NR 325: Exam 3 Study Questions, exam 3 adult health

14. When a patient is scheduled for stereotactic core biopsy of the breast, which information will the nurse include in patient education? a. A local anesthetic will be given before the biopsy specimen is obtained. b. You will need to lie flat on your back and lie very still during the biopsy. c. A thin needle will be inserted into the lump and aspirated to remove tissue. d. You should not have anything to eat or drink for 6 hours before the procedure.

ANS: A A local anesthetic is given before stereotactic biopsy. NPO status is not needed because no sedative drugs are given. The patient is placed in the prone position. A biopsy gun is used to obtain the specimens.

14. Which action by nursing assistive personnel (NAP) when caring for a patient who has just returned to the nursing unit after an esophagogastroduodenoscopy (EGD) requires that the RN intervene? a. Offering the patient a glass of water b. Positioning the patient on the right side c. Checking the vital signs every 30 minutes d. Swabbing the patient's mouth with cold water

ANS: A Immediately after EGD, the patient will have a decreased gag reflex and is at risk for aspiration. Assessment for return of the gag reflex should be done by the RN. The other actions by the NAP are appropriate.

23. After providing discharge instructions to a patient following a laparoscopic cholecystectomy, the nurse recognizes that teaching has been effective when the patient states, a. "I can remove the bandages on my incisions tomorrow and take a shower." b. "I can expect some yellow-green drainage from the incision for a few days." c. "I should plan to limit my activities and not return to work for 4 to 6 weeks." d. "I will always need to maintain a low-fat diet since I no longer have a gallbladder."

ANS: A After a laparoscopic cholecystectomy, the patient will have Band-Aids in place over the incisions. Patients are discharged the same (or next) day and have few restrictions on activities of daily living. Drainage from the incisions would be abnormal, and the patient should be instructed to call the health care provider if this occurs. A low-fat diet may be recommended for a few weeks after surgery but will not be a life-long requirement.

21. When obtaining a health history from a patient with acute pancreatitis, the nurse asks the patient specifically about a history of a. alcohol use. b. diabetes mellitus. c. high-protein diet. d. cigarette smoking.

ANS: A Alcohol use is one of the most common risk factors for pancreatitis in the United States. Cigarette smoking, diabetes, and high-protein diets are not risk factors.

5. A 19-year-old patient who is being assessed for amenorrhea at the clinic makes all of the following statements to the nurse. Which one indicates a need for patient teaching? a. "I run at least 8 miles every day to keep in shape." b. "I drink at least 3 glasses of non-fat milk every day." c. "I am not sexually active but currently I have an IUD [intrauterine device]." d. "I was recently treated for a sexually transmitted disease."

ANS: A Excessive exercise can cause amenorrhea. The other statements by the patient do not suggest any urgent teaching needs.

3. A patient with a small immobile breast lump is advised to have a fine needle aspiration (FNA) biopsy. The nurse explains that an advantage to this procedure is that a. FNA is done in the outpatient clinic, and results are available in 1 to 2 days. b. only a small incision is needed, resulting in minimal breast pain and scarring. c. if the biopsy results are negative, no further diagnostic testing will be needed. d. FNA is guided by a mammogram, ensuring that cells are taken from the lesion.

ANS: A FNA is done in outpatient settings and results are available in 24 to 48 hours. No incision is needed. FNA may be guided by ultrasound, but not by mammogram. Since the immobility of the breast lump suggests cancer, further testing will be done if the FNA is negative.

3. A patient in the outpatient clinic is diagnosed with acute hepatitis C (HCV) infection. Which action by the nurse is appropriate? a. Schedule the patient for HCV genotype testing. b. Administer immune globulin and the HCV vaccine. c. Instruct the patient on ribavirin (Rebetol) treatment. d. Teach that the infection will resolve in a few months.

ANS: A Genotyping of HCV has an important role in managing treatment and is done before drug therapy is initiated. Since most patients with acute HCV infection convert to the chronic state, the nurse should not teach the patient that the HCV will resolve in a few months. Immune globulin or vaccine is not available for HCV. Ribavirin is used for chronic HCV infection.

24. Which data obtained by the nurse during the assessment of a patient with cirrhosis will be of most concern? a. The patient's hands flap back and forth when the arms are extended. b. The patient has ascites and a 2-kg weight gain from the previous day. c. The patient's skin has multiple spider-shaped blood vessels on the abdomen. d. The patient complains of right upper-quadrant pain with abdominal palpation.

ANS: A The asterixis indicates that the patient has hepatic encephalopathy, and hepatic coma may occur. The spider angiomas and right upper quadrant abdominal pain are not unusual for the patient with cirrhosis and do not require a change in treatment. The ascites and weight gain do indicate the need for treatment but not as urgently as the changes in neurologic status.

9. A 32-year-old patient is diagnosed with early alcoholic cirrhosis. Which topic is most important to include in patient teaching? a. Need to abstain from alcohol b. Use of vitamin B supplements c. Maintenance of a nutritious diet d. Treatment with lactulose (Cephulac)

ANS: A The disease progression can be stopped or reversed by alcohol abstinence. The other interventions may be used when cirrhosis becomes more severe to decrease symptoms or complications, but the priority for this patient is to stop the progression of the disease.

23. During examination of a 67-year-old man, the nurse notes bilateral enlargement of the breasts. Which action should the nurse take first? a. Question the patient about any medications being currently used. b. Teach the patient about how to palpate the breast tissue for lumps. c. Refer the patient for mammography and biopsy of the breast tissue. d. Explain that this is a temporary condition due to hormonal changes.

ANS: A The first action should be further assessment. Since gynecomastia is a possible side effect of drug therapy, asking about the current drug regimen is appropriate. The other actions may be needed, depending on the data that are obtained with further assessment.

7. To palpate the liver, the nurse a. places one hand on the patient's back and presses upward and inward with the other hand below the patient's right costal margin. b. places one hand on top of the other and uses the upper fingers to apply pressure and the bottom fingers to feel for the liver edge. c. presses slowly and firmly over the right costal margin with one hand and withdraws the fingers quickly after the liver edge is felt. d. places one hand under the patient's lower ribs and presses the left lower rib cage forward, palpating below the costal margin with the other hand.

ANS: A The liver is normally not palpable below the costal margin, the nurse needs to push inward below the right costal margin while lifting the patient's back slightly with the left hand. The other methods will not allow palpation of the liver.

13. Which nursing action will be included in the plan of care for a patient who is being treated for bleeding esophageal varices with balloon tamponade? a. Monitor the patient for shortness of breath. b. Encourage the patient to cough every 4 hours. c. Deflate the gastric balloon every 8 to 12 hours. d. Verify the position of the balloon every 6 hours.

ANS: A The most common complication of balloon tamponade is aspiration pneumonia. In addition, if the gastric balloon ruptures, the esophageal balloon may slip upward and occlude the airway. Coughing increases the pressure on the varices and increases the risk for bleeding. Balloon position is verified after insertion and does not require further verification. The esophageal balloon is deflated every 8 to 12 hours to avoid necrosis, but if the gastric balloon is deflated, the esophageal balloon may occlude the airway.

15. The health care provider sees a patient at 10 AM and writes an order for endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which of these actions that are included in the agency policy for ERCP should the nurse take first? a. Place the patient on NPO status. b. Administer sedative medications. c. Ensure the consent form is signed. d. Explain the procedure to the patient.

ANS: A The patient will need to be NPO for 8 hours before the ERCP is done, so the nurse's initial action should be to place the patient on NPO status. The other actions can be done after the patient is NPO.

12. A patient who has advanced cirrhosis is receiving lactulose (Cephulac). Which finding by the nurse indicates that the medication is effective? a. The patient is alert and oriented. b. The patient denies nausea or anorexia. c. The patient's bilirubin level decreases. d. The patient has at least one stool daily.

ANS: A The purpose for lactulose in the patient with cirrhosis is to lower ammonia levels and prevent encephalopathy. Although lactulose may be used to treat constipation, that is not the purpose for this patient. Lactulose will not decrease nausea and vomiting or lower bilirubin levels.

5. When combination therapy of -interferon and ribavirin (Rebetol) is being used to treat chronic hepatitis C, the nurse will plan to monitor for a. leukopenia. b. hypokalemia. c. polycythemia. d. hypoglycemia.

ANS: A Therapy with ribavirin and -interferon may cause leukopenia. The other problems are not associated with this drug therapy.

6. When the nurse is assessing the sexual-reproductive functional health pattern for a 34-year-old man, which question is most useful in determining the patient's sexual orientation and risk factors? a. "Do you have sex with men, women, or both?" b. "Which gender do you prefer to have sex with?" c. "What types of sexual activities do you prefer?" d. "Are you heterosexual, homosexual, or bisexual?"

ANS: A This question is the most simply stated and will increase the likelihood of obtaining the relevant information about sexual orientation and possible risk factors associated with sexual activity. A patient who prefers intercourse with women also may have intercourse at times with men. The types of sexual activities engaged in may not indicate sexual orientation. Many patients who have intercourse with both men and women do not identify themselves as homosexual or bisexual.

15. A student nurse prepares a list of teaching topics for a patient with a new diagnosis of breast cancer. Which topic indicates that the student needs more education about breast cancer diagnostic testing? a. CA 15-3 level testing b. HER-2 receptor testing c. Estrogen receptor testing d. Oncotype DX assay testing

ANS: A Tumor markers such as CA 15-3 are used to monitor response to treatment for breast cancer, not to detect or diagnose breast cancer. The other tests are likely to be used for additional diagnostic testing in a patient with breast cancer.

40. After an unimmunized individual is exposed to hepatitis B through a needle-stick injury, which actions will the nurse plan to take (select all that apply)? a. Administer hepatitis B vaccine. b. Test for antibodies to hepatitis B. c. Teach about α-interferon therapy. d. Give hepatitis B immune globulin. e. Educate about oral antiviral therapy.

ANS: A, B, D The recommendations for hepatitis B exposure include both vaccination and immune globulin administration. In addition, baseline testing for hepatitis B antibodies will be needed. Interferon and oral antivirals are not used for hepatitis B prophylaxis.

13. Which assessment finding in a patient who is being admitted to the hospital is most important to report to the health care provider? a. Tympany on percussion of the abdomen b. Liver edge 3 cm below the costal margin c. Bowel sounds of 20/minute in each quadrant d. Aortic pulsations visible in the epigastric area

ANS: B Normally the lower border of the liver is not palpable below the ribs, so this finding suggests hepatomegaly. The other findings are within normal range for the physical assessment.

4. The nurse will monitor a patient who has an obstruction of the common bile duct for a. melena. b. steatorrhea. c. decreased serum cholesterol levels. d. increased serum indirect bilirubin levels.

ANS: B A common bile duct obstruction will reduce the absorption of fat in the small intestine, leading to fatty stools. Gastrointestinal (GI) bleeding is not caused by common bile duct obstruction. Serum cholesterol levels are increased with biliary obstruction. Direct bilirubin level is increased with biliary obstruction.

12. Which information collected by the nurse when caring for a patient who has just arrived in the recovery area after an upper endoscopy is most important to communicate to the health care provider? a. The patient is very sleepy. b. The oral temperature is 101.6° F. c. The apical pulse is 104 beats/minute. d. The patient complains of a sore throat.

ANS: B A temperature elevation may indicate that a perforation has occurred. The other assessment data are normal immediately after the procedure.

22. A 33-year-old who has a diagnosis of fibrocystic breast changes calls the nurse in the clinic with these symptoms. Which is most important to report to the health care provider? a. There is yellow-green discharge from one of the patient's nipples. b. There is an area on the breast that is hot, pink, and tender to touch. c. The lumps are firm feeling and most are in the upper outer breast quadrants. d. The lumps are larger and more painful before the patient's menstrual period.

ANS: B An area that is hot or pink suggests an infectious process such as mastitis, which would require further assessment and treatment. The other information also will be reported, but these findings are typical in fibrocystic breasts.

11. To evaluate the effectiveness of treatment for a patient who has hepatic encephalopathy, which action should the nurse take? a. Request that the patient stand on one foot. b. Ask the patient to extend both arms to the front. c. Instruct the patient to perform the Valsalva maneuver. d. Have the patient walk a few steps with the eyes closed.

ANS: B Extending the arms allows the nurse to check for asterixis, a classic sign of hepatic encephalopathy. The other tests also might be done as part of the neurologic assessment but would not be diagnostic for hepatic encephalopathy.

7. A patient at the clinic who has metastatic breast cancer has a new prescription for trastuzumab (Herceptin). The nurse will plan to a. have the patient schedule frequent eye examinations. b. instruct the patient to call if she notices ankle swelling. c. remind the patient that hot flashes may occur with the medication. d. teach the patient about the need to monitor serum electrolyte levels.

ANS: B Herceptin can lead to ventricular dysfunction, so the patient is taught to self-monitor for symptoms of heart failure. There is no need to monitor serum electrolyte levels. Hot flashes or changes in visual acuity may occur with tamoxifen, but not with trastuzumab.

4. When the nurse is assessing the breasts of a 31-year-old, which finding is most indicative of a need for further evaluation? a. Bilateral nodules that are tender with palpation b. A nodule that is 1 cm in size, painless, and fixed c. A lump that increases in size before the menstrual period d. A lump that is small, mobile, and has a rubbery consistency

ANS: B Painless and fixed lumps suggest breast cancer. The other findings are more suggestive of benign processes such as fibrocystic breasts and fibroadenoma.

22. When educating a patient with chronic pancreatitis about the prescribed pancrelipase (Viokase), the nurse will teach the patient to take the medication a. at bedtime. b. with every meal. c. upon arising in the morning. d. as soon as abdominal pain occurs.

ANS: B Pancreatic enzymes are used to help with digestion of nutrients and should be taken with every meal.

12. Which information will the nurse include when teaching a patient about the transverse rectus abdominis musculocutaneous (TRAM) procedure? a. Saline-filled implants are placed under the pectoral muscles. b. Recovery from the TRAM surgery takes at least 6 to 8 weeks. c. Muscle tissue is removed from the back and used to form a breast. d. TRAM flap procedures may be done in outpatient surgery centers.

ANS: B Patients take at least 6 to 8 weeks to recover from the TRAM surgery. Tissue from the abdomen is used to reconstruct the breast. The TRAM procedure can take up to 8 hours and requires postoperative hospitalization. Saline implants are used in mammoplasty.

31. The nurse is caring for a patient with chronic hepatitis C infection who has these medications prescribed. Which medication requires further discussion with the health care provider prior to administration? a. ribavirin (Rebetol, Copegus) 600 mg PO bid b. pegylated α-interferon (PEG-Intron, Pegasys) SQ daily c. diphenhydramine (Benadryl) 25 mg PO every 4 hours PRN itching d. dimenhydrinate (Dramamine) 50 mg PO every 6 hours PRN nausea

ANS: B Pegylated α-interferon is administered weekly. The other medications are appropriate for a patient with chronic hepatitis C infection.

15. A 22-year-old female patient who has been admitted to the emergency department after an automobile accident is scheduled for abdominal x-rays. Which information is most important to report to the health care provider before the x-rays are obtained? a. Abdominal pain b. Positive hCG testing c. Temperature 102.1° F (38.9° C) d. Blood pressure 172/88 mm Hg

ANS: B Positive hCG testing indicates that the patient is pregnant and that unnecessary abdominal x-rays should be avoided. The other information also is important to report, but it will not affect whether the x-rays should be done.

39. Which of the following nursing actions included in the plan of care for a patient with cirrhosis can the RN delegate to nursing assistive personnel? a. Assessing the patient for jaundice b. Providing oral hygiene before meals c. Palpating the abdomen for distention d. Assisting the patient in choosing the diet

ANS: B Providing oral hygiene is included in the education and scope of practice of nursing assistants. Assessments and assisting patients to choose therapeutic diets are nursing actions that require higher-level nursing education and scope of practice and would be delegated to LPNs/LVNs or RNs.

10. Which information about a 22-year-old who wants to start using oral contraceptives is most important to report to the health care provider? a. The patient quit smoking 6 months previously. b. The patient's blood pressure is 164/90 mm Hg. c. The patient has not been vaccinated for rubella. d. The patient has chronic iron-deficiency anemia.

ANS: B Since hypertension increases the risk for morbidity and mortality in women taking oral contraceptives, the patient's blood pressure should be controlled before oral contraceptives are prescribed. The other information also will be reported but will not affect the choice of contraceptive.

25. A patient with cirrhosis and esophageal varices has a new prescription for propranolol (Inderal). Which assessment finding is the best indicator that the medication has been effective? a. The apical pulse rate is 68 beats/minute. b. Stools test negative for occult blood. c. The patient denies complaints of chest pain. d. Blood pressure is less than 140/90 mm Hg.

ANS: B Since the purpose of -blocker therapy for patients with esophageal varices is to decrease the risk for bleeding from esophageal varices, the best indicator of the effectiveness for propranolol is the lack of blood in the stools. Although propranolol is used to treat hypertension, angina, and tachycardia, the purpose for use in this patient is to decrease the risk for bleeding from esophageal varices.

17. Following a lumpectomy, a patient is scheduled for external beam radiation to the right breast. Which information should the nurse include in patient teaching? a. The radiation therapy will take a week to complete. b. Careful skin care in the radiated area will be necessary. c. Visitors are restricted until the radiation therapy is completed. d. Wigs may be used until the hair regrows after radiation therapy.

ANS: B Skin care will be needed because of the damage caused to the skin by the radiation. External beam radiation is done over a 5- to 6-week period. Hair loss does not occur with radiation therapy. Since the patient does not have radioactive implants, no visitor restrictions are necessary.

10. A patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix) has a serum potassium level of 3.2 mEq/L (3.2 mmol/L). Which action should the nurse take? a. Give both drugs as scheduled. b. Administer the spironolactone. c. Administer the furosemide and withhold the spironolactone. d. Withhold both drugs until talking with the health care provider.

ANS: B Spironolactone is a potassium-sparing diuretic and will help to increase the patient's potassium level. The nurse does not need to talk with the doctor before giving the spironolactone, although the health care provider should be notified about the low potassium value. The furosemide will further decrease the patient's potassium level and should be held until the nurse talks with the health care provider.

14. A patient with severe cirrhosis has an episode of bleeding esophageal varices. To detect possible complications of the bleeding episode, it is most important for the nurse to monitor a. bilirubin levels. b. ammonia levels. c. potassium levels. d. prothrombin time.

ANS: B The blood in the gastrointestinal (GI) tract will be absorbed as protein and may result in an increase in ammonia level because the liver cannot metabolize protein well. The prothrombin time, bilirubin, and potassium levels also should be monitored, but these will not be affected by the bleeding episode.

37. A patient is admitted to the hospital with acute cholecystitis. Which assessment information will be most important for the nurse to report to the health care provider? a. The patient's urine is bright yellow. b. The patient's stools are clay colored. c. The patient complains of chronic heartburn. d. The patient has an increase in pain after eating.

ANS: B The clay-colored stools indicate biliary obstruction, which requires rapid intervention to resolve. The other data are not unusual for a patient with this diagnosis, although the nurse also would report the other assessment information to the health care provider.

33. A homeless patient with severe anorexia and fatigue is admitted to the hospital with viral hepatitis. Which patient goal has the highest priority when the nurse is developing the plan of care? a. Increase activity level. b. Maintain adequate nutrition. c. Establish a stable home environment. d. Identify the source of exposure to hepatitis.

ANS: B The highest priority outcome is to maintain nutrition because adequate nutrition is needed for hepatocyte regeneration. Finding a home for the patient and identifying the source of the infection would be appropriate activities, but they do not have as high a priority as ensuring adequate nutrition. Although the patient's activity level will be gradually increased, rest is indicated during the acute phase of hepatitis.

10. After the nurse completes discharge teaching for a patient who has had a left modified radical mastectomy and lymph node dissection, which statement by the patient indicates that teaching has been successful? a. "I will need to use my right arm and to rest the left one." b. "I will avoid reaching over the stove with my left hand." c. "I will keep my left arm in a sling until the incision is healed." d. "I will stop the left arm exercises if moving the arm is painful."

ANS: B The patient should avoid any activity that might injure the left arm, such as reaching over a burner. If the left arm exercises are painful, analgesics should be used and the exercises continued in order to restore strength and range of motion. The left arm should be elevated at or above heart level and should be used to improve range of motion and function.

11. A patient has a saline breast implant inserted in the outpatient surgery area. Which instruction will the nurse include in the discharge teaching? a. Take aspirin every 4 hours to reduce inflammation. b. Check wound drains for excessive blood or any foul odor. c. Wear a loose-fitting bra to decrease irritation of the sutures. d. Resume normal activities 2 to 3 days after the mammoplasty.

ANS: B The patient should be taught drain care because the drains will be in place for 2 or 3 days after surgery. Normal activities can be resumed after 2 to 3 weeks. A bra that provides good support is typically ordered. Aspirin will decrease coagulation and is typically not given after surgery.

2. The nurse determines that administration of hepatitis B vaccine to a patient has been effective when a specimen of the patient's blood reveals a. HBsAg. b. anti-HBs. c. anti-HBc IgG. d. anti-HBc IgM.

ANS: B The presence of surface antibody to HBV (anti-HBs) is a marker of a positive response to the vaccine. The other laboratory values indicate current infection with HBV.

2. To promote bowel evacuation in a patient with chronic complaints of constipation, the nurse will suggest that the patient should attempt defecation a. in the mid-afternoon. b. after eating breakfast. c. right after getting up in the morning. d. immediately before the first daily meal.

ANS: B These reflexes are most active after the first daily meal. Arising in the morning, the anticipation of eating, and physical exercise do not stimulate these reflexes.

6. A patient with stage II breast cancer tells the nurse, "I need to decide about what type of surgery to have, but I feel so overwhelmed that I cannot make any decisions yet! What do you think I should do?" Which response by the nurse is best? a. "I would have a lumpectomy, but you need to decide what is best for you." b. "Tell me what you understand about the surgical options that are available." c. "It would not be appropriate for me to make the decision about your health." d. "There is no need to make a decision rapidly; you have time to think about this."

ANS: B This response indicates the nurse's willingness to assist the patient with the decision-making process without imposing the nurse's values or opinions. Response B indicates that the nurse is not willing to help the patient with the decision about treatment. Because treatment decisions for breast cancer do need to be made relatively quickly, response C is not accurate. Since the nurse's values and situation are not the same as the patient's, imposing the nurse's opinions during this emotionally vulnerable time is not appropriate.

8. When the nurse is listening to a patient's abdomen, which finding indicates a need for a focused abdominal assessment? a. Loud gurgles b. High-pitched gurgles c. Absent bowel sounds d. Frequent clicking sounds

ANS: C Absent bowel sounds are abnormal and require further assessment by the nurse. The other sounds may be heard normally.

9. When caring for a patient following a needle biopsy of the liver at the bedside, the nurse should a. put pressure on the biopsy site using a sandbag. b. elevate the head of the bed to facilitate breathing. c. place the patient on the right side with the bed flat. d. check the patient's postbiopsy coagulation studies.

ANS: C After a biopsy, the patient lies on the right side with the bed flat to splint the biopsy site. Coagulation studies are checked before the biopsy. A sandbag does not exert adequate pressure to splint the site.

19. Which of these laboratory test results will be most important for the nurse to monitor when evaluating the effects of therapy for a patient who has acute pancreatitis? a. Calcium b. Bilirubin c. Amylase d. Potassium

ANS: C Amylase is elevated in acute pancreatitis. Although changes in the other values may occur, they would not be as useful in evaluating whether the prescribed therapies have been effective.

5. A 51-year-old woman at menopause is considering the use of hormone replacement therapy (HRT) but is concerned about the risk of breast cancer. Which information will the nurse include when discussing HRT with the patient? a. HRT does not appear to increase the risk for breast cancer unless there are other risk factors. b. HRT is a safe therapy for menopausal symptoms if there is no family history of BRCA genes. c. She and her health care provider must weigh the benefits of HRT against the possible risks of breast cancer. d. Alternative therapies with herbs and natural drugs are as effective as estrogen in relieving menopausal symptoms.

ANS: C Because HRT has been linked to increased risk for breast cancer, the patient and provider must determine whether or not to use HRT. Breast cancer incidence is increased in women using HRT, independent of other risk factors. HRT increases the risk for both non-BRCA-associated cancer and BRCA-related cancers. Alternative therapies can be used but are not consistent in relieving menopausal symptoms.

12. A patient calls the clinic and tells the nurse, "My menstrual period is very heavy. I have to change my tampon every 4 hours." Which action should the nurse take next? a. Tell the patient that her flow is not unusually heavy. b. Schedule the patient for an appointment later that day. c. Ask the patient how heavy her usual menstrual flow is. d. Have the patient call again if the heavy flow continues.

ANS: C Because a heavy menstrual flow is usually indicated by saturating a pad or tampon in 1 to 2 hours, the nurse should first assess how heavy the patient's usual flow is. There is no need to schedule the patient for an appointment that day. The patient may need to call again, but this is not the first action that the nurse should take. Telling the patient that she does not have a heavy flow implies that the patient's concern is not important.

21. When the nurse is caring for a patient with left arm lymphedema, which action will be included in the plan of care? a. Check BP on both right and left arms. b. Avoid isometric exercise on the left arm. c. Assist with application of compression dressings. d. Keep the left arm at or below the level of the heart.

ANS: C Compression of the arm assists in improving lymphatic flow toward the heart. Isometric exercises may be prescribed for lymphedema. BPs should only be done on the patient's right arm. The arm should not be placed in a dependent position.

2. To determine the risk for breast cancer in a 52-year-old patient who has found a small lump in her breast, which question is most pertinent for the nurse to ask? a. "Do you currently smoke cigarettes?" b. "Have you ever had any breast injuries?" c. "At what age did you start having menstrual periods?" d. "Is there any family history of fibrocystic breast changes?"

ANS: C Early menarche and late menopause are risk factors for breast cancer because of the prolonged exposure to estrogen that occurs. Cigarette smoking, breast trauma, and fibrocystic breast changes are not associated with increased breast cancer risk.

1. Which question should the nurse ask when assessing a patient who has a history of benign prostatic hyperplasia (BPH)? a. "Have you noticed any unusual discharge from your penis?" b. "Has there been any change in your sex life in the last year?" c. "Has there been a decrease in the force of your urinary stream?" d. "Have you been experiencing any difficulty in achieving an erection?"

ANS: C Enlargement of the prostate blocks the urethra, leading to urinary changes such as a decrease in the force of the urinary stream. The other questions address possible problems with infection or sexual difficulties, but would not be helpful in determining whether there were functional changes caused by BPH.

10. Which information obtained by the nurse when admitting a patient who is scheduled for an ultrasound of the gallbladder indicates that the ultrasound may need to be rescheduled? a. The patient has a permanent gastrostomy tube. b. The patient took a laxative the previous evening. c. The patient ate a low-fat bagel an hour previously. d. The patient had a high-fat meal the previous evening.

ANS: C Food intake can cause the gallbladder to contract and result in a suboptimal study. The patient should be NPO for 8 to 12 hours before the test. A high-fat meal the previous evening, laxative use, or a gastrostomy tube will not affect the results of the study.

8. A couple who has not been able to conceive is scheduled for a Huhner test for infertility. In preparation for the test, the nurse will instruct the couple about a. possible shoulder pain after the procedure. b. sedative medications used during the procedure. c. ways to determine the estimated time of ovulation. d. how long to refrain from intercourse before the test.

ANS: C For the Huhner test, the couple should have intercourse at the estimated time of conception and then arrive for the test 2 to 8 hours after intercourse. The other instructions would be used for other types of fertility testing.

18. When assessing a patient who had a liver transplant a week previously, the nurse obtains the following data. Which finding is most important to communicate to the health care provider? a. Dry lips and oral mucosa b. Crackles at both lung bases c. Temperature 100.8° F (38.2° C) d. No bowel movement for 4 days

ANS: C Infection risk is high in the first few months after liver transplant and fever is frequently the only sign of infection. The other patient data indicate the need for further assessment or nursing actions, but do not indicate a need for urgent action.

20. When the nurse is working in the women's health care clinic, which of these actions is appropriate to take? a. Educate a healthy 36-year-old about the need for an annual mammogram. b. Discuss the need for a clinical breast examination every year with a 22-year-old. c. Talk about magnetic resonance imaging (MRI) with a 26-year-old with a BRCA-1 mutation. d. Teach an active 70-year-old that mammography frequency can be reduced to every 3 years.

ANS: C MRI (in addition to mammography) is recommended for women who are at high risk for breast cancer. A 22-year-old patient should have a clinical breast exam every 3 years. Annual mammograms are recommended for women starting at age 40. Annual mammography is recommended for healthy older women.

2. After a patient has been treated for pelvic inflammatory disease, the nurse will plan to implement teaching about a. irregularities in the menstrual cycle. b. changes in secondary sex characteristics. c. possible difficulty with becoming pregnant. d. use of hormone replacement therapy (HRT).

ANS: C Pelvic inflammatory disease may cause scarring of the fallopian tubes and result in difficulty in fertilization or implantation of the fertilized egg. Because ovarian function is not affected, the patient will not require HRT, have irregular menstrual cycles, or experience changes in secondary sex characteristics.

35. In planning care for a patient with acute severe pancreatitis, the nurse assigns the highest priority to the patient outcome of a. expressing satisfaction with pain control. b. developing no ongoing pancreatic problems. c. maintenance of normal respiratory function. d. having adequate fluid and electrolyte balance.

ANS: C Respiratory failure can occur as a complication of acute pancreatitis, and maintenance of adequate respiratory function is the priority goal. The other outcomes also would be appropriate for the patient.

11. A 42-year-old man who is taking the following medications tells the nurse that he has had difficulty in achieving an erection. Which of the following medications may cause erectile dysfunction (ED)? a. atorvastatin (Lipitor) for hyperlipidemia b. metformin (Glucophage) for type 2 diabetes c. propranolol (Inderal) for high blood pressure d. ranitidine (Zantac) for gastroesophageal reflux

ANS: C Some antihypertensives may cause erectile dysfunction, and the nurse should anticipate a change in antihypertensive therapy. The other medications will not affect erectile function.

30. Which nursing action will be included in the plan of care for a patient who has recently been diagnosed with asymptomatic nonalcoholic fatty liver disease (NAFLD)? a. Teach symptoms of variceal bleeding. b. Discuss the need to increase caloric intake. c. Review the patient's current medication list. d. Draw blood for hepatitis serology testing.

ANS: C Some medications can increase the risk for NAFLD and these should be eliminated. NAFLD is not associated with hepatitis, weight loss is usually indicated, and variceal bleeding would not be a concern in a patient with asymptomatic NAFLD.

16. After a patient has had a transjugular intrahepatic portosystemic shunt (TIPS) placement, which finding indicates that the procedure has been effective? a. Lower indirect bilirubin level b. Increase in serum albumin level c. Decrease in episodes of variceal bleeding d. Improvement in alertness and orientation

ANS: C TIPS is used to lower pressure in the portal venous system and decrease the risk of bleeding from esophageal varices. Indirect bilirubin level and serum albumin levels are not affected by shunting procedures. TIPS will increase the risk for hepatic encephalopathy.

8. The pathology report for a 42-year-old who has had a modified radical mastectomy identifies the tumor as an estrogen-receptor positive adenocarcinoma. The nurse will plan on teaching the patient about a. estradiol (Estrace). b. raloxifene (Evista). c. tamoxifen (Nolvadex). d. trastuzumab (Herceptin).

ANS: C Tamoxifen is used for estrogen-dependent breast tumors in premenopausal women. Raloxifene is used to prevent breast cancer, but it is not used postmastectomy to treat breast cancer. Estradiol will increase the growth of estrogen-dependent tumors. Trastuzumab is used to treat tumors that have the HER-2 receptor.

34. A patient with cirrhosis who has been vomiting blood is admitted to the emergency department. Which action should the nurse take first? a. Insert a large-gauge IV catheter. b. Draw blood for coagulation studies. c. Check BP, heart rate, and respirations. d. Place the patient in the supine position.

ANS: C The nurse's first action should be to determine the patient's hemodynamic status by assessing vital signs. Drawing blood for coagulation studies and inserting an IV catheter also are appropriate. However, the vital signs may indicate the need for more urgent actions. Since aspiration is a concern for this patient, the nurse will need to assess the patient's vital signs and neurologic status before placing the patient in the supine position.

9. A patient returns to the surgical unit following a right modified radical mastectomy with dissection of axillary lymph nodes. Which nursing action should be included in the plan of care? a. Insist that the patient examine the surgical incision when the dressings are removed. b. Teach the patient to use the ordered patient-controlled analgesia (PCA) every 10 minutes. c. Post a sign at the bedside warning against blood pressures or venipunctures in the right arm. d. Obtain a permanent breast prosthesis for the patient before she is discharged from the hospital.

ANS: C The patient is at risk for lymphedema and infection if blood pressures or venipuncture are done on the right arm. The patient is taught to use the PCA as needed for pain control rather than at a set time. The nurse allows the patient to examine the incision and participate in care when the patient feels ready. Permanent breast prostheses are usually obtained about 6 weeks after surgery.

17. The health care provider plans a paracentesis for a patient with ascites caused by liver cancer. To prepare the patient for the procedure, the nurse a. places the patient on NPO status. b. assists the patient to lie flat in bed. c. asks the patient to empty the bladder. d. positions the patient on the right side.

ANS: C The patient should empty the bladder to decrease the risk of bladder perforation during the procedure. The patient would be positioned in Fowler's position and would not be able to lie flat without compromising breathing. Since no sedation is required for paracentesis, the patient does not need to be NPO.

27. When taking the BP of a patient with severe acute pancreatitis, the nurse notices carpal spasm of the patient's hand. Which action should the nurse take next? a. Ask the patient about any arm pain. b. Retake the patient's blood pressure. c. Check the calcium level on the chart. d. Notify the health care provider immediately.

ANS: C The patient with acute pancreatitis is at risk for hypocalcemia, and the assessment data indicate a positive Trousseau's sign. The health care provider should be notified after the nurse checks the patient's calcium level. There is no indication that the patient needs to have the BP rechecked or that there is any arm pain.

16. The following patients call the outpatient clinic. Which phone call should the nurse return first? a. A patient who has severe breast tenderness following a breast biopsy b. A patient who has bloody discharge after a hysteroscopy earlier today c. A patient who is complaining of dyspnea after a pelvic computed tomography (CT) with contrast d. A patient who is experiencing shoulder pain after a laparoscopy yesterday

ANS: C The patient's dyspnea suggests a delayed reaction to the iodine dye used for the CT scan. The other patient's symptoms are not unusual after the procedures they had done.

7. A patient is admitted with an abrupt onset of jaundice, nausea, and abnormal liver function studies. Serologic testing is negative for viral causes of hepatitis. Which question by the nurse is most appropriate? a. "Is there any history of IV drug use?" b. "Are you taking corticosteroids for any reason?" c. "Do you use any over-the-counter (OTC) drugs?" d. "Have you recently traveled to a foreign country?"

ANS: C The patient's symptoms, lack of antibodies for hepatitis, and the abrupt onset of symptoms suggest toxic hepatitis, which can be caused by commonly used OTC drugs such as acetaminophen (Tylenol). Travel to a foreign country and a history of IV drug use are risk factors for viral hepatitis. Corticosteroid use does not cause the symptoms listed.

15. Which nursing action will be included in the plan of care for a patient with cirrhosis who has ascites and 4+ edema of the feet and legs? a. Restrict dietary protein intake. b. Reposition the patient every 4 hours. c. Use a pressure-relieving mattress. d. Perform passive range of motion qid.

ANS: C The pressure-relieving mattress will decrease the risk for skin breakdown for this patient. Adequate dietary protein intake is necessary in patients with ascites to improve oncotic pressure. Repositioning the patient every 4 hours will not be adequate to maintain skin integrity. Passive range of motion will not take pressure off areas like the sacrum that are vulnerable to breakdown.

32. During change-of-shift report, the nurse learns about the following four patients. Which patient requires the most rapid assessment? a. 50-year-old with chronic pancreatitis who has gnawing abdominal pain b. 48-year-old who has compensated cirrhosis and is complaining of anorexia c. 45-year-old with cirrhosis and severe ascites who has an oral temperature of 102° F (38.8° C) d. 56-year-old who is recovering from a laparoscopic cholecystectomy and has severe shoulder pain

ANS: C This patient's history and fever suggest spontaneous bacterial peritonitis, which would require rapid assessment and interventions such as antibiotic therapy. The clinical manifestations for the other patients are consistent with their diagnoses and do not indicate complications are occurring.

11. When the nurse is assessing an alert and independent older patient in the clinic for malnutrition risk, the most appropriate initial question is, a. "How do you get to the grocery store to buy your food?" b. "Do you have any difficulty in preparing or eating food?" c. "Can you tell me the foods that you have eaten over the past 24 hours?" d. "Are you taking any medications that alter your taste or tolerance of foods?"

ANS: C This question is the most open-ended and will provide the best overall information about the patient's daily intake and risk for poor nutrition. The other questions may be asked, depending on the patient's response to the first question.

1. The nurse is performing an assessment of an 80-year-old patient. Which information obtained by the nurse will be of most concern? a. Decreased appetite b. Difficulty chewing food c. Unintentional weight loss d. Complaints of indigestion

ANS: C Unintentional weight loss is not a normal finding in older patients and may indicate a problem such as cancer or depression. Poor appetite, difficulty in chewing, and complaints of indigestion are common in older patients. These will need to be addressed, but are not of as much concern as the weight loss

17. A woman calls the clinic because she is having an unusually heavy menstrual flow. She tells the nurse that she has saturated two tampons in the past 2 hours. The nurse estimates that the amount of blood loss is a. 10 to 20 mL. b. 20 to 30 mL. c. 30 to 40 mL. d. 40 to 60 mL.

ANS: D The average tampon absorbs 20 to 30 mL.

13. A patient with a possible ovarian cyst is scheduled for ultrasound. The nurse will teach the patient that she should a. discontinue taking aspirin before the procedure. b. receive IV contrast solution during the procedure. c. expect mild abdominal cramps after the procedure. d. drink several glasses of fluids before the procedure.

ANS: D A full bladder is needed for many ultrasound procedures, so the nurse will have the patient drink fluids before arriving for the ultrasound. The other instructions are not accurate for this procedure.

29. When the nurse is caring for a patient with acute pancreatitis, which assessment finding is of most concern? a. Absent bowel sounds b. Abdominal tenderness c. Left upper quadrant pain d. Palpable abdominal mass

ANS: D A palpable abdominal mass may indicate the presence of a pancreatic abscess, which will require rapid surgical drainage to prevent sepsis. Absent bowel sounds, abdominal tenderness, and left upper quadrant pain are common in acute pancreatitis and do not require rapid action to prevent further complications.

6. Which information given by a patient when the nurse is taking a health history indicates that screening for hepatitis C should be done? a. The patient eats frequent meals in fast-food restaurants. b. The patient recently traveled to an undeveloped country. c. The patient had a blood transfusion after surgery in 1998. d. The patient reports a one-time use of IV drugs 20 years ago.

ANS: D Any patient with a history of IV drug use should be tested for hepatitis C. Blood transfusions given after 1992, when an antibody test for hepatitis C became available, do not pose a risk for hepatitis C. Hepatitis C is not spread by the oral-fecal route and therefore is not caused by contaminated food or by traveling in underdeveloped countries.

19. Which action should the nurse take first when caring for a patient who has been admitted for lumpectomy and axillary lymph node dissection? a. Teach the patient how to deep breathe and cough. b. Discuss options for postoperative pain management. c. Explain the postdischarge care of the axillary drains. d. Ask the patient to describe what she knows about the surgery.

ANS: D Before teaching, the nurse should assess the patient's current knowledge level. The other teaching also may be appropriate, depending on the assessment findings.

6. When the nurse is obtaining a history from a patient who is admitted with jaundice, which statement is most indicative of a need for patient teaching? a. "I used cough syrup several times a day last week." b. "I take a baby aspirin every day to prevent strokes." c. "I need to take an antacid for indigestion several times a week" d. "I use acetaminophen (Tylenol) every 4 hours for chronic pain."

ANS: D Chronic use of high doses of acetaminophen can be hepatotoxic and may have caused the patient's jaundice. The other patient statements require further assessment by the nurse, but do not indicate a need for patient education.

18. When performing a physical assessment on a male patient, the nurse obtains this information. Which finding is most important to report to the health care provider? a. One testis hangs lower than the other. b. Inguinal lymph nodes are nonpalpable. c. Genital hair distribution is diamond shaped. d. Clear penile discharge is present at the meatus.

ANS: D Clear penile discharge may be indicative of a sexually transmitted disease (STD). The other findings are normal and do not need to be reported.

7. When preparing a patient for colposcopy with a cervical biopsy, the nurse explains to the patient that the procedure a. involves dilation of the cervix and biopsy of the tissue lining the uterus. b. will take place in a same-day surgery center so that local anesthesia can be used. c. requires that the patient have nothing to eat or drink for 6 hours before the procedure. d. is similar to a speculum examination of the cervix and should result in little or no pain.

ANS: D Colposcopy involves visualization of the cervix with a binocular microscope and is similar to a speculum examination. A cervical biopsy may cause a minimal amount of pain.

36. Which nursing action is a priority when the nurse is caring for a patient with pancreatic cancer? a. Offer high-calorie, high-protein dietary choices. b. Offer psychologic support for anxiety or depression. c. Educate about the need to avoid scratching pruritic areas. d. Administer prescribed opioids to relieve pain as needed.

ANS: D Effective pain management will be necessary in order for the patient to improve nutrition, be receptive to education, or manage anxiety or depression.

1. A patient contracts hepatitis from contaminated food. During the acute (icteric) phase of the patient's illness, the nurse would expect serologic testing to reveal a. antibody to hepatitis D (anti-HDV). b. hepatitis B surface antigen (HBsAg). c. anti-hepatitis A virus immunoglobulin G (anti-HAV IgG). d. anti-hepatitis A virus immunoglobulin M (anti-HAV IgM).

ANS: D Hepatitis A is transmitted through the oral-fecal route, and antibody to HAV IgM appears during the acute phase of hepatitis A. The patient would not have antigen for hepatitis B or antibody for hepatitis D. Anti-HAV IgG would indicate past infection and lifelong immunity.

5. During change-of-shift report, the nurse receives the following information about a patient who is scheduled for a colonoscopy. Which information should be communicated to the health care provider before sending the patient for the procedure? a. The patient has a permanent pacemaker to prevent bradycardia. b. The patient is worried about discomfort during the examination. c. The patient has had an allergic reaction to shellfish and iodine in the past. d. The patient refused to drink the ordered polyethylene glycol (GoLYTELY).

ANS: D If the patient has had inadequate bowel preparation, the colon cannot be visualized and the procedure should be rescheduled. Because contrast solution is not used during colonoscopy, the iodine allergy is not pertinent. A pacemaker is a contraindication to magnetic resonance imaging (MRI), but not to colonoscopy. The nurse should instruct the patient about the sedation used during the examination to decrease the patient's anxiety about discomfort.

4. When a patient is diagnosed with acute hepatitis B, the nurse will plan to teach the patient about a. ways to increase exercise and activity level. b. self-administration of α-interferon (Intron A). c. side effects of nucleoside and nucleotide analogs. d. measures that will be helpful in improving appetite.

ANS: D Maintaining adequate nutritional intake is important for regeneration of hepatocytes. Interferon and antivirals may be used for chronic hepatitis B, but they are not prescribed for acute hepatitis B infection. Rest is recommended.

20. Which assessment finding in a patient with acute pancreatitis would the nurse need to report most quickly to the health care provider? a. Nausea and vomiting b. Hypotonic bowel sounds c. Abdominal tenderness and guarding d. Muscle twitching and finger numbness

ANS: D Muscle twitching and finger numbness indicate hypocalcemia, which may lead to tetany unless calcium gluconate is administered. Although the other findings also should be reported to the health care provider, they do not indicate complications that require rapid action.

28. A patient with acute pancreatitis has a nasogastric (NG) tube to suction and is NPO. Which information obtained by the nurse indicates that these therapies have been effective? a. Bowel sounds are present. b. Grey Turner sign resolves. c. Electrolyte levels are normal. d. Abdominal pain is decreased.

ANS: D NG suction and NPO status will decrease the release of pancreatic enzymes into the pancreas and decrease pain. Although bowel sounds may be hypotonic with acute pancreatitis, the presence of bowel sounds does not indicate that treatment with NG suction and NPO status have been effective. Electrolyte levels will be abnormal with NG suction and must be replaced by appropriate IV infusion. Although Grey Turner sign will eventually resolve, it would not be appropriate to wait for this occur to determine whether treatment was effective.

14. A 52-year-old man is scheduled for an annual physical exam. The nurse will plan to teach the patient about a. increased risk for testicular cancer. b. possible changes in erectile function. c. normal decreases in testosterone level. d. annual prostate specific antigen (PSA) testing.

ANS: D PSA testing should be done annually for all men, starting at age 50. There is no indication that the other patient teaching topics are appropriate for this patient.

1. When teaching a 28-year-old patient about breast self-examination (BSE), the nurse will instruct the patient that a. BSE will reduce the risk of dying from breast cancer. b. BSE should be done daily while taking a bath or shower. c. annual mammograms should be scheduled in addition to BSE. d. performing BSE right after the menstrual period will improve comfort.

ANS: D Performing BSE at the end of the menstrual period will reduce the breast tenderness associated with the procedure. The evidence is not clear that BSE reduces breast cancer mortality. BSE should be done monthly. Annual mammograms are not routinely scheduled for women under age 40.

38. When caring for a patient following an incisional cholecystectomy for cholelithiasis, the nurse places the highest priority on assisting the patient to a. choose low-fat foods from the menu. b. perform leg exercises hourly while awake. c. ambulate the evening of the operative day. d. turn, cough, and deep breathe every 2 hours.

ANS: D Postoperative nursing care after a cholecystectomy focuses on prevention of respiratory complications because the surgical incision is high in the abdomen and impairs coughing and deep breathing. The other nursing actions also are important to implement but are not as high a priority as ensuring adequate ventilation.

18. After the nurse has completed teaching a patient who has breast cancer about the newly prescribed tamoxifen (Nolvadex), which patient statement indicates that the teaching has been effective? a. "I will expect to have leg cramps with this drug." b. "I will call the clinic if I develop any hot flashes." c. "I will be taking the medication for at least a year." d. "I will call immediately if I have any eye problems."

ANS: D Retinopathy, cataracts, and decreased visual acuity should be immediately reported because it is likely that the tamoxifen will be discontinued or decreased. Tamoxifen treatment generally lasts 5 years. Hot flashes are an expected side effect of tamoxifen. Leg cramps may be a sign of deep vein thrombosis, and the patient should immediately notify the health care provider if pain occurs.

9. A patient in the sexually transmitted disease clinic has a positive Venereal Disease Research Laboratory (VDRL) test, but no chancre is noted. The nurse will plan to send specimens for a. gram stain. b. cytologic studies. c. rapid plasma reagin (RPR) agglutination. d. fluorescent treponemal antibody absorption (FTA-ABS).

ANS: D Since false positives are common with VDRL and RPR testing, FTA-ABS testing is recommended to confirm a diagnosis of syphilis. Gram staining is used for other sexually transmitted diseases (STDs) such as gonorrhea and chlamydia and cytologic studies are used to detect abnormal cells (such as neoplastic cells).

16. After a patient is diagnosed with lobular carcinoma in situ (LCIS), the nurse will anticipate that patient teaching may be needed about a. lumpectomy. b. lymphatic mapping. c. MammaPrint testing. d. tamoxifen (Nolvadex).

ANS: D Tamoxifen is used as a chemopreventive therapy in some patients with LCIS. The other diagnostic tests and therapies are not needed because LCIS does not usually require treatment.

3. While the nurse is assessing a 62-year-old man, the patient says that he does not respond to sexual stimulation the way he did when he was younger. The nurse's best response to the patient's comment is, a. "Many men need more sexual stimulation with aging." b. "Interest in sex frequently decreases as men get older." c. "Erectile dysfunction is a common problem with older men." d. "Tell me more about how your sexual response has changed."

ANS: D The initial response by the nurse should be further assessment of the problem. The other statements by the nurse are accurate but might not respond to the patient's concerns.

8. A patient with cirrhosis has 4+ pitting edema of the feet and legs. The data indicate that it is most important for the nurse to monitor the patient's a. hemoglobin. b. temperature. c. activity level. d. albumin level.

ANS: D The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in the development of edema. The other parameters also should be monitored, but they are not directly associated with the patient's current symptoms.

3. When a patient has a history of a total gastrectomy, the nurse will monitor for clinical manifestations of a. constipation. b. dehydration. c. elevated total cholesterol. d. cobalamin (vitamin B12) deficiency.

ANS: D The patient with a total gastrectomy does not secrete intrinsic factor, which is needed for cobalamin (vitamin B12) absorption. Because the stomach absorbs only small amounts of water and nutrients, the patient is not at higher risk for dehydration, elevated cholesterol, or constipation.

4. When scheduling a pelvic examination and Pap test for a patient, the nurse instructs the patient that she should a. shower, but not take a tub bath, before the examination. b. not have sexual intercourse the day before the Pap test. c. plan to have the Pap test just after her menstrual period. d. avoid douching for at least 24 hours before the examination.

ANS: D The results of a Pap test may be affected by douching, and so the patient should not douche before the examination. The exam may be scheduled without regard to the menstrual period. The patient may shower or bathe before the examination. Sexual intercourse does not affect the results of the examination or Pap test.

13. Which statement by a 52-year-old patient newly diagnosed with stage I breast cancer indicates to the nurse that patient teaching may be needed? a. "There are several options available for treating the cancer." b. "I will probably need radiation to the breast after having the surgery." c. "I can probably have reconstructive surgery at the same time as a mastectomy." d. "Mastectomy will be the best choice to decrease the chance of cancer recurrence."

ANS: D The survival rates with lumpectomy and radiation or modified radical mastectomy are comparable. The other patient statements indicate a good understanding of stage I breast cancer treatment.

26. A patient who was admitted with acute bleeding from esophageal varices asks the nurse the purpose for the ordered ranitidine (Zantac). Which response by the nurse is most appropriate? a. The medication will reduce the risk for aspiration. b. The medication will decrease nausea and anorexia. c. The medication will inhibit the development of gastric ulcers. d. The medication will prevent irritation to the esophageal varices.

ANS: D The therapeutic action of H2 receptor blockers in patients with esophageal varices is to prevent irritation and bleeding from the varices caused by reflux of acid gastric contents. Although ranitidine does decrease the risk for peptic ulcers, reduce nausea, and help prevent aspiration pneumonia, these are not the primary purpose for H2 receptor blockade in this patient.