304 Final Exam

A 49-year-old female client has sought care because of severe perimenopausal symptoms. The client has asked the nurse if she should talk to the doctor about beginning hormone replacement therapy (HRT). How should the nurse best respond?

"HRT often relieves many of the symptoms of menopause, but it's not without some risks."

The nurse has provided education about the HPV vaccine to a 20-year-old female client. The client needs further teaching if she makes which statement?

"I need to have my female health exam every other year."

Which response by the nurse would be most appropriate when a male client asks why he has to have a prostate exam when he is having difficulty voiding?

"If the prostate is enlarged, it can cause difficulty passing urine."

A 17-year-old client has expressed concern over having a vaginal discharge just before her menses begins. What response should the nurse provide the client to best address her concerns?

"If there are no other signs or symptoms, it is likely a result of normal ovulation."

While interviewing a teenage male client, the nurse reviews the various structures of the male genitalia. The client asks, "So what does this epididymis do?" What would the nurse include in the response?

"It allows sperm to mature."

During the health history, a young male client asks the nurse why his scrotum rises and relaxes. The nurse would include which statement when responding to the client?

"The cremasteric reflex controls the rise and relaxation of the scrotum."

A 57-year-old woman calls the clinic reporting painful intercourse followed by spotting. She tells the nurse that she hasn't had a period in 2 years. What should the nurse tell her?

"These findings are common in postmenopausal women."

Which of the following recommendations should the nurse provide to clients in an effort to reduce their risk of developing colorectal cancer?

A high-fiber diet coupled with regular exercise

A nurse is caring for a client with prostatitis. The nurse knows that what nursing care measure will be employed when caring for this client?

Administer the prescribed dose of antibiotics

While inspecting the vagina, the nurse observes a thin, grayish-white vaginal discharge with a fishy odor. What would the nurse suspect?

Bacterial Vaginosis

A 30-year-old paralegal analyst comes to the clinic reporting a bad-smelling vaginal discharge with some mild itching, present for about 3 weeks. Douching did not help. She has had no pain with urination or with sexual intercourse. She has noticed that the smell increases after intercourse and during her period last week. She denies any upper respiratory, gastrointestinal, cardiac, or pulmonary symptoms. Past medical history consists of one spontaneous vaginal birth. She is married with one child. She denies tobacco, alcohol, or drug use. Her mother has high blood pressure, and her father died from heart disease. On examination she appears healthy and has unremarkable vital signs. On examination of the perineum no lesions are noted. On palpation of the inguinal nodes there is no lymphadenopathy. On speculum examination a thin gray-white discharge is seen in the vault. The pH of the discharge is over 4.5, and there is a fishy odor when potassium hydroxide KOH is applied to the vaginal secretions on the slide. Wet prep shows epithelial cells with stippled borders (clue cells). What type of vaginitis best describes her findings?

Bacterial vaginosis

A client is explaining to the nurse how vaginal dryness has decreased her enjoyment of sexual intercourse. The nurse is aware that which of the following are the glands that produce mucus that lubricates the vagina during intercourse?

Bartholin's glands

A 60-year-old coach comes to the clinic complaining of difficulty starting to urinate for the last several months. He believes the problem is steadily getting worse. When asked he says he has a very weak stream, and it feels like it takes 10 minutes to empty his bladder. He also has the urge to go to the bathroom more often than he used to. He denies any blood or sediment in his urine and any pain with urination. He has had no fever, weight gain, weight loss, or night sweats. His medical history includes type 2 diabetes and high blood pressure treated with medications. He does not smoke but drinks a six pack of beer weekly. He has been married for 35 years. His mother died of a myocardial infarction in her 70s, and the client's father is currently in his 80s with high blood pressure and arthritis. Examination reveals a mildly obese alert and cooperative man. His blood pressure is 130/70 with a heart rate of 80. He is afebrile, and his cardiac, lung, and abdominal examinations are normal. Visualization of the anus shows no inflammation, masses, or fissures. Digital rectal examination reveals a smooth, enlarged prostate. No discrete masses are felt. There is no blood on the glove. An analysis of the urine shows no red blood cells, white blood cells, or bacteria. What disorder of the anus, rectum, or prostate is most likely?

Benign prostatic hyperplasia (BPH)

The nurse is palpating the prostate of a 55-year-old client and finds it to be enlarged, smooth, firm, and slightly elastic, without a median sulcus. Which condition should the nurse most suspect?

Benign prostatic hypertrophy

A client is being evaluated for upper gastrointestinal bleeding. The nurse would expect to observe stool that is which color?

Black

A nurse is caring for a 45-year-old client with human papillomavirus (HPV) infection. The nurse should inform the client that she is at risk for developing what cancer?

Cervical Cancer

A nurse examining a client's external genitalia notices that his scrotum and testes draw up and he shivers. This phenomenon is known as which of the following?

Cremasteric reflex

A nurse examines the external genitalia of a client and observes that the scrotum is underdeveloped and the testis cannot be palpated. How should the nurse document this condition?

Cryptorchidism

A client has been to the clinic multiple times in the past year with vaginal infections, the most frequent of which was candidiasis. The nurse would assess the client for symptoms most likely related to which condition?

Diabetes mellitus

A client presents to the health care clinic for a routine pelvic examination. The client tells the nurse that she has experienced several yeast infections over the past year. The nurse should ask the client about the presence of which disease process?

Diabetes mellitus

A nurse examines the external genitalia of a client and observes that the scrotum is enlarged, reddened, and swollen. On palpation, the epididymis is tender and the client complains of sudden pain. How should the nurse document this condition?

Epididymitis

A mother brings her adolescent daughter to the clinic. The mother is worried that her daughter is sexually active. When assessing the adolescent, it is vital for the nurse to do what?

Establish a trusting and confidential relationship with the client

If a male client is uncircumcised, the glans of the penis is covered by the

Foreskin

A 22-year-old architecture major comes to the office reporting severe burning with urination, a fever, and aching all over. She denies any upper respiratory, gastrointestinal, cardiac, or pulmonary symptoms. Her past medical history consists of severe acne. She is currently taking an oral contraceptive. She has had no pregnancies or surgeries. She reports one new sexual partner within the last month. She does not smoke but drinks occasionally. Her parents are both in good health. Examination reveals a young woman appearing slightly ill. Temperature is 38.0°C; pulse and blood pressure are unremarkable. Head, ears, eyes, nose, throat, cardiac, pulmonary, and abdominal examinations are unremarkable. Palpation of the inguinal nodes shows lymphadenopathy bilaterally. On visualization of the perineum there are more than 10 shallow ulcers along each side of the vulva. Speculum and bimanual examinations are unremarkable for findings, although she is very tender at the introitus. Urine analysis has some white blood cells but no red blood cells or bacteria. Her urine pregnancy test is negative. Which disorder of the vulva is most likely in this case?

Genital herpes

While assessing the genitalia of a female client, the nurse observes moist fleshy lesions on the client's labia. The nurse should refer the client to a physician for possible

Genital warts

A nurse assesses a 22-year-old client who has never had a Pap test. Which factor should the nurse explain to the client as being a risk for cervical cancer?

Having multiple sexual partners

The nurse is assessing male genitalia and finds clusters of pimple-like clear vesicles. The nurse recognizes this as what?

Herpes

While assessing an adult male client, the nurse detects pimple-like lesions on the client's glans. The nurse explains the need for a referral to the client. The nurse determines that the client has understood the instructions when the client says he may have

Herpes infection

A client asks the nurse for suggestions about what to eat to reduce the risk of colon cancer. The nurse would suggest that the client eat which of the following types of food?

High in fiber

Which of the following should nurses teach all men, especially those who have had cryptorchidism?

How to perform a testicular self-examination.

A nurse teaches a male client how to perform testicular self-examination. The nurse should instruct the client to perform the self-examination at which frequency?

Monthly

When palpating the Bartholin's glands, the nurse expresses a purulent discharge. What would the nurse do next?

Obtain a culture

A nurse is preparing a presentation for a local women's group about cervical cancer and prevention. Which of the following would the nurse address as possible risk factors?

Oral contraceptive use over 5 years

A nurse is instructing a client on how to perform testicular self-examination (TSE). Which of the following should the nurse mention? Select all that apply.

Perform the TSE once a month Stand in front of a mirror and check for scrotal swelling Roll the testis gently in a horizontal plane between thumb and fingers Not: Perform the TSE just before showering Use one hand to palpate the testis If one testis is larger than the other, report it to your physician

An uncircumcised, 78 year-old male has presented at the clinic complaining that he cannot retract his foreskin over his glans. On examination it is noted that the foreskin is very constricted. What is this condition called?

Phimosis

An adult male client reports hesitancy when urinating. The nurse would further assess this client for which complication?

Prostate enlargement

Mr. Jackson, 50 years old, has had discomfort between his scrotum and anus. He also has had some fevers and dysuria. Rectal examination is halted by tenderness anteriorly, but no frank mass is palpable. What is the most likely diagnosis?

Prostatitis

A group of students is reviewing information about the male genitalia in preparation for a test. The students demonstrate understanding of the material when they identify which of the following as external genitalia?

Scrotum

The nurse prepares material to teach a group of adolescent male students on testicular self-examination. What should the nurse include in this teaching? Select all that apply.

Stand in front of a mirror Perform the examination one a month Complete the examination after a warm bath or shower Use the thumb, and index and middle finger for the examination Not: Apply lotion to the hands before beginning the examination

An older adult client states, "Sometimes when I sneeze, I notice that I wet my pants." How would the nurse interpret this finding?

Stress incontinence

A client calls the clinic and tells the nurse they have a white, curd-like discharge from the vagina. The client asks the nurse what the significance of this discharge is. What should the nurse responds?

The client may have a Candida species infection.

An uncircumcised male client has just come to the recovery room following a 4-hour back surgery. Before surgery a urinary catheter was placed. During the postoperative assessment, the recovery nurse discovers that the client has developed paraphimosis. What might have happened to the client to cause this?

The foreskin was not pulled back over the head of the penis after catheter placement

An adult client has sought care at the clinic, stating that she believes she has "a raging yeast infection." The nurse would expect to assess what type of vaginal discharge?

Thick, white vaginal discharge

A female client with HIV has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client?

This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) test annually.

While reviewing the medical record before examining a male clinic client, the nurse notes that the urinary meatus is located on the top of the glans of the penis. The nurse understands the correct term for this congenital defect is

epispadias

A risk factor for cervical cancer includes

exposure to HPV

A client visits the clinic and tells the nurse that her stools have been black for the past 3 days. The nurse should assess the client for

gastrointestinal bleeding.

During assessment of the vaginal area of an adult client, the client tells the nurse that she has had pain in her vaginal area. The nurse should further assess the client for

infection.

During assessment of an elderly male client, the client tells the nurse that he has had difficulty urinating for the past few weeks. The nurse should refer the client to the physician for possible

prostate enlargement.

An older adult client visits the clinic for a gynecologic examination. The client tells the nurse that she has been told that she has uterine prolapse. The nurse should further assess the client for

stress incontinence

While inspecting the genitalia of a male client, the nurse observes a chancre lesion under the foreskin. The nurse has explained this observation to the client. The nurse determines that the client understands the need for a referral when the client says that chancre lesions are associated with

syphilis.