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9. Which of the following would the nurse expect to be done to assess the size of the prostate? A) Digital rectal examination B) Transillumination C) Pelvic examination D) Bladder percussion

Ans: A Feedback: A digital rectal examination is performed to assess the prostate for size as well as evidence of tumor. Transillumination is used to determine the density of scrotal tissue. Pelvic examination is performed to evaluate female reproductive structures. Bladder

25. The nurse is caring for a client who is beginning doxorubicin (Adriamycin) therapy for breast cancer. When preparing the client for probable side effects, which would the nurse include? A) Information regarding wigs from the American Cancer Society B) Information about blood donation from the American Red Cross C) Information regarding high caloric meals from a dietician D) Information regarding depression from a mental health association

Ans: A Feedback: Alopecia is a common side effect from the use of doxorubicin (Adriamycin). It is best for the client to be proactive in planning for hair loss so that the client has a suitable plan. Also, the American Cancer Society in some areas offers financial support and guidance in obtaining a wig or head covering. Blood donation is not completed during chemotherapy because anemia is common. Due to recent antiemetic medications, nausea is less common not as prolonged. Client's rarely need a high-calorie diet. Emphasis is placed on nutrient dense, not calorie dense. Depression may be a concern, and a support group is an excellent resource. A mental health association may be more than what is needed.

13. The nurse is caring for a breastfeeding client who has developed a breast abscess. When instructing on the cause of abscess formation, which organism is the most common cause? A) Staphylococcus aureus B) Escherichia coli C) Pseudomonas aeruginosa D) Enterococcus faecalis

Ans: A Feedback: An abscess in the breast is most frequently a complication of mastitis. The most common cause is Staphylococcus aureus (S. aureus).

7. A client with breast cancer is scheduled to undergo chemotherapy with aromatase inhibitors. Which of the following best reflects the rationale for using this group of drugs? A) They lower the level of estrogen in the body blocking the tumor's ability to use it. B) They block progesterone-dependent tumors from growing. C) They attach to endogenous protein receptors to slow the growth of cancerous cells. D) They stimulate the immune system to attack a protein common in many tumors.

Ans: A Feedback: Aromatase inhibitors lower the level of estrogen in the body thereby interfering with the ability of hormone-sensitive tumors to use estrogen for growth. Antiprogestin drug, such as mifepristone, blocks progesterone-dependent breast cancers. The monoclonal antibody, trastuzumab attaches to protein receptors to slow the growth of cancer cells. A breast cancer vaccine is under investigation in Italy. This vaccine stimulates the immune system to attack a protein called mammaglobin-A, which is found in 80% of breast cancer tumors.

2. The nurse is assisting a 30-year-old client in scheduling an appointment for a cervical biopsy. The nurse would recommend that the client schedule the testing at which time? A) 1 week after completion of the client's menstrual cycle B) 2 weeks before the onset of the client's menstrual cycle C) 3 weeks after the onset of the client's menstrual cycle D) 2 weeks after the cessation of the client's menstrual cycle

Ans: A Feedback: Because the client is premenopausal, the nurse would recommend scheduling the cervical biopsy for 1 week after the end of a menstrual period, when the cervix is least vascular. Scheduling the test for any other time would be inappropriate.

16. The nurse is caring for a client diagnosed with fibrocystic disease and prescribed danazol (Danocrine). Which is essential before drug therapy is initiated? A) Pregnancy test B) Liver function test C) MUGA scan D) Blood chemistry

Ans: A Feedback: Before initiating drug therapy, it is essential to confirm that the client is not pregnant. Ingesting danazol (Danocrine) may be teratogenic to the fetus. Liver function test, MUGA scan, and blood chemistry can provide relevant information of the status of the liver, heart, and general overall condition.

9. A nurse is describing the advantages and disadvantages associated with tamoxifen therapy as a means of breast cancer prevention. The nurse would identify that the drug has a beneficial effect on which of the following? A) Bone mineral density B) High density lipoprotein levels C) Risk for endometrial cancer D) Cataract formation

Ans: A Feedback: Besides reducing the risk of breast cancer, tamoxifen preserves bone mineral density, thus preventing osteoporosis. It also lowers the low-density lipoprotein cholesterol levels, although it is still unknown if it decreases the incidence of myocardial infarction in women. Tamoxifen can have detrimental effects. It increases the incidences of endometrial cancer, deep vein thrombosis, pulmonary embolism, and cataracts.

33. The nurse is preparing the female client for a pelvic examination. In which position will the nurse assist the client? A) Lithotomy position B) Supine position C) Trendelenburg's position D) Lateral recumbent

Ans: A Feedback: For a pelvic examination, the nurse is most correct to assist the client to the lithotomy position. In this position, the client lies on her back with the legs bent and spread. Many times, the feet are in lithotomy stirrups. The supine position is flat on the back. The Trendelenburg's position provides the feet higher than the head at a 15° to 30° angle. The lateral recumbent position is a side-lying position.

3. The nurse is providing care to a client who has had surgery as treatment for breast cancer. The nurse would be alert for the development of which of the following? A) Lymphedema B) Fibrocystic breast disease C) Fibroadenoma D) Breast abscess

Ans: A Feedback: Lymphedema occurs in some women after breast cancer surgery. It causes disfigurement and increases the lifetime potential for infection and poor healing. Fibrocystic breast disease and fibroadenoma are two benign breast conditions that occur usually in premenopausal woman. Breast abscess is the infectious and inflammatory breast condition that is common among breastfeeding mothers.

2. Which of the following recommendations would a nurse advocate during infancy and childhood to help reduce potential adult complications such as orchitis? A) Ensure immunizations against infectious diseases such as mumps. B) Engage in activities and exercises that minimize heavy lifting. C) Encourage the consumption of foods that are rich in fat and starch. D) Urge the limited intake of foods and fluids containing caffeine.

Ans: A Feedback: Nurses should advocate for infant and childhood immunizations against infectious diseases such as mumps to reduce potential adult complications such as orchitis. Minimizing activities involving heavy lifting or urging limited intake of caffeine have no effect on the potential for adult complications such as orchitis. The nurse should encourage foods that are low in fat and starch; however, this also would have no effect on the potential for orchitis.

26. The nurse is caring for a group of breast cancer survivors postmastectomy. When developing a list of instructions of points to avoid, which point is highlighted? A) No lifting greater than 15 lb B) Wearing loose fitting shirts C) Applying cream to breast D) Arm exercises on affected side

Ans: A Feedback: Of the list citing things to avoid, the correct option to avoid is lifting more than 15 lb. This fact is important and needs to be highlighted. Tight-fitting or constrictive clothing is to be avoided. The client is encouraged to place cream on any area of the breast which is dry. Arm exercises are routinely completed on the affected arm.

15. A hydrocele is suspected in a client with scrotal edema. Which assessment technique would the nurse anticipate to be done first? A) Transillumination of the scrotum B) Palpate for presence of testicle C) Examine for soft tissue swelling D) Assess for collect-on of blood in the scrotum

Ans: A Feedback: Transillumination, shining a light through the scrotum, will determine if the swelling in the scrotum is caused by serous fluid versus a solid mass. Palpation for testicle is not indicated with a hydrocele. Soft-tissue swelling and/or collection of blood in the scrotum is not indicated with hydrocele.

5. A client is considering breast augmentation. Which of the following would the nurse recommend to the client to ensure that there are no malignancies? A) Mammogram B) Mastopexy C) Ultrasound D) Breast biopsy

Ans: A Feedback: When caring for a client considering breast augmentation, the nurse should provide her with a general guideline to have a mammogram to verify that there are no malignancies. Mastopexy involves a breast life for drooping breasts. Ultrasound or breast biopsy would not be necessary unless there was evidence of a problem.

29. The physician and nurse are completing a physical examination of the male genitalia. Which assessment findings are documented? Select all that apply. A) Inspection for urethral drainage B) Cultures C) Digital rectal examination D) Transillumination E) Palpation of the testes F) Prostate-specific antigen level

Ans: A, C, D, E Feedback: The nurse and physician document the physical assessment including inspection of external genitalia and noting any drainage. A digital rectal examination and transillumination also provides physical assessment data of the status of the prostate gland. Cultures and prostate-specific antigen levels provide diagnostic information.

22. The nurse is working at an oncologist's office specializing in breast cancer. The nurse cares for individuals of varied ages, backgrounds, and stages of breast cancer. Which criteria are considered a priority when determining adjunct treatment in addition to surgery? Select all that apply. A) Stage of tumor B) Cosmetic consequence C) Presence of metastasis D) Age E) Gender F) Sensitivity to estrogen

Ans: A, C, D, F Feedback: When working in an oncologists' office, the nurse is correct to identify that the stage of tumor and presence of metastasis help to guide treatment. Other factors include age of client and sensitivity to estrogen. Cosmetic consequence is not considered a priority when considering lifesaving treatment options. Many times, reconstruction is a possibility. Gender is not a consideration because treatment options are very similar.

29. While collecting data on reproductive history, the client discloses early menarche, early sexual engagement, chlamydia infection, and treatment for gonorrhea. The nurse knows that this client is at highest risk for the development of which of the following? A) Sexually Transmitted Infections B) Breast cancer C) Fibroid tumor or myoma D) Cervical cancer

Ans: A, D Feedback: Cervical cancer is the second most frequent malignancy of the female reproductive system and is associated with risk factors such as becoming sexually active at an early age, acquiring genital infections, or STIs. Breast cancer and fibroid tumors are not indicated with the history presented.

10. A client is scheduled to undergo a procedure to lift her breasts that have drooped because of significant weight loss. The nurse identifies this procedure as which of the following? A) Reduction mammoplasty B) Mastopexy C) Autogenous breast reconstruction D) Mastectomy

Ans: B Feedback: A mastopexy is a procedure that involves lifting a breast. This procedure is similar to a reduction mammoplasty (removal of glandular breast tissue, fat, and skin bilaterally to decrease the size of large pendulous breasts), although the incision and scar line are smaller and the recovery time is shorter. Autogenous breast reconstruction involves the harvesting of the client's tissue from the rectus abdominis muscle to create a new breast. A mastectomy is a removal of a breast.

19. A young client presenting at the health clinic with fever and mucopurulent vaginal drainage is diagnosed with acute pelvic inflammatory disease (PID). Which long-term affect is of greatest concern in the care of this client? A) Chronic pelvic inflammatory disease B) Infertility C) Pelvic pain D) Ascending infection

Ans: B Feedback: About one third of all women who are infertile have lost the ability to conceive due to PID. Early treatment of PID prevents the infection from ascending up the reproductive tract and/or from becoming chronic. Pelvic pain is a common symptom associated with

30. Following a colposcopy, the confirmation of in situ carcinoma of the cervix has been determined. Which comment by the client indicates an appropriate understanding of the diagnosis? A) "I will not need any further treatment." B) "The cancer has not spread." C) "I will need surgery and chemotherapy to increase my odds for survival." D) "I can wait until I have finished having babies to seek treatment."

Ans: B Feedback: Carcinoma in situ means the cancer has not left the original site and therefore has not invaded other tissues. Further treatment is required, which usually consists of cryosurgery or hysterectomy. Surgery with adjuvant chemotherapy is usually reserved for cancers that are more advanced. Even though cervical cancers tend to be slower growing, treatment should not be delayed.

21. The nurse is completing community education when asked by a client without health insurance why a mammogram is needed if the women are completing breast self-examinations at home. The nurse is most correct to respond stating which of the following? A) "Mammograms are just better." B) "Mammograms can detect cysts or tumors too small to palpate." C) "Mammograms provide a baseline that shows changes in breast tissue." D) "Mammograms provide a reassurance that the breast is free of cancer."

Ans: B Feedback: During community instruction, it is most important to relay facts in a clear, factual, and nonjudgmental way. Stating the need for mammograms to detect small cysts or tumors is clear and factual. Stating the mammograms are "better" is vague and provides no better understanding. Although a mammogram does provide a baseline and reassurance of breast health, the most clear and factual reason why the mammogram is completed is its ability to detect cancerous tumors at an early stage.

11. The nurse is providing instruction for testicular self-examination to a group of young adolescents. Which is the most correct examination technique? A) Palpate both testicles simultaneously for comparison. B) Palpate each testicle separately, following a warm shower. C) Palpate the front of the testicle first, where most tumors are found. D) Palpate for a soft, round shape with normal ridges on the testicles.

Ans: B Feedback: It is best to examine and palpate each testicle following a warm shower, when the testes are relaxed and not retracted. Because one testicle is normally larger and hangs lower, comparing the two sides is not indicated. Both testes should be oval in shape, smooth, and firm without masses or tenderness. Most tumors are located on the lateral aspect of the testicles.

30. The client states to the nurse that he is very anxious about having prostate cancer ever since his prostate-specific antigen (PSA) test came back elevated. The client asks, "Which diagnostic test produces definitive results if cancer is present?" The nurse is most correct to state which of the following? A) Transrectal ultrasonography B) Tissue biopsy C) Tumor marker studies D) Digital rectal exam

Ans: B Feedback: Obtaining an actual piece of the tissue and analyzing it for cancer is a definitive test when cancer is found. A transrectal ultrasonography is a test to view the prostate gland from different angles. This test provides additional data on the status of the prostate gland. The tumor marker studies include the prostate-specific antigen (PSA) level. This antigen indicates a potential problem but is not definitive. PSA elevations have been noted for reasons other than cancer. A digital rectal exam provided data on the shape, size, and texture of the prostate gland.

11. The nurse is obtaining a history from a client who states recurrent breast tenderness. The client inquires if there is something wrong with her breasts. Which question by the nurse is best? A) "Do you have a history of breast disorders and cancer in the family?" B) "Does the tenderness occur around the same time each month?" C) "Have you pulled a muscle or had any injury to the breast?" D) "When did you first recognize the symptoms?"

Ans: B Feedback: The breasts are part of the female reproductive system, and they respond to the hormonal cycle associated with ovulation, menstruation, and pregnancy. Because the hormonal cycle is monthly, it is best to ask the client if the tenderness occurs at the same time each month. The other options are also important questions to ask.

17. The nurse at a gynecologist's office is obtaining a client history including the fact that several of the client's relatives have had breast cancer. Which general information regarding the most common type of cancer is accurate? A) Inflammatory breast cancer B) Ductal carcinoma C) Lobular carcinoma D) Medullary carcinoma

Ans: B Feedback: The nurse is most accurate to state that the most common malignancy is ductal carcinoma overwhelmingly at 80%. Inflammatory breast cancer is 1% to 3%, lobular carcinoma is 10%, and medullary carcinoma is rare.

19. A suspicious breast lump is noted on a mammogram. The client asks the nurse which diagnostic test confirms if the lump is cancerous or benign. Which response by the nurse is most correct? A) An ultrasound B) A biopsy C) A magnetic resonance imaging (MRI) D) A clinical breast exam

Ans: B Feedback: To confirm whether a breast lump is cancerous or benign, a tissue sample must be obtained to examine the cells. Although an ultrasound, MRI, and clinical breast exam provides data on the characteristics of the lump, only examining the tissue can specifically identify if and what type of cancer is present.

8. A client with a fibroadenoma is being scheduled for diagnostic testing. Which of the following would the nurse expect as most likely? A) Mammogram B) Ultrasound C) Excisional biopsy D) Culture of discharge

Ans: B Feedback: Ultrasound can reveal physical characteristics unique to a fibroadenoma versus malignant mass with a higher degree of accuracy than mammography. In the case of very young women—an atypical age for breast cancer—an excisional biopsy is performed only if the mass changes or becomes larger. If the mass is detected in a woman with a higher risk for developing breast cancer, such as one with a family history or of an older age, a biopsy is performed to confirm that the tissue is indeed benign. There is no discharge to culture.

13. A young client is admitted with torsion of the spermatic cord. Which is the most appropriate action to be taken by the nurse? A) Elevate the scrotum. B) Keep the client NPO. C) Monitor vital signs for cardiac changes. D) Avoid the use of analgesics.

Ans: B Feedback: With torsion of the spermatic cord, immediate surgery is necessary to prevent atrophy of the cord and preserve fertility. The client should be placed on NPO status in preparation for surgery. Elevating the scrotum intensifies the pain by increasing the degree of twist. Analgesics are prescribed preoperatively to control pain. Cardiac changes are not indicated unless client history warrants assessment.

27. The surgeon has ordered belladonna and opium (B and O) suppositories for the management of a postoperative prostatectomy client who is receiving continuous bladder irrigation. Which of the following symptoms would indicate to the nurse the need for administration of this drug? Select all that apply. A) Increased blood in the catheter tubing B) Slowed or stopped infusion rate C) Increased bladder pressure and pain D) Increased speed of infusion rate E) Signs of urinary retention F) Increased force of urinary stream

Ans: B, C Feedback: Belladonna and opium suppositories are ordered to reduce bladder spasms that cause increased bladder pressure and pain following a prostatectomy. As spasms occur, the infusion of saline will slow or stop. Increased blood in the catheter tubing is a sign of active bleeding. With an indwelling three-way catheter, urinary retention and increased force of urinary stream are not present.

14. The nurse is providing dietary instruction for the client with fibrocystic breast disease. Which of the client's favorite foods are discouraged? (Select all that apply.) A) Lasagna B) Chocolate pudding C) Organ meat D) Cola products E) Popcorn

Ans: B, D Feedback: When instructing the client on appropriate food choices, the nurse instructs the client to avoid caffeine. Caffeine is in products such as chocolate and cola drinks.

24. Which of the following should be included when teaching a client about the management of benign prostatic hyperplasia (BPH)? Select all that apply. A) Moderate use of alcohol is useful for bladder relaxation. B) Do not delay the urge to void. C) Low-dose Benadryl will promote restful sleep. D) Prolonged exposure to heat increases bladder spasms. E) Painless hematuria is a common symptom of BPH. F) Schedule digital rectal exams.

Ans: B, F Feedback: The client should be instructed to void promptly when the urge to empty the bladder is signaled by the stretch receptors in the bladder. Voiding promptly will decrease the risk for urinary retention. Digital rectal exams should be monitored to detect further enlargement of the gland and/or presence of prostatic nodules. Alcohol and antihistamines (e.g., Benadryl) should be avoided in the management of BPH. Exposure to heat and painless hematuria are not significant in the management of BPH. Alcohol and antihistamines interact with many BPH drugs.

29. A client who is diagnosed with stage II prostate cancer asks the nurse if a transurethral resection of the prostate (TURP) can be done for this disorder. Which is the best response by the nurse? A) "A TURP is a viable option. Let's talk to the surgeon." B) "Stage II means the cancer has already spread from the prostate gland." C) "A TURP is a removal of only a portion of the prostate gland." D) "You have the right to choose which ever surgery you feel is best for you."

Ans: C Feedback: A TURP is not a viable option for treatment of prostate cancer and will only scrape or remove the portion of the gland that is causing obstruction of the urethra. Stage II cancer is a tumor that is still confined to the prostate gland and has not metastasized. The surgical treatment of choice is determined by the surgeon and client together and is not based on feelings but rather evidence-based practice and best prognosis and outcome.

32. The client is asking the nurse to explain the typical treatment expected when a class 4 Papanicolaou test is reported. The nurse is most correct to state which of the following? A) No further treatment is considered. B) The test will need repeated in 3 months. C) Further evaluation is needed for potential malignancy. D) Chemotherapy is needed and radiation is suggested.

Ans: C Feedback: A class 4 Papanicolaou test (Pap test) is strongly suggestive of malignancy. Further testing is needed to confirm the type and extent of cancer. The nurse would not suggest that no treatment is needed or to wait for 3 months. The nurse would also not suggest a typical treatment without further diagnostic testing.

20. A 52-year-old client asks the nurse how she is to remember when to schedule her clinical breast examination. Which response by the nurse is most correct? A) "The office staff can schedule your clinical breast examination twice a year." B) "The diagnostic center will send you a reminder card to complete the annual examination." C) "The clinical breast evaluation will be completed with annual gynecologic examination." D) "You can complete the examination at home and report if you found anything abnormal."

Ans: C Feedback: A clinical breast examination is completed by a physician, nurse, or physician's assistant as part of the gynecologic examination, an annual examination, or before a mammogram. Unless there is an abnormality, a clinical breast examination does not need to be completed more than annually as the client is completing the monthly self-breast examinations. The examination is typically performed in the physician's office and not a diagnostic center unless the client happens to be also scheduled for a mammogram.

35. The nurse is providing shift report related to a client newly received back to the unit from the postanesthesia care unit (PACU). The nurse is stating that the client had breast tissue removed with 7 of 14 lymph nodes, the lining of the chest muscles and pectoralis minor muscle removed. The oncoming nurse documents which procedure completed? A) A segmental mastectomy B) A total mastectomy C) A modified radical mastectomy D) A radical mastectomy

Ans: C Feedback: A modified radical mastectomy is a procedure in which the breast, some lymph nodes, the lining over the chest muscles, and the pectoralis minor muscle is removed. A segmental mastectomy is where the tumor and some breast tissue and lymph nodes are removed. A total mastectomy includes only breast tissue. A radical mastectomy includes the breast axillary lymph nodes, and pectoralis major and minor muscles are removed. Sternal lymph nodes may also be removed with this procedure.

28. A client with a normal prostate-specific antigen (PSA) level is reporting painful urination and the presence of blood in urine and semen. The nurse understands that the best option for management of this client includes which of the following? A) Wait-and-see approach B) Continue to monitor PSA levels. C) Further evaluation D) Treat the symptoms.

Ans: C Feedback: Although PSA levels of 4 ng/mL or greater is a basis for performing more definitive diagnostic tests, screening measurements of PSA are becoming more controversial. The presence of dysuria, hematuria, and hemospermia are indicative of prostate tumor growth and should be receive further evaluation. The wait-and-see approach is not appropriate if the client is symptomatic. Treating the symptoms without diagnosis could place the client at greater risk for metastasis.

26. Immediately following a transurethral resection of the prostate (TURP), which is the best method to determine if active bleeding is occurring? A) Assess hemoglobin and hematocrit. B) Assess blood in catheter collection bag. C) Assess catheter tubing. D) Assess blood pressure and pulse.

Ans: C Feedback: Assessing the color of drainage in the catheter tubing will alert the nurse to active bleeding. If the bleeding is active, it will be bright red in color and may become increased enough to make reading newspaper print through the tubing impossible. Blood in the collection bag is expected and does not signify active bleeding. Assessment of vital signs is necessary to determine is excessive blood loss has occurred, resulting in symptoms of hypovolemia. Waiting for an H and H report is not the best method for determining active bleeding.

12. The lactation nurse is caring for a mother who is 2 weeks postpartum and has mastitis. Which statement, made by the client, requires instruction and is the probable cause of the mastitis? A) "I feed the baby every 2 hours." B) "I break the baby's suck before pulling the baby off of the breast." C) "I nurse the baby on one breast each feeding." D) "I use a lanolin ointment on my dry nipples."

Ans: C Feedback: Because the client has mastitis, emptying each breast with alternate feedings is important. The baby's suck is strongest at the beginning of the feeding; thus, the mother should alternate the breast that the baby starts nursing from. If not, one breast would not be drained of the milk.

12. Which assessment finding is most important in determining which client has a higher risk for developing testicular cancer? A) Previous sexually transmitted infection (STI) B) Low sperm count C) Cryptorchidism as an infant D) Family history of cancer

Ans: C Feedback: Caucasian men who have had cryptorchidism as an infant, regardless of whether an orchiopexy was performed, are at higher risk for incidence of testicular cancer. STIs, low sperm count, and family history of general cancers are not indicative of testicular cancer risk.

4. While obtaining the history, a client reports that her mother was treated with diethylstilbestrol (DES) during her pregnancy. The nurse determines that this client is at risk for which of the following? A) Vulvar cancer B) Breast cancer C) Cervical cancer D) Endometrial cancer

Ans: C Feedback: Cervical cancer affects the lowest portion of the uterus and is associated with the risk factor of being born to mothers treated with DES during their pregnancy. DES is not a risk factor associated with vulvar or breast cancers. Endometrial cancer occurs in women who take estrogens without the addition of progesterone for 5 or more years during and after menopause.

2. A client complains of having tender and painful breasts, often feeling multiple lumps within her breast tissue. The nurse would need to gather additional information about which of the following? A) Alcohol and caffeine consumption B) Client's workplace in relation to the surroundings C) Timing of symptoms in relation to the menstrual cycle D) Bathing frequency and living surroundings

Ans: C Feedback: Considering that the client has tender and painful breasts and that she often feels lumps within her breast tissue, it is most likely that she suffers from fibrocystic breast disease. To confirm these findings, the nurse should ask relevant questions about the characteristics and timing of symptoms in relation to the menstrual cycle. Symptoms of fibrocystic breast disease are noticeable before menstruation and usually abate during menstruation. The size of the cyst becomes larger before menstruation and often changes with the menstrual cycle. The nurse should further ask the client about her habits of smoking and consuming coffee, chocolate, and caffeinated soft drinks, not alcohol, because they aggravate the condition. Workplace surroundings or cleanliness habits do not matter because fibrocystic breast disease is not infectious.

23. A client is admitted to the hospital with the diagnosis of sepsis secondary to pelvic inflammatory disease. Which transmission-based precaution will be initiated by the nurse? A) Standard precautions B) Protective precautions C) Contact precautions D) Droplet precautions

Ans: C Feedback: Contact isolation is a category of transmission-based precautions for controlling the spread of infectious microorganisms found in body fluids. Standard precautions are used in the care of all clients in the prevention of HIV and Hepatitis. Protective precautions are instituted when a client is immune compromised and needs protected from others. Droplet precautions are not indicated with PID.

24. A family member asks the nurse of the benefits of immunotherapy. The nurse would be most correct to state which of the following? A) Immunotherapy strengthens the immune system to prevent cancer. B) Immunotherapy uses homeopathic properties to prevent free radical release. C) Immunotherapy stimulates the immune response to attack and rid the body of cancer cells. D) Immunotherapy promotes removal of good and bad multiplying cells.

Ans: C Feedback: Immunotherapy is the basis for various drugs and therapeutic cancer vaccines. Rather than prevent breast cancer, they stimulate the immune system's ability to attack and rid the body of cancer cells. Immunotherapy does not prevent cancer, prevent free radical release, and remove good and bad multiplying cells.

21. The nurse is caring for a client with breast cancer and removal of axillary lymph nodes. Which assessment finding is documented and brought to the physician's attention as potential lymphedema? A) A reddened area around the breast B) Fluid accumulation under in the axilla C) Enlargement of the arm or hand D) Drainage from the areola

Ans: C Feedback: Lymphedema, soft-tissue swelling from accumulated lymphatic fluid, occurs in some women after they have undergone breast cancer surgery and the removal or irradiating of axillary lymph nodes. Lymphedema does not impact the breast area or axilla.

19. What information would the nurse give the client when the client inquires what makes breast milk production? A) Estrogen B) Progesterone C) Prolactin D) Testosterone

Ans: C Feedback: Prolactin promotes the production of breast milk. Estrogen secreted by the ovaries at the onset of puberty causes the development of the mammary system. Progesterone, secreted by the placenta, stimulates the development of alveoli, which secrete the milk. Testosterone does not impact milk production.

6. A client who comes to the clinic complaining of perineal pain, dysuria, and fever is diagnosed with prostatitis. The nurse understands that which of the following organisms would be the most likely cause? A) Staphylococcus B) Streptococcus C) Escherichia coli D) Paramyxovirus

Ans: C Feedback: Prostatitis is an inflammation of the prostate gland and is most often caused by microorganisms that reach the prostate by way of the urethra. Escherichia coli and microbes that cause sexually transmitted infections often are responsible. Staphylococcus and Streptococcus are not typically a cause of prostatitis. Paramyxovirus is the cause of mumps.

20. The nurse is caring for a client who is ordered a sentinel lymph node biopsy. The physician explained the procedure and desired outcome. Which statement, made by the client, indicates a need for further instruction? A) The procedure allows for an understanding of the spread of cancer cells. B) The procedure allows for conservation of breast tissue. C) The procedure removes all cancer from the body. D) The procedure includes minimal surrounding tissue damage.

Ans: C Feedback: Sentinel lymph node mapping involves identifying the first (sentinel) lymph nodes through which the breast cancer cells would spread to regional lymph nodes in the axilla. Validating the lack of lymph node metastasis allows the surgeon to preserve more breast tissue, axillary tissue and chest muscle. Further instruction would be needed to explain that the sentinel lymph node biopsy does not remove cancer from the body.

6. Which of the following client statements indicates successful teaching of a client who is scheduled to have a Pap test? A) "I'll schedule the test for the time when I have my next menstrual period." B) "I need to refrain from sexual intercourse for at least 1 week before the test." C) "I will stop using any vaginal medications at least 48 hours before the test." D) "I need to use a vinegar and water douche the morning of the test."

Ans: C Feedback: Teaching is effective when the client schedules an appointment at a time other than during menstruation and does the following before the appointment: (1) avoids intercourse for 2 days, (2) refrains from douching for 1 day, and (3) ceases the use of vaginal medications for at least 48 hours.

17. A mother of an adolescent female is asking the nurse for guidelines of when her daughter should have her first Papanicolaou test (Pap test) and then the subsequent frequency. The nurse is most correct to state which? A) The first Pap test should be at age 16 years and then annually thereafter. B) The first Pap test should be no later than 18 years of age and then every other year afterward. C) The first Pap test should be no later than age 21 years and then every 3 to 5 years afterward. D) The first Pap test should be within the first year of menstruation and annually afterward.

Ans: C Feedback: The American Cancer Society (ACS) recommends that all women have an initial Pap test by 21 years of age. According to the American College of Obstetricians and Gynecologists, most women do not need cervical cancer screening more frequently than every 3 to 5 years.

16. The nurse is obtaining a health history at the client's annual gynecologic exam. Which of the following statements regarding a Papanicolaou test (Pap test) for cancer screening would delay the exam? A) "I had sexual intercourse several days ago." B) "I voided before entering the exam room." C) "My menstrual period began yesterday." D) "I use no vaginal sprays or creams."

Ans: C Feedback: The nurse advises that the Pap test be rescheduled to a time other than during the menstrual period. The other options are acceptable to continue the test procedure.

17. The client is asking if there is a pill that can be ordered to control the symptoms of menopause. Which assessment finding is most important in determining nursing care in association with hormone replacement therapy? A) Presence of kyphosis B) Symptoms of hot flashes C) Family history of breast cancer D) History of osteoporosis

Ans: C Feedback: The risk of endometrial or breast cancer in women prescribed HRT may outweigh the benefits of relieving symptoms of menopause and preventing kyphosis or hip fractures associated with osteoporosis.

33. The nurse is interviewing a postmenopausal client during an annual gynecologic exam. Which assessment finding presents the greatest concern in the care of this client? A) Positive for human papillomavirus (HPV) B) Use of pessary C) Vaginal bleeding D) Urinary stress incontinence

Ans: C Feedback: Vaginal bleeding in a client after menopause is abnormal and a predominant symptom for vaginal cancers. The incidence of vaginal cancer is higher among woman infected with HPV and those who use a pessary but neglect to remove and clean it. Urinary stress incontinence is not a significant concern.

15. The client arrives at a public health clinic worried that she has breast cancer since finding a lump in her breast. When assessing the breast, which assessment finding is characteristic of fibrocystic disease? A) One breast is larger than the other. B) The lump is firm and nonmovable. C) The lump is round and movable. D) Nipple retractions are noted.

Ans: C Feedback: When assessing a breast with fibrocystic disease, the lumps typically are different from cancerous lumps. The characteristic breast mass of fibrocystic disease is soft to firm, circular, movable, and unlikely to cause nipple retraction. A cancerous mass is typically irregular in shape, firm, and nonmovable. Lumps typically do not make one breast larger

5. After examination, a client is found to have a prostatic nodule and is scheduled for prostatic-specific antigen (PSA) testing. When reviewing the results, which of the following would indicate that the nodule is malignant? A) 4 ng/mL B) 7 ng/mL C) 9 ng/mL D) 12 ng/mL

Ans: D Feedback: After a prostatic nodule is detected, prostate-specific antigen testing may be done. A PSA greater than 4 ng/mL is the basis for performing more definitive diagnostic procedures, and a PSA greater than 10 ng/mL indicates a prostatic malignancy. A PSA greater than 80 ng/mL indicates advanced metastatic disease.

34. Which nursing question is essential when caring for a client prior to a pelvic examination? A) "Are you sexually active?" B) "Do you have any sexually transmitted diseases?" C) "Would you like to have assistance to get in position for the exam?" D) "Would you like to void at this time?"

Ans: D Feedback: Prior to a pelvic examination, the nurse offers the client the use of the restroom to void. It is most important for the client to empty her bladder so that the physician can feel pelvic structures more clearly and also for the comfort of the client. Asking client history questions is completed at the beginning of the appointment. It is important to

1. A female client is diagnosed with breast abscess. She would like to continue to breast-feed her newborn. Which of the following would be most appropriate in this situation? A) Encourage the client to include protein content in the diet. B) Instruct the client to wear a tight-fitting bra. C) Reduce the frequency of removing and reapplying the dressings. D) Assist the client to pump the breasts to remove breast milk.

Ans: D Feedback: The nurse should help the client pump the breasts and remove breast milk to prevent engorgement. Because the client has decided to continue breastfeeding, the client should wear a loose-fitting bra. Including protein content in the diet would be unrelated to the client's current situation. Frequency of dressing changes does not play a role in the intervention.

6. A client with fibrocystic breast disease has been receiving treatment with danazol (Danocrine) therapy for the past 6 months. In anticipation of the drug being discontinued, the nurse instructs the client to inform the healthcare provider about which of the following? A) Nausea or vomiting occurring beyond 9 days after discontinuing the drug B) Inability to sleep after discontinuing the drug C) Constipation occurring 90 days after discontinuing the drug D) Lack of return of regular menses within 90 days after discontinuing the drug

Ans: D Feedback: The nurse should tell the client to inform the healthcare provider if regular menses do not resume within 90 days after discontinuing the drug. Nausea, constipation, and sleep are not associated with danazol or its discontinuation.

1. Which of the following should nurses teach all men, especially those who have had cryptorchidism? A) Need for blood tests to measure serum acid phosphatase levels B) Importance of regular monitoring of prostate-specific antigen (PSA) levels C) Need to undergo a baseline and follow up lymph node biopsies D) How to perform a testicular self-examination

Ans: D Feedback: The nurses should teach all men, especially those who have had cryptorchidism, to perform testicular self-examination to detect any abnormal mass in the scrotum. The nurse instructs the clients to examine the testicles monthly, preferably when warm, such as in the shower. Having regular PSA levels, lymph node biopsies, and blood tests for measuring serum acid phosphatase are for the clients who are treated for prostate cancer.

18. The nurse is obtaining health histories from women at a busy low-income clinic. Which of the following clients should the nurse follow closely as being at high risk for developing breast cancer? A) The client who is over 50 years of age B) The client with a mother who had breast cancer C) The client who is African American D) The client has relatives with the BRCA1 mutated gene

Ans: D Feedback: There are several risk factors that the nurse must identify; however, the most important risk factor to be identified is the presence of the mutated BRCA1 gene that makes the client "very likely" to develop breast cancer. Other risk factors include being female, being older than 50 years old, and having a family history of breast cancer. White women are at a higher risk than African Americans.

22. A nurse is caring for a client who is being evaluated for a lump found on the lateral aspect of the right breast. The client is anxious and asks the nurse if the next step is to have a mastectomy. Which is the nurse's best response? A) "Yes, breast lumps are abnormal and will need to be removed." B) "The doctor will need a biopsy first to see if the lump is cancerous." C) "The doctor will answer your questions when he or she arrives." D) "Many times, an ultrasound is done to distinguish between a tumor and cyst."

Ans: D Feedback: Ultrasonography is often used with a mammogram or after a breast lump is found to provide additional data on the breast lump. An ultrasound can differentiate if the lump is a fluid filled cyst or other types of breast lesions. This step may be used before a mastectomy is performed or even a biopsy is completed. The nurse is able to provide factual information on common treatment paths, understanding that it is the physician who prescribes the medical care.

17. Which of the following nursing assessment findings would be most significant in determining sterility in a male client? A) Uncircumcised penis B) Recurrent urinary tract infections (UTI) C) Multiple sex partners D) Mumps at age 15 years

Ans: D Feedback: Viral mumps infection that occurs after puberty can be the cause of orchitis, which may result in testicular atrophy and sterility. Uncircumcised penis, UTIs, and number of sex