Reproductive Practice Questions

A patient has just returned to the postsurgical unit from post-anesthetic recovery after breast surgery for removal of a malignancy. What is the most likely major nursing diagnosis to include in this patient's immediate plan of care? A) Acute pain related to tissue manipulation and incision B) Ineffective coping related to surgery C) Risk for trauma related to post-surgical injury D) Chronic sorrow related to change in body image

A (Feedback: Although many patients experience minimal pain, it is still important to assess for this postsurgical complication. Sorrow and ineffective coping are possible, but neither is likely to be evident in the immediate postoperative period. There is minimal risk of trauma.)

A 42 year-old patient tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. She says that she is afraid that she has cancer. Which assessment finding would most strongly suggest that this patient's lump is cancerous? A) Eversion of the right nipple and mobile mass B) A nonmobile mass with irregular edges C) A mobile mass that is soft and easily delineated D) Nonpalpable right axillary lymph nodes

B (Feedback: Breast cancer tumors are typically fixed, hard, and poorly delineated with irregular edges. A mobile mass that is soft and easily delineated is most commonly a fluid-filled benign cyst. Axillary lymph nodes may or may not be palpable on initial detection of a cancerous mass. Nipple retraction, not eversion, may be a sign of cancer.)

A patient is being discharged home from the ambulatory surgery center after an incisional biopsy of a mass in her left breast. What are the criteria for discharging this patient home? Select all that apply. A) Patient must understand when she can begin ambulating B) Patient must have someone to accompany her home C) Patient must understand activity restrictions D) Patient must understand care of the biopsy site E) Patient must understand when she can safely remove her urinary catheter

B, C, D (Feedback: Prior to discharge from the ambulatory surgical center or the office, the patient must be able to tolerate fluids, ambulate, and void. The patient must have somebody to accompany her home and would not be discharged with urinary catheter in place.)

A woman scheduled for a simple mastectomy in one week is having her preoperative education provided by the clinic nurse. What educational intervention will be of primary importance to prevent hemorrhage in the postoperative period? A) Limit her intake of green leafy vegetables. B) Increase her water intake to 8 glasses per day. C) Stop taking aspirin. D) Have nothing by mouth for 6 hours before surgery.

C (Feedback: The nurse should instruct the patient to stop taking aspirin due to its anticoagulant effect. Limiting green leafy vegetables will decrease vitamin K and marginally increase bleeding. Increasing fluid intake or being NPO before surgery will have no effect on bleeding.)

The nurse is reviewing the physician's notes from the patient who has just left the clinic. The nurse learns that the physician suspects a malignant breast tumor. On palpation, the mass most likely had what characteristic? A) Nontenderness B) A size of £ 5 mm C) Softness and a regular shape D) Mobility

A (Feedback: Generally, the lesions are nontender, fixed rather than mobile, and hard with irregular borders. Small size is not suggestive of malignancy.)

A man tells the nurse that his father died of prostate cancer and he is concerned about his own risk of developing the disease, having heard that prostate cancer has a genetic link. What aspect of the pathophysiology of prostate cancer would underlie the nurse's response? A) A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer. B) HNPCC is a mutation of two genes that causes prostate cancer in men and it is autosomal dominant. C) Studies have shown that the presence of the TP53 gene strongly influences the incidence of prostate cancer. D) Recent research has demonstrated that prostate cancer is the result of lifestyle factors and that genetics are unrelated.

Ans: A A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer. Feedback: A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer. HPNCC is a form of colon cancer. The TP53 gene is associated with breast cancer.

A 22-year-old male is being discharged home after surgery for testicular cancer. The patient is scheduled to begin chemotherapy in 2 weeks. The patient tells the nurse that he doesn't think he can take weeks or months of chemotherapy, stating that he has researched the adverse effects online. What is the most appropriate nursing action for this patient at this time? A) Provide empathy and encouragement in an effort to foster a positive outlook. B) Tell the patient it is his decision whether to accept or reject chemotherapy. C) Report the patient's statement to members of his support system. D) Refer the patient to social work.

Ans: A Provide empathy and encouragement in an effort to foster a positive outlook. Feedback: Patients may be required to endure a long course of therapy and will need encouragement to maintain a positive attitude. It is certainly the patient's ultimate decision to accept or reject chemotherapy, but the nurse should focus on promoting a positive outlook. It would be a violation of confidentiality to report the patient's statement to members of his support system and there is no obvious need for a social work referral.

To decrease glandular cellular activity and prostate size, an 83-year-old patient has been prescribed finasteride (Proscar). When performing patient education with this patient, the nurse should be sure to tell the patient what? A) Report the planned use of dietary supplements to the physician. B) Decrease the intake of fluids to prevent urinary retention. C) Abstain from sexual activity for 2 weeks following the initiation of treatment. D) Anticipate a temporary worsening of urinary retention before symptoms subside.

Ans: A Report the planned use of dietary supplements to the physician. Feedback: Some herbal supplements are contraindicated with Proscar, thus their planned use should be discussed with the physician or pharmacist. The patient should maintain normal fluid intake. There is no need to abstain from sexual activity and a worsening of urinary retention is not anticipated.

A patient who is scheduled for an open prostatectomy is concerned about the potential effects of the surgery on his sexual function. What aspect of prostate surgery should inform the nurse's response? A) Erectile dysfunction is common after prostatectomy as a result of hormonal changes. B) All prostatectomies carry a risk of nerve damage and consequent erectile dysfunction. C) Erectile dysfunction after prostatectomy is expected, but normally resolves within several months. D) Modern surgical techniques have eliminated the risk of erectile dysfunction following prostatectomy.

Ans: B All prostatectomies carry a risk of nerve damage and consequent erectile dysfunction. Feedback: All prostatectomies carry a risk of impotence because of potential damage to the pudendal nerves. If this damage occurs, the effects are permanent. Hormonal changes do not affect sexual functioning after prostatectomy.

A physician explains to the patient that he has an inflammation of the Cowper glands. Where are the Cowper glands located? A) Within the epididymis B) Below the prostate, within the posterior aspect of the urethra C) On the inner epithelium lining the scrotum, lateral to the testes D) Medial to the vas deferens

Ans: B Below the prostate, within the posterior aspect of the urethra Feedback: Cowper glands lie below the prostate, within the posterior aspect of the urethra. This gland empties its secretions into the urethra during ejaculation, providing lubrication. The Cowper glands do not lie within the epididymis, within the scrotum, or alongside the vas deferens.

A nurse is providing an educational event to a local men's group about prostate cancer. The nurse should cite an increased risk of prostate cancer in what ethnic group? A) Native Americans B) Caucasian Americans C) African Americans D) Asian Americans

Ans: C African Americans Feedback: African American men have a high risk of prostate cancer; furthermore, they are more than twice as likely to die from prostate cancer as men of other racial or ethnic groups.

A nurse is caring for a 33-year-old male who has come to the clinic for a physical examination. He states that he has not had a routine physical in 5 years. During the examination, the physician finds that digital rectal examination (DRE) reveals stoney hardening in the posterior lobe of the prostate gland that is not mobile. The nurse recognizes that the observation typically indicates what? A) A normal finding B) A sign of early prostate cancer C) Evidence of a more advanced lesion D) Metastatic disease

Ans: C Evidence of a more advanced lesion Feedback: Routine repeated DRE (preferably by the same examiner) is important, because early cancer may be detected as a nodule within the gland or as an extensive hardening in the posterior lobe. The more advanced lesion is stony hard and fixed. This finding is not suggestive of metastatic disease.

A patient has returned to the floor after undergoing a transurethral resection of the prostate (TURP). The patient has a continuous bladder irrigation system in place. The patient tells you he is experiencing bladder spasms and asks what you can do to relieve his discomfort. What is the most appropriate nursing action to relieve the discomfort of the patient? A) Apply a cold compress to the pubic area. B) Notify the urologist promptly. C) Irrigate the catheter with 30 to 50 mL of normal saline as ordered. D) Administer a smooth-muscle relaxant as ordered.

Ans: D Administer a smooth-muscle relaxant as ordered. Feedback: Administering a medication that relaxes smooth muscles can help relieve bladder spasms. Neither a cold compress nor catheter irrigation will alleviate bladder spasms. In most cases, this problem can be relieved without the involvement of the urologist, who will normally order medications on a PRN basis.

A patient has presented at the clinic with symptoms of benign prostatic hyperplasia. What diagnostic findings would suggest that this patient has chronic urinary retention? A) Hypertension B) Peripheral edema C) Tachycardia and other dysrhythmias D) Increased blood urea nitrogen (BUN)

Ans: D Increased blood urea nitrogen (BUN) Feedback: Hypertension, edema, and tachycardia would not normally be associated with benign prostatic hyperplasia. Azotemia is an accumulation of nitrogenous waste products, and renal failure can occur with chronic urinary retention and large residual volumes.

A public health nurse has been asked to provide a health promotion session for men at a wellness center. What should the nurse inform the participants about testicular cancer? A) It is most common among men over 55. B) It is one of the least curable solid tumors. C) It typically does not metastasize. D) It is highly responsive to treatment.

Ans: D It is highly responsive to treatment. Feedback: Testicular cancer is most common among men 15 to 35 years of age and produces a painless enlargement of the testicle. Testicular cancers metastasize early but are one of the most curable solid tumors, being highly responsive to chemotherapy.

A nurse is examining a patient who has been diagnosed with a fibroadenoma. The nurse should recognize what implication of this patient's diagnosis? A) The patient will be scheduled for radiation therapy. B) The patient might be referred for a biopsy. C) The patient's breast mass is considered an age-related change. D) The patient's diagnosis is likely related to her use of oral contraceptives.

B (Feedback: Fibroadenomas are firm, round, movable, benign tumors. These masses are nontender and are sometimes removed for biopsy and definitive diagnosis. They are not considered to be an age-related change, even though they are benign. Radiation therapy is unnecessary and fibroadenomas do not result from oral contraceptive use.)

A nurse is teaching a group of women about the potential benefits of breast self-examination (BSE). The nurse should teach the women that effective BSE is dependent on what factor? A) Women's knowledge of how their breasts normally look and feel B) The rapport that exists between the woman and her primary care provider C) Synchronizing women's routines around BSE with the performance of mammograms D) Women's knowledge of the pathophysiology of breast cancer

A (Feedback: Current practice emphasizes the importance of breast self-awareness, which is a woman's attentiveness to the normal appearance and feel of her breasts. BSE does not need to be synchronized with the performance of mammograms. Rapport between the patient and the care provider is beneficial, but does not necessarily determine the effectiveness of BSE. The woman does not need to understand the pathophysiology of breast cancer to perform BSE effectively.)

A patient has just been told she needs to have an incisional biopsy of a right breast mass. During preoperative teaching, how could the nurse best assess this patient for specific educational, physical, or psychosocial needs she might have? A) By encouraging her to verbalize her questions and concerns B) By discussing the possible findings of the biopsy C) By discussing possible treatment options if the diagnosis is cancer D) By reviewing her medical history

A (Feedback: During the preoperative visit, the nurse assesses the patient for any specific educational, physical, or psychosocial needs that she may have. This can be accomplished by encouraging her to verbalize her fears, concerns, and questions. Reviewing her medical history may be beneficial, but it is not the best way to ascertain her needs. Discussing possible findings of the biopsy and possible treatment options is the responsibility of the treating physician.)

A patient has had a total mastectomy with immediate reconstruction. The patient asks the nurse when she can take a shower. What should the nurse respond? A) Not until the drain is removed B) On the second postoperative day C) Now, if you wash gently with soap and water D) Seven days after your surgery

A (Feedback: If immediate reconstruction has been performed, showering may be contraindicated until the drain is removed.)

A patient who came to the clinic after finding a mass in her breast is scheduled for a diagnostic breast biopsy. During the nurse's admission assessment, the nurse observes that the patient is distracted and tense. What is it important for the nurse to do? A) Acknowledge the fear the patient is likely experiencing. B) Describe the support groups that exist in the community. C) Assess the patient's stress management skills. D) Document a nursing diagnosis of ineffective coping.

A (Feedback: In the breast cancer diagnostic phase it is appropriate to acknowledge the patient's feelings of fear, concern, and apprehension. This must precede interventions such as referrals, if appropriate. Assessment of stress management skills made be necessary, but the nurse should begin by acknowledging the patient's feelings. Fear is not necessarily indicative of ineffective coping.)

A patient has been referred to the breast clinic after her most recent mammogram revealed the presence of a lump. The lump is found to be a small, well-defined nodule in the right breast. The oncology nurse should recognize the likelihood of what treatment? A) Lumpectomy and radiation B) Partial mastectomy and radiation C) Partial mastectomy and chemotherapy D) Total mastectomy and chemotherapy

A (Feedback: Treatment for breast cancer depends on the disease stage and type, the patient's age and menopausal status, and the disfiguring effects of the surgery. For this patient, lumpectomy is the most likely option because the nodule is well-defined. The patient usually undergoes radiation therapy afterward. Because a lumpectomy is possible, mastectomy would not be the treatment of choice.)

A new mother who is breastfeeding calls the clinic to speak to a nurse. The patient is complaining of pain in her left breast and describes her breast as feeling doughy. The nurse tells her to come into the clinic and be checked. The patient is diagnosed with acute mastitis and placed on antibiotics. What comfort measure should the nurse recommend? A) Apply cold compresses as ordered. B) Avoid wearing a bra until the infection clears. C) Avoid washing the breasts. D) Perform gentle massage to stimulate neutrophil migration.

A (Feedback: Treatment of mastitis consists of antibiotics and local application of cold compresses to relieve discomfort. A broad-spectrum antibiotic agent may be prescribed for 7 to 10 days. The patient should wear a snug bra and perform personal hygiene carefully. Massage is not recommended.)

A patient is to undergo an ultrasound-guided core biopsy. The patient tells the nurse that a friend of hers had a stereotactic core biopsy. She wants to understand the differences between the two procedures. What would be the nurse's best response? A) An ultrasound-guided core biopsy is faster, less expensive, and does not use radiation. B) An ultrasound-guided core biopsy is a little more expensive, but it doesn't use radiation and it is faster. C) An ultrasound-guided core biopsy is a little more expensive, and it also uses radiation but it is faster. D) An ultrasound-guided core biopsy takes more time, and it also uses radiation, but it is less expensive.

A (Feedback: Ultrasound-guided core biopsy does not use radiation and is also faster and less expensive than stereotactic core biopsy.)

A patient has been discharged home after a total mastectomy without reconstruction. The patient lives alone and has a home health referral. When the home care nurse performs the first scheduled visit this patient, what should the nurse assess? Select all that apply. A) Adherence to the exercise plan B) Overall psychological functioning C) Integrity of surgical drains D) Understanding of cancer E) Use of the breast prosthesis

A, B, C (Feedback: Patients who have difficulty managing their postoperative care at home may benefit from a home health care referral. The home care nurse assesses the patient's incision and surgical drain(s), adequacy of pain management, adherence to the exercise plan, and overall physical and psychological functioning. It is unnecessary to assess the patient's understanding of cancer at this stage of recovery. Prostheses may be considered later in the recovery process.)

A 35-year-old man is seen in the clinic because he is experiencing recurring episodes of urinary frequency, dysuria, and fever. The nurse should recognize the possibility of what health problem? A) Chronic bacterial prostatitis B) Orchitis C) Benign prostatic hyperplasia D) Urolithiasis

Ans: A Chronic bacterial prostatitis Feedback: Prostatitis is an inflammation of the prostate gland that is often associated with lower urinary tract symptoms and symptoms of sexual discomfort and dysfunction. Symptoms are usually mild, consisting of frequency, dysuria, and occasionally urethral discharge. Urinary incontinence and retention occur with benign prostatic hyperplasia or hypertrophy. The patient may experience nocturia, urgency, decrease in volume and force of urinary stream. Urolithiasis is characterized by excruciating pain. Orchitis does not cause urinary symptoms.

A nurse is providing care for a patient who has recently been admitted to the postsurgical unit from PACU following a transuretheral resection of the prostate. The nurse is aware of the nursing diagnosis of Risk for Imbalanced Fluid Volume. In order to assess for this risk, the nurse should prioritize what action? A) Closely monitoring the input and output of the bladder irrigation system B) Administering parenteral nutrition and fluids as ordered C) Monitoring the patient's level of consciousness and skin turgor D) Scanning the patient's bladder for retention every 2 hours

Ans: A Closely monitoring the input and output of the bladder irrigation system Feedback: Continuous bladder irrigation effectively reduces the risk of clots in the GU tract but also creates a risk for fluid volume excess if it becomes occluded. The nurse must carefully compare input and output, and ensure that these are in balance. Parenteral nutrition is unnecessary after prostate surgery and skin turgor is not an accurate indicator of fluid status. Frequent bladder scanning is not required when a urinary catheter is in situ.

A patient has just returned to the floor following a transurethral resection of the prostate. A triple-lumen indwelling urinary catheter has been inserted for continuous bladder irrigation. What, in addition to balloon inflation, are the functions of the three lumens? A) Continuous inflow and outflow of irrigation solution B) Intermittent inflow and continuous outflow of irrigation solution C) Continuous inflow and intermittent outflow of irrigation solution D) Intermittent flow of irrigation solution and prevention of hemorrhage

Ans: A Continuous inflow and outflow of irrigation solution Feedback: For continuous bladder irrigation, a triple-lumen indwelling urinary catheter is inserted. The three lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution.

A 29-year-old patient has just been told that he has testicular cancer and needs to have surgery. During a presurgical appointment, the patient admits to feeling devastated that he requires surgery, stating that it will leave him emasculated and a shell of a man. The nurse should identify what nursing diagnosis when planning the patient's subsequent care? A) Disturbed Body Image Related to Effects of Surgery B) Spiritual Distress Related to Effects of Cancer Surgery C) Social Isolation Related to Effects of Surgery D) Risk for Loneliness Related to Change in Self-Concept

Ans: A Disturbed Body Image Related to Effects of Surgery Feedback: The patient's statements specifically address his perception of his body as it relates to his identity. Consequently, a nursing diagnosis of Disturbed Body Image is likely appropriate. This patient is at risk for social isolation and loneliness, but there's no indication in the scenario that these diagnoses are present. There is no indication of spiritual element to the patient's concerns.

A nurse is teaching a 53-year-old man about prostate cancer. What information should the nurse provide to best facilitate the early identification of prostate cancer? A) Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. B) Have a transrectal ultrasound every 5 years. C) Perform monthly testicular self-examinations, especially after age 60. D) Have a complete blood count (CBC), blood urea nitrogen (BUN) and creatinine assessment performed annually.

Ans: A Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. Feedback: The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and the PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that should be done yearly. Testicular self-examinations won't identify changes in the prostate gland due to its location in the body. A transrectal ultrasound and CBC with BUN and creatinine assessment are usually done after diagnosis to identify the extent of disease and potential metastases.

A patient is 24 hours postoperative following prostatectomy and the urologist has ordered continuous bladder irrigation. What color of output should the nurse expect to find in the drainage bag? A) Red wine colored B) Tea colored C) Amber D) Light pink

Ans: D Light pink Feedback: The urine drainage following prostatectomy usually begins as a reddish pink, then clears to a light pink 24 hours after surgery.

A patient who is postoperative day 12 and recovering at home following a laparoscopic prostatectomy has reported that he is experiencing occasional dribbling of urine. How should the nurse best respond to this patient's concern? A) Inform the patient that urinary control is likely to return gradually. B) Arrange for the patient to be assessed by his urologist. C) Facilitate the insertion of an indwelling urinary catheter by the home care nurse. D) Teach the patient to perform intermittent self-catheterization.

Ans: A Inform the patient that urinary control is likely to return gradually. Feedback: It is important that the patient know that regaining urinary control is a gradual process; he may continue to dribble after being discharged from the hospital, but this should gradually diminish (usually within 1 year). At this point, medical follow-up is likely not necessary. There is no need to perform urinary catheterization.

A patient has experienced occasional urinary incontinence in the weeks since his prostatectomy. In order to promote continence, the nurse should encourage which of the following? A) Pelvic floor exercises B) Intermittent urinary catheterization C) Reduced physical activity D) Active range of motion exercises

Ans: A Pelvic floor exercises Feedback: Pelvic floor muscles can promote the resumption of normal urinary function following prostate surgery. Catheterization is normally unnecessary, and it carries numerous risks of adverse effects. Increasing or decreasing physical activity is unlikely to influence urinary function.

A public health nurse is teaching a health class for the male students at the local high school. The nurse is teaching the boys to perform monthly testicular self-examinations. What point would be appropriate to emphasize? A) Testicular cancer is a highly curable type of cancer. B) Testicular cancer is very difficult to diagnose. C) Testicular cancer is the number one cause of cancer deaths in males. D) Testicular cancer is more common in older men.

Ans: A Testicular cancer is a highly curable type of cancer. Feedback: Testicular cancer is highly curable, particularly when it's treated in its early stage. Self-examination allows early detection and facilitates the early initiation of treatment. The highest mortality rates from cancer among men are with lung cancer. Testicular cancer is found more commonly in younger men.

The nurse is leading a workshop on sexual health for men. The nurse should teach participants that organic causes of erectile dysfunction include what? Select all that apply. A) Diabetes B) Testosterone deficiency C) Anxiety D) Depression E) Parkinsonism

Ans: A, B, E Feedback: Organic causes of ED include cardiovascular disease, endocrine disease (diabetes, pituitary tumors, testosterone deficiency, hyperthyroidism, and hypothyroidism), cirrhosis, chronic renal failure, genitourinary conditions (radical pelvic surgery), hematologic conditions (Hodgkin disease, leukemia), neurologic disorders (neuropathies, parkinsonism, spinal cord injury, multiple sclerosis), trauma to the pelvic or genital area, alcohol, smoking, medications, and drug abuse. Anxiety and depression are considered to be psychogenic causes.

A patient has returned to the floor from the PACU after undergoing a suprapubic prostatectomy. The nurse notes significant urine leakage around the suprapubic tube. What is the nurse's most appropriate action? A) Cleanse the skin surrounding the suprapubic tube. B) Inform the urologist of this finding. C) Remove the suprapubic tube and apply a wet-to-dry dressing. D) Administer antispasmodic drugs as ordered.

Ans: B Inform the urologist of this finding. Feedback: The physician should be informed if there is significant leakage around a suprapubic catheter. Cleansing the skin is appropriate but does not resolve the problem. Removing the suprapubic tube is contraindicated because it is unsafe. Administering drugs will not stop the leakage of urine around the tube.

A 55-year-old man presents at the clinic complaining of erectile dysfunction. The patient has a history of diabetes. The physician orders tadalafil (Cialis) to be taken 1 hour before sexual intercourse. The nurse reviews the patient's history prior to instructing the patient on the use of this medication. What disorder will contraindicate the use of tadalafil (Cialis)? A) Cataracts B) Retinopathy C) Hypotension D) Diabetic nephropathy

Ans: B Retinopathy Feedback: Patients with cataracts, hypotension, or nephropathy will be allowed to take tadalafil (Cialis) and sildenafil (Viagra) if needed. However, tadalafil (Cialis) and sildenafil (Viagra) are usually contraindicated with diabetic retinopathy.

A 75-year-old male patient is being treated for phimosis. When planning this patient's care, what health promotion activity is most directly related to the etiology of the patient's health problem? A) Teaching the patient about safer sexual practices B) Teaching the patient about the importance of hygiene C) Teaching the patient about the safe use of PDE-5 inhibitors D) Teaching the patient to perform testicular self-examination

Ans: B Teaching the patient about the importance of hygiene Feedback: Poor hygiene often contributes to cases of phimosis. This health problem is unrelated to sexual practices, the use of PDE-5 inhibitors, or testicular self-examination.

A patient has been prescribed sildenafil. What should the nurse teach the patient about this medication? A) Sexual stimulation is not needed to obtain an erection. B) The drug should be taken 1 hour prior to intercourse. C) Facial flushing or headache should be reported to the physician immediately. D) The drug has the potential to cause permanent visual changes

Ans: B The drug should be taken 1 hour prior to intercourse. Feedback: The patient must have sexual stimulation to create the erection, and the drug should be taken 1 hour before intercourse. Facial flushing, mild headache, indigestion, and running nose are common side effects of Viagra and do not normally warrant reporting to the physician. Some visual disturbances may occur, but these are transient.

A man comes to the clinic complaining that he is having difficulty obtaining an erection. When reviewing the patient's history, what might the nurse note that contributes to erectile dysfunction? A) The patient has been treated for a UTI twice in the past year. B) The patient has a history of hypertension. C) The patient is 66 years old. D) The patient leads a sedentary lifestyle.

Ans: B The patient has a history of hypertension. Feedback: Past history of infection and lack of exercise do not contribute to impotence. With advancing age, sexual function and libido and potency decrease somewhat, but this is not the primary reason for impotence. Vascular problems cause about half the cases of impotence in men older than 50 years; hypertension is a major cause of such problems.

A 35-year-old father of three tells the nurse that he wants information on a vasectomy. What would the nurse tell him about ejaculate after a vasectomy? A) There will be no ejaculate after a vasectomy, though the patient's potential for orgasm is unaffected. B) There is no noticeable decrease in the amount of ejaculate even though it contains no sperm. C) There is a marked decrease in the amount of ejaculate after vasectomy, though this does not affect sexual satisfaction. D) There is no change in the quantity of ejaculate after vasectomy, but the viscosity is somewhat increased.

Ans: B There is no noticeable decrease in the amount of ejaculate even though it contains no sperm. Feedback: Seminal fluid is manufactured predominantly in the seminal vesicles and prostate gland, which are unaffected by vasectomy, thus no noticeable decrease in the amount of ejaculate occurs (volume decreases approximately 3%), even though it contains no spermatozoa. The viscosity of ejaculate does not change.

A clinic nurse is providing preprocedure education for a man who will undergo a vasectomy. Which of the following measures will enhance healing and comfort? Select all that apply. A) Abstaining from sexual intercourse for at least 14 days postprocedure B) Wearing a scrotal support garment C) Using sitz baths D) Applying a heating pad intermittently E) Staying on bed rest for 48 to 72 hours post-procedure

Ans: B, C Feedback: Applying ice bags intermittently to the scrotum for several hours after surgery can reduce swelling and relieve discomfort, and is preferable to the application of heat. The nurse advises the patient to wear snug, cotton underwear or a scrotal support for added comfort and support. Sitz baths can also enhance comfort. Extended bed rest is unnecessary, and sexual activity can usually be resumed in 1 week.

A nurse is assessing a patient who presented to the ED with priapism. The student nurse is aware that this condition is classified as a urologic emergency because of the potential for what? A) Urinary tract infection B) Chronic pain C) Permanent vascular damage D) Future erectile dysfunction

Ans: C Permanent vascular damage Feedback: The ischemic form of priapism, which is described as nonsexual, persistent erection with little or no cavernous blood flow, must be treated promptly to prevent permanent damage to the penis. Priapism has not been indicated in the development of UTIs, chronic pain, or erectile dysfunction.

A nurse practitioner is assessing a 55-year-old male patient who is complaining of perineal discomfort, burning, urgency, and frequency with urination. The patient states that he has pain with ejaculation. The nurse knows that the patient is exhibiting symptoms of what? A) Varicocele B) Epididymitis C) Prostatitis D) Hydrocele

Ans: C Prostatitis Feedback: Perineal discomfort, burning, urgency, frequency with urination, and pain with ejaculation is indicative of prostatitis. A varicocele is an abnormal dilation of the pampiniform venous plexus and the internal spermatic vein in the scrotum (the network of veins from the testis and the epididymis that constitute part of the spermatic cord). Epididymitis is an infection of the epididymis that usually descends from an infected prostate or urinary tract; it also may develop as a complication of gonorrhea. A hydrocele is a collection of fluid, generally in the tunica vaginalis of the testis, although it also may collect within the spermatic cord.

A nurse is performing an admission assessment on a 40-year-old man who has been admitted for outpatient surgery on his right knee. While taking the patient's family history, he states, My father died of prostate cancer at age 48. The nurse should instruct him on which of the following health promotion activities? A) The patient will need PSA levels drawn starting at age 55. B) The patient should have testing for presence of the CDH1 and STK11 genes. C) The patient should have PSA levels drawn regularly. D) The patient should limit alcohol use due to the risk of malignancy.

Ans: C The patient should have PSA levels drawn regularly. Feedback: PSA screening is warranted by the patient's family history and should not be delayed until age 55. The CDH1 and STK11 genes do not relate to the risk for prostate cancer. Alcohol consumption by the patient should be limited. However, this is not the most important health promotion intervention.

A nurse is planning the postoperative care of a patient who is scheduled for radical prostatectomy. What intraoperative position will place the patient at particular risk for the development of deep vein thrombosis postoperatively? A) Fowler's position B) Prone position C) Supine position D) Lithotomy position

Ans: D Lithotomy position Feedback: Elastic compression stockings are applied before surgery and are particularly important for prevention of deep vein thrombosis if the patient is placed in a lithotomy position during surgery. During a prostatectomy, the patient is not placed in the supine, prone, or Fowler's position.

A 57-year-old male comes to the clinic complaining that when he has an erection his penis curves and becomes painful. The patient's diagnosis is identified as severe Peyronie's disease. The nurse should be aware of what likely treatment modality? A) Physical therapy B) Treatment with PDE-5 inhibitors C) Intracapsular hydrocortisone injections D) Surgery

Ans: D Surgery Feedback: Surgical removal of mature plaques is used to treat severe Peyronie's disease. There is no potential benefit to physical therapy and hydrocortisone injections are not normally used. PDE-5 inhibitors would exacerbate the problem.

A 60-year-old man presents at the clinic complaining that his breasts are tender and enlarging. The patient is subsequently diagnosed with gynecomastia. The patient should be assessed for the possibility of what causative factor? A) Age-related physiologic changes B) Medication adverse effects C) Poor nutrition D) Fluid overload

B (Feedback: Gynecomastia can also occur in older men and usually presents as a firm, tender mass underneath the areola. In these patients, gynecomastia may be diffuse and related to the use of certain medications. It is unrelated to fluid overload or nutrition and is not considered an age-related change.)

A patient at high risk for breast cancer is scheduled for an incisional biopsy in the outpatient surgery department. When the nurse is providing preoperative education, the patient asks why an incisional biopsy is being done instead of just removing the mass. What would be the nurse's best response? A) An incisional biopsy is performed because it's known to be less painful and more accurate than other forms of testing. B) An incisional biopsy is performed to confirm a diagnosis and so that special studies can be done that will help determine the best treatment. C) An incisional biopsy is performed to assess the potential for recovery from a mastectomy. D) An incisional biopsy is performed on patients who are younger than the age of 40 and who are otherwise healthy.

B (Feedback: Incisional biopsy surgically removes a portion of a mass. This is performed to confirm a diagnosis and to conduct special studies that will aid in determining treatment. Incisional biopsies cannot always remove the whole mass, nor is it always beneficial to the patient to do so. The procedure is not chosen because of the potential for pain, the possibility of recovery from mastectomy, or the patient's age.)

A 42-year-old man has come to the clinic for an annual physical. The nurse notes in the patient's history that his father was treated for breast cancer. What should the nurse provide to the patient before he leaves the clinic? A) A referral for a mammogram B) Instructions about breast self-examination (BSE) C) A referral to a surgeon D) A referral to a support group

B (Feedback: Instructions about BSE should be provided to men if they have a family history of breast cancer, because they may have an increased risk of male breast cancer. It is not within the scope of the practice of a nurse to refer a patient for a mammogram or to a surgeon; these actions are not necessary or recommended. In the absence of symptoms or a diagnosis, referral to a support group is unnecessary.)

A 45-year-old woman comes into the health clinic for her annual check-up. She mentions to the nurse that she has noticed dimpling of the right breast that has occurred in a few months. What assessment would be most appropriate for the nurse to make? A) Evaluate the patient's milk production. B) Palpate the area for a breast mass. C) Assess the patient's knowledge of breast cancer. D) Assure the patient that this likely an age-related change.

B (Feedback: It would be most important for the nurse to palpate the breast to determine the presence of a mass and to refer the patient to her primary care provider. Edema and pitting of the skin may result from a neoplasm blocking lymphatic drainage, giving the skin an orange-peel appearance (peau d'orange), a classic sign of advanced breast cancer. Evaluation of milk production is required in lactating women. There is no indication of lactation in the scenario. The patient's knowledge of breast cancer is relevant, but is not a time-dependent priority. This finding is not an age-related change.)

The nurse is performing a comprehensive health history of a patient who is in her 50s. The nurse should identify what risk factor that may increase this patient's risk for breast cancer? A) The patient breastfed each of her children. B) The patient gave birth to her first child at age 38. C) The patient experienced perimenopausal symptoms starting at age 46. D) The patient experienced menarche at age 13.

B (Feedback: Late age at first pregnancy is a risk factor for breast cancer. None of the other listed aspects of the patient's health history is considered to be a risk factor for breast cancer.)

A 52-year-old woman has just been told she has breast cancer and is scheduled for a modified mastectomy the following week. The nurse caring for this patient knows that she is anxious and fearful about the upcoming procedure and the newly diagnosed malignancy. How can the nurse most likely alleviate this patient's fears? A) Provide written material on the procedure that has been scheduled for the patient. B) Provide the patient with relevant information about expected recovery. C) Give the patient current information on breast cancer survival rates. D) Offer the patient alternative treatment options.

B (Feedback: Providing the patient with realistic expectations about the healing process and expected recovery can help alleviate fears. Offering the patient alternative treatment options is not within the nurse's normal scope of practice. Addressing survival rates may or may not be beneficial for the patient. Written material is rarely sufficient to meet patients' needs.)

A woman aged 48 years comes to the clinic because she has discovered a lump in her breast. After diagnostic testing, the woman receives a diagnosis of breast cancer. The woman asks the nurse when her teenage daughters should begin mammography. What is the nurse's best advice? A) Age 28 B) Age 35 C) Age 38 D) Age 48

C (Feedback: A general guideline is to begin screening 5 to 10 years earlier than the age at which the youngest family member developed breast cancer, but not before age 25 years. In families with a history of breast cancer, a downward shift in age of diagnosis of about 10 years is seen. Because their mother developed breast cancer at age 48 years, the daughters should begin mammography at age 38 to 43 years.)

A patient has just been diagnosed with breast cancer and the nurse is performing a patient interview. In assessing this patient's ability to cope with this diagnosis, what would be an appropriate question for the nurse to ask this patient? A) What is your level of education? B) Are you feeling alright these days? C) Is there someone you trust to help you make treatment choices? D) Are you concerned about receiving this diagnosis?

C (Feedback: A trusted ally to assist in making treatment choices is beneficial to the patient's coping ability. It is condescending and inappropriate to ask if the patient is feeling alright these days or is concerned about the diagnosis. The patient's education level is irrelevant.)

For which of the following population groups would an annual clinical breast examination be recommended? A) Women over age 21 B) Women over age 25 C) Women over age 40 D) All post-pubescent females with a family history of breast cancer

C (Feedback: Annual clinical breast examination is recommended for women aged 40 years and older. Younger women may have examinations less frequently.)

A nurse is explaining that each breast contains 12 to 20 cone-shaped lobes. The nurse should explain that each lobe consists of what elements? A) Modified tendons and ligaments B) Connective tissue and smooth muscle C) Lobules and ducts D) Endocrine glands and sebaceous glands

C (Feedback: Each breast contains 12 to 20 cone-shaped lobes, which are made up of glandular elements (lobules and ducts) and separated by fat and fibrous tissue that binds the lobes together. These breast lobes do not consist of tendons, ligaments, endocrine glands, or smooth muscle.)

A 23-year-old woman comes to the free clinic stating I think I have a lump in my breast. Do I have cancer? The nurse instructs the patient that a diagnosis of breast cancer is confirmed by what? A) Supervised breast self-examination B) Mammography C) Fine-needle aspiration D) Chest x-ray

C (Feedback: Fine-needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis, although falsenegative and falsepositive findings are possibilities. A breast self-examination, if done regularly, is the most reliable method for detecting breast lumps early, but is not diagnostic of cancer. Mammography is used to detect tumors that are too small to palpate. Chest x-rays can be used to pinpoint rib metastasis. Neither test is considered diagnostic of breast cancer, however.)

The nurse is caring for a patient who has just had a radical mastectomy and axillary node dissection. When providing patient education regarding rehabilitation, what should the nurse recommend? A) Avoid exercise of the arm for next 2 months. B) Keep cuticles clipped neatly. C) Avoid lifting objects heavier than 10 pounds. D) Use a sling until healing is complete.

C (Feedback: Following an axillary dissection, the patient should avoid lifting objects greater than 5 to 10 pounds, cutting the cuticles, and undergoing venipuncture on the affected side. Exercises of the hand and arm are encouraged and the use of a sling is not necessary.)

During a recent visit to the clinic a woman presents with erythema of the nipple and areola on the right breast. She states this started several weeks ago and she was fearful of what would be found. The nurse should promptly refer the patient to her primary care provider because the patient's signs and symptoms are suggestive of what health problem? A) Peau d'orange B) Nipple inversion C) Paget's disease D) Acute mastitis

C (Feedback: Paget's disease presents with erythema of the nipple and areola. Peau d'orange, which is associated with breast cancer, is caused by interference with lymphatic drainage, but does not cause these specific signs. Nipple inversion is considered normal if long-standing; if it is associated with fibrosis and is a recent development, malignancy is suspected. Acute mastitis is associated with lactation, but it may occur at any age.)

When planning discharge teaching with a patient who has undergone a total mastectomy with axillary dissection, the nurse knows to instruct the patient that she should report what sign or symptom to the physician immediately? A) Fatigue B) Temperature greater than 98.5ºF C) Sudden cessation of output from the drainage device D) Gradual decline in output from the drain

C (Feedback: The patient should report sudden cessation of output from the drainage device, which could indicate an occlusion. Gradual decline in output is expected. A temperature of 100.4°F or greater should also be reported to rule out postoperative infection, but a temperature of 98.5°F is not problematic. Fatigue is expected during the recovery period.)

The nurse leading an educational session is describing self-examination of the breast. The nurse tells the women's group to raise their arms and inspect their breasts in a mirror. A member of the women's group asks the nurse why raising her arms is necessary. What is the nurse's best response? A) It helps to spread out the fat that makes up your breast. B) It allows you to simultaneously assess for pain. C) It will help to observe for dimpling more closely. D) This is what the American Cancer Society recommends.

C (Feedback: The primary reason for raising the arms is to detect any dimpling. To elicit skin dimpling or retraction that may otherwise go undetected, the examiner instructs the patient to raise both arms overhead. Citing American Cancer Society recommendations does not address the woman's question. The purpose of raising the arms is not to elicit pain or to redistribute adipose tissue.(

The nurse is teaching breast self-examination (BSE) to a group of women. The nurse should recommend that the women perform BSE at what time? A) At the time of menses B) At any convenient time, regardless of cycles C) Weekly D) Between days 5 and 7 after menses

D (Feedback: BSE is best performed after menses, on day 5 to day 7, counting the first day of menses as day 1. Monthly performance is recommended.)

A 35-year-old mother of three young children has been diagnosed with stage II breast cancer. After discussing treatment options with her physician, the woman goes home to talk to her husband, later calling the nurse for clarification of some points. The patient tells the nurse that the physician has recommended breast conservation surgery followed by radiation. The patient's husband has done some online research and is asking why his wife does not have a modified radical mastectomy to be sure all the cancer is gone. What would be the nurse's best response? A) Modified radical mastectomies are very hard on a patient, both physically and emotionally and they really aren't necessary anymore. B) According to current guidelines, having a modified radical mastectomy is no longer seen as beneficial. C) Modified radical mastectomies have a poor survival rate because of the risk of cancer recurrence. D) According to current guidelines, breast conservation combined with radiation is as effective as a modified radical mastectomy.

D (Feedback: Breast conservation along with radiation therapy in stage I and stage II breast cancer results in a survival rate equal to that of modified radical mastectomy. Mastectomies are still necessary in many cases, but are not associated with particular risk of recurrence.)

A woman is considering breast reduction mammoplasty. When weighing the potential risks and benefits of this surgical procedure, the nurse should confirm that the patient is aware of what potential consequence? A) Chronic breast pain B) Unclear mammography results C) Increased risk of breast cancer D) Decreased nipple sensation

D (Feedback: During the preoperative consultation, the patient should be informed of a possibility that sensory changes of the nipple (e.g., numbness) may occur. There is no consequent increase in breast cancer risk and it does not affect future mammography results. Chronic pain is not an expected complication.)

A nurse has assessed that a patient is not yet willing to view her mastectomy site. How should the nurse best assist the patient is developing a positive body image? A) Ask the woman to describe the current appearance of her breast. B) Help the patient to understand that many women have gone through the same unpleasant experience. C) Explain to the patient that her body image does not have to depend on her physical appearance. D) Provide the patient with encouragement in an empathic and thoughtful manner.

D (Feedback: Gentle encouragement can help the patient progress toward accepting the change in her appearance. The nurse should not downplay the significance of physical appearance. Explaining that others have had similar experiences may or may not benefit the patient. Asking the patient to describe the appearance of her breast is likely to exacerbate the woman's reluctance to do so.)

A woman is being treated for a tumor of the left breast. If the patient and her physician opt for prophylactic treatment, the nurse should prepare the woman for what intervention? A) More aggressive chemotherapy B) Left mastectomy C) Radiation therapy D) Bilateral mastectomy

D (Feedback: Right mastectomy would be considered a prophylactic measure to reduce the risk of cancer in the patient's unaffected breast. None of the other listed interventions would be categorized as being prophylactic rather than curative.)

The nurse is caring for a 52-year-old woman whose aunt and mother died of breast cancer. The patient states, My doctor and I talked about Tamoxifen to help prevent breast cancer. Do you think it will work? What would be the nurse's best response? A) Yes, it's known to have a slight protective effect. B) Yes, but studies also show an increased risk of osteoporosis. C) You won't need to worry about getting cancer as long as you take Tamoxifen. D) Tamoxifen is known to be a highly effective protective measure.

D (Feedback: Tamoxifen has been shown to be a highly effective chemopreventive agent. However, it cannot reduce the risk of cancer by 100%. It also acts to prevent osteoporosis.)

A patient newly diagnosed with breast cancer states that her physician suspects regional lymph node involvement and told her that there are signs of metastatic disease. The nurse learns that the patient has been diagnosed with stage IV breast cancer. What is an implication of this diagnosis? A) The patient is not a surgical candidate. B) The patient's breast cancer is considered highly treatable. C) There is a 10% chance that the patient's cancer will self-resolve. D) The patient has a 15% chance of 5-year survival

D (Feedback: The 5-year survival rate is approximately 15% for stage IV breast cancer. Surgery is still a likely treatment, but the disease would not be considered to be highly treatable. Self-resolution of the disease is not a possibility.)

A patient in her 30s has two young children and has just had a modified radical mastectomy with immediate reconstruction. The patient shares with the nurse that she is somewhat worried about her future, but she appears to be adjusting well to her diagnosis and surgery. What nursing intervention is most appropriate to support this patient's coping? A) Encourage the patient's spouse or partner to be supportive while she recovers. B) Encourage the patient to proceed with the next phase of treatment. C) Recommend that the patient remain optimistic for the sake of her children. D) Arrange a referral to a community-based support program.

D (Feedback: The patient is not exhibiting clear signs of anxiety or depression. Therefore, the nurse can probably safely approach her about talking with others who have had similar experiences. The nurse may educate the patient's spouse or partner to listen for concerns, but the nurse should not tell the patient's spouse what to do. The patient must consult with her physician and make her own decisions about further treatment. The patient needs to express her sadness, frustration, and fear. She cannot be expected to be optimistic at all times.)

A patient has presented for her annual mammogram. The patient voices concerns related to exposure to radiation. What should the nurse teach the patient about a mammogram? A) It does not use radiation. B) Radiation levels are safe as long as mammograms are performed only once per year. C) The negative effects of radiation do not accumulate until late in life. D) Radiation from a mammogram is equivalent to an hour of sunlight.

D (Feedback: The radiation exposure of mammogram is equivalent to about 1 hour of exposure to sunlight. Consequently, the benefits of mammography far outweigh any risks associated with the procedure. Negative consequences are insignificant, and do not accumulate later in life.)