Oncology/reproductive NCLEX

Within the free clinic where you practice nursing, you hold weekly sexual education classes open to the public. Within the classroom, you communicate the CDC's numbers for the incidence of STIs and their impact upon public health. Which is the fastest-spreading bacterial STI in the United States? a) Gonorrhea b) Chlamydia c) Herpes simplex 1 d) HPV

B) Chlamydia Chlamydia is the most common and fastest-spreading bacterial STI in the United States.

A school nurse is teaching a group of 10-year-old girls about the onset of menstruation. What does the nurse include in the presentation?

"After you have your first menstrual period, you will have it every 28 days." Incorrect: The idealized menstrual cycle is 28 days, but variation is normal and expected, especially at the onset of menstruation. N. "Most girls begin to menstruate between 10 and 12 years of age." Incorrect: Most girls begin to menstruate between 10 and 16 years of age. O. "Ovulation occurs 7 days before the beginning of your next menstrual cycle." Incorrect: Ovulation occurs about 14 days before the beginning of the next menstrual cycle. P. "Your early menstrual cycles will be irregular owing to the hormones that control your ovulation." Correct Correct: Irregular menstruation is a result of anovulation, which is due to the immature hypothalamic-pituitary-ovarian-uterine axis.

A client with possible prostate cancer has a transrectal ultrasound and needle biopsy. The next day, which client statement is of greatest concern to the nurse?

"I am really worried about the test results." Incorrect: Some worrying about test results is not abnormal for a client who had a transrectal biopsy. KKK. "I feel like I have a fever and my back aches." Correct Correct: Low back pain and fever are indications of infection, a potentially life-threatening complication. LLL. "I had some bright red spotting after the procedure." Incorrect: Some bright red spotting after the procedure is not abnormal for a client who had a transrectal biopsy. MMM. "I haven't had a bowel movement since the biopsy." Incorrect: Having no bowel movement since the biopsy (yesterday) is not abnormal for a client who had a transrectal biopsy.

A newly graduated RN is orienting to a same-day surgery unit. Which client does the charge nurse to assign to the new graduate?

25-year-old with infertility having a laparoscopy under general anesthesia Incorrect: A laparoscopy under general anesthesia is a procedure that will require more client teaching and postoperative monitoring. This client should be cared for by more experienced nursing staff. YY. 32-year-old with a breast lump scheduled for a needle biopsy under local anesthesia Correct Correct: A needle biopsy of the breast has the least risk for possible complications and the least complex client teaching of the listed procedures. ZZ. 40-year-old with possible cervical cancer having a laser excision conization Incorrect: A laser excision conization is a procedure that will require complex client teaching and postoperative monitoring. This client should be cared for by more experienced nursing staff. AAA. 66-year-old with prostatic enlargement scheduled for a transrectal needle biopsy Incorrect: A transrectal needle biopsy is a procedure that will require complex client teaching and postoperative monitoring. This client should be cared for by more experienced nursing staff.

A nurse is teaching a client how to prevent vaginal inflammation and itching. What information does the nurse include?

A. Avoid loose, flapping clothing; pants should fit well. Incorrect: Tight clothing, such as pantyhose or tight jeans, should be avoided because it can cause chafing. Tight clothing can also cause someone to get hot and sweaty, which can lead to infection. B. Cleanse the inner labia daily with soap and water. Incorrect: During a bath or shower, the inner labial mucosa should be cleansed with only water, not soap. It is an irritant to the sensitive skin in those areas. C. Do not have unprotected sex with multiple partners. Correct Correct: Unprotected sex with multiple partners can lead to vaginal infection. D. Monthly douching should help reduce symptoms. Incorrect: The use of douches or feminine hygiene sprays is not recommended. They disturb the balance of both pH and bacteria and can aggravate irritation.

Katrina Sterrett, a 26-year-old preschool teacher, is being seen by a physician who is part of the internist group where you practice nursing. She is undergoing her annual physical and is having many lab tests done as a condition of her employment and upcoming wedding. She is returning for her results and is devastated to learn that she has the sexually-transmitted infection, gonorrhea. What would contribute to her ignorance of her condition? a) Being asymptomatic b) All options are correct c) Being sexually inactive d) Knowing the signs and symptoms of STIs

A) Being asymptomatic Many women who have gonorrhea are asymptomatic, a factor that contributes to the spread of the disease.

A male client reports urethral pain and a creamy yellow, bloody discharge from the penis. The nurse associates these characteristics with which of the following sexually transmitted infections? a) Gonorrhea b) Candidiasis c) Chancroid d) Trichomoniasis

A) Gonorrhea In men, the initial symptoms of gonorrhea include urethral pain and a creamy, yellow, sometimes bloody discharge. Candidiasis, trichomoniasis, and bacterial vaginosis are vaginal infections that can be sexually transmitted, and the male partner usually is asymptomatic. Chancroid causes genital ulcers; the lesions begin as macules, progress to pustules, and then rupture.

A client with a history of HSV-2 infection asks the nurse about future sexual activity. Which of the following responses would be most appropriate? a) "Inform all potential sexual partners about the infection, even if it is inactive.". b) "Use a condom during sexual activity if the infection becomes active again." c) "If the infection has healed, you probably don't have to use a condom." d) "Refrain from all sexual activity until you don't have another outbreak for a year."

A) Inform all potential sexual partners about the infection, even if its inactive. The nurse should advise the client to inform all potential sexual partners of the HSV infection even if it is in an inactive state. The nurse should also advise the client to use a condom during sexual activity even if the disease is dormant and to avoid sexual contact if the infection is active. Condoms do not protect skin and mucous membranes left exposed.

A 22-year-old patient has presented to her primary care provider for her scheduled Pap smear. Abnormal results of this diagnostic test may imply infection with: a) human papillomavirus (HPV). b) Chlamydia trachomatis. c) Candida albicans. d) Trichomonas vaginalis.

A) human papillomavirus (HPV) Although a Pap smear does not test directly for HPV, dysplasia of cervical cells is strongly associated with HPV infection. An abnormal Pap smear is not indicative of chlamydial infection, trichomoniasis, or candidiasis.

A client is being treated for endometriosis with medrodroxyprogesterone (Depo-Provera). Which client statement indicates correct understanding of this drug therapy?

A. "A daily pill will help by preventing the formation of new blood vessels." Incorrect: Endostatins block the formation of new blood vessels and are used to decrease ectopic endometrial growth. B. "It is an injection that I will receive monthly." Correct Correct: Depo-Provera is an injectable form of progestin. It is given every 2 weeks to once a month, depending on the severity of the client's symptoms. C. "Side effects may include a decrease in my bone density." Incorrect: Gonadotropin-releasing hormone (GnRH) agonists, not menstrual cycle control agents, may cause a decrease in bone density. D. "Treatment may cause me to develop certain food cravings." Incorrect: Food cravings are not known to be side effects of Depo-Provera.

A client asks the nurse about early detection of breast masses. Which statement by the nurse about early detection of breast masses is correct?

A. "A yearly breast examination by a health care provider can substitute for breast self-examination (BSE)." Incorrect: A yearly breast examination by a health care provider cannot substitute for BSE. B. "Detection of breast cancer before axillary node invasion yields the same survival rate." Incorrect: Detection of breast cancer before axillary node invasion increases the chance of survival. C. "Mammography as a baseline screening is recommended by the American Cancer Society at 30 years of age." Incorrect: The American Cancer Society recommends a baseline screening mammogram at 40 years of age and yearly screening for women beginning at age 40. D. "The goal of screening for breast cancer is early detection because BSE does not prevent breast cancer." Correct Correct: The purpose of screening is early detection. BSE does not prevent breast cancer.

A nurse is teaching a male client about having a prostate-specific antigen (PSA) test to screen for prostate cancer. Which client statement indicates correct understanding of the testing?

A. "African-American men often have a lower normal PSA value." Incorrect: African-American men often have higher normal PSA values. B. "I should not ejaculate for at least 24 hours before the test." Correct Correct: The client should not ejaculate for at least 24 hours before the test to avoid having a false-positive result. C. "My PSA normal levels will get lower as I age." Incorrect: PSA normal levels actually get higher as men age. D. "The health care provider will perform the digital rectal examination before drawing blood for PSA levels." Incorrect: The health care provider will perform the digital rectal examination after drawing blood for PSA levels. This also avoids having a false-positive result.

Situation: A nurse is caring for a 42-year-old woman with an intramural leiomyoma (myomas and fibroids). She has been taking estrogen replacement therapy for menopausal symptoms. She had a total abdominal hysterectomy (TAH) 2 days ago and is to be discharged on antibiotics. What does the nurse include in her discharge teaching about antibiotics?

A. "After your first day at home, you can stop them if you do not have a fever." Incorrect: The client must finish her entire course of antibiotics. She must take them after she has diminished signs or symptoms. This is a fundamental principle of antibiotic administration. B. "It is important to take them as directed until all are gone." Correct Correct: Antibiotics should be taken as directed until all are gone. C. "Stop the antibiotic if you feel nauseated-it loses its effectiveness." Incorrect: The client should never be instructed to stop a course of antibiotics. In cases when clients are unable to take an antibiotic (owing to nausea or another problem), an alternative antibiotic will be prescribed. D. "You will need to take the drug until your incision heals." Incorrect: The client's incision should be healed by the time that the antibiotic course is completed, but this is not the parameter that is used for continuation of the therapy. The client needs to complete the prescribed doses of the antibiotic.

A client who had an anterior colporrhaphy is being discharged. What does the nurse tell the client before her discharge?

A. "Avoid lifting more than 25 pounds." Incorrect: Teach the client to avoid lifting anything heavier than 5 pounds. B. "Do not have sexual intercourse for at least 2 weeks." Incorrect: Teach the client to avoid sexual intercourse for 6 weeks. C. "Return to the clinic in 6 weeks for suture removal." Incorrect: Sutures do not need to be removed because they may be absorbable or they may fall out (slough-off) as healing occurs. D. "Take a hot bath or use a moist heating pad for discomfort." Correct Correct: For discomfort, tell the client to use heat-either a moist heating pad or warm compresses applied to the abdomen. A hot bath may also be helpful.

A client has gynecologic cancer. Which client statement demonstrates correct understanding of her treatment options?

A. "Chemotherapy will be used to shrink my cancer before I have my operation." Incorrect: Chemotherapy is used as palliative treatment for advanced and recurrent disease when it has spread to other parts of the body. B. "External beam radiation therapy (EBRT) may be used after my cancer surgery." Correct Correct: External beam radiation therapy (EBRT) may be used to treat any stage of gynecologic cancer in combination with surgery. C. "Brachytherapy is given on an outpatient basis for 4 to 6 weeks before surgery." Incorrect: External treatment, not brachytherapy, is given on an ambulatory care basis after surgery, if needed. D. "The purpose of brachytherapy is to dissolve the cancer." Incorrect: The purpose of brachytherapy is to assist in preventing disease recurrence.

A 32-year-old client has a laparoscopic removal of endometrial adhesions at a same-day surgery center. What does the nurse tell her to expect postprocedure?

A. "Do not expect to get your menstrual period for at least 3 months; this procedure really gets your hormones out of balance." Incorrect: This procedure should not postpone the client's period for 3 months. It should not interrupt the client's menstrual cycle for longer than a month, if at all. B. "You may have some referred pain in your chest and shoulders because of the carbon dioxide (CO2) used." Correct Correct: Clients often have their abdomen insufflated during these procedures for better visualization. As the CO2 leaves the body, it causes muscular discomfort that is referred and presents as chest and shoulder pain. C. "This procedure will guarantee that you and your partner will be able to get pregnant within the next year." Incorrect: Clients have adhesions removed for various reasons. Sometimes, it is a matter of pain reduction from the endometriosis. It may be done because the couple is having fertility problems. If this is the reason for the procedure, the nurse can never guarantee any sort of outcome, especially pregnancy. D. "You will most likely have a fever and a strong-smelling vaginal discharge for several days following the procedure." Incorrect: Fever and vaginal discharge would be abnormal expectations following the procedure.

Situation: A nurse is caring for a 42-year-old woman with an intramural leiomyoma (myomas or fibroids). She has been taking estrogen replacement therapy for menopausal symptoms. What does the nurse tell her about estrogen replacement therapy and how it relates to her fibroids?

A. "Estrogen will help shrink your fibroids." Incorrect: On the contrary, estrogen may actually cause the fibroids to enlarge. B. "Increasing the amount of estrogen you are taking will be necessary." Incorrect: The estrogen may be decreased or eliminated. C. "The fibroids may continue to grow." Correct Correct: The fibroids may continue to grow because of the estrogen stimulation. Therefore she will need to be taught to see her provider as instructed to monitor their growth. D. "Your estrogen dosage will not change." Incorrect: The client's estrogen dose will probably change. It will most likely need to be decreased at some point. This will aggravate the client's uterine fibroid growth.

The nurse is teaching postmastectomy exercises to the client. Which statement made by the client indicates that teaching has been effective?

A. "For the pulley exercise, I'll drape a 6-foot-long rope over a shower curtain rod or over the top of a door." Correct Correct: This is a correct description of how to perform the pulley exercise properly. B. "In rope turning, I'll hold the rope with my arms flexed." Incorrect: In rope turning, the client holds the end of the rope and steps back from the door until the arm is almost straight out in front. C. "In rope turning, I'll start by making large circles." Incorrect: In rope turning, the client starts with small circles and gradually increases to larger circles as the client becomes more flexible. D. "With hand wall climbing, I'll walk my hands up the wall and back down until they are at waist level." Incorrect: With hand wall climbing, the client walks her hands up the wall and then back down until they are at shoulder level.

The nurse assesses a 76-year-old man with chronic myeloid leukemia receiving nilotinib (Tasigna). It is most important for the nurse to ask which question? A. "Have you had a fever?" B. "Have you lost any weight?" C. "Has diarrhea been a problem?" D. "Have you noticed any hair loss?"

A. "Have you had a fever?" An adverse effect of nilotinib is neutropenia. Infection is common in neutropenic patients and is the primary cause of death in cancer patients. Patients should report a temperature of 100.4o F or higher. Other adverse effects of nilotinib are thrombocytopenia, bleeding, nausea, fatigue, elevated lipase level, fever, rash, pruritus, diarrhea, and pneumonia.

A nurse is teaching a group of young boy and girl clients about getting vaccinated for HPV (human papilloma virus). Which statement by one of the girls needs to be clarified?

A. "Having the vaccine will help keep me from getting cancer of my cervix." Incorrect: Having the vaccine will help prevent girls and women from developing cancer of the cervix. B. "I will need to have all three injections to be protected from the disease." Incorrect: The client does need three injections-administered over a 6-month period. C. "It is better to have the vaccination before I start having sexual relations." Incorrect: It is advised that young women have the vaccination before they start having sexual relations. It is given between ages 9 to 10 and 25 to 26. D. "The vaccine is for girls; a different one is available for boys." Correct Correct: The same vaccine is advised to be given to both girls and women, as well as to boys and men. It protects men from genital warts and from some strains of HPV.

The nurse is discussing treatment options with the client newly diagnosed with breast cancer. Which statement by the client indicates a need for further teaching?

A. "Hormonal therapy is only used to prevent the growth of cancer. It won't get rid of it." Incorrect: The purpose of hormonal therapy is to reduce the estrogen available to breast tumors to stop or prevent their growth. B. "I might have chemotherapy before surgery." Incorrect: Chemotherapy drugs destroy breast cancer cells that may be present anywhere in the body. They are typically administered after surgery for breast cancer, although neoadjuvant chemotherapy may be given to reduce the size of a tumor before surgery. C. "If I get radiation, I am not radioactive to others." Incorrect: The client is radioactive only if the radiation source is dwelling inside the breast tissue. D. "Radiation will remove the cancer, so I might not need surgery." Correct Correct: Typically, radiation therapy follows surgery to kill residual tumor cells. Radiation therapy plays a critical role in the therapeutic regimen and is effective treatment for almost all sites where breast cancer can metastasize. The purpose of radiation therapy is to reduce the risk for local recurrence of breast cancer.

A nurse is doing discharge teaching for a client who is recovering from a total abdominal hysterectomy (TAH). Which client statement indicates a need for clarification?

A. "I cannot jog for 2 to 6 weeks." Incorrect: The client who has had a TAH must avoid jogging, aerobic exercise, participating in sports, or any strenuous activity for 2 to 6 weeks. B. "I must take my temperature twice a day for the first days after surgery." Incorrect: The client must take her temperature twice a day for the first days after surgery as a precaution to monitor for infection. C. "I will need to find a new form of birth control." Correct Correct: The client who has had a hysterectomy can no longer become pregnant. Therefore, birth control is no longer necessary. D. "I will no longer have menstrual periods." Incorrect: The client who has had a TAH will no longer have a period, although she may have some vaginal discharge for a few days after going home.

A nurse is teaching care principles to a client who plans uterus-sparing surgery to remove uterine fibroids. Which client statement needs clarification?

A. "I will be able to return to my usual activities in about 2 weeks." Incorrect: Most clients can return to their usual activities within 2 weeks of having uterus-sparing surgery for fibroids. B. "It is important to avoid having sexual intercourse for 3 weeks after surgery." Correct Correct: The client will need to avoid having sexual intercourse for at least 6 weeks (not 3 weeks) after the surgery. C. "Probably I will be able to go home on the day of the surgery." Incorrect: Most clients do go home on the day of the surgery. D. "Fewer complications occur with this procedure than with hysterectomies." Incorrect: Postoperative pain is less and complications fewer with these procedures than with routine hysterectomies.

A 52-year-old client has been diagnosed with endometrial (uterine) cancer. She says to her nurse, "I was told that my cancer is stage II. What does that mean?" How does the nurse respond?

A. "It means that your cancer remains confined to your uterus." Incorrect: Cancer that remains confined to the endometrium (innermost lining) of the uterus is classified as stage I. B. "The spread of your cancer is beyond your pelvic area." Incorrect: The spread of cancer that is beyond the pelvic area is classified as stage IV cancer. C. "Vaginal and lymph nodes are areas of involvement with your cancer." Incorrect: Vaginal and lymph node areas of involvement indicate that the cancer is classified as stage III. D. "Your cancer has spread from your uterus to your cervix." Correct Correct: Stage II means that the cancer now also involves the client's uterine cervix.

The client is struggling with body image after breast cancer surgery. Which behavior indicates to the nurse that the client is maladaptive?

A. Avoiding eye contact with staff Correct Correct: Avoiding eye contact may be an indication of decreased self-image. B. Saying, "I feel like less of a woman" Incorrect: This comment illustrates expected feelings. By verbalizing her frustration, the client suggests a willingness to discuss and express feelings. C. Requesting a temporary prosthesis immediately Incorrect: Requesting a prosthesis can be a sign of healing and working through body image changes. D. Saying, "This is the ugliest scar ever" Incorrect: This comment illustrates expected feelings. By verbalizing her frustration, the client suggests a willingness to discuss and express feelings.

The client who has had a mastectomy asks the nurse about breast reconstructive surgery. Which statement by the nurse about breast reconstruction is true?

A. "Many women want breast reconstruction using their own tissue immediately after mastectomy." Correct Correct: Many women want autogenous reconstruction after mastectomy. B. "Placement of saline- or gel-filled prostheses is not recommended because of the nature of the surgery." Incorrect: Saline- or gel-filled prostheses are recommended as breast expanders in breast augmentation surgery, not for reconstructive surgery. C. "Reconstruction of the nipple-areola complex is the first stage in the reconstruction of the breast." Incorrect: Reconstruction of the nipple-areola complex is the last stage in breast reconstruction surgery. D. "The surgeon should offer the option of breast reconstruction surgery once healing has occurred after the mastectomy." Incorrect: Breast reconstruction surgery should be discussed before mastectomy takes place.

Which assessment finding indicates to the nurse that the client is at high risk for a malignant breast lesion?

A. 1-cm freely mobile rubbery mass discovered by the client Incorrect: On clinical examination, fibroadenomas are oval, freely mobile, rubbery masses usually discovered by the woman herself. Their size varies from smaller than 1 cm in diameter to as large as 15 cm in diameter. Although the immediate fear concerns breast cancer, the risk of its occurring within a fibroadenoma is very small. B. Ill-defined painful rubbery lump in the outer breast quadrant Incorrect: Breast pain and tender lumps or areas of thickening in the breasts are typical symptoms of a fibrocystic breast condition. The lumps are rubbery, ill defined, and commonly found in the upper outer quadrant of the breast. C. Backache and breast fungal infection Incorrect: Many large-breasted women develop fungal infection under the breasts, especially in hot weather, because it is difficult to keep this area dry and exposed to air. Backaches from the added weight are also common. D. Nipple discharge and dimpling Correct Correct: Nipple discharge and dimpling are high-risk assessment findings for a malignant breast lesion.

Four women phone the Gynecology Clinic about having new-onset vaginal bleeding. Which call does the RN decide to return first?

A. 23-year-old using medroxyprogesterone acetate (Depo-Provera) Incorrect: Bleeding in the 23-year-old using medroxyprogesterone acetate (Depo-Provera) is not unusual. The nurse will need to follow up with this client, but presently she is not causing the most concern. B. 34-year-old with a history of multiple leiomyomas Incorrect: Bleeding in the 34-year-old with a history of multiple leiomyomas is not unusual. The nurse will need to follow up with this client, but presently she is not causing the most concern. C. 48-year-old who had a endocervical curettage yesterday Incorrect: Bleeding in the 48-year-old who had a endocervical curettage yesterday is not unusual. The nurse will need to follow up with this client, but presently she is not causing the most concern. D. 62-year-old with no previous gynecologic problems Correct Correct: Vaginal bleeding in a postmenopausal woman is abnormal and may be an indication of serious problems such as endometrial cancer.

Which gynecologic clients does a charge nurse assign to an LPN/LVN? Select all that apply.

A. 23-year-old who is nauseated after her laparotomy and needs to receive antiemetic drugs Correct B. 34-year-old who had a total hysterectomy for invasive cervical cancer and has a blood pressure of 88/54 mm Hg C. 42-year-old who had an abdominal hysterectomy whose health care provider wants to remove sutures at her bedside Correct D. 48-year-old who is receiving IV chemotherapy to treat stage II cervical cancer Correct Feedback: Correct: The client who is nauseated after laparotomy and needs to receive antiemetic drugs needs monitoring and care that can be provided by LPNs/LVNs. Correct: A client who had an abdominal hysterectomy and whose health care provider wants to remove sutures requires care that can be provided by LPNs/LVNs. Incorrect Feedback: Incorrect: The client with a total hysterectomy for invasive cervical cancer who has blood pressure of 88/54 mm Hg has a deteriorating status (dropping BP) and requires treatment that only an RN can administer. Incorrect: The client who is receiving IV chemotherapy to treat stage II cervical cancer requires treatment that only an RN can administer.

Which client does the RN assess first after receiving change-of-shift report?

A. 45-year-old with a history of hypothyroidism who is scheduled for a hysterectomy and bladder suspension Incorrect: The client with a history of hypothyroidism who is scheduled for a hysterectomy and bladder suspension is not unusual and does not require rapid intervention by the nurse. B. 48-year-old who is reporting abdominal pain and light vaginal spotting after an endometrial biopsy Incorrect: The woman who is reporting abdominal pain and light vaginal spotting after an endometrial biopsy is not unusual and does not require rapid intervention by the nurse. C. 50-year-old who is receiving morphine through a patient-controlled analgesia (PCA) device after a hysterectomy and who rates her pain at a level 3 (1 to 10 scale) Incorrect: The client who is receiving morphine through a PCA device after a hysterectomy and who rates her pain at a level 3 (1 to 10 scale) is not unusual and does not require rapid intervention by the nurse. She is indicating that her pain is being managed. D. 54-year-old with an anterior and posterior colporrhaphy who has an elevated heart rate and an oral temperature of 101.2° F Correct Correct: This client is showing signs of postoperative infection and warrants frequent assessments that need to be communicated to the surgeon in charge of care.

Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which dietary modification should the nurse recommend? A. A bland, low-fiber diet B. A high-protein, high-calorie diet C. A diet high in fresh fruits and vegetables D. A diet emphasizing whole and organic foods

A. A bland, low-fiber diet Patients experiencing diarrhea secondary to chemotherapy and/or radiation therapy often benefit from a diet low in seasonings and roughage before the treatment. Foods should be easy to digest and low in fat. Fresh fruits and vegetables are high in fiber and should be minimized during treatment. Whole and organic foods do not prevent diarrhea.

An 18-year-old female is diagnosed with possible toxic shock syndrome (TSS) and has these vital signs: T 103.2° F (39.6° C), P 124, R 36, BP 84/30. Which health care provider request does the nurse implement first?

A. Administer O2 at 6 L/min. Correct Correct: The highest priority action for clients with shock is to maintain adequate gas exchange, so administration of oxygen should be the nurse's first action. B. Give cefazolin (Ancef) 500 mg IV. Incorrect: Giving cefazolin (Ancef) 500 mg IV will need to be implemented rapidly for this client. She needs to be on an antibiotic to fight infection and sepsis. C. Infuse normal saline intravenously at 500 mL/hr. Incorrect: Infusing normal saline intravenously at 500 mL/hr will need to be implemented rapidly for this client. She needs to be hydrated and treated for shock. D. Obtain blood cultures ×2 sites. Incorrect: Obtain blood cultures will need to be implemented rapidly for this client-but her oxygenation is the priority.

The client who has undergone breast surgery is struggling with issues concerning her sexuality. What is the best way for the nurse to address the client's concerns?

A. Allow the client to bring up the topic first. Incorrect: The client may be embarrassed to discuss the topic of sexuality. The nurse must be sensitive to possible concerns and approach the subject first. B. Remind the client to avoid sexual intercourse for 2 months after the surgery. Incorrect: Sexual intercourse can be resumed after surgery whenever the client is comfortable. C. Suggest that the client wear a bra during intercourse. Correct Correct: Clients may prefer to lay a pillow over the surgical site or wear a bra or camisole to prevent contact with the surgical site during intercourse. D. Teach the client that birth control is a priority. Incorrect: Sexually active clients receiving chemotherapy or radiotherapy must use birth control because of the therapy's teratogenic effects, but this is not necessary for clients who have had surgery only.

A nurse is reviewing laboratory results on a 34-year-old client who is suspected of having endometrial (uterine) cancer. Which laboratory tests does the nurse expect to see? Select all that apply.

A. Alpha-fetoprotein (AFP) test Correct B. CA (cancer antigen)-125 test Correct C. Human chorionic gonadotropin (hCG) level Correct D. Liver function tests (LFTs) E. Serum electrolytes F. Testing for hereditary nonpolyposis colon cancer (HNPCC) Correct Correct Feedback: Correct: AFP may be elevated when the cancer has spread to the ovaries. It would be checked for this client. Correct: CA-125 test may be elevated when the cancer has spread to the ovaries. It would be checked for this client. Correct: hCG level should be checked to rule out pregnancy in a client of this age. This is a precaution before treatment is started. Correct: Testing for HNPCC is done if a family history is reported. A connection has been noted between HNPCC and endometrial cancer. Incorrect Feedback: Incorrect: LFTs are not routinely checked in the diagnostic process for endometrial cancer. This test might be given later. Incorrect: Electrolyte values are not routinely checked in the diagnostic process for endometrial cancer. This test might be given later.

A client with endometriosis asks a nurse where to find a support group. What resource does the nurse suggest?

A. American Cancer Society (ACS) Incorrect: The ACS offers information on local support groups for people and families dealing with cancer. B. American Endometrial Society (AES) Incorrect: The American Endometrial Society is not an existing organization. The association is the Endometriosis Association. C. Endometrial United Association (EUA) Incorrect: Endometrial United is not an existing organization. The association is the Endometriosis Association. D. RESOLVE Correct Correct: RESOLVE is an organization for infertile couples, many of whom have endometriosis.

A nurse is teaching a local young women's group about health promotion and maintenance measures for prevention of gynecologic cancers. Which preventive factors does the nurse stress? Select all that apply.

A. Annual endometrial biopsy B. Annual human papilloma virus (HPV) vaccination C. Annual Pap test and cervical examination Correct D. Safe sex Correct E. Well-balanced diet Correct Correct Feedback: Correct: Annual PAP tests are recommended starting 3 years after a woman becomes sexually active-or at the age of 21-whichever is sooner. Young women should have the test done annually. Correct: Using barrier protection, especially if a woman has multiple sexual partners, is recommended. Knowing the history of partners is also a factor in having safe sex. Correct: Eating a diet that includes a variety of healthy food choices (fruits, vegetables, low-fat protein, and healthy dairy) is known to help a woman have a healthy reproductive system. Incorrect Feedback: Incorrect: Endometrial biopsies are not routinely performed annually except when risk for the development of the disease is increased. Incorrect: HPV vaccination is given to young girls (and boys) in a series of three injections over a 6-month time frame. It is best administered before they become sexually active.

Which action can the same-day surgery charge nurse delegate to an experienced unlicensed assistive personnel (UAP) who is helping with the care of a client who is having a breast biopsy?

A. Assess anxiety level about the surgery. Incorrect: Nursing assessment is appropriate for nursing staff with broader education and a higher-level scope of practice. B. Monitor the vital signs after surgery. Correct Correct: Vital sign assessment is included in nursing assistant education and usually is part of the job description for UAP working in a hospital setting. C. Obtain data about breast cancer risk factors. Incorrect: Obtaining data is appropriate for nursing staff with broader education and a higher-level scope of practice. D. Teach about postoperative routine care. Incorrect: Client teaching is not within the scope of practice for UAP and should be done by licensed nursing staff.

A client who has just been discharged from the hospital after a modified radical mastectomy is referred to a home health agency. Which nursing action will be most appropriate to delegate to an experienced home health aide?

A. Assessing the safety of the home environment Incorrect: Assessment is not within the scope of practice of a home health aide and should be done by licensed nursing staff. B. Developing a plan to decrease lymphedema risk Incorrect: Developing a care plan is not within the scope of practice of a home health aide and should be done by licensed nursing staff. C. Monitoring pain level and analgesic effectiveness Incorrect: Monitoring pain level and analgesic effectiveness is not within the scope of practice of a home health aide and should be done by licensed nursing staff. D. Reinforcing the guidelines for hand and arm care Correct Correct: Reinforcement of previously taught information about hand and arm care should be done by all caregivers.

The large-breasted client reports discomfort, backaches, and fungal infections because of her excessive breast size. The nurse plans to provide information to the client about which breast treatment option?

A. Augmentation Incorrect: Breast augmentation surgery enhances the size, shape, or symmetry of breasts. B. Compression Incorrect: Breast compression is not a treatment. C. Reconstruction Incorrect: Breast reconstruction surgery is typically performed for women after a mastectomy. D. Reduction mammoplasty Correct Correct: Breast reduction mammoplasty surgery removes excess breast tissue and repositions the nipple and remaining skin flaps to produce the best cosmetic effect.

A nurse is teaching a health class to a group of clients likely to be at highest risk for gonorrhea. What is the age range of the clients? a) 60 to 70 years b) 15 to 24 years c) 25 to 29 years d) 30 to 45 years

B) 15 to 24 years Gonorrhea is the second most frequently reported communicable disease in the United States. Its highest incidence occurs in the 15- to 24-year-old age group.

A client is scheduled for a total hysterectomy with a laparoscopic vaginal approach after a diagnosis of microinvasive cervical cancer. What psychological and/or social changes does the nurse expect this client to experience?

A. Because the surgery does not affect a visible site, altered body image issues will be fewer in number. Incorrect: Altered body image issues must be expected with the client. For many women, hysterectomy can mean the loss of their femininity. B. Client will be actively involved in her own care in the immediate postoperative period. Incorrect: Hysterectomy is major surgery. The client will be convalescing for days to a week or longer. Active involvement in her self-care will be delayed until she has moved past the initial surgical procedure recovery period. C. Sexual counseling may be needed, especially if the client has doubts about her ability to feel like a woman and engage in sexual activities. Correct Correct: Sexual function may be (or feel) different after a hysterectomy. Couples may need counseling about intercourse or alternative sexual activities. The nurse assesses the need for sexual counseling by listening for cues about altered perceptions of body image and anxiety in either of the sexual partners' responses. D. The client should demonstrate reality testing and should experience a grief reaction immediately after her surgery. Incorrect: Reality testing is a later step in the grief and acceptance processes that women who have hysterectomies experience .

A client with a high genetic risk for breast cancer asks the nurse about options for prevention and early detection. Which option for prevention and early detection is the option of choice?

A. Breast self-examination (BSE) beginning at 20 years of age Incorrect: BSE is recommended for everyone, not just those at high genetic risk for breast cancer. B. Hormone replacement therapy combining estrogen and progesterone Incorrect: An increase in the risk for breast cancer has been shown in postmenopausal women receiving hormone replacement therapy (HRT) after 5 or more years of use. HRT that includes the combination of estrogen and progesterone carries the highest increased risk. C. Magnetic resonance imaging (MRI) and mammography every year beginning at age 30 Correct Correct: The American Cancer Society recommends that high-risk women (greater than 20% lifetime risk) have an MRI and mammography every year beginning at age 30. D. Prophylactic mastectomy Incorrect: Prophylactic (preventive) mastectomy (surgical breast removal) is an option for reducing the risk for breast cancer but is a highly controversial practice. Even though a woman may decide to have a prophylactic mastectomy, a small risk exists that breast cancer will develop in residual breast glandular tissue, because no mastectomy reliably removes all mammary tissue.

Situation: A client who is being treated for dysfunctional uterine bleeding (DUB) reports heavy vaginal bleeding, abdominal pain, and anemia. She is started on a gonadotropin-releasing hormone (GnRH) agonist, leuprolide (Lupron). What side effects may be of concern to this client? Select all that apply.

A. Breast swelling or tenderness Correct B. Decreased interest in sex Correct C. Hot flashes Correct D. Increased vaginal bleeding E. Increased appetite and weight gain F. Skin problems or acne Correct Correct Feedback: Correct: Breast swelling or tenderness is a mild side effect that need not be reported to the health care provider unless it becomes troublesome to the client. Correct: Decreased interest in sex is a mild side effect that need not be reported to the health care provider unless it becomes troublesome to the client. Correct: Hot flashes are mild side effects that need not be reported to the health care provider unless they become troublesome to the client. Correct: Skin problems and acne are mild side effects that need not be reported to the health care provider unless they become troublesome to the client. Incorrect Feedback: Incorrect: Increased vaginal bleeding is not a side effect of Lupron. Incorrect: Increased appetite and weight gain are not side effects of Lupron, rather a decrease in appetite is sometimes a problem.

Situation: A client who is being treated for endometriosis reports abdominal pain, dyspareunia, low back pain, and infertility. She had heard that various vitamins and minerals might relieve muscle cramping but cannot remember which ones. What vitamins and minerals that are known to help relieve muscle cramping does the nurse suggest?

A. Calcium and magnesium Correct Correct: Calcium and magnesium may relieve muscle cramping. B. Calcium and sodium Incorrect: Sodium causes clients to retain fluids and would not be advisable for women, especially during the years that they are menstruating. C. Magnesium and sodium Incorrect: Sodium causes clients to retain fluids and would not be advisable for women, especially during the years that they are menstruating. D. Potassium and magnesium Incorrect: Potassium is not known to help in the relief of endometriosis.

A client with newly diagnosed gynecologic cancer is being discharged home. Which health care team member does the nurse contact to coordinate nursing care at home for this client?

A. Case manager Correct Correct: If nursing care is needed at home, the hospital nurse or case manager makes referrals to a home health care agency. B. Health care provider Incorrect: The health care provider is not the correct team member to coordinate home care. C. Hospice Incorrect: Hospice care is provided for clients who are at the end of their lives. This type of care is not necessary (or indicated) for this client. D. Social services Incorrect: A referral to a social services agency is needed if the client is unable to meet the financial demands of treatment and long-term follow-up.

The laboratory reports that the cells from the patient's tumor biopsy are Grade II. What should the nurse know about this histologic grading? A. Cells are abnormal and moderately differentiated. B. Cells are very abnormal and poorly differentiated. C. Cells are immature, primitive, and undifferentiated. D. Cells differ slightly from normal cells and are well-differentiated

A. Cells are abnormal and moderately differentiated. Grade II cells are more abnormal than Grade I and moderately differentiated. Grade I cells differ slightly from normal cells and are well-differentiated. Grade III cells are very abnormal and poorly differentiated. Grade IV cells are immature, primitive, and undifferentiated; the cell origin is difficult to determine.

A client is being treated for gonorrhea. Which agent would the nurse expect the physician to prescribe? a) Tetracycline b) Ceftriaxone c) Penicillin d) Levofloxacin

B) Ceftriaxone The microorganism N. gonorrhoeae has become increasingly resistant to penicillin and tetracyclines, and fluoroquinolones (such as levofloxacin). Therefore, the current CDC (2006) recommendation for treating gonorrhea is a single intramuscular dose of a broad-spectrum cephalosporin such as ceftriaxone (Rocephin) or oral dosing with cefixime (Suprax).

The client has been diagnosed with breast cancer. Which treatment option chosen by the client requires the nurse to discuss with the client the necessity of considering additional therapy?

A. Chemotherapy Incorrect: Chemotherapy is usually used for stage II or higher breast cancer and may or may not be used as a single treatment option. B. Complementary and alternative therapy (CAM) Correct Correct: No proven benefit has been found with using complementary and alternative therapy alone as a cure for breast cancer. The nurse must ensure that the client's choices can be safely integrated with conventional treatment for breast cancer. C. Hormonal therapy Incorrect: The purpose of hormonal therapy is to reduce the estrogen available to breast tumors to stop or prevent their growth. It may or may not be used with other treatment options. D. Neoadjuvant therapy Incorrect: A large tumor is sometimes treated with chemotherapy, called neoadjuvant therapy, to shrink the tumor before it is surgically removed. An advantage of this therapy is that cancers can be removed by lumpectomy rather than mastectomy.

A client is being discharged after having an abdominal hysterectomy (TAH). What principle guides the nurse who is providing discharge planning and instructions for her?

A. Clients generally adapt better if they are still in their childbearing years. Incorrect: Generally, clients adjust better to the surgery if they have completed their childbearing years, among other factors. B. No special home equipment will be necessary for the client. Correct Correct: Usually, no special home equipment is needed for the client who has undergone a hysterectomy. C. Psychological reactions should be evident by the time of discharge. Incorrect: Psychological reactions can occur months to years after surgery, particularly if sexual functioning and libido are diminished. D. The client will be able to return to normal activities upon discharge. Incorrect: The client who has undergone an abdominal hysterectomy should be taught about the expected physical changes, including any activity restrictions. A 4- to 6-week convalescent period is usually required.

The nurse is instructing a client with breast cancer who will be undergoing chemotherapy about side effects of doxorubicin (Adriamycin). Which side effect will the nurse instruct the client to report to the physician?

A. Diaphoresis Incorrect: Diaphoresis (profuse sweating) is not an associated side effect of doxorubicin (Adriamycin). B. Dysphagia Incorrect: Dysphagia (difficulty swallowing) is not an associated side effect of doxorubicin (Adriamycin). C. Edema Correct Correct: Doxorubicin (Adriamycin) is an anthracycline, and clients must be instructed to be aware of and to report cardiotoxic effects, including edema, shortness of breath, chronic cough, and excessive fatigue. D. Hearing loss Incorrect: Hearing loss is not an associated side effect of doxorubicin (Adriamycin).

A nurse is teaching a client how to adapt to physical and psychological changes after surgery for ovarian cancer. What is included in the teaching plan? Select all that apply.

A. Encouraging the use of support groups and counseling Correct B. Encouraging the expression of grief and fears Correct C. Offering vaginal dilators D. Suggesting alternatives to vaginal intercourse Correct E. Suggesting the use of oil-based lubricants Correct Feedback: Correct: Support groups such as Gilda's Club are advisable for clients with ovarian cancer. Correct: The loss of reproductive organs involves a grief reaction. Ovarian cancer particularly carries the connotation of being serious and incurable in the view of many women. Correct: Because the client must refrain from having sexual intercourse for 6 weeks after surgery, it is appropriate to discuss alternatives. These could include expressing affection in other ways such as cuddling or being close with the woman's partner. Incorrect Feedback: Incorrect: Sexual intercourse should be avoided for 6 weeks after surgery. The use of a vaginal dilator is not indicated. Incorrect: After the woman becomes sexually active, she may have a problem with vaginal dryness as the result of hormonal changes. Water-based, rather than oil-based, lubricants should be suggested.

The client is receiving chemotherapy treatment for breast cancer and asks for additional support for managing the associated nausea and vomiting. Which complementary therapy will the nurse suggest?

A. Ginger Correct Correct: It has long been believed that ginger helps alleviate nausea and vomiting. Current studies are being done on the effect of ginger on chemotherapy-induced nausea. B. Journaling Incorrect: Journaling is good for reducing anxiety, stress, and fear. It is not used to manage nausea and vomiting. C. Meditation Incorrect: Meditation helps reduce stress, improve mood, improve quality of sleep, and reduce fatigue. It is not typically used to manage nausea and vomiting. D. Yoga Incorrect: Yoga has been shown to improve physical functioning, reduce fatigue, improve sleep, and improve one's overall quality of life. It is not typically used to manage nausea and vomiting.

A nurse is discussing transvaginal repair for pelvic organ prolapse (POP) using surgical vaginal mesh with a client who plans to have the procedure. What teaching does the nurse include? Select all that apply.

A. Incisional care instructions B. Manufacturer's labeling and information Correct C. Signs and symptoms of infection Correct D. Statements from women who have had successful outcomes E. When to contact the surgeon after the procedure Correct Correct Feedback: Correct: The manufacturer's labeling and information is included so that the client has an understanding of the product, its qualifications, and the recommendations from the US Food and Drug Administration. Correct: Although rare, infection is one of the possible complications. Women should know the signs and symptoms. Correct: Clients who have had this procedure need to know when to seek help from their gynecologist/surgeon. The nurse should include these criteria. Incorrect Feedback: Incorrect: No surgical incision is involved with the procedure. Incorrect: Statements (testimonials) from other women are not appropriate for client education.

What action does the RN delegate to unlicensed assistive personnel (UAP) working on the medical-surgical unit?

A. Inserting a catheter in a client who has a history of uterine prolapse Incorrect: Catheterizing a client who has a history of uterine prolapse is a complex action and should be done by licensed nurses. Some specially trained UAPs do catheterize clients, but a client with a uterine prolapse poses additional problems. B. Giving report to a receiving nurse about a client who is being transferred Incorrect: Giving report to a receiving nurse about a client who is being transferred is a more complex activity and should be done a licensed nurse. This interaction should be "nurse-to-nurse." C. Assisting with a sitz bath for a client with ulcerative vulvitis Correct Correct: Assisting with a sitz bath is within the UAP scope of practice and can safely be delegated. D. Providing discharge teaching for a client who is scheduled for brachytherapy Incorrect: Providing discharge teaching for a client who will be having brachytherapy (intracavitary radiation) is a complex nursing action and should be done by a licensed registered nurse.

The nurse is instructing a client on how to perform breast self-examination (BSE). Which techniques will the nurse include in teaching the client about BSE? Select all that apply.

A. Instruct the client to keep her arm by her side while performing the examination. B. Ensure that the setting in which BSE is demonstrated is private and comfortable. Correct C. Ask the client to remove her shirt. The bra may be left in place. D. Ask the client to demonstrate her own method of BSE. Correct E. Use the fingertips, which are more sensitive than the finger pads, to palpate the breasts. Correct Feedback: Correct: The setting should be private and comfortable to promote an environment conducive to learning and to prevent potential client embarrassment. Correct: Before teaching breast palpation, ask the client to demonstrate her own method, so that the nurse can assess the client's understanding of BSE. Incorrect Feedback: Incorrect: For better visualization, the arm should be placed over the head. Incorrect: The client should undress from the waist up. Incorrect: The finger pads, which are more sensitive than the fingertips, are used when palpating the breasts.

A nurse is teaching a group of clients with endometriosis about complementary and alternative therapies that may bring relief to them. What does the nurse suggest? Select all that apply.

A. Low-fiber diets B. Low-level heat applications Correct C. Massage Correct D. Protein supplements E. Relaxation techniques Correct F. Yoga Correct Correct Feedback: Correct: Low-level heat applications can provide temporary relief from the pain that frequently accompanies endometriosis. Correct: Massage may decrease tissue hypoxia and hypertonicity and relieve ischemia by increasing blood flow (oxygen) to affected areas. Correct: Relaxation techniques may decrease tissue hypoxia and hypertonicity and relieve ischemia by increasing blood flow (oxygen) to affected areas. Correct: Yoga may decrease tissue hypoxia and hypertonicity and relieve ischemia by increasing blood flow (oxygen) to affected areas. Incorrect Feedback: Incorrect: Dietary changes are not among the recommended therapies for endometriosis.

The patient and his family are upset that the patient is going through procedures to diagnose cancer. What nursing actions should the nurse use first to facilitate their coping with this situation (select all that apply)? A. Maintain hope. B. Exhibit a caring attitude. C. Plan realistic long-term goals. D. Give them antianxiety medications. E. Be available to listen to fears and concerns. F. Teach them about all the types of cancer that could be diagnosed.

A. Maintain hope. B. Exhibit a caring attitude. E. Be available to listen to fears and concerns. Maintaining hope, exhibiting a caring attitude, and being available to actively listen to fears and concerns would be the first nursing interventions to use as well as assessing factors affecting coping during the diagnostic period. Providing relief from distressing symptoms for the patient and teaching them about the diagnostic procedures would also be important. Realistic long-term goals and teaching about the type of cancer cannot be done until the cancer is diagnosed. Giving the family antianxiety medications would not be appropriate.

Which client history places a woman at highest risk for developing endometrial (uterine) cancer?

A. Multiparity, human papilloma virus (HPV), smoking, and African-American ethnicity Incorrect: Multiparity, HPV, smoking, and African-American ethnicity are all risk factors for cervical cancer. B. Nulliparity, endometriosis, diabetes mellitus, first pregnancy older than 20 years Incorrect: Nulliparity, endometriosis, diabetes mellitus, and first pregnancy older than 20 are all risk factors for ovarian cancer. C. Nulliparity, smoking, uterine polyps, hypertension Correct Correct: Nulliparity, smoking, uterine polyps, and hypertension are all risk factors for endometrial cancer. D. Oral contraceptive use, smoking, localized pain in the thigh Incorrect: Oral contraceptive use, smoking, and localized pain in the thigh are all risk factors for a thrombus.

The client who has recently had breast cancer surgery requests a volunteer to visit her home to help with recovery. Which community resource will the nurse recommend?

A. National Breast Cancer Coalition Incorrect: The National Breast Cancer Coalition is an organization dedicated to ending breast cancer through action and advocacy. It does not provide volunteers to visit the home. B. Reach for Recovery Correct Correct: The American Cancer Society's program "Reach for Recovery" provides volunteers who visit clients in the hospital or at home. They bring personal messages of hope, informational materials on breast cancer recovery, and a soft, temporary breast form. C. Susan G. Komen for the Cure Incorrect: Susan G. Komen for the Cure is an organization that supports breast cancer research. It does not provide volunteers to visit the home. D. Young Survival Coalition Incorrect: The Young Survival Coalition is an organization dedicated to educating the medical, research, breast cancer, and legislative communities about breast cancer, as well as serving as a point of contact for young women living with breast cancer. However, it does not provide volunteers to visit the home.

The nurse suspects that which client has the highest risk for breast cancer?

A. Older adult woman with high breast density Correct Correct: People at high increased risk for breast cancer include women aged 65 years and older with high breast density. B. Nullipara older adult woman Incorrect: Nullipara women are at low increased risk for breast cancer. C. Obese older adult male with gynecomastia Incorrect: Men are not at high increased risk for breast cancer. Obesity can cause gynecomastia. D. Middle-aged woman with high breast density Incorrect: Being middle-aged does not indicate a high increased risk for breast cancer.

Which client being cared for on the medical-surgical unit will be best to assign to a nurse who has floated from the intensive care unit (ICU)?

A. Recent radical mastectomy client who requires chemotherapy administration Incorrect: This client requires chemotherapy. It is more appropriate to assign her to nurses who are familiar with teaching, monitoring, and providing chemotherapy for clients with breast cancer. B. Modified radical mastectomy client who needs discharge teaching Incorrect: This client requires discharge teaching and is more appropriate to assign to nurses who are familiar with breast cancer. C. Stage III breast cancer client who is requesting information about radiation and chemotherapy Incorrect: This client requires information about radiation and chemotherapy and is more appropriate to assign to nurses who are familiar with breast cancer. D. A client with a Jackson-Pratt drain in place who has just arrived from the postanesthesia care unit (PACU) after a quadrantectomy Correct Correct: A nurse working in the ICU would be familiar with postoperative monitoring and care of clients with Jackson-Pratt drains.

A nurse is caring for a client diagnosed with a chlamydia infection. The nurse teaches the client about disease transmission and advises the client to inform his sexual partners of the infection. The client refuses, stating, "This is my business and I'm not telling anyone. Beside, chlamydia doesn't cause any harm like the other STDs." How should the nurse proceed? a) Do nothing because the client's sexual habits place him at risk for contracting other STDs. b) Educate the client about why it's important to inform sexual contacts so they can receive treatment. c) Inform the health department that this client contracted an STD. d) Inform the client's sexual contacts of their possible exposure to chlamydia.

B) Educate the client about why it's important to inform sexual contacts so they can receive treatment. The nurse should educate the client about the disease and how it impacts a person's health. Further education allows the client to make an informed decision about notifying sexual contacts. The nurse must maintain client confidentiality unless law mandates reporting the illness; contacting sexual contacts breaches client confidentiality. Doing nothing for the client is judgmental; everyone is entitled to health care regardless of his health habits.

A student nurse is caring for a male patient diagnosed with gonorrhea. The patient is receiving ceftriaxone and doxycycline. The nursing instructor asks the student why the patient is receiving two antibiotics. What is the student nurse's best response? a) "This combination of medications will eradicate the infection faster than a single antibiotic." b) "Many people infected with gonorrhea are infected with chlamydia as well." c) "The combination of these two antibiotics reduces the risk of reinfection." d) "There are many resistant strains of gonorrhea, so more than one antibiotic may be required for successful treatment."

B) Many people infected with gonorrhea are infected with chlamydia as well Treatment of gonorrhea includes the antibiotic ceftriaxone. Because many people with gonorrhea have a coexisting chlamydial infection, doxycycline or azithromycin is prescribed as well. There has been an increase in the number of resistant strains of gonorrhea, but that isn't the reason for this dual therapy. This combination of antibiotics doesn't reduce the risk of reinfection or provide a faster cure.

The nurse is teaching a wellness class to a group of women at their workplace. The nurse knows that which woman is at highest risk for developing cancer? A. A woman who obtains regular cancer screenings and consumes a high-fiber diet B. A woman who has a body mass index of 35 kg/m2 and smoked cigarettes for 20 years C. A woman who exercises five times every week and does not consume alcoholic beverages D. A woman who limits fat consumption and has regular mammography and Pap screenings

B. A woman who has a body mass index of 35 kg/m2 and smoked cigarettes for 20 years Cancer prevention and early detection are associated with the following behaviors: limited alcohol use; regular physical activity; maintaining a normal body weight; obtaining regular cancer screenings; avoiding cigarette smoking and other tobacco use; using sunscreen with SPF 15 or higher; and practicing healthy dietary habits (e.g., reduced fat and increased fruits and vegetables).

What can the nurse do to facilitate cancer prevention for the patient in the promotion stage of cancer development? A. Teach the patient to exercise daily. B. Teach the patient promoting factors to avoid. C. Tell the patient to have the cancer surgically removed now. D. Teach the patient which vitamins will improve the immune system. Incorrect

B. Teach the patient promoting factors to avoid. The promotion stage of cancer is characterized by the reversible proliferation of the altered cells. Changing the lifestyle to avoid promoting factors (dietary fat, obesity, cigarette smoking, and alcohol consumption) can reduce the chance of cancer development. Daily exercise and vitamins alone will not prevent cancer. Surgery at this stage may not be possible without a critical mass of cells, and this advice would not be the nurse's role.

The patient is receiving an IV vesicant chemotherapy drug. The nurse notices swelling and redness at the site. What should the nurse do first? A. Ask the patient if the site hurts. B. Turn off the chemotherapy infusion. C. Call the ordering health care provider. D. Administer sterile saline to the reddened area.

B. Turn off the chemotherapy infusion. Because extravasation of vesicants may cause severe local tissue breakdown and necrosis, with any sign of extravasation the infusion should first be stopped. Then the protocol for the drug-specific extravasation procedures should be followed to minimize further tissue damage. The site of extravasation usually hurts, but it may not. It is more important to stop the infusion immediately. The health care provider may be notified by another nurse while the patient's nurse starts the drug-specific extravasation procedures, which may or may not include sterile saline.

A client with pelvic pain is admitted to the same-day surgery unit for a laparoscopic procedure. Which nursing action(s) does the RN delegate to unlicensed assistive personnel (UAP)?

BBB. Educating the client about analgesic use for referred pain Incorrect: Client teaching is a higher-level skill and should be done by the RN. CCC. Inserting a retention catheter using sterile technique Incorrect: Catheter insertion is a higher-level skill and should be done by the RN-unless the UAP has had specialized training to perform this skill safely. DDD. Taking the client's admission blood pressure and heart rate Correct Correct: Although most of the admission assessment and history will be completed by the RN, the admission vital signs can be delegated to unlicensed nursing personnel. EEE. Teaching the client about postoperative activity restrictions Incorrect: Client teaching is a higher-level skill and should be done by the RN.

A nurse is educating a group of middle-aged women about their risk for developing breast cancer. What does the nurse include as a risk factor?

Becoming sexually active as a teenager Incorrect: Sexual activity at a young age is not associated with the development of breast cancer. It is associated with increased risk for cervical cancer. UU. Eating a diet that has a high amount of animal fat Incorrect: A diet that is high in animal fat is not associated with the development of breast cancer. VV. Not having experienced childbirth Correct Correct: Breast cancer is more common in women who have not experienced childbearing. WW. Sun exposure that is frequent and prolonged Incorrect: Sun exposure that is frequent and prolonged is not associated with the development of breast cancer. It may be linked to certain types of skin cancers.

A client with primary syphilis is allergic to penicillin. The nurse would expect the physician to order which agent? a) Podophyllum resin b) Tetracycline c) Ceftriaxone d) Acyclovir

C) Tetracycline Clients who are allergic to penicillin are given a 14-day regimen of tetracycline or doxycycline. Acyclovir is used to treat genital herpes. Ceftriaxone may be used for gonorrhea. Podophyllum resin is used to treat genital warts.

A female college student is distressed at the recent appearance of genital warts, an assessment finding that her care provider has confirmed as attributable to human papillomavirus (HPV) infection. Which of the following information should the nurse give the patient? a) "It's important to start treatment soon, so you will be prescribed pills today." b) "I'd like to give you an HPV vaccination if that's okay with you." c) "There is a chance that these will clear up on their own without any treatment." d) "Unfortunately, this is going to greatly increase your chance of developing pelvic inflammatory disease."

C) There is a chance that these will clear up on their own without any tx Genital warts may resolve spontaneously, although this does not preclude recurrence. Pharmacologic treatments are topical and vaccination is ineffective after infection has occurred. HPV infection is not correlated with pelvic inflammatory disease (PID).

The patient has osteosarcoma of the right leg. The unlicensed assistive personnel (UAP) reports that the patient's vital signs are normal, but the patient says he still has pain in his leg and it is getting worse. What assessment question should the nurse ask the patient to determine treatment measures for this patient's pain? A. "Where is the pain?" B. "Is the pain getting worse?" C. "What does the pain feel like?" D. "Do you use medications to relieve the pain?"

C. "What does the pain feel like?" The unlicensed assistive personnel (UAP) told the nurse the location of the patient's pain and the worsening of pain (pattern). Asking about the quality of the pain will help in planning further treatment. The nurse should already know if the patient is using medication to relieve the pain or can check the patient's medication administration record to see if analgesics have been administered. The intensity of pain using a pain scale should also be assessed.

The female patient is having whole brain radiation for brain metastasis. She is concerned about how she will look when she loses her hair. What is the best response by the nurse to this patient? A. "When your hair grows back it will be patchy." B. "Don't use your curling iron and that will slow down the loss." C. "You can get a wig now to match your hair so you will not look different." D. "You should contact "Look Good, Feel Better" to figure out what to do about this.

C. "You can get a wig now to match your hair so you will not look different." Hair loss with radiation is usually permanent. The best response by the nurse is to suggest getting a wig before she loses her hair so she will not look or feel so different. When hair grows back after chemotherapy, it is frequently a different color or texture. Avoiding use of electric hair dryers, curlers, and curling irons may slow the hair loss but will not answer the patient's concern. The American Cancer Society's "Look Good, Feel Better" program will be helpful, but this response is avoiding the patient's immediate concern.

The patient was told that he would have intraperitoneal chemotherapy. He asks the nurse when the IV will be started for the chemotherapy. What should the nurse teach the patient about this type of chemotherapy delivery? A. It is delivered via an Ommaya reservoir and extension catheter. B. It is instilled in the bladder via a urinary catheter and retained for 1 to 3 hours. C. A Silastic catheter will be percutaneously placed into the peritoneal cavity for chemotherapy administration. D. The arteries supplying the tumor are accessed with surgical placement of a catheter connected to an infusion pump.

C. A Silastic catheter will be percutaneously placed into the peritoneal cavity for chemotherapy administration. Intraperitoneal chemotherapy is delivered to the peritoneal cavity via a temporary percutaneously inserted Silastic catheter and drained from this catheter after the dwell time in the peritoneum. The Ommaya reservoir is used for intraventricular chemotherapy. Intravesical bladder chemotherapy is delivered via a urinary catheter. Intraarterial chemotherapy is delivered via a surgically placed catheter that delivers chemotherapy via an external or internal infusion pump.

The patient with breast cancer is having teletherapy radiation treatments after her surgery. What should the nurse teach the patient about the care of her skin? A. Use Dial soap to feel clean and fresh. B. Scented lotion can be used on the area. C. Avoid heat and cold to the treatment area. D. Wear the new bra to comfort and support the area.

C. Avoid heat and cold to the treatment area. Avoiding heat and cold in the treatment area will protect it. Only mild soap and unscented, nonmedicated lotions may be used to prevent skin damage. The patient will want to avoid wearing tight-fitting clothing such as a bra over the treatment field and will want to expose the area to air as often as possible.

The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that this patient is at risk for tumor lysis syndrome (TLS) and will monitor the patient closely for which abnormality associated with this oncologic emergency? A. Hypokalemia B. Hypouricemia C. Hypocalcemia D. Hypophosphatemia

C. Hypocalcemia TLS is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. This can rapidly lead to acute renal injury. The hallmark signs of TLS are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia.

A 33-year-old patient has recently been diagnosed with stage II cervical cancer. What should the nurse understand about the patient's cancer? A. It is in situ. B. It has metastasized. C. It has spread locally. D. It has spread extensively.

C. It has spread locally. Stage II cancer is associated with limited local spread. Stage 0 denotes cancer in situ; stage I denotes tumor limited to the tissue of origin with localized tumor growth. Stage III denotes extensive local and regional spread. Stage IV denotes metastasis.

The patient is told that the adenoma tumor is not encapsulated but has normally differentiated cells and that surgery will be needed. The patient asks the nurse what this means. What should the nurse tell the patient? A. It will recur. B. It has metastasized. C. It is probably benign. D. It is probably malignant.

C. It is probably benign. Benign tumors usually are encapsulated and have normally differentiated cells. They do not metastasize and rarely recur as malignant tumors do.

A 64-year-old male patient who is receiving radiation to the head and neck as treatment for an invasive malignant tumor complains of mouth sores and pain. Which intervention should the nurse add to this patient's plan of care? A. Weigh the patient every month to monitor for weight loss. B. Cleanse the mouth every 2 to 4 hours with hydrogen peroxide. C. Provide high-protein and high-calorie, soft foods every 2 hours. D. Apply palifermin (Kepivance) liberally to the affected oral mucosa.

C. Provide high-protein and high-calorie, soft foods every 2 hours. A patient with stomatitis should have soft, nonirritating foods offered frequently. The diet should be high in protein and high in calories. Saline or water should be used to cleanse the mouth (not hydrogen peroxide). Palifermin is administered intravenously as a growth factor to stimulate cells on the surface layer of the mouth to grow. Patients should be weighed at least twice each week to monitor for weight loss.

After teaching a group of students about sexually transmitted infections (STIs), the instructor determines that additional teaching is necessary when the students identify which STI as curable with treatment? a) Syphillis b) Gonorrhea c) Chlamydia d) Genital herpes

D) Genital herpes Besides AIDS, the five most common STIs are chlamydia, gonorrhea, syphilis, genital herpes, and genital warts. Of these, chlamydia, gonorrhea, and syphilis are easily cured with early and adequate treatment. Genital herpes recurs.

A nurse is teaching a client with genital herpes. Education for this client should include an explanation of: a) why the disease is transmittable only when visible lesions are present. b) the need for the use of petroleum products. c) the option of disregarding safer-sex practices now that he's already infected. d) the importance of informing his partners of the disease.

D) Importance of informing his partners of the disease. Clients with genital herpes should inform their partners of the disease to help prevent transmission. Petroleum products should be avoided because they can cause the virus to spread. The notion that genital herpes is only transmittable when visible lesions are present is false. Anyone not in a long-term, monogamous relationship, regardless of current health status, should follow safer-sex practices.

A 16-year-old patient comes to the free clinic and is diagnosed with primary syphilis. The patient states that she contracted this disease by holding hands with someone who has syphilis. What is the most appropriate nursing diagnosis for this patient? a) Alteration in comfort related to impaired skin integrity b) Fear related to complications c) Noncompliance with treatment regimen related to age d) Knowledge deficit related to modes of transmission

D) Knowledge deficit related to modes of transmission. Syphilis is spread mainly by sexual contact and may be congenital. The patient displays knowledge deficit about the modes of transmission for syphilis.

The nurse is caring for an 18-year-old female patient with acute lymphocytic leukemia who is scheduled to receive hematopoietic stem cell transplantation (HSCT). Which statement, if made by the patient, indicates a correct understanding of the procedure? A. "After the transplant I will feel better and can go home in 5 to 7 days." B. "I understand the transplant procedure has no dangerous side effects." C. "My brother will be a 100% match for the cells used during the transplant." D. "Before the transplant I will have chemotherapy and possibly full body radiation."

D. "Before the transplant I will have chemotherapy and possibly full body radiation." Hematopoietic stem cell transplantation (HSCT) requires eradication of diseased or cancer cells. This is accomplished by administering higher-than-usual dosages of chemotherapy with or without radiation therapy. A relative such as a brother would not be a perfect match with human leukocyte antigens; only identical twins are an exact match. HSCT is an intensive procedure with adverse effects and possible death. HSCT recipients can expect a 2- to 4-week hospitalization after the transplant.

Which item would be most beneficial when providing oral care to a patient with metastatic cancer who is at risk for oral tissue injury secondary to chemotherapy? A. Firm-bristle toothbrush B. Hydrogen peroxide rinse C. Alcohol-based mouthwash D. 1 tsp salt in 1 L water mouth rinse

D. 1 tsp salt in 1 L water mouth rinse A salt-water mouth rinse will not cause further irritation to oral tissue that is fragile because of mucositis, which is a side effect of chemotherapy. A soft-bristle toothbrush will be used. One teaspoon of sodium bicarbonate may be added to the salt-water solution to decrease odor, alleviate pain, and dissolve mucin. Hydrogen peroxide and alcohol-based mouthwash are not used because they would damage the oral tissue.

The patient is receiving biologic and targeted therapy for ovarian cancer. What medication should the nurse expect to administer before therapy to combat the most common side effects of these medications? A. Morphine sulfate B. Ibuprofen (Advil) C. Ondansetron (Zofran) D. Acetaminophen (Tylenol)

D. Acetaminophen (Tylenol) Acetaminophen is administered before therapy and every 4 hours to prevent or decrease the intensity of the severe flu-like symptoms, especially with interferon which is frequently used for ovarian cancer. Morphine sulfate and ibuprofen will not decrease flu-like symptoms. Ondansetron is an antiemetic, but not used first to combat flu-like symptoms of headache, fever, chills, myalgias, etc.

The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which strategy would be most appropriate for the nurse to use to increase the patient's nutritional intake? A. Increase intake of liquids at mealtime to stimulate the appetite. B. Serve three large meals per day plus snacks between each meal. C. Avoid the use of liquid protein supplements to encourage eating at mealtime. D. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods

D. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foodS The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (such as peanut butter, skim milk powder, cheese, honey, or brown sugar) to foods the patient will eat. Increasing fluid intake at mealtime fills the stomach with fluid and decreases the desire to eat. Small frequent meals are best tolerated. Supplements can be helpful.

When caring for the patient with cancer, what does the nurse understand as the response of the immune system to antigens of the malignant cells? A. Metastasis B. Tumor angiogenesis C. Immunologic escape D. Immunologic surveillance

D. Immunologic surveillance Immunologic surveillance is the process where lymphocytes check cell surface antigens and detect and destroy cells with abnormal or altered antigenic determinants to prevent these cells from developing into clinically detectable tumors. Metastasis is increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site in the progression stage of cancer development. Tumor angiogenesis is the process of blood vessels forming within the tumor itself. Immunologic escape is the cancer cells' evasion of immunologic surveillance that allows the cancer cells to reproduce.

Which nursing diagnosis is most appropriate for a patient experiencing myelosuppression secondary to chemotherapy for cancer treatment? A. Acute pain B. Hypothermia C. Powerlessness D. Risk for infection

D. Risk for infection Myelosuppression is accompanied by a high risk of infection and sepsis. Hypothermia, powerlessness, and acute pain are also possible nursing diagnoses for patients undergoing chemotherapy, but the threat of infection is paramount.

A 70-year-old man who has end-stage lung cancer is admitted to the hospital with confusion and oliguria for 2 days. Which finding would the nurse report immediately to the health care provider? A. Weight gain of 2 lb D. Urine specific gravity of 1.015 C. Blood urea nitrogen of 20 mg/dL D. Serum sodium level of 118 mEq/L

D. Serum sodium level of 118 mEq/L Lung cancer cells are able to manufacture and release antidiuretic hormone (ADH) with resultant water retention and hyponatremia. Hyponatremia (serum sodium levels less than 135 mEq/L) may lead to central nervous system symptoms such as confusion, seizures, coma, and death. A weight gain may be due to fluid retention. The urine specific gravity and blood urea nitrogen are normal.

The patient is being treated with brachytherapy for cervical cancer. What factors must the nurse be aware of to protect herself when caring for this patient? A. The medications the patient is taking B. The nutritional supplements that will help the patient C. How much time is needed to provide the patient's care D. The time the nurse spends at what distance from the patient

D. The time the nurse spends at what distance from the patient The principles of ALARA (as low as reasonably achievable) and time, distance, and shielding are essential to maintain the nurse's safety when the patient is a source of internal radiation. The patient's medications, nutritional supplements, and time needed to complete care will not protect the nurse caring for a patient with brachytherapy for cervical cancer.

A pregnant client asks a nurse to help her understand "decreased estriol levels." The nurse tells the client that they are frequently associated with which condition?

DD. An impending miscarriage Correct Correct: Decreased levels of estradiol, total estrogens, and estriol in women indicate possible amenorrhea, climacteric, impending miscarriage, or hypothalamic disorders. EE. Impending birth of multiples (twins, etc.) Incorrect: Decreased estriol levels in the pregnant client do not indicate impending birth. FF. Infertility problems Incorrect: Decreased estriol levels in the pregnant client do not indicate infertility. GG. Normal pregnancy Incorrect: Decreased estriol levels are not normal findings during pregnancy.

A nurse is obtaining a personal health history on a 24-year-old male whose male partner is present. How does the nurse approach questions about his sexual practices?

Defers questions about his sexual practices to the health care provider Incorrect: Deferring questions about sexual practices to the health care provider is missing potentially important data. The nurse needs to establish trust with the client and then proceed with data collection. MM. Directs questions about sexual and reproductive practices to both the client and his partner Incorrect: The nurse is collecting data on the client, not on the client's relationship with his partner or on the partner. This practice could make both of them very uncomfortable. NN. Respects the client's choice to answer or refuse to answer questions about sexual practices Correct Correct: Respecting the client's choice to answer or refuse to answer questions about sexual practices is an important part of the process of taking the sexual/reproductive history. The nurse must be sensitive to know when to ask and when to permit the client his or her privacy. OO. Skips the assessment questions about his sexual and reproductive practices Incorrect: Skipping the assessment questions about his sexual and reproductive practices is missing potentially important data. The nurse needs to establish trust with the client and then proceed with this data collection.

A client scheduled for a hysterosalpingogram is interviewed by a registered nurse (RN). What interview data are critical for the nurse to report to the health care provider before the procedure?

Develops a rash when she eats shellfish Correct Correct: The contrast medium used during hysterosalpingography is iodine based, so the client will need premedication with an antihistamine and/or corticosteroid before the procedure. OOO. Had an abortion 2 months ago Incorrect: Obstetric history is communicated to the provider but does not require any change in the procedure. This amount of time between the abortion and the procedure is adequate. PPP. Her menstrual period ended 3 days ago. Incorrect: Menstrual history is communicated to the provider but does not require any change in the procedure. This test is done just at the completion of menses so that it would not interrupt a pregnancy-should there be one in the uterus or the fallopian tube. QQQ. Used a rectal suppository 4 hours ago Incorrect: Recent medications are communicated to the provider but do not usually require any change in the procedure.

A middle-aged female client is scheduled for her first mammogram. What does the nurse tell the client before the test?

E. "A mammogram will x-ray the hard tissue of your breasts." Incorrect: Mammography is an x-ray of the soft tissue of the breast. F. "Do not eat anything for 12 hours before having your mammogram." Incorrect: Dietary restrictions are not necessary before a mammogram. G. "You should not wear deodorant the day of your mammogram." Correct Correct: Deodorant may not be worn before a mammogram because it can show up on the x-ray. H. "You will not feel any discomfort during your mammography procedure." Incorrect: The client may experience some temporary discomfort when the breast is compressed during positioning and the test.

A nurse is teaching a group of young adult women about the risks for developing cervical cancer. What cancer risk is included in the content of the presentation?

Eating a diet that is high in fat content Incorrect: Eating a diet that is high in fat content has not been identified as increasing the risk for cervical cancer. QQ. Having more than six pregnancies Incorrect: The number of pregnancies has not been identified as increasing a woman's risk for cervical cancer. RR. Starting to have sexual intercourse at a very early age Correct Correct: Having intercourse at a very early age and /or multiple sex partners places a woman at high risk for the development of cervical cancer. SS. Using a diaphragm with spermicidal jelly as a contraceptive device Incorrect: Using a diaphragm has not been identified as increasing the risk for cervical cancer.

An RN working at the college health clinic is caring for a sexually active 19-year-old female client who is having a routine checkup. What information is of greatest concern to the RN?

FFF. Client states, "My menstrual periods are irregular." Incorrect: Irregular periods may require further investigation but are not as large a concern as the possibility that the client may be in danger. GGG. Left breast is slightly smaller than the right breast. Incorrect: Disparity in the size of the client's breasts may require further investigation or may indicate a need for client teaching, but this is not as large a concern as the possibility that the client may be in danger. HHH. No history of rubella vaccination or infection is reported. Incorrect: The lack of history on rubella status may require further investigation or may indicate a need for client teaching, but this is not as large a concern as the possibility that the client may be in danger. III. Bruising is evident on the vulvar and inner thigh areas. Correct Correct: Vulvar and inner thigh bruising may indicate that the client is involved in an abusive relationship; this assessment information requires further follow-up by the nurse and health care provider.

A certified nurse-midwife (CNM) completes a cervical biopsy on a client and performs postprocedure teaching. What does the CNM tell the client?

HH. "Do not have intercourse for 24 hours after the procedure." Incorrect: The client should not have intercourse for about 2 weeks after the procedure. II. "Rest for at least 6 hours after the procedure." Incorrect: The client should rest for 24 hours after the procedure. JJ. "There is no limit on weight lifting; do what you normally do." Incorrect: The client should not lift heavy objects for about 2 weeks after the procedure. KK. "Use the antiseptic solution rinses to clean your perineum." Correct Correct: The client must keep the perineum clean and dry by using antiseptic solution rinses as directed by the health care provider, and should change pads frequently.

A 12-year-old girl says to the nurse, "I've had my first period, so can I have a baby now?" How does the nurse respond?

I. "A boy's sperm must unite with your egg to make a baby." Incorrect: This response addresses physiologic facts but does not relate to the psychological issues involved with pregnancy and parenthood. J. "Technically yes you can; but how can you take care of a baby?" Incorrect: This response projects the nurse's own values. It is accusative and could place the girl on the defensive. K. "Yes, you can." Incorrect: This response is too simple and uninformative. L. "You are physically able to, but let's discuss becoming a parent." Correct Correct: This response addresses the physiologic, psychological, and developmental facts related to the client's question.

An older adult woman tells a nurse about vaginal drying. What does the nurse suggest?

Q. "Be sure to tell your health care provider about this." Incorrect: Vaginal dryness is a normal indication of aging. There is no need to inform the health care provider. R. "I think that you should have additional pelvic examinations." Incorrect: More pelvic examinations are not indicated for this client. S. "Let me teach you how to do Kegel exercises." Incorrect: Kegel exercises are used for clients with incontinence. T. "Products such as water-soluble lubricants are helpful with this problem." Correct Correct: Information about vaginal estrogen therapy and water-soluble lubricants should be provided to the older woman with vaginal dryness.

A nurse is conducting a reproductive assessment of a young adult client. What assessment questions does the nurse ask? Select all that apply.

U. "Have you had any sexually transmitted diseases?" Correct V. "How would you describe yourself?" Correct W. "If you engage in sexual activities, do you practice 'safe' sex?" Correct X. "What changes would you like to see in your appearance?" Y. "When did you first start menstruating?" Correct Correct Feedback: Correct: This is a question included in the health perception/health management pattern for performing a reproductive assessment. If the answer is "yes," the nurse continues with "When?" and "What type?" Correct: This question is included in the self-perception/self-concept pattern. The nurse follows with "Do you feel good or not-so-good about yourself?" Correct: It is important to note, if the client is sexually active, that he or she practices (and understands) "safe" sexual practices. This might include the use of condoms, being tested for human immune deficiency virus (HIV), and other measures to keep from acquiring sexually transmitted infection. Correct: The age of onset of menses in women is important to note. Either early or late onset may indicate a problem or the increased likelihood for one to develop. Incorrect Feedback: Incorrect: Although a nurse might inquire whether a client has experienced changes in his or her body appearance or function, asking about changes the client might want to see is not important in doing a reproductive assessment.

A nurse is educating an 18-year-old girl about the Papanicolaou (Pap) test. Which client statement indicates that further teaching is needed?

Z. "I can have sexual intercourse the night before the test." Correct Correct: The woman should not have sexual intercourse for at least 24 hours before the test. AA. "It is recommended that women up to age 30 have an annual Pap test." Incorrect: Annual screening is recommended to 30 years of age with the conventional Pap test. After age 30 and three or more consecutive negative test results, Pap tests may be performed less frequently until 70 years of age. BB. "Pap smears help detect precancerous and cancerous cells." Incorrect: The Pap smear is a cytologic study that is effective in detecting precancerous and cancerous cells in the cervix. CC. "The specimen will be sent to a laboratory for evaluation." Incorrect: The specimen-containing slides from a Pap smear are sent to a laboratory for evaluation.