Consult with the health care provider for referral to a counselor. Although accurate documentation is important with regard to the client's statements, this client's symptoms indicate she may be experiencing post-traumatic stress disorder. Male-to-female individuals are more than two times more likely to experience physical violence and discrimination than non-transwomen. Asking the client about drug and alcohol use is an important part of the assessment, but it is only one component, and the use of the word "abusing" implies it is the client who is in the wrong. Assessing for signs of self-harm is also important and part of the physical assessment, but again, it is only one small component. (Chp. 73, elsevier resources)

A client wishes to begin hormone therapy. What criteria must be met for the client to be eligible? (Select all that apply.) a) Over age 25 b) Continued and well-documented gender dysphoria c) Evaluation by a qualified mental health professional d) Signed informed consent e) No medical history issues (Chp. 73, elsevier resources)

b) Continued and well-documented gender dysphoria c) Evaluation by a qualified mental health professional d) Signed informed consent To be eligible for hormone therapy, the client must have continued and well-documented gender dysphoria, since hormone therapy is not without risks and does not take effect immediately. The client must also have been evaluated by a qualified mental health professional, and the client must give informed consent. The client must be over the age of 18. If the client has any medical or mental health diagnoses, they must be well controlled; however, simply because a client has a positive medical history, that does not mean the client is ineligible for treatment. (Chp. 73, elsevier resources)

For the 12 months prior to surgery, what is one of the requirements for a client requesting a vaginoplasty or a phalloplasty? a) Biweekly therapy sessions with a licensed psychotherapist b) Continuously living in the role of the desired gender identity c) Hormone therapy d) Monthly vocal coaching (Chp. 73, elsevier resources)

b) Continuously living in the role of the desired gender identity Vaginoplasty and phalloplasty are very extensive surgeries that alter the external appearance of a client. Continuously living in the gender role that is congruent with the client's gender identity for 12 months is required prior to surgery. It is highly recommended that the client be engaged in regular visits with a mental health professional. There is no requirement for hormone therapy. Vocal therapy may be of benefit to male-to-female clients, but this is not a requirement for surgery. (Chp. 73, elsevier resources)

The nurse is instructing a client on how to perform breast self-examination (BSE). Which techniques does the nurse include in teaching the client about BSE? (Select all that apply.) a) Instruct the client to keep her arm by her side while performing the examination. b) Ensure that the setting in which BSE is demonstrated is private and comfortable. c) Ask the client to remove her shirt. The bra may be left in place. d) Ask the client to demonstrate her own method of BSE. e) Use the fingertips, which are more sensitive than the finger pads, to palpate the breasts. (Chp. 70, elsevier resources)

b) Ensure that the setting in which BSE is demonstrated is private and comfortable. d) Ask the client to demonstrate her own method of BSE. The setting should be private and comfortable to promote an environment conducive to learning and to prevent potential client embarrassment. Before teaching breast palpation, ask the client to demonstrate her own method, so that the nurse can assess the client's understanding of BSE. For better visualization, the arm should be placed over the head. The client should undress completely from the waist up. The finger pads, which are more sensitive than the fingertips, are used when palpating the breasts. (Chp. 70, elsevier resources)

A client is having a radical prostatectomy. Which preoperative teaching specific to this surgery does the nurse emphasize? a) Incentive spirometry b) Kegel exercises c) Pain control d) Penile implants (Chp 72, elsevier resources)

b) Kegel exercises Kegel perineal exercises may reduce the severity of urinary incontinence after radical prostatectomy. The client is taught to contract and relax the perineal and gluteal muscles in several ways. Incentive spirometry and pain control are important for everyone who undergoes surgery; neither is specific to radical prostatectomy. Penile implants are not important to discuss during preoperative teaching; however, they may be necessary to discuss later. (Chp 72, elsevier resources)

For feminizing surgery, in what position should the client be placed? a) Fowler's b) Lithotomy c) Prone d) Trendelenburg (Chp. 73, elsevier resources)

b) Lithotomy For feminizing surgery, the lithotomy position with feet in stirrups is utilized. The other positions do not allow adequate access and visualization of the area for the multiple components of this procedure. (Chp. 73, elsevier resources)

Which action can the same-day surgery charge nurse delegate to an experienced unlicensed assistive personnel (UAP) who is helping with the care of a client who is having a breast biopsy? a) Assess anxiety level about the surgery. b) Monitor vital signs after surgery. c) Obtain data about breast cancer risk factors. d) Teach about postoperative routine care. (Chp. 70, elsevier resources)

b) Monitor vital signs after surgery. Vital sign assessment is included in UAP education and usually is part of the job description for UAP working in a hospital setting. Nursing assessment, obtaining data, and client teaching are not within the scope of practice for UAP and should be done by licensed nursing staff. (Chp. 70, elsevier resources)

A female-to-male client wishes to retain the option of having biological children after transitioning. What available option does the nurse suggest to the client? a) Oocyte freezing can occur after hormone therapy has started and before menstruation ceases. b) Oocyte freezing can occur prior to hormone therapy or gender reassignment surgery. c) Oocyte freezing can occur any time before gender reassignment surgery. d) No options are available to a client with gender dysphoria. (Chp. 73, elsevier resources)

b) Oocyte freezing can occur prior to hormone therapy or gender reassignment surgery. Although expensive, oocyte or embryo freezing should take place prior to the use of any hormone therapy or gender reassignment surgery if the client wishes to preserve reproductive options. Once hormone therapy or gender reassignment surgery has taken place, these options are no longer viable. Oocyte freezing is an option for a client with gender dysphoria. (Chp. 73, elsevier resources)

Why is prostate cancer screening often emphasized to the African-American population in the United States? a) Metastasis of prostate cancer is higher. b) Prostate cancer occurs at an earlier age. c) Prostate-specific antigen (PSA) is not sensitive to prostate disease. d) Clinical presentation is different. (Chp 72, elsevier resources)

b) Prostate cancer occurs at an earlier age. In the United States, prostate cancer affects African-American men the most and at an earlier age. There is no difference in prostate cancer metastasis, PSA sensitivity, or clinical presentation of prostate cancer in the African-American population as compared to other populations. (Chp 72, elsevier resources)

A client who recently had a mastectomy requests a volunteer to visit her home to help with recovery. Which community resource does the nurse recommend? a) National Breast Cancer Coalition b) Reach to Recovery c) Susan G. Komen for the Cure d) Young Survival Coalition (Chp. 70, elsevier resources)

b) Reach to Recovery The American Cancer Society's program Reach to Recovery provides volunteers who visit clients in the hospital or at home. They bring personal messages of hope; informational materials on breast cancer recovery; and a soft, temporary breast form. The National Breast Cancer Coalition is an organization dedicated to ending breast cancer through action and advocacy. Susan G. Komen for the Cure is an organization that supports breast cancer research. The Young Survival Coalition is an organization dedicated to educating the medical, research, breast cancer, and legislative communities about breast cancer, as well as serving as a point of contact for young women living with breast cancer. None of these other community resources provide volunteers to visit the home. (Chp. 70, elsevier resources)

The nurse is assigned care for a client who has undergone a modified radical left mastectomy for breast cancer. When delegating care, which statement by the nursing assistant would require further teaching by the nurse? a) "I will report urine intake and output to you." b) "If the client appears to be in pain, I will tell you right away." c) "It is important for me to take blood pressure on the client's left arm." d) "When ambulating, I will assist the client to stand straight with arms hanging at the side." (Ignatavicius & Workman, p. 1474)

c) "It is important for me to take blood pressure on the client's left arm." (Ignatavicius & Workman, p. 1474)

What is the correct way to refer to a client who self-identifies as the opposite gender? a) A transgender b) Transgender c) Transgendered d) Transvestite (Chp. 73, elsevier resources)

b) Transgender Transgender describes clients who self-identify as the opposite gender or whose gender does not match the one with which they were born (or natal sex). It is never correct to refer to someone as "a transgender," or to say someone is "transgendered." Transvestite may have negative connotations in some cultures. The best way to determine how someone wishes to be addressed is always to ask the client. (Chp. 73, elsevier resources)

The nurse is facilitating a discussion at an LGBTQ gathering at the local community college. One student asks what kind of genital surgeries are available for someone who wants to transition from female to male (FtM). What options will the nurse tell the group are available for FtM clients? (Select all that apply.) a) Penectomy b) Vaginectomy c) Mastectomy d) Metoidioplasty e) Scrotoplasty (Chp. 73, elsevier resources)

b) Vaginectomy d) Metoidioplasty e) Scrotoplasty The types of genital surgeries the FtM client may undergo include vaginectomy (removal of the vagina), metoidioplasty (creation of a small penis using hormone-enhanced clitoral tissue), and scrotoplasty (creation of a scrotum). Penectomy is surgical removal of the penis, which is not a genital surgery associated with FtM sexual reassignment. A mastectomy is the removal of breast tissue and, although many clients opt for this surgery, it is not a genital surgery. (Chp. 73, elsevier resources)

A client had an orchiectomy and laparoscopic radical retroperitoneal lymph node dissection this morning. What is the nurse's priority for care? a) assess the client's pain level and provide pain management b) ensure that the client's urinary catheter is draining clear yellow urine c) observe the client's incision for redness, swelling, and drainage d) apply oxygen therapy via nasal cannula at 2 L/min (Ignatavicius & Workman, p. 1515)

b) ensure that the client's urinary catheter is draining clear yellow urine (Ignatavicius & Workman, p. 1515)

A client had a transurethral resection of the prostate (TURP) with continuous bladder irrigation yesterday. The staff nurse notes that the urinary drainage is bright red and thick. What is the nurse's best action? a) notify the charge nurse as soon as possible b) increase the rate of bladder irrigation c) document the assessment in the medical record d) prepare the patient for a blood transfusion (Ignatavicius & Workman, p. 1506)

b) increase the rate of bladder irrigation (Ignatavicius & Workman, p. 1506)

The nurse provides health teaching for a client receiving estrogen therapy. Which statement by the client indicates a need for further teaching? a) "I need to check my blood pressure frequently when taking this drug.: b) "I will call my doctor if I have any redness or swelling in my legs." c) "I will drink extra fluids because this drug will cause me to urinate a lot." d) "I will eat more oranges and bananas to replace the potassium I will lose." (Ignatavicius & Workman, p. 1524)

c) "I will drink extra fluids because this drug will cause me to urinate a lot." (Ignatavicius & Workman, p. 1524)

From what age may a child begin to feel a sense of maleness or femaleness? a) Birth b) 6 months c) 2 years d) 5 years (Chp. 73, elsevier resources)

c) 2 years By the time a child is around 2 years old, he or she may begin to feel a sense of gender. Children are not born with a sense of gender identity. Some transgender individuals, however, may sense a mismatch from early childhood. This may lead to gender dysphoria or being uncomfortable with one's natal sex. (Chp. 73, elsevier resources)

With which male client does the nurse conduct prostate screening and education? a) Young adult with a history of urinary tract infections b) Client who has sustained an injury to the external genitalia c) Adult who is older than 50 years d) Sexually active client (Chp 72, elsevier resources)

c) Adult who is older than 50 years A man who is 50 years or older is at higher risk for prostate cancer. A history of urinary tract infections, injury to the external genitalia, and sexual activity are not risk factors for prostate cancer. (Chp 72, elsevier resources)

The nurse is instructing a client with breast cancer who will be undergoing chemotherapy about the side effects of doxorubicin (Adriamycin). Which side effect does the nurse instruct the client to report to the health care provider? a) Diaphoresis b) Dysphagia c) Edema d) Hearing loss (Chp. 70, elsevier resources)

c) Edema Doxorubicin is an anthracycline, and clients must be instructed to be aware of and to report cardiotoxic effects, including edema, shortness of breath, chronic cough, and excessive fatigue. Diaphoresis (profuse sweating), dysphagia (difficulty swallowing), and hearing loss are not associated side effects of doxorubicin. (Chp. 70, elsevier resources)

A premenopausal client diagnosed with breast cancer will be receiving hormonal therapy. The nurse anticipates that the health care provider will request which medication for this client? a) Anastrozole (Arimdex) b) Fulvestrant (Faslodex) c) Leuprolide (Lupron) d) Trastuzumab (Herceptin) (Chp. 70, elsevier resources)

c) Leuprolide (Lupron) Leuprolide is used in premenopausal women whose main estrogen source is the ovaries and who may benefit from luteinizing hormone-releasing hormone agonists that inhibit estrogen synthesis. Anastrozole is an aromatase inhibitor that is used in postmenopausal women whose main source of estrogen is not the ovaries, but rather body fat. Fulvestrant is a second-line hormonal therapy for postmenopausal women with advanced breast cancer. Trastuzumab is not a hormone and is used for targeted therapy for breast cancer. (Chp. 70, elsevier resources)

Which option for prevention and early detection of breast cancer is the option of choice for a client with a high genetic risk? a) Breast self-examination (BSE) beginning at 20 years of age b) Hormone replacement therapy (HRT) combining estrogen and progesterone c) Magnetic resonance imaging (MRI) and mammography every year beginning at age 30 d) Prophylactic mastectomy (Chp. 70, elsevier resources)

c) Magnetic resonance imaging (MRI) and mammography every year beginning at age 30 The American Cancer Society recommends that high-risk women (>20% lifetime risk) have an MRI and mammogram every year beginning at age 30. BSE is an option for everyone, not just those at high genetic risk for breast cancer. Use of HRT containing both estrogen and progestin increases risk; risk diminishes after 5 years of discontinuation. With a prophylactic mastectomy, there is a small risk that breast cancer will develop in residual breast glandular tissue because no mastectomy reliably removes all mammary tissue. (Chp. 70, elsevier resources)

A client has returned to the floor after a vaginoplasty. Which assessment finding would concern the nurse? a) Edema of the perineum b) Drainage in the Jackson-Pratt drain c) Numbness in the right leg d) Request for pain medication every 4 hours (Chp. 73, elsevier resources)

c) Numbness in the right leg Clients placed in the lithotomy position for prolonged periods of time are at risk for either compartment syndrome or nerve injury due to pressure on the femoral or peroneal nerve. Edema and pain of the perineum are to be expected, as is drainage in the Jackson-Pratt drain. Drainage should be monitored carefully for amount and color. (Chp. 73, elsevier resources)

Which assessment finding causes the nurse to suspect that a client may have testicular cancer? a) Hematuria b) Penile discharge c) Painless testicular lump d) Sudden increase in libido (Chp 72, elsevier resources)

c) Painless testicular lump A painless lump or swelling in the testicles is the most common manifestation of testicular cancer. Hematuria is not a symptom of testicular cancer, but could be indicative of other conditions such as bladder cancer. Penile discharge is not a symptom of testicular cancer, but could be indicative of another condition. A sudden increase in libido is not a symptom of testicular cancer. (Chp 72, elsevier resources)

The potential problem of grief is most relevant to a client after which procedure? a) Cystoscopy b) Transurethral microwave therapy c) Radical prostatectomy d) Sperm banking (Chp 72, elsevier resources)

c) Radical prostatectomy A radical prostatectomy may lead to erectile dysfunction, which could present a potential problem of grief at loss of function. Cystoscopy, a test to view the interior of the bladder, the bladder neck, and the urethra, does not affect sexuality. Transurethral microwave therapy is a minimally invasive procedure involving high temperatures that heat and destroy excess prostate tissue, and does not affect sexuality. The process of sperm banking would not result in a diagnosis of altered self-image; however, the diagnosis leading to the necessity of sperm banking might cause this. (Chp 72, elsevier resources)

Which method is a common complementary and alternative therapy for benign prostatic hyperplasia (BPH)? a) Acupuncture b) Calcium supplements c) Serenoa repens d) Yoga (Chp 72, elsevier resources)

c) Serenoa repens Serenoa repens (saw palmetto), a plant extract, is often used by men with early to moderate BPH. They believe that this agent relieves their symptoms and prefer this treatment over prescription drugs or surgery. (It should be noted, however, that studies on the effectiveness of Serenoa repens have not shown that it is effective.) Acupuncture, calcium, and yoga are not common alternative therapies for BPH. (Chp 72, elsevier resources)

A client who has undergone breast surgery is struggling with issues concerning her sexuality. What is the best way for the nurse to address the client's concerns? a) Allow the client to bring up the topic first. b) Remind the client to avoid sexual intercourse for 2 months after the surgery. c) Suggest that the client wear a bra or camisole during intercourse. d) Teach the client that birth control is a priority. (Chp. 70, elsevier resources)

c) Suggest that the client wear a bra or camisole during intercourse. Clients may prefer to lay a pillow over the surgical site or wear a bra or camisole to prevent contact with the surgical site during intercourse. The client may be embarrassed to discuss the topic of sexuality, so the nurse must be sensitive to possible concerns and approach the subject first. Sexual intercourse can be resumed after surgery whenever the client is comfortable. Sexually active clients receiving chemotherapy or radiotherapy must use birth control because of the therapy's teratogenic effects, but this is not necessary for clients who have had surgery only. (Chp. 70, elsevier resources)

A client is admitted to the postanesthesia care unit (PACU) following a vaginoplasty. Which nursing interventions are appropriate for this client? Select all that apply. a) irrigate the nasogastric tube every 4 hours b) keep the client in a sitting position to facilitate breathing c) apply an ice pack to the perineal area d) monitor drainage from the Jackson-Pratt tube e) perform frequent neurovascular assessments of the legs (Ignatavicius & Workman, p. 1528)

c) apply an ice pack to the perineal area d) monitor drainage from the Jackson-Pratt tube e) perform frequent neurovascular assessments of the legs (Ignatavicius & Workman, p. 1528)

A client is scheduled for her final preoperative visit before a vaginoplasty. Which statement by the client indicates a need for further teaching prior to surgery? a) "My surgeon wants me to take vitamin C so I will heal more quickly." b) "I should let my doctor know I am allergic to metronidazole (Flagyl)." c) "I will need to start taking the laxatives the day before the surgery." d) "I cannot drink anything at all once I start the bowel preparation." (Chp. 73, elsevier resources)

d) "I cannot drink anything at all once I start the bowel preparation." Laxatives are part of the bowel preparation that precede vaginoplasty. This will help decrease the risk of infection. Up until the client goes to bed the night before surgery, the client should increase liquid intake since the bowel preparation can be very dehydrating. Vitamin C can decrease bruising as well as promote wound healing. Antibiotics such as neomycin and metronidazole are given prior to surgery; the client should alert the surgical team about an allergy to metronidazole so a substitution can be made. (Chp. 73, elsevier resources)

The nurse is educating a group of young men about testicular self-examination (TSE). Which statement by a member of the group indicates teaching has been effective? a) "I will examine my testicles right before taking a shower." b) "I should squeeze each testicle in my hand to feel any lumps." c) "I should only report any large lumps to my health care provider." d) "I will look and feel for any lumps or changes to my testes." (Chp 72, elsevier resources)

d) "I will look and feel for any lumps or changes to my testes." With early detection by monthly TSE and treatment, testicular cancer can be successfully cured. In TSE, the client should look and feel for any lumps or changes to the testes. Any lumps that are detected should be immediately reported. A TSE should be performed immediately following a shower. The client should gently roll each testicle between the thumb and forefinger. All lumps should be reported to the provider, no matter the size. (Chp 72, elsevier resources)

The nurse is teaching a client about taking sildenafil (Viagra) for erectile dysfunction. Which statement by the client indicates a need for further teaching? a) "I should have sex within an hour after taking the drug." b) "I should avoid alcohol when on the drug or it might not work well." c) "I can expect to maybe get a stuffy nose or headache when I take the drug." d) "If I have chest pain during sex, I should take a nitroglycerin tablet." (Ignatavicius & Workman, p. 1513)

d) "If I have chest pain during sex, I should take a nitroglycerin tablet." (Ignatavicius & Workman, p. 1513)

A client receiving external beam radiation therapy calls the nurse to report rectal urgency, cramping, and passing of mucus and blood. What is the nurse's best response? a) "This is an emergency. Go directly to the emergency department." b) "This is normal and will resolve as soon as the treatment stops." c) "Avoid caffeine and continue drinking plenty of water and other fluids." d) "Limit spicy or fatty foods, caffeine, and dairy products." (Chp 72, elsevier resources)

d) "Limit spicy or fatty foods, caffeine, and dairy products." The client's symptoms indicate that he is experiencing radiation proctitis, a common complication of external beam radiation therapy. The nurse's instructions to limit spicy or fatty foods, caffeine, and dairy products describe what the client should do to alleviate these symptoms. The client's symptoms do not indicate an emergency, but they should be reported to the health care provider. The client's symptoms should resolve 4 to 6 weeks after the treatment stops. Avoiding caffeine and drinking water and other fluids describe what the client should do if he is experiencing radiation cystitis, which he is not. (Chp 72, elsevier resources)

The nurse is discussing treatment options with a client newly diagnosed with breast cancer. Which statement by the client indicates a need for further teaching? a) "Hormonal therapy is only used to prevent the growth of cancer. It won't get rid of it." b) "I might have chemotherapy before surgery." c) "If I get radiation, I am not radioactive to others." d) "Radiation will remove the cancer, so I might not need surgery." (Chp. 70, elsevier resources)

d) "Radiation will remove the cancer, so I might not need surgery." Typically, radiation therapy follows surgery to kill residual tumor cells. Radiation therapy plays a critical role in the therapeutic regimen and is an effective treatment for almost all sites where breast cancer can metastasize. The purpose of radiation therapy is to reduce the risk for local recurrence of breast cancer. The purpose of hormonal therapy is to reduce the estrogen available to breast tumors to stop or prevent their growth. Chemotherapy drugs destroy breast cancer cells that may be present anywhere in the body; they are typically administered after surgery for breast cancer, although neoadjuvant chemotherapy may be given to reduce the size of a tumor before surgery. The client receiving radiation therapy is radioactive only if the radiation source is dwelling inside the breast tissue. (Chp. 70, elsevier resources)

The nurse has completed discussing the process of gender reassignment surgery with a male-to-female client during her first visit to the office. Which statement by the client indicates a need for more education? a) "I will need to take hormones for 12 months before my surgery." b) "My insurance probably won't cover this." c) "I will need to have at least one referral from a therapist before I have surgery." d) "The surgeon who performed my appendectomy can do my surgery." (Chp. 73, elsevier resources)

d) "The surgeon who performed my appendectomy can do my surgery." Not all surgeons are comfortable performing gender reassignment surgeries. Frequently these surgeries are performed by urologists and plastic surgeons. Careful evaluation of the surgeon's expertise should be undertaken. Hormone therapy is required for 12 months prior to surgery, and at least one referral from a qualified psychotherapist is required prior to an orchiectomy. In many cases, insurance will not cover costs associated with gender reassignment surgery. (Chp. 73, elsevier resources)

The nurse is caring for four clients. Which client does the nurse recognize as having the highest risk for development of breast cancer? a) 45-year-old male with gynecomastia b) 40-year-old female whose father had colon cancer c) 50-year-old male whose mother had ovarian cancer d) 65-year-old female with history of a prior episode of breast cancer (Ignatavicius & Workman, p. 1467)

d) 65-year-old female with history of a prior episode of breast cancer (Ignatavicius & Workman, p. 1467)

Which client being cared for on the medical-surgical unit will be best to assign to a nurse who has floated from the intensive care unit (ICU)? a) Recent radical mastectomy client requiring chemotherapy administration b) Modified radical mastectomy client needing discharge teaching c) Stage III breast cancer client requesting information about radiation and chemotherapy d) Client with a Jackson-Pratt drain who just arrived from the postanesthesia care unit after a quadrantectomy (Chp. 70, elsevier resources)

d) Client with a Jackson-Pratt drain who just arrived from the postanesthesia care unit after a quadrantectomy A nurse working in the ICU would be familiar with postoperative monitoring and care of clients with Jackson-Pratt drains. The recent radical mastectomy client requires chemotherapy, so it is more appropriate to assign her to nurses who are familiar with teaching, monitoring, and providing chemotherapy for clients with breast cancer. The modified radical mastectomy client who requires discharge teaching, and the stage III breast cancer client requiring information about radiation and chemotherapy are more appropriate to assign to nurses who are familiar with breast cancer. (Chp. 70, elsevier resources)

A male-to-female (MtF) client is unable to tolerate estrogen therapy, so she has been prescribed spironolactone (Aldactone). What are the mechanisms of action of this drug when used in this context? (Select all that apply.) a) Blocks follicular maturation b) Blocks conversion of testosterone to dihydrotestosterone c) Acts as diuretic to remove excess potassium d) Inhibits androgen binding to androgen receptors e) Inhibits testosterone secretion (Chp. 73, elsevier resources)

d) Inhibits androgen binding to androgen receptors e) Inhibits testosterone secretion Spironolactone inhibits androgen binding to androgen receptors and also inhibits testosterone secretion. It is a diuretic, but is not useful in this context for MtF clients. Ethinyl estradiol blocks follicular maturation and is a combination of estrogen and progestin. 5-Alpha reductase inhibitors such as finasteride (Proscar) block the conversion of testosterone to dihydrotestosterone. (Chp. 73, elsevier resources)

Which assessment finding indicates to the nurse that a client is at high risk for a malignant breast lesion? a) A 1-cm freely mobile rubbery mass discovered by the client b) Ill-defined painful rubbery lump in the outer breast quadrant c) Backache and breast fungal infection d) Nipple discharge and dimpling (Chp. 70, elsevier resources)

d) Nipple discharge and dimpling Nipple discharge and dimpling are high-risk assessment findings for a malignant breast lesion. On clinical examination, fibroadenomas are oval, freely mobile, rubbery masses usually discovered by the woman herself; their size varies from smaller than 1 cm in diameter to as large as 15 cm in diameter. Although the immediate fear is breast cancer, the risk of its occurring within a fibroadenoma is very small. Breast pain and tender lumps or areas of thickening in the breasts are typical symptoms of a fibrocystic breast condition; the lumps are rubbery, ill-defined, and commonly found in the upper outer quadrant of the breast. Many large-breasted women develop fungal infection under the breasts, especially in hot weather, because it is difficult to keep this area dry and exposed to air. Backaches from the added weight are also common. (Chp. 70, elsevier resources)

A large-breasted client reports discomfort, backaches, and fungal infections because of her excessive breast size. The nurse provides information to the client about which breast treatment option? a) Augmentation b) Compression c) Reconstruction d) Reduction mammoplasty (Chp. 70, elsevier resources)

d) Reduction mammoplasty Breast reduction mammoplasty surgery removes excess breast tissue and repositions the nipple and remaining skin flaps to produce the best cosmetic effect. Breast augmentation surgery enhances the size, shape, or symmetry of breasts. Breast compression is not a treatment. Breast reconstruction surgery is typically performed for women after a mastectomy. (Chp. 70, elsevier resources)

A client who has just been discharged from the hospital after a modified radical mastectomy is referred to a home health agency. Which nursing action is most appropriate to delegate to an experienced home health aide? a) Assessing the safety of the home environment b) Developing a plan to decrease lymphedema risk c) Monitoring pain level and analgesic effectiveness d) Reinforcing the guidelines for hand and arm care (Chp. 70, elsevier resources)

d) Reinforcing the guidelines for hand and arm care Reinforcement of previously taught information about hand and arm care should be done by all caregivers. Assessment, developing a care plan, and monitoring pain level and analgesic effectiveness are not within the scope of practice of a home health aide and should be done by licensed nursing staff. (Chp. 70, elsevier resources)

A new transgender client is admitted to the unit for treatment. The nurse uses the wrong pronoun when addressing the client and taking the admitting history. What should the nurse do? a) Apologize repeatedly throughout the shift. b) Ask for reassignment to another client. c) Report the error to the charge nurse and write a variance. d) Self-correct and continue with the admitting history. (Chp. 73, elsevier resources)

d) Self-correct and continue with the admitting history. Errors may occur and transgender clients may very well have encountered them before. If there was no intent on the part of the nurse to be disrespectful, the best action is to self-correct and continue with the admitting history. Apologizing repeatedly focuses on the error and emphasizes it. The nurse should not ask for reassignment or fill out a variance as this would imply that something was wrong either with the client's care, the nurse, or the client. (Chp. 73, elsevier resources)

The issue that is often foremost in the minds of men who have been diagnosed with prostate cancer and must be addressed by the nurse is the alteration of which factor? a) Comfort because of surgical pain b) Mobility after treatment c) Nutrition because of radiation side effects d) Sexual function after treatment (Chp 72, elsevier resources)

d) Sexual function after treatment Altered sexual function is one of the biggest concerns of men after cancer treatment. Comfort, mobility, and nutrition are important, but are typically not the foremost concern in the minds of men with prostate cancer. (Chp 72, elsevier resources)

A client with testicular cancer is worried about sterility and the ability to conceive children later. Which resource does the nurse refer the client to before surgery takes place? a) American Cancer Society b) American Fertility Society c) RESOLVE: The National Infertility Association d) Sperm bank (Chp 72, elsevier resources)

d) Sperm bank After radiation therapy or chemotherapy has been started, the client is at increased risk for producing mutagenic sperm, which may not be viable or may result in fetal abnormalities. If the client is interested in having children, he should be encouraged to arrange for semen storage as soon as possible after diagnosis. Sperm collection should be completed before radiation therapy or chemotherapy is started. The client is referred to the American Cancer Society for more generalized information on testicular cancer. The American Fertility Society and RESOLVE: The National Infertility Association are appropriate referrals if permanent sterility occurs and sperm storage has not been feasible. (Chp 72, elsevier resources)

Hormone treatment for prostate cancer works by which action? a) Decreases blood flow to the tumor b) Destroys the tumor c) Shrinks the tumor d) Suppresses growth of the tumor (Chp 72, elsevier resources)

d) Suppresses growth of the tumor Hormone therapy, particularly antiandrogen drugs, inhibits tumor progression by blocking the uptake of testicular and adrenal androgens at the prostate tumor site. Antiandrogens may be used alone or in combination with luteinizing hormone-releasing hormone agonists for a total androgen blockade (hormone ablation). Hormone treatment for prostate cancer does not decrease blood flow to the tumor, destroy the tumor, or shrink the tumor. (Chp 72, elsevier resources)

Which statement about the early detection of breast masses is correct? a) Clinical breast examinations should be done yearly starting at age 20. b) Detection of breast cancer before or after axillary node invasion yields the same survival rate. c) Mammography as a baseline screening is recommended by the American Cancer Society at 30 years of age. d) The goal of screening for breast cancer is early detection. (Chp. 70, elsevier resources)

d) The goal of screening for breast cancer is early detection. The purpose of screening is early detection of cancer before it spreads. It is recommended that the clinical breast examination be part of a periodic health assessment at least every 3 years for women in their 20s and 30s, and every year for asymptomatic women who are at least 40 years of age. Detection of breast cancer before axillary node invasion increases the chance of survival. The American Cancer Society recommends screening with mammography annually beginning at age 40. (Chp. 70, elsevier resources)

A client has recently had a vaginoplasty and has noticed stool coming from her vagina. She calls her provider's office and the nurse advises her to immediately go the emergency department. What is the nurse's concern? a) Dislodgement of the urinary catheter b) Labial hematoma c) Prolapse d) Vaginal-rectal fistula (Chp. 73, elsevier resources)

d) vaginal-rectal fistula A vaginal-rectal fistula is caused by a rectal perforation during the surgery to create the vagina and may lead to passage of stool into the vagina. This is a major complication that will necessitate a temporary colostomy as well as extensive wound care. A urinary catheter is usually left in during the immediate postoperative period. A labial hematoma would be apparent on the labia but would not cause passage of stool. A prolapse or herniation of contents would not create passage of stool. (Chp. 73, elsevier resources)