Reproductive System Disorders

18. What should the nurse include when teaching the patient with acute PID how to care for herself? a. Promote rest in semi-Fowler's position. b. Perform vaginal irrigations every 4 hours. c. Instruct the patient to use tampons to control vaginal drainage. d. The patient should ambulate frequently to promote drainage of exudate.

. a. Physical rest in semi-Fowler's position promotes drainage of the pelvic cavity by gravity and may prevent the development of abscesses high in the abdomen. Coitus, douching, and tampon use should be avoided to prevent spreading infection upward from the vagina, although frequent perineal care should be performed to remove infectious drainage.

19. Following a mastectomy, a patient develops lymphedema of the affected arm. What does the nurse teach the patient to do? a. Avoid skin-softening agents on the arm. b. Protect the arm from any type of trauma. c. Abduct and adduct the arm at the shoulder hourly. d. Keep the arm positioned so that it is in straight and dependent alignment.

. b. Removal of the axillary lymph nodes impairs lymph drainage from the affected arm and predisposes the patient to infection of the arm. The arm must be protected from even minor trauma. BP, venipunctures, and injections should not be done on the arm. The arm should never be dependent, even during sleep, and should be elevated to promote lymph drainage.

15. Sentinel lymph node biopsy (SLNB) is planned for a patient undergoing a modified radical mastectomy for breast cancer. What does the nurse teach the patient and her family about the purpose of this specific procedure? a. SLNB provides metastatic lymph nodes to test for responsiveness to chemotherapy. b. If one sentinel lymph node is positive for malignant cells, all of the sentinel lymph nodes will be removed. c. A radioisotope indicates which lymph nodes are most likely to have metastasis, and all of those nodes are removed. d. If malignant cells are found in any sentinel nodes, a complete axillary lymph node dissection (ALND) will be do

. c. In a sentinel lymph node biopsy (SLNB) radioisotopes or dye identify lymph nodes that drain from the tumor site, and they are removed. Those nodes are examined for malignant cells. If any of the nodes have malignant cells, the next step is a complete axillary lymph node dissection (ALND). If the sentinel nodes are negative, no additional lymph nodes are removed.

Which diagnostic test is most accurate and advantageous in terms of time and expense in diagnosis of malignant breast disorders? a. Mammography b.excisional biopsy c. Fine-needle aspiration d. Core (core needle) biopsy

. d. A definitive diagnosis of breast cancer can be made only by a histologic examination of biopsied tissue. A core (core needle) biopsy is as reliable as an excisional biopsy and has the advantages of decreased length of time for the procedure and recovery and reduced cost. A limitation of fine-needle aspiration is that if negative results are found, more definitive biopsy procedures are required.

1. A patient asks the nurse what the difference is between benign prostatic hyperplasia (BPH) and prostate cancer. The best response by the nurse includes what information about BPH? a. BPH is a benign tumor that does not spread beyond the prostate gland. b. BPH is a precursor to prostate cancer but does not yet show any malignant changes. c. BPH is an enlargement of the gland caused by an increase in the size of existing cells. d. BPH is a benign enlargement of the gland caused by an increase in the number of normal cells.

1. d. Hyperplasia is an increase in the number of cells and in benign prostatic hyperplasia (BPH), it is thought that the enlargement caused by the increase in new cells results from hormonal changes associated with aging. The hyperplasia is not considered a tumor, nor has BPH been proven to predispose to cancer of the prostate. Hypertrophy refers to an increase in the size of existing cells.

6. After undergoing a modified radical mastectomy, a cli- ent is transferred to the postanesthesia care unit. Which nursing action is best to assign to an experi- enced LPN/LVN? 1. Monitoring the client's dressing for any signs of bleeding 2. Documenting the initial assessment on the client's chart 3. Communicating the client's status report to the charge nurse on the surgical unit 4. Teaching the client about the importance of using pain medication as needed

Ans: 1 An LPN/LVN working in a postanesthesia care unit would be expected to check dressings for bleeding and alert RN staff members if bleeding occurs. The other tasks are more appropriate for nurs- ing staff with RN-level education and licensure. Focus: Assignment.

11. After a radical prostatectomy, a client is ready to be dis- charged. Which nursing action included in the dis- charge plan should be assigned to an experienced LPN/LVN? 1. Reinforcing the client's need to check his tempera- ture daily 2. Teaching the client how to care for his retention catheter 3. Documenting a discharge assessment in the client's chart 4. Instructing the client about the prescribed narcotic analgesic

Ans: 1 Reinforcement of previous teaching is an expected role of the LPN/LVN. Planning and imple- menting client initial teaching and documentation of a client's discharge assessment should be performed by experienced RN staff members

31. The nurse is reviewing medication lists for several cli- ents. Which medication is most important for the nurse to question? 1. Testosterone transdermal gel for a client who has prostate cancer 2. Metformin for a client whose only diagnosis is polystic ovary syndrome 3. Sildenafil for a client who is also taking hydrochlorothiazide for hypertension 4. Methoprogesterone for a client who has infertilityassociated with endometriosis

Ans: 1 Testosterone is contraindicated in clients who have prostate cancer because it can promote growth of prostate cancer. Although metformin is most com- monly prescribed for type 2 diabetes, it can be helpful in restoring ovulation in clients with polycystic ovary syndrome. Sildenafil lowers blood pressure and should not be used by clients who are taking nitrates or alpha- adrenergic blockers but may be used in clients taking other antihypertensives. Progestin therapy alone will not treat infertility caused by endometriosis but may be used to shrink endometrial tissue

13. The emergency department nurse receives change-of- shift report about four clients. Which one should be assessed first? 1. A 19-year-old client with scrotal swelling and severe pain that has not decreased with elevation of the scrotum 2. A 25-year-old client who has a painless indurated lesion on the glans penis 3. A 44-year-old client with an elevated temperature, chills, and back pain associated with recurrent prostatitis 4. A77-year-oldclientwithabdominalpainandacute bladder distention

Ans: 1 This client has symptoms of testicular tor- sion, an emergency that needs immediate assessment and intervention because it can lead to testicular ische- mia and necrosis within a few hours. The other clients also have symptoms of acute problems (primary syph- ilis, acute bacterial prostatitis, and prostatic hyperplasia with urinary retention), which need rapid assessment and intervention, but these are not as urgent as the pos- sible testicular torsion

30. An 86-year-old woman had an anterior and posterior colporrhaphy (A & P repair) several days ago. Her retention catheter was removed 8 hours ago. Which assessment finding requires that the nurse act most rapidly? 1. Her oral temperature is 100.7°F (38.2°C). 2. Her abdomen is firm and tender to palpation above the symphysis pubis. 3. Her breath sounds are decreased, with fine crackles audible at both bases. 4. Her apical pulse is 86 beats/min and slightly irregular.

Ans: 2 After an A & P repair, it is essential that the bladder be empty to avoid putting pressure on the suture lines. The abdominal firmness and tenderness indicate that the client's bladder is distended. The health care provider should be notified and an order for catheterization obtained. The other data also indi- cate a need for further assessment of her cardiac status and actions such as having the client cough and deep breathe, but these are not such immediate concerns.

.A client who is being treated as an outpatient for pelvic inflammatory disease (PID) with oral antibiotics returns to the clinic after 3 days of treatment. Which finding by the nurse is of highest concern? 1. Client reports nausea after taking the antibiotics. 2. Client's abdominal rebound pain is unchanged. 3. Client says she feels ashamed to have the infection. 4. Client's cervical culture report shows gonorrhea.

Ans: 2 Because clinical manifestations of PID should be improving with 3 days of effective antibiotic treatment, the client's ongoing pain indicates a need for actions such as hospitalization for intravenous antibi- otic therapy. Nausea is an adverse effect of many anti- biotics, but the client will be instructed to continue the medications. The client's feeling of shame should be addressed by the nurse but is not the most important finding. Because Neisseria gonorrhoeae is a common cause of PID, all drug regimens that are used will be effective in treating gonorrhea (and Chlamydia tracho- matis)

26. The clinic nurse reviews information about four clients who are requesting Pap testing. Which client needs to be scheduled first? 1. A 19-year-old client who first had intercourse at age 13 years 2. A 25-year-old client who has never had a pelvic examination 3. A 33-year-old client who had a normal Pap test 2 years previously 4. A 67-year-old client who says her previous Pap test results have been normal

Ans: 2 Current guidelines indicate that Pap testing should be started at age 21 years, regardless of when a woman has become sexually active. The 19-year-old client should be counseled that there is an increased risk for cervical cancer associated with sex- ual activity before age 17 years and encouraged to schedule Pap testing, human papillomavirus testing, or both at age 21 years. The 33-year-old client will need screening every 3 years, and the 67-year-old will not need further Pap screening if she has had several normal Pap test results within the past 2 to 3 years.

10 he nurse is caring for a client who has just returned to the surgical unit after a transurethral resection of the prostate (TURP). Which assessment finding will require the most immediate action? 1. Blood pressure reading of 153/88 mm Hg 2. Catheter that is draining deep red blood 3. Client not wearing antiembolism hose 4. Client report of abdominal cramping

Ans: 2 Hemorrhage is a major complication after TURP and should be reported to the surgeon immedi- ately. The other assessment data also indicate a need for nursing action but not as urgently. Focus: Prioritization

7. The nurse is working with an unlicensed assistive per- sonnel (UAP) to care for a client who has had a right breast lumpectomy and axillary lymph node dissection. Which nursing action can be delegated to the UAP? 1. Teaching the client why blood pressure measure- ments are taken on the left arm 2. Elevating the client's arm on two pillows to promote lymphatic drainage 3. Assessing the client's right arm for lymphedema 4.Reinforcing the dressing if it becomes saturated

Ans: 2 Positioning the client's arm is a task within the scope of practice for UAP working on a surgical unit. Client teaching and assessment are RN-level skills. The RN should reinforce dressings as necessary because this requires assessment of the surgical site and possible communication with the surgeon.

27. When assessing a client with cervical cancer who had a total abdominal hysterectomy yesterday, the nurse obtains the following data. Which information has the most immediate implications for planning of the client's care? 1. Fine crackles are audible at the lung bases. 2. The client's right calf is swollen, and she reports mild calf tenderness. 3. The client uses the patient-controlled analgesia device every 30 minutes. 4. Urine in the collection bag is amber and clear.

Ans: 2 Right calf swelling and tenderness indicate the possible presence of deep vein thrombosis. This will change the plan of care because the client may be placed on bed rest and will require diagnostic testing and possible anticoagulant therapy. The other data indicate the need for common postoperative nursing actions such as having the client cough, assessing her pain, and increasing her fluid intake.

16. A client who has just returned to the surgical unit after a transurethral resection of the prostate (TURP) reports acute bladder spasms. In which order will the nurse perform these prescribed actions? 1. Administer acetaminophen/oxycodone 325 mg/ 5 mg. 2. Irrigate the retention catheter with 30 to 50 mL of sterile normal saline. 3. Infuse 500 mL of 5% dextrose in lactated Ringer's solution over 2 hours. 4. Offer the client oral fluids to at least 2500 to 3000 mL/day.

Ans: 2, 1, 3, 4 Bladder spasms after a TURP are usu- ally caused by the presence of clots that obstruct the catheter, so irrigation should be the first action taken. Administration of analgesics may help to reduce spasm. Administration of a bolus of IV fluids is com- monly used in the immediate postoperative period to help maintain fluid intake and increase urinary flow. Oral fluid intake should be encouraged when the nurse is sure that the client is not nauseated and has adequate bowel tone

21. A client has had a needle biopsy of the prostate gland using the transrectal approach. Which statement is most important to include in the client teaching plan? 1. "The health care provider (HCP) will call you about the test results." 2. "Serious infections may occur as a complication of this test." 3. "You will need to call the HCP if you develop a fever or chills." 4. "It is normal to have a small amount of rectal bleeding after the test."

Ans: 3 Although infection occurs only rarely as a complication of transrectal prostate biopsy, it is impor- tant that the client receive teaching about checking his temperature and calling the HCP if there is any fever or other signs of systemic infection. The client should understand that the test results will not be available immediately but that he will be notified about the results. Transient rectal bleeding may occur after the biopsy, but bleeding that lasts for more than a few hours indicates that there may have been rectal trauma.

33. Which information obtained when taking a client's health history will be most important in determining whether the client should receive the human papillo- mavirus (HPV) immunization? 1. Client is 19 years old. 2. Client is sexually active. 3. Client has a positive pregnancy test result. 4. Client has tested positive for HPV previously.

Ans: 3 Centers for Disease Control and Prevention guidelines indicate that the HPV immunization should not be given during pregnancy. Ideally, the immuniza- tion series should start at age 11 or 12 years for girls and boys, but it may be started up through age 26 years. HPV immunization is most effective in preventing HPV infection and cervical cancer when it is started before the individual is sexually active and before any HPV infection, but these are not contraindications for vaccination

28. The nurse is supervising a student nurse who is caring for a client who has an intracavitary radioactive implant in place to treat cervical cancer. Which action by the student requires that the nurse intervene immediately? 1. Standing next to the client for 5 minutes while assisting with her bath 2. Asking the client how she feels about losing her childbearing ability 3. Assisting the client to the bedside commode for a bowel movement 4. Offering to get the client whatever she would like to eat or drink

Ans: 3 Clients with intracavitary implants are kept in bed during the treatment to avoid dislodgement of the implant. The other actions may also require the nurse to intervene by providing guidance to the student. Minimal time should be spent close to clients who are receiving internal irradiation. Asking the client about her reaction to losing childbearing abilities may be inappropriate at this time. Clients are fre- quently placed on low-residue diets to decrease bowel distention while implants are in place

15. The nurse is interviewing a woman who is in the clinic for a well woman exam, and the woman requests a screening test for ovarian cancer. Which response by the nurse is best? 1. "Only a small number of ovarian cancers are diagnosed at an early stage." 2. "There is no effective screening test for ovarian cancer in low-risk women." 3. "Benefits of ovarian cancer screening will depend on your medical history." 4. "Ovarian cancer screening will probably not be covered by your insurance."

Ans: 3 Current guidelines state that there is no effec- tive screening tool for low-risk women, but women who are high risk because of family history or the BRCA genes may be screened with transvaginal ultra- sonography and serum marker CA-125 levels. The other statements are accurate but do not respond as well to the client's concern.

35. The nurse is working on a medical unit staffed with LPNs/LVNs and unlicensed assistive personnel (UAP) when a client with stage IV ovarian cancer and recurrent ascites is admitted for paracentesis. Which activity is best to assign to an experienced LPN/LVN? 1. Obtaining a paracentesis tray from the central supply area 2. Completing the short-stay client admission form 3. Measuring vital signs every 15 minutes after the procedure 4. Providing discharge instructions after the procedure

Ans: 3 LPN/LVN education includes vital sign monitoring after procedures such as paracentesis; an experienced LPN/LVN would recognize and report significant changes in vital signs to the RN. The paracentesis tray could be obtained by a UAP. Client admission assessment and teaching require RN-level education and experience, although part of the data gathering may be done by an LPN/LVN.

32. The nurse is providing orientation for a new RN on the medical-surgical unit who is caring for a client with severe pelvic inflammatory disease (PID). Which action by the new RN is most important to correct quickly? 1. Telling the client that she should avoid using tam- pons in the future 2. Offering the client an ice pack to decrease her abdominal pain 3. Positioning the client flat in bed while helping her take a bath 4. Teaching the client that she should not have inter- course for 2 months

Ans: 3 The client should be positioned in a semi- Fowler position to decrease pain and minimize the risk of abscess development higher in the abdomen. The other actions also require correction but not as rapidly. Tampon use is not contraindicated after an episode of PID, although some sources recommend not using tampons during the acute infection. Heat application to the abdomen and pelvis is used for pain relief. Inter- course is safe a few weeks after effective treatment for PID.

4 The nurse is assessing a long-term-care client with a history of benign prostatic hyperplasia. Which infor- mation will require the most immediate action? 1. The client states that he always has trouble starting his urinary stream. 2.The chart shows an elevated level of prostate- specific antigen. 3. The bladder is palpable above the symphysis pubis, and the client is restless. 4. The client says he has not voided since having a glass of juice 4 hours ago.

Ans: 3A palpable bladder and restlessness are indi- cators of urinary retention, which would require action (e.g., insertion of a catheter) to empty the bladder. The other data would be consistent with the client's diagno- sis of benign prostatic hyperplasia. More detailed assessment may be indicated, but no immediate action is required.

9. A client with benign prostatic hyperplasia has a new prescription for tamsulosin. Which statement about tamsulosin is most important to include when teaching this client? 1. "This medication will improve your symptoms by shrinking the prostate." 2. "The force of your urinary stream will probably increase." 3. "Your blood pressure might decrease as a result of taking this medication." 4. "You should avoid sitting up or standing up too quickly."

Ans: 4 Because tamsulosin blocks alpha receptors in the peripheral arterial system, the most significant side effects are orthostatic hypotension and dizziness. To avoid falls, it is important that the client change posi- tions slowly. The other information is also accurate and may be included in client teaching but is not as impor- tant as decreasing the risk for falls. Focus: Prioritiza- tion; Test Taking Tip: When any medication might lower blood pressure, be aware that safety is a priority. Avoid risk for falls by teaching clients to change posi- tion slowly.

22. The nurse is working in the postanesthesia care unit caring for a 32-year-old client who has just arrived after undergoing dilation and curettage to evaluate infertil- ity. Which assessment finding should be immediately communicated to the surgeon? 1. Blood pressure of 162/90 mm Hg 2. Saturation of the perineal pad after the first 30 minutes 3. Oxygen saturation of 91% to 95% 4. Sharp, continuous, level 8 abdominal pain (on a scale of 0 to 10)

Ans: 4 Cramping or aching abdominal pain is com- mon after dilation and curettage; however, sharp, con- tinuous pain may indicate uterine perforation, which would require rapid intervention by the surgeon. The other data indicate a need for ongoing assessment or interventions. Transient blood pressure elevation may occur because of the stress response after surgery. Bleeding after the procedure is expected but should decrease over the first 2 hours. Although the oxygen saturation is not at an unsafe level, interventions to improve the saturation should be carried out.

5. While performing a breast examination on a 22-old client, the nurse obtains these data. Which finding is of most concern? 1. Both breasts have many nodules in the upper outer quadrants. 2. The client reports bilateral breast tenderness with palpation. 3. The breast on the right side is slightly larger than the left breast. 4. An irregularly shaped, nontender lump is palpable in the left breast.

Ans: 4 Irregularly shaped and nontender lumps are consistent with a diagnosis of breast cancer, so this cli- ent needs immediate referral for diagnostic tests such as mammography or ultrasonography. The other infor- mation is not unusual and does not indicate the need for immediate action. Focus: Prioritization; Test Tak- ing Tip: Remember to investigate further when a cli- ent has a nontender lump or swelling because lumps that are not painful are a common clinical manifestation of cancer in areas such as the breasts or lymph tissues. Pain is rarely an early manifestation of cancer but occurs as tumors grow and place pressure on other organs or tissues

12. The day after a radical prostatectomy, a client has blood clots in the urinary catheter and reports bladder spasms. The client says that his right calf is sore and that he feels short of breath. Which action will the nurse take first? 1. Irrigate the catheter with 50 mL of sterile saline. 2. Administer oxybutynin 5 mg orally. 3. Apply warm packs to the right calf. 4. Measure oxygen saturation using pulse oximetry.

Ans: 4 It is important to assess oxygenation because the client's calf tenderness and shortness of breath sug- gest a possible venous thromboembolism and pulmo- nary embolus, serious complications of transurethral resection of the prostate. The other activities are appro- priate but are not as high a priority as ensuring that oxygenation is adequate. Focus: Prioritization; Test Taking Tip: You should rapidly investigate any client report of shortness of breath because oxygenation is the most basic physiologic need.

14. The nurse obtains this information when taking the health history of a 56-year-old postmenopausal woman. Which information is most important to report to the health care provider (HCP)? 1. Sagging of breasts bilaterally 2. Vaginal dryness and painful intercourse 3. Hot flashes occurring during the night 4. Occasional painless vaginal bleeding

Ans: 4 Painless vaginal bleeding in postmenopausal women may indicate endometrial or cervical cancer and will require diagnostic testing such as endometrial biopsy. Breast atrophy, vaginal dryness and painful intercourse, and hot flashes are common after meno- pause, although these symptoms should also be dis- cussed with the HCP and may need treatment.

8. The nurse obtains the following assessment data about a client who has had a transurethral resection of the prostate (TURP) and has continuous bladder irriga- tion. Which finding indicates the most immediate need for nursing intervention? 1. The client states that he feels a continuous urge to void. 2. The catheter drainage is light pink with occasional clots. 3. The catheter is taped to the client's thigh. 4. The client reports painful bladder spasms.

Ans: 4 The bladder spasms may indicate that blood clots are obstructing the catheter, which would indicate the need for irrigation of the catheter with 30 to 50 mL of normal saline using a piston syringe. The other data would all be normal after a TURP, but the client may need some teaching about the usual post-TURP symp- toms and care.

38. While the nurse is working in the clinic, a healthy 32-year-old woman whose sister is a carrier of the BRCA gene asks which form of breast cancer screening is the most effective for her. Which response is best? 1. "An annual mammogram is usually sufficient screening for women your age." 2. "Monthly self-breast examination is recommended because of your higher risk." 3. "A yearly breast examination by a health care provider should be scheduled." 4. "Magnetic resonance imaging (MRI) is recommended in addition to annual mammography."

Ans: 4 The current guidelines, supported by nonran- domized screening trials and observational data, call for first-degree relatives of clients with the BRCA gene to be screened with both annual mammography and MRI. Although annual mammography, breast self- examination, and clinical breast examination by a health care provider may help to detect cancer, the best option for this client is annual mammography and MRI.

.Identify the four screening guidelines for breast cancer recommended by the American Cancer Society. a. b. c. d.

Screening recommendations: a. Women with an average risk for breast cancer should undergo regular screening mammography starting at age 45 years. b. Women aged 45 to 54 years should be screened annually. c. Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually. d. Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer. In women with increased risk, decisions for additional and more frequent testing should be determined with the HCP

16. What accurately describes prostate cancer detection and/or treatment (select all that apply)? a. The symptoms of pelvic or perineal pain, fatigue, and malaise may be present. b. Palpation of the prostate reveals hard and asymmetric enlargement with areas of induration or nodules. c. Orchiectomy is a treatment option for all patients with prostatic cancer except those with stage IV tumors. d. The preferred hormonal therapy for treatment of prostate cancer includes estrogen and androgen receptor blockers. e. Early detection of cancer of the prostate is increased with annual rectal examinations and serum prostatic acid phosphatase (PAP) measurements. f. An annual prostate examination is recommended starting at age 45 for African American men with a first- degree relative with prostate cancer at an early age.

a, b, f. Pelvic or perineal pain, fatigue, malaise, and a hard, asymmetric, enlarged prostate may be present with prostate cancer. Annual prostate examination is recommended starting at a younger age for African American men because of increased diagnosis and mortality from prostate cancer in this ethnic group. An orchiectomy may be done with prostatectomy or for metastatic stages of prostate cancer. Hormonal treatment includes androgen deprivation therapy, luteinizing hormone-releasing hormone agonists, and androgen receptor blockers. Early detection of prostate cancer is best detected with annual rectal exams and serum PSA. Elevated prostatic acid phosphatase (PAP) will be seen with metastasis, not a new diagnosis.

16. What describes the use of high-dose brachytherapy radiation (select all that apply)? a. May be completed in 5 days b. A primary treatment after mastectomy of breast c. Alternative to traditional radiation therapy for early stage breast cancer d. Used to treat possible local residual cancer cells following a mastectomy e. Used to reduce tumor size and stabilize metastatic lesions for pain relief

a, c. High-dose brachytherapy may be completed in 5 days and is an alternative to traditional, longer-term radiation for early stage breast cancer. External radiation is a primary treatment after mastectomy for breast cancer. Radiation as an adjuvant to surgery is used to treat possible residual cancer cells postmastectomy. Palliative radiation is used to reduce tumor size and relieve pain.

12. When assessing an aging adult man, what does the nurse note as a normal finding? a. Decreased penis size c. A decrease in scrotal color b. Decreased pubic hair d. Unilateral breast enlargement

a. A decrease in the size of the penis is a normal finding in the older man. Loss of pubic hair is not normal, nor is the enlargement of one breast. The normally darker color of the scrotum does not change with aging

12. The best prognosis is indicated in the patient with breast cancer when diagnostic studies reveal a. negative axillary lymph nodes. b. aneuploid DNA tumor content. c. cells with high S-phase fractions. d. an estrogen receptor- and progesterone receptor-negative tumor.

a. Axillary lymph node status is one of the most important prognostic factors in primary breast cancer; the more nodes involved, the higher the risk for relapse or metastasis. Aneuploid DNA tumor content indicates that cells have abnormally high or low DNA content compared with normal cells and is associated with tumor aggressiveness. Cells in S-phase have a higher risk for recurrence and can produce earlier cancer death. Hormone receptor-negative tumors are usually poorly differentiated histologically, frequently recur, and are usually unresponsive to hormonal therapy

23. A patient is seeking medical intervention for erectile dysfunction (ED). Why should he be thoroughly evaluated? a. It is important to determine if ED is reversible before treatment is started. b. Psychologic counseling can reverse the problem in 80% to 90% of the cases. c. Most treatments for ED are contraindicated in patients with systemic diseases. d. New invasive and experimental techniques currently used have unknown risks.

a. Before treatment for ED is initiated, reversibility must be determined so that appropriate treatment can be planned. The actual cause may be determined, but this is more expensive. Only a small percentage of ED is caused by psychologic factors. In the case of the 80% to 90% of ED that is of physiologic causes, interventions are directed at correcting or eliminating the cause or restoring function by medical means. Patients with systemic diseases can be treated medically if the cause cannot be eliminated. New invasive or experimental treatments are not widely used and should be limited to research centers.

4. What is the effect of finasteride (Proscar) in the treatment of BPH? a. A reduction in the size of the prostate gland b. Relaxation of the smooth muscle of the urethra c. Increased bladder tone that promotes bladder emptying d. Relaxation of the bladder detrusor muscle promoting urine flow

a. Finasteride results in suppression of dihydroxytestosterone (DHT) formation, which reduces the size of the prostate gland. Drugs affecting bladder tone are not indicated. α-Adrenergic receptor blockers are used to cause smooth muscle relaxation in the prostate, which improves urine flow.

When teaching a 24-yr-old woman who desires to learn BSE, the nurse knows that it is important to do what? a. Provide time for a return demonstration. b. Emphasize the statistics related to breast cancer survival and mortality. c. Have the woman set a consistent monthly date for performing the examination. d. Inform the woman that professional examinations are not necessary unless she finds an abnormality.

a. One of the major reasons why women do not examine their breasts regularly is because of a lack of confidence in BSE skill. A teaching program should include allowing time for women to ask questions and perform a return demonstration of the examination on themselves. Fear and denial often interfere with BSE even when women know that the perceived risk for cancer is high, know the statistics, and know that they should seek medical care if an abnormality is detected. Examinations in premenopausal women should be done right after the menstrual period and specific dates are set for postmenopausal women or those who have had hysterectomies.

37. Priority Decision: To prepare a woman who has been raped for physical examination, what should the nurse do first? a. Ensure that a signed informed consent is obtained from the patient. b. Provide a private place for the patient to talk about what happened to her. c. Instruct the patient not to wash, eat, drink, or urinate before the examination. d. Administer prophylaxis for sexually transmitted infections (STIs) and tetanus.

a. Specific informed consent must be obtained from the rape victim before any examination can be made or rape data collected. Following consent, the patient is advised not to wash, eat, drink, or urinate before the examination so that evidence can be collected for medicolegal use. Prophylaxis for STIs, hepatitis B, and tetanus is administered following examination and follow-up testing for pregnancy and human immunodeficiency virus (HIV) is done in several weeks.

17. A patient with a positive breast biopsy tells the nurse that she read about tamoxifen on the Internet and asks about its use. The best response by the nurse includes which information? a. Tamoxifen is the treatment of choice if the tumor has receptors for estrogen on its cells. b. Tamoxifen is the primary treatment for breast cancer if axillary lymph nodes are positive for cancer. c. Tamoxifen is used only to prevent the development of new primary tumors in women with high risk for breast cancer. d. Because tamoxifen has been shown to increase the risk for uterine cancer, it is used only when other treatment has not been successful.

a. Tamoxifen is an antiestrogen agent that blocks the estrogen-receptor sites of malignant cells and is the usual first choice of treatment in women with hormone receptor-positive tumors, with or without nodal involvement. Tamoxifen reduces the risk for recurrent breast cancer and also that for new primary tumors. The side effects of the drug are minimal and are those commonly associated with decreased estrogen.

25. Patient-Centered Care: A 47-yr-old patient who is experiencing hypogonadism has decided to try the testosterone gel Testim. What should the nurse teach the patient and his wife about this gel? a. Wash the hands with soap and water after applying it. b. His wife should apply it to help him feel better about using it. c. Do not wear clothing over the area until it has been absorbed. d. The gel may be taken buccally if it is not effective on the abdomen.

a. The gel may spread the testosterone to others if it is not washed off of his hands after application. If his wife applies the gel, she should wear gloves to prevent absorption of the testosterone and its effects on her body. Clothing over the area until it has dried is recommended. The gel is only topical; a buccal testosterone tablet is called Striant.

1. A couple seeks assistance from an infertility specialist for evaluation of their infertility. What does the nurse inform the couple they can expect during the initial visit? a. Physical and psychosocial functioning examinations b. Assessment of tubal patency with a hysterosalpingogram c. Pelvic ultrasound for the woman and semen analysis for the man d. Postcoital testing to evaluate sperm numbers and motility in cervical and vaginal secretions

a. The initial visit of a couple seeking assistance with infertility includes a history and physical for both partners, psychosocial functioning, testing for medical problems and sexually transmitted infections (STIs), a cervical Papanicolaou (Pap) test, possible semen analysis, and instruction for at-home ovulation testing. A discussion of possible future testing options and cost is also done. If the couple decides to continue with treatment, further visits will include more intensive evaluation, including postcoital testing, a hysterosalpingogram, pelvic ultrasound, and midluteal progesterone and prolactin levels.

3. The extent of urinary obstruction caused by BPH can be determined by which diagnostic study? a. Uroflowmetry c. Transrectal ultrasound b. A cystometrogram d. Postvoiding catheterization

a. Uroflowmetry is used to measure the volume of urine expelled from the bladder to determine the extent of urethral blockage. Cystourethroscopy may also evaluate the degree of obstruction, but a cystometrogram measures bladder tone. A transrectal ultrasound may determine the size and configuration of the prostate gland. Postvoiding catheterization measures residual urine.

22. A patient undergoing a modified radical mastectomy for cancer of the breast is going to use tissue expansion and an implant for breast reconstruction. What should the nurse teach the patient about tissue expansion? a. Weekly injections of sterile saline into the expander will be required. b. The expander cannot be placed until healing from the mastectomy is complete. c. This method of breast reconstruction uses the patient's own tissue to replace breast tissue. d. The nipple from the affected breast will be saved to be grafted onto the reconstructed breast.

a. When an expander is used to stretch the skin and muscle at the mastectomy site, the expander is gradually increased in size by weekly injections of sterile saline until the site is large enough for an implant to be inserted or remains in place to become the implant. Placement of the expander can be at the time of mastectomy or at a later date. An autologous tissue flap procedure is a type of reconstruction using the patient's own tissue. The nipple of the affected breast is removed at mastectomy, and a new nipple can be reconstructed after breast reconstruction from various normal tissues.

9. Which therapies for BPH are done on an outpatient basis (select all that apply)? a. Intraprostatic urethral stents d. Transurethral incision of prostate (TUIP) b. Transurethral needle ablation (TUNA) e. Transurethral microwave therapy (TUMT) c. Photovaporization of the prostate (PVP)

b, d, e. TUNA, TUIP, and TUMT are currently done on an outpatient basis or in a HCP's office.

17. Which laboratory tests are used to diagnose Chlamydia (select all that apply)? a. Pap test b. Gram stain c. Rapid plasma reagin (RPR) d. Nucleic acid amplified test (NAAT) e. Venereal Disease Research Laboratory (VDRL) f. Fluorescent treponemal antibody absorption (FTA-Abs)

b, d. Gram stain smears, nucleic acid amplification test (NAAT), and cultures can screen for Chlamydia from vaginal, endocervical, urinary, and urethral samples. The NAAT can also be used to detect gonorrhea. A Pap test detects potentially cancerous cells. The rapid plasma reagin (RPR), the Venereal Disease Research Laboratory (VDRL), and fluorescent treponemal antibody absorption (FTA-Abs) tests all screen for syphilis.

21. What is the fertility test that requires a couple to have no sexual intercourse for 2 to 3 days before the test? a. Urinary LH c. Endometrial biopsy b. Semen analysis d. Hysterosalpingogram

b. A semen analysis requires a couple to have no sexual intercourse 2 to 3 days before an examination of semen for the volume, viscosity, number, mobility, and structure of sperm. Urinary LH is an over-the-counter test to identify midcycle LH surge that precedes ovulation by 1 to 2 days. An endometrial biopsy provides a sample of endometrium to evaluate its changes under the influence of progesterone. A hysterosalpingogram is a contrast x-ray of the uterine cavity and fallopian tubes. Intercourse does not affect these other three test results.

11) A 58-yr-old man is being assessed by the nurse. Which information would identify the need for further examination for benign prostatic hyperplasia (BPH)? a. A mass on the scrotum or testes b. Difficulty starting a slow urinary stream c. Patient describes a single, small, painless blister d. A bulging inguinal ring while the patient bears down

b. A slow and difficult-to-start urinary stream indicates a need for further examination for benign prostatic hyperplasia (BPH). A mass could indicate cancer or other scrotal problems. A single, painless, small blister could indicate lymphogranuloma venereum or cancer. Palpating a bulging inguinal ring while the patient bears down is indicative of an inguinal hernia.

36. Priority Decision: On admission of a victim of sexual assault to the ED, what should be the first priority of the nurse? a. Contact a rape support person for the patient. b. Assess the patient for urgent medical problems. c. Question the patient about the details of the assault. d. Inform the patient what procedures and treatments will be performed.

b. Sexual assault is an act of violence and the first priority of care for the patient should be assessment and treatment of serious injuries involving extragenital areas, such as fractures, subdural hematomas, cerebral concussions, and intraabdominal injuries. All of the other options as well as preserving forensic evidence are appropriate treatments, but treatment for shock and urgent medical injuries is the first priority.

22. A patient with a stage 0 cervical cancer identified from a Papanicolaou (Pap) test asks the nurse what this finding means. The nurse's response should include which information? a. Malignant cells have extended beyond the cervix to the upper vagina. b. Abnormal cells are present but are confined to the epithelial layer of the cervix. c. Atypical cells characteristic of inflammation but not necessarily malignancy are present. d. This is a common finding on Pap testing, and she will be examined frequently to see whether the abnormal cells spread beyond the cervix.

b. A stage 0 cervical cancer indicates cancer in situ that is confined to the epithelial layer of the cervix and requires treatment. Stage 0 is the least invasive. Stage I is confined to the cervix. Stage II has spread beyond the cervix to the upper two thirds of the vagina but not the tissues around the uterus. Stage III involves the pelvic wall, lower third of the vagina, and/or kidney problems. Stage IV indicates spread to distant organs.

13. The nurse provides discharge teaching to a patient following a TURP and determines that the patient understands the instructions when he makes which statement? a. "I should use daily enemas to avoid straining until healing is complete." b. "I will avoid heavy lifting, climbing, and driving until my follow-up visit." c. "At least I don't have to worry about developing cancer of the prostate now." d. "Every day I should drink 10 to 12 glasses of liquids such as coffee, tea, or soft drinks."

b. Activities that increase intraabdominal pressure should be avoided until the surgeon approves these activities at a follow-up visit. Stool softeners and high-fiber diets may be used to promote bowel elimination, but enemas should not be used because they increase intraabdominal pressure and may initiate bleeding. Because TURP does not remove the entire prostate gland, the patient needs annual prostatic examinations to screen for cancer of the prostate. Fluid intake should be high, but caffeine and alcohol should not be used because they have a diuretic effect and increase bladder distention.

10. Before undergoing a TURP, what should the patient be taught? a . Some degree of urinary incontinence is likely to occur. b. This surgery results in some degree of retrograde ejaculation. c. Erectile dysfunction is a common complication of this prostate surgery. d. An indwelling catheter will be used to maintain urinary output until healing is complete.

b. Because of injury to the internal urinary sphincter, there is usually some degree of retrograde ejaculation following most transurethral surgeries, especially following TURP. Some semen travels back with ejaculation into the bladder and is eliminated with the next voiding. Urinary incontinence, erectile dysfunction, and continued catheterization are uncommon following TURP.

13. The health care provider of a patient with a positive biopsy of a 2-cm breast tumor has recommended a lumpectomy with radiation therapy or a modified radical mastectomy as treatment. The patient says that she does not know how to choose and asks the female nurse what she would do if she had to make the choice. What is the best response by the nurse to this patient? a. "It doesn't matter what I would do. It is a decision you have to make for yourself." b. "There are advantages and disadvantages of both procedures. What do you know about these procedures?" c. "I would choose the modified radical mastectomy because it would ensure that the entire tumor was removed." d. "The lumpectomy maintains a nearly normal breast, but the survival rate is not as good as it is with a mastectomy"

b. Either treatment choice is indicated for women with early stage breast cancer because the 10-year survival rate with lumpectomy with radiation is about the same as that with modified radical mastectomy. Each procedure has advantages and disadvantages that the patient must consider in making an informed choice and the nurse should make that information available to the patient to assist in decision making.

Priority Decision: A 56-yr-old patient is undergoing a mammoplasty for breast reconstruction following a mastectomy 1 year ago. During the preoperative preparation of the patient, what is important for the nurse to do? a. Determine why the patient is choosing reconstruction surgery rather than the use of an external prosthesis. b. Ensure that the patient has realistic expectations about the outcome and possible complications of the surgery. c. Inform the patient that implants used for breast reconstruction have been shown to cause immune-related diseases. d. Let the patient know that, although the shape will be different from the other breast, the nipple can be reconstructed from other erectile tissue.

b. It is most important for the patient planning a mammoplasty that she have a realistic idea about what the surgery can accomplish and about possible complications. Currently surgery cannot restore nipple sensation or erectility, and the breast will not fully resemble its premastectomy appearance, but the outcome is usually more acceptable than the mastectomy scar. The woman's motives for breast reconstruction should not be questioned. There have been allegations of immune- related diseases associated with the use of silicone gel implants but after further evaluation the Food and Drug Administration (FDA) has approved these implants for use.

11. The nurse would be most concerned when the patient's breast examination reveals which finding? a. A large, tender, moveable mass in the upper inner quadrant b. An immobile, hard, nontender lesion in the upper outer quadrant c. A 2- to 3-cm, firm, defined, mobile mass in the lower outer quadrant d. A painful, immobile mass with reddened skin in the upper outer quadrant

b. On palpation, malignant lesions are characteristically hard, irregularly shaped, poorly delineated, nontender, and nonmobile and the most common site is the upper outer quadrant of the breast. Fibrocystic lesions are usually large, tender, moveable masses found throughout the breast tissue. A fibroadenoma is firm, defined, and mobile. A painful, immobile mass under a reddened area of skin is most typical of a local abscess.

17. A young woman is admitted to the hospital with acute pelvic inflammatory disease (PID). During the nursing history, the nurse notes which risk factor as being most significant for this patient? a. Lack of any method of birth control c. Use of a vaginal sponge for contraception b. Sexual activity with multiple partners d. Recent antibiotic-induced monilial vaginitis

b. Sexual activity with multiple partners increases the risk for pelvic inflammatory disease (PID), and there is often a history of an acute infection of the lower genital tract caused by gonococcal or chlamydia microorganisms. The only significant contraceptive issue related to PID is that condom use will help to prevent STIs that may lead to PID.

12. Priority Decision: A patient with continuous bladder irrigation following a prostatectomy tells the nurse that he has bladder spasms and leaking of urine around the catheter. What should the nurse do first? a. Slow the rate of the irrigation. b. Assess the patency of the catheter. c. Encourage the patient to try to urinate around the catheter. d. Administer a belladonna and opium (B&O) suppository as prescribed.

b. The nurse should first check for the presence of clots obstructing the catheter or tubing and remove them by irrigation. Then a belladonna and opium (B&O) suppository is administered, if one is ordered. The flow rate of the irrigation fluid may be decreased if orders permit because fast-flowing, cold fluid may also contribute to spasms. The patient should not try to void around the catheter because this will increase the spasms.

19. A 20-yr-old patient with PID is crying and tells the nurse that she is afraid she will not be able to have children as a result of the infection. What is the nurse's best response to this patient? a. "I would not worry about that now. Our immediate concern is to cure the infection you have." b. "PID increases the possibility of infertility. Would you like to talk about what it means to you?" c. "Sterility following PID is possible but not common, and it is too soon to know what the effects will be." d. "The infection can cause more serious complications, such as abscesses and shock that you should be more concerned about."

b. The risk for infertility following PID is high, and the nurse should allow time for the patient to express her feelings, clarify her concerns, and begin problem solving with regard to the outcomes of the disease. Responses that do not allow for discussion of feelings and concerns and that tell the patient how she should feel or what she should worry about are not therapeutic.

7. Which treatment for BPH uses a low-wave radiofrequency to precisely destroy prostate tissue? a. Laser prostatectomy b. Transurethral needle ablation (TUNA) c. Transurethral microwave thermotherapy (TUMT) d. Transurethral electrovaporization of prostate (TUVP)

b. The transurethral needle ablation (TUNA) uses low-wave radiofrequency to heat the prostate, causing necrosis. Laser prostatectomy uses a laser beam. Transurethral microwave thermotherapy (TUMT) uses microwave radiating heat to produce coagulative necrosis of the prostate and is not used for men with rectal problems. Transurethral electrovaporization of prostate (TUVP) uses electrosurgical vaporization and desiccation to destroy prostate tissue.

A woman at the health clinic tells the nurse that she does not do breast self-examination (BSE) because it just seems too much of a bother. What is the best response by the nurse about BSE? a. It reduces mortality from breast cancer in women under the age of 50. b. It is useful to help women learn how their breasts normally look and feel. c. BSE has little value in detection of cancer and is not recommended anymore. d. BSE is the most common way that malignant tumors of the breast are discovered.

b. The value of breast self-examination (BSE) in reducing mortality rates from breast cancer in women is currently controversial and under review. However, it is still a useful tool in helping women to become self-aware of how their breasts normally look and feel. None of the other options has been validated at this time.

25. A patient has been diagnosed with cancer of the ovary. In planning care for the patient, the nurse recognizes that treatment of the patient depends on what? a. Results of a direct-needle biopsy of the ovary b. Results of a laparotomy with multiple biopsies c. Whether the patient desires to maintain fertility d. The findings of metastasis by ultrasound or CT scan

b. Treatment of ovarian cancer is determined by staging from the results of laparotomy with multiple biopsies of the ovaries and other tissue throughout the pelvis and lower abdomen. The patient's desire for fertility is not a consideration because of the high mortality rate associated with ovarian cancer. Although diagnosis of ovarian tumors may be made by transvaginal ultrasound or CT scan, the treatment of ovarian cancer depends on the staging of the tumor.

21. Serum tumor markers that may be elevated on diagnosis of testicular cancer and used to monitor the response to therapy include a. tumor necrosis factor (TNF) and C-reactive protein (CRP). b. α-fetoprotein (AFP) and human chorionic gonadotropin (hCG). c. prostate-specific antigen (PSA) and prostate acid phosphatase (PAP). d. carcinoembryonic antigen (CEA), antinuclear antibody (ANA) and HER-2.

b. α-Fetoprotein (AFP) and human chorionic gonadotropin (hCG) are glycoproteins that may be elevated in testicular cancer. If they are elevated before surgical treatment, the levels are noted, and if response to therapy is positive, the levels will decrease. Lactate dehydrogenase (LDH) may also be elevated. Tumor necrosis factor (TNF) is a normal cytokine responsible for tumor surveillance and destruction. C-reactive protein (CRP) is found in inflammatory conditions and widespread malignancies. PSA and PAP are used for screening of prostatic cancer. Carcinoembryonic antigen (CEA) is a tumor marker for cancers of the GI system. Antinuclear antibody (ANA) is found most frequently in autoimmune disorders. HER-2 is used as a marker in breast cancer.

15. Priority Decision: When caring for a patient following a radical prostatectomy with a perineal approach, what is the priority nursing intervention the nurse should use to prevent complications? a. Use chemotherapy to prevent metastasis. b. Administer sildenafil (Viagra) as needed for erectile dysfunction. c. Provide wound care after each bowel movement to prevent infection. d. Insert a smaller indwelling urinary catheter to prevent urinary retention.

c. A prostatectomy performed with a perineal approach has a high risk for infection because of the proximity of the wound to the anus, so wound care is the priority. Chemotherapy is usually not the first choice of drug therapy following surgery, nor is sildenafil. The catheter size would not be changed but the catheter would be removed. Urinary incontinence is a bigger problem than retention.

29. A 44-yr-old woman undergoing a total abdominal hysterectomy asks whether she will need to take estrogen until she reaches the age of menopause. What is the best response by the nurse? a. "Yes, it will help to prevent the more intense symptoms caused by surgically induced menopause." b. "You are close enough to normal menopause that you probably won't need additional estrogen." c. "Because your ovaries won't be removed, they will continue to secrete estrogen until your normal menopause." d. "There are so many risks associated with estrogen replacement therapy that it is best to begin menopause now."

c. A total hysterectomy involves the removal of the uterus and cervix, but the fallopian tubes and ovaries are left intact. Although menstruation is terminated, normal ovarian production of estrogen continues. When the uterus, tubes, and ovaries are removed, it is called a total hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO).

18. During the immediate postoperative period following a modified radical mastectomy, the nurse initially institutes which exercises for the affected arm? a. Have the patient brush or comb her hair with the affected arm. b. Perform full passive range-of-motion (ROM) exercises to the affected arm. c. Ask the patient to flex and extend the fingers and wrist of the operative side. d. Have the patient crawl her fingers up the wall, raising her arm above her head.

c. As early as in the recovery room following a modified radical mastectomy, the patient should start flexing and extending the fingers and wrist of the affected arm with daily increases in activity. Postoperative mastectomy exercises, such as wall climbing with the fingers, shoulder rotation and extension, and hair care, are instituted gradually to prevent disruption of the wound.

5. On admission to the ambulatory surgical center, a patient with BPH informs the nurse that he is going to have a laser treatment of his enlarged prostate. The nurse plans patient teaching with the knowledge that the patient will need to know what? a. The effects of general anesthesia c. Home management of an indwelling catheter b. The possibility of short-term incontinence d. Monitoring for postoperative urinary retention

c. Because of edema, urinary retention, and delayed sloughing of tissue that occurs with a laser prostatectomy, the patient will have a postprocedure urinary catheter for up to 7 days. The procedure is done under local anesthetic, and incontinence or urinary retention is not usually a problem with laser prostatectomy.

2. When taking a nursing history from a patient with BPH, the nurse would expect the patient to report a. nocturia, dysuria, and bladder spasms. b. urinary frequency, hematuria, and perineal pain. c. urinary hesitancy, postvoid dribbling, and weak urinary stream. d. urinary urgency with a forceful urinary stream and cloudy urine.

c. Classic symptoms of uncomplicated BPH are those associated with irritative symptoms, including nocturia, frequency, urgency, dysuria, bladder pain, and incontinence associated with inflammation or infection. Obstructive symptoms caused by prostate enlargement include diminished caliber and force of the urinary stream, hesitancy or difficulty initiating voiding, intermittent urination, dribbling at the end of urination, and a feeling of incomplete bladder emptying because of urinary retention. Bladder spasms, hematuria, perineal pain, and cloudy urine do not occur with BPH.

23. Fertility and normal reproductive function can be maintained when a cancer of the cervix is successfully treated with which therapy? a. External radiation therapy c. Conization or laser surgery b. Internal radiation implants d. Cryotherapy or subtotal hysterectomy

c. Conization (an excision of a cone-shaped section of the cervix) and laser treatment both are effective to locally remove or destroy malignant cells of the cervix and preserve fertility. Radiation treatments frequently impair ovarian and uterine function and lead to sterility. A subtotal hysterectomy would be contraindicated in the treatment of cervical cancer because the cervix would be left intact in this procedure.

2. An infertile couple has used at-home ovulation testing using basal body temperature without conceiving. The nurse understands that what will be used first to treat this infertile couple? a. Surgery to reduce endometriosis b. Intrauterine insemination with sperm from the husband c. Selective estrogen receptor modulator (clomiphene [Clomid]) d. Assisted reproductive technologies (e.g., in vitro fertilization [IVF])

c. Drug therapy will be used before more invasive treatments. Drugs may include selective estrogen receptor modulators, menotropin (human menopausal gonadotropin), follicle-stimulating hormone agonists, gonadotropin-releasing hormone (GnRH) antagonists, GnRH agonists, or human chorionic gonadotropin (hCG). If the husband's reproductive system is functioning, intrauterine insemination with his sperm may later be done. The assisted reproductive technologies may be used if this is not successful. The surgery for endometriosis could be done if this was diagnosed, but that is not included in this question.

14. A 55-yr-old man with a history of prostate cancer in his family asks the nurse what he can do to decrease his risk of prostate cancer. What should the nurse teach him about prostate cancer risks? a. Nothing can decrease the risk because prostate cancer is primarily a disease of aging. b. Treatment of any enlargement of the prostate gland will help to prevent prostate cancer. c. Substituting fresh fruits and vegetables for high-fat foods in the diet may lower the risk of prostate cancer. d. Using a natural herb, such as saw palmetto, has been found to be an effective protection against prostate cancer.

c. Most prostate cancers (about 75%) are considered sporadic. About the only modifiable risk factor for prostate cancer is its association with a diet high in red and processed meat and high-fat dairy products along with a low intake of vegetables and fruits. Age, ethnicity, and family history are risk factors for prostate cancer but are not modifiable. Environment may also play a role. Simple enlargement or hyperplasia of the prostate is not a risk factor for prostate cancer. There is no evidence that saw palmetto is more effective than a placebo.

20. A patient undergoing surgery and radiation for treatment of breast cancer has a nursing diagnosis of disturbed body image related to absence of the breast. What is an appropriate nursing intervention for this patient? a. Provide the patient with information about surgical breast reconstruction. b. Restrict visitors and phone calls until the patient feels better about herself. c. Arrange for a Reach to Recovery visitor or similar resource available in the community. d. Encourage the patient to obtain a permanent breast prosthesis as soon as she is discharged from the hospital.

c. The Reach to Recovery program consists of volunteers, all women, who have had breast cancer and can answer questions about what to expect at home, how to tell people about the surgery, and what prosthetic devices are available. It is a valuable resource for patients who have breast cancer and should be used if available in the community. If a volunteer is not available, the nurse is responsible for assisting the patient in the same manner. Although the nurse can discuss wearing a prosthesis, a permanent prosthesis cannot be used until healing is complete and inflammation is resolved

22. The nurse should teach the patient having a vasectomy that what occurs after the procedure? a. The amount of ejaculate will be noticeably decreased. b. He may have difficulty maintaining an erection for several months. c. An alternative form of contraception must be used for 6 to 8 weeks. d. The testes will gradually decrease production of sperm and testosterone.

c. Until sperm distal to the anastomotic site is ejaculated or absorbed by the body, the semen will contain sperm and alternative contraceptive methods must be used. When a postoperative semen examination reveals no sperm, the patient is considered sterile. Following vasectomy, there is rarely noticeable difference in the amount of ejaculate because ejaculate is primarily seminal and prostatic fluid. Vasectomy does not cause erectile dysfunction (ED), nor does it affect testicular production of sperm or hormones.

13. When assessing an aging adult woman, what does the nurse note as a normal finding? a. Rectocele c. Vaginal dryness b. Larger breasts d. Severe osteoporosis

c. Vaginal dryness occurs with decreased estrogen and increased androgens circulating in the aging female. This also leads to breast and genital atrophy, reduction in bone mass, and increased atherosclerosis. A rectocele may occur and cause sexual or fecal elimination problems for the patient that will need treatment, but this is not a normal finding. Severe osteoporosis is not a normal change of agin

10. Which patient probably has the highest risk of breast cancer? a. 60-yr-old obese man b. 58-yr-old woman with sedentary lifestyle c. 55-yr-old woman with fibrocystic breast changes d. 65-yr-old woman with a sister diagnosed with breast cancer

d. After the age of 60, the incidence of breast cancer increases dramatically and advanced age is the highest risk factor for females. Ninety-nine percent of breast cancer cases occur in women. A first-degree relative with breast cancer is a contributing factor for breast cancer. Genetic mutations in BRCA1, BRCA2, p53, ATM, and CHEK2 genes may increase the risk of breast cancer. Obesity and lack of physi cal activity are other contributing factors. Fibrocystic breast changes are neither a precursor of breast cancer nor a known risk factor for cancer.

11. Following a TURP, a patient has continuous bladder irrigation. Four hours after surgery, the catheter is draining thick, bright red clots and tissue. What should the nurse do? a. Release the traction on the catheter. b. Clamp the drainage tube and notify the patient's HCP. c. Manually irrigate the catheter until the drainage is clear. d. Increase the rate of the irrigation and take the patient's vital signs..

d. Bleeding and blood clots from the bladder are expected after a TURP, and continuous irrigation is used to keep clots from obstructing the urinary tract. The rate of the irrigation may be titrated to keep the clots from forming, if ordered, but the nurse should also check the vital signs because hemorrhage is the most common complication of prostatectomy. The traction on the catheter applies pressure to the operative site to control bleeding and should be relieved on schedule. The catheter will be manually irrigated only to release a blockage. Clamping the drainage tube is contraindicated because it would distend the bladder.

24. A 66-yr-old male patient is experiencing ED. He and his wife have used tadalafil (Cialis), but because he experienced priapism they have decided to change their treatment option to an intraurethral device. How should the nurse explain how this device works? a. The device relaxes smooth muscle in the penis. b. Blood is drawn into corporeal bodies and held with a ring. c. The device is implanted into corporeal bodies to firm the penis. d. The device directly applies drugs that increase blood flow in the penis.

d. Intraurethral devices include the use of vasoactive drugs administered as a topical gel or medication pellet (alprostadil) inserted into the urethra (intraurethral) using a medicated urethral system for erection (MUSE) device, or an injection into the penis (intracavernosal self- injection). The vasoactive drugs enhance blood flow into the penile arteries for erection. Erectogenic drugs (e.g., tadalafil [Cialis]) cause smooth muscle relaxation and increase blood flow to promote an erection. Blood drawn into corporeal bodies and held with a ring is achieved with a vacuum constriction device (VCD). Devices implanted into corporeal bodies to firm the penis are penile implants. Androgen or testosterone replacement therapy may also be used for erectile dysfunction.

While examining a patient's breasts, the nurse notes multiple, bilateral mobile lumps. To assess the patient further, what is the most appropriate question by the nurse? a. "Do you have a high caffeine intake?" b. "When did you last have a mammogram?" c. "Is there a history of breast cancer in your mother or sisters?" d. "Do the size and tenderness of the lumps change with your menstrual cycle?"

d. Most breast lesions are benign, and many mobile cystic lesions change in response to the menstrual cycle, whereas most malignant tumors do not. Caffeine has been associated with fibrocystic changes in some women, but research has not established caffeine as a cause of breast pain or cysts. Questions regarding a patient's last mammogram or family history are not closely related to the nurse's findings

. A patient undergoing either a mastectomy or a lumpectomy for treatment of breast cancer can also usually expect to undergo what other treatment? a. Chemotherapy b. Radiation therapy c. Hormonal therapy d. Sentinel lymph node dissection

d. Sentinel lymph node dissection (SLND) has become the standard of care, with axillary lymph node dissection reserved for patients with clinical indications of disease in the axilla. SLND provides prognostic information and helps to determine further treatment. A lumpectomy, or breast-conservation surgery, is followed by radiation therapy to the entire breast and the use of chemotherapy or hormone therapy depends on the characteristics of the tumor and evidence of metastases.

34. Priority Decision: The patient's diagnosis is a large rectocele requiring surgery. What nursing interventions will be the priority postoperatively? a. An ice pack to relieve swelling c. Administration of a stool softener each night b. An enema each day to relieve constipation d. Perineal care after each urination or defecation

d. The primary goal of care is to prevent wound infection and pressure on the vaginal incision, which requires perineal cleansing at least twice daily and after each urination and defecation. An ice pack and stool softener will be used, but they are not the priority. The enema would have been done preoperatively.

6. What is the most common screening intervention for detecting BPH in men over age 50? a. PSA level c. Cystoscopy b. Urinalysis d. Digital rectal examination

d. The prostate gland can be easily palpated by rectal examination, and enlargement of the gland is detected early if yearly examinations are performed. If symptoms of prostatic hyperplasia are present, further diagnostic testing, including prostate-specific antigen (PSA), a urinalysis, and cystoscopy may be indicated.

16. During examination of the female reproductive system, the nurse would note which finding as abnormal? a. Clear vaginal discharge c. Nonpalpable Skene's glands b. Perineal episiotomy scars d. Reddened base of the vulva

d. The vulva should be the color of the skin or slightly pink. Redness indicates inflammation and possible genital herpes. A small amount of clear vaginal discharge is normal in females, as are episiotomy scars in women who have had children. Skene's glands should not be palpable.

26. The couple has not been able to become pregnant. The wife has not been diagnosed with any infertility problems. Which treatment will the nurse expect to teach the couple about if the problem is the most common testicular problem causing male infertility? a. Antibiotic c.Avoidance of scrotal heat b. Semen analysis d. Surgery to correct the problem

d. Varicocele is the most common testicular cause of infertility. Surgical ligation of the spermatic vein is done to correct the problem. Antibiotics are used if there is an infection, but this is not as common as a varicocele. Semen analysis is the first study done when investigating male infertility, but it is not a treatment. Avoidance of scrotal heat is a lifestyle change that may be used with idiopathic infertility.

8. Which characteristics describe transurethral resection of the prostate (TURP) (select all that apply)? a. Best used for a very large prostate gland b. Inappropriate for men with rectal problems c. Involves an external incision prostatectomy d. Uses transurethral incision into the prostate e. Most common surgical procedure to treat BPH f. Resectoscopic excision and cauterization of prostate tissue

e, f. The transurethral resection of the prostate (TURP) is the most common surgical procedure to treat BPH and uses a resectoscopic excision and cauterization of prostate tissue. Photovaporization of the prostate (PVP) or a simple open prostatectomy may be used for a very large prostate and has an external incision. TUMT is not approved for men with rectal problems. Transurethral incision into the prostate to expand the urethra for a small to moderate-sized prostate is done with a transurethral incision of the prostate (TUIP).