Exam 3

13. A client is brought to the emergency department by the family, who state that the client was diagnosed last week with gonorrhea but has not taken the medications yet. Today the family notes that the client is "not acting right" and seems confused. Which action by the nurse is most appropriate? a. Start an IV and notify the health care provider about the client's diagnosis. b. Perform a thorough neurologic assessment and document the findings. c. Administer acetaminophen (Tylenol) if the client has a fever. d. Ask the client why he or she has not started the medication regimen yet.

ANS: A A rare but possible complication of gonorrhea is meningitis. Because the client has a change in mental status according to the family, the nurse must prepare the client for IV antibiotics to be given as soon as possible. The provider needs to know the diagnosis of untreated gonorrhea to help plan appropriate, rapid care. Conducting a neurologic examination and administering Tylenol are appropriate but do not take priority over initiating appropriate therapy. When the client is stable, the nurse can assess for reasons leading to noncompliance and offer appropriate assistance, such as referral to social services if the client cannot afford medications.

17. A client has returned to the nursing unit after a total abdominal hysterectomy. The nurse auscultates the client's abdomen and does not hear bowel sounds. Which is the nurse's priority intervention? a. Document the finding in the chart. b. Position the client on the right side. c. Irrigate the nasogastric tube. d. Measure abdominal girth.

ANS: A Absence of bowel sounds for 1 to 2 days after abdominal surgery is an expected finding that should be documented. No intervention specific to this finding is needed.

20. A female client admitted for cardiac problems also has condyloma acuminatum. Which type of precautions does the nursing staff implement with this client? a. Standard b. Airborne c. Contact d. Droplet

ANS: A Although it is considered highly contagious, condyloma acuminatum requires close intimate contact for transmission. Only Standard Precautions are needed for health care providers.

24. A client is scheduled to have a hysteroscopic myomectomy. Which statement by the client indicates that she understands the procedure? a. "I will need to deliver future children by cesarean section." b. "I need to schedule this during the last part of my cycle." c. "My uterus will be removed through tiny incisions." d. "This operation will make me infertile."

ANS: A Because of the risk for uterine rupture after this procedure, future deliveries will be done by cesarean section. The procedure is done during the early part of the menstrual cycle to limit blood loss and reduce the possibility of interrupting a pregnancy. This operation is a uterus-sparing procedure. The woman will not be infertile after the myomectomy.

4. Which statement indicates that a client understands the most appropriate time of day to take an alpha blocker drug for treatment of benign prostatic hyperplasia (BPH)? a. "I'll take my medication at bedtime." b. "As soon as I get up, I will take my medication." c. "I will take my medication with food or milk." d. "I'll take my medication on an empty stomach."

ANS: A Bedtime dosing should decrease the risk of hypotension with an alpha blocker drug. Giving the medication during the day will increase the client's risk of experiencing weakness, lightheadedness, and dizziness.

13. A client with a catheter in place after a suprapubic prostatectomy has decreased urinary output. Which action by the nurse is most appropriate? a. Assess the client for bladder spasms. b. Encourage the client to drink more water. c. Administer pain medication. d. Have the client try to void around the catheter.

ANS: A Bladder spasms and decreased urinary output can indicate obstruction. The nurse should assess whether the client is experiencing these spasms and should treat the client with an antispasmodic if needed. Encouraging increased intake will not be helpful if the problem is obstruction. Pain medication will not be helpful, although an antispasmodic can be beneficial. Trying to void around the catheter is not recommended.

8. A client has advanced breast cancer and bone metastasis. Which problem does the nurse consider the priority? a. Pain b. Mobility problems c. Risk for infection d. Malnutrition

ANS: A Bone metastasis can cause intense continuous pain that disrupts the client's activities and sleep and reduces the client's quality of life. This problem should be managed ahead of all other problems. Although the client may also be experiencing impaired mobility and risks for infection and malnutrition, none of these problems will be as disruptive as acute pain. The pain must become manageable before the other problems can be addressed.

1. A client is in the clinic reporting stress incontinence. Which other assessment is the priority for the nurse to perform? a. Ask the client about vaginal discharge or bleeding. b. Have the client perform a 24-hour fluid recall. c. Inquire about fever, chills, and burning on urination. d. Obtain the client's reproductive history.

ANS: A Gynecologic problems are often accompanied by urinary symptoms. Because women are often hesitant or embarrassed to discuss gynecologic problems, the nurse should specifically assess for them in clients reporting urinary issues. The other assessments are important as well but are not the priority.

16. A client had a uterine artery embolization and has just returned to the nursing unit. She is asking when she can get up to go to the bathroom. Which question does the nurse ask during hand-off report? a. "Was a vascular closure device used?" b. "What was her estimated blood loss?" c. "Is there an order for a catheter?" d. "When was the client's last sedation?"

ANS: A If a vascular closure device was used after the procedure, the client can get up in about 2 hours. If a closure device was not used, the client needs to be on bedrest for 4 hours. Although all questions are important during hand-off report, the question specific for activity restrictions is the one that asks about the vascular closure device.

9. A client had a mastectomy nearly a year ago and is distressed over continued tingling and burning in the ipsilateral arm. What orders does the nurse prepare to implement? a. Teach the client about gabapentin (Neurontin). b. Demonstrate the use of heat therapy to the axilla. c. Discuss ways to prevent constipation with pain meds. d. Reassure the client that this will disappear shortly.

ANS: A Injury to nerves causes paresthesias such as burning, tingling, "pins and needles," and numbness after a mastectomy. These sensations are usually gone by the end of a year. Because this client's symptoms are distressing and have lasted so long, the nurse should anticipate an order for Neurontin. Narcotic pain medications will not be helpful or needed. Heat therapy may or may not be helpful, and reassuring the client at this point will sound unbelievable.

20. A client had a mastectomy with reconstruction, and several axillary nodes were dissected. Which statement by the client indicates good understanding of discharge instructions? a. "I must be careful not to injure the arm or hand on the side of my surgery." b. "I'm glad that lymphedema is no longer a problem, as it was in my mother's day." c. "I will have a hard time waiting for a whole year to see how my breast will look." d. "I need to pull my drains out by inch each day until they are totally out."

ANS: A Lymphedema is a complication following mastectomy, especially if lymph nodes have been removed. The client must use measures to prevent this from occurring for the rest of her life. Preventing injury is one way of preventing lymphedema. Breast reconstruction should look optimal in 3 to 6 months. The health care provider will remove drains at a postoperative appointment. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations) MSC: Integrated Process: Nursing Process (Evaluation)

14. A client had a seminoma removed via an open procedure. The following day, the client's abdomen is soft and nontender, but no bowel sounds are present. Which action by the nurse is most appropriate? a. Encourage the client to ambulate several times a day. b. Reassess the client's abdomen in 4 hours. c. Document the finding and call the surgeon immediately. d. Give the client a laxative and encourage high-fiber food.

ANS: A Paralytic ileus is a complication of open seminoma removal. However, on the day after a major, lengthy operation, it is common for bowel sounds to still be absent. Narcotic analgesics can diminish bowel activity. The client can improve peristalsis with increased activity. It is not necessary to re-examine the client in 4 hours, nor is it necessary to call the surgeon right away. A laxative probably is not needed yet. The client should eat high-fiber foods when they can be tolerated.

19. A client had a total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node dissection 2 days ago. The nurse finds the client short of breath, tachycardic, and anxious. What intervention takes priority? a. Assess oxygen saturation and apply oxygen if needed. b. Have the client cough and deep breathe or use the spirometer. c. Call respiratory therapy to provide a nebulizer treatment. d. Prepare to administer furosemide (Lasix) IV push.

ANS: A Pulmonary embolism is a risk of major abdominal surgery. The client is exhibiting signs of pulmonary embolism. The nurse should first assess and treat oxygenation problems, then notify the Rapid Response Team. Pulmonary hygiene will not be aggressive enough to help this client. No indications suggest that the client needs a nebulizer treatment. Lasix is not warranted.

1. A client recently had a mammogram. Which statement by the client indicates a need for clarification regarding the importance or purpose of this procedure? a. "Now that I have had a mammogram, my risk for getting breast cancer is reduced." b. "I will still do a breast self-examination monthly even after the mammogram." c. "Yearly mammograms can reduce my risk of dying from breast cancer." d. "The amount of radiation exposure from a mammogram is very low."

ANS: A Regular or yearly mammography does not decrease the incidence of breast cancer. It only assists in early detection and diagnosis and decreases the mortality rate from breast cancer. The client should be instructed that the mammogram uses a very small amount of radiation in the test, and that consistent scheduling of a mammogram, along with a breast self-examination performed at least monthly, can reduce the client's risk of dying from breast cancer.

22. A client with a history of breast cancer is admitted through the emergency department with shortness of breath, weakness, fatigue, and new lower extremity edema. The client's oxygen saturation is 88%. After stabilizing the client, which action by the nurse is most important? a. Obtain a list of the client's medications. b. Orient her to her room and surroundings. c. Place the client on intake and output. d. Assess the client's family cardiac history.

ANS: A Some chemotherapeutic drugs, such as doxorubicin (Adriamycin) and trastuzumab (Herceptin), are known to be cardiotoxic. Although all other actions are appropriate, the nurse (and the provider) must know the medications the client is on, with specific emphasis on assessing for causative agents.

5. The nurse is working with a client who is recovering after a cervical biopsy. Which statement by the client indicates a need for further instruction? a. "I can resume vaginal intercourse after 6 weeks." b. "I should report heavy bleeding to the health care provider." c. "I must not lift heavy objects for about 2 weeks." d. "I will use the antiseptic rinse on a regular basis."

ANS: A The client should be instructed to keep the perineum clean and dry by using antiseptic solution rinses (as directed by her health care provider) and changing pads frequently. In addition, the client is instructed not to lift heavy objects for 2 weeks and to report excessive bleeding (more than like a normal period). She can resume intercourse in about 2 weeks, when the site has healed; she does not need to wait 6 weeks.

15. A client has undergone cryosurgery for stage I cervical cancer. Which precaution or action does the nurse teach this client? a. "Use sanitary napkins to manage discharge for the next several weeks." b. "Avoid sexual intercourse or becoming pregnant for the next 12 months." c. "If you should become pregnant, you will be at increased risk for preterm labor." d. "Your next menstrual cycle will be delayed because of this procedure."

ANS: A The effects of cryosurgery include a heavy, watery vaginal discharge for 3 to 6 weeks after the procedure. Clients are cautioned to avoid the use of tampons and intercourse during this time to reduce the risk for infection. The other statements are inaccurate.

2. Which statement by a middle-aged woman indicates that further instruction is needed for her and her partner regarding prevention of sexually transmitted diseases (STDs)? a. "I'm glad we don't have to use condoms anymore because I can't get pregnant." b. "Changes in my vagina may make me more likely to be at risk for an STD." c. "I told my partner that we need to switch to condoms instead of the pill now." d. "I should report any evidence of infection, even if symptoms are minor."

ANS: A The female who is probably postmenopausal should still use barrier protection to decrease the risk of contracting a sexually transmitted disease. Unfortunately, many women forget that they need barrier protection (i.e., condoms) once the need for contraception is gone. Any evidence of infection should be reported promptly because vaginal atrophy makes this client more vulnerable to develop an STD.

23. A client with BPH asks why his enlarged prostate is causing difficulty with urination. Which is the nurse's most accurate response? a. "It compresses the urethra, blocking the flow of urine." b. "It presses on the kidneys, decreasing urine formation." c. "It secretes acids that weaken the bladder, causing dribbling." d. "It destroys nerves, decreasing awareness of a full bladder."

ANS: A The prostate gland encircles the urethra and bladder neck like a doughnut. Enlargement of the gland constricts the urethra and obstructs the outflow of urine by encroaching on the bladder opening. The other responses are inaccurate.

15. When scheduling an annual pelvic examination and Pap test, the client asks if she should abstain from intercourse before the test. Which is the nurse's best response? a. "Yes. Avoid having intercourse for 24 hours before the test." b. "Yes. Avoid having intercourse for 2 hours before the test." c. "No. Intercourse does not interfere with this test." d. "No. Intercourse can actually enhance the test results."

ANS: A The woman should not douche, use vaginal medications or deodorants, or have sexual intercourse for at least 24 hours before the test. Such activities may prevent the accurate evaluation of smears, cultures, and cytologic data.

2. A woman reports cyclical abdominal pain, and her pelvic examination reveals tender nodules in the posterior vagina. The nurse plans to educate the woman about which treatment? a. Medroxyprogesterone (Depo-Provera) b. Radiation therapy c. Doxycycline (Vibramycin) d. Endometrial ablation

ANS: A This client has manifestations of endometriosis, and menstrual cycle control is a common therapy. Oral contraceptives or injectables such as Depo-Provera are often used. Radiation therapy is used for cancer. Doxycycline is an antibiotic used for bacterial infection. Endometrial ablation is a treatment used for dysfunctional uterine bleeding.

25. A client is recovering from a hysteroscopic myomectomy. The nurse assesses the client and finds the following: 2+ bilateral pedal edema; pulse, 108 beats/min; and respiratory rate, 28 breaths/min. Which action by the nurse takes priority? a. Assess lung sounds and oxygen saturation. b. Call for an immediate electrocardiogram (ECG). c. Notify the health care provider as soon as possible. d. Review the client's intake and output pattern.

ANS: A This client has signs of fluid overload, which is a possible complication of hysteroscopic surgery. The nurse should assess the client's oxygenation status, then should notify the provider or call the Rapid Response Team. An ECG may be ordered but is not the priority, nor is reviewing intake and output patterns. Although the provider does need to be notified, the nurse needs further assessment data to report.

9. A client tells the nurse she is happy that she never had children because she has less risk of developing cancer. Which response by the nurse is best? a. "Actually, your risk of breast cancer is slightly higher." b. "You're right; your risk of all reproductive cancer is quite low." c. "In reality, smoking is the leading risk factor for all types of cancer." d. "Your risk of uterine cancer is higher because you had no children."

ANS: A Women who have never had children have a slightly higher risk of breast cancer than the general population. Smoking is a major risk factor for many, but not all, cancers. Uterine cancer is not influenced by pregnancy.

17. A client is in the clinic for an annual examination and questions the need for a pelvic examination and Pap smear because she had a hysterectomy many years ago. Which response by the nurse is most appropriate? a. "Do you still have your cervix?" b. "Are you sexually active?" c. "We can skip it if you like." d. "Let's see what the doctor says."

ANS: A Women who still have their cervix after hysterectomy still need a Pap smear according to the guidelines established for other women. Sexual activity is not relevant. Simply stating that it can be skipped does not help the woman protect her health. Asking the provider does not help the nurse further assess the client.

1. The nurse is teaching a woman's group about gynecologic cancers. Which does the nurse teach are risk factors? (Select all that apply.) a. Nulliparity b. Multiple sex partners c. Obesity d. Smoking e. Delayed first intercourse

ANS: A, B, C, D Nulliparity, smoking, and obesity are risk factors for uterine cancer. Risk factors for cervical cancer include multiple sex partners, obesity, and smoking. Early age at first intercourse (before 18) is a risk factor for cervical cancer.

1. Which symptoms are expected in orchitis? (Select all that apply.) a. Scrotal pain b. Dysuria c. Scrotal edema d. Priapism e. Penile discharge f. Inability to ejaculate

ANS: A, B, C, E Manifestations of orchitis include scrotal pain, edema, reports of heavy feelings in the involved testicle(s), dysuria, pain on ejaculation, blood in the semen, and discharge from the penis. Ejaculation may be painful. Priapism is not a manifestation.

2. Which factors are considered to be indicative of a moderately increased risk of a client's developing breast cancer? (Select all that apply.) a. High postmenopausal bone density b. Ionizing radiation c. Family history of one first-degree relative d. Genetic factors e. First child born after age 30 f. Biopsy-confirmed atypical hyperplasia

ANS: A, B, C, F Factors considered to be indicative of a moderately increased risk of a client's developing breast cancer include high postmenopausal bone density, ionizing radiation, family history of one firstdegree relative, and biopsy-confirmed atypical hyperplasia. Female gender and genetic factors are indicative of high increased risk. The first child born after age 30 is indicative of low increased risk of developing breast cancer.

1. The nurse is teaching high school girls about the female reproductive tract. Which statements by the nurse are accurate? (Select all that apply.) a. The vagina has an acidic environment. b. The cervix is where the Pap smear is taken from. c. The ovum is fertilized in the uterus. d. Ovaries produce sex steroid hormones. e. The breasts contain fat tissue.

ANS: A, B, D, E The acidic environment of the vagina helps protect against infection. The cervix is the site for Pap testing. The ovaries produce sex steroid hormones. The breasts contain fat, glandular, fibrous, and ductal tissue. Ova are fertilized in the fallopian tubes.

2. A young adult client is in the clinic for evaluation of amenorrhea lasting 3 months. She takes birth control pills but is on no other medications. Which actions by the nurse are most appropriate? (Select all that apply.) a. Instruct the client on collecting a urinalysis for a pregnancy test. b. Assess the client's urinary and bowel habits. c. Perform a physical assessment on the client's abdomen. d. Weigh the client and calculate the body mass index. e. Reassure the client that amenorrhea can occur with oral contraception.

ANS: A, D Amenorrhea can be caused by several things, but not by urinary or bowel problems. Pregnancy should always be considered, even if the woman is on birth control of any type. Too little body fat can lead to menstrual irregularities. Simply reassuring the client is not as helpful as conducting further assessment.

9. A client with primary syphilis was treated with an intramuscular injection of benzathine penicillin G. Later, the client reports a hard painful lump at the injection site and aching joints. Which is the nurse's highest priority initial action? a. Assess the client's vital signs. b. Give the client acetaminophen (Tylenol). c. Document the finding in the chart. d. Apply a warm compress to the site.

ANS: A. A common reaction to penicillin injections for primary syphilis is the Jarisch-Herxheimer reaction, caused by rapid destruction of the causative microorganism and release of intracellular products. This is not usually serious, but it can cause fever and hypotension. The nurse should first assess the client's blood pressure for stability and should take the temperature. Then if the client's condition warrants, the nurse can administer acetaminophen or even fluids if needed. Documentation can be completed after the assessment is done. A warm compress to the site may or may not be helpful.

2. When performing a clinical breast examination on a client, the nurse palpates a thickened area where the skin folds under the breast. Which is the nurse's best action? a. Proceed with the examination. b. Determine whether the thickness is bilateral. c. Ask how long the thickness has been present. d. Change the client's position and re-assess.

ANS: A. thickened area where the skin folds under the breast is the inframammary ridge, a normal anatomic finding. Clients should be taught to identify this ridge and not confuse it with the presence of a lump or abnormal tissue thickening. Because this is a normal finding, no concern is necessary about whether it is present bilaterally or occurs in a different position, or how long the finding has been notable.

4. A 48-year-old woman reports to the nurse about new "flooding" with her periods. Which other complaint is the nurse prepared to investigate more thoroughly? a. Hot flashes and sweating episodes b. Fatigue during typical activity c. More frequent periods than usual d. Abdominal cramping with periods

ANS: B A description of "flooding" during the menstrual cycle indicates heavy bleeding, which may be due to dysfunctional uterine bleeding (DUB). DUB usually occurs at the beginning or at the end of a woman's reproductive years. Because this woman is 48, she might be entering the perimenopausal period. Fatigue during usual activities can indicate anemia. Hot flashes with sweating are a manifestation of menopause. More frequent menstrual bleeding also occurs in DUB. Abdominal cramping may be normal for this client.

6. A client's prostate-specific antigen (PSA) level is 2.0 ng/mL. Which action by the nurse is most appropriate? a. Inform the client that the results are normal and no cancer has been detected. b. Inform the client that results are normal and schedule a digital rectal examination. c. Let the client know that the results are elevated and he is at risk for prostate cancer. d. Tell the client that cancer is indicated and that the health care provider recommends watchful waiting.

ANS: B A normal PSA in men younger than age 50 is less than 2.5 ng/mL. Although the finding is within normal limits for a PSA value, a client could have prostate cancer and not present with an elevated PSA. Also, laboratory findings should not be used as the sole screening tool. Without a digital rectal examination (DRE), the health care provider cannot know whether the client is in the early stages of prostate cancer. The client should be informed that although the level is within the normal range, he still needs a DRE.

19. An African-American client has a prostate-specific antigen (PSA) of 12 ng/mL. Which action by the nurse is best? a. Remind the client to repeat the test in 1 year. b. Prepare the client for further diagnostic testing. c. Ask if the client ejaculated within 48 hours of the test. d. Assess the client for alcohol and tobacco use.

ANS: B A normal PSA level is less than 4 ng/mL. Elevated PSA levels, particularly those over 10 ng/mL, are associated with cancer. African Americans tend to have higher PSA levels as they age, but this level is so high that the nurse must suspect cancer and prepare the client for further diagnostic testing. The client should not wait a year to repeat the test. The client should not ejaculate for 24 hours before having blood drawn. Alcohol and tobacco use does not cause an elevation in PSA.

1. The nurse is counseling a postmenopausal woman about her new stress incontinence. Which statement by the nurse is most important? a. "You can try a variety of briefs and undergarments." b. "It will be important to keep that area clean and dry." c. "I can refer you to a good incontinence clinic." d. "Unfortunately, incontinence is common in women your age."

ANS: B After menopause, the vagina becomes dry, thinner, and smoother. This atrophy places the vagina at risk for infection. The combination of this fact with the presence of urine places the woman at higher risk for infection. The nurse should teach the client good hygienic practices to reduce the likelihood of infection. Education about briefs/undergarments may be needed, and a referral to an incontinence clinic would be very helpful, but neither takes priority over preventing infection. Stating that incontinence is common is not a helpful strategy.

18. A client who was treated 1 year ago for testicular cancer now has an elevated serum alpha- fetoprotein level. Which topic is most important for the nurse to teach this client about? a. Sperm banking options b. Effects of chemotherapy c. Hospice philosophy d. Importance of yearly monitoring

ANS: B Alpha-fetoprotein is a tumor marker that is not produced in significant amounts by normal adult tissues. An increase in the level of alpha-fetoprotein after treatment most commonly indicates recurrence or metastasis. Chemotherapy is used to treat recurrent or metastatic disease. The client should already have been taught about sperm banking. Hospice is not indicated at this time. Because a rise in these levels indicates recurrence or metastasis, yearly monitoring is not appropriate.

22. The nurse manages a clinic in an area with a high rate of sexually transmitted diseases (STDs). Which strategy best helps decrease the rate of infection? a. Start an expedited partner treatment program. b. Use a single-dose drug given in the clinic. c. Provide referrals to a low-cost pharmacy. d. Plan occasional community educational programs.

ANS: B Although all options could decrease the occurrence rate of STDs, administering the medications needed to control two common STDs (gonorrhea and Chlamydia) right in the clinic improves compliance and will help decrease rates of infection in the fastest way. The manager would need to investigate the legal issues surrounding expedited partner treatment before starting a program.

17. A female client is diagnosed with human papilloma virus (HPV) infection. Which intervention by the nurse takes priority? a. Instruct the client on using podofilox (Condylox) cream. b. Prepare the client for a Pap test and HPV DNA testing. c. Teach the client to take all medications until they are gone. d. Encourage the client to drink 8 to 10 glasses of water daily.

ANS: B Because certain strains of HPV cause cervical cancer, the client needs to have a Pap smear and HPV DNA testing done. The nurse should also teach her to use topical medications, such as Condylox, but this is not as high a priority as diagnostic testing. The other two options are not related to infection with HPV.

2. A client's laboratory findings reveal an elevated serum acid phosphatase level and a high-normal prostate-specific antigen level. How does the nurse interpret this information? a. The client shows evidence of renal disease and should be evaluated further. b. These results may indicate prostate cancer. He should be further evaluated. c. These results are not abnormal. He does not need to be evaluated further. d. These results may indicate an infection. He should be evaluated further.

ANS: B Both serum acid phosphatase and prostate-specific antigen levels will be elevated when the client has prostate cancer. The results are not indicative of renal disease or infection, but they are abnormal, may indicate prostate cancer, and should be further evaluated.

6. Which statement made by a client about breast cancer indicates correct understanding of the disease? a. "Breast cancer is the leading cause of cancer deaths among women in the United States." b. "Breast cancer is the leading type of cancer among women in North America." c. "Late onset of menses and early menopause increase the risk for breast cancer." d. "Breast cancer decreases with age, and very old women have virtually no risk."

ANS: B Breast cancer is the second most common form of cancer diagnosed in women (after skin cancer) and is the second leading cause of cancer deaths in women in the United States (after lung cancer). The incidence of breast cancer increases with age. Early onset of menses and late menopause increase the risk for breast cancer.

11. The nurse is teaching a postmenopausal woman about nutrition. Which statement by the nurse is most appropriate? a. "Be sure to eat cereal fortified with folic acid and B vitamins." b. "Make sure you take a calcium supplement every day." c. "Vitamin C is important for the postmenopausal woman." d. "You can get all the iron you need in two daily meat servings."

ANS: B Calcium is important throughout life, but for the postmenopausal woman, it is vital to help prevent osteoporosis. Folic acid and B and C vitamins are very important for the woman taking oral contraceptives. Iron might be important for this client for other reasons but is especially important for women with heavy menstrual bleeding.

28. A woman had returned to the nursing unit after a total abdominal hysterectomy. After settling the client and performing a thorough assessment including vital signs, which action by the nurse is most important? a. Consult with physical therapy about ambulating the client. b. Obtain and apply sequential compression devices. c. Order the client's next-day chest x-ray and laboratory work. d. Assist the client to order light food items for dinner.

ANS: B Care of a client post-abdominal hysterectomy includes measures to prevent deep vein thrombosis and pulmonary embolism. The client needs sequential compression devices ordered and applied. The other actions might be needed, but they are not the priority.

8. Which action does the nurse teach the client to prevent toxic shock syndrome? a. "Use a barrier method of contraception." b. "Wash your hands before inserting a tampon." c. "Avoid intercourse with more than one partner." d. "Empty your bladder immediately after intercourse."

ANS: B Certain strains of Staphylococcus aureus, commonly found on skin surfaces, produce a toxin that can enter the bloodstream through the vaginal mucosa. Handwashing before tampon insertion reduces the chance that the organism will enter the vagina.

26. A woman has been told she has cervical polyps. Which statement by the client indicates a good understanding of the teaching the nurse provided? a. "I hope my polyp doesn't turn cancerous like colon polyps can." b. "These can be removed easily in the doctor's office with little pain." c. "I will need to have more frequent screening for cervical cancer." d. "I will need to finish all my medication before having sex again."

ANS: B Cervical polyps are benign growths. They can be removed easily in the physician's office with little to no pain. The other statements are inaccurate: Polyps are not related to cancer or to sexually transmitted diseases.

3. A woman has endometriosis and is visibly upset. She tells the nurse that she just got married and wants to have children but is distressed because now she will be infertile. Which response by the nurse is most appropriate? a. "Treatment for endometriosis often causes infertility; I can refer you to a support group." b. "Endometriosis is more common in infertile women, but not all treatments cause infertility." c. "You shouldn't worry about fertility until after we know that this didn't cause cancer." d. "Unfortunately, you will have to take birth control pills for the rest of your life."

ANS: B Endometriosis is more common among infertile women than in the general population. However, treatments can be chosen on the basis of symptoms, extent of the disease, and the woman's desire to remain fertile. Menstrual cycle control with hormones is often a choice and would not leave the woman infertile. Endometriosis only rarely causes cancer. The woman would not have to take birth control pills for the rest of her life.

7. A postmenopausal client says that she is experiencing difficulty with vaginal dryness during intercourse and wonders what might be causing this. Which is the nurse's best response? a. "The less frequently you have intercourse, the drier the vaginal tissues become." b. "Estrogen deficiency causes the vaginal tissues to become drier and thinner." c. "Drinking at least 3 liters of water each day will make all your tissues less dry." d. "Try using a water-soluble lubricant during intercourse."

ANS: B Estrogen deprivation, which occurs as a result of menopause, decreases the moisture-secreting capacity of vaginal cells, thereby making the area drier. The vaginal tissues also become thinner and the rugae become smoother. Reduced frequency of intercourse will not dry out the vaginal tissues. Drinking excess water will not make the tissues less dry. A water-soluble lubricant may make intercourse less difficult. However, the client is asking what causes the problem.

14. A young woman is not pregnant but has not had a menstrual period for 5 months. Which factors does the nurse explore as a possible cause of the amenorrhea? a. The client's mother having type 2 diabetes mellitus b. Running 10 to 15 miles/day c. Taking aspirin daily d. Having a diet high in protein

ANS: B Excessive exercise, with corresponding loss of body fat, is associated with insufficient estrogen levels for the maintenance of normal ovulatory and menstrual cycles. The other factors are noncontributory.

25. A client is receiving brachytherapy for prostate cancer. Which intervention is most important for the nurse to include in the client's care plan? a. Reassure the client that erectile dysfunction does not occur with brachytherapy. b. Help the client plan activities interspersed with rest periods during the day. c. Remind the client that while hospitalized, he cannot have any visitors. d. Discuss hospice philosophy and availability with the client and family.

ANS: B Fatigue is common throughout treatment and may continue for several months after treatment has concluded. The client will need to learn to manage the fatigue; this can include spacing activities and planning for rest periods throughout the day. Erectile dysfunction can occur as a side effect of brachytherapy. This procedure is usually done on an outpatient basis, and the client does not pose a danger to others. Brachytherapy is often a first-line treatment choice, so discussion of hospice is not appropriate at this time.

23. A client has recently undergone an anterior colporrhaphy. Which is the most important discharge instruction that the nurse can provide? a. "Avoid sexual intercourse for 2 weeks." b. "Call us for fever and pain that does not improve." c. "Sutures will need to be removed in 2 weeks." d. "An ice pack on your incision will help the pain."

ANS: B Fever and pain may indicate an infection and should be reported. Sexual activity is restricted for 6 weeks. Sutures will absorb or fall out. Discomfort can be lessened with heat, not cold, therapy.

2. An older woman is asking the nurse about her husband's sexual functioning. Which statement by the nurse is most accurate? a. "Men his age tend to have a rapid decline in sexual abilities." b. "His testosterone levels will decrease only slightly until he is quite old." c. "Changes in testosterone levels do not affect sexual performance." d. "You are lucky your husband is healthy enough for sexual activity."

ANS: B Men experience a gradual but slight decrease in testosterone until they are in their 80s. Low testosterone levels do affect sexual performance. Stating that the woman is lucky does not give accurate information about sexual functioning.

14. Which exercise plan or activity does the nurse teach the client for the first postoperative day after a modified radical mastectomy? a. "Perform no movement or exercise today. Keep the arm supported and the elbow flexed, and as close to your body as possible." b. "Without moving your shoulder, straighten your elbow three times hourly and squeeze a rubber ball with your fingers." c. "Face the wall and extend your arm straight out to the wall. Walk your fingers as far above your head as your arm will reach, and then walk them back down." d. "Hold your operative arm straight out from the shoulder to the side. Use your nonoperative arm to pull the operative arm completely straight above your head."

ANS: B Mild exercise begins on the first postoperative day. Exercises should not put stress on the incision and do not involve the shoulder at this point. Full extension of the elbow, with support, is important, as is using grip maneuvers for the hand on the affected side. Total immobility is not recommended. The other two exercises can be performed a few days after the operation.

21. Why are women more likely than men to have silent sexually transmitted disease (STD) infection? a. Women are less susceptible to STDs and are not assessed often for them. b. Lesions may not be visible, or the woman can be asymptomatic. c. A man's longer urethra provides increased opportunity for bacteria to multiply. d. Symptoms of infection in women are likely to be systemic and vague, not local.

ANS: B Most clinical manifestations of an STD in a man are experienced in or around the penis. Most of a woman's genital mucous membranes are inside the vagina and around the cervix, where direct observation of any lesions is unlikely. Also some women have no symptoms or only vague symptoms of STDs, and this leads to a delay in diagnosis.

13. A client asks how soon after a mastectomy she can engage in sexual activity. Which is the nurse's best response? a. "When do you want to resume sexual activity?" b. "Most surgeons say to wait several weeks after the operation." c. "As soon as the incision has healed completely." d. "You shouldn't worry about sexuality right now."

ANS: B Most surgeons prefer that the client wait 4 to 6 weeks postoperatively before resuming sexual activity, although this very personal advice should be individualized. Asking the client when she wants to resume sexual activity places the burden on her to make a tentative decision. Until the incision is healed, clients should be taught how to protect the incision and avoid contact with the surgical site during intercourse. Telling the client not to worry about sexuality is dismissing and disrespectful.

5. A client has been diagnosed with genital herpes. Which statement by the client indicates an accurate understanding of the disease and treatment? a. "Antiviral drugs can cure genital herpes and prevent a recurrence." b. "I can prevent outbreaks with suppressive antiviral therapy." c. "Suppressive therapy will prevent shedding of the virus." d. "Medication should be taken only when symptoms are present."

ANS: B No cure for the disease is known, but it can be controlled with suppressive therapy with antiviral drugs. The client can be shedding the virus with no symptoms present and despite the use of antiviral medications. Medications should be taken on a suppressive basis or as soon as the client has symptoms.

10. Which statement made by a client about condom use indicates a need for clarification? a. "I will use a new condom each time I have intercourse." b. "I will use an oil-based lubricant whenever I have intercourse." c. "I will always use a latex condom rather than a natural membrane condom." d. "I will keep the condom on until I have withdrawn from the vagina."

ANS: B Oil-based lubricants can dissolve or damage the condom. Only water-soluble lubricants should be used with condoms. The other statements are accurate.

15. Which client is most likely to have organic erectile dysfunction? a. Middle-aged man who first had sexual intercourse at age 15 b. Middle-aged man who has had diabetes mellitus for 25 years c. Young man who had a myocardial infarction 2 years ago d. Young man who has a job that causes him high stress levels

ANS: B Organic erectile dysfunction occurs as a gradual reduction in sexual functioning. Diabetes mellitus causes microvascular and macrovascular complications that decrease the sensation and autonomic nerve activity required for achievement of an erection. The other factors will not increase the client's risk for development of organic erectile dysfunction.

18. Why are the death rates from ovarian cancer so high? a. The causative oncovirus is resistant to chemotherapy and to radiation. b. No symptoms are obvious during the early stages of this disorder. c. Radiation therapy is ineffective because the ovaries are located deep in the pelvis. d. Ovarian cancer occurs mostly in women over the age of 70 who have other health problems.

ANS: B Ovarian cancer is poorly detected in its early stages, when the chances for cure or control are better. The other statements are inaccurate.

9. A client has been taking finasteride (Proscar) for 4 weeks and reports that he has not yet seen a reduction in symptoms. Which response by the nurse is most appropriate? a. "Have you been taking the medication as ordered?" b. "It may take several months to see results." c. "It may not be the right drug for you." d. "We can try dutasteride (Avodart) next."

ANS: B So that he does not become discouraged, the nurse should first reassure the client that this class of medications may take up to 6 months to be effective. The nurse then can assess for compliance, but asking that question first may put the client on the defensive. The client needs to try the medication for several more months before the health care team changes it. Avodart is in the same class of medications, and its use for up to 6 months of therapy may be required before results are seen.

10. A client had a mastectomy and axillary node dissection. The nurse empties sanguineous drainage from the client's incisional Jackson-Pratt drain on the first postoperative day. Which other action regarding the drain is of high priority for the nurse? a. Flushing the tubing with urokinase to ensure patency b. Compressing and closing the drain to ensure suction c. Advancing the tubing inch from the insertion site d. Clamping the drain for 2 hours and releasing it for 2 hours

ANS: B The Jackson-Pratt drain removes fluid from the wound through closed suction. The drain must be compressed and closed to create suction as it slowly re-expands. The drain should never be flushed with urokinase, tubing should not be advanced, and the drain should not be clamped and released for 2 hours.

5. Which client does the nurse encourage to seek genetic counseling regarding her risk for BRCA1 or BCRA2 gene mutation-related breast cancer? a. Woman whose father had lung cancer and mother had leukemia b. Woman whose sister has breast cancer and mother has ovarian cancer c. Woman whose fraternal twin sister has breast cancer d. Older woman who has bilateral benign breast disease

ANS: B The best-defined increased genetic risk for breast cancer is related to mutations in the BRCA1 or BRCA2 gene. Families in which either of these genes is mutated have higher rates of breast and ovarian cancer in first-degree relatives. Being older is the primary risk factor for developing breast cancer but is not related to the genetic component; neither is benign breast disease. Lung cancer and leukemia are not genetically related to breast cancer. Having a twin with breast cancer does increase the genetic risk, but not as much as having two first-degree relatives with related cancers.

3. The nurse is preparing a teaching plan for a client who is scheduled to undergo mammography for the first time. What instruction by the nurse is accurate? a. "The test should be carried out even if you are pregnant." b. "Do not use deodorant on breasts or underarms before the test." c. "You will not experience any discomfort because this is just an x-ray." d. "The entire test should not take longer than 1 hour."

ANS: B The client should be reminded not to use creams, powders, or deodorant on breast or underarm areas before mammography because these products can show on the x-ray. The test should be rescheduled if any possibility exists that the client is pregnant. Women can experience discomfort as the breasts are compressed. The test is generally much less than an hour in duration.

15. A client is experiencing lymphedema in the arm on the operative side after a modified radical mastectomy. Which statement indicates correct understanding of managing this problem? a. "I will reduce my intake of salt and water." b. "I will elevate my arm on a pillow at night." c. "I will try to drink at least 3 liters of water each day." d. "I will wear long sleeves to prevent sun exposure."

ANS: B The formation of edema is aggravated by having the arm in a position dependent to the heart. Elevating the arm as much as possible assists gravity to promote better venous and lymph return. This will be a more effective intervention than salt reduction or drinking large amounts of water. Preventing sun exposure will have no effect on the lymphedema.

16. Which should be the nursing focus for a female client during the initial outbreak of genital herpes simplex? a. Instruction in condom use b. Promotion of comfort c. Prevention of pregnancy d. Institution of isolation

ANS: B The initial outbreak of genital herpes simplex in a woman causes severe discomfort. Promotion of comfort is the first priority, because clients may not be receptive to instruction attempts until some degree of comfort has been achieved.

8. A client has secondary syphilis. What precautions are necessary for the nurse to take when caring for this client? a. No precautions in addition to Standard Precautions are necessary. b. Gloves should be worn whenever direct contact with the client's skin is required. c. Handwashing is required before and after contact with the client. d. A mask should be worn by anyone entering the client's room.

ANS: B The secondary stage of syphilis is a systemic disease, with microorganisms present in the client's blood. Skin lesions and rashes are present. These lesions are considered highly contagious and should not be touched without gloves. Handwashing before and after contact is needed but is not sufficient to prevent spread of the disease. Masks are not needed.

11. A client has been diagnosed with Trichomonas vaginalis. Which statement by the client indicates an accurate understanding of this disease? a. "I need to have a throat culture for Trichomonas." b. "This will affect only my vagina and can cause itching." c. "My partner does not need to be treated." d. "My lymph nodes may stay swollen after treatment."

ANS: B Trichomoniasis affects only the vagina in females, leading to itching and vaginal discharge. Men can get it too, so both partners need treatment. Lymph nodes are not affected.

10. A client had a transurethral prostatectomy and has incontinence. Which statement by the client indicates a need for clarification about managing this condition? a. "I will practice stopping the urine stream to strengthen my sphincter control." b. "I will limit my fluid intake every day to prevent incontinence." c. "I will avoid vigorous activity for the first 3 weeks after surgery." d. "I will avoid caffeinated beverages and spicy foods."

ANS: B Unless fluid restriction is needed because of another medical problem, clients with incontinence should drink plenty of water and other fluids. Client statements regarding Kegel exercises, activity restrictions post-surgery, and avoiding bladder irritants are all indicative of understanding.

1. The nurse is teaching a young woman about her risk of contracting a sexually transmitted disease (STD). Which statement by the client indicates that further instruction is needed? a. "I am at decreased risk for an STD if I don't rely on contraceptive sponges or foams to protect me." b. "I am at decreased risk for an STD because I am using an intrauterine device for contraception." c. "I am at increased risk for an STD because of the way that my body is designed as a woman." d. "I will be at increased risk for an STD if I rely on oral contraceptives to protect me from contracting a disease."

ANS: B Using an intrauterine device provides no protection against contracting a sexually transmitted disease. Other risk factors that increase a young woman's chances of contracting a sexually transmitted disease include the vascularity of the vagina and reliance on contraceptive sponges or foams or on oral contraceptives for protection against pregnancy and STDs.

7. A client has just been diagnosed with a recurrence of genital herpes simplex. She asks how this is possible because she has not had sex since she was diagnosed and treated 1 year ago. Which is the nurse's best response? a. "Sometimes one course of therapy is not enough to eradicate the disease." b. "The disease can be controlled but is never cured, and outbreaks are common." c. "Did you take the medication exactly the way it was prescribed for you?" d. "If you have more than one sex partner, you may have more than one strain."

ANS: B Viral diseases cannot be cured. Antiviral drugs suppress viral replication but do not kill the organism. The causative virus remains in the body and can become active at any time. The other statements are not accurate.

29. An older client with benign prostatic hyperplasia (BPH) and hypertension is being treated with doxazosin (Cardura) while staying in the hospital. Which activity does the nurse delegate to the unlicensed assistive personnel (UAP) as a priority? a. Helping the client choose low-sodium meal items b. Assisting the client whenever he gets out of bed c. Encouraging the client to use the spirometer hourly d. Frequently re-orienting the client to his surroundings

ANS: B When treating a client in an inpatient setting with alpha blockers such as doxazosin (Cardura) or terazosin (Hytrin), the nurse must provide for the client's safety because this medication can cause orthostatic hypotension or syncope. The nurse should instruct the UAP to help the client whenever he gets out of bed, to prevent injury. Because this medication is being used for BPH and not for hypertension, a low-sodium diet is not necessary. Using the spirometer is always a good intervention, but it use is not related to safety and to this medication. The client, although older, may not be confused and may not need frequent reorientation.

2. A client has returned to the nursing unit after a prostatectomy. Which activities does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Demonstrating how to use the incentive spirometer b. Measuring and recording output from the in-dwelling catheter c. Encouraging the client to get out of bed and into the chair d. Irrigating the catheter with normal saline for blood clots e. Re-taping the catheter tape if the client reports pain

ANS: B, C The UAP can assess and document intake and output and can encourage the client to get out of bed. Use of the incentive spirometer is taught by the nurse or respiratory therapist. The catheter is irrigated by the nurse. The catheter should be taped so that slight traction is left on it to help with bleeding; this may cause discomfort and would need to be explained to the client. The catheter should not be repositioned and then re-taped.

1. The nurse is assessing a client with a history of ductal ectasia. Which signs and symptoms supporting this diagnosis does the nurse correlate with this condition? (Select all that apply.) a. A soft mass on palpation b. Greenish-brown nipple discharge c. Enlarged axillary nodes d. A mass with regular borders e. Redness and edema over the site of the mass f. Mass tenderness on palpation

ANS: B, C, E, F The benign condition, ductal ectasia, is caused by dilation and thickening of collecting ducts in the subareolar area. It results in activation of the inflammatory response when the ducts fill with cellular debris. Clinical manifestations of this condition include development of a hard mass with irregular borders that is tender on palpation. A greenish-brown nipple discharge, enlarged axillary nodes, and redness and edema over the site of the mass are also noted. Palpation of a soft mass or a mass with regular borders is not applicable to ductal ectasia.

5. The nurse is assessing a client who has undergone a transurethral resection of the prostate (TURP). Which assessment finding requires immediate action by the nurse? a. Passing small blood clots after catheter removal b. Experiencing urinary frequency after catheter removal c. Having bright red drainage with multiple blood clots d. Having the urge to void continuously while the catheter is inserted

ANS: C A client who undergoes a TURP is at risk for bleeding during the first 24 hours after surgery. Passage of small blood clots and tissue debris, urinary frequency and leakage, and the urge to void continuously while the client still has the catheter inserted are all considered to be expected complications of the procedure. They will resolve as the client continues to recover and the catheter is removed. However, the presence of bright red blood with clots indicates arterial bleeding and should be reported to the provider.

20. Which intervention is essential for the nurse to perform for a client who had a total abdominal hysterectomy? a. Instruct the client on a low-fat diet. b. Monitor for the onset of menopause. c. Assess for problems with intercourse. d. Teach exercises to prevent incontinence.

ANS: C A hysterectomy and the accompanying menopause can lead to vaginal changes. Pain or difficulty with intercourse can occur, and the client should be reassured that gentle dilation will overcome this problem. Sexuality concerns should always be assessed in clients, particularly after they undergo procedures that can alter sexuality. The client would not necessarily need a low-fat diet, and the onset of menopause occurs with surgery. The client will not necessarily have incontinence.

12. A client had a posterior colporrhaphy. Which statement by the client indicates an adequate understanding of discharge instructions? a. "I'll eat a high-fiber diet so I won't get constipated again." b. "I'll expect my periods to decrease within the next 6 months." c. "I'll need to eat a low-residue diet." d. "I'll call the surgeon if I saturate more than one pad in 4 hours."

ANS: C A posterior colporrhaphy is a treatment for a rectocele. After-care instructions include a low-residue (fiber) diet and stool softeners to decrease stool numbers and straining. A high-fiber diet is used when rectoceles are managed medically. The repair will have no effect on vaginal bleeding or on the number of periods.

17. A client had a spermatocele removed in an outpatient surgical center. Which statement by the client indicates good understanding of discharge instructions? a. "The heavy drainage will go away within a few days." b. "I need to buy dressing supplies at the drugstore." c. "I should report any redness or drainage from the incision." d. "Because of all the narcotics I'll be taking, I will need laxatives."

ANS: C A spermatocele is removed via a small scrotal incision. Heavy drainage should not occur, nor should extensive dressing supplies be needed. The small incision should not require the use of large doses of narcotics.

13. The nurse is counseling a mother who wants her teenage daughter to have a Pap smear and pelvic examination. Which statement by the nurse is most accurate? a. "If your daughter is over 18, she needs a pelvic examination and Pap smear." b. "A teenager does not need this examination unless she is sexually active." c. "Teach her to have her first examination by the age of 21 at the latest." d. "It is not needed unless you are worried about sexually transmitted diseases."

ANS: C A woman needs to have her first pelvic examination with Pap smear by the age of 21, or within 3 years of becoming sexually active. The other statements are not accurate.

4. A client has just been diagnosed with fibrocystic breast disease. She asks what this means in terms of her health. Which is the nurse's best response? a. "This increases your risk for breast cancer, so schedule yearly mammograms." b. "This will increase as you age, especially if you have never been pregnant." c. "This will diminish with menopause if you don't take replacement hormones." d. "This is genetic and you should teach your daughters about it."

ANS: C Although the cause of fibrocystic breast changes is unknown, the condition seems to be related to normal fluctuations in estrogen levels during the menstrual cycle. Symptoms usually resolve after menopause in the absence of estrogen supplementation. The presence of fibrocystic breast changes does not necessarily increase the client's risk for breast cancer, will not necessarily increase with age, and does not routinely have a genetic component.

21. A client is being treated with anastrozole (Arimidex) for breast cancer. The nurse is developing a plan of care for the client. Which intervention is the highest priority? a. Teach the client to weigh herself each day at the same time. b. Instruct the client to keep a symptom journal for menopausal symptoms. c. Monitor the client closely for evidence of osteoporosis. d. Review the client's dietary habits to prevent weight gain.

ANS: C Arimidex is an aromatase inhibitor. A major side effect of the aromatase inhibitors is loss of bone density. Fluid retention, menopausal symptoms, and weight gain are not primary side effects of Arimidex or other aromatase inhibitors. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesAdverse Effects/Contraindications/Side Effects/Interactions) MSC: Integrated Process: Nursing Process (Planning)

12. When performing an assessment of the external genitalia of an older man, the nurse observes the scrotum to have smooth skin and to be very pendulous. Which action by the nurse is most appropriate? a. Suggest to the client that he should wear an athletic supporter while awake. b. Ask the client if he has been treated for a sexually transmitted disease. c. Document the observation and continue the assessment. d. Notify the health care provider and facilitate a scrotal ultrasound.

ANS: C As the male client ages, the scrotum loses rugae and becomes increasingly pendulous. This is a normal assessment finding. No further action is needed.

16. A woman is asking about monthly breast self-examination (BSE). What information does the nurse provide to the client? a. "It is a valuable tool for finding breast lumps early." b. "After menopause, it is no longer useful." c. "BSE should be combined with other assessments." d. "Women in their 30s should begin monthly BSE."

ANS: C BSE can be presented as an option for breast self-awareness. However, BSE is no better than awareness of normal breast findings. It is best when combined with clinical breast examinations and mammography. Women of all ages can practice BSE.

21. A woman has had recurrent Bartholin cysts. Which intervention is most appropriate for the nurse to add to the client's care plan? a. Assess the woman for sexually transmitted diseases (STDs). b. Prepare a family diagram to investigate a familial pattern. c. Teach the woman about surgical marsupialization. d. Instruct the woman to wear only cotton underwear.

ANS: C Bartholin cysts tend to recur and can be treated with surgical marsupialization, the creation of a pouch as a new opening for the cysts, so it does not become obstructed again. The woman should have already been screened for STDs, Bartholin cysts are not genetic in nature, and wearing cotton underwear will not prevent them from occurring.

19. A client is scheduled for a penectomy for penile cancer. Which action by the nurse is most important? a. Teaching the client to sit when he urinates b. Demonstrating dressing changes and wound cleaning c. Assessing the client's psychosocial status and support d. Explaining the purpose of the in-dwelling catheter

ANS: C Clients may have strong emotional responses to penectomy, even when they seem to be accepting of the surgery, and the risk for suicide is present. It is critical to assess the client's emotional status and support systems before the operation is performed (and afterward). The other actions are appropriate too but do not take priority over ensuring the client's safety.

12. A client diagnosed with early prostate cancer is confused that surgery has not been planned. Which is the nurse's best response? a. "The disease is slow-growing. The risks of surgery at your age are not justified by the outcome." b. "Your disease is so advanced that surgery at this point would not increase your chances of cure." c. "Your disease is in a very early stage and is slow-growing. Your doctor will monitor you." d. "This stage indicates that you do not really have cancer, so surgery is not necessary."

ANS: C Early prostate cancer may have no clinical manifestations and may be found on a routine physical. It is slow-growing and may never become a problem for the client. Close follow-up (or watchful waiting) is the common prescription for this stage unless the client experiences symptoms. Telling the client that surgery is not justified, or that the cancer is too advanced at this point, and stating that he does not have cancer are inaccurate statements.

8. The nurse is assessing a client with a history of irregular periods. Which condition does the nurse possibly correlate with this problem? a. Childhood mumps b. Past valve replacement surgery c. Diabetes mellitus d. Mild intermittent asthma

ANS: C Endocrine disorders can affect the hypothalamic-pituitary-gonadal function of both men and women. Mumps would be important to know if the client were male. Past valve replacement surgery would not be contributory. Mild intermittent asthma also would not contribute to this problem. However, a client with more severe asthma who takes steroids on a long-term basis may develop secondary diabetes.

5. For which problem are Kegel exercises recommended? a. Cyst b. Fistula c. Cystocele d. Rectocele

ANS: C Kegel exercises, alternately tightening and relaxing the pelvic floor muscles, can strengthen muscles sufficiently to support the bladder and reduce the discomfort that accompanies a cystocele. They are not used for treatment for a cyst or fistula. A rectocele, another type of pelvic organ prolapse, is managed by promoting bowel elimination.

18. A 24-year-old woman has just been diagnosed with human papilloma virus (HPV) infection. She is very angry at her ex-boyfriend, who has been her only sexual contact. She is crying and says that she isn't going to tell him that he is infected. Which is the nurse's best response? a. "You do not have to tell him because this is not a reportable disease in this state." b. "Because there is no cure for this disease, telling him would be of no benefit." c. "He should be told so he can take precautions to prevent the spread of infection." d. "You should tell him because he may not know that this can cause cancer."

ANS: C Many clients are angry at the person who infected them with a sexually transmitted disease. Even though HPV is not a reportable disease in many states, all contacts should be told, so that they can take precautions to prevent infecting others. Although some strains of HPV do cause cancer, this is not the primary reason for telling a male sexual contact about the infection.

4. The nurse is counseling a client who has recently been diagnosed with syphilis. Which is the highest priority instruction that the nurse provides to the client regarding sexual partners? a. "As long as both of you are being treated, abstinence is not necessary." b. "If you both have the same disease, you can continue to have sex." c. "Your partner must be treated with antibiotics within the next 90 days." d. "Once the health department gets your partner's name, confidentiality is not considered to be important."

ANS: C Once a client has been diagnosed with syphilis, his or her partner must be prophylactically treated as soon as possible, preferably within the next 90 days. Sexual abstinence is required of both partners until they complete treatment. Although the disease will be reported to the local health department, all information will be held in strictest confidence.

17. A client with a family history of breast cancer tells the nurse that she has made several recent lifestyle changes. Which question by the nurse about these practices is most important? a. "Are you a vegetarian?" b. "Do you drink green tea?" c. "What supplements do you use?" d. "Do you smoke cigarettes?"

ANS: C Soy supplements in high amounts should be avoided by women who have breast cancer or who are at high risk for breast cancer. Dietary soy, eaten in normal amounts, does not appear to present the same risk. The other activities do not have the same risk as taking large quantities of soy supplements.

12. A client with pelvic inflammatory disease (PID) from gonorrhea asks how this can cause sterility. Which is the nurse's response? a. "The infection damages the ovary so that less estrogen is secreted and ovulation is not possible." b. "The infection remains in your body and can infect your baby, so it is best if you don't become pregnant." c. "If the infection is present in the fallopian tubes, it can cause enough scarring to block the tubes permanently." d. "The infection causes such damage to the cervix that it cannot contain a pregnancy inside the uterus for longer than 3 months."

ANS: C The chronic inflammation sets up scar tissue formation in the fallopian tubes, thereby narrowing or completely blocking the lumens. This situation can prevent fertilization by not allowing sperm to reach the ovulated egg. Irreversible scarring or stricture, causing sterility, may occur even before the condition is diagnosed. The other statements are inaccurate.

11. A client is postoperative from a left-sided mastectomy. She says that the incision and the inner side of her arm from the armpit to the elbow are numb. Which is the nurse's best action? a. Teach the client to avoid lifting heavy objects. b. Measure the circumference of the client's left arm. c. Reassure the client that this is an expected finding. d. Notify the surgeon as soon as possible.

ANS: C The nerves supplying the skin in the area were injured during surgery, decreasing sensation to the area. These problems frequently resolve over time. Teaching the client to avoid lifting heavy objects or measuring the circumference of the arm will not improve sensation to the client's arm. The surgeon does not need to be notified about normal findings.

11. A client with prostate cancer reports pain in his lower back and legs. Which action by the nurse is most appropriate? a. Discuss medications for arthritis. b. Perform a bladder scan. c. Facilitate imaging studies. d. Encourage weight-bearing exercises.

ANS: C The primary site of metastasis for prostate cancer is the bone of the spine and the legs. The nurse should suspect metastasis and inform the health care provider. The client will need imaging studies to look for metastasis, and the nurse should facilitate them. The other interventions are not appropriate.

6. A client has recently been diagnosed with gonorrhea. The client comes from a deeply religious family. When the nurse finds the client weeping, the client tells the nurse, "I'm being punished for having an affair." How does the nurse respond? a. "Surely you don't really believe that." b. "Why don't we get you a sedative?" c. "Tell me more about how you feel." d. "Which religion do you practice?"

ANS: C The priority for the nurse is to gain more information to have a clear understanding about how the client feels. The other answers discount the seriousness of the client's feelings or are evasive.

18. A client is scheduled for an ultrasound to evaluate for possible uterine fibroids. Which instruction by the nurse is most appropriate? a. "Do not eat or drink anything after midnight." b. "Take these laxatives the morning of the test." c. "Do not urinate an hour before the test; a full bladder will give best results." d. "Have a designated driver because you will be sleepy from the anesthesia."

ANS: C The scan is noninvasive and painless. The abdominal and pelvic organs are better visualized with the bladder full during the scan. The other statements are inaccurate.

28. The nurse is caring for a young adult who just got married and has been diagnosed with testicular cancer. To which community resource does the nurse refer him? a. American Cancer Society b. Red Cross c. Sperm bank d. Public Health Department

ANS: C The young man with testicular cancer should be referred to a sperm bank, so that he will have the option to have children in the future if he so desires. The other resources listed will not provide assistance in this area. The American Cancer Society does offer several resources for clients with cancer and their families, but referral to a sperm bank would be the priority owing to the man's age and his newly married status.

9. A young woman calls the clinic to report a fever and a funny rash with peeling skin on the palms of her hands and the soles of her feet. Which action by the nurse is most appropriate? a. Make an appointment for her to be seen the next day at the clinic. b. Instruct her to take warm baths with oatmeal added to the water. c. Tell her to go to the emergency department immediately. d. Have her take acetaminophen (Tylenol) every 4 hours and drink fluids.

ANS: C These signs are consistent with toxic shock syndrome, a potentially life-threatening bacterial infection often associated with tampon use in menstruating women. The client requires immediate medical attention and should go to the nearest emergency department. Waiting until the next day, taking warm baths, and using symptom control measures such as Tylenol and fluids only lead to delay in obtaining necessary care.

23. The clinic nurse is preparing a client for a physical and breast examination. The nurse notes the client's breast appears with dimpling of the skin. Which action by the nurse takes priority? a. Continue preparations and note the finding in the client's chart. b. Ask the client how long this problem has been present. c. Alert the health care provider and prepare to order a mammogram. d. Question the client about routine drug and alcohol intake.

ANS: C This finding (dimpling of the skin) is suspicious for infiltrating ductal carcinoma. The nurse should alert the provider and prepare to order a mammogram for the client. In addition, the nurse should be prepared to refer the client to a breast spet. The nurse does need to continue preparing the client and document the finding, but this is not as important as the mammogram and referral. Assessment can continue before, during, or after the examination, but is also not as vital as facilitating further diagnostic testing.

16. During examination of the male client's external genitalia, the nurse observes a discharge from the urethra when compressing the glans. Which is the nurse's next action? a. Document the observation. b. Ask the client to turn his head and cough. c. Obtain a specimen for culture. d. Test the cremasteric reflex.

ANS: C Urethral discharge is not considered normal in a continent client and should be cultured. The other options would not help provide information about the nature of the discharge.

26. A client is taking goserelin (Zoladex). What periodic assessment does the nurse plan for this client? a. Weight and abdominal girth b. Pulmonary function tests c. Bone density testing d. Abdominal ultrasound

ANS: C Zoladex is a luteinizing hormone-releasing hormone (LH-RH) agonist. Side effects include hot flashes, erectile dysfunction, decreased libido, gynecomastia, and osteoporosis. A periodic bone density screening test should be done to assess for osteoporosis. The other assessments would not be needed to assess for side effects of this drug.

3. Which client statement indicates understanding about a transrectal ultrasound? a. "This will determine if the outlet of my bladder is obstructed." b. "This will determine the amount of residual urine present." c. "This is performed to view the interior of the bladder and urethra." d. "This is performed to view the prostate and do a tissue biopsy."

ANS: D A transrectal ultrasound is performed to view the prostate and surrounding structures and possibly also to do a tissue biopsy. A urodynamic pressure flow study will determine if the outlet of the client's bladder is obstructed. A bladder scan will determine the amount of residual urine that is present. A cytoscopy will allow the interior of the bladder and urethra to be visualized

10. A client with pelvic organ prolapse has chosen treatment with a vaginal mesh. Which action by the nurse before the procedure is most important? a. Administering the preoperative sedative medication b. Giving the woman the manufacturer's labeling information c. Ensuring that the woman has a ride home after she recovers d. Witnessing the client signature on the informed consent

ANS: D All activities are important before surgery. However, the priority before any operation is to obtain informed consent. The nurse's main responsibilities regarding informed consent including having the client sign the form and witnessing the signature.

4. The nurse is conducting a reproductive assessment of a postmenopausal woman. Which assessment finding reported by the client requires immediate intervention by the nurse? a. Urinary incontinence b. Vaginal dryness c. Painful intercourse d. Returning periods

ANS: D All client reports require some action by the nurse, but the priority would be to further investigate and report the "returning periods." In a postmenopausal woman, this can signal cancer.

13. A woman is receiving radiation via brachytherapy for endometrial cancer. Which statement by the woman indicates a need for further education about the procedure? a. "I can go about my usual activities between sessions." b. "I might experience more fatigue than usual during therapy." c. "I should report any fever over 100 degrees to my doctor." d. "I must stay away from my young grandchildren for 6 weeks."

ANS: D Brachytherapy is provided mostly on an outpatient basis, and the client does not have restrictions placed on her interactions with her family during this time. The radiologist inserts an applicator into the woman's uterus through which the radioactive isotope is placed for treatment. After the treatment, the isotope and the applicator are removed. The other statements show good understanding of brachytherapy.

14. A client was diagnosed with chancroid. Which manifestation does the nurse associate with this condition? a. Vaginal discharge b. High fever c. History of ectopic pregnancies d. Genital ulcers

ANS: D Chancroid is characterized by genital ulcers and occasionally by enlarged lymph nodes. The other assessment findings are not related to chancroid.

6. The nurse is working with a client who is recovering after a laparoscopy. Which assessment finding is considered a priority by the nurse? a. Slight drainage from the incision site b. Grogginess after the anesthesia c. Discomfort from the catheter d. Reports of shoulder pain

ANS: D Clients should expect mild drainage or blood from the incision site. Grogginess from the anesthesia and discomfort from a catheter are also expected minor occurrences post-laparoscopy. The nurse would not be concerned about these but should intervene and treat the client with shoulder pain. Shoulder pain is referred pain from phrenic nerve irritation and can be expected.

10. A client who has had numerous children is having her annual examination. The nurse wishes to discuss contraception, but the client is not interested. Which action by the nurse is most appropriate? a. Provide education on the value of spacing children. b. Explain the many alternatives from which to choose. c. Ask the client how her husband feels about so many children. d. Assess the client's religious and cultural background.

ANS: D Cultural and religious backgrounds can have a great deal of influence on clients' attitudes toward sexuality and reproduction. Because the client does not seem interested in the topic, the nurse should gently assess for these background influences and respect them. Providing education that the client does not want is not helpful and is disrespectful. Asking about the husband's preferences diminishes the nurse-client relationship, which should be focused on the client.

11. Which statement made by a woman who is being discharged after a hysterectomy indicates understanding and acceptance? a. "I wish I had delayed this surgery so that I could have had one more child." b. "I will diet to prevent the weight gain most women have after hysterectomy." c. "Now that my uterus will be gone, I'll probably develop stress incontinence." d. "My husband and I hope to have more sex because I won't have so much bleeding."

ANS: D Discontent with loss of fertility and misconceptions about the effects of hysterectomy are common contributors to psychological or adjustment problems following hysterectomy. Positive attitudes and family support decrease the risk for psychological problems. Wanting to delay the surgery for childbearing indicates unresolved grief for fertility. Gaining weight and developing incontinence are misconceptions about the operation.

16. A client is going home after outpatient surgery for a hydrocele. Which information does the nurse emphasize in teaching this client? a. "Report to the doctor immediately any drainage from your drain." b. "Use a condom during intercourse to prevent incisional infection." c. "Sit when you urinate until all swelling is gone and drainage has stopped." d. "Wear the scrotal support device for at least 3 weeks after surgery."

ANS: D Edema from residual inflammation can remain for several weeks. This problem is increased if the scrotum is not supported and can cause the client considerable discomfort. The client needs to wear a supportive garment such as a jockstrap during this time. If the client goes home with a drain in place, serosanguineous drainage can be expected for up to 2 days.

19. A client has been diagnosed with anal cancer. Which test does the nurse prepare the client for? a. Darkfield microscopy b. Culture of discharge c. Blood draw for the Venereal Disease Research Laboratory (VDRL) test d. Human papilloma virus (HPV) DNA

ANS: D Human papilloma virus is known to cause cancers of the genitals, anus, and perianal areas. The client needs to undergo testing for HPV DNA. Darkfield microscopy is used to detect syphilis. Discharge is tested for gonorrhea, Chlamydia, and pelvic inflammatory disease. The VDRL is also used for syphilis.

14. Which clinical manifestation in a client with invasive cervical cancer alerts the nurse to the possibility of metastasis? a. Amenorrhea b. Weight gain c. Breast tenderness d. Swelling of one leg

ANS: D Leg pain or unilateral swelling of a leg is a symptom of disease progression as the tumor enlarges, or of recurrent disease.

7. Which symptom experienced by a woman in her 20s alerts the nurse to the possibility of endometriosis? a. Bleeding between periods b. Cessation of menstruation c. Premenstrual tension headache d. Pain before the onset of menstrual flow

ANS: D Pain is the most common symptom of endometriosis. The peak of pain usually occurs just before the menstrual flow.

27. The nurse is performing a psychosocial assessment of a young man diagnosed with testicular cancer. Which does the nurse include as a priority in the assessment? a. Encouraging the client to verbalize his thoughts and feelings to his health care provider b. Assisting the client in locating a support group for men with testicular cancer c. Asking the client to rate his fears of sexual deficiency on a scale of 1 to 10 d. Identifying all components of his support system, including his partner

ANS: D Part of conducting a psychosocial assessment is determining who makes up the client's support system. It would be ineffective merely to refer the client to a support group, ask him to rate his fears of sexual inadequacy, or encourage him to discuss thoughts and feelings not with the nurse, but with his provider.

15. Which disease process places the client at greatest risk for development of an ectopic pregnancy? a. Chlamydia infection b. Genital herpes c. Human papilloma virus infection d. Pelvic inflammatory disease (PID)

ANS: D Pelvic inflammatory disease is a leading cause of infertility and ectopic pregnancies. The other diseases are not as likely to cause an ectopic pregnancy.

21. The client with sickle cell anemia has had an erection for longer than 4 hours. How does the nurse intervene? a. Administer a diuretic to increase urine output. b. Attempt to relieve pressure by catheterizing the client. c. Document the finding and reassess in 4 hours. d. Notify the health care provider and prepare to give meperidine (Demerol).

ANS: D Prolonged penile erectionpriapismis common during sickle cell crisis. It is considered a urologic emergency because circulation to the penis may be compromised, and the client may not be able to void. Therefore, the provider must be notified promptly. Demerol is often given to induce hypotension. A diuretic will not help the client. Catheterization should be reserved for the man who cannot void. Waiting another 4 hours to intervene may lead to ischemia.

7. Which comment made by a client with breast cancer indicates correct understanding regarding cancer causes and prevention? a. "I will prevent recurrence of my cancer by eating a low-fat diet from now on." b. "If I had breast-fed my children, this would not have happened to me." c. "I hope this doesn't increase my risk for bone cancer or lung cancer." d. "I will have regular mammograms on my other breast to detect cancer early."

ANS: D Regular mammography can help detect breast cancer at an early stage. Women who have had breast cancer have a greater risk of developing cancer in the other breast. The other statements are inaccurate.

24. A client has decided to treat his enlarged prostate with saw palmetto. Which is the nurse's best response? a. "You'll need to get permission from your health care provider to make that decision." b. "Saw palmetto is a well-respected alternative therapy for benign prostatic hyperplasia." c. "Have you discussed this decision with your family?" d. "What has your health care provider told you about this choice of therapy?"

ANS: D Saw palmetto is an alternative therapy for benign prostatic hyperplasia (BPH) that has not yet been proven to be therapeutic. A client's decision to use this as the primary form of treatment should be discussed with his provider. Some herbs and natural products interfere with the actions of medications taken for other conditions. The other statements do not give the client accurate information to help him make this decision.

12. A client receiving tamoxifen (Tamofen) asks how this therapy helps fight breast cancer. Which is the nurse's best response? a. "This agent decreases estrogen levels. so the cancer stops growing." b. "The drug causes you to secrete testosterone, which limits cancer growth." c. "Tamoxifen kills estrogen-secreting cells and growth of blood vessels to cancer cells." d. "It blocks estrogen receptors, and this limits cancer cell growth."

ANS: D Tamoxifen is an estrogen antagonist-agonist. Its use in breast cancer is limited to cancers that express the estrogen receptor. Tamoxifen binds to estrogen receptors, inhibiting the binding of estrogen to receptors, thereby "starving" the cancer cells of an essential growth factor. The drug does not decrease circulating levels of estrogen, does not cause testosterone to be secreted instead of estrogen, and does not kill off estrogen-secreting cells.

18. A client has large breasts. Which health problem is she most likely to develop? a. Breast tenderness b. Breast cancer c. Chest pain d. Back pain

ANS: D The added weight of large breasts and the altered center of gravity increase spinal pull and contribute to back pain. She is not at risk for developing increased breast tenderness, cancer, or chest pain.

8. A client is scheduled for a prostatectomy for benign prostatic hyperplasia (BPH). On the morning of surgery, the laboratory report on the client's urine indicates the presence of red blood cells, white blood cells, and bacteria. Which is the nurse's highest priority action? a. Document the report in the client's chart. b. Insert a new Foley catheter before surgery. c. Strain the client's urine. d. Assess the client's vital signs and notify the health care provider.

ANS: D The client may have a urinary tract infection. The nurse should obtain a set of vital signs and notify the provider of the laboratory results. Any surgery may need to be delayed if the client has infection. Documentation is needed after other actions have been taken. Inserting a catheter and straining the client's urine will not be beneficial.

27. A client is crying because her endometrial cancer is scheduled to be treated with chemotherapy agents that will cause hair loss. Which is the most appropriate response from the nurse? a. "You should prepare yourself for total hair loss all over your body." b. "You can start shopping for wigs and scarves now so you'll have them available." c. "Why not shave your hair off now so that you can have it made into a wig?" d. "Would you like me to put you in touch with a former client so that you can talk?"

ANS: D The client should be given the opportunity to talk with someone who has undergone treatment with chemotherapy that causes hair loss. It would be ineffective for the nurse to suggest that the client should simply start shopping for wigs/scarves or shave her head. This would prevent the client from making her own decision. It would be incorrect for the nurse to tell the client that total body hair loss will occur. This may not happen. It depends completely on the agent given.

3. A client who has discovered a lump in her breast becomes tearful when scheduling a mammogram. Which is the nurse's best response? a. "All lumps are considered cancerous until proven otherwise." b. "Unless you have a relative with breast cancer, this lump is probably benign." c. "Diagnosing cancer at this early stage is most likely to result in a cure." d. "Many women have breast lumps, and most of the lumps are benign."

ANS: D The finding of a breast lump or mass is a frightening experience. Clients should be reassured, until they can be seen or testing is done, that 90% of all breast lumps or masses are benign. It is inaccurate for the nurse to state that all lumps are considered cancerous until proven benign, or that the lump is probably benign unless the client has a relative with breast cancer. Diagnosing cancer at an early stage results in cure more often than when the cancer is in later stages, but such a comment before diagnosis will only scare the client more.

23. The nurse assesses a client and finds the manifestation shown in the photograph. Which drug does the nurse prepare to administer to the client? a. Doxycycline (Vibramycin) b. Ceftriaxone (Rocephin) c. Acyclovir (Zovirax) d. Podophyllin (Pododerm)

ANS: D The image is of a perianal HPV infection, which can be treated by provider-applied Pododerm. Doxycycline is used to treat chlamydia, ceftriaxone is for gonorrhea, and acyclovir is for herpes.

3. The nurse is conducting an assessment on a client and identifies a lesion that appears as a smooth indurated area. Which is the highest priority action on the part of the nurse? a. Question the client further regarding sexual practices. b. Ask the client about any associated symptoms. c. Document the findings and obtain a specimen of fluid from the lesion. d. Don gloves before continuing to assess the lesion any further.

ANS: D The lesion could be a chancre, which is highly contagious. The nurse should be wearing gloves. The nurse should finish assessment of the lesion before continuing to interview the client and documenting findings. The nurse does need to collect fluid for a culture, but the nurse's safety is the priority.

22. Which intervention helps the client with chronic prostatitis prevent spread of infection to other areas of the urinary tract? a. "Wear a condom during intercourse." b. "Avoid alcohol and caffeinated beverages." c. "Be sure to empty your bladder completely at each voiding." d. "Sexual intercourse or masturbation can help drain the prostate."

ANS: D The prostate is not easily penetrated by antibiotics and can serve as a reservoir for microorganisms, which can infect other areas of the genitourinary tract. Draining the prostate regularly through intercourse or masturbation decreases the number of microorganisms present and reduces the risk for further infection. The other interventions listed will be ineffective with prostatitis.

7. Which client diagnosed with prostate cancer is not a candidate for watchful waiting? a. Client with very early cancer of the prostate b. Client who is asymptomatic c. Client who wants to avoid urinary incontinence as a result of treatment d. Client who refuses frequent digital rectal examinations (DREs)

ANS: D To participate in watchful waiting, the client must be monitored on a regular basis with a DRE and prostate-specific antigen (PSA) testing. Clients who are asymptomatic, who have early cancer, and who wish to avoid urinary incontinence from treatment would all be excellent candidates for watchful waiting.

20. Which client statement indicates understanding about post-orchiectomy care for testicular cancer? a. "I will avoid contact sports to prevent injury and development of cancer in my remaining testis." b. "I will always use a condom because I am at increased risk for acquiring a sexually transmitted disease." c. "I will wear an athletic supporter and cup to prevent testicular cancer in my remaining testicle." d. "I will continue to perform testicular self-examination (TSE) monthly on my remaining testicle."

ANS: D Treatment (e.g., surgery, radiation, chemotherapy) for testicular cancer does not protect the person from development of testicular cancer in the remaining testicle. A monthly TSE should be performed to monitor for changes in size, shape, or consistency of the testis. The other statements are inaccurate. Testicular cancer is not caused by trauma, cannot be prevented by an athletic cup, and does not cause increased risk for sexually transmitted diseases.

19. A client is undergoing treatment for breast cancer and asks the nurse about "natural" treatments for her chemotherapy-induced nausea. Which is the most appropriate response by the nurse? a. "Anything you can take will interfere with your chemotherapy." b. "I don't know of any recommended complementary treatments for nausea." c. "Black cohosh and flaxseed are good for combating nausea." d. "Ginger has been used for nausea; would you consider taking it?"

ANS: D Up to 80% of women with breast cancer have used complementary therapies. Ginger, along with acupuncture, aromatherapy, hypnosis, progressive muscle relaxation, and shiatsu, has been used for nausea. Black cohosh and flaxseed are used for hot flashes. The client should check with her provider and other credible sources regarding any desired therapies to ensure that they won't interfere with the chemotherapy. Even if the nurse doesn't know of specific therapies, it is never appropriate to just say, "I don't know." The nurse should investigate for the client.

6. When the history of a female client is taken, which client statement does the nurse refer to the health care provider? a. "I had a fibroadenoma of the breast when I was 22 years old." b. "I had my first child when I was 26 years old and my second child when I was 32." c. "I stopped using oral contraceptives when I was no longer sexually active." d. "I had my menopause 2 years ago and have started to have vaginal bleeding again."

ANS: D Vaginal bleeding that occurs after menopause can indicate cancer and should be promptly evaluated. The other statements by the client would not be cause for alarm and would not need to be reported to the provider.

22. The client has been diagnosed with possible vulvovaginitis pending the outcome of laboratory tests. What information does the nurse teach the client? a. "Use sanitary pads, not tampons, when you have your period." b. "Limit douching to once a month or so, after your period." c. "Scrub your vulvar area with antibacterial soap when you bathe." d. "Wear only cotton underwear and wear looser jeans or slacks."

ANS: D Vulvovaginitis occurs as a result of imbalances in the hormones and florae of the vulva and/or vagina. Several causative factors are known, and self-care includes wearing cotton underwear and not wearing tight-fitting jeans or pants. Using tampons will not prevent it. Douching and washing the area with antibacterial soap should be avoided.