NU 225 Quiz #3 all combined

After a vasectomy, what instruction should be included in discharge teaching? "Some secondary sexual characteristics may be lost after the surgery." "Use an alternative form of contraception until your semen is sperm free." "Erectile dysfunction may be present for several months after this surgery." "You will be uncomfortable, but you may safely have sexual intercourse today."

"Use an alternative form of contraception until your semen is sperm free." Because vasectomies are usually done for sterilization purposes, to safely have sexual intercourse, the patient will need to use an alternative form of contraception until semen examination reveals no sperm. Hormones are not affected, so there is no loss of secondary sexual characteristics or erectile function. Most men experience too much pain to have sexual intercourse on the day of their surgery, so this is not an appropriate comment by the nurse.

Which information will the nurse include in patient teaching for a 36-yr-old patient who is scheduled for stereotactic core biopsy of the breast? 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.

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.

A patient diagnosed with breast cancer asks the nurse what "triple negative" means. An accurate response from the nurse about triple-negative breast cancer should include that a. the tumor is not likely to be responsive to hormone therapy. b. HER-2 receptor testing was repeated for a total of three samples. c. treatment with chemotherapy is not likely to be recommended. d. estrogen receptor testing identified the three hormones causing the cancer.

A A patient whose breast cancer tests negative for all three receptors (estrogen, progesterone, and HER-2) has triple-negative breast cancer. These cancers do not usually respond to hormone therapy or therapy for the human epidermal growth factor receptor 2 (HER-2). Chemotherapy appears to have the most success in treating triple-negative breast cancer.

A 51-yr-old patient with a small immobile breast lump is considering having 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.

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. Because the immobility of the breast lump suggests cancer, further testing will be done if the FNA results are negative.

Client Needs: Physiologic Integrity 11. The average man is taller than the average woman at maturity because of a. A longer period of skeletal growth b. Earlier development of secondary sexual characteristics c. Earlier onset of growth spurt d. Starting puberty at an earlier age

A Feedback A The man's greater height at maturity is the combined result of beginning the growth spurt at a later age and continuing it for a longer period. B Girls develop earlier than boys. C Boys' growth spurts start at a later age. D Girls start puberty approximately 6 months to 1 year earlier than boys. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 203 OBJ: Nursing Process: Assessment

Client Needs: Health Promotion and Maintenance 3. Which of these is a secondary sexual characteristic? a. Female breast development b. Production of sperm c. Maturation of ova d. Secretion of gonadotropin-releasing hormone

A Feedback A secondary sexual characteristic is one not directly related to reproduction, such as development of the characteristic female body form. Production of sperm is directly related to reproduction and is a primary sexual characteristic. Maturation of ova is directly related to reproduction and is a primary sexual characteristic. Secretion of hormones is directly related to reproduction and is a primary sexual characteristic. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 201 OBJ: Nursing Process: Assessment

1. Which man is most likely to have abnormal sperm formation resulting in infertility? a. A 20-year-old man with undescended testicles b. An uncircumcised 40-year-old man c. A 35-year-old man with previously treated sexually transmitted disease d. A 16-year-old adolescent who is experiencing nocturnal emissions

A Feedback For normal sperm formation, a man's testes must be cooler than his core body temperature. Circumcision does not prevent fertility. Scar tissue in the fallopian tubes as a result of a sexually transmitted disease can be a cause of infertility in women. Nocturnal emissions of seminal fluid are normal and expected in teenagers. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 211 OBJ: Nursing Process: Assessment

The nurse will anticipate teaching a patient who is diagnosed with lobular carcinoma in situ (LCIS) about a. tamoxifen c. lymphatic mapping. b. lumpectomy. d. MammaPrint testing.

A 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.

After a 48-yr-old patient has had a modified radical mastectomy, the pathology report identifies the tumor as an estrogen-receptor positive adenocarcinoma. The nurse will plan to teach the patient about a. tamoxifen b. estradiol (Estrace). c. raloxifene (Evista). d. trastuzumab (Herceptin).

A 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.

A patient who is scheduled for a lumpectomy and axillary lymph node dissection tells the nurse, "I would rather not know much about the surgery." Which response by the nurse is best? a. "Tell me what you think is important to know about the surgery." b. "It is essential that you know enough to provide informed consent." c. "Many patients do better after surgery if they have more information." d. "You can wait until after surgery for teaching about pain management."

A This response shows sensitivity to the individual patient's need for information about the surgery. The other responses are also accurate, but the nurse should tailor patient teaching to individual patient preferences.

Physiological Integrity 20. A 56-year-old woman is concerned about having a moderate amount of vaginal bleeding after 4 years of menopause. The nurse will anticipate teaching the patient about a. endometrial biopsy. b. endometrial ablation. c. uterine balloon therapy. d. dilation and curettage (D&C).

A A postmenopausal woman with vaginal bleeding should be evaluated for endometrial cancer, and endometrial biopsy is the primary test for endometrial cancer. D&C will be needed only if the biopsy does not provide sufficient information to make a diagnosis. Endometrial ablation and balloon therapy are used to treat menorrhagia, which is unlikely in this patient. DIF: Cognitive Level: Apply (application) REF: 1294 TOP: Nursing Process: Planning MSC:

Psychosocial Integrity 13. Which statement by the patient indicates that the nurse's teaching about treating vaginal candidiasis has been effective? a. "I should clean carefully after each urination and bowel movement." b. "I can douche with warm water if the itching continues to bother me." c. "I will insert the antifungal cream right before I get up in the morning." d. "I will tell my husband that we cannot have intercourse for the next month."

A Cleaning of the perineal area will decrease itching caused by contact of the irritated tissues with urine and reduce the chance of further infection of irritated tissues by bacteria in the stool. Sexual intercourse should be avoided for 1 week. Douching will disrupt normal protective mechanisms in the vagina. The cream should be used at night so that it will remain in the vagina for longer periods of time. DIF: Cognitive Level: Apply (application) REF: 1287 TOP: Nursing Process: Evaluation MSC:

Physiological Integrity 39. A 58-year-old patient who has undergone a radical vulvectomy for vulvar carcinoma returns to the medical-surgical unit after the surgery. The priority nursing diagnosis for the patient at this time is a. risk for infection related to contact of the wound with urine and stool. b. self-care deficit: bathing/hygiene related to pain and difficulty moving. c. imbalanced nutrition: less than body requirements related to low-residue diet. d. risk for ineffective sexual pattern related to disfiguration caused by the surgery.

A Complex and meticulous wound care is needed to prevent infection and delayed wound healing. The other nursing diagnoses may also be appropriate for the patient but are not the highest priority immediately after surgery. DIF: Cognitive Level: Apply (application) REF: 1299 OBJ: Special Questions: Prioritization TOP: Nursing Process: Analysis MSC:

Physiological Integrity 18. A 28-year-old patient with endometriosis asks why she is being treated with medroxyprogesterone (Depo-Provera), a medication that she thought was an oral contraceptive. The nurse explains that this therapy a. suppresses the menstrual cycle by mimicking pregnancy. b. will relieve symptoms such as vaginal atrophy and hot flashes. c. prevents a pregnancy that could worsen the menstrual bleeding. d. will lead to permanent suppression of abnormal endometrial tissues.

A Depo-Provera induces a pseudopregnancy, which suppresses ovulation and causes shrinkage of endometrial tissue. Menstrual bleeding does not occur during pregnancy. Vaginal atrophy and hot flashes are caused by synthetic androgens such as danazol or gonadotropin-releasing hormone agonists (GNRH) such as leuprolide. Although hormonal therapies will control endometriosis while the therapy is used, endometriosis will recur once the menstrual cycle is reestablished. DIF: Cognitive Level: Apply (application) REF: 1290 TOP: Nursing Process: Implementation MSC:

Physiological Integrity 32. The nurse will plan to teach the female patient with genital warts about the a. importance of regular Pap tests. b. increased risk for endometrial cancer. c. appropriate use of oral contraceptives. d. symptoms of pelvic inflammatory disease (PID).

A Genital warts are caused by the human papillomavirus (HPV) and increase the risk for cervical cancer. There is no indication that the patient needs teaching about PID, oral contraceptives, or endometrial cancer. DIF: Cognitive Level: Apply (application) REF: 1286 | 1292 TOP: Nursing Process: Planning MSC:

Health Promotion and Maintenance 31. A 50-year-old patient is diagnosed with uterine bleeding caused by a leiomyoma. Which information will the nurse include in the patient teaching plan? a. The symptoms may decrease after the patient undergoes menopause. b. The tumor size is likely to increase throughout the patient's lifetime. c. Aspirin or acetaminophen may be used to control mild to moderate pain. d. The patient will need frequent monitoring to detect any malignant changes.

A Leiomyomas appear to depend on ovarian hormones and will atrophy after menopause, leading to a decrease in symptoms. Aspirin use is discouraged because the antiplatelet effects may lead to heavier uterine bleeding. The size of the tumor will shrink after menopause. Leiomyomas are benign tumors that do not undergo malignant changes. DIF: Cognitive Level: Apply (application) REF: 1290 TOP: Nursing Process: Planning MSC:

Health Promotion and Maintenance 44. A 22-year-old tells the nurse that she has not had a menstrual period for the last 2 months. Which action is most important for the nurse to take? a. Obtain a urine specimen for a pregnancy test. b. Ask about any recent stressful lifestyle changes. c. Measure the patient's current height and weight. d. Question the patient about prescribed medications.

A Pregnancy should always be considered a possible cause of amenorrhea in women of childbearing age. The other actions are also appropriate, but it is important to check for pregnancy in this patient because pregnancy will require rapid implementation of actions to promote normal fetal development such as changes in lifestyle, folic acid intake, etc. DIF: Cognitive Level: Apply (application) REF: 1281 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC:

Physiological Integrity 34. A 48-year-old woman in the emergency department reports that she has been sexually assaulted. Which action by the nurse will be most important in maintaining the medicolegal chain of evidence? a. Labeling all specimens and other materials obtained from the patient. b. Assisting the patient in filling out the application for financial compensation. c. Discussing the availability of the "morning-after pill" for pregnancy prevention. d. Educating the patient about baseline sexually transmitted infection (STI) testing.

A The careful labeling of specimens and materials will assist in maintaining the chain of evidence. Assisting with paperwork, and discussing STIs and pregnancy prevention are interventions that might be appropriate after sexual assault, but they do not help maintain the legal chain of evidence. DIF: Cognitive Level: Apply (application) REF: 1302 TOP: Nursing Process: Implementation MSC:

Health Promotion and Maintenance 30. A 19-year-old visits the health clinic for a routine checkup. Which question should the nurse ask to determine whether a Pap test is needed? a. "Have you had sexual intercourse?" b. "Do you use any illegal substances?" c. "Do you have cramping with your periods?" d. "At what age did your menstrual periods start?"

A The current American Cancer Society recommendation is that a Pap test be done every 3 years, starting 3 years after the first sexual intercourse and no later than age 21. The information about menstrual periods and substance abuse will not help determine whether the patient requires a Pap test. DIF: Cognitive Level: Apply (application) REF: 1292-1293 TOP: Nursing Process: Assessment MSC:

Physiological Integrity 27. A 54-year-old patient is on the surgical unit after a radical abdominal hysterectomy. Which finding is most important to report to the health care provider? a. Urine output of 125 mL in the first 8 hours after surgery b. Decreased bowel sounds in all four abdominal quadrants c. One-inch area of bloody drainage on the abdominal dressing d. Complaints of abdominal pain at the incision site with coughing

A The decreased urine output indicates possible low blood volume and further assessment is needed to assess for possible internal bleeding. Decreased bowel sounds, minor drainage on the dressing, and abdominal pain with coughing are expected after this surgery. DIF: Cognitive Level: Apply (application) REF: 1296 TOP: Nursing Process: Assessment MSC:

Physiological Integrity 38. A 32-year-old woman brought to the emergency department reports being sexually assaulted. The patient is confused about where she is and she has a large laceration above the right eye. Which action should the nurse take first? a. Assess the patient's neurologic status. b. Assist the patient to remove her clothing. c. Contact the sexual assault nurse examiner (SANE). d. Ask the patient to describe what occurred during the assault.

A The first priority is to treat urgent medical problems associated with the sexual assault. The patient's head injury may be associated with a head trauma such as a skull fracture or subdural hematoma. Therefore her neurologic status should be assessed first. The other nursing actions are also appropriate, but they are not as high in priority as assessment and treatment for acute physiologic injury. DIF: Cognitive Level: Apply (application) REF: 1302 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC:

Health Promotion and Maintenance 6. A 28-year-old patient reports anxiety, headaches with dizziness, and abdominal bloating occurring before her menstrual periods. Which action is best for the nurse to take at this time? a. Ask the patient to keep track of her symptoms in a diary for 3 months. b. Suggest that the patient try aerobic exercise to decrease her symptoms. c. Teach the patient about appropriate lifestyle changes to reduce premenstrual syndrome (PMS) symptoms. d. Advise the patient to use nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen (Advil) to control symptoms.

A The patient's symptoms indicate possible PMS, but they also may be associated with other diagnoses. Having the patient keep a symptom diary for 2 or 3 months will help in confirming a diagnosis of PMS. The nurse should not implement interventions for PMS until a diagnosis is made. DIF: Cognitive Level: Apply (application) REF: 1279 TOP: Nursing Process: Implementation MSC:

Physiological Integrity 26. Which topic will the nurse include in the preoperative teaching for a patient admitted for an abdominal hysterectomy? a. Purpose of ambulation and leg exercises b. Adverse effects of systemic chemotherapy c. Decrease in vaginal sensation after surgery d. Symptoms caused by the drop in estrogen level

A Venous thromboembolism (VTE) is a potential complication after the surgery, and the nurse will instruct the patient about ways to prevent it. Vaginal sensation is decreased after a vaginal hysterectomy but not after abdominal hysterectomy. Leiomyomas are benign tumors, so chemotherapy and radiation will not be prescribed. Because the patient will still have her ovaries, the estrogen level will not decrease. DIF: Cognitive Level: Apply (application) REF: 1298 TOP: Nursing Process: Implementation MSC:

A 28-year-old pregnant woman is spilling sugar in her urine. The physician orders a glucose tolerance test, which reveals gestational diabetes. The patient is shocked by the diagnosis, stating that she is conscientious about her health, and asks the nurse what causes gestational diabetes. The nurse should explain that gestational diabetes is a result of what etiologic factor? A) Increased caloric intake during the first trimester B) Changes in osmolality and fluid balance C) The effects of hormonal changes during pregnancy D) Overconsumption of carbohydrates during the first two trimesters

A 28-year-old pregnant woman is spilling sugar in her urine. The physician orders a glucose tolerance test, which reveals gestational diabetes. The patient is shocked by the diagnosis, stating that she is conscientious about her health, and asks the nurse what causes gestational diabetes. The nurse should explain that gestational diabetes is a result of what etiologic factor? A) Increased caloric intake during the first trimester B) Changes in osmolality and fluid balance C) The effects of hormonal changes during pregnancy D) Overconsumption of carbohydrates during the first two trimesters

The nurse is teaching clinic patients about risk factors for testicular cancer. Which individual is at highest risk for developing testicular cancer? A 30-yr-old white man with a history of cryptorchidism A 48-yr-old African American man with erectile dysfunction A 19-yr-old Asian man who had surgery for testicular torsion A 28-yr-old Hispanic man with infertility caused by a varicocele

A 30-yr-old white man with a history of cryptorchidism The incidence of testicular cancer is four times higher in white men than in African American men. Testicular tumors are also more common in men who have had undescended testes (cryptorchidism) or a family history of testicular cancer or anomalies. Other predisposing factors include orchitis, human immunodeficiency virus infection, maternal exposure to exogenous estrogen, and testicular cancer in the contralateral testis.

A male patient complains of fever, dysuria, and cloudy urine. What additional information may indicate that these manifestations may be something other than a urinary tract infection (UTI)? E. coli bacteria in his urine A very tender prostate gland Complaints of chills and rectal pain Complaints of urgency and frequency

A very tender prostate gland A tender and swollen prostate is indicative of prostatitis, which is a more serious male reproductive problem because an acute episode can result in chronic prostatitis and lead to epididymitis or cystitis. E. coli in his urine, chills and rectal pain, and urgency and frequency are all present with a UTI and not specifically indicative of prostatitis.

Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE 1. A young female patient comes to the health unit at school to discuss her irregular periods. In providing education regarding the female reproductive cycle, the nurse describes the regular and recurrent changes related to theovaries and the uterine endometrium. Although this is generally referred to as the menstrual cycle, the ovarian cycle includes which phases? Select all that apply. a. Follicular b. Ovulatory c. Luteal d. Proliferative e. Secretory

A, B, C Feedback Correct The follicular phase is the period during which the ovum matures. It begins on day 1 and ends around day 14. The ovulatory phase occurs near the middle of the cycle, approximately 2 days before ovulation. After ovulation and under the influence of the luteinizing hormone, the luteal phase corresponds with the last 12 days of the menstrual cycle. Incorrect The proliferative and secretory phases are part of the endometrial cycle. The proliferative phase takes place during the first half of the ovarian cycle when the ovum matures. The secretory phase occurs during the second half of the cycle when the uterus is prepared to accept the fertilized ovum. These are followed by the menstrual phase if fertilization does not occur. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 208-209 OBJ: Nursing Process: Assessment

Physiological Integrity MULTIPLE RESPONSE 1. Which nonhormonal therapies will the nurse suggest for a healthy perimenopausal woman who prefers not to use hormone therapy (HT) (select all that apply)? a. Reduce coffee intake. b. Exercise several times a week. c. Take black cohosh supplements. d. Have a glass of wine in the evening. e. Increase intake of dietary soy products.

A, B, C, E Reduction in caffeine intake, use of black cohosh, increasing dietary soy intake, and exercising three to four times weekly are recommended to reduce symptoms associated with menopause. Alcohol intake in the evening may increase the sleep problems associated with menopause. DIF: Cognitive Level: Analyze (analysis) REF: 1285 TOP: Nursing Process: Implementation MSC:

Client Needs: Health Promotion and Maintenance 2. A number of major hormones are necessary for healthy reproduction to occur. These hormones are produced by a number of different organs. The anterior pituitary gland is responsible for producing (select all that apply) a. Follicle-stimulating hormone (FSH) b. Luteinizing hormone (LH) c. Gonadotropin-releasing hormone (GnRH) d. Oxytocin e. Prolactin

A, B, E Feedback Correct FSH and LH are both produced by the anterior pituitary gland. Both of these hormones assist in the stimulation and maturation of the ovarian follicle. Prolactin is also produced by the anterior pituitary and is required for milk production (lactogenesis) to occur. Incorrect GnRH is produced by the hypothalamus and stimulates the release of FSH and LH. Oxytocin is produced by the posterior pituitary gland and is responsible for stimulating uterine contractions during birth. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 202 | Table 11-1 OBJ: Nursing Process: Assessment

When providing teaching to a patient with gonorrhea, which statement is indicative that further teaching is needed? A. "I'll take the medication until the discharge is gone." B. "I will wear cotton panties rather than a thong." C. "I will skip sex for the next week, then use a condom." D. "My partner has to come to the clinic to be treated too."

A. "I'll take the medication until the discharge is gone."

The nurse is caring for a patient with chlamydial infection. For which complications does the nurse monitor this patient on the basis of the current diagnosis? Select all that apply. A. Abscess B. Infertility C. Cold sores D. Atonic bladder E. Reactive arthritis

A. Abscess B. Infertility E. Reactive arthritis

A patient reports tingling, burning, and itching in the genital area. Based on these symptoms, what type of medication does the nurse anticipate administering? A. Antivirals B. Antibiotics C. Vaccination D. Contraceptives

A. Antivirals

What instructions should the nurse include when teaching a patient about ways to prevent reinfection by gonorrhea? Select all that apply. A. Avoid alcohol. B. Receive a vaccine to prevent gonorrhea. C. Abstain from sexual intercourse until the treatment is complete. D. Avoid going out in public and minimize physical contact with people. E. Avoid squeezing the penis to look for a discharge.

A. Avoid alcohol. C. Abstain from sexual intercourse until the treatment is complete. E. Avoid squeezing the penis to look for a discharge.

A patient is suspected of having a sexually transmitted disease. What are the possible routes through which the patient may have contracted the infection? Select all that apply. A. Blood transfusion B. Sharing of intravenous needles or syringes C. Consuming contaminated water D. Inhaling air in contact with an affected person E. Sexual contact with any person with a sexually transmitted infection (STI)

A. Blood transfusion B. Sharing of intravenous needles or syringes E. Sexual contact with any person with a sexually transmitted infection (STI)

A patient comes to the clinic after being informed by a sexual partner of possible recent exposure to syphilis. The nurse will examine the patient for what characteristic finding of syphilis in the primary clinical stage? A. Chancre B. Alopecia C. Condylomata lata D. Regional adenopathy

A. Chancre

The nurse is teaching a group of young women about prevention of sexually transmitted infections (STIs). Which method of contraception also helps give some protection against STIs? A. Condoms B. Intrauterine devices C. Oral contraceptive pills D. Medroxyprogesterone

A. Condoms

The nurse is caring for a patient with genital herpes. What should the nurse emphasize while providing psychologic support to this patient? Select all that apply. A. Encourage the patient to verbalize feelings. B. Instruct the patient to avoid interaction with others. C. Help the patient realize that he or she should never be sexually active henceforth. D. Help the patient understand that the treatment could run for a long duration. E. Help the patient identify and avoid the factors that precipitated the condition.

A. Encourage the patient to verbalize feelings. D. Help the patient understand that the treatment could run for a long duration. E. Help the patient identify and avoid the factors that precipitated the condition.

A nurse is administering a human papillomavirus vaccine to an adolescent. What precaution does the nurse need to take while administering this vaccine? A. Ensure that the patient is lying down or sitting during vaccine administration. B. Ensure that the patient has an intravenous line placed before vaccine administration. C. Ensure that the patient has a complete liver profile done before receiving the vaccine. D. Ensure that the patient takes the vaccine on an empty stomach.

A. Ensure that the patient is lying down or sitting during vaccine administration.

When performing an assessment of a patient with herpes simplex virus (HSV) type 1, which body parts would the nurse find to be affected? Select all that apply. A. Gingiva B. Upper respiratory tract C. Central nervous system D. Genital tract E. Perineum

A. Gingiva B. Upper respiratory tract C. Central nervous system

A patient is receiving treatment for a sexually transmitted infection prior to culture results being obtained. The nurse is to administer ceftriaxone intramuscularly. What sexually transmitted infection does the nurse recognize is being treated? A. Gonorrhea B. Candidiasis C. Herpes simplex virus type 2 D. Human immunodeficiency virus

A. Gonorrhea

The nurse is educating a patient about high-risk sexual behaviors. What should the nurse include when discussing what places them at a higher risk for contracting a sexually transmitted infection (STI)? Select all that apply. A. Greater sexual freedom B. Later reproductive maturity C. Limited number of susceptible hosts D. The media's increased emphasis on sexuality E. Substance abuse leads to unsafe sexual practices

A. Greater sexual freedom D. The media's increased emphasis on sexuality E. Substance abuse leads to unsafe sexual practices

A patient suspected of having syphilis tests positive on the Venereal Disease Research Laboratory (VDRL) test. Which other diseases can give false-positive results when testing for syphilis? Select all that apply. A. Hepatitis B. Hyperlipidemia C. Infectious mononucleosis D. Systemic lupus erythematosus E. Type 2 diabetes mellitus

A. Hepatitis C. Infectious mononucleosis D. Systemic lupus erythematosus

A nurse is assessing a patient with a suspected sexually transmitted infection (STI). What questions about lifestyle patterns should a nurse include to assess high-risk behavior? Select all that apply. A. Illicit use of intravenous drugs B. Method of contraception used C. Sexual preference D. Diet and exercise regimen E. Number of sexual partners F. Smoking and alcohol consumption

A. Illicit use of intravenous drugs B. Method of contraception used C. Sexual preference E. Number of sexual partners

A patient is infected with the herpes virus exhibiting lesions on the genital area. What instructions should the nurse give to this patient? Select all that apply. A. Maintain good hygiene. B. Keep the lesions clean and dry. C. Take frequent sitz baths. D. Burst the vesicles to drain the fluid. E. Use hot fomentation on the vesicles. F. Wear loose-fitting cotton undergarments.

A. Maintain good hygiene. B. Keep the lesions clean and dry. C. Take frequent sitz baths. F. Wear loose-fitting cotton undergarments.

When performing an assessment of a patient with anorectal gonorrhea, what are the symptoms that the nurse is likely to find? Select all that apply. A. Mucopurulent anal discharge B. Bleeding C. Tenesmus D. Loose watery stools E. Hemorrhoids

A. Mucopurulent anal discharge B. Bleeding C. Tenesmus

The nurse is assessing a patient suspected of having a chlamydial infection. What diagnostic tests should the nurse prepare the patient for? Select all that apply. A. Nucleic acid amplification test B. Direct fluorescent antibody test C. Venereal Disease Research Laboratory test D. Enzyme immunoassay test E. Western blot test

A. Nucleic acid amplification test B. Direct fluorescent antibody test D. Enzyme immunoassay test

When performing a physical examination of a male patient with suspected gonorrhea, what symptoms is the nurse likely to find? Select all that apply. A. Pain during urination B. Purulent discharge from the urethra C. Warts and growths on the penis D. Swollen testicles E. Erectile dysfunction

A. Pain during urination B. Purulent discharge from the urethra D. Swollen testicles

A woman with chlamydial infection complains of pelvic pain, nausea, vomiting, fever, and abnormal vaginal bleeding. What might be the possible cause of these symptoms? A. Pelvic inflammatory disease B. Ectopic pregnancy C. Infertility D. Reactive arthritis

A. Pelvic inflammatory disease

A patient with neurosyphilis is being discharged after treatment. What follow-up care should the nurse advise for the patient? Select all that apply. A. Periodic serologic testing B. Clinical evaluation at six-month intervals C. Periodic cerebrospinal fluid examinations for at least three years D. Continued use of oral acyclovir E. Viral cultures of active lesions

A. Periodic serologic testing B. Clinical evaluation at six-month intervals C. Periodic cerebrospinal fluid examinations for at least three years

A patient is suspected to have syphilis. Which stage of syphilis is most infectious and may have chancres? A. Primary B. Secondary C. Latent D. Tertiary

A. Primary

The nurse is teaching a group of parents at a local high school about the importance of the human papilloma virus vaccine. Which strategies by the nurse would help address religious concerns? Select all that apply. A. Providing accurate and current information about the vaccine B. Discussing the prevention of cancer as the major role of vaccine C. Discussing why religious concerns are not important enough to prevent use of the vaccine D. Allowing parents to ask questions and express concerns about the vaccine in an open, supportive environment E. Informing parents that they will be responsible for their children's death from a preventable cancer if they do not vaccinate

A. Providing accurate and current information about the vaccine B. Discussing the prevention of cancer as the major role of vaccine D. Allowing parents to ask questions and express concerns about the vaccine in an open, supportive environment

A patient comes to the clinic with a chancre on the penis. Which diagnostic test does the nurse anticipate preparing the patient for? A. Rapid plasma region test B. Human papillomavirus DNA tests C. Treponema pallidum particle agglutination test D. Fluorescent treponemal antibody absorption test

A. Rapid plasma region test

The nurse working in the emergency department has seen several patients with sexually transmitted infections (STIs) that must be reported to state or local health departments. Which STIs must the nurse report? Select all that apply. A. Syphilis B. Gonorrhea C. Herpes simplex virus (HSV) D. Human papilloma virus (HPV) E. Condylomata acuminate

A. Syphilis B. Gonorrhea

A parent is deciding whether to allow an adolescent child to receive the Gardasil vaccine. What information should the nurse provide to the parent? Select all that apply. A. The vaccine provides protection against certain types of cancer. B. Often persons with human papillomavirus (HPV) are asymptomatic. C. The vaccine protects against HPV types 6, 11, 16, 18. D. One dose of the vaccine protects against HPV. E. The vaccine is used to treat active infections. F. It is recommended because one does not know if one's child is sexually active.

A. The vaccine provides protection against certain types of cancer. B. Often persons with human papillomavirus (HPV) are asymptomatic. C. The vaccine protects against HPV types 6, 11, 16, 18.

A patient had successful treatment for an existing sexually transmitted infection (STI). What instructions should the nurse provide to this patient to prevent reinfection or complications? Select all that apply. A. Use condoms. B. Avoid using tampons. C. Use an intrauterine device. D. Avoid having multiple sexual partners. E. Make sure to get periodic Pap smears.

A. Use condoms. D. Avoid having multiple sexual partners. E. Make sure to get periodic Pap smears.

When performing discharge teaching for a patient after a vasectomy, the nurse instructs the patient that he a. should continue to use other methods of birth control for 6 weeks. b. should not have sexual intercourse until his 6-week follow-up visit. c. may have temporary erectile dysfunction (ED) because of swelling. d. will notice a decrease in the appearance and volume of his ejaculate.

ANS: A Because it takes about 6 weeks to evacuate sperm that are distal to the vasectomy site, the patient should use contraception for 6 weeks. ED that occurs after vasectomy is psychologic in origin and not related to postoperative swelling. The patient does not need to abstain from intercourse. The appearance and volume of the ejaculate are not changed because sperm are a minor component of the ejaculate. DIF: Cognitive Level: Understand (comprehension) REF: 1286 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

A 22-yr-old patient tells the nurse at the health clinic that he has recently had some problems with erectile dysfunction. Which question should the nurse ask to assess for possible etiologic factors in this age group? a. "Do you use recreational drugs or drink alcohol?" b. "Do you experience an unusual amount of stress?" c. "Do you have cardiovascular or peripheral vascular disease?" d. "Do you have a history of an erection that lasted for 6 hours or more?"

ANS: A A common etiologic factor for erectile dysfunction (ED) in younger men is use of recreational drugs or alcohol. Stress, priapism, and cardiovascular illness also contribute to ED, but they are not common etiologic factors in younger men. DIF: Cognitive Level: Apply (application) REF: 1287 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

A 70-yr-old patient who has had a transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) is being discharged from the hospital today. Which patient statement indicates a need for the nurse to provide additional instruction? a. "I should call the doctor if I have incontinence at home." b. "I will avoid driving until I get approval from my doctor." c. "I should schedule yearly appointments for prostate examinations." d. "I will increase fiber and fluids in my diet to prevent constipation."

ANS: A Because incontinence is common for several weeks after a TURP, the patient does not need to call the health care provider if this occurs. The other patient statements indicate that the patient has a good understanding of post-TURP instructions. DIF: Cognitive Level: Apply (application) REF: 1274 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

A patient with urinary obstruction from benign prostatic hyperplasia (BPH) tells the nurse, "My symptoms are much worse this week." Which response by the nurse is appropriate? a. "Have you taken any over-the-counter (OTC) medications recently?" b. "I will talk to the doctor about a prostate specific antigen (PSA) test." c. "Have you talked to the doctor about surgery such as transurethral resection of the prostate (TURP)?" d. "The prostate gland changes in size from day to day, and this may be making your symptoms worse."

ANS: A Because the patient's increase in symptoms has occurred abruptly, the nurse should ask about OTC medications that might cause contraction of the smooth muscle in the prostate and worsen obstruction. The prostate gland does not vary in size from day to day. A TURP may be needed, but more assessment about possible reasons for the sudden symptom change is a more appropriate first response by the nurse. PSA testing is done to differentiate BPH from prostatic cancer. DIF: Cognitive Level: Apply (application) REF: 1273 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

The nurse will inform a patient with cancer of the prostate that side effects of leuprolide (Lupron) may include a. flushing. c. infection. b. dizziness. d. incontinence.

ANS: A Hot flashes may occur with decreased testosterone production. Dizziness may occur with the a-blockers used for benign prostatic hyperplasia. Urinary incontinence may occur after prostate surgery, but it is not an expected side effect of medication. Risk for infection is increased in patients receiving chemotherapy. DIF: Cognitive Level: Understand (comprehension) REF: 1280 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

The nurse will plan to teach a 67-yr-old patient who has been diagnosed with orchitis about a. pain management. b. emergency surgery. c. application of heat to the scrotum. d. aspiration of fluid from the scrotal sac.

ANS: A Orchitis is very painful, and effective pain management will be needed. Heat, aspiration, and surgery are not used to treat orchitis. DIF: Cognitive Level: Apply (application) REF: 1284 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

Several patients call the urology clinic requesting appointments with the health care provider as soon as possible. Which patient will the nurse schedule to be seen first? a. A 22-yr-old patient who has noticed a firm, nontender lump on his scrotum b. A 35-yr-old patient who is concerned that his scrotum "feels like a bag of worms" c. A 40-yr-old patient who has pelvic pain while being treated for chronic prostatitis d. A 70-yr-old patient who is reporting frequent urinary dribbling after a prostatectomy

ANS: A The patient's age and symptoms suggest possible testicular cancer. Some forms of testicular cancer can be very aggressive, so the patient should be evaluated by the health care provider as soon as possible. Varicoceles do require treatment but not emergently. Ongoing pelvic pain is common with chronic prostatitis. Urinary dribbling is a common problem after prostatectomy. DIF: Cognitive Level: Analyze (analysis) REF: 1285 OBJ: Special Questions: Multiple Patients | Special Questions: Prioritization TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment

The following male patients recently arrived in the emergency department. Which one should the nurse assess first? a. A 19-yr-old patient who is complaining of severe scrotal pain b. A 60-yr-old patient with a nontender ulceration of the glans penis c. A 64-yr-old patient who has dysuria after brachytherapy for prostate cancer d. A 22-yr-old patient who has purulent urethral drainage and severe back pain

ANS: A The patient's age and symptoms suggest possible testicular torsion, which will require rapid treatment to prevent testicular necrosis. The other patients also require assessment by the nurse, but their history and symptoms indicate nonemergent problems (acute prostatitis, cancer of the penis, and radiation-associated urinary tract irritation). DIF: Cognitive Level: Analyze (analysis) REF: 1285 OBJ: Special Questions: Prioritization | Special Questions: Multiple Patients TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment

The nurse is assessing the sexual-reproductive functional health pattern of a 32-year-old woman. 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 sex with women may also have intercourse at times with men. The types of sexual activities engaged in may not indicate sexual orientation. Many patients who have sex with both men and women do not identify themselves as homosexual or bisexual.

The health care provider prescribes finasteride (Proscar) for a patient who has benign prostatic hyperplasia (BPH). When teaching the patient about the drug, the nurse informs him that a. he should change position from lying to standing slowly to avoid dizziness. b. his interest in sexual activity may decrease while he is taking the medication. c. improvement in the obstructive symptoms should occur within about 2 weeks. d. he will need to monitor his blood pressure frequently to assess for hypertension.

ANS: B A decrease in libido is a side effect of finasteride because of the androgen suppression that occurs with the drug. Although orthostatic hypotension may occur if the patient is also taking a medication for erectile dysfunction, it should not occur with finasteride alone. Improvement in symptoms of obstruction takes about 6 months. The medication does not cause hypertension. DIF: Cognitive Level: Apply (application) REF: 1271 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

After scheduling a patient with a possible ovarian cyst for ultrasound, the nurse will teach the patient that she should a. expect to receive IV contrast during the procedure. b. drink several glasses of fluids before the procedure. c. experience mild abdominal cramps after the procedure. d. discontinue taking aspirin for 7 days before the procedure.

ANS: B 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.

A 24-year-old female says she wants to begin using oral contraceptives. Which information from the nursing assessment is most important to report to the health care provider? a. The patient quit smoking 5 months previously. b. The patient's blood pressure is 154/86 mm Hg. c. The patient has not been vaccinated for rubella. d. The patient has chronic iron-deficiency anemia.

ANS: B Because 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.

A 58-yr-old patient with erectile dysfunction (ED) tells the nurse he is interested in using sildenafil (Viagra). Which action should the nurse take first? a. Assure the patient that ED is common with aging. b. Ask the patient about any prescription drugs he is taking. c. Tell the patient that Viagra does not always work for ED. d. Discuss the common adverse effects of erectogenic drugs.

ANS: B Because some medications can cause ED and patients using nitrates should not take sildenafil, the nurse should first assess for prescription drug use. The nurse may want to teach the patient about realistic expectations and adverse effects of sildenafil therapy, but this should not be the first action. Although ED does increase with aging, it may be secondary to medication use or cardiovascular disease. DIF: Cognitive Level: Analysis (analyze) REF: 1288 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

A 22-year-old patient reports her concern about not having a menstrual period for the past 7 months. Which statement by the patient indicates a possible related factor to the amenorrhea? a. "I drink at least 3 glasses of nonfat milk every day." b. "I run 7 to 8 miles every day to keep my weight down." c. "I was treated for a sexually transmitted infection 2 years ago." d. "I am not sexually active but currently I have an IUD."

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

A couple is scheduled to have a Huhner test for infertility. In preparation for the test, the nurse will instruct the couple about a. being sedated during the procedure. b. determining the estimated time of ovulation. c. experiencing shoulder pain after the procedure. d. refraining from intercourse before the appointment.

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

The nurse will plan to teach the patient who is incontinent of urine following a radical retropubic prostatectomy to a. restrict oral fluid intake. b. do pelvic muscle exercises. c. perform intermittent self-catheterization. d. use belladonna and opium suppositories.

ANS: B Pelvic floor muscle training (Kegel) exercises are recommended to strengthen the pelvic floor muscles and improve urinary control. Belladonna and opium suppositories are used to reduce bladder spasms after surgery. Intermittent self-catheterization may be taught before surgery if the patient has urinary retention, but it will not be useful in reducing incontinence after surgery. The patient should have a daily oral intake of 2 to 3 L. DIF: Cognitive Level: Apply (application) REF: 1278 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

The nurse performing a focused examination to determine possible causes of infertility will assess for a. hydrocele. c. epididymitis. b. varicocele. d. paraphimosis.

ANS: B Persistent varicoceles are commonly associated with infertility. Hydrocele, epididymitis, and paraphimosis are not risk factors for infertility. DIF: Cognitive Level: Understand (comprehension) REF: 1285 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

An 18-year-old female patient who has been admitted to the emergency department after a motor vehicle crash is scheduled for chest and abdominal x-rays. Which information is most important to report to the health care provider before the x-rays are obtained? a. Severity of abdominal pain b. Positive result of hCG test c. Blood pressure 172/88 mm Hg d. Temperature 102.1° F (38.9° C)

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

The nurse in a health clinic receives requests for appointments from several patients. Which patient should be seen by the health care provider first? a. A 48-yr-old patient who has perineal pain and a temperature of 100.4° F b. A 58-yr-old patient who has a painful erection that has lasted more than 6 hours c. A 38-yr-old patient who reports that he had difficulty maintaining an erection twice last week d. A 68-yr-old patient who has pink urine after a transurethral resection of the prostate (TURP) 3 days ago

ANS: B Priapism can cause complications such as necrosis or hydronephrosis, and this patient should be treated immediately. The other patients do not require immediate action to prevent serious complications. DIF: Cognitive Level: Analyze (analysis) REF: 1283 OBJ: Special Questions: Multiple Patients | Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

The nurse in the clinic notes elevated prostate specific antigen (PSA) levels in the laboratory results of these patients. Which patient's PSA result is not expected to be elevated? a. A 38-yr-old patient who is being treated for acute prostatitis b. A 48-yr-old patient whose father died of metastatic prostate cancer c. A 52-yr-old patient who goes on long bicycle rides every weekend d. A 75-yr-old patient who uses saw palmetto to treat benign prostatic hyperplasia (BPH)

ANS: B The family history of prostate cancer and elevation of PSA indicate that further evaluation of the patient for prostate cancer is needed. Elevations in PSA for the other patients are not unusual. DIF: Cognitive Level: Apply (application) REF: 1281 OBJ: Special Questions: Multiple Patients TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance

A 27-yr-old patient who has testicular cancer is being admitted for a unilateral orchiectomy. The patient does not talk to his wife and speaks to the nurse only to answer the admission questions. Which action is appropriate for the nurse to take? a. Teach the patient and the wife that impotence is unlikely after unilateral orchiectomy. b. Ask the patient if he has any questions or concerns about the diagnosis and treatment. c. Inform the patient's wife that concerns about sexual function are common with this diagnosis. d. Document the patient's lack of communication on the health record and continue preoperative care.

ANS: B The initial action by the nurse should be assessment for any anxiety or questions about the surgery or postoperative care. The nurse should address the patient, not the spouse, when discussing the diagnosis and any possible concerns. Without further assessment of patient concerns, the nurse should not offer teaching about complications after orchiectomy. Documentation of the patient's lack of interaction is not an adequate nursing action in this situation. DIF: Cognitive Level: Apply (application) REF: 1280 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

A patient who has benign prostatic hyperplasia (BPH) with urinary retention is admitted to the hospital with elevated blood urea nitrogen (BUN) and creatinine. Which prescribed therapy should the nurse implement first? a. Infuse normal saline at 50 mL/hr. b. Insert a urinary retention catheter. c. Draw blood for a complete blood count. d. Schedule pelvic magnetic resonance imaging

ANS: B The patient data indicate that the patient may have acute kidney injury caused by the BPH. The initial therapy will be to insert a catheter. The other actions are also appropriate, but they can be implemented after the acute urinary retention is resolved. DIF: Cognitive Level: Analyze (analysis) REF: 1269 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

The nurse will plan to teach the patient scheduled for photovaporization of the prostate (PVP) a. that urine will appear bloody for several days. b. how to care for an indwelling urinary catheter. c. that symptom improvement takes 2 to 3 weeks. d. about complications associated with urethral stenting.

ANS: B The patient will have an indwelling catheter for 24 to 48 hours and will need teaching about catheter care. There is minimal bleeding with this procedure. Symptom improvement is almost immediate after PVP. Stent placement is not included in the procedure. DIF: Cognitive Level: Apply (application) REF: 1272 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

A patient tells the nurse that he decided to seek treatment for erectile dysfunction (ED) because his wife "is losing patience with the situation." The nurse's follow-up questions should focus on the man's identified concern with a. low self-esteem. c. increased anxiety. b. role performance. d. infrequent intercourse.

ANS: B The patient's statement indicates that the relationship with his wife is his primary concern. Although anxiety, low self-esteem, and ineffective sexuality patterns may also be concerns, the patient information suggests that addressing the role performance problem will lead to the best outcome for this patient. DIF: Cognitive Level: Apply (application) REF: 1288 TOP: Nursing Process: Intervention MSC: NCLEX: Psychosocial Integrity

Which information will the nurse plan to include when teaching a young adult who has a family history of testicular cancer about testicular self-examination? a. Testicular self-examination should be done at least weekly. b. Testicular self-examination should be done in a warm room. c. The only structure normally felt in the scrotal sac is the testis. d. Call the health care provider if one testis is larger than the other.

ANS: B The testes will hang lower in the scrotum when the temperature is warm (e.g., during a shower), and it will be easier to palpate. The epididymis is also normally palpable in the scrotum. One testis is normally larger. Men at high risk should perform testicular self-examination monthly. DIF: Cognitive Level: Understand (comprehension) REF: 1286 TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance

When caring for a patient with continuous bladder irrigation after having transurethral resection of the prostate, which action could the nurse delegate to unlicensed assistive personnel (UAP)? a. Teach the patient how to perform Kegel exercises. b. Report any complaints of pain or spasms to the nurse. c. Monitor for increases in bleeding or presence of clots. d. Increase the flow rate of the irrigation if clots are noted.

ANS: B UAP education and role includes reporting patient concerns to supervising nurses. Patient teaching, assessments for complications, and actions such as bladder irrigation require more education and should be done by licensed nursing staff. DIF: Cognitive Level: Apply (application) REF: 1274 OBJ: Special Questions: Delegation TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment

The nurse taking a focused health history for a patient with possible testicular cancer will ask the patient about a history of a. testicular torsion. b. testicular trauma. c. undescended testicles. d. sexually transmitted infection (STI).

ANS: C Cryptorchidism is a risk factor for testicular cancer if it is not corrected before puberty. STI, testicular torsion, and testicular trauma are risk factors for other testicular conditions but not for testicular cancer. DIF: Cognitive Level: Understand (comprehension) REF: 1284 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

A 53-yr-old patient is scheduled for an annual physical examination. The nurse will plan to teach the patient about the purpose of a. urinalysis collection. b. uroflowmetry studies. c. prostate specific antigen (PSA) testing. d. transrectal ultrasound scanning (TRUS).

ANS: C An annual digital rectal exam (DRE) and PSA are usually recommended starting at age 50 years for men who have an average risk for prostate cancer. Urinalysis and uroflowmetry studies are done if patients have symptoms of urinary tract infection or changes in the urinary stream. TRUS may be ordered if the DRE or PSA results are abnormal. DIF: Cognitive Level: Apply (application) REF: 1273 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

A 19-year-old patient calls the school clinic and tells the nurse, "My menstrual period is very heavy this time. 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.

The nurse is providing teaching by telephone to a patient who is scheduled for a pelvic examination and Pap test next week. 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. avoid douching for at least 24 hours before the examination. d. schedule to have the Pap test just after her menstrual period.

ANS: C Because the results of a Pap test may be affected by douching, 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.

Which finding from the nurse's physical assessment of a 42-year-old male patient should be reported to the health care provider? a. One testis hangs lower than the other. b. Genital hair distribution is diamond shaped. c. Clear discharge is present at the penile meatus. d. Inguinal lymph nodes are nonpalpable bilaterally.

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

A patient who has been recently diagnosed with benign prostatic hyperplasia (BPH) tells the nurse that he does not want to have a transurethral resection of the prostate (TURP) because it might affect his ability to have sexual intercourse. Which action should the nurse take? a. Discuss alternative methods of sexual expression. b. Teach about medication for erectile dysfunction (ED). c. Clarify that TURP does not commonly affect erection. d. Offer reassurance that fertility is not affected by TURP.

ANS: C ED is not a concern with TURP, although retrograde ejaculation is likely, and the nurse should discuss this with the patient. Erectile function is not usually affected by a TURP, so the patient will not need information about penile implants or reassurance that other forms of sexual expression may be used. Because the patient has not asked about fertility, reassurance about sperm production does not address his concerns. DIF: Cognitive Level: Apply (application) REF: 1272 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

Which information will the nurse teach a patient who has chronic prostatitis? a. Ibuprofen (Motrin) should provide good pain control. b. Prescribed antibiotics should be taken for 7 to 10 days. c. Intercourse or masturbation will help relieve symptoms. d. Cold packs used every 4 hours will decrease inflammation.

ANS: C Ejaculation helps drain the prostate and relieve pain. Warm baths are recommended to reduce pain. Nonsteroidal antiinflammatory drugs (NSAIDs) are frequently prescribed but usually do not offer adequate pain relief. Antibiotics for chronic prostatitis are taken for 4 to 12 weeks. DIF: Cognitive Level: Apply (application) REF: 1283 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

Which question should the nurse ask when assessing a 60-year-old 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 they would not be helpful in determining whether there were functional changes caused by BPH.

Which action by the unlicensed assistive personnel (UAP) who are assisting with the care of male patients with reproductive problems indicates that the nurse should provide more teaching? a. The UAP apply a cold pack to the scrotum for a patient with mumps orchitis. b. The UAP help a patient who has had a prostatectomy to put on antiembolism hose. c. The UAP leave the foreskin pulled back after cleaning the glans of a patient who has a retention catheter. d. The UAP encourage a high oral fluid intake for patient who had transurethral resection of the prostate yesterday.

ANS: C Paraphimosis can be caused by failing to replace the foreskin back over the glans after cleaning. The other actions by UAP are appropriate. DIF: Cognitive Level: Apply (application) REF: 1274 OBJ: Special Questions: Delegation TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

A 49-year-old man who has type 2 diabetes, high blood pressure, hyperlipidemia, and gastroesophageal reflux tells the nurse that he has had recent difficulty in achieving an erection. Which of the following drugs from his current medications list may cause erectile dysfunction (ED)? a. Ranitidine (Zantac) b. Atorvastatin (Lipitor) c. Propranolol (Inderal) d. Metformin (Glucophage)

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.

The nurse is obtaining the pertinent health history for a man who is being evaluated for infertility. Which question focuses on a possible cause of infertility? a. "Are you circumcised?" b. "Have you had surgery for phimosis?" c. "Do you use medications to improve muscle mass?" d. "Is there a history of prostate cancer in your family?"

ANS: C Testosterone or testosterone-like medications may adversely affect sperm count. The other information will be obtained in the health history but does not affect the patient's fertility. DIF: Cognitive Level: Apply (application) REF: 1289 TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance

To determine the severity of the symptoms for a patient with benign prostatic hyperplasia (BPH), the nurse will ask the patient about a. blood in the urine. . b. lower back or hip pain. c. force of urinary stream d. erectile dysfunction (ED).

ANS: C The American Urological Association Symptom Index for a patient with BPH asks questions about the force and frequency of urination, nocturia, and so on. Blood in the urine, ED, and back or hip pain are not typical symptoms of BPH. DIF: Cognitive Level: Apply (application) REF: 1268 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

The following patients call the outpatient clinic. Which phone call should the nurse return first? a. A 44-year-old patient who has bloody discharge after a hysteroscopy earlier today b. A 64-year-old patient who is experiencing shoulder pain after a laparoscopy yesterday c. A 34-year-old patient who is short of breath after pelvic computed tomography (CT) with contrast d. A 54-year-old patient who has severe breast tenderness following a needle aspiration breast biopsy

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.

The plan of care for a patient immediately after a perineal radical prostatectomy will include decreasing the risk for infection related to a. urinary incontinence. c. fecal wound contamination. b. prolonged urinary stasis. d. suprapubic catheter placement.

ANS: C The perineal approach increases the risk for infection because the incision is located close to the anus, and contamination with feces is possible. Urinary stasis and incontinence do not occur because the patient has a retention catheter in place for 1 to 2 weeks. A urethral catheter is used after the surgery. DIF: Cognitive Level: Apply (application) REF: 1278 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

The health care provider prescribes the following interventions for a patient with acute prostatitis caused by Escherichia coli. Which intervention should the nurse question? a. Give trimethoprim/sulfamethoxazole 1 tablet daily for 28 days. b. Administer ibuprofen 400 mg every 8 hours as needed for pain. c. Instruct patient to avoid sexual intercourse until treatment is complete. d. Catheterize the patient as needed if symptoms of urinary retention develop.

ANS: D Although acute urinary retention may occur, insertion of a catheter through an inflamed urethra is contraindicated, and the nurse will anticipate that the health care provider will need to insert a suprapubic catheter. The other actions are appropriate. DIF: Cognitive Level: Apply (application) REF: 1282 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

A 44-year-old patient in the sexually transmitted infection clinic has a positive Venereal Disease Research Laboratory (VDRL) test, but no chancre is visible on assessment. 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 Because 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 infections (STIs) such as gonorrhea and Chlamydia and cytologic studies are used to detect abnormal cells (such as neoplastic cells).

The nurse explains to a 37-year-old patient being prepared for colposcopy with a cervical biopsy 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 discomfort.

ANS: D Colposcopy involves visualization of the cervix with a binocular microscope and is similar to a speculum examination. Anesthesia is not required and fasting is not necessary. A cervical biopsy may cause a minimal amount of pain.

The nurse will anticipate that a 61-yr-old patient who has an enlarged prostate detected by digital rectal examination (DRE) and an elevated prostate specific antigen (PSA) level will need teaching about a. cystourethroscopy. b. uroflowmetry studies. c. magnetic resonance imaging (MRI). d. transrectal ultrasonography (TRUS).

ANS: D In a patient with an abnormal DRE and elevated PSA, transrectal ultrasound is used to visualize the prostate for biopsy. Uroflowmetry studies help determine the extent of urine blockage and treatment, but there is no indication that this is a problem for this patient. Cystoscopy may be used before prostatectomy but will not be done until after the TRUS and biopsy. MRI is used to determine whether prostatic cancer has metastasized but would not be ordered at this stage of the diagnostic process. DIF: Cognitive Level: Apply (application) REF: 1270 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

The nurse will plan to teach a 51-year-old man who is scheduled for an annual physical exam about a(n) a. increased risk for testicular cancer. b. possible changes in erectile function. c. normal decreases in testosterone level. d. prostate specific antigen (PSA) testing.

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

A patient who has been diagnosed with stage 2 prostate cancer chooses the option of active surveillance. The nurse will plan to a. vaccinate the patient with sipuleucel-T (Provenge). b. provide the patient with information about cryotherapy. c. teach the patient about placement of intraurethral stents. d. schedule the patient for annual prostate-specific antigen testing.

ANS: D Patients who opt for active surveillance need to have annual digital rectal examinations and prostate-specific antigen testing. Vaccination with sipuleucel-T, cryotherapy, and stent placement are options for patients who choose to have active treatment for prostate cancer. DIF: Cognitive Level: Understand (comprehension) REF: 1269 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

After a 26-year-old patient has been treated for pelvic inflammatory disease, the nurse will plan to teach about a. use of hormone therapy (HT). b. irregularities in the menstrual cycle. c. changes in secondary sex characteristics. d. possible difficulty with becoming pregnant.

ANS: D 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 HT, have irregular menstrual cycles, or experience changes in secondary sex characteristics.

After a transurethral resection of the prostate (TURP), a 64-yr-old patient with continuous bladder irrigation complains of painful bladder spasms. The nurse observes clots in the urine. Which action should the nurse take first? a. Increase the flow rate of the bladder irrigation. b. Administer the prescribed IV morphine sulfate. c. Give the patient the prescribed belladonna and opium suppository. d. Manually instill and then withdraw 50 mL of saline into the catheter.

ANS: D The assessment suggests that obstruction by a clot is causing the bladder spasms, and the nurse's first action should be to irrigate the catheter manually and to try to remove the clots. IV morphine will not decrease the spasm, although pain may be reduced. Increasing the flow rate of the irrigation will further distend the bladder and may increase spasms. The belladonna and opium suppository will decrease bladder spasms but will not remove the obstructing blood clot. DIF: Cognitive Level: Analysis (analyze) REF: 1272 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

A woman calls the clinic because she is having an unusually heavy menstrual flow. She tells the nurse that she has saturated three tampons in the past 2 hours. The nurse estimates that the amount of blood loss over the past 2 hours is _____ mL. a. 20 to 30 b. 30 to 40 c. 40 to 60 d. 60 to 90

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

Which assessment information collected by the nurse may present a contraindication to a testosterone replacement therapy (TRT)? a. The patient has noticed a decrease in energy level for a few years. b. The patient's symptoms have increased steadily over the past few years. c. The patient has been using sildenafil (Viagra) several times every week. d. The patient has had a gradual decrease in the force of his urinary stream.

ANS: D The decrease in urinary stream may indicate benign prostatic hyperplasia (BPH) or prostate cancer, which are contraindications to the use of testosterone replacement therapy (TRT). The other patient data indicate that TRT may be a helpful therapy for the patient. DIF: Cognitive Level: Apply (application) REF: 1269 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

A 68-year-old male patient tells the nurse that he is worried because he does not respond to sexual stimulation the same way he did when he was younger. The nurse's best response to the patient's concern is which of the following? a. "Interest in sex frequently decreases as men get older." b. "Many men need additional sexual stimulation with aging." 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 may not respond to the patient's concerns.

Which information about continuous bladder irrigation will the nurse teach to a patient who is being admitted for a transurethral resection of the prostate (TURP)? a. Bladder irrigation decreases the risk of postoperative bleeding. b. Hydration and urine output are maintained by bladder irrigation. c. Antibiotics are infused continuously through the bladder irrigation. d. Bladder irrigation prevents obstruction of the catheter after surgery.

ANS: D The purpose of bladder irrigation is to remove clots from the bladder and prevent obstruction of the catheter by clots. The irrigation does not decrease bleeding or improve hydration. Antibiotics are given by the IV route, not through the bladder irrigation. DIF: Cognitive Level: Understand (comprehension) REF: 1274 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

ANS: B Bladder spasms and lack of urine output indicate that the nurse needs to assess the continuous bladder irrigation for kinks and may need to manually irrigate the patient's catheter. The other information will also require actions, such as having the patient take deep breaths and cough and discussing the need for antihypertensive medication prescriptions with the health care provider, but the nurse's first action should be to address the problem with the urinary drainage system. DIF: Cognitive Level: Apply (application) REF: 1274 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

After reviewing the electronic medical record shown in the accompanying figure for a patient who had transurethral resection of the prostate the previous day, which information requires the most rapid action by the nurse? a. Elevated temperature and pulse b. Bladder spasms and urine output c. Respiratory rate and lung crackles d. No prescription for antihypertensive drugs

A nurse is conducting a class on how to self-manage insulin regimens. A patient asks how long a vial of insulin can be stored at room temperature before it "goes bad." What would be the nurse's best answer? A) "If you are going to use up the vial within 1 month it can be kept at room temperature." B) "If a vial of insulin will be used up within 21 days, it may be kept at room temperature." C) "If a vial of insulin will be used up within 2 weeks, it may be kept at room temperature." D) "If a vial of insulin will be used up within 1 week, it may be kept at room temperature."

Ans: A Feedback: If a vial of insulin will be used up within 1 month, it may be kept at room temperature.

A diabetic nurse is working for the summer at a camp for adolescents with diabetes. When providing information on the prevention and management of hypoglycemia, what action should the nurse promote? A) Always carry a form of fast-acting sugar. B) Perform exercise prior to eating whenever possible. C) Eat a meal or snack every 8 hours. D) Check blood sugar at least every 24 hours.

Ans: A Feedback: The following teaching points should be included in information provided to the patient on how to prevent hypoglycemia: Always carry a form of fast-acting sugar, increase food prior to exercise, eat a meal or snack every 4 to 5 hours, and check blood sugar regularly.

A 15-year-old child is brought to the emergency department with symptoms of hyperglycemia and is subsequently diagnosed with diabetes. Based on the fact that the child's pancreatic beta cells are being destroyed, the patient would be diagnosed with what type of diabetes? A) Type 1 diabetes B) Type 2 diabetes C) Non-insulin-dependent diabetes D) Prediabetes

Ans: A Feedback: Beta cell destruction is the hallmark of type 1 diabetes. Non-insulin-dependent diabetes is synonymous with type 2 diabetes, which involves insulin resistance and impaired insulin secretion, but not beta cell destruction. Prediabetes is characterized by normal glucose metabolism, but a previous history of hyperglycemia, often during illness or pregnancy.

The most recent blood work of a patient with a longstanding diagnosis of type 1 diabetes has shown the presence of microalbuminuria. What is the nurse's most appropriate action? A) Teach the patient about actions to slow the progression of nephropathy. B) Ensure that the patient receives a comprehensive assessment of liver function. C) Determine whether the patient has been using expired insulin. D) Administer a fluid challenge and have the test repeated.

Ans: A Feedback: Clinical nephropathy eventually develops in more than 85% of people with microalbuminuria. As such, educational interventions addressing this microvascular complication are warranted. Expired insulin does not cause nephropathy, and the patient's liver function is not likely affected. There is no indication for the use of a fluid challenge.

A patient presents to the clinic complaining of symptoms that suggest diabetes. What criteria would support checking blood levels for the diagnosis of diabetes? A) Fasting plasma glucose greater than or equal to 126 mg/dL B) Random plasma glucose greater than 150 mg/dL C) Fasting plasma glucose greater than 116 mg/dL on 2 separate occasions D) Random plasma glucose greater than 126 mg/dL

Ans: A Feedback: Criteria for the diagnosis of diabetes include symptoms of diabetes plus random plasma glucose greater than or equal to 200 mg/dL, or a fasting plasma glucose greater than or equal to 126 mg/dL.

A patient with a longstanding diagnosis of type 1 diabetes has a history of poor glycemic control. The nurse recognizes the need to assess the patient for signs and symptoms of peripheral neuropathy. Peripheral neuropathy constitutes a risk for what nursing diagnosis? A) Infection B) Acute pain C) Acute confusion D) Impaired urinary elimination

Ans: A Feedback: Decreased sensations of pain and temperature place patients with neuropathy at increased risk for injury and undetected foot infections. The neurologic changes associated with peripheral neuropathy do not normally result in pain, confusion, or impairments in urinary function.

A patient has been brought to the emergency department by paramedics after being found unconscious. The patient's Medic Alert bracelet indicates that the patient has type 1 diabetes and the patient's blood glucose is 22 mg/dL (1.2 mmol/L). The nurse should anticipate what intervention? A) IV administration of 50% dextrose in water B) Subcutaneous administration of 10 units of Humalog C) Subcutaneous administration of 12 to 15 units of regular insulin D) IV bolus of 5% dextrose in 0.45% NaCl

Ans: A Feedback: In hospitals and emergency departments, for patients who are unconscious or cannot swallow, 25 to 50 mL of 50% dextrose in water (D50W) may be administered IV for the treatment of hypoglycemia. Five percent dextrose would be inadequate and insulin would exacerbate the patient's condition.

A patient has been living with type 2 diabetes for several years, and the nurse realizes that the patient is likely to have minimal contact with the health care system. In order to ensure that the patient maintains adequate blood sugar control over the long term, the nurse should recommend which of the following? A) Participation in a support group for persons with diabetes B) Regular consultation of websites that address diabetes management C) Weekly telephone "check-ins" with an endocrinologist D) Participation in clinical trials relating to antihyperglycemics

Ans: A Feedback: Participation in support groups is encouraged for patients who have had diabetes for many years as well as for those who are newly diagnosed. This is more interactive and instructive than simply consulting websites. Weekly telephone contact with an endocrinologist is not realistic in most cases. Participation in research trials may or may not be beneficial and appropriate, depending on patients' circumstances.

A diabetes nurse educator is teaching a group of patients with type 1 diabetes about "sick day rules." What guideline applies to periods of illness in a diabetic patient? A) Do not eliminate insulin when nauseated and vomiting. B) Report elevated glucose levels greater than 150 mg/dL. C) Eat three substantial meals a day, if possible. D) Reduce food intake and insulin doses in times of illness.

Ans: A Feedback: The most important issue to teach patients with diabetes who become ill is not to eliminate insulin doses when nausea and vomiting occur. Rather, they should take their usual insulin or oral hypoglycemic agent dose, then attempt to consume frequent, small portions of carbohydrates. In general, blood sugar levels will rise but should be reported if they are greater than 300 mg/dL.

A diabetic educator is discussing "sick day rules" with a newly diagnosed type 1 diabetic. The educator is aware that the patient will require further teaching when the patient states what? A) "I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours." B) "If I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding six to eight times a day." C) "I will call the doctor if I am not able to keep liquids in my body due to vomiting or diarrhea." D) "I will call the doctor if my blood sugar is over 300 mg/dL or if I have ketones in my urine."

Ans: A Feedback: The nurse must explanation the "sick day rules" again to the patient who plans to stop taking insulin when sick. The nurse should emphasize that the patient should take insulin agents as usual and test one's blood sugar and urine ketones every 3 to 4 hours. In fact, insulin-requiring patients may need supplemental doses of regular insulin every 3 to 4 hours. The patient should report elevated glucose levels (greater than 300 mg/dL or as otherwise instructed) or urine ketones to the physician. If the patient is not able to eat normally, the patient should be instructed to substitute soft foods such a gelatin, soup, and pudding. If vomiting, diarrhea, or fever persists, the patient should have an intake of liquids every 30 to 60 minutes to prevent dehydration.

A nurse is caring for a patient newly diagnosed with type 1 diabetes. The nurse is educating the patient about self-administration of insulin in the home setting. The nurse should teach the patient to do which of the following? A) Avoid using the same injection site more than once in 2 to 3 weeks. B) Avoid mixing more than one type of insulin in a syringe. C) Cleanse the injection site thoroughly with alcohol prior to injecting. D) Inject at a 45º angle.

Ans: A Feedback: To prevent lipodystrophy, the patient should try not to use the same site more than once in 2 to 3 weeks. Mixing different types of insulin in a syringe is acceptable, within specific guidelines, and the needle is usually inserted at a 90º angle. Cleansing the injection site with alcohol is optional.

The nurse is discussing macrovascular complications of diabetes with a patient. The nurse would address what topic during this dialogue? A) The need for frequent eye examinations for patients with diabetes B) The fact that patients with diabetes have an elevated risk of myocardial infarction C) The relationship between kidney function and blood glucose levels D) The need to monitor urine for the presence of albumin

Ans: B Feedback: Myocardial infarction and stroke are considered macrovascular complications of diabetes, while the effects on vision and renal function are considered to be microvascular.

An occupational health nurse is screening a group of workers for diabetes. What statement should the nurse interpret as suggestive of diabetes? A) "I've always been a fan of sweet foods, but lately I'm turned off by them." B) "Lately, I drink and drink and can't seem to quench my thirst." C) "No matter how much sleep I get, it seems to take me hours to wake up." D) "When I went to the washroom the last few days, my urine smelled odd."

Ans: B Feedback: Classic clinical manifestations of diabetes include the "three Ps": polyuria, polydipsia, and polyphagia. Lack of interest in sweet foods, fatigue, and foul-smelling urine are not suggestive of diabetes.

A patient with type 2 diabetes achieves adequate glycemic control through diet and exercise. Upon being admitted to the hospital for a cholecystectomy, however, the patient has required insulin injections on two occasions. The nurse would identify what likely cause for this short-term change in treatment? A) Alterations in bile metabolism and release have likely caused hyperglycemia. B) Stress has likely caused an increase in the patient's blood sugar levels. C) The patient has likely overestimated her ability to control her diabetes using nonpharmacologic measures. D) The patient's volatile fluid balance surrounding surgery has likely caused unstable blood sugars.

Ans: B Feedback: During periods of physiologic stress, such as surgery, blood glucose levels tend to increase, because levels of stress hormones (epinephrine, norepinephrine, glucagon, cortisol, and growth hormone) increase. The patient's need for insulin is unrelated to the action of bile, the patient's overestimation of previous blood sugar control, or fluid imbalance.

A diabetic patient calls the clinic complaining of having a "flu bug." The nurse tells him to take his regular dose of insulin. What else should the nurse tell the patient? A) "Make sure to stick to your normal diet." B) "Try to eat small amounts of carbs, if possible." C) "Ensure that you check your blood glucose every hour." D) "For now, check your urine for ketones every 8 hours."

Ans: B Feedback: For prevention of DKA related to illness, the patient should attempt to consume frequent small portions of carbohydrates (including foods usually avoided, such as juices, regular sodas, and gelatin). Drinking fluids every hour is important to prevent dehydration. Blood glucose and urine ketones must be assessed every 3 to 4 hours.

A patient with a history of type 1 diabetes has just been admitted to the critical care unit (CCU) for diabetic ketoacidosis. The CCU nurse should prioritize what assessment during the patient's initial phase of treatment? A) Monitoring the patient for dysrhythmias B) Maintaining and monitoring the patient's fluid balance C) Assessing the patient's level of consciousness D) Assessing the patient for signs and symptoms of venous thromboembolism

Ans: B Feedback: In addition to treating hyperglycemia, management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin. The nurse should monitor the patient for dysrhythmias, decreased LOC and VTE, but restoration and maintenance of fluid balance is the highest priority.

A nurse is caring for a patient with type 1 diabetes who is being discharged home tomorrow. What is the best way to assess the patient's ability to prepare and self-administer insulin? A) Ask the patient to describe the process in detail. B) Observe the patient drawing up and administering the insulin. C) Provide a health education session reviewing the main points of insulin delivery. D) Review the patient's first hemoglobin A1C result after discharge.

Ans: B Feedback: Nurses should assess the patient's ability to perform diabetes related self-care as soon as possible during the hospitalization or office visit to determine whether the patient requires further diabetes teaching. While consulting a home care nurse is beneficial, an initial assessment should be performed during the hospitalization or office visit. Nurses should directly observe the patient performing the skills such as insulin preparation and infection, blood glucose monitoring, and foot care. Simply questioning the patient about these skills without actually observing performance of the skill is not sufficient. Further education does not guarantee learning.

A medical nurse is caring for a patient with type 1 diabetes. The patient's medication administration record includes the administration of regular insulin three times daily. Knowing that the patient's lunch tray will arrive at 11:45, when should the nurse administer the patient's insulin? A) 10:45 B) 11:15 C) 11:45 D) 11:50

Ans: B Feedback: Regular insulin is usually administered 20-30 min before a meal. Earlier administration creates a risk for hypoglycemia; later administration creates a risk for hyperglycemia.

A diabetes nurse is assessing a patient's knowledge of self-care skills. What would be the most appropriate way for the educator to assess the patient's knowledge of nutritional therapy in diabetes? A) Ask the patient to describe an optimally healthy meal. B) Ask the patient to keep a food diary and review it with the nurse. C) Ask the patient's family what he typically eats. D) Ask the patient to describe a typical day's food intake.

Ans: B Feedback: Reviewing the patient's actual food intake is the most accurate method of gauging the patient's diet.

A patient has just been diagnosed with type 2 diabetes. The physician has prescribed an oral antidiabetic agent that will inhibit the production of glucose by the liver and thereby aid in the control of blood glucose. What type of oral antidiabetic agent did the physician prescribe for this patient? A) A sulfonylurea B) A biguanide C) A thiazolidinedione D) An alpha glucosidase inhibitor

Ans: B Feedback: Sulfonylureas exert their primary action by directly stimulating the pancreas to secrete insulin and therefore require a functioning pancreas to be effective. Biguanides inhibit the production of glucose by the liver and are in used in type 2 diabetes to control blood glucose levels. Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas. Alpha glucosidase inhibitors work by delaying the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level.

An elderly patient comes to the clinic with her daughter. The patient is a diabetic and is concerned about foot care. The nurse goes over foot care with the patient and her daughter as the nurse realizes that foot care is extremely important. Why would the nurse feel that foot care is so important to this patient? A) An elderly patient with foot ulcers experiences severe foot pain due to the diabetic polyneuropathy. B) Avoiding foot ulcers may mean the difference between institutionalization and continued independent living. C) Hypoglycemia is linked with a risk for falls; this risk is elevated in older adults with diabetes. D) Oral antihyperglycemics have the possible adverse effect of decreased circulation to the lower extremities.

Ans: B Feedback: The nurse recognizes that providing information on the long-term complications—especially foot and eye problems—associated with diabetes is important. Avoiding amputation through early detection of foot ulcers may mean the difference between institutionalization and continued independent living for the elderly person with diabetes. While the nurse recognizes that hypoglycemia is a dangerous situation and may lead to falls, hypoglycemia is not directly connected to the importance of foot care. Decrease in circulation is related to vascular changes and is not associated with drugs administered for diabetes.

A patient is brought to the emergency department by the paramedics. The patient is a type 2 diabetic and is experiencing HHS. The nurse should identify what components of HHS? Select all that apply. A) Leukocytosis B) Glycosuria C) Dehydration D) Hypernatremia E) Hyperglycemia

Ans: B, C, D, E Feedback: In HHS, persistent hyperglycemia causes osmotic diuresis, which results in losses of water and electrolytes. To maintain osmotic equilibrium, water shifts from the intracellular fluid space to the extracellular fluid space. With glycosuria and dehydration, hypernatremia and increased osmolarity occur. Leukocytosis does not take place.

A patient newly diagnosed with type 2 diabetes is attending a nutrition class. What general guideline would be important to teach the patients at this class? A) Low fat generally indicates low sugar. B) Protein should constitute 30% to 40% of caloric intake. C) Most calories should be derived from carbohydrates. D) Animal fats should be eliminated from the diet.

Ans: C Feedback: Currently, the ADA and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) recommend that for all levels of caloric intake, 50% to 60% of calories should be derived from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein.Low fat does not automatically mean low sugar. Dietary animal fat does not need to be eliminated from the diet.

A nurse is providing health education to an adolescent newly diagnosed with type 1 diabetes mellitus and her family. The nurse teaches the patient and family that which of the following nonpharmacologic measures will decrease the body's need for insulin? A) Adequate sleep B) Low stimulation C) Exercise D) Low-fat diet

Ans: C Feedback: Exercise lowers blood glucose, increases levels of HDLs, and decreases total cholesterol and triglyceride levels. Low fat intake and low levels of stimulation do not reduce a patient's need for insulin. Adequate sleep is beneficial in reducing stress, but does not have an effect that is pronounced as that of exercise.

A patient with type 1 diabetes mellitus is seeing the nurse to review foot care. What would be a priority instruction for the nurse to give the patient? A) Examine feet weekly for redness, blisters, and abrasions. B) Avoid the use of moisturizing lotions. C) Avoid hot-water bottles and heating pads. D) Dry feet vigorously after each bath.

Ans: C Feedback: High-risk behaviors, such as walking barefoot, using heating pads on the feet, wearing open-toed shoes, soaking the feet, and shaving calluses, should be avoided. Socks should be worn for warmth. Feet should be examined each day for cuts, blisters, swelling, redness, tenderness, and abrasions. Lotion should be applied to dry feet but never between the toes. After a bath, the patient should gently, not vigorously, pat feet dry to avoid injury.

A student with diabetes tells the school nurse that he is feeling nervous and hungry. The nurse assesses the child and finds he has tachycardia and is diaphoretic with a blood glucose level of 50 mg/dL (2.8 mmol/L). What should the school nurse administer? A) A combination of protein and carbohydrates, such as a small cup of yogurt B) Two teaspoons of sugar dissolved in a cup of apple juice C) Half of a cup of juice, followed by cheese and crackers D) Half a sandwich with a protein-based filling

Ans: C Feedback: Initial treatment for hypoglycemia is 15 g concentrated carbohydrate, such as two or three glucose tablets, 1 tube glucose gel, or 0.5 cup juice. After initial treatment, the nurse should follow with a snack including starch and protein, such as cheese and crackers, milk and crackers, or half of a sandwich. It is unnecessary to add sugar to juice, even it if is labeled as unsweetened juice, because the fruit sugar in juice contains enough simple carbohydrate to raise the blood glucose level and additional sugar may result in a sharp rise in blood sugar that will last for several hours.

A diabetes educator is teaching a patient about type 2 diabetes. The educator recognizes that the patient understands the primary treatment for type 2 diabetes when the patient states what? A) "I read that a pancreas transplant will provide a cure for my diabetes." B) "I will take my oral antidiabetic agents when my morning blood sugar is high." C) "I will make sure to follow the weight loss plan designed by the dietitian." D) "I will make sure I call the diabetes educator when I have questions about my insulin."

Ans: C Feedback: Insulin resistance is associated with obesity; thus the primary treatment of type 2 diabetes is weight loss. Oral antidiabetic agents may be added if diet and exercise are not successful in controlling blood glucose levels. If maximum doses of a single category of oral agents fail to reduce glucose levels to satisfactory levels, additional oral agents may be used. Some patients may require insulin on an ongoing basis or on a temporary basis during times of acute psychological stress, but it is not the central component of type 2 treatment. Pancreas transplantation is associated with type 1 diabetes.

A patient with type 1 diabetes has told the nurse that his most recent urine test for ketones was positive. What is the nurse's most plausible conclusion based on this assessment finding? A) The patient should withhold his next scheduled dose of insulin. B) The patient should promptly eat some protein and carbohydrates. C) The patient's insulin levels are inadequate. D) The patient would benefit from a dose of metformin (Glucophage).

Ans: C Feedback: Ketones in the urine signal that there is a deficiency of insulin and that control of type 1 diabetes is deteriorating. Withholding insulin or eating food would exacerbate the patient's ketonuria. Metformin will not cause short-term resolution of hyperglycemia.

A physician has explained to a patient that he has developed diabetic neuropathy in his right foot. Later that day, the patient asks the nurse what causes diabetic neuropathy. What would be the nurse's best response? A) "Research has shown that diabetic neuropathy is caused by fluctuations in blood sugar that have gone on for years." B) "The cause is not known for sure but it is thought to have something to do with ketoacidosis." C) "The cause is not known for sure but it is thought to involve elevated blood glucose levels over a period of years." D) "Research has shown that diabetic neuropathy is caused by a combination of elevated glucose levels and elevated ketone levels."

Ans: C Feedback: The etiology of neuropathy may involve elevated blood glucose levels over a period of years. High blood sugars (rather than fluctuations or variations in blood sugars) are thought to be responsible. Ketones and ketoacidosis are not direct causes of neuropathies.

Which of the following patients with type 1 diabetes is most likely to experience adequate glucose control? A) A patient who skips breakfast when his glucose reading is greater than 220 mg/dL B) A patient who never deviates from her prescribed dose of insulin C) A patient who adheres closely to a meal plan and meal schedule D) A patient who eliminates carbohydrates from his daily intake

Ans: C Feedback: The therapeutic goal for diabetes management is to achieve normal blood glucose levels without hypoglycemia. Therefore, diabetes management involves constant assessment and modification of the treatment plan by health professionals and daily adjustments in therapy (possibly including insulin) by patients. For patients who require insulin to help control blood glucose levels, maintaining consistency in the amount of calories and carbohydrates ingested at meals is essential. In addition, consistency in the approximate time intervals between meals, and the snacks, help maintain overall glucose control. Skipping meals is never advisable for person with type 1 diabetes.

A school nurse is teaching a group of high school students about risk factors for diabetes. Which of the following actions has the greatest potential to reduce an individual's risk for developing diabetes? A) Have blood glucose levels checked annually. B) Stop using tobacco in any form. C) Undergo eye examinations regularly. D) Lose weight, if obese.

Ans: D Feedback: Obesity is a major modifiable risk factor for diabetes. Smoking is not a direct risk factor for the disease. Eye examinations are necessary for persons who have been diagnosed with diabetes, but they do not screen for the disease or prevent it. Similarly, blood glucose checks do not prevent the diabetes.

A nurse is assessing a patient who has diabetes for the presence of peripheral neuropathy. The nurse should question the patient about what sign or symptom that would suggest the possible development of peripheral neuropathy? A) Persistently cold feet B) Pain that does not respond to analgesia C) Acute pain, unrelieved by rest D) The presence of a tingling sensation

Ans: D Feedback: Although approximately half of patients with diabetic neuropathy do not have symptoms, initial symptoms may include paresthesias (prickling, tingling, or heightened sensation) and burning sensations (especially at night). Cold and intense pain are atypical early signs of this complication.

A patient has received a diagnosis of type 2 diabetes. The diabetes nurse has made contact with the patient and will implement a program of health education. What is the nurse's priority action? A) Ensure that the patient understands the basic pathophysiology of diabetes. B) Identify the patient's body mass index. C) Teach the patient "survival skills" for diabetes. D) Assess the patient's readiness to learn.

Ans: D Feedback: Before initiating diabetes education, the nurse assesses the patient's (and family's) readiness to learn. This must precede other physiologic assessments (such as BMI) and providing health education.

A diabetes nurse educator is presenting the American Diabetes Association (ADA) recommendations for levels of caloric intake. What do the ADA's recommendations include? A) 10% of calories from carbohydrates, 50% from fat, and the remaining 40% from protein B) 10% to 20% of calories from carbohydrates, 20% to 30% from fat, and the remaining 50% to 60% from protein C) 20% to 30% of calories from carbohydrates, 50% to 60% from fat, and the remaining 10% to 20% from protein D) 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein

Ans: D Feedback: Currently, the ADA and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) recommend that for all levels of caloric intake, 50% to 60% of calories come from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein.

A medical nurse is aware of the need to screen specific patients for their risk of hyperglycemic hyperosmolar syndrome (HHS). In what patient population does hyperosmolar nonketotic syndrome most often occur? A) Patients who are obese and who have no known history of diabetes B) Patients with type 1 diabetes and poor dietary control C) Adolescents with type 2 diabetes and sporadic use of antihyperglycemics D) Middle-aged or older people with either type 2 diabetes or no known history of diabetes

Ans: D Feedback: HHS occurs most often in older people (50 to 70 years of age) who have no known history of diabetes or who have type 2 diabetes.

A nurse is teaching basic "survival skills" to a patient newly diagnosed with type 1 diabetes. What topic should the nurse address? A) Signs and symptoms of diabetic nephropathy B) Management of diabetic ketoacidosis C) Effects of surgery and pregnancy on blood sugar levels D) Recognition of hypoglycemia and hyperglycemia

Ans: D Feedback: It is imperative that newly diagnosed patients know the signs and symptoms and management of hypo- and hyperglycemia. The other listed topics are valid points for education, but are not components of the patient's immediate "survival skills" following a new diagnosis.

A patient has just been prescribed furosemide (Lasix). After reviewing the patient's medication history, what drug would cause the nurse concern when taken with furosemide (Lasix)? A) Acetaminophen B) Ferrous sulfate (Feosol) C) Naproxen sodium (Naprosyn) D) Ampicillin

Ans: D Feedback: Metformin has the potential to be nephrotoxic; consequently, the nurse should monitor the patient's renal function. This drug does not typically affect patients' neutrophils, liver function, or cognition.

An older adult patient with type 2 diabetes is brought to the emergency department by his daughter. The patient is found to have a blood glucose level of 623 mg/dL. The patient's daughter reports that the patient recently had a gastrointestinal virus and has been confused for the last 3 hours. The diagnosis of hyperglycemic hyperosmolar syndrome (HHS) is made. What nursing action would be a priority? A) Administration of antihypertensive medications B) Administering sodium bicarbonate intravenously C) Reversing acidosis by administering insulin D) Fluid and electrolyte replacement

Ans: D Feedback: The overall approach to HHS includes fluid replacement, correction of electrolyte imbalances, and insulin administration. Antihypertensive medications are not indicated, as hypotension generally accompanies HHS due to dehydration. Sodium bicarbonate is not administered to patients with HHS, as their plasma bicarbonate level is usually normal. Insulin administration plays a less important role in the treatment of HHS because it is not needed for reversal of acidosis, as in diabetic ketoacidosis (DKA).

A newly admitted patient with type 1 diabetes asks the nurse what caused her diabetes. When the nurse is explaining to the patient the etiology of type 1 diabetes, what process should the nurse describe? A) "The tissues in your body are resistant to the action of insulin, making the glucose levels in your blood increase." B) "Damage to your pancreas causes an increase in the amount of glucose that it releases, and there is not enough insulin to control it." C) "The amount of glucose that your body makes overwhelms your pancreas and decreases your production of insulin." D) "Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down."

Ans: D Feedback: Type 1 diabetes is characterized by the destruction of pancreatic beta cells, resulting in decreased insulin production, unchecked glucose production by the liver, and fasting hyperglycemia. Also, glucose derived from food cannot be stored in the liver and remains circulating in the blood, which leads to postprandial hyperglycemia. Type 2 diabetes involves insulin resistance and impaired insulin secretion. The body does not "make" glucose.

A patient with type 2 diabetes has been managing his blood glucose levels using diet and metformin (Glucophage). Following an ordered increase in the patient's daily dose of metformin, the nurse should prioritize which of the following assessments? A) Monitoring the patient's neutrophil levels B) Assessing the patient for signs of impaired liver function C) Monitoring the patient's level of consciousness and behavior D) Reviewing the patient's creatinine and BUN levels

Ans: D) To avoid rebound edema

A hospitalized older patient reports his foreskin is retracted and will not return to normal. Which action is the priority? Start antibiotics. Apply ice to reduce swelling. Attempt to move the foreskin over the glans. Call the physician to prepare for circumcision.

Attempt to move the foreskin over the glans. Paraphimosis can occur when the foreskin is pulled back during bathing, during catheter insertion, or after intercourse and not returned to the normal position. Attempting to return the foreskin over glans is the priority action. If the nurse is unsuccessful, then ice would be applied to decrease swelling. If the foreskin is not returned to the normal position manually by the health care provider, then circumcision would be indicated. Paraphimosis is considered a urologic emergency because arterial blood flow to the glans penis is impaired.

The nurse is caring for a 62-yr-old man after a transurethral resection of the prostate (TURP). Which instructions should the nurse include in the teaching plan? Avoid straining during defecation. Restrict fluids to prevent incontinence. Sexual functioning will not be affected. Prostate examinations are not needed after surgery.

Avoid straining during defecation. Activities that increase abdominal pressure, such as sitting or walking for prolonged periods and straining to have a bowel movement (Valsalva maneuver), should be avoided in the postoperative recovery period to prevent a postoperative hemorrhage. Instruct the patient to drink at least 2 L of fluid every day. Digital rectal examinations should be performed yearly. The prostate gland is not totally removed and may enlarge after a TURP. Sexual functioning may change after prostate surgery. Changes may include retrograde ejaculation, erectile dysfunction, and decreased orgasmic sensation.

A 36-yr-old patient who has a diagnosis of fibrocystic breast changes calls the nurse in the clinic reporting symptoms. Which information is likely to change the treatment plan? a. There is yellow discharge from the patient's right nipple. b. An area on the breast is hot, pink, and tender to the touch. c. Firm, moveable lumps are in the upper outer breast quadrants. d. The lumps get more painful before the patient's menstrual period.

B An area that is hot or pink suggests an infectious process such as mastitis, which would require further assessment and treatment. Manifestations of fibrocystic breast changes include one or more palpable lumps that are often round, well delineated, and freely movable within the breast. Discomfort ranging from tenderness to pain may also occur. The lump is usually observed to increase in size and perhaps in tenderness before menstruation. Nipple discharge associated with fibrocystic breasts is often milky, watery-milky, yellow, or green.

Which action will the nurse include in the plan of care for a patient with right arm lymphedema? a. Avoid isometric exercise on the right arm. b. Assist with application of a compression sleeve. c. Keep the right arm at or below the level of the heart. d. Check blood pressure (BP) on both right and left arms.

B 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 left arm. The arm should not be placed in a dependent position.

Client Needs: Health Promotion and Maintenance 8. If a woman's menstrual cycle began on June 2 and normally lasts 28 days, ovulation would mostly likely occur on June a. 10 b. 16 c. 21 d. 29

B Feedback A June 10 would just be 8 days into the cycle and too early for ovulation. B Ovulation occurs approximately 12 to 14 days after the beginning of the menstrual period in a 28-day cycle. Ovulation normally occurs approximately 14 days before the beginning of the next period. C June 21 would be 18 days into the cycle. Ovulation should have already occurred at this point. D June 29 would be 27 days into the cycle and almost time for the next period. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 209 OBJ: Nursing Process: Assessment

Client Needs: Health Promotion and Maintenance 4. Fertilization of the ovum takes place in which part of the fallopian tube? a. Interstitial portion b. Ampulla c. Isthmus d. Infundibulum

B Feedback The interstitial portion runs into the uterine cavity. This area is too close to the uterine body for fertilization to occur; it would lead to improper placement for implantation. The ampulla is the wider middle part of the tube lateral to the isthmus and is where fertilization occurs. The isthmus is the narrowest portion of the tube. The infundibulum is the end of the tube that opens into the abdominal cavity. Fertilization at this area may lead to an abdominal pregnancy. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 206 OBJ: Nursing Process: Assessment

A 58-yr-old woman tells the nurse, "I understand that I have stage II breast cancer and I need to decide on a surgery, but I feel overwhelmed. 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 a decision about your health." d. "There is no need to make a decision rapidly; you have time to think about this."

B Inquiring about the patient's understanding shows the nurse's willingness to assist the patient with the decision-making process without imposing the nurse's values or opinions. Treatment decisions for breast cancer do need to be made relatively quickly. Imposing the nurse's opinions or showing an unwillingness to discuss the topic could cut off communication.

Which assessment finding in a 36-yr-old patient is most indicative of a need for further evaluation? a. Bilateral breast nodules that are tender with palpation b. A breast nodule that is 1 cm in size, nontender, and fixed c. A breast lump that increases in size before the menstrual period d. A breast lump that is small, mobile, with a rubbery consistency

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

The nurse is providing preoperative teaching about the transverse rectus abdominis musculocutaneous (TRAM) procedure to a patient. Which information will the nurse include? 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 removed from the back is used to form a breast. d. TRAM flap procedures may be done in outpatient surgery centers.

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.

Which patient statement indicates that the nurse's teaching about tamoxifen has been effective? a. "I can expect to have leg cramps." b. "I will call if I have any eye problems." c. "I should contact you if I have hot flashes." d. "I will be taking the medication for 6 to 12 months."

B 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.

Which information should the nurse include in teaching a patient who is scheduled for external beam radiation to the breast? 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.

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. Scalp hair loss does not occur with breast radiation therapy. Because the patient does not have radioactive implants, no visitor restrictions are necessary.

The nurse notes bilateral enlargement of the breasts during examination of a 62-yr-old male patient. Which action should the nurse take first? a. Refer the patient for mammography. b. Question the patient about current medications. c. Explain that this is temporary due to hormonal changes. d. Teach the patient how to palpate the breast tissue for lumps.

B The first action should be further assessment. Because 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.

The nurse provides discharge teaching for a 61-yr-old 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."

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.

A 33-yr-old 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 a 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.

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.

Physiological Integrity 25. A 31-year-old patient who has been diagnosed with human papillomavirus (HPV) infection gives a health history that includes smoking tobacco, taking oral contraceptives, and having been treated twice for vaginal candidiasis. Which topic will the nurse include in patient teaching? a. Use of water-soluble lubricants b. Risk factors for cervical cancer c. Antifungal cream administration d. Possible difficulties with conception

B Because HPV infection and smoking are both associated with increased cervical cancer risk, the nurse should emphasize the importance of avoiding smoking. An HPV infection does not decrease vaginal lubrication, decrease ability to conceive, or require the use of antifungal creams. DIF: Cognitive Level: Apply (application) REF: 1292 TOP: Nursing Process: Implementation MSC:

Physiological Integrity 9. When caring for a 58-year-old patient with persistent menorrhagia, the nurse will plan to monitor the a. estrogen level. b. complete blood count (CBC). c. gonadotropin-releasing hormone (GNRH) level. d. serial human chorionic gonadotropin (hCG) results.

B Because anemia is a likely complication of menorrhagia, the nurse will need to check the CBC. Estrogen and GNRH levels are checked for patients with other problems, such as infertility. Serial hCG levels are monitored in patients who may be pregnant, which is not likely for this patient. DIF: Cognitive Level: Apply (application) REF: 1281 TOP: Nursing Process: Planning MSC:

Health Promotion and Maintenance 4. A 25-year-old woman has an induced abortion with suction curettage at an ambulatory surgical center. Which instructions will the nurse include when discharging the patient? a. "Heavy vaginal bleeding is expected for about 2 weeks." b. "You should abstain from sexual intercourse for 2 weeks." c. "Contraceptives should be avoided until your reexamination." d. "Irregular menstrual periods are expected for the next few months."

B Because infection is a possible complication of this procedure, the patient is advised to avoid intercourse until the reexamination in 2 weeks. Patients may be started on contraceptives on the day of the procedure. The patient should call the doctor if heavy vaginal bleeding occurs. No change in the regularity of the menstrual periods is expected. DIF: Cognitive Level: Apply (application) REF: 1279 TOP: Nursing Process: Implementation MSC:

Physiological Integrity 24. The nurse will plan to teach a 34-year-old patient diagnosed with stage 0 cervical cancer about a. radiation. b. conization. c. chemotherapy. d. radical hysterectomy.

B Because the carcinoma is in situ, conization can be used for treatment. Radical hysterectomy, chemotherapy, or radiation will not be needed. DIF: Cognitive Level: Apply (application) REF: 1293 TOP: Nursing Process: Planning MSC:

Health Promotion and Maintenance 8. A 32-year-old who was admitted to the emergency department with severe abdominal pain is diagnosed with an ectopic pregnancy. The patient begins to cry and asks the nurse to leave her alone to grieve. Which action should the nurse take next? a. Stay with the patient and encourage her to discuss her feelings. b. Explain the reason for taking vital signs every 15 to 30 minutes. c. Close the door to the patient's room and minimize disturbances. d. Provide teaching about options for termination of the pregnancy.

B Because the patient is at risk for rupture of the fallopian tube and hemorrhage, frequent monitoring of vital signs is needed. The patient has asked to be left alone, so staying with her and encouraging her to discuss her feelings are inappropriate actions. Minimizing contact with her and closing the door of the room is unsafe because of the risk for hemorrhage. Because the patient has requested time to grieve, it would be inappropriate to provide teaching about options for pregnancy termination. DIF: Cognitive Level: Apply (application) REF: 1298 TOP: Nursing Process: Implementation MSC:

Psychosocial Integrity 3. A 29-year-old patient who is trying to become pregnant asks the nurse how to determine when she is most likely to conceive. The nurse explains that a. ovulation is unpredictable unless there are regular menstrual periods. b. ovulation prediction kits provide accurate information about ovulation. c. she will need to bring a specimen of cervical mucus to the clinic for testing. d. she should take her body temperature daily and have intercourse when it drops.

B Ovulation prediction kits indicate when luteinizing hormone (LH) levels first rise. Ovulation occurs about 28 to 36 hours after the first rise of LH. This information can be used to determine the best time for intercourse. Body temperature rises at ovulation. Postcoital cervical smears are used in infertility testing, but they do not predict the best time for conceiving and are not obtained by the patient. Determination of the time of ovulation can be predicted by basal body temperature charts or ovulation prediction kits and is not dependent on regular menstrual periods. DIF: Cognitive Level: Apply (application) REF: 1277 TOP: Nursing Process: Implementation MSC:

Health Promotion and Maintenance 46. A healthy 28-year-old who has been vaccinated against human papillomavirus (HPV) has a normal Pap test. Which information will the nurse include in patient teaching when calling the patient with the results of the Pap test? a. You can wait until age 30 before having another Pap test. b. Pap testing is recommended every 3 years for women your age. c. No further Pap testing is needed until you decide to become pregnant. d. Yearly Pap testing is suggested for women with multiple sexual partners.

B The current national guidelines suggest Pap testing every 3 years for patients between ages 21 to 65. Although HPV immunization does protect against cervical cancer, the recommendations are unchanged for individuals who have received the HPV vaccination. DIF: Cognitive Level: Understand (comprehension) REF: 1293 TOP: Nursing Process: Planning MSC:

Physiological Integrity 16. A 24-year-old patient with pelvic inflammatory disease (PID) is being treated with oral antibiotics as an outpatient. Which instruction will be included in patient teaching? a. Abdominal pain may persist for several weeks. b. Return for a follow-up appointment in 2 to 3 days. c. Instruct a male partner to use a condom during sexual intercourse for the next week. d. Nonsteroidal antiinflammatory drug (NSAID) use may prevent pelvic organ scarring

B The patient is instructed to return for follow-up in 48 to 72 hours. The patient should abstain from intercourse for 3 weeks. Abdominal pain should subside with effective antibiotic therapy. Corticosteroids may help prevent inflammation and scarring, but NSAIDs will not decrease scarring. DIF: Cognitive Level: Apply (application) REF: 1288 TOP: Nursing Process: Implementation MSC:

Physiological Integrity 28. A 63-year-old woman undergoes an anterior and posterior (A&P) colporrhaphy for repair of a cystocele and rectocele. Which nursing action will be included in the postoperative care plan? a. Encourage a high-fiber diet. b. Perform indwelling catheter care. c. Repack the vagina with gauze daily. d. Teach the patient to insert a pessary.

B The patient will have a retention catheter for several days after surgery to keep the bladder empty and decrease strain on the suture. A pessary will not be needed after the surgery. Vaginal wound packing is not usually used after an A&P repair. A low-residue diet will be ordered after posterior colporrhaphy. DIF: Cognitive Level: Apply (application) REF: 1301 TOP: Nursing Process: Planning MSC:

1. A 34-year-old woman who is discussing contraceptive options with the nurse says, "I want to have children, but not for a few years." Which response by the nurse is appropriate? a. "If you do not become pregnant within the next few years, you never will." b. "You may have more difficulty becoming pregnant after about age 35." c. "You have many years of fertility left, so there is no rush to have children." d. "You should plan to stop taking oral contraceptives several years before you want to become pregnant."

B The probability of successfully becoming pregnant decreases after age 35, although some patients may have no difficulty in becoming pregnant. Oral contraceptives do not need to be withdrawn for several years for a woman to become pregnant. Although the patient may be fertile for many years, it would be inaccurate to indicate that there is no concern about fertility as she becomes older. Although the risk for infertility increases after age 35, not all patients have difficulty in conceiving. DIF: Cognitive Level: Apply (application) REF: 1283 TOP: Nursing Process: Implementation MSC:

Health Promotion and Maintenance 37. Which assessment finding in a woman who recently started taking hormone therapy (HT) is most important for the nurse to report to the health care provider? a. Breast tenderness b. Left calf swelling c. Weight gain of 3 lb d. Intermittent spotting

B Unilateral calf swelling may indicate deep vein thrombosis caused by the changes in coagulation associated with HT and would indicate that the HT should be discontinued. Breast tenderness, weight gain, and intermittent spotting are common side effects of HT and do not indicate a need for a change in therapy. DIF: Cognitive Level: Apply (application) REF: 1284 OBJ: Special Questions: Prioritization TOP: Nursing Process: Evaluation MSC:

Health Promotion and Maintenance 5. A 32-year-old woman is scheduled for an induced abortion using instillation of hypertonic saline solution. Which information will the nurse plan to discuss with the patient before the procedure? a. The patient will require a general anesthetic. b. The expulsion of the fetus may take 1 to 2 days. c. There is a possibility that the patient may deliver a live fetus. d. The procedure may be unsuccessful in terminating the pregnancy.

B Uterine contractions take 12 to 36 hours to begin after the hypertonic saline is instilled. Because the saline is feticidal, the nurse does not need to discuss any possibility of a live delivery or that the pregnancy termination will not be successful. General anesthesia is not needed for this procedure. DIF: Cognitive Level: Apply (application) REF: 1278 TOP: Nursing Process: Implementation MSC:

Physiological Integrity 17. A 32-year-old patient has oral contraceptives prescribed for endometriosis. The nurse will teach the patient to a. expect to experience side effects such as facial hair. b. take the medication every day for the next 9 months. c. take calcium supplements to prevent developing osteoporosis during therapy. d. use a second method of contraception to ensure that she will not become pregnant.

B When oral contraceptives are prescribed to treat endometriosis, the patient should take the medications continuously for 9 months. Facial hair is a side effect of synthetic androgens. The patient does not need to use additional contraceptive methods. The hormones in oral contraceptives will protect against osteoporosis. DIF: Cognitive Level: Apply (application) REF: 1290 TOP: Nursing Process: Implementation MSC:

Health Promotion and Maintenance 2. Which nursing actions can the nurse working in a women's health clinic delegate to unlicensed assistive personnel (UAP) (select all that apply)? a. Call a patient with the results of an endometrial biopsy. b. Assist the health care provider with performing a Pap test. c. Draw blood for CA-125 levels for a patient with ovarian cancer. d. Screen a patient for use of medications that may cause amenorrhea. e. Teach the parent of a 10-year-old about the human papilloma virus (HPV) vaccine (Gardasil).

B, C Assisting with a Pap test and drawing blood (if trained) are skills that require minimal critical thinking and judgment and can be safely delegated to UAP. Patient teaching, calling a patient who may have questions about results of diagnostic testing, and risk-factor screening all require more education and critical thinking and should be done by the registered nurse (RN). DIF: Cognitive Level: Apply (application) REF: 15-16 OBJ: Special Questions: Delegation TOP: Nursing Process: Planning MSC:

A nurse is assessing the risk behaviors for the spread of sexually transmitted infections (STIs) in a group of people. Which patients are at high risk of contracting an STI? Select all that apply. A. A woman who has not had a sexual relationship B. A man having sexual relationships with multiple partners C. A woman having polygamous relationships and who is on oral contraceptive pills D. A man having a monogamous relationship with his partner and using a condom E. A woman having a monogamous relationship, whose partner has a history of a recent STI F. A man having a monogamous relationship who uses condoms but often consumes drugs with shared needles

B. A man having sexual relationships with multiple partners C. A woman having polygamous relationships and who is on oral contraceptive pills E. A woman having a monogamous relationship, whose partner has a history of a recent STI F. A man having a monogamous relationship who uses condoms but often consumes drugs with shared needles

The patient is being treated for a recurrent episode of chlamydia. What should the nurse include in this teaching? A. If you are treated, your sexual partner will not need to be treated. B. Abstain from sexual intercourse for seven days after finishing the treatment. C. You will probably get gonorrhea if you have another recurrence of chlamydia. D. Because you have been treated before, you do not need to take a full course of medication this time.

B. Abstain from sexual intercourse for seven days after finishing the treatment.

The nurse is educating a patient about the advantages of acyclovir therapy for herpes infection. What information should the nurse include? Select all that apply. A. Acyclovir cures herpes infection. B. Acyclovir shortens the duration of viral shedding. C. Acyclovir shortens the healing time of genital lesions. D. Acyclovir makes the patient noninfectious. E. Acyclovir reduces outbreaks of the lesions.

B. Acyclovir shortens the duration of viral shedding. C. Acyclovir shortens the healing time of genital lesions. E. Acyclovir reduces outbreaks of the lesions.

A patient is diagnosed with genital herpes infection. What symptoms assessed in the patient should be reported immediately? Select all that apply. A. Diarrhea B. Constipation C. Atonic bladder D. Disorientation or confusion E. Burning sensation in the vesicles

B. Constipation C. Atonic bladder D. Disorientation or confusion

The newborn nursery nurse administers Erythromycin ophthalmic ointment prophylactically to a neonate to prevent blindness. What is the nurse explanation to the parent as to why this is being done? A. Due to potential exposure to syphilis B. Due to potential exposure to gonorrhea C. Due to potential exposure to chlamydia D. Due to potential exposure to Pseudomonas

B. Due to potential exposure to gonorrhea

A pregnant woman with a sexually transmitted infection (STI) is admitted in labor. Which STIs would support the need for a cesarean delivery? Select all that apply. A. Chlamydial infection B. Genital warts blocking the cervix C. Active lesions of genital herpes D. Syphilis E. Gonorrheal infection with purulent discharge from the cervix

B. Genital warts blocking the cervix C. Active lesions of genital herpes

A patient with genital herpes reports severe pain and a burning sensation during urination. What are the measures that a nurse can implement to ease this discomfort? Select all that apply. A. Catheterize the patient. B. Give frequent sitz baths to sooth the area. C. Advise the patient to void urine in a warm tub of water or a warm shower. D. Keep the patient on a fluid-only diet and do not allow the patient to move about. E. Use drying agents, such as colloidal oatmeal and aluminum salts, and local anesthetics, such as lidocaine.

B. Give frequent sitz baths to sooth the area. C. Advise the patient to void urine in a warm tub of water or a warm shower. E. Use drying agents, such as colloidal oatmeal and aluminum salts, and local anesthetics, such as lidocaine.

A patient reports dysuria and profuse purulent urethral discharge. During the assessment, the nurse finds that the patient's testicles are swollen and performs a nucleic acid amplification test as prescribed. Which disease does nurse anticipate on the basis of the assessment data? A. Syphilis B. Gonorrhea C. Genital warts D. Chlamydial infection

B. Gonorrhea

A patient has tested positive for syphilis. For which other condition should the patient be tested for, based on the positive syphilis test result? A. Tuberculosis B. Human immunodeficiency virus (HIV) C. Genital warts D. Diabetes type 2

B. Human immunodeficiency virus (HIV)

A patient suspected of neurosyphilis underwent cerebrospinal fluid (CSF) analysis. What changes in the CSF does the nurse recognize will indicate neurosyphilis? Select all that apply. A. Increased sugar levels B. Increased white blood cell count C. Increased total proteins D. A positive treponemal antibody test E. Increased creatinine levels

B. Increased white blood cell count C. Increased total proteins D. A positive treponemal antibody tesT

A patient who does not exhibit signs or symptoms of syphilis receives a positive treponemal antibody test result. On the basis of these data, which stage of syphilis does the nurse suspect? A. Late B. Latent C. Primary D. Secondary

B. Latent

The health care provider advises expedited partner therapy (EPT) to a patient with a sexually transmitted infection (STI). What should the nurse explain to this patient about EPT? A. The patient should cut off all ties with the partner because the patient will become reinfected. B. Prescription or medications can be given to the patient's partner; no examination is required. C. The partner of the concerned patient will be examined and will be advised if treatment is needed. D. The partner of the patient will be given a vaccine to prevent transmission of the sexually transmitted infection.

B. Prescription or medications can be given to the patient's partner; no examination is required.

A nurse is screening a person for syphilis. What are the behavior patterns that contribute to an increased risk for developing syphilis? Select all that apply. A. Consumption of polluted water in an area with a high incidence of syphilis B. Sexual intercourse with an infected person C. Sharing of intravenous needles for drugs D. Consumption of food prepared by a person who has syphilis E. Contact with lesions of a person with syphilis

B. Sexual intercourse with an infected person C. Sharing of intravenous needles for drugs E. Contact with lesions of a person with syphilis

The nurse is assessing a patient suspected of being infected with gonorrhea. What symptom elicited by a nurse assessing a male patient correlates with this suspicion? A. Scrotal edema B. Urethral discharge C. A rash on the penis D. Enlarged inguinal lymph nodes

B. Urethral discharge

In telling a patient with infertility what she and her partner can expect, the nurse explains that: A. ovulatory studies can help determine tube patency B. a hysterosalpingogram is a common diagnostic study C. the cause will remain unexplained for 40% of couples D. if postcoital studies are normal, infection tests will be done

B. a hysterosalpingogram is a common diagnostic study

The nurse teaches a 30-yr-old man with a family history of prostate cancer about dietary factors associated with prostate cancer. The nurse determines that teaching is successful if the patient selects which menu? Grilled steak, French fries, and vanilla shake Hamburger with cheese, pudding, and coffee Baked chicken, peas, apple slices, and skim milk Grilled cheese sandwich, onion rings, and hot tea

Baked chicken, peas, apple slices, and skim milk A diet high in red meat and high-fat dairy products along with a low intake of vegetables and fruits may increase the risk of prostate cancer.

A 73-yr-old male patient admitted for total knee replacement states during the health history interview that he has no problems with urinary elimination except that the "stream is less than it used to be." The nurse should give anticipatory guidance regarding what condition? A tumor of the prostate Benign prostatic hyperplasia Bladder atony because of age Age-related altered innervation of the bladder

Benign prostatic hyperplasia Benign prostatic hyperplasia is an enlarged prostate gland because of an increased number of epithelial cells and stromal tissue. It occurs in about 50% of men older than age 50 years and 80% of men older than age 80 years. Only about 16% of men develop prostate cancer. Bladder atony and age-related altered innervations of the bladder do not lead to a weakened stream.

A 53-yr-old woman who is experiencing menopause is discussing the use of hormone therapy (HT) with the nurse. Which information about the risk of breast cancer will the nurse provide? a. HT is a safe therapy for menopausal symptoms if there is no family history of BRCA genes. b. HT does not appear to increase the risk for breast cancer unless there are other risk factors. c. The patient and her health care provider must weigh the benefits of HT against the risks of breast cancer. d. Natural herbs are as effective as estrogen in relieving symptoms without increasing the risk of breast cancer.

C Because HT has been linked to increased risk for breast cancer, the patient and health care provider must determine whether or not to use HT. Breast cancer incidence is increased in women using HT, independent of other risk factors. HT 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.

The nurse is caring for a patient with breast cancer who is receiving chemotherapy with doxorubicin and cyclophosphamide. Which assessment finding is most important to communicate to the health care provider? a. The patient complains of fatigue. b. The patient eats only 25% of meals. c. The patient's apical pulse is irregular. d. The patient's white blood cell (WBC) count is 5000/μL.

C Doxorubicin can cause cardiac toxicity. The dysrhythmia should be reported because it may indicate a need for a change in therapy. Anorexia, fatigue, and a low-normal WBC count are expected effects of chemotherapy.

During a well-woman physical examination, a 43-yr-old patient asks about her risk for breast cancer. Which question is most pertinent for the nurse to ask? a. "Do you currently smoke tobacco?" b. "Have you ever had a breast injury?" c. "At what age did you start having menstrual periods?" d. "Is there a family history of fibrocystic breast changes?"

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.

Client Needs: Health Promotion and Maintenance 7. In describing the size and shape of the nonpregnant uterus to a patient, the nurse would say it is approximately the size and shape of a a. Cantaloupe b. Grapefruit c. Pear d. Large orange

C Feedback A A cantaloupe is too large and the wrong shape for the uterus. B A grapefruit is too large for the nonpregnant uterus, and the uterus is larger at the upper end and tapers down. C The nonpregnant uterus is approximately 7.5 ´ 5.0 ´ 2.5 cm, which is close to the size and shape of a pear. D An orange may be the appropriate size, but it is not the appropriate shape. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 204 OBJ: Nursing Process: Implementation

Client Needs: Physiologic Integrity 6. It is important for the nurse to understand that the levator ani is a(n) a. Imaginary line that divides the true and false pelvis b. Basin-shaped structure at the lower end of the spine c. Collection of three pairs of muscles d. Division of the fallopian tube

C Feedback A The linea terminalis is the imaginary line that divides the false pelvis from the true pelvis. B The basin-shaped structure at the lower end of the spine is the bony pelvis. C The levator ani is a collection of three pairs of muscles that support internal pelvic structures and resist increases in intraabdominal pressure. D The fallopian tube divisions are the interstitial portion, isthmus, ampulla, and infundibulum. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 206 OBJ: Nursing Process: Assessment

Client Needs: Health Promotion and Maintenance 9. A patient states, "My breasts are so small, I don't think I will be able to breastfeed." The nurse's best response is a. "It may be difficult, but you should try anyway." b. "You can always supplement with formula." c. "All women have approximately the same amount of glandular tissue to secrete milk." d. "The ability to produce breast milk depends on increased levels of estrogen and progesterone."

C Feedback A The size of the breasts does not ensure success or failure in breastfeeding. B Supplementation decreases the production of breast milk by decreasing stimulation. Stimulation of the breast, not the size of the breast, brings about milk production. C All women have 15 to 20 lobes arranged around and behind the nipple and areola. These lobes, not the size of the breast, are responsible for milk production. D Increased levels of estrogen decrease the production of milk by affecting prolactin. PTS: 1 DIF: Cognitive Level: Application REF: p. 210 OBJ: Nursing Process: Implementation

Client Needs: Health Promotion and Maintenance 5. Which 16-year-old female is most likely to experience secondary amenorrhea? a. A girl who is 5 ft 2 in, 130 lb b. A girl who is 5 ft 9 in, 150 lb c. A girl who is 5 ft 7 in, 96 lb d. A girl who is 5 ft 4 in, 120 lb

C Feedback A This girl's (5 ft 2 in, 130 lb) body mass index (BMI) is sufficient to assist with sex hormone production. A low BMI (or body fat) is a risk factor for secondary amenorrhea. B This girl's (5 ft 9 in, 150 lb) BMI is sufficient to assist with sex hormone production. Low body fat is a risk factor for secondary amenorrhea. C Because of her height and low body weight, a female who is 5 ft 7 in and 96 lb is at risk of developing secondary amenorrhea, which occurs in women who are thin and have a low percentage of body fat. Fat is necessary to make sex hormones that stimulate ovulation and menstruation. D This girl's (5 ft 4 in, 120 lb) body fat is sufficient to assist with sex hormone production. Low BMIs are a risk factor for secondary amenorrhea. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 201 OBJ: Nursing Process: Assessment

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

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.

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

C 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.

Safe and Effective Care Environment 43. Which information will the nurse include when teaching a patient who has developed a small vesicovaginal fistula 2 weeks into the postpartum period? a. Take stool softeners to prevent fecal contamination of the vagina. b. Limit oral fluid intake to minimize the quantity of urinary drainage. c. Change the perineal pad frequently to prevent perineal skin breakdown. d. Call the health care provider immediately if urine drains from the vagina.

C Because urine will leak from the bladder, the patient should plan to use perineal pads and change them frequently. A high fluid intake is recommended to decrease the risk for urinary tract infections. Drainage of urine from the vagina is expected with vesicovaginal fistulas. Fecal contamination is not a concern with vesicovaginal fistulas. DIF: Cognitive Level: Apply (application) REF: 1301 TOP: Nursing Process: Planning MSC:

Physiological Integrity 14. A 25-year-old woman who is scheduled for a routine gynecologic examination tells the nurse that she has had intercourse during the last year with several men. The nurse will plan to teach about the reason for a. contraceptive use. b. antibiotic therapy. c. Chlamydia testing. d. pregnancy testing.

C Chlamydia testing is recommended annually for women with multiple sex partners. There is no indication that the patient needs teaching about contraceptives, pregnancy testing, or antibiotic therapy. DIF: Cognitive Level: Apply (application) REF: 1287 TOP: Nursing Process: Planning MSC:

Health Promotion and Maintenance 11. A 49-year-old woman is considering the use of combined estrogen-progesterone hormone replacement therapy (HT) during menopause. Which information will the nurse include during their discussion? a. Use of estrogen-containing vaginal creams provides most of the same benefits as oral HT. b. Increased incidence of colon cancer in women taking HT requires more frequent colonoscopy. c. HT decreases osteoporosis risk and increases the risk for cardiovascular disease and breast cancer. d. Use of HT for up to 10 years to prevent symptoms such as hot flashes is generally considered safe.

C Data from the Women's Health Initiative indicate an increased risk for cardiovascular disease and breast cancer in women taking combination HT but a decrease in hip fractures. Vaginal creams decrease symptoms related to vaginal atrophy and dryness, but they do not offer the other benefits of HT, such as decreased hot flashes. Most women who use HT are placed on short-term treatment and are not treated for up to 10 years. The incidence of colon cancer decreases in women taking HRT. DIF: Cognitive Level: Apply (application) REF: 1284 TOP: Nursing Process: Implementation MSC:

Physiological Integrity 41. A 27-year-old patient tells the nurse that she would like a prescription for oral contraceptives to control her premenstrual dysphoric disorder (PMD-D) symptoms. Which patient information is most important to communicate to the health care provider? a. Bilateral breast tenderness b. Frequent abdominal bloating c. History of migraine headaches d. Previous spontaneous abortion

C Oral contraceptives are contraindicated in patients with a history of migraine headaches. The other patient information would not prevent the patient from receiving oral contraceptives. DIF: Cognitive Level: Apply (application) REF: 1280 TOP: Nursing Process: Assessment MSC:

Health Promotion and Maintenance 36. An 18-year-old requests a prescription for birth control pills to control severe abdominal cramping and headaches during her menstrual periods. Which should the nurse take first? a. Determine whether the patient is sexually active. b. Teach about the side effects of oral contraceptives. c. Take a personal and family health history from the patient. d. Suggest nonsteroidal antiinflammatory drugs (NSAIDs) for relief.

C Oral contraceptives may be appropriate to control this patient's symptoms, but the patient's health history may indicate contraindications to oral contraceptive use. Because the patient is requesting contraceptives for management of dysmenorrhea, whether she is sexually active is irrelevant. Because the patient is asking for birth control pills, responding that she should try NSAIDs is nontherapeutic. The patient does not need teaching about oral contraceptive side effects at this time. DIF: Cognitive Level: Apply (application) REF: 1280 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC:

Safe and Effective Care Environment 23. Which patient in the women's health clinic will the nurse expect to teach about an endometrial biopsy? a. The 55-year-old patient who has 3 to 4 alcoholic drinks each day b. The 35-year-old patient who has used oral contraceptives for 15 years c. The 25-year-old patient who has a family history of hereditary nonpolyposis colorectal cancer d. The 45-year-old patient who has had 6 full-term pregnancies and 2 spontaneous abortions

C Patients with a personal or familial history of hereditary nonpolyposis colorectal cancer are at increased risk for endometrial cancer. Alcohol addiction does not increase this risk. Multiple pregnancies and oral contraceptive use offer protection from endometrial cancer. DIF: Cognitive Level: Apply (application) REF: 1294 OBJ: Special Questions: Multiple Patients TOP: Nursing Process: Assessment MSC:

Safe and Effective Care Environment 35. Which action should the nurse take when a 35-year-old patient has a result of minor cellular changes on her Pap test? a. Teach the patient about colposcopy. b. Teach the patient about punch biopsy. c. Schedule another Pap test in 4 months. d. Administer the human papillomavirus (HPV) vaccine.

C Patients with minor changes on the Pap test can be followed with Pap tests every 4 to 6 months because these changes may revert to normal. Punch biopsy or colposcopy may be used if the Pap test shows more prominent changes. The HPV vaccine may reduce the risk for cervical cancer, but it is recommended only for ages 9 through 26. DIF: Cognitive Level: Apply (application) REF: 1293 TOP: Nursing Process: Implementation MSC:

Health Promotion and Maintenance 15. The nurse is caring for a 20-year-old patient with pelvic inflammatory disease (PID) requiring hospitalization. Which nursing intervention will be included in the plan of care? a. Monitor liver function tests. b. Use cold packs PRN for pelvic pain. c. Elevate the head of the bed to at least 30 degrees. d. Teach the patient how to perform Kegel exercises.

C The head of the bed should be elevated to at least 30 degrees to promote drainage of the pelvic cavity and prevent abscess formation higher in the abdomen. Although a possible complication of PID is acute perihepatitis, liver function tests will remain normal. There is no indication for increased fluid intake. Application of heat is used to reduce pain. Kegel exercises are not helpful in PID. DIF: Cognitive Level: Apply (application) REF: 1288 TOP: Nursing Process: Planning MSC:

Physiological Integrity 10. A 47-year-old woman asks whether she is going into menopause if she has not had a menstrual period for 3 months. The best response by the nurse is which of the following? a. "Have you thought about using hormone replacement therapy?" b. "Most women feel a little depressed about entering menopause." c. "What was your menstrual pattern before your periods stopped?" d. "Since you are in your mid-40s, it is likely that you are menopausal."

C The initial response by the nurse should be to assess the patient's baseline menstrual pattern. Although many women do enter menopause in the mid-40s, more information about this patient is needed before telling her that it is likely she is menopausal. Although hormone therapy (HT) may be prescribed, further assessment of the patient is needed before discussing therapies for menopause. Because the response to menopause is very individual, the nurse should not assume that the patient is experiencing any adverse emotional reactions. DIF: Cognitive Level: Apply (application) REF: 1283-1285 TOP: Nursing Process: Implementation MSC:

Physiological Integrity 21. A nursing diagnosis that is likely to be appropriate for a 67-year-old woman who has just been diagnosed with stage III ovarian cancer is a. sexual dysfunction related to loss of vaginal sensation. b. risk for infection related to impaired immune function. c. anxiety related to cancer diagnosis and need for treatment decisions. d. situational low self-esteem related to guilt about delaying medical care.

C The patient with stage III ovarian cancer is likely to be anxious about the poor prognosis and about the need to make decisions about the multiple treatments that may be used. Decreased vaginal sensation does not occur with ovarian cancer. The patient may develop immune dysfunction when she receives chemotherapy, but she is not currently at risk. It is unlikely that the patient has delayed seeking medical care because the symptoms of ovarian cancer are vague and occur late in the course of the cancer. DIF: Cognitive Level: Apply (application) REF: 1298 TOP: Nursing Process: Analysis MSC:

Health Promotion and Maintenance 42. The nurse has just received change-of-shift report about the following four patients. Which patient should be assessed first? a. A patient with a cervical radium implant in place who is crying in her room b. A patient who is complaining of 5/10 pain after an abdominal hysterectomy c. A patient with a possible ectopic pregnancy who is complaining of shoulder pain d. A patient in the fifteenth week of gestation who has uterine cramping and spotting

C The patient with the ectopic pregnancy has symptoms consistent with rupture and needs immediate assessment for signs of hemorrhage and possible transfer to surgery. The other patients should also be assessed as quickly as possible but do not have symptoms of life-threatening complications. DIF: Cognitive Level: Analyze (analysis) REF: 1282 OBJ: Special Questions: Prioritization; Multiple Patients TOP: Nursing Process: Assessment MSC:

Health Promotion and Maintenance 12. A female patient tells the nurse that she has been having nightmares and acute anxiety around men since being sexually assaulted 3 months ago. The most appropriate nursing diagnosis for the patient is a. anxiety related to effects of being raped. b. sleep deprivation related to frightening dreams. c. rape-trauma syndrome related to rape experience. d. ineffective coping related to inability to resolve incident.

C The patient's symptoms are most consistent with the nursing diagnosis of rape-trauma syndrome. The nursing diagnoses of sleep deprivation, ineffective coping, and anxiety address some aspects of the patient's symptoms but do not address the problem as completely as the rape-trauma syndrome diagnosis. DIF: Cognitive Level: Apply (application) REF: 1302 TOP: Nursing Process: Diagnosis MSC:

Health Promotion and Maintenance 2. The nurse in the infertility clinic is explaining in vitro fertilization (IVF) to a couple. The woman tells the nurse that they cannot afford IVF on her husband's salary. The man replies that if his wife worked outside the home, they would have enough money. Which nursing diagnosis is appropriate? a. Decisional conflict related to inadequate financial resources b. Ineffective sexuality patterns related to psychological stress c. Defensive coping related to anxiety about lack of conception d. Ineffective denial related to frustration about continued infertility

C The statements made by the couple are consistent with the diagnosis of defensive coping. No data indicate that ineffective sexuality and ineffective denial are problems. Although the couple is quarreling about finances, the data do not provide information indicating that the finances are inadequate. DIF: Cognitive Level: Apply (application) REF: 1278 TOP: Nursing Process: Diagnosis MSC:

A woman infected with gonorrhea has a vaginal birth. What precautions should the nurse follow to protect the baby from complications of gonorrhea? Select all that apply. A. Administer paracetamol drops to the baby. B. Administer amoxicillin solution to the baby. C. Administer silver nitrate aqueous solution to the baby. D. Administer erythromycin ophthalmic ointment to the baby. E. Administer an intramuscular dose of ceftriaxone to the baby.

C. Administer silver nitrate aqueous solution to the baby. D. Administer erythromycin ophthalmic ointment to the baby.

When evaluating a patient for sexually transmitted infections (STIs), the nurse is aware that which STI is the most common bacterial STI? A. Gonorrhea B. Syphilis C. Chlamydia D. Trichomoniasis

C. Chlamydia

A patient is on intravenous acyclovir for management of genital herpes-related pneumonitis. For which symptoms should the nurse look in this patient? Select all that apply. A. Disorientation B. Loss of sense of taste C. Elevated creatinine levels D. Decreased urinary output E. Peripheral edema, especially in the feet

C. Elevated creatinine levels D. Decreased urinary output E. Peripheral edema, especially in the feet

When collecting health history from a patient with chlamydial infection, what symptoms is the patient likely to report? Select all that apply. A. Bleeding from the anus B. Tenesmus C. Frequent and painful urination D. Pain during intercourse E. Menstrual abnormalities

C. Frequent and painful urination D. Pain during intercourse E. Menstrual abnormalities

A female patient reports the recent appearance of itchy lesions on her vulva, some of which have burst recently. What problem should the nurse first suspect related to the patient's description of her problem? A. Gonorrhea B. Chlamydia C. Genital herpes D. Human immunodeficiency virus (HIV)

C. Genital herpes

The nurse is educating a patient with genital warts about treatment options. Which treatment options are patient-managed? Select all that apply. A. 80% to 90% trichloroacetic acid B. Podophyllin resin (10% to 25%) C. Podofilox (5%) liquid D. Podofilox (5%) E. Imiquimod (5%) cream

C. Podofilox (5%) liquid D. Podofilox (5%) E. Imiquimod (5%) cream

There are several pregnant women ready to deliver their babies. Which woman should the nurse expect to require a cesarean section to deliver her baby? A. The woman who had contact with an individual with syphilis two weeks ago B. The woman who had treatment for gonococcal pharyngitis before conception C. The woman who has herpes simplex virus type 2 vesicles on her cervix at the time of delivery D. The woman who received treatment for Chlamydia trachomatis at her 20th week of gestation

C. The woman who has herpes simplex virus type 2 vesicles on her cervix at the time of delivery

A patient who is sexually active with multiple partners is at the clinic with symptoms of purulent vaginal discharge, dysuria, and dyspareunia. What should the nurse explain to the patient as the rationale for screening her for chlamydia? A. Chlamydia frequently is comorbid with human immunodeficiency virus (HIV). B. Chlamydial infections may progress to sepsis. C. Untreated chlamydial infections can lead to infertility. D. Chlamydial infections are treatable only in the early stages of infection.

C. Untreated chlamydial infections can lead to infertility.

A patient with a chlamydial infection has completed the course of treatment. What advice should the nurse provide to this patient to avoid reinfection? Select all that apply. A. Avoid heavy exercise. B. Use oral contraceptive pills. C. Use condoms in the future during sexual activity. D. Have the sexual partner or partners screened and treated. E. Avoid sexual intercourse for seven days after finishing treatment.

C. Use condoms in the future during sexual activity. D. Have the sexual partner or partners screened and treated. E. Avoid sexual intercourse for seven days after finishing treatment.

The nurse is educating a patient with a sexually transmitted infection about hygiene tips. What should the nurse include when discussing this with the patient? Select all that apply. A. Perform regular douching B. Avoid using public toilets C. Use cotton underwear D. Frequently wash hands and regularly bathe E. Avoid any physical contact with strangers

C. Use cotton underwear D. Frequently wash hands and regularly bathe

A patient is diagnosed with human papillomavirus (HPV) infection. What teaching should the nurse provide to the patient? A. The importance of taking Gardasil after diagnosis. B. Being sure to take all antibiotic therapy C. Wart removal options D. Treatment with antiviral drugs

C. Wart removal options

A patient is one day postoperative after a transurethral resection of the prostate (TURP). Which event is an unexpected finding? Requires two tablets of Tylenol #3 during the night Complains of fatigue and claims to have minimal appetite Continuous bladder irrigation (CBI) infusing, but output has decreased Expressed anxiety about his planned discharge home the following day

Continuous bladder irrigation (CBI) infusing, but output has decreased A decrease or cessation of output in a patient with CBI requires immediate intervention. The nurse should temporarily stop the CBI and attempt to resume output by repositioning the patient or irrigating the catheter. Complaints of pain, fatigue, and low appetite at this early postoperative stage are not unexpected. Discharge planning should be addressed, but this should not precede management of the patient's CBI.

The outpatient clinic receives telephone calls from four patients. Which patient should the nurse call back first? a. A 57-yr-old patient with ductal ectasia who has sticky multicolored nipple discharge and severe nipple itching b. A 21-yr-old patient with a family history of breast cancer who wants to discuss genetic testing for the BRCA gene c. A 40-yr-old patient who still has left side chest and arm pain 2 months after a left modified radical mastectomy d. A 50-yr-old patient with stage 2 breast cancer who is receiving doxorubicin and has ankle swelling and fatigue

D Although all the patients have needs that the nurse should address, the patient who is receiving a cardiotoxic medication and has symptoms of heart failure should be assessed by the nurse first. BRCA testing may be appropriate for the 21-yr-old patient, but it does not need to be done immediately. Chest and arm pain are normal up to 3 months after mastectomy. Nipple discharge and itching is a common finding with ductal ectasia.

The nurse is admitting a patient scheduled this morning for lumpectomy and axillary lymph node dissection. Which action should the nurse take first? 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.

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.

Client Needs: Physiologic Integrity 10. The function of the cremaster muscle in men is to a. Aid in voluntary control of excretion of urine. b. Entrap blood in the penis to produce an erection. c. Assist with transporting sperm. d. Aid in temperature control of the testicles.

D Feedback A The urinary meatus aids in controlling the excretion of urine. B Entrapment of the blood in the penis is a result of its spongy tissue. C Seminal fluid assists with transporting sperm. D A cremaster muscle is attached to each testicle. Its function is to bring the testicle closer to the body to warm it or allow it to fall away from the body to cool it, thus promoting normal sperm production. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 211 OBJ: Nursing Process: Assessment

Client Needs: Physiologic Integrity 2. Which combination of sex chromosomes is present in a female? a. XY b. XYY c. XXY d. XX

D Feedback An XY is the indication for a male. There are normally only two sex chromosomes. There are normally only two sex chromosomes. The combination of an X chromosome from each parent produces a female. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 200 OBJ: Nursing Process: Assessment

A patient has had left-sided lumpectomy (breast-conservation surgery) and an axillary lymph node dissection. Which nursing intervention is appropriate to delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Teaching the patient how to avoid injury to the left arm b. Assessing the patient's range of motion for the left arm c. Evaluating the patient's understanding of instructions about drain care d. Administering an analgesic 30 minutes before scheduled arm exercises

D LPN/LVN education and scope of practice include administration and evaluation of the effects of analgesics. Assessment, teaching, and evaluation of a patient's understanding of instructions are more complex tasks that are more appropriate to RN level education and scope of practice.

When the nurse is working in the women's health care clinic, which action is appropriate to take? a. Teach a healthy 30-yr-old patient about the need for an annual mammogram. b. Discuss scheduling an annual clinical breast examination with a 22-year-old patient. c. Explain to a 60-yr-old patient that mammography frequency can be reduced to every 3 years. d. Teach a 28-yr-old patient with a BRCA-1 mutation about magnetic resonance imaging (MRI).

D MRI (in addition to mammography) is recommended for women who are at high risk for breast cancer. A woman should have a clinical breast examination about every 3 years for women in their 20s and 30s and every year for women age 40 years and older. Annual mammograms are recommended for women older than 40 years of age.

The nurse teaching a young women's community service group about breast self- examination (BSE) will include 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 after the menstrual period is more comfortable.

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 mortality from breast cancer. BSE should be done monthly. Annual mammograms are not routinely scheduled for women younger than age 40 years, and newer guidelines suggest delaying them until age 50.

The nurse will teach a patient with metastatic breast cancer who has a new prescription for trastuzumab (Herceptin) that a. hot flashes may occur with the medication. b. serum electrolyte levels will be drawn monthly. c. the patient will need frequent eye examinations. d. the patient should call if she notices ankle swelling.

D Trastuzumab 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.

Physiological Integrity 40. The nurse notes that a patient who has a large cystocele, admitted 10 hours ago, has not yet voided. Which action should the nurse take first? a. Insert a straight catheter per the PRN order. b. Encourage the patient to increase oral fluids. c. Notify the health care provider of the inability to void. d. Use an ultrasound scanner to check for urinary retention.

D Because urinary retention is common with a large cystocele, the nurse's first action should be to use an ultrasound bladder scanner to check for the presence of urine in the bladder. The other actions may be appropriate, depending on the findings with the bladder scanner. DIF: Cognitive Level: Apply (application) REF: 1300-1301 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC:

Health Promotion and Maintenance 33. A 31-year-old patient has just been instructed in the treatment for a Chlamydia trachomatis vaginal infection. Which patient statement indicates that the nurse's teaching has been effective? a. "I can purchase an over-the-counter medication to treat this infection." b. "The symptoms are due to the overgrowth of normal vaginal bacteria." c. "The medication will need to be inserted once daily with an applicator." d. "Both my partner and I will need to take the medication for a full week."

D Chlamydia is a sexually transmitted bacterial infection that requires treatment of both partners with antibiotics for 7 days. The other statements are true for the treatment of Candida albicans infection. DIF: Cognitive Level: Apply (application) REF: 1287 TOP: Nursing Process: Evaluation MSC:

Physiological Integrity 29. A 49-year-old woman tells the nurse that she is postmenopausal but has occasional spotting. Which initial response by the nurse is most appropriate? a. "A frequent cause of spotting is endometrial cancer." b. "How long has it been since your last menstrual period?" c. "Breakthrough bleeding is not unusual in women your age." d. "Are you using prescription hormone replacement therapy?"

D In postmenopausal women, a common cause of spotting is hormone therapy (HT). Because breakthrough bleeding may be a sign of problems such as cancer or infection, the nurse would not imply that this is normal. The length of time since the last menstrual period is not relevant to the patient's symptoms. Although endometrial cancer may cause spotting, this information is not appropriate as an initial response. DIF: Cognitive Level: Apply (application) REF: 1281 | 1284 TOP: Nursing Process: Implementation MSC:

Health Promotion and Maintenance 7. A 19-year-old has been diagnosed with primary dysmenorrhea. How will the nurse suggest that the patient prevent discomfort? a. Avoid aerobic exercise during her menstrual period. b. Use cold packs on the abdomen and back for pain relief. c. Talk with her health care provider about beginning antidepressant therapy. d. Take nonsteroidal antiinflammatory drugs (NSAIDs) when her period starts.

D NSAIDs should be started as soon as the menstrual period begins and taken at regular intervals during the usual time frame in which pain occurs. Aerobic exercise may help reduce symptoms. Heat therapy, such as warm packs, is recommended for relief of pain. Antidepressant therapy is not a typical treatment for dysmenorrhea. DIF: Cognitive Level: Apply (application) REF: 1280 TOP: Nursing Process: Implementation MSC:

Physiological Integrity 19. A 28-year-old patient was recently diagnosed with polycystic ovary syndrome. It is most important for the nurse to teach the patient a. reasons for a total hysterectomy. b. how to decrease facial hair growth. c. ways to reduce the occurrence of acne. d. methods to maintain appropriate weight.

D Obesity exacerbates the problems associated with polycystic ovary syndrome, such as insulin resistance and type 2 diabetes. The nurse should also address the problems of acne and hirsutism, but these symptoms are lower priority because they do not have long-term health consequences. Although some patients do require total hysterectomy, this is usually performed only after other therapies have been unsuccessful. DIF: Cognitive Level: Apply (application) REF: 1292 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC:

Health Promotion and Maintenance 45. To prevent pregnancy in a patient who has been sexually assaulted, the nurse in the emergency department will plan to teach the patient about the use of a. mifepristone (RU-486). b. dilation and evacuation. c. methotrexate with misoprostol. d. levonorgestrel (Plan-B One-Step).

D Plan B One-Step reduces the risk of pregnancy when taken within 72 hours of intercourse. The other methods are used for therapeutic abortion, but not for pregnancy prevention after unprotected intercourse. DIF: Cognitive Level: Understand (comprehension) REF: 1303 TOP: Nursing Process: Planning MSC:

Physiological Integrity 22. When caring for a patient who has a radium implant for treatment of cancer of the cervix, the nurse will a. assist the patient to ambulate every 2 to 3 hours. b. use gloves and gown when changing the patient's bed. c. flush the toilet several times right after the patient voids. d. encourage the patient to discuss needs or concerns by telephone.

D The nurse should spend minimal time in the patient's room to avoid exposure to radiation. The patient and nurse can have longer conversations by telephone between the patient room and nursing station. To prevent displacement of the implant, absolute bed rest is required. Wearing of gloves and gown when changing linens, and flushing the toilet several times are not necessary because the isotope is confined to the implant. DIF: Cognitive Level: Apply (application) REF: 1297 | 1299 TOP: Nursing Process: Implementation MSC:

Health Promotion and Maintenance 47. The nurse in the women's health clinic has four patients who are waiting to be seen. Which patient should the nurse see first? a. 22-year-old with persistent red-brown vaginal drainage 3 days after having balloon thermotherapy b. 42-year-old with secondary amenorrhea who says that her last menstrual cycle was 3 months ago c. 35-year-old with heavy spotting after having a progestin-containing IUD (Mirena) inserted a month ago d. 19-year-old with menorrhagia who has been using superabsorbent tampons and has fever with weakness

D The patient's history and clinical manifestations suggest possible toxic shock syndrome, which will require rapid intervention. The symptoms for the other patients are consistent with their diagnoses and do not indicate life-threatening complications. DIF: Cognitive Level: Analyze (analysis) REF: 1282 OBJ: Special Questions: Prioritization; Multiple Patients TOP: Nursing Process: Assessment MSC:

A clinic nurse is seeing a patient who is receiving treatment for condylomata. The patient asks the nurse, "Why is it important to get this treatment?" What is the best response by the nurse? A. "If you don't take this treatment, then it will turn into gonorrhea." B. "The human papillomavirus (HPV) also can cause you to develop a herpes outbreak." C. "Genital warts make you more likely to develop recurrent urinary tract infections (UTIs)." D. "Because this sexually transmitted infection increases the risk of developing cervical cancer."

D. "Because this sexually transmitted infection increases the risk of developing cervical cancer."

The nurse has instructed a male patient who has gonorrhea about self-care. Which statement made by the patient indicates the need for further teaching? A. "I should ask my partner to get tested." B. "I need to take the antibiotics until they're finished." C. "I can keep taking showers while I'm getting treated." D. "I can have sex tonight as long as I make sure to wear a condom."

D. "I can have sex tonight as long as I make sure to wear a condom."

Upon examination of a male patient, the nurse notes profuse, purulent urethral discharge and the patient states that he has dysuria and "painful testicles." Based on these findings, which medication does the nurse anticipate the primary health care provider will prescribe? A. Acyclovir B. Penicillin G C. Podofilox D. Ceftriaxone

D. Ceftriaxone

The nurse is assessing a patient suspected of having syphilis. What medication should the nurse prepare to administer? A. Podophyllin resin B. Acyclovir C. Azithromycin D. Penicillin G benzathine

D. Penicillin G benzathine

To monitor the progression of decreased urinary stream, the nurse should encourage which type of regular screening? Uroflowmetry Transrectal ultrasound Digital rectal examination (DRE) Prostate-specific antigen (PSA) monitoring

Digital rectal examination (DRE) DRE is part of a regular physical examination and is a primary means of assessing symptoms of decreased urinary stream, which is often caused by benign prostatic hyperplasia (BPH) in men older than 50 years of age. The uroflowmetry helps determine the extent of urethral blockage and the type of treatment needed but is not done on a regular basis. Transrectal ultrasound is indicated with an abnormal DRE and elevated PSA to differentiate between BPH and prostate cancer. The PSA monitoring is done to rule out prostate cancer, although levels may be slightly elevated in patients with BPH.

The nurse coordinates postoperative care for a 70-yr-old man with osteoarthritis after prostate surgery. Which task is appropriate for the nurse to delegate to a licensed practical/vocational nurse (LPN/LVN) (select all that apply.)? Select all that apply. Clean around the catheter daily. Increase flow of irrigation solution. Teach the patient how to perform Kegel exercises. Provide instructions to the patient on catheter care. Administer oxybutynin (Ditropan) for bladder spasms. Manually irrigate the urinary catheter to restore catheter flow.

Increase flow of irrigation solution. Administer oxybutynin (Ditropan) for bladder spasms. The nurse may delegate the following to an LPN/LVN: monitor catheter drainage for increased blood or clots, increase flow of irrigating solution to maintain light pink color in outflow, and administer antispasmodics and analgesics as needed. The UAP will clean around the catheter daily. A registered nurse may not delegate teaching, assessments, or clinical judgments to a LPN/LVN.

The patient has a history of cardiovascular disease and has developed erectile dysfunction. He is frustrated because he is taking nitrates and cannot take erectogenic medications. What should the nurse do first? Give the patient choices for penile implant surgery. Recommend counseling for the patient and his partner. Obtain a thorough sexual, health, and psychosocial history. Assess levels of testosterone, prolactin, luteinizing hormone, and thyroid hormones.

Obtain a thorough sexual, health, and psychosocial history. The nurse's first action to help this patient is to obtain a thorough sexual, health, and psychosocial history. Alternative treatments for the cardiac disease would then be explored if that had not already been done. Further examination or diagnostic testing would be based on the history and physical assessment, including hormone levels, counseling, or penile implant options.

Which task can the nurse delegate to an unlicensed assistive personnel (UAP) in the care of a patient who has recently undergone prostatectomy? Assessing the patient's incision Irrigating the patient's urinary catheter Reporting complaints of pain or bladder spasms Evaluating the patient's pain and selecting analgesia

Reporting complaints of pain or bladder spasms Cleaning around the catheter, recording intake and output, and reporting complaint of pain or bladder spasms to the registered nurse are appropriate tasks for delegation to the UAP. Selecting analgesia, irrigating the patient's catheter, and assessing the incision are not appropriate skills or tasks for unlicensed personnel.

A 71-yr-old patient with a diagnosis of benign prostatic hyperplasia (BPH) has been scheduled for a contact laser technique. What is the primary goal of this intervention? Resumption of normal urinary drainage Maintenance of normal sexual functioning Prevention of acute or chronic renal failure Prevention of fluid and electrolyte imbalances

Resumption of normal urinary drainage The most significant signs and symptoms of BPH relate to the disruption of normal urinary drainage and consequent urine retention, incontinence, and pain. A laser technique vaporizes prostate tissue and cauterizes blood vessels and is used as an effective alternative to a TURP to resolve these problems. Fluid imbalances, impaired sexual functioning, and kidney disease may result from uncontrolled BPH, but the central focus remains urinary drainage.

The patient has a low-grade carcinoma on the left lateral aspect of the prostate gland and has been on "watchful waiting" status for 5 years. Six months ago, his last prostate-specific antigen (PSA) level was 5 ng/mL. Which manifestations indicate prostate cancer may be extending and require a change in the plan of care (select all that apply.)? Select all that apply. Casts in his urine Presence of α-fetoprotein Serum PSA level 10 ng/mL Onset of erectile dysfunction Nodularity of the prostate gland Development of a urinary tract infection

Serum PSA level 10 ng/mL Nodularity of the prostate gland The manifestations of increased PSA level along with the new nodularity of the prostate gland potentially indicate that the tumor may be growing. Casts in the urine, presence of α-fetoprotein, and new onset of erectile dysfunction do not indicate prostate cancer growth. Development of a urinary tract infection may indicate urinary retention or could be related to other issues.

Client Needs: Health Promotion and Maintenance 2. A woman may assess the elasticity of her cervical mucus either to avoid or to promote conception. ______________ refers to the elasticity of the cervical mucus.

Spinnbarkeit During most of the female reproductive cycle, the mucus of the cervix is scant, thick, and sticky. Just before ovulation, cervical mucus becomes thin, clear, and elastic to promote passage of sperm into the uterus and fallopian tubes, where they can fertilize the ovum.

A 33-yr-old patient noticed a painless lump and heaviness in his scrotum during testicular self-examination. The nurse should provide the patient information on which diagnostic test? Ultrasound Cremasteric reflex Doppler ultrasound Transillumination with a flashlight

Ultrasound When the scrotum has a painless lump, scrotal swelling, and a feeling of heaviness, testicular cancer is suspected, and an ultrasound of the testes is indicated. Blood tests will also be done. The cremasteric reflex and Doppler ultrasound are done to diagnose testicular torsion. Transillumination with a flashlight is done to diagnose a hydrocele.

Which factors would place a patient at risk for prostate cancer (select all that apply) a. Older than 65 y.o. b.Asian or Native American c.Long-term use of an indwelling urethral catheter d.Father diagnosed and treated for early stage prostate cancer e. Previous history of undescended testicle and testicular cancer

a. Older than 65 y.o. d.Father diagnosed and treated for early stage prostate cancer

Post-op goals in caring for the patient who has undergone a abd. hysterectomy include( select all that apply) a. monitor urine output b. change position frequently c. restrict all food for 24 hours d. observe perineal pad for bleeding e. encourage leg exercises to promote circulation

a. monitor urine output b. change position frequently e. encourage leg exercises to promote circulation

Symptoms of BPH are primarily caused by a. obstruction of the urethra b. untreated chronic prostatitis c. decreased bladder compliance d. excessive secretion of testosterone

a. obstruction of the urethra

The first nursing intervention for the patient who has been sexually assaulted is to a. treat urgent medical problems b.contact support person for patient c. provide supplies for the patient to cleanse self document bruises and lacerations of the perineum and the cervix

a. treat urgent medical problems

A patient scheduled for a prostatectomy for prostate cancer expresses the fear that he will have erectile dysfunction. In response to this patient the nurse should keep in mind that a.erectyle dysfunction can occur even with a nerve-sparing procedure b.the most common complication of this surgery is postoperative bowel incontinance c. retrograde ejaculation affects sexual function more frequently than erectile dysfunction d. preoperative sexual function is the most important factor in determining postoperative erectile dysfunction

a.erectyle dysfunction can occur even with a nerve-sparing procedure

The nurse should explain to the patient who has erectile dysfunction (ED) (select all that apply) a. The most common cause is benign prostatic hypertrophy b. ED may be do to medications or conditions such as diabetes c. only men who are over 65 years or older benefit from PDE5 inhibitors d. there are medications and devices that can be used to help with erections e. this condition is primarily due to anxiety and best treated with psychotherapy

b. ED may be do to medications or conditions such as diabetes d. there are medications and devices that can be used to help with erections

The nurse explains to the patient with chronic bacterial prostatitis who is undergoing antibiotic therapy that (select all that apply) a.all patients require hospitalization b. pain will lessen once treatment has ended c. course of treatment is generally 2 to 4 weeks d. long-term therapy may be indicated in immunocompromised patient e. if the condition is unresolved and untreated, he is at risk for prostate cancer

b. pain will lessen once treatment has ended d. long-term therapy may be indicated in immunocompromised patient

To decrease the patient's discomfort related to discussing his reproductive organs, the nurse should a. relate his sexual concerns to his sexual partner b. arrange to have male nurses care for the patient c. maintain a nonjudgmental attitude towards sexual practices d. use technical terminology when discussing reproductive function

c. maintain a nonjudgmental attitude towards sexual practices

To prevent or decrease age-related changes that occur after menopause in a patient who chose no to take hormone therapy, the most important self care-measure to teach is a.maintaining usual sexual activity b.increasing the intake of dairy products c. preforming regular aerobic, weight-beating exercises d. taking vitamin E and B complex vitamins

c. preforming regular aerobic, weight-beating exercises

The nurse should advise the woman recovering from surgical treatment of an ectopic pregnancy that? a. she has an increased risk of salpinigitis b.bed rest must must be maintained for 12 hours to assist in healing c.having one eptopic pregnancy increases her risk of another one d.intrauterine devices and infertility treatments should be avoided

c.having one eptopic pregnancy increases her risk of another one

In caring for a patient with endometriosis, the nurse teaches the patient that interventions used to treat or cure this condition include ( select all that apply) a.raditaion b. antibiotic therapy c.oral contraceptives d. surgical removal of tissue e total abd. hysterectomy and salpingo-oopherectomy

c.oral contraceptives d. surgical removal of tissue e total abd. hysterectomy and salpingo-oopherectomy

Post-op nursing care for the woman with a gynecologic fistula includes( select all that apply) a.bed rest b.bladder training c.warm sitz baths d. perineal hygiene e. use of stool softners

c.warm sitz baths d. perineal hygiene

Client Needs: Health Promotion and Maintenance COMPLETION 1. A woman's ability to reproduce decreases over a period of years. This is often referred to as the _____________.

climacteric The climacteric refers to the physical and emotional changes that occur at the end of the reproductive period. In most women this occurs between the ages of 45 and 50. At this time, maturation of ova and production of ovarian hormones declines. Menopause describes the final menstrual period. The terms menopause and climacteric are often used interchangeably. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 203 OBJ: Nursing Process: Assessment

Postoperatively, a patient who has had a laser prostatectomy has ocntious bladder irrigation with a three-way urinary catheter with a 30-mL balloon. When he complains of bladder spasms with the catheter in place, the nurse should a. deflate the balloon to 10 mL to decrease bulk of the bladder b. deflate the balloon and then reinflate to ensure that it is patent c. encourage the patient to try to have a bowel to releave colon pressure d. explain that this feeling is normal and that he should not try to urinate around the catheter

d. explain that this feeling is normal and that he should not try to urinate around the catheter

In assessing a patient for testicular cancer, the nurse understands that the manifestations of this disease often include a. acute back spasms and testicular pain b. rapid onset of scrotal and testicular pain c. fertility problems and bilateral scrotal tenderness d. painless mass and heaviness sensation in the scrotal area

d. painless mass and heaviness sensation in the scrotal area

An appropriate question to ask the patient with painful menstruation differentiate primary from secondary dysmenorrhea is a.does your pain become worse with activity or overexertion? b.have you had a recent personal crisis or change in lifestyle? c.is your pain relived by non steroidal anti inflammatory medications? d. when in your menstrual history did the pain with your period begin?

d. when in your menstrual history did the pain with your period begin?

nursing responsibilities related to the patient with endometrial cancer who has a total abdominal hysterectomy and salpingetcomy and oophorectomy include a. maintaining absolute bed rest b.keeping the patient high fowler c. need for supplemental estrogen after removal of overies d.encouraging movement and walking as much as tolerated

d.encouraging movement and walking as much as tolerated