renal/repo nclex

11) During the vaginal examination of a 33-year-old patient, a nontender mass at the posterolateral portion of the labia majora is noted. What should the nurse suspect is occurring with the patient? 1. Rectocele 2. Fistula 3. Bartholin cyst 4. Cyst of Skene's gland

3. The Bartholin gland is located at the posterolateral labia majora. This gland provides lubrication to the female genitalia. A swelling in this area is consistent with the diagnosis of Bartholin's cyst.

16) The nurse provides aftercare teaching to a patient recovering from a colposcopy. Which patient statement indicates an understanding of the information? Select all that apply. 1. "I will need to avoid heavy lifting for the next 4 weeks." 2. "I should douche at the end of 1 week to remove vaginal discharge." 3. "I can take ibuprofen for pain if needed." 4. "I will have some light vaginal discharge." 5. "I will report a temperature elevation to the physician's office."

3. The colposcopy is a minor procedure to manage cervical dysplasia. The procedure is performed in the physician's office. The patient may experience some mild discomfort, for which an NSAID such as ibuprofen may be taken. 4. Vaginal discharge is anticipated after the procedure. Perineal pads should be used to manage the discharge.

22) A patient who has been experiencing premenstrual syndrome (PMS) reports to the clinic with a diet diary she has kept over the past several weeks. For which entry should the nurse recommend making a dietary change? 1. Daily intake of caffeine-free soda 2. Daily intake of low-fat yogurt 3. Daily intake of foods rich in magnesium 4. Daily intake of white bread

4. Simple carbohydrates should be reduced. White bread should be traded for whole-grain bread if possible.

13) The nipples of a 22-year-old female patient's breasts are pointing in different directions. What action should the nurse take? 1. The findings should be documented as normal. 2. The nurse will need to question the patient to determine if she is breastfeeding. 3. The finding will need to be reported for follow-up hormone level assessments. 4. The finding will need to be reported for further testing to rule out a malignancy.

4. The nipples should point in the same direction. Asymmetry in direction may indicate the presence of a malignancy.

34) A female patient is informed that she has the BRCA1 gene. On which health problems should the nurse focus when assessing this patient? Select all that apply. 1. Asthma 2. Fibromyalgia 3. Heart disease 4. Breast cancer 5. Ovarian cancer

4. There is a clear genetic link for some cases of both breast and ovarian cancer. One breast cancer susceptibility gene, BRCA1, increases a woman's risk for having breast cancer at some point in her life. 5. There is a clear genetic link for some cases of both breast and ovarian cancer. One breast cancer susceptibility gene, BRCA1, increases a woman's risk for having ovarian cancer at some

3) The nurse is performing an assessment of a female patient's breasts. Which finding indicates the need for further assessment? Select all that apply. 1. The breasts are not the same size. 2. The breasts do not display prominent veins. 3. The nipples are flat. 4. The breasts are reddened. 5. There is an area of dimpled skin.

Answer: 4, 5 4. Reddened skin of the breast indicates the possible presence of a malignancy. 5. Dimpling and abnormal contours should be further evaluated.

7) A male patient has a history of calcium calculi. Which medication should the nurse expect to be prescribed for this patient? 1. Metolazone (Zaroxolyn) 2. Penicillin (Pentids) 3. Allopurinol (Alloprim) 4. NSAIDs

Answer: 1 Explanation: 1. A thiazide diuretic, which is frequently prescribed for calcium calculi, acts to reduce urinary calcium excretion and is very effective in preventing further stones. Metolazone (Zaroxolyn) is a thiazide diuretic.

23) A 40-year-old male patient is unable to have an erection since being prescribed an antispasmodic for a muscular back injury and hydrocortisone cream to manage a chronic integumentary condition. What should the nurse suspect this patient is experiencing? 1. Side effect of the antispasmodic medication 2. Age-related erectile dysfunction 3. Side effect of the hydrocortisone cream 4. Result of the muscular back injury

Answer: 1 Explanation: 1. Antispasmodic medication may cause problems with sexual function.

34) A female patient is complaining of a "watery" vaginal discharge with a "really strong fishy" odor. Which health problem should the nurse suspect this patient is experiencing? 1. Bacterial vaginosis 2. Yeast infection 3. Trichomoniasis infection 4. Genital warts

Answer: 1 Explanation: 1. Bacterial vaginosis is the most common cause of vaginal infection in women of reproductive age. The primary manifestation is a vaginal discharge that is thin and grayish-white, and has a foul, fishy odor. 2. Yeast infections present with a thick, cheesy discharge. 3. Trichomoniasis presents with a frothy, yellow discharge with a strong odor. 4. Genital warts are growths.

31) A patient is experiencing postoperative urinary retention. Which medication should the nurse expect to be prescribed for this patient? 1. Bethanechol chloride (Urecholine) 2. Tolterodine (Detrol) 3. Propantheline bromide (Pro-Banthine) 4. Nitrofurantoin (Macrobid)

Answer: 1 Explanation: 1. Bethanechol chloride (Urecholine) increases detrusor muscle tone, producing a contraction strong enough to initiate micturition. It is primarily used to treat postoperative and postpartum urinary retention.

16) A patient is diagnosed with benign prostatic hyperplasia. For which reason should this patient's blood pressure be closely monitored? 1. Whether the patient can tolerate doxazosin (Cardura) 2. Whether surgery is indicated 3. The volume of urine being retained in the bladder 4. The dose of finasteride (Proscar)

Answer: 1 Explanation: 1. Excessive smooth muscle contraction in benign prostatic hyperplasia (BPH) may be blocked with the alpha-adrenergic antagonists such as doxazosin (Cardura). This medication relieves obstruction and increases the flow of urine. It may cause orthostatic hypotension. 2. The use of surgical intervention to manage BPH is not determined by monitoring blood pressure alone. 3. The volume of urinary residual does not have bearing in this question. 4. Finasteride (Proscar) does not impact blood pressure.

18) A patient who is recovering from spinal surgery had "an accident" while attempting to reach the bathroom to void. Which type of incontinence did this patient probably experience? 1. Functional 2. Urge 3. Stress 4. Total

Answer: 1 Explanation: 1. Functional incontinence results from physical, environmental, or psychosocial causes. Impaired mobility is one such cause.

30) A patient is diagnosed with struvite kidney stones. What interventions should the nurse anticipate being prescribed for this patient? 1. Surgical intervention and antibiotic therapy 2. Limiting foods high in calcium and taking thiazide diuretics 3. Sodium-restricted diet and taking penicillamine 4. Low-purine diet and taking potassium citrate

Answer: 1 Explanation: 1. Management of the patient with struvite kidney stones includes surgical intervention or lithotripsy to remove the stone and antibiotic therapy for urinary tract infections (UTIs).

10) A patient who is being treated for epididymitis stops taking his antibiotics. Which health problem is this patient at risk for developing? 1. Orchitis 2. Priapism 3. Hydrocele 4. Spermatocele

Answer: 1 Explanation: 1. Orchitis is an acute inflammation or infection of the testes. It most commonly occurs as a complication of a systemic illness or as an extension of a genitourinary infection, such as epididymitis.

26) The nurse is placing an indwelling urinary catheter in an uncircumcised male patient. For which reason should the nurse replace the foreskin after insertion? 1. Paraphimosis may occur as a result of long-term retraction of the foreskin causing ischemia of the glans. 2. Phimosis may occur due to chronic infections and adhesions under the foreskin which results in constriction of the foreskin. 3. Priapism may occur as a result of impaired blood flow in the penis. 4. Replacement of the foreskin prevents malignant changes of the penis.

Answer: 1 Explanation: 1. Paraphimosis may occur as a result of long-term retraction of the foreskin, which can result in ischemia of the glans.

28) The patient undergoing brachytherapy for prostate cancer is being given instructions for home care. Which patient statement indicates a need for clarification? 1. "It will be nice to sleep in the same bed as my partner." 2. "Guess I'll have to go buy a box of condoms." 3. "I'll be disappointed about not seeing my grandkids." 4. "I'll make an appointment for my next PSA examination."

Answer: 1 Explanation: 1. Patients receiving brachytherapy should be instructed to sleep alone.

40) A patient is concerned because the urine has changed to red-brown in color since starting a new medication. Which medication should the nurse suspect is causing this patient's change in urine color? 1. Phenytoin (Dilantin) 2. Amitriptyline (Elavil) 3. Injectable iron 4. Phenazopyridine (Pyridium)

Answer: 1 Explanation: 1. Red-brown urine can occur when taking phenytoin (Dilantin). 2. Amitriptyline (Elavil) can cause the urine to turn green or blue. 3. Injectable iron can cause the urine to turn brown or black. 4. Phenazopyridine (Pyridium) can cause the urine to turn orange.

6) A patient who is diagnosed with renal cancer states, "I only lost a few pounds! I had no other symptoms!" What should the nurse realize as being the only consistent symptom of renal cancer? 1. Hematuria 2. Flank pain 3. Nausea 4. Vomiting

Answer: 1 Explanation: 1. Renal tumors are often silent and have few manifestations. The classic triad of symptoms, which is gross hematuria, flank pain, and palpable abdominal mass, is seen in only about 10% of people with renal cell carcinoma. Hematuria, often microscopic, is the most consistent symptom. 2. The classic triad of symptoms, which is gross hematuria, flank pain, and palpable abdominal mass, is seen in only about 10% of people with renal cell carcinoma.

23) A patient who has prescriptions for renal tests plans to have an intravenous pyelogram before a barium enema. Which response should the nurse make to the patient? 1. "Please make your appointments as you have indicated." 2. "Please clarify with your primary healthcare provider which should be completed first." 3. "Please reverse the order of your planned appointments." 4. "The order of the tests is irrelevant. You may change the order to meet your needs."

Answer: 1 Explanation: 1. Schedule an IVP prior to any ordered barium test or gallbladder studies using contrast material, as residual contrast material from the barium enema or gallbladder studies may interfere with the IVP results.

14) While being catheterized for urinary retention, a patient becomes diaphoretic and pale. What should the nurse do to help this patient? 1. The nurse should clamp the catheter after draining 500 mL of urine. 2. No action is needed, as this situation is transient. 3. The nurse should remove the urinary catheter. 4. The nurse should provide the patient with fluids.

Answer: 1 Explanation: 1. Some patients may experience a vasovagal response and become pale, sweaty, and hypotensive if the bladder is rapidly drained. The nurse should be aware that it is a possible response in some patients and be able to recognize and respond to it. Draining 500 mL increments and clamping the catheter for 5 to 10 minutes between increments may prevent this response.

15) An older patient with diabetes is diagnosed with a flaccid bladder. What should be included in the care of this patient? 1. Instruction on the Credé method of bladder emptying 2. The importance of maintaining alkaline urine 3. Instruction on the use of anticholinergic medications 4. Reminder to restrict fluids

Answer: 1 Explanation: 1. The Credé method (applying pressure to the suprapubic region with the fingers of one or both hands), manual pressure on the abdomen, and the Valsalva maneuver (bearing down while holding one's breath) promote bladder emptying for the patient with a spastic or flaccid bladder.

21) The nurse is evaluating the effectiveness of dietary teaching provided to a patient with chronic kidney disease. Which menu choices indicate that the patient understands the dietary regimen? 1. Apple and oatmeal for breakfast; peanut butter sandwich for lunch; pasta with fish for dinner 2. Bacon and eggs for breakfast; hot dog with sauerkraut for lunch; baked canned ham with green peas for dinner 3. Two bananas for breakfast; rice and beans for lunch; fruit salad, green beans, and an 8-ounce steak for dinner 4. Half a cantaloupe and three eggs for breakfast; a baked potato with processed cheese spread and broccoli for lunch; chicken, pinto beans, squash, and pecan pie for dinner

Answer: 1 Explanation: 1. The patient with chronic kidney disease needs to adhere to a low-protein, sodium- and potassium-restricted diet. These menu choices adhere to the dietary regimen. 2. Processed foods (canned ham, sauerkraut, cheese spread) contain high levels of sodium, which is restricted. 3. These menu choices include excessive amounts of potassium (bananas) and protein, which are restricted. 4. These menu choices include processed foods (canned ham, sauerkraut, cheese spread) that contain high levels of sodium, which is restricted.

27) The nurse is instructing a patient with uric acid stones on methods to prevent lithiasis. Which patient statement indicates that teaching has been effective? 1. "I should avoid organ meats and sardines in my diet." 2. "I will increase purine-rich foods in my diet." 3. "I know to avoid eating vitamin D-enriched foods." 4. "I will have to make my urine more acidic by eating cheese, cranberries, grapes, and tomatoes."

Answer: 1 Explanation: 1. The patient with uric acid stones requires a diet low in purines, which are found in organ meats and sardines.

17) A patient is planning to have surgery for the treatment of benign prostatic hyperplasia. Which procedure should the nurse explain has the fewest postoperative complications? 1. Transurethral needle ablation (TUNA) 2. Transurethral incision of the prostate (TURP) 3. Perineal prostatectomy 4. Suprapubic prostatectomy

Answer: 1 Explanation: 1. The transurethral needle ablation (TUNA) system uses low-level radiofrequency through twin needles to burn away a region of the enlarged prostate. Shields protect the urethra. TUNA improves the flow of urine through the urethra and does not cause impotence or incontinence. 2. Transurethral incision of the prostate (TURP) involves the insertion of a surgical instrument and optical device into the urethra to the prostate. Erectile dysfunction is not a common occurrence with this procedure; however, there may be retrograde ejaculation.

5) A patient is recovering from a penile implant procedure. What should be included in the care of and teaching about the implant? Select all that apply. 1. Encourage the patient to practice inflating and deflating the device during the recovery period. 2. Suggest wearing snug-fitting underwear and loose-fitting trousers to conceal the semi-erection. 3. Encourage the patient to resume sexual activity within three weeks. 4. Remind the patient to not inflate or deflate the device for at least four weeks. 5. Suggest wearing loose-fitting underwear and trousers.

Answer: 1, 2 Explanation: 1. For a penile implant, teach the patient and his partner how to use the pump, including how to inflate and deflate the device. Suggest that he practice inflation and deflation during the postoperative period. 2. Suggest wearing snug-fitting underwear with the penis placed in an upright position on the abdomen and loose trousers.

28) A patient recovering from a total nephrectomy is being discharged. What should the nurse instruct the patient about care at home? Select all that apply. 1. Avoid contact sports and falls. 2. Older males should schedule routine screening examinations for prostatic hypertrophy. 3. Monitor weight. 4. Monitor for signs of rejection. 5. Maintain prescribed fluid restrictions

Answer: 1, 2 Explanation: 1. Home care teaching focuses on protecting the remaining kidney by avoiding contact sports and using measures to prevent motor vehicle accidents and falls that could damage it. 2. Older male patients should know manifestations of prostatic hypertrophy and schedule routine screening examinations.

21) A patient is being instructed on how to perform Kegel exercises. What should be included in these instructions? Select all that apply. 1. While voiding, stop the flow of urine and hold for a few minutes. 2. Tighten the muscles around the anus to resist defecation. 3. Take a deep breath and hold while performing the exercise. 4. Perform these exercises at least once per day. 5. Perform these exercises for at least several months.

Answer: 1, 2 Explanation: 1. The patient begins Kegel exercises by identifying the pelvic muscles by stopping the flow of urine during voiding and holding for a few seconds. 2. The patient begins Kegel exercises by identifying the pelvic muscles by tightening the muscles around the anus as though resisting defecation.

18) A patient is scheduled for a cystogram. What information in the patient's history should the nurse bring to the healthcare provider's attention as potentially causing a problem with the patient? Select all that apply. 1. Cystitis 2. Prostatitis 3. Hypersensitivity to anesthetics 4. Right-sided hemiplegia 5. Chronic pain

Answer: 1, 2, 3 Explanation: 1. A history of cystitis could result in sepsis after the procedure. 2. A history of prostatitis could result in sepsis after the procedure. 3. A history of hypersensitivity to anesthetics could result in problems after the procedure.

30) The nurse is caring for a patient who had a prostatectomy and is now having bladder spasms. What action should the nurse take? Select all that apply. 1. Administer belladonna and opium (B&O) suppositories as prescribed. 2. Check to see if the urinary catheter is draining. 3. Ask the patient if he feels the need to have a bowel movement. 4. Increase the rate of flow of urinary catheter irrigation solution. 5. Assess the patient's temperature.

Answer: 1, 2, 3 Explanation: 1. Bladder spasms are one of the three types of pain following prostatectomy, and belladonna and opium (B&O) suppositories may be used to relieve bladder spasms. 2. The presence of a urinary catheter will stimulate the urge to void and bladder spasms. If the catheter becomes kinked and urine fills the bladder, the patient may feel the urge to void and strain, which induces spasms. 3. Straining to have a bowel movement may stimulate bladder spasms.

24) A patient recovering from prostate surgery is being discharged. What should the nurse include in this patient's instructions? Select all that apply. 1. Do not drive for two weeks. 2. Sexual intercourse should not occur for six weeks. 3. Call the physician if the scrotum becomes swollen and tender. 4. Take aspirin or NSAIDs for discomfort. 5. You may return to work in two weeks.

Answer: 1, 2, 3 Explanation: 1. Discharge teaching following prostate surgery should include instructions to avoid driving for two weeks, except for short rides. 2. Discharge teaching following prostate surgery should include instructions to avoid sexual intercourse for six weeks to avoid bleeding. 3. Discharge teaching following prostate surgery should include instructions to call the physician if the scrotum becomes swollen and tender.

9) A 40-year-old male is diagnosed with epididymitis. What should the nurse consider as being a potential cause of this disorder? Select all that apply. 1. Urinary tract infection 2. Prostatitis 3. Unprotected anal intercourse 4. Gonorrhea 5. Undiagnosed congenital disorder

Answer: 1, 2, 3 Explanation: 1. In men older than 35, epididymitis is associated with a urinary tract infection. 2. In men older than 35, epididymitis is associated with prostatitis. 3. Men who practice unprotected anal intercourse may acquire sexually transmitted epididymitis.

42) While conducting a physical assessment, the nurse suspects that a male patient has a urinary tract or sexually transmitted infection. What did the nurse assess to make this clinical decision? Select all that apply. 1. Redness of the urinary meatus 2. Swelling from the urinary meatus 3. Discharge from the urinary meatus 4. Urinary meatus on the dorsal surface 5. Urinary meatus on the ventral surface

Answer: 1, 2, 3 Explanation: 1. Increased redness of the urinary meatus may indicate UTI or sexually transmitted infection. 2. Swelling of the urinary meatus may indicate UTI or sexually transmitted infection. 3. Discharge from the urinary meatus may indicate UTI or sexually transmitted infection.

14) A patient with chronic kidney disease is trying to decide between hemodialysis and peritoneal dialysis. What should the nurse encourage the patient to consider as advantages of peritoneal dialysis? Select all that apply. 1. Minimal vascular complications 2. Liberal intake of fluids 3. Better self-management 4. Better metabolite elimination 5. Lower risk of infection

Answer: 1, 2, 3 Explanation: 1. Peritoneal dialysis has several advantages over hemodialysis. Heparinization and vascular complications associated with an arteriovenous (AV) fistula are avoided. 2. More liberal intake of fluid and nutrients is often allowed for the patient on continuous ambulatory peritoneal dialysis (CAPD). 3. The patient on peritoneal dialysis is better able to self-manage the treatment regimen, which reduces feelings of helplessness. 4. The major disadvantages of peritoneal dialysis include less effective metabolite elimination. 5. The major disadvantages of peritoneal dialysis include risk for infection (peritonitis).

30) A patient is in the recovery phase of acute tubular necrosis (ATN). What manifestation should the nurse observe that indicates this phase is progressing as expected? Select all that apply. 1. Elevated serum potassium level 2. Urine output excessive for intake 3. Elevated blood urea nitrogen level 4. Decrease in serum phosphate level 5. Urine output low in relation to intake

Answer: 1, 2, 3 Explanation: 1. The recovery phase of ATN is characterized by a process of tubule cell repair and regeneration and gradual return of the GFR to normal. Serum potassium levels remain high and may continue to rise in spite of increasing urine output. 2. The recovery phase of ATN is characterized by a process of tubule cell repair and regeneration and gradual return of the GFR to normal. Diuresis may occur as the nephrons and GFR recover. 3. The recovery phase of ATN is characterized by a process of tubule cell repair and regeneration and gradual return of the GFR to normal. BUN levels remain high and may continue to rise in spite of increasing urine output.

15) The nurse is reviewing the serum creatinine laboratory results for a group of patients. Which patient should the nurse identify as being at risk for having falsely altered serum creatinine levels? Select all that apply. 1. Patient with rhinovirus taking 10,000 mg of vitamin C daily 2. Patient with Parkinson disease and a prescription for methyldopa 3. Patient with bipolar disorder and a prescription for lithium carbonate 4. Patient with acne vulgaris and a prescription for tetracycline 5. Patient with insomnia taking over-the-counter melatonin

Answer: 1, 2, 3 Explanation: 1. Vitamin C (ascorbic acid) can affect the serum creatinine level. 2. Methyldopa can affect the serum creatinine level. 3. Lithium carbonate can affect the serum creatinine level.

27) The nurse is concerned that a patient is at risk for developing cancer of the penis. What did the nurse assess to make this clinical determination? Select all that apply. 1. Phimosis 2. Human papilloma virus (HPV) 3. HIV infection 4. Excessive ultraviolet light exposure 5. Being Jewish or Muslim

Answer: 1, 2, 3, 4 Explanation: 1. Cancer of the penis is rare in North America, but risk factors include the presence of phimosis. 2. Cancer of the penis is rare in North America, but risk factors include the presence of HPV. 3. Cancer of the penis is rare in North America, but risk factors include HIV. 4. Cancer of the penis is rare in North America, but risk factors include ultraviolet light exposure, such as used to treat psoriasis.

35) A patient with repeated bouts of epididymitis is adamant that prescribed medication is always taken. What additional question should the nurse ask to determine possible causes of epididymitis? Select all that apply. 1. "Are you sexually active?" 2. "Do you use condoms?" 3. "Do you practice unprotected anal intercourse?" 4. "Do you do any heavy lifting?" 5. "Do you use any drugs or alcohol?"

Answer: 1, 2, 3, 4 Explanation: 1. Epididymitis is more often seen in sexually active men who are less than 35 years of age. 2. Sexually transmitted urethritis is usually the precipitating factor for epididymitis in younger men. 3. Unprotected anal intercourse is a cause of epididymitis. 4. Chemical epididymitis may be the problem due to reflux of urine into the ejaculatory ducts with increased abdominal pressure from excessive heavy lifting.

38) A patient with osteoarthritis is postmenopausal and is upset because intercourse is uncomfortable. What should the nurse suggest to this patient? Select all that apply. 1. Use a water-soluble vaginal lubricant. 2. Consider estrogen replacement therapy. 3. Engage in intercourse on a regular basis. 4. Adapt the position for intercourse to reduce pain. 5. Accept that sexual intercourse will need to reduced.

Answer: 1, 2, 3, 4 Explanation: 1. For problems related to vaginal dryness and dyspareunia, water-soluble vaginal lubricants should be recommended. 2. Estrogen replacement therapy can be suggested for vaginal dryness and dyspareunia. 3. Intercourse on a regular basis can be suggested for vaginal dryness and dyspareunia. 4. Women who experience joint pain or other musculoskeletal pain due to conditions such as arthritis can benefit from instruction on how to adapt positions for intercourse.

36) A patient is diagnosed with priapism. What should the nurse include in the plan of care for this patient? Select all that apply. 1. Assess the penis to include color changes and degree of erection. 2. Palpate the penis for firmness and rigidity. 3. Administer analgesics as prescribed for pain. 4. Administer iced saline enemas as prescribed. 5. Push oral fluids.

Answer: 1, 2, 3, 4 Explanation: 1. Priapism is an involuntary, sustained, painful erection that is not associated with sexual arousal. Impaired blood flow results in ischemia. The nurse will assess the penis for color changes and degree of erection. 2. The nurse will palpate for firmness and rigidity. 3. Analgesics are given for pain control. 4. Iced saline enemas induce anesthesia. 5. Intake and output should be monitored as acute urinary retention can occur. Excessive oral intake would be inappropriate.

45) A male patient is admitted for renal colic. When conducting this patient's physical assessment, on which area should the nurse focus to determine the type and amount of pain? Select all that apply. 1. Flank 2. Testes 3. Urethra 4. Bladder 5. Umbilicus

Answer: 1, 2, 3, 4 Explanation: 1. Renal colic is pain associated with renal calculi moving through the ureter. This pain is severe, sharp, stabbing, and excruciating and is often felt in the flank. 2. Renal colic is pain associated with renal calculi moving through the ureter. This pain is severe, sharp, stabbing, and excruciating and is often felt in the testes. 3. Renal colic is pain associated with renal calculi moving through the ureter. This pain is severe, sharp, stabbing, and excruciating and is often felt in the urethra. 4. Renal colic is pain associated with renal calculi moving through the ureter. This pain is severe, sharp, stabbing, and excruciating and is often felt in the bladder.

36) The nurse instructs a patient with spastic bladder about the prescribed medication tolterodine (Detrol). What patient statements indicate that teaching has been effective? Select all that apply. 1. "I can take this with or without food." 2. "This medication might make me drowsy." 3. "I should call my doctor if I have problems breathing." 4. "I should be careful driving while taking this medication." 5. "I can drink wine with dinner while taking this medication."

Answer: 1, 2, 3, 4 Explanation: 1. This medication can be taken irrespective of food intake. 2. This medication may cause drowsiness. 3. The patient should report any difficulty breathing. 4. The patient should use caution when driving while taking this medication.

29) Long-term hormone replacement therapy (HRT) is being discussed with a patient who is scheduled for a total hysterectomy. For which health problem will this patient be at risk for developing? Select all that apply. 1. Breast cancer 2. Stroke 3. Venous thrombosis 4. Colon cancer 5. Heart attack

Answer: 1, 2, 3, 5 Explanation: 1. Long-term hormone replacement therapy increases the risk for breast cancer. 2. Long-term hormone replacement therapy increases the risk for stroke. 3. Long-term hormone replacement therapy increases the risk for venous thrombosis. 4. This therapy does not increase the risk for colon cancer. 5. Long-term hormone replacement therapy increases the risk for heart attack.

38) A male patient is concerned about the inability to ejaculate during sexual intercourse. What information in the patient's medical record should the nurse use to help determine the cause for the patient's health problem? Select all that apply. 1. Medication for hypertension 2. Medication for anxiety 3. Treatment for bipolar disorder 4. Topical steroid for psoriasis 5. Narcotic for chronic back pain

Answer: 1, 2, 3, 5 Explanation: 1. The inability to ejaculate may be caused by certain medications such as antihypertensives. 2. The inability to ejaculate may be caused by certain medications such as anxiolytics. 3. The inability to ejaculate may be caused by certain medications such as antidepressants. 4. Topical steroids are not identified as affecting ejaculation. 5. The inability to ejaculate may be caused by certain medications, such as narcotics.

30) A patient asks about alternative and complementary therapies that might be used in place of hormone replacement therapy after menopause. Which herbal supplement should the nurse review with the patient? Select all that apply. 1. Black cohosh 2. Ginseng 3. Ginger 4. Flaxseed 5. St. John's wort

Answer: 1, 2, 4 Explanation: 1. Black cohosh has been used as an alternative therapy by menopausal women. 2. Ginseng has been used as an alternative therapy by menopausal women. 3. Ginger is used to treat nausea and vomiting, particularly after chemotherapy. 4. Flaxseed has been used as an alternative therapy by menopausal women. 5. St. John's wort is used to treat depression.

A patient is discharged after transurethral resection of a superficial bladder tumor. What should the nurse include in this patient's discharge instructions? Select all that apply. 1. Avoid constipation and continue to use stool softener. 2. Increase fluid intake. 3. Maintain bed rest. 4. Call the physician if painless hematuria develops. 5. Make a follow-up appointment in 1 year.

Answer: 1, 2, 4 Explanation: 1. The patient should be instructed to avoid straining with stool and take a stool softener. 2. The patient should be instructed to increase fluids to 2500-3000 mL/day. 4. The patient should be instructed to monitor for excessive bleeding.

12) A female patient is experiencing a recurrence of endometrial cancer. Which treatment should the nurse expect to be prescribed for this patient? Select all that apply. 1. Radiation therapy 2. Hormone therapy 3. Partial abdominal hysterectomy 4. Chemotherapy 5. Endometrial ablation

Answer: 1, 2, 4 Explanation: 1. Treatment with external and internal radiation may be performed as adjuvant treatment in advanced cases. 2. Hormone therapy may include progestins, antiestrogrens, gonadotropin-releasing hormone agonists, or aromatase inhibitors. 4. A combination of drugs may be used to treat endometrial cancer, including doxorubicin (Adriamycin), cisplatin, carboplatin, and paclitaxel (Taxol).

40) A patient is prescribed pain medication to assist in the treatment of bacterial prostatitis. What additional nonpharmacological intervention should the nurse suggest to the patient to help control the pain of this health problem? Select all that apply. 1. Warm bath 2. Avoiding sitting 3. Taking a walk 4. Stress-reduction activities 5. Applying ice to the rectal area

Answer: 1, 2, 4 Explanation: 1. When pain is most severe with bacterial prostatitis, warm baths have been reported to assist in pain reduction. 2. When pain is most severe with bacterial prostatitis, avoidance of sitting has been reported to assist in pain reduction. 3. Walking is not identified as a way to reduce the pain associated with bacterial prostatitis. 4. When pain is most severe with bacterial prostatitis, stress-reducing activities have been reported to assist in pain reduction. 5. Application of ice to the rectal area is not identified as a way to reduce the pain associated with bacterial prostatitis.

39) The nurse suspects that patient who received intramuscular penicillin for treatment of secondary syphilis is developing the Jarisch-Herxheimer reaction. What information did the nurse use to make this clinical determination? Select all that apply. 1. New onset of fever 2. Heart rate 112 beats per minute 3. Sudden severe abdominal cramping 4. Complaints of musculoskeletal pain 5. Administration of medication 16 hours ago

Answer: 1, 2, 4, 5 Explanation: 1. Manifestations of the Jarisch-Herxheimer reaction include fever. 2. Manifestations of the Jarisch-Herxheimer reaction include tachycardia. 3. Sudden severe abdominal cramping is not a manifestation of the Jarisch-Herxheimer reaction. 4. Manifestations of the Jarisch-Herxheimer reaction include musculoskeletal pain. 5. The Jarisch-Herxheimer reaction generally begins within 24 hours of treatment.

41) During a health interview, a male patient expresses the desire to avoid developing prostate cancer with aging. What should the nurse recommend to reduce this patient's risk factors for the health problem? Select all that apply. 1. Avoiding vasectomy 2. Reducing the intake of animal fat 3. Increasing the intake of vitamin C 4. Restricting exposure to spermicides 5. Taking vitamin A supplements

Answer: 1, 2, 5 Explanation: 1. Risk factors for prostate cancer include having a vasectomy because it is believed to increase the levels of circulating free testosterone. 2. A diet high in animal fat is believed to increase the risk for prostate cancer. 3. Vitamin C does not impact the risk for prostate cancer. 4. Spermicides are not identified as increasing the risk for prostate cancer. 5. Excessive supplemental vitamin A is believed to increase the risk for prostate cancer.

34) A patient with a history of recurrent urinary tract infections (UTIs) asks if there are any complementary approaches to reducing the risk of developing future infections. What should the nurse instruct this patient? Select all that apply. 1. Take saw palmetto. 2. Drink blueberry juice. 3. Drink cranberry juice. 4. Limit the intake of vitamin C. 5. Apply lavender over the abdomen.

Answer: 1, 3 Explanation: 1. Herbal supplements, such as saw palmetto, have a urinary antiseptic effect and may be beneficial in treating or preventing UTIs. 3. Research supports the use of cranberry products to prevent UTIs in women with recurrent symptomatic infections.

23) A female patient has just been diagnosed with a trichomonas infection. What symptom should the nurse expect to assess in this patient? Select all that apply. 1. Frothy yellow drainage 2. Smooth lesions on labia majora 3. Itching and irritation of the genitalia 4. Dysuria 5. Fever

Answer: 1, 3, 4 Explanation: 1. A frothy yellow or white drainage is associated with this infection. 2. Lesions are usually not associated with a trichomoniasis infection. 3. Burning and itching of the vulva is associated with this infection. 4. The symptoms can also include dysuria. 5. Fever is usually not associated with a trichomoniasis infection.

16) A patient who contracted syphilis from a sexual partner infected the spouse. What intervention should the nurse plan for this couple? Select all that apply. 1. Explain the need for follow-up testing in three months and six months. 2. Refer to a marriage counselor. 3. Administer intramuscular injection of penicillin G as prescribed. 4. Discuss abstaining from sexual activity until cured. 5. Review handwashing techniques.

Answer: 1, 3, 4 Explanation: 1. In order to confirm that the disease is eradicated, follow-up testing is required at three months and six months. 2. Partners should be referred for treatment; however, marriage counseling is not specifically identified. 3. The most important part of the treatment process is the immediate medical treatment of the syphilis in order to contain it in the first stage. The preferred treatment is the injection of the penicillin G. 4. In order to prevent further spread of the disease and risk reinfection, abstinence from all sexual activity is required until cured. 5. Handwashing is not an identified intervention for this disease process.

19) A patient diagnosed with gonorrhea has not been adhering to the prescribed medication regime. What finding indicates the patient is experiencing complications of the disease? Select all that apply. 1. WBC 22,000 2. Ambulating slowly with legs apart 3. Abdominal pain 4. Vaginal bleeding unrelated to menstruation 5. Serum potassium of 3.8 mEq/L

Answer: 1, 3, 4 Explanation: 1. The elevation in white blood count is an indicator of an infectious process somewhere in the body. 2. Ambulating slowly with the legs apart is not a manifestation of this disease process. 3. Abdominal pain is a manifestation of pelvic inflammatory disease. 4. Abnormal bleeding is a manifestation of pelvic inflammatory disease. 5. The serum potassium level is not used to identify a complication from this disease.

29) During the assessment the nurse suspects a patient with injuries from a motor vehicle crash sustained kidney trauma. What did the nurse assess to make this clinical decision? Select all that apply. 1. Turner sign 2. Nausea and vomiting 3. Microscopic hematuria 4. Blood pressure 88/58 mmHg 5. Heart rate 118 beats per minute

Answer: 1, 3, 4, 5 Explanation: 1. In kidney trauma, retroperitoneal bleeding from the kidney may cause Turner sign, a bluish discoloration of the flank. 3. The primary manifestation of kidney trauma includes microscopic hematuria. 4. In kidney trauma, signs of shock such as hypotension can occur. 5. In kidney trauma, signs of shock such as tachycardia can occur.

35) A patient with bladder cancer is scheduled for surgery to create a continent urinary reservoir. What should the nurse include when teaching the patient about this procedure? Select all that apply. 1. Electrolytes may need to be monitored. 2. The ureters are brought to the surface. 3. Part of the bowel is used for the pouch. 4. The patient will learn how to perform self-catheterization. 5. A urinary collection device is not necessary.

Answer: 1, 3, 4, 5 Explanation: 1. The continent urinary reservoir may absorb urea and electrolytes, resulting in imbalances. Electrolytes may need to be monitored. 3. A significant portion of the bowel is required to form the pouch and stoma of a continent urinary reservoir. 4. With a continent urinary reservoir, the patient must be able and motivated to manage self-catheterization. 5. With a continent urinary reservoir, a drainage collection device is not necessary.

33) A patient with abnormal uterine bleeding (AUB) has been informed that this problem requires surgical intervention. Which procedure should the nurse review with this patient? Select all that apply. 1. Hysterectomy 2. Laparoscopy 3. Endometrial ablation 4. Hormonal agents 5. Therapeutic dilatation and curettage (D&C)

Answer: 1, 3, 5 Explanation: 1. Surgical intervention is based on using the least invasive method that provides effective relief. Hysterectomy is performed if other approaches are not effective. 2. Laparoscopy is not indicated for dysfunctional uterine bleeding. 3. Surgical intervention is based on using the least invasive method that provides effective relief. Endometrial ablation is indicated if another approach does not work. 4. Administering hormonal agents is not a surgical procedure. 5. Surgical intervention is based on using the least invasive method that provides effective relief. Dilatation and curettage is the first surgical option used to control bleeding.

35) The nurse is preparing to assess a female adolescent diagnosed with Turner syndrome. What finding should the nurse expect because of this genetic disorder? Select all that apply. 1. Webbed neck 2. Muscle atrophy 3. Short stature 4. Facial hair growth 5. Lack of sexual development

Answer: 1, 3, 5 Explanation: 1. Turner syndrome is a disorder in a female caused by complete or partial absence of one of the two X chromosomes. The disorder is characterized by a webbed neck. 2. Muscle atrophy is not a manifestation of Turner syndrome. 3. Turner syndrome is a disorder in a female caused by complete or partial absence of one of the two X chromosomes. The disorder is characterized by short stature. 4. Facial hair growth is not a manifestation of Turner syndrome. 5. Turner syndrome is a disorder in a female caused by complete or partial absence of one of the two X chromosomes. The disorder is characterized by a lack of sexual development at

1) A 40-year-old male seeks medical attention for impotence. Which patient statement should the nurse further investigate? Select all that apply. 1. "I take medications to help me sleep several times per week." 2. "I had the mumps when I was a boy." 3. "I had a vasectomy 4 years ago." 4. "I have had diabetes for several years." 5. "My wife has a history of cervical cancer."

Answer: 1, 4 Explanation: 1. The causes of impotence may be related to medication use, performance anxiety, or chronic disease processes. The patient who takes tranquilizers or medications for sleep may experience impotence. 4. Diabetes mellitus over time may cause vascular damage, resulting in impotence.

24) The nurse is preparing to examine a male patient's reproductive organs. What should the nurse do in preparation for this examination? Select all that apply. 1. Secure a private examination room. 2. Use clean hands for the examination. 3. Ask the patient to lie down on the examination table. 4. Ask the patient to empty his bladder. 5. Make sure the room temperature is cool.

Answer: 1, 4 Explanation: 1. The nurse ensures that the examining room is warm and private.v 4. The patient is asked to empty his bladder, remove his clothing, and put on a gown or drape.

20) A male patient complains of frequently "not being able to hold urine," especially when the bladder is very full or when lifting objects. What should the nurse do to help this patient? Select all that apply. 1. Instruct the patient how to do Kegel exercises. 2. Suggest that the patient ask the physician for medications to control this incontinence. 3. Suggest that the patient restrict fluids. 4. Suggest the patient wear a Texas catheter. 5. Suggest the patient wear adult absorbent briefs.

Answer: 1, 4 Explanation: 1. The symptoms being described by the patient are consistent with incontinence. The treatment plan for incontinence should initially begin with the least invasive measures. Kegel exercises can be used to improve tone and eliminate or reduce stress incontinence. 2. The treatment plan for incontinence should initially begin with the least invasive measures. 3. Restricting fluids will not decrease incontinence. 4. A Texas catheter is noninvasive and usually suggested for full incontinence. It may improve the patient's self-esteem and allow him to return to regular activities. 5. The use of adult absorbent briefs can be embarrassing to the patient, are recommended for patients who are unable to control their bladders, have problems with mobility, or are bedridden.

13) A patient is diagnosed with asymptomatic inflammatory prostatitis. In which way was this diagnosis made? 1. After examining tissue from the prostate 2. By testing the serum PSA (prostate-specific antigen) level 3. According to the patient's symptoms 4. After palpating the patient's prostate gland

Answer: 2 2. Asymptomatic inflammatory prostatitis is usually diagnosed when the man is undergoing assessment for another issue or during general healthcare screening (such as PSA testing).

8) A female patient is experiencing a painless, ulcerated area on the labia. What should the nurse suspect is occurring with this patient? 1. Herpes simplex II 2. Syphilis 3. Condylomata acuminata 4. Gonorrhea

Answer: 2 Explanation: 1. Herpes simplex II infection will present with a painful ulceration. 2. The primary stage of syphilis is characterized by the appearance of a chancre. Little or no pain accompanies this sore. 3. Condylomata acuminata appear as fleshy growths in which the skin is intact. 4. Gonorrhea infections manifest with dysuria or discharge.

38) A patient is to receive hormone therapy as adjunct treatment for advanced breast cancer. Which oral medication should the nurse anticipate being prescribed for this patient? 1. Trastuzumab (Herceptin) 2. Bevacizumab (Avastin) 3. Goserelin (Zoladex) 4. Fulvestrant (Faslodex)

Answer: 2 Explanation: 1. Trastuzumab (Herceptin) is an IV immunotherapy drug that stops the growth of breast tumors. 2. Bevacizumab (Avastin) is an oral drug that targets the HER2 protein. 3. The gonadotropin-releasing hormone agonist (GnRH-a) goserelin (Zoladex) is used to treat endometrial cancer. 4. Fulvestrant (Faslodex) eliminates estrogen receptors and is given by injection once a month

2) While collecting data from a couple experiencing infertility, the male partner, age 52, asks why information about his mother's pregnancy is important. How should the nurse respond? 1. "Collecting information about a patient's immediate family is required." 2. "Medication exposure during pregnancy may impact the long-range fertility of the woman's male children." 3. "If your mother experienced infertility, you are at a higher risk for infertility." 4. "Although the greater concerns relate to the female's mother, we collect information on both of you to create a more balanced picture."

Answer: 2 2. Men born to women treated during pregnancy with diethylstilbestrol (DES), a drug used in the 1940s and 1950s to prevent miscarriage, may have congenital deformities of the urinary tract as well as reduced semen levels.

27) The nurse is preparing to administer an osmotic diuretic to a patient. What should the nurse do when providing this medication? Select all that apply. 1. Check solution for crystallization prior to IV administration. 2. Evaluate urine output after test dose is given. 3. Assess for signs of worsening heart failure. 4. Assess for orthostatic hypotension. 5. Monitor patient for signs of ototoxicity.

Answer: 2, 3 Explanation: 1. There is no documentation that these solutions crystallize. 2. A test dose may be given, and urine output is evaluated for an adequate response. 3. The patient should be assessed for signs of worsening heart failure because of the increased vascular volume that occurs with these medications. 4. Orthostatic hypotension is not an issue due to the increase in intravascular volume but should be assessed when giving loop diuretics. 5. Ototoxicity is a concern with high doses of loop diuretics.

41) A patient is preparing to return home after repair of a vaginal fistula. What teaching should the nurse provide before this patient is discharged? Select all that apply. 1. Maintain bed rest for a week. 2. Use perineal pads as directed. 3. Perform perineal irrigation as prescribed. 4. Cleanse the perineal area daily with a sitz bath. 5. Apply topical antibacterial ointment to the area.

Answer: 2, 3, 4 Explanation: 1. Bed rest is not indicated in the postoperative care of a vaginal fistula. 2. Perineal pads may be used to absorb urine or fecal drainage. 3. Perineal irrigation will keep the area clean, reduce irritation, and prevent further tissue breakdown. 4. Sitz baths will help with cleansing the area. 5. Topical antibacterial ointment is not used in the care of a vaginal fistula.

32) During a health history, the nurse becomes concerned that a male patient is at risk for cancer of the reproductive organs. What genetic information about this patient caused the nurse's concern? Select all that apply. 1. The patient's mother has arthritis. 2. The patient's father had prostate cancer. 3. The patient's brother was treated for testicular cancer. 4. The patient was treated for cryptorchidism as a young child. 5. The patient's uncle has been diagnosed with type 2 diabetes mellitus.

Answer: 2, 3, 4 2. Several diseases of the male reproductive system have a genetic component. During the health assessment interview, it is especially important to ask about a family history of prostate cancer. Although the exact genetic predisposition in some men for prostate cancer is unknown, many studies have identified a family history as a major risk factor. 3. Several diseases of the male reproductive system have a genetic component. During the health assessment interview, it is especially important to ask about a family history of testicular cancer, which is a risk factor for cancer of the testes. 4. Several diseases of the male reproductive system have a genetic component. During the health assessment interview, it is especially important to ask about a family history of testicular or prostate cancer. Cryptorchidism can be a risk factor for testicular cancer.cer.

33) After genetic testing, it is determined that a male patient is missing the sex-determining region Y gene (SRY). What manifestations should the nurse expect to assess in this patient? Select all that apply. 1. Balanitis 2. Minimal libido 3. Negative sperm production 4. No secondary sex characteristics 5. Changes in bone and muscle structure

Answer: 2, 3, 4, 5 2. Men who are missing the SRY often have altered testicular development. Testosterone, the primary androgen produced by the testes, promotes libido (sexual desire). 3. Men who are missing the SRY often have altered testicular development. Testosterone, the primary androgen produced by the testes, is essential for spermatogenesis. 4. Men who are missing the SRY often have altered testicular development. Testosterone, the primary androgen produced by the testes, is essential for the development and maintenance of secondary sex characteristics. 5. Men who are missing the SRY often have altered testicular development. Testosterone, the primary androgen produced by the testes, promotes the growth of muscles and bone.

38) The nurse provides a patient with a subcutaneous dose of bethanechol chloride (Urecholine). For which manifestation should the nurse prepare to give the patient atropine? Select all that apply. 1. Voided 250 mL 2. Audible wheezes 3. Increase in heart rate 4. Drop in blood pressure 5. New onset shortness of breath

Answer: 2, 3, 4, 5 2. Atropine is the antidote for an adverse reaction from bethanechol chloride (Urecholine). Audible wheezes would necessitate the use of atropine. 3. Atropine is the antidote for an adverse reaction from bethanechol chloride (Urecholine). An increase in heart rate would necessitate the use of atropine. 4. Atropine is the antidote for an adverse reaction from bethanechol chloride (Urecholine). A drop in blood pressure would necessitate the use of atropine. 5. Atropine is the antidote for an adverse reaction from bethanechol chloride (Urecholine). Shortness of breath would necessitate the use of atropine.

47) A patient has a history of urinary tract infections (UTIs). What should the nurse instruct this patient to help maintain acid urine? Select all that apply. 1. Reduce the intake of water. 2. Avoid drinking fruit juices. 3. Take vitamin C supplements. 4. Avoid excess milk consumption. 5. Drink two glasses of low sugar cranberry juice each day.

Answer: 2, 3, 4, 5 2. Suggesting measures to maintain acid urine include avoid drinking fruit juices. 3. Suggesting measures to maintain acid urine include taking vitamin C supplements. 4. Suggesting measures to maintain acid urine include avoiding excess milk consumption. 5. Suggesting measures to maintain acid urine include drinking two glasses of low sugar cranberry juice each day.

26) A patient reports having pain during intercourse. For which health problem should the nurse assess this patient? Select all that apply. 1. Perforated hymen 2. Vaginal scarring 3. Fear of sexual abuse 4. Vaginismus 5. Climacteric

Answer: 2, 3, 4, 5 Explanation: 1. A physical condition that may result in pain during intercourse is an imperforate hymen. 2. Vaginal scarring can cause the vaginal muscles at the introitus to contract so tightly that an erect penis cannot be inserted. 3. Fear of sexual abuse is one cause of painful intercourse. 4. In vaginismus, the vaginal muscles at the introitus contract so tightly that an erect penis cannot be inserted. 5. Estrogen decreases in perimenopause and menopause, resulting in vaginal dryness and painful intercourse.

28) A patient believes that she is beginning menopause. For which manifestation should the nurse assess this patient? Select all that apply. 1. Increased body hair 2. Vaginal dryness 3. Hot flashes 4. Night sweats 5. Vaginitis

Answer: 2, 3, 4, 5 Explanation: 1. As estrogen levels decline, decreasing body hair may be noted. 2. As estrogen levels decline, vaginal dryness is noted. 3. As estrogen levels decline, hot flashes are noted. 4. As estrogen levels decline, night sweats are noted. 5. As estrogen levels decline, vaginitis may be noted.

37) The nurse is preparing a teaching tool on testicular self-examination. Which information should the nurse include? Select all that apply. 1. Examine the testicles once a week. 2. Examine while taking a warm shower. 3. Identify the epididymis as soft and tender. 4. Identify the spermatic cord as firm and smooth. 5. Gently roll each testicle between the thumb and fingers.

Answer: 2, 3, 4, 5 Explanation: 1. The testicles should be examined once a month. 2. The testicles should be examined when taking a warm shower or bath or just after if a mirror is used to compare the size. 3. The epididymis is just above and behind the testicle and feels soft and tender. 4. The spermatic cord extends up from the epididymis and feels firm and smooth. 5. The testicles should be gently rolled between the thumb and fingers of each hand.

27) The nurse is preparing to counsel a 46-year-old woman who has been postmenopausal for 1 year about the common health risks associated with menopause. What should the nurse include in this teaching? Select all that apply. 1. Hypertension 2. Heart disease 3. Diabetes 4. Macular degeneration 5. Osteoporosis

Answer: 2, 4, 5 Explanation: 1. Hypertension is not identified as a health risk after menopause. 2. Certain health risks increase after menopause, including heart disease. 3. The risk of developing diabetes is more closely associated with other factors, such as obesity. 4. Certain health risks increase after menopause, including macular degeneration. 5. Certain health risks increase after menopause, including osteoporosis.

36) The nurse is concerned that a male patient may have breast cancer. What did the nurse assess to make this clinical decision? Select all that apply. 1. A painless nodule in the testis 2. Enlarged supraventricular nodes 3. Femoral bulge that increases with coughing 4. Tender disk of breast tissue behind the areola 5. Hard, irregular, fixed nodule in the nipple area

Answer: 2, 5 Explanation: 1. A painless nodule in the testis is associated with testicular cancer. 2. Enlarged supraclavicular nodes may indicate metastasis. 3. A femoral bulge that increases with coughing or straining suggests a hernia. 4. A tender disk of breast tissue behind the areola indicates gynecomastia. 5. A hard, irregular, fixed nodule in the nipple area suggests carcinoma.

38) The nurse is reviewing medication prescribed for a patient with uncomplicated gonorrhea. Which medication should the nurse expect to be prescribed for this patient? Select all that apply. 1. Cefoxitin 2. Ceftriaxone 3. Doxycycline 4. Clindamycin 5. Azithromycin

Answer: 2, 5 Explanation: 1. Cefoxitin is used to treat pelvic inflammatory disease. 2. A dual therapy of ceftriaxone with azithromycin is the recommended treatment. 3. Doxycycline is not recommended to treat gonorrhea. 4. Clindamycin is used to treat pelvic inflammatory disease. 5. A dual therapy of ceftriaxone with azithromycin is the recommended treatment.

31) A male patient is concerned about a "smooth growth" that appeared on the penis. Which type of genital wart should the nurse suspect this patient is experiencing? 1. Condyloma acuminatum 2. Keratotic wart 3. Papular wart 4. Flat wart

Answer: 3 Explanation: 1. Condyloma acuminata are cauliflower-shaped lesions that appear on moist skin surfaces such as the vagina or anus. 2. Keratotic warts are thick, hard lesions that develop on keratinized skin such as the labia major, penis, or scrotum. 3. Papular warts are smooth lesions that also develop on keratinized skin. 4. Flat warts are slightly raised lesions, often invisible to the naked eye, that develop on keratinized skin.

29) During an assessment of a female patient's internal genitalia, the nurse feels a bulge along the posterior vaginal wall. What should the nurse suspect is occurring with this patient? 1. Prolapsed uterus 2. Cystocele 3. Rectocele 4. Blocked gland

Answer: 3 Explanation: 1. Protrusion of the cervix or uterus into the vagina indicates uterine prolapse. 2. Bulging of the anterior vaginal wall and urinary incontinence indicates a cystocele. 3. Bulging of the posterior wall indicates a rectocele. 4. The vagina does not contain glands but rather is lubricated by mucus-producing cells. Skene's and Bartholin glands are located between the labia in the vestibule.

32) The nurse is caring for a patient with a urinary stoma. In which order should the nurse provide care? Place in order the steps of the process. Choice 1. Cleanse the skin around stoma with soap and water, rinse, and pat or air-dry. Choice 2. Assess the stoma, noting color and moisture. Choice 3. Remove the old pouch; use warm water to loosen the seal. Choice 4. Use the stoma guide to determine the size of the bag opening and/or protective ring. Trim as needed. Choice 5. Apply the bag with an opening no more than 1-2 mm wider than the outside of the stoma. Choice 6. Apply a skin barrier; allow the skin to dry, then connect the bag to the urine-collection device.

Answer: 3, 2, 1, 4, 6, 5

37) The nurse is completing a health history with a male patient and decides to include an assessment of the patient's sexual history for potential erectile dysfunction. What information in the history caused the nurse to make this decision? Select all that apply. 1. Brother treated for testicular cancer 2. Hip replacement surgery 6 months ago 3. Aortic aneurysm repair 2 years ago 4. Acetaminophen (Tylenol) for arthritis pain 5. Coronary artery bypass surgery 10 years ago

Answer: 3, 5 Explanation: 1. A family history of testicular cancer will not increase the patient's risk for erectile dysfunction. 2. Hip replacement surgery is not implicated as a cause for erectile dysfunction. 3. A vascular disorder is identified as a potential cause for erectile dysfunction. 4. Acetaminophen (Tylenol) is not implicated as a cause for erectile dysfunction. 5. A vascular disorder is identified as a potential cause for erectile dysfunction.

11) A postmenopausal patient is diagnosed with cervical dysplasia caused by the human papillomavirus. For which procedure that would both diagnose and treat the dysplasia should the nurse prepare this patient? 1. Pap smear 2. Colposcopy 3. Cervical biopsy 4. Loop diathermy

Answer: 4 4. A loop diathermy technique or loop electrosurgical excision procedure (LEEP) allows simultaneous diagnosis and treatment of dysplastic lesions found on colposcopy. This procedure is performed in the office and uses a wire for both cutting and coagulation during excision of the dysplastic region of the cervix.

9) A female patient of childbearing age is diagnosed with large uterine fibroids. What should the nurse expect the treatment of choice would be for this patient? 1. Oral contraceptives 2. Estrogen replacement 3. Iron replacement therapy 4. Leuprolide acetate (Lupron)

Answer: 4 4. Leuprolide acetate (Lupron) is used to reduce bleeding and shrinks the fibroids.