NR 354 EXAM 3 2024-2025 WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS |FR, Exams of Nursing

Download NR 354 EXAM 3 2024-2025 WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS |FR and more Exams Nursing in PDF only on Docsity! 1 | P a g e NR 354 EXAM 3 2024-2025 WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS |FREQUENTLY TESTED QUESTIONS AND SOLUTIONS |ALREADY GRADED A+|NEWEST|GUARANTEED PASS|LATEST UPDATE 1. The nurse is performing an assessment of an 80-year-old patient. Which information obtained by the nurse will be of most concern? a. Decreased appetite b. Difficulty chewing food c. Unintentional weight loss d. Complaints of indigestion ANS: C Unintentional weight loss is not a normal finding in older patients and may indicate a problem such as cancer or depression. Poor appetite, difficulty in chewing, and complaints of indigestion are common in older patients. These will need to be addressed, but are not of as much concern as the weight loss 2. To promote bowel evacuation in a patient with chronic complaints of constipation, the nurse will suggest that the patient should attempt defecation a. in the mid-afternoon. b. after eating breakfast. c. right after getting up in the morning. d. immediately before the first daily meal. ANS: B These reflexes are most active after the first daily meal. Arising in the morning, the anticipation of eating, and physical exercise do not stimulate these reflexes. 3. When a patient has a history of a total gastrectomy, the nurse will monitor for clinical manifestations of a. constipation. b. dehydration. c. elevated total cholesterol. d. cobalamin (vitamin B12) deficiency. 2 | P a g e ANS: D The patient with a total gastrectomy does not secrete intrinsic factor, which is needed for cobalamin (vitamin B12) absorption. Because the stomach absorbs only small amounts of water and nutrients, the patient is not at higher risk for dehydration, elevated cholesterol, or constipation. 4. The nurse will monitor a patient who has an obstruction of the common bile duct for a. melena. b. steatorrhea. c. decreased serum cholesterol levels. d. increased serum indirect bilirubin levels. ANS: B A common bile duct obstruction will reduce the absorption of fat in the small intestine, leading to fatty stools. Gastrointestinal (GI) bleeding is not caused by common bile duct obstruction. Serum cholesterol levels are increased with biliary obstruction. Direct bilirubin level is increased with biliary obstruction. 5. During change-of-shift report, the nurse receives the following information about a patient who is scheduled for a colonoscopy. Which information should be communicated to the health care provider before sending the patient for the procedure? a. The patient has a permanent pacemaker to prevent bradycardia. b. The patient is worried about discomfort during the examination. c. The patient has had an allergic reaction to shellfish and iodine in the past. d. The patient refused to drink the ordered polyethylene glycol (GoLYTELY). ANS: D If the patient has had inadequate bowel preparation, the colon cannot be visualized and the procedure should be rescheduled. Because contrast solution is not used during colonoscopy, the iodine allergy is not pertinent. A pacemaker is a contraindication to magnetic resonance imaging (MRI), but not to colonoscopy. The nurse should instruct the patient about the sedation used during the examination to decrease the patient's anxiety about discomfort. 6. When the nurse is obtaining a history from a patient who is admitted with jaundice, which statement is most indicative of a need for patient teaching? a. "I used cough syrup several times a day last week." b. "I take a baby aspirin every day to prevent strokes." c. "I need to take an antacid for indigestion several times a week" d. "I use acetaminophen (Tylenol) every 4 hours for chronic pain." ANS: D Chronic use of high doses of acetaminophen can be hepatotoxic and may have caused the patient's jaundice. The other patient statements require further assessment by the nurse, but do not indicate a need for patient education. 7. To palpate the liver, the nurse a. places one hand on the patient's back and presses upward and inward with the other hand below the patient's right costal margin. 5 | P a g e included in the agency policy for ERCP should the nurse take first? a. Place the patient on NPO status. b. Administer sedative medications. c. Ensure the consent form is signed. d. Explain the procedure to the patient. ANS: A The patient will need to be NPO for 8 hours before the ERCP is done, so the nurse's initial action should be to place the patient on NPO status. The other actions can be done after the patient is NPO. 1. A patient contracts hepatitis from contaminated food. During the acute (icteric) phase of the patient's illness, the nurse would expect serologic testing to reveal a. antibody to hepatitis D (anti-HDV). b. hepatitis B surface antigen (HBsAg). c. anti-hepatitis A virus immunoglobulin G (anti-HAV IgG). d. anti-hepatitis A virus immunoglobulin M (anti-HAV IgM). ANS: D Hepatitis A is transmitted through the oral-fecal route, and antibody to HAV IgM appears during the acute phase of hepatitis A. The patient would not have antigen for hepatitis B or antibody for hepatitis D. Anti-HAV IgG would indicate past infection and lifelong immunity. 2. The nurse determines that administration of hepatitis B vaccine to a patient has been effective when a specimen of the patient's blood reveals a. HBsAg. b. anti-HBs. c. anti-HBc IgG. d. anti-HBc IgM. ANS: B The presence of surface antibody to HBV (anti-HBs) is a marker of a positive response to the vaccine. The other laboratory values indicate current infection with HBV. 3. A patient in the outpatient clinic is diagnosed with acute hepatitis C (HCV) infection. Which action by the nurse is appropriate? a. Schedule the patient for HCV genotype testing. b. Administer immune globulin and the HCV vaccine. c. Instruct the patient on ribavirin (Rebetol) treatment. d. Teach that the infection will resolve in a few months. ANS: A Genotyping of HCV has an important role in managing treatment and is done before drug therapy is initiated. Since most patients with acute HCV infection convert to the chronic state, the nurse should not teach the patient that the HCV will resolve in a few months. Immune globulin or vaccine is not available for HCV. Ribavirin is used for chronic HCV infection. 4. When a patient is diagnosed with acute hepatitis B, the nurse will plan to teach the patient about a. ways to increase exercise and activity level. 6 | P a g e b. self-administration of α-interferon (Intron A). c. side effects of nucleoside and nucleotide analogs. d. measures that will be helpful in improving appetite. ANS: D Maintaining adequate nutritional intake is important for regeneration of hepatocytes. Interferon and antivirals may be used for chronic hepatitis B, but they are not prescribed for acute hepatitis B infection. Rest is recommended. 5. When combination therapy of -interferon and ribavirin (Rebetol) is being used to treat chronic hepatitis C, the nurse will plan to monitor for a. leukopenia. b. hypokalemia. c. polycythemia. d. hypoglycemia. ANS: A Therapy with ribavirin and -interferon may cause leukopenia. The other problems are not associated with this drug therapy. 6. Which information given by a patient when the nurse is taking a health history indicates that screening for hepatitis C should be done? a. The patient eats frequent meals in fast-food restaurants. b. The patient recently traveled to an undeveloped country. c. The patient had a blood transfusion after surgery in 1998. d. The patient reports a one-time use of IV drugs 20 years ago. ANS: D Any patient with a history of IV drug use should be tested for hepatitis C. Blood transfusions given after 1992, when an antibody test for hepatitis C became available, do not pose a risk for hepatitis C. Hepatitis C is not spread by the oral-fecal route and therefore is not caused by contaminated food or by traveling in underdeveloped countries. 7. A patient is admitted with an abrupt onset of jaundice, nausea, and abnormal liver function studies. Serologic testing is negative for viral causes of hepatitis. Which question by the nurse is most appropriate? a. "Is there any history of IV drug use?" b. "Are you taking corticosteroids for any reason?" c. "Do you use any over-the-counter (OTC) drugs?" d. "Have you recently traveled to a foreign country?" ANS: C The patient's symptoms, lack of antibodies for hepatitis, and the abrupt onset of symptoms suggest toxic hepatitis, which can be caused by commonly used OTC drugs such as acetaminophen (Tylenol). Travel to a foreign country and a history of IV drug use are risk factors for viral hepatitis. Corticosteroid use does not cause the symptoms listed. 7 | P a g e 8. A patient with cirrhosis has 4+ pitting edema of the feet and legs. The data indicate that it is most important for the nurse to monitor the patient's a. hemoglobin. b. temperature. c. activity level. d. albumin level. ANS: D The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in the development of edema. The other parameters also should be monitored, but they are not directly associated with the patient's current symptoms. 9. A 32-year-old patient is diagnosed with early alcoholic cirrhosis. Which topic is most important to include in patient teaching? a. Need to abstain from alcohol b. Use of vitamin B supplements c. Maintenance of a nutritious diet d. Treatment with lactulose (Cephulac) ANS: A The disease progression can be stopped or reversed by alcohol abstinence. The other interventions may be used when cirrhosis becomes more severe to decrease symptoms or complications, but the priority for this patient is to stop the progression of the disease. 10. A patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix) has a serum potassium level of 3.2 mEq/L (3.2 mmol/L). Which action should the nurse take? a. Give both drugs as scheduled. b. Administer the spironolactone. c. Administer the furosemide and withhold the spironolactone. d. Withhold both drugs until talking with the health care provider. ANS: B Spironolactone is a potassium-sparing diuretic and will help to increase the patient's potassium level. The nurse does not need to talk with the doctor before giving the spironolactone, although the health care provider should be notified about the low potassium value. The furosemide will further decrease the patient's potassium level and should be held until the nurse talks with the health care provider. 11. To evaluate the effectiveness of treatment for a patient who has hepatic encephalopathy, which action should the nurse take? a. Request that the patient stand on one foot. b. Ask the patient to extend both arms to the front. c. Instruct the patient to perform the Valsalva maneuver. d. Have the patient walk a few steps with the eyes closed. ANS: B Extending the arms allows the nurse to check for asterixis, a classic sign of hepatic encephalopathy. The 10 | P a g e a. Calcium b. Bilirubin c. Amylase d. Potassium ANS: C Amylase is elevated in acute pancreatitis. Although changes in the other values may occur, they would not be as useful in evaluating whether the prescribed therapies have been effective. 20. Which assessment finding in a patient with acute pancreatitis would the nurse need to report most quickly to the health care provider? a. Nausea and vomiting b. Hypotonic bowel sounds c. Abdominal tenderness and guarding d. Muscle twitching and finger numbness ANS: D Muscle twitching and finger numbness indicate hypocalcemia, which may lead to tetany unless calcium gluconate is administered. Although the other findings also should be reported to the health care provider, they do not indicate complications that require rapid action. 21. When obtaining a health history from a patient with acute pancreatitis, the nurse asks the patient specifically about a history of a. alcohol use. b. diabetes mellitus. c. high-protein diet. d. cigarette smoking. ANS: A Alcohol use is one of the most common risk factors for pancreatitis in the United States. Cigarette smoking, diabetes, and high-protein diets are not risk factors. 22. When educating a patient with chronic pancreatitis about the prescribed pancrelipase (Viokase), the nurse will teach the patient to take the medication a. at bedtime. b. with every meal. c. upon arising in the morning. d. as soon as abdominal pain occurs. ANS: B Pancreatic enzymes are used to help with digestion of nutrients and should be taken with every meal. 23. After providing discharge instructions to a patient following a laparoscopic cholecystectomy, the nurse recognizes that teaching has been effective when the patient states, a. "I can remove the bandages on my incisions tomorrow and take a shower." 11 | P a g e b. "I can expect some yellow-green drainage from the incision for a few days." c. "I should plan to limit my activities and not return to work for 4 to 6 weeks." d. "I will always need to maintain a low-fat diet since I no longer have a gallbladder." ANS: A After a laparoscopic cholecystectomy, the patient will have Band-Aids in place over the incisions. Patients are discharged the same (or next) day and have few restrictions on activities of daily living. Drainage from the incisions would be abnormal, and the patient should be instructed to call the health care provider if this occurs. A low-fat diet may be recommended for a few weeks after surgery but will not be a life-long requirement. 24. Which data obtained by the nurse during the assessment of a patient with cirrhosis will be of most concern? a. The patient's hands flap back and forth when the arms are extended. b. The patient has ascites and a 2-kg weight gain from the previous day. c. The patient's skin has multiple spider-shaped blood vessels on the abdomen. d. The patient complains of right upper-quadrant pain with abdominal palpation. ANS: A The asterixis indicates that the patient has hepatic encephalopathy, and hepatic coma may occur. The spider angiomas and right upper quadrant abdominal pain are not unusual for the patient with cirrhosis and do not require a change in treatment. The ascites and weight gain do indicate the need for treatment but not as urgently as the changes in neurologic status. 25. A patient with cirrhosis and esophageal varices has a new prescription for propranolol (Inderal). Which assessment finding is the best indicator that the medication has been effective? a. The apical pulse rate is 68 beats/minute. b. Stools test negative for occult blood. c. The patient denies complaints of chest pain. d. Blood pressure is less than 140/90 mm Hg. ANS: B Since the purpose of -blocker therapy for patients with esophageal varices is to decrease the risk for bleeding from esophageal varices, the best indicator of the effectiveness for propranolol is the lack of blood in the stools. Although propranolol is used to treat hypertension, angina, and tachycardia, the purpose for use in this patient is to decrease the risk for bleeding from esophageal varices. 26. A patient who was admitted with acute bleeding from esophageal varices asks the nurse the purpose for the ordered ranitidine (Zantac). Which response by the nurse is most appropriate? a. The medication will reduce the risk for aspiration. b. The medication will decrease nausea and anorexia. c. The medication will inhibit the development of gastric ulcers. d. The medication will prevent irritation to the esophageal varices. ANS: D The therapeutic action of H2 receptor blockers in patients with esophageal varices is to prevent irritation and bleeding from the varices caused by reflux of acid gastric contents. Although ranitidine 12 | P a g e does decrease the risk for peptic ulcers, reduce nausea, and help prevent aspiration pneumonia, these are not the primary purpose for H2 receptor blockade in this patient. 27. When taking the BP of a patient with severe acute pancreatitis, the nurse notices carpal spasm of the patient's hand. Which action should the nurse take next? a. Ask the patient about any arm pain. b. Retake the patient's blood pressure. c. Check the calcium level on the chart. d. Notify the health care provider immediately. ANS: C The patient with acute pancreatitis is at risk for hypocalcemia, and the assessment data indicate a positive Trousseau's sign. The health care provider should be notified after the nurse checks the patient's calcium level. There is no indication that the patient needs to have the BP rechecked or that there is any arm pain. 28. A patient with acute pancreatitis has a nasogastric (NG) tube to suction and is NPO. Which information obtained by the nurse indicates that these therapies have been effective? a. Bowel sounds are present. b. Grey Turner sign resolves. c. Electrolyte levels are normal. d. Abdominal pain is decreased. ANS: D NG suction and NPO status will decrease the release of pancreatic enzymes into the pancreas and decrease pain. Although bowel sounds may be hypotonic with acute pancreatitis, the presence of bowel sounds does not indicate that treatment with NG suction and NPO status have been effective. Electrolyte levels will be abnormal with NG suction and must be replaced by appropriate IV infusion. Although Grey Turner sign will eventually resolve, it would not be appropriate to wait for this occur to determine whether treatment was effective. 29. When the nurse is caring for a patient with acute pancreatitis, which assessment finding is of most concern? a. Absent bowel sounds b. Abdominal tenderness c. Left upper quadrant pain d. Palpable abdominal mass ANS: D A palpable abdominal mass may indicate the presence of a pancreatic abscess, which will require rapid surgical drainage to prevent sepsis. Absent bowel sounds, abdominal tenderness, and left upper quadrant pain are common in acute pancreatitis and do not require rapid action to prevent further complications. 15 | P a g e b. The patient's stools are clay colored. c. The patient complains of chronic heartburn. d. The patient has an increase in pain after eating. ANS: B The clay-colored stools indicate biliary obstruction, which requires rapid intervention to resolve. The other data are not unusual for a patient with this diagnosis, although the nurse also would report the other assessment information to the health care provider. 38. When caring for a patient following an incisional cholecystectomy for cholelithiasis, the nurse places the highest priority on assisting the patient to a. choose low-fat foods from the menu. b. perform leg exercises hourly while awake. c. ambulate the evening of the operative day. d. turn, cough, and deep breathe every 2 hours. ANS: D Postoperative nursing care after a cholecystectomy focuses on prevention of respiratory complications because the surgical incision is high in the abdomen and impairs coughing and deep breathing. The other nursing actions also are important to implement but are not as high a priority as ensuring adequate ventilation. 39. Which of the following nursing actions included in the plan of care for a patient with cirrhosis can the RN delegate to nursing assistive personnel? a. Assessing the patient for jaundice b. Providing oral hygiene before meals c. Palpating the abdomen for distention d. Assisting the patient in choosing the diet ANS: B Providing oral hygiene is included in the education and scope of practice of nursing assistants. Assessments and assisting patients to choose therapeutic diets are nursing actions that require higher- level nursing education and scope of practice and would be delegated to LPNs/LVNs or RNs. 40. After an unimmunized individual is exposed to hepatitis B through a needle-stick injury, which actions will the nurse plan to take (select all that apply)? a. Administer hepatitis B vaccine. b. Test for antibodies to hepatitis B. c. Teach about α-interferon therapy. d. Give hepatitis B immune globulin. e. Educate about oral antiviral therapy. ANS: A, B, D The recommendations for hepatitis B exposure include both vaccination and immune globulin 16 | P a g e administration. In addition, baseline testing for hepatitis B antibodies will be needed. Interferon and oral antivirals are not used for hepatitis B prophylaxis. Chapter 51: Reproductive System 1. Which question should the nurse ask when assessing a patient who has a history of benign prostatic hyperplasia (BPH)? a. "Have you noticed any unusual discharge from your penis?" b. "Has there been any change in your sex life in the last year?" c. "Has there been a decrease in the force of your urinary stream?" d. "Have you been experiencing any difficulty in achieving an erection?" ANS: C Enlargement of the prostate blocks the urethra, leading to urinary changes such as a decrease in the force of the urinary stream. The other questions address possible problems with infection or sexual difficulties, but would not be helpful in determining whether there were functional changes caused by BPH. 2. After a patient has been treated for pelvic inflammatory disease, the nurse will plan to implement teaching about a. irregularities in the menstrual cycle. b. changes in secondary sex characteristics. c. possible difficulty with becoming pregnant. d. use of hormone replacement therapy (HRT). ANS: C Pelvic inflammatory disease may cause scarring of the fallopian tubes and result in difficulty in fertilization or implantation of the fertilized egg. Because ovarian function is not affected, the patient will not require HRT, have irregular menstrual cycles, or experience changes in secondary sex characteristics. 3. While the nurse is assessing a 62-year-old man, the patient says that he does not respond to sexual stimulation the way he did when he was younger. The nurse's best response to the patient's comment is, a. "Many men need more sexual stimulation with aging." b. "Interest in sex frequently decreases as men get older." c. "Erectile dysfunction is a common problem with older men." d. "Tell me more about how your sexual response has changed." ANS: D The initial response by the nurse should be further assessment of the problem. The other statements by the nurse are accurate but might not respond to the patient's concerns. 4. When scheduling a pelvic examination and Pap test for a patient, the nurse instructs the patient that she should 17 | P a g e a. shower, but not take a tub bath, before the examination. b. not have sexual intercourse the day before the Pap test. c. plan to have the Pap test just after her menstrual period. d. avoid douching for at least 24 hours before the examination. ANS: D The results of a Pap test may be affected by douching, and so the patient should not douche before the examination. The exam may be scheduled without regard to the menstrual period. The patient may shower or bathe before the examination. Sexual intercourse does not affect the results of the examination or Pap test. 5. A 19-year-old patient who is being assessed for amenorrhea at the clinic makes all of the following statements to the nurse. Which one indicates a need for patient teaching? a. "I run at least 8 miles every day to keep in shape." b. "I drink at least 3 glasses of non-fat milk every day." c. "I am not sexually active but currently I have an IUD [intrauterine device]." d. "I was recently treated for a sexually transmitted disease." ANS: A Excessive exercise can cause amenorrhea. The other statements by the patient do not suggest any urgent teaching needs. 6. When the nurse is assessing the sexual-reproductive functional health pattern for a 34-year-old man, which question is most useful in determining the patient's sexual orientation and risk factors? a. "Do you have sex with men, women, or both?" b. "Which gender do you prefer to have sex with?" c. "What types of sexual activities do you prefer?" d. "Are you heterosexual, homosexual, or bisexual?" ANS: A This question is the most simply stated and will increase the likelihood of obtaining the relevant information about sexual orientation and possible risk factors associated with sexual activity. A patient who prefers intercourse with women also may have intercourse at times with men. The types of sexual activities engaged in may not indicate sexual orientation. Many patients who have intercourse with both men and women do not identify themselves as homosexual or bisexual. 7. When preparing a patient for colposcopy with a cervical biopsy, the nurse explains to the patient that the procedure a. involves dilation of the cervix and biopsy of the tissue lining the uterus. b. will take place in a same-day surgery center so that local anesthesia can be used. c. requires that the patient have nothing to eat or drink for 6 hours before the procedure. d. is similar to a speculum examination of the cervix and should result in little or no pain. ANS: D Colposcopy involves visualization of the cervix with a binocular microscope and is similar to a speculum examination. A cervical biopsy may cause a minimal amount of pain. 20 | P a g e ANS: B Positive hCG testing indicates that the patient is pregnant and that unnecessary abdominal x-rays should be avoided. The other information also is important to report, but it will not affect whether the x-rays should be done. 16. The following patients call the outpatient clinic. Which phone call should the nurse return first? a. A patient who has severe breast tenderness following a breast biopsy b. A patient who has bloody discharge after a hysteroscopy earlier today c. A patient who is complaining of dyspnea after a pelvic computed tomography (CT) with contrast d. A patient who is experiencing shoulder pain after a laparoscopy yesterday ANS: C The patient's dyspnea suggests a delayed reaction to the iodine dye used for the CT scan. The other patient's symptoms are not unusual after the procedures they had done. 17. A woman calls the clinic because she is having an unusually heavy menstrual flow. She tells the nurse that she has saturated two tampons in the past 2 hours. The nurse estimates that the amount of blood loss is a. 10 to 20 mL. b. 20 to 30 mL. c. 30 to 40 mL. d. 40 to 60 mL. ANS: D The average tampon absorbs 20 to 30 mL. 18. When performing a physical assessment on a male patient, the nurse obtains this information. Which finding is most important to report to the health care provider? a. One testis hangs lower than the other. b. Inguinal lymph nodes are nonpalpable. c. Genital hair distribution is diamond shaped. d. Clear penile discharge is present at the meatus. ANS: D Clear penile discharge may be indicative of a sexually transmitted disease (STD). The other findings are normal and do not need to be reported. Chapter 52: Breast Disorders 1. When teaching a 28-year-old patient about breast self-examination (BSE), the nurse will instruct the patient that a. BSE will reduce the risk of dying from breast cancer. b. BSE should be done daily while taking a bath or shower. c. annual mammograms should be scheduled in addition to BSE. d. performing BSE right after the menstrual period will improve comfort. ANS: D Performing BSE at the end of the menstrual period will reduce the breast tenderness associated with the 21 | P a g e procedure. The evidence is not clear that BSE reduces breast cancer mortality. BSE should be done monthly. Annual mammograms are not routinely scheduled for women under age 40. 2. To determine the risk for breast cancer in a 52-year-old patient who has found a small lump in her breast, which question is most pertinent for the nurse to ask? a. "Do you currently smoke cigarettes?" b. "Have you ever had any breast injuries?" c. "At what age did you start having menstrual periods?" d. "Is there any family history of fibrocystic breast changes?" ANS: C Early menarche and late menopause are risk factors for breast cancer because of the prolonged exposure to estrogen that occurs. Cigarette smoking, breast trauma, and fibrocystic breast changes are not associated with increased breast cancer risk. 3. A patient with a small immobile breast lump is advised to have a fine needle aspiration (FNA) biopsy. The nurse explains that an advantage to this procedure is that a. FNA is done in the outpatient clinic, and results are available in 1 to 2 days. b. only a small incision is needed, resulting in minimal breast pain and scarring. c. if the biopsy results are negative, no further diagnostic testing will be needed. d. FNA is guided by a mammogram, ensuring that cells are taken from the lesion. ANS: A FNA is done in outpatient settings and results are available in 24 to 48 hours. No incision is needed. FNA may be guided by ultrasound, but not by mammogram. Since the immobility of the breast lump suggests cancer, further testing will be done if the FNA is negative. 4. When the nurse is assessing the breasts of a 31-year-old, which finding is most indicative of a need for further evaluation? a. Bilateral nodules that are tender with palpation b. A nodule that is 1 cm in size, painless, and fixed c. A lump that increases in size before the menstrual period d. A lump that is small, mobile, and has a rubbery consistency ANS: B Painless and fixed lumps suggest breast cancer. The other findings are more suggestive of benign processes such as fibrocystic breasts and fibroadenoma. 5. A 51-year-old woman at menopause is considering the use of hormone replacement therapy (HRT) but is concerned about the risk of breast cancer. Which information will the nurse include when discussing HRT with the patient? a. HRT does not appear to increase the risk for breast cancer unless there are other risk factors. b. HRT is a safe therapy for menopausal symptoms if there is no family history of BRCA genes. c. She and her health care provider must weigh the benefits of HRT against the possible risks of breast 22 | P a g e cancer. d. Alternative therapies with herbs and natural drugs are as effective as estrogen in relieving menopausal symptoms. ANS: C Because HRT has been linked to increased risk for breast cancer, the patient and provider must determine whether or not to use HRT. Breast cancer incidence is increased in women using HRT, independent of other risk factors. HRT increases the risk for both non-BRCA-associated cancer and BRCA-related cancers. Alternative therapies can be used but are not consistent in relieving menopausal symptoms. 6. A patient with stage II breast cancer tells the nurse, "I need to decide about what type of surgery to have, but I feel so overwhelmed that I cannot make any decisions yet! What do you think I should do?" Which response by the nurse is best? a. "I would have a lumpectomy, but you need to decide what is best for you." b. "Tell me what you understand about the surgical options that are available." c. "It would not be appropriate for me to make the decision about your health." d. "There is no need to make a decision rapidly; you have time to think about this." ANS: B This response indicates the nurse's willingness to assist the patient with the decision-making process without imposing the nurse's values or opinions. Response B indicates that the nurse is not willing to help the patient with the decision about treatment. Because treatment decisions for breast cancer do need to be made relatively quickly, response C is not accurate. Since the nurse's values and situation are not the same as the patient's, imposing the nurse's opinions during this emotionally vulnerable time is not appropriate. 7. A patient at the clinic who has metastatic breast cancer has a new prescription for trastuzumab (Herceptin). The nurse will plan to a. have the patient schedule frequent eye examinations. b. instruct the patient to call if she notices ankle swelling. c. remind the patient that hot flashes may occur with the medication. d. teach the patient about the need to monitor serum electrolyte levels. ANS: B Herceptin can lead to ventricular dysfunction, so the patient is taught to self-monitor for symptoms of heart failure. There is no need to monitor serum electrolyte levels. Hot flashes or changes in visual acuity may occur with tamoxifen, but not with trastuzumab. 8. The pathology report for a 42-year-old who has had a modified radical mastectomy identifies the tumor as an estrogen-receptor positive adenocarcinoma. The nurse will plan on teaching the patient about a. estradiol (Estrace). b. raloxifene (Evista). c. tamoxifen (Nolvadex). d. trastuzumab (Herceptin). 25 | P a g e detect or diagnose breast cancer. The other tests are likely to be used for additional diagnostic testing in a patient with breast cancer. 16. After a patient is diagnosed with lobular carcinoma in situ (LCIS), the nurse will anticipate that patient teaching may be needed about a. lumpectomy. b. lymphatic mapping. c. MammaPrint testing. d. tamoxifen (Nolvadex). ANS: D Tamoxifen is used as a chemopreventive therapy in some patients with LCIS. The other diagnostic tests and therapies are not needed because LCIS does not usually require treatment. 17. Following a lumpectomy, a patient is scheduled for external beam radiation to the right breast. Which information should the nurse include in patient teaching? a. The radiation therapy will take a week to complete. b. Careful skin care in the radiated area will be necessary. c. Visitors are restricted until the radiation therapy is completed. d. Wigs may be used until the hair regrows after radiation therapy. ANS: B Skin care will be needed because of the damage caused to the skin by the radiation. External beam radiation is done over a 5- to 6-week period. Hair loss does not occur with radiation therapy. Since the patient does not have radioactive implants, no visitor restrictions are necessary. 18. After the nurse has completed teaching a patient who has breast cancer about the newly prescribed tamoxifen (Nolvadex), which patient statement indicates that the teaching has been effective? a. "I will expect to have leg cramps with this drug." b. "I will call the clinic if I develop any hot flashes." c. "I will be taking the medication for at least a year." d. "I will call immediately if I have any eye problems." ANS: D Retinopathy, cataracts, and decreased visual acuity should be immediately reported because it is likely that the tamoxifen will be discontinued or decreased. Tamoxifen treatment generally lasts 5 years. Hot flashes are an expected side effect of tamoxifen. Leg cramps may be a sign of deep vein thrombosis, and the patient should immediately notify the health care provider if pain occurs. 19. Which action should the nurse take first when caring for a patient who has been admitted for lumpectomy and axillary lymph node dissection? a. Teach the patient how to deep breathe and cough. b. Discuss options for postoperative pain management. c. Explain the postdischarge care of the axillary drains. d. Ask the patient to describe what she knows about the surgery. 26 | P a g e ANS: D Before teaching, the nurse should assess the patient's current knowledge level. The other teaching also may be appropriate, depending on the assessment findings. 20. When the nurse is working in the women's health care clinic, which of these actions is appropriate to take? a. Educate a healthy 36-year-old about the need for an annual mammogram. b. Discuss the need for a clinical breast examination every year with a 22-year-old. c. Talk about magnetic resonance imaging (MRI) with a 26-year-old with a BRCA-1 mutation. d. Teach an active 70-year-old that mammography frequency can be reduced to every 3 years. ANS: C MRI (in addition to mammography) is recommended for women who are at high risk for breast cancer. A 22-year-old patient should have a clinical breast exam every 3 years. Annual mammograms are recommended for women starting at age 40. Annual mammography is recommended for healthy older women. 21. When the nurse is caring for a patient with left arm lymphedema, which action will be included in the plan of care? a. Check BP on both right and left arms. b. Avoid isometric exercise on the left arm. c. Assist with application of compression dressings. d. Keep the left arm at or below the level of the heart. ANS: C Compression of the arm assists in improving lymphatic flow toward the heart. Isometric exercises may be prescribed for lymphedema. BPs should only be done on the patient's right arm. The arm should not be placed in a dependent position. 22. A 33-year-old who has a diagnosis of fibrocystic breast changes calls the nurse in the clinic with these symptoms. Which is most important to report to the health care provider? a. There is yellow-green discharge from one of the patient's nipples. b. There is an area on the breast that is hot, pink, and tender to touch. c. The lumps are firm feeling and most are in the upper outer breast quadrants. d. The lumps are larger and more painful before the patient's menstrual period. ANS: B An area that is hot or pink suggests an infectious process such as mastitis, which would require further assessment and treatment. The other information also will be reported, but these findings are typical in fibrocystic breasts. 23. During examination of a 67-year-old man, the nurse notes bilateral enlargement of the breasts. Which action should the nurse take first? a. Question the patient about any medications being currently used. b. Teach the patient about how to palpate the breast tissue for lumps. c. Refer the patient for mammography and biopsy of the breast tissue. d. Explain that this is a temporary condition due to hormonal changes. 27 | P a g e ANS: A The first action should be further assessment. Since gynecomastia is a possible side effect of drug therapy, asking about the current drug regimen is appropriate. The other actions may be needed, depending on the data that are obtained with further assessment. 24. Which of the following nursing interventions for the patient who has had right-sided breast- conservation surgery and an axillary lymph node dissection is appropriate to delegate to an LPN/LVN? a. Teaching the patient how to avoid injury to the right arm b. Assessing the patient's range of motion for the right arm c. Administering an analgesic 30 minutes before the scheduled arm exercises d. Evaluating the patient's understanding of discharge instructions about drain care ANS: C LPN/LVN education and scope of practice include administration and evaluation of the effects of analgesics. Assessment, teaching, and evaluation of a patient's understanding of instructions are more complex tasks that are more appropriate to RN level education and scope of practice. 25. When the nurse is caring for a patient with breast cancer who is receiving chemotherapy with doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan), which assessment finding is most important to communicate to the health care provider? a. The patient's apical pulse is irregular. b. The patient has complaints of fatigue. c. The patient eats only 15% of food on meal tray. d. The patient's white blood cell (WBC) count is 5000/mm3. ANS: A Doxorubicin can cause cardiac toxicity; the dysrhythmia should be reported because it may indicate a need for a change in therapy. Anorexia, fatigue, and a low-normal WBC count are expected effects of chemotherapy. Chapter 53: Sexually Transmitted Diseases 1. A man who has a profuse, purulent urethral discharge with painful urination is seen at the sexually transmitted disease (STD) clinic. Which information will be most important for the nurse to obtain? a. Contraceptive use b. Sexual orientation c. Immunization history d. Recent sexual contacts ANS: D Information about sexual contacts is needed to help establish whether the patient has been exposed to an STD and because sexual contacts also will need treatment. The other information also may be gathered, but is not as important in determining the plan of care for the patient's current symptoms. 2. A 21-year-old woman is being seen in the family medicine clinic for an annual physical exam. The nurse will plan to teach the patient about a. testing for chlamydia infection. b. immunization for herpes simplex. 30 | P a g e 9. A woman who is 6 weeks' pregnant is diagnosed with primary syphilis. The nurse will plan to teach the patient about a. the likelihood of a stillbirth. b. the need for cesarean section. c. intramuscular injection of penicillin. d. use of antibiotic eye drops for the newborn. ANS: C A single injection of penicillin is recommended to treat primary syphilis, and this will treat the mother and prevent transmission of the disease to the fetus. Instillation of erythromycin into the eyes of the newborn is used to prevent gonorrheal eye infections. C-section is used to prevent the transmission of herpes to the newborn. Although stillbirth can occur if the fetus is infected with syphilis, treatment before the tenth week of gestation will eliminate in utero transmission to the fetus. 10. A 23-year-old patient has genital warts around her external genitalia and perianal area. She tells the nurse that she has not had treatment until now because "the warts are so disgusting." Which nursing diagnosis is most appropriate? a. Disturbed body image related to feelings about the genital warts b. Ineffective coping related to denial of increased risk for infection c. Risk for infection related to lack of knowledge about transmission d. Anxiety related to impact of condition on interpersonal relationships ANS: A The patient's statement that her lesions are disgusting suggests that disturbed body image is the major concern. There is no evidence to indicate ineffective coping or lack of knowledge about mode of transmission. The patient may be experiencing anxiety, but there is nothing in the data indicating that the genital warts are impacting interpersonal relationships. 11. When a patient returns to the clinic for follow-up after treatment for gonococcal urethritis, a purulent urethral discharge is still present. When trying to determine the reason for the recurrent infection, which question is most appropriate for the nurse to ask the patient? a. "Did you take the prescribed antibiotic for a week?" b. "Did you drink at least 2 quarts of fluids every day?" c. "Were your sexual partners treated with antibiotics?" d. "Do you wash your hands after using the bathroom?" ANS: C A common reason for recurrence of symptoms is reinfection because infected partners have not been simultaneously treated. Because gonorrhea is treated with one dose of antibiotic, antibiotic therapy for a week is not needed. An adequate fluid intake is important, but a low fluid intake is not a likely cause for failed treatment. Poor hygiene may cause complications such as ocular trachoma but will not cause a failure of treatment. 12. A patient is treated for chlamydia that was detected during a routine pelvic examination. The nurse knows that teaching regarding the management of the condition has been effective when the patient says, a. "Go ahead and give me the antibiotic injection so I will be cured." 31 | P a g e b. "My boyfriend will need to take antibiotics at the same time I do." c. "I will use condoms during sex until I finish taking all the antibiotics." d. "Since I do not plan on having any children, treatment is not as important." ANS: B Sex partners should be treated simultaneously to prevent reinfection. Chlamydia is treated with oral antibiotics. Abstinence from sexual intercourse is recommended for 7 days after treatment, and condoms should be recommended during all sexual contacts to prevent infection. Chronic pelvic pain, as well as infertility, can result from untreated chlamydia. 13. A woman in the sexually transmitted disease (STD) clinic tells the nurse that she is concerned she may have been exposed to gonorrhea by her partner. To determine whether the patient has gonorrhea, the nurse will plan to a. interview the patient about symptoms of gonorrhea. b. take a sample of cervical discharge for Gram staining. c. draw a blood specimen or rapid plasma reagin (RPR) testing. d. obtain vaginal secretions for a nucleic acid amplification test (NAAT). ANS: D NAAT has a high sensitivity (similar to a culture) for gonorrhea. Because women have few symptoms of gonorrhea, asking the patient about symptoms is not helpful in making a diagnosis. Smears and Gram staining are not useful because the female genitourinary tract has many normal flora that resemble N. gonorrhoeae. RPR testing is used to detect syphilis. 14. A woman who is diagnosed with chlamydia tells the nurse that she is very angry because her husband is her only sexual partner. Which response should the nurse make first? a. "You may need professional counseling to help resolve your anger." b. "It is understandable that you are angry with your husband right now." c. "Your feelings are justified and you should share them with your husband." d. "It is important that both you and your husband be treated for the infection." ANS: B This response expresses the nurse's acceptance of the patient's feelings and encourages further discussion and problem solving. The patient may need professional counseling, but more assessment of the patient is needed before making this judgment. The nurse also should assess further before suggesting that the patient share her feelings with the husband because problems such as abuse might be present in the relationship. Although it is important that both partners be treated, the patient's current anger suggests that this is not the appropriate time to bring this up. 15. Which of these patients will the nurse plan on teaching about the Gardasil vaccine? a. A 50-year-old woman who has multiple sexual partners b. A 23-year-old woman who is pregnant for the first time c. An 18-year-old female who has never been sexually active d. A 28-year-old woman who is in a monogamous relationship 32 | P a g e ANS: C Gardasil is recommended for females ages 9 through 26, preferably those who have never been sexually active. It is not recommended for men, women during pregnancy, or for older women. A 47-year-old patient with a long history of IV drug use is seen at a community clinic, where the patient reports difficulty walking because "I don't know where my feet are." Diagnostic screening reveals positive Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorption (FAT-ABS) tests. Based on the patient history, the nurse will assess which of the following (select all that apply)? a. Heart sounds b. Genitalia for lesions c. Joints for swelling and inflammation d. Mental state for judgment and orientation e. Skin and mucous membranes for gummas ANS: A, D, E The patient's clinical manifestations and laboratory tests are consistent with tertiary syphilis; valvular insufficiency, gummas, and changes in mentation are other clinical manifestations of this stage. Chapter 54: Female Reproductive Problems 1. A 33-year-old woman who uses oral contraceptives tells the nurse, "I want to have children in a few years." Which response by the nurse is appropriate? a. "You may have more difficulty becoming pregnant after about age 35." b. "You have many years of fertility left, so there is no rush to have children." c. "You should plan to stop taking oral contraceptives several years before you want to become pregnant." d. "If you do not have children within the next few years, it will be very difficult for you to become pregnant." ANS: A The probability of successfully becoming pregnant decreases after age 35, although some patients may have no difficulty in becoming pregnant. Oral contraceptives do not need to be withdrawn for several years for a woman to become pregnant. Although the patient may be fertile for many years, it would be inaccurate to indicate that there is no concern about infertility as she becomes older. Although the risk for infertility increases after age 35, not all patients have difficulty in conceiving. 2. A couple is considering the possibility of in vitro fertilization (IVF). The woman tells the nurse that they cannot afford IVF on her husband's salary, and the husband replies that if the wife would get a job, they would have enough money. Which nursing diagnosis is appropriate? a. Decisional conflict related to inadequate financial resources b. Ineffective sexuality patterns related to psychological stress c. Defensive coping related to anxiety about lack of conception d. Ineffective denial related to frustration about continued infertility 35 | P a g e ANS: B Because anemia is a likely complication of menorrhagia, the nurse will need to check the CBC. Estrogen and GNRH levels are checked for patients with other problems, such as infertility. Serial -hCG levels are monitored in patients who may be pregnant, which is not likely for this patient. 10. A 46-year-old woman tells the nurse that she has not had a menstrual period for 3 months and asks whether she is going into menopause. The best response by the nurse is, a. "Have you thought about using hormone replacement therapy?" b. "Most women feel a little depressed about entering menopause." c. "What was your menstrual pattern before your periods stopped?" d. "Since you are in your mid-40s, it is likely that you are menopausal." ANS: C The initial response by the nurse should be to assess the patient's baseline menstrual pattern. Although many women do enter menopause in the mid-40s, more information about this patient is needed before telling her that it is likely she is menopausal. Although hormone replacement therapy (HRT) may be prescribed, further assessment of the patient is needed before discussing therapies for menopause. Because the response to menopause is very individual, the nurse should not assume that the patient is experiencing any adverse emotional reactions. 11. Which information will the nurse include when teaching a 51-year-old woman who is considering the use of combined estrogen-progesterone hormone replacement therapy (HRT) during menopause? a. Use of estrogen-containing vaginal creams provides most of the same benefits as oral HRT. b. Use of HRT for up to 10 years to prevent symptoms such as hot flashes is generally considered safe. c. HRT decreases osteoporosis risk and increases the risk for cardiovascular disease and breast cancer. d. Increased incidence of colon cancer in women taking HRT requires frequent stool assessment for occult blood. ANS: C Data from the Women's Health Initiative indicate an increased risk for cardiovascular disease and breast cancer in women taking combination HRT but a decrease in hip fractures. Vaginal creams decrease symptoms related to vaginal atrophy and dryness, but they do not offer the other benefits of HRT, such as decreased hot flashes. Most women who use HRT are placed on short-term treatment and are not treated for up to 10 years. The incidence of colon cancer decreases in women taking HRT. 12. Six months after being sexually assaulted, a woman tells the nurse that she has nightmares about the incident and develops acute anxiety if she finds herself alone in situations where several men are present. The most appropriate nursing diagnosis for the patient is a. anxiety related to effects of being raped. b. sleep deprivation related to frightening dreams. c. rape-trauma syndrome related to rape experience. d. ineffective coping related to inability to resolve incident. 36 | P a g e ANS: C The patient's symptoms are most consistent with the nursing diagnosis of rape-trauma syndrome. The nursing diagnoses of sleep deprivation, ineffective coping, and anxiety address some aspects of the patient's symptoms but do not address the problem as completely as the rape-trauma syndrome diagnosis. 13. A patient is diagnosed with vaginal candidiasis and an antifungal vaginal cream is prescribed. Which statement by the patient indicates that the nurse's teaching about the treatment plan has been effective? a. "I will tell my husband that we cannot have sex for the next month." b. "I should clean carefully after each urination and bowel movement." c. "I can douche daily with warm water if the itching continues to bother me." d. "I will insert the cream using the applicator before I get up in the morning." ANS: B Cleaning of the perineal area will decrease itching caused by contact of the irritated tissues with urine and reduce the chance of further infection of irritated tissues by bacteria in the stool. Sexual intercourse should be avoided for 1 week. Douching will disrupt normal protective mechanisms in the vagina. The cream should be used at night so that it will remain in the vagina for longer. 14. A 22-year-old woman who is scheduled for a Pap test tells the nurse that she has had intercourse during the last year with several men. The nurse will plan to teach about the reason for a. contraceptive use. b. antibiotic therapy. c. chlamydia testing. d. pregnancy testing. ANS: C Chlamydia testing is recommended annually for women with multiple sex partners. There is no indication that the patient needs teaching about contraceptives, pregnancy testing, or antibiotic therapy. 15. When the nurse is caring for a patient with pelvic inflammatory disease (PID) requiring hospitalization, which nursing intervention will be included in the plan of care? a. Monitor liver function tests. b. Use cold packs PRN for pelvic pain. c. Teach the patient how to perform Kegel exercises. d. Elevate the head of the bed to at least 30 degrees. ANS: D The head of the bed should be elevated to at least 30 degrees to promote drainage of the pelvic cavity and prevent abscess formation higher in the abdomen. Although a possible complication of PID is acute perihepatitis, liver function tests will remain normal. There is no indication for increased fluid intake. Application of heat is used to reduce pain. Kegel exercises are not helpful in PID. 16. A patient with pelvic inflammatory disease (PID) is treated on an outpatient basis with oral antibiotics. Which instruction will be included in patient teaching? 37 | P a g e a. Return for a follow-up appointment in 2 days. b. Abdominal pain may persist for several weeks. c. Sexual intercourse should be avoided for 1 week. d. Nonsteroidal antiinflammatory drug (NSAID) use may prevent scarring of pelvic organs. ANS: A The patient is instructed to return for follow-up in 48 to 72 hours. The patient should abstain from intercourse for 3 weeks. Abdominal pain should subside with effective antibiotic therapy. Corticosteroids may help prevent inflammation and scarring, but NSAIDs will not decrease scarring. 17. When a patient has oral contraceptives prescribed for endometriosis, the nurse will teach the patient to a. expect to experience side effects such as facial hair. b. take the medication every day for the next 9 months. c. use a second method of contraception to ensure that she will not become pregnant. d. take calcium supplements to prevent osteoporosis from developing during therapy. ANS: B When oral contraceptives are prescribed to treat endometriosis, the patient should take the medications continuously for 9 months. Facial hair is a side effect of synthetic androgens. The patient does not need to use additional contraceptive methods. The hormones in oral contraceptives will protect against osteoporosis. 18. A patient with endometriosis is treated with medroxyprogesterone (Depo-Provera). The nurse explains that this therapy a. suppresses the menstrual cycle by mimicking pregnancy. b. may cause symptoms such as vaginal atrophy and hot flashes. c. is associated with loss of bone density and increased fracture risk. d. will lead to permanent suppression of abnormal endometrial tissues. ANS: A Depo-Provera induces a pseudopregnancy, which suppresses ovulation and causes shrinkage of endometrial tissue. Vaginal atrophy and hot flashes are caused by synthetic androgens such as danazol or gonadotropin-releasing hormone agonists (GNRH) such as leuprolide. Although hormonal therapies will control endometriosis while the therapy is used, endometriosis will recur once the menstrual cycle is reestablished. Depo-Provera use is not associated with bone loss. 19. When caring for a patient recently diagnosed with polycystic ovary syndrome, it is most important for the nurse to teach the patient a. reasons for a total hysterectomy. b. how to decrease facial hair growth. c. ways to reduce the occurrence of acne. d. methods to maintain appropriate weight. ANS: D Obesity exacerbates the problems associated with polycystic ovary syndrome, such as insulin resistance and type 2 diabetes. The nurse also will address the problems of acne and hirsutism, but these 40 | P a g e b. Urine output of 100 mL in the first 8 hours after surgery c. One inch area of bloody drainage on the abdominal dressing d. Complaints of abdominal pain at the incision site with coughing ANS: B The decreased urine output indicates possible low blood volume and further assessment is needed to assess for possible internal bleeding. The other findings are not unusual after this surgery. 28. A 56-year-old woman undergoes an anterior and posterior (A&P) colporrhaphy for repair of a cystocele and rectocele. Which nursing action will be included in the postoperative care plan? a. Teach the patient correct pessary use. b. Perform indwelling catheter care daily. c. Repack the vaginal wound daily with gauze. d. Provide patient teaching about a high fiber diet. ANS: B The patient will have a retention catheter for several days after surgery to keep the bladder empty and decrease strain on the suture. A pessary will not be needed after the surgery. Vaginal wound packing is not usually used after an A&P repair. A low-residue diet will be ordered after posterior colporrhaphy. 29. A 54-year-old woman tells the nurse that she is postmenopausal but has occasional spotting. Which initial response by the nurse is most appropriate? a. "A frequent cause of spotting is endometrial cancer." b. "How long has it been since your last menstrual period?" c. "Breakthrough bleeding is not unusual in women your age." d. "Are you using prescription hormone replacement therapy?" ANS: D In postmenopausal women, a common cause of spotting is hormone replacement therapy (HRT). Because breakthrough bleeding may be a sign of problems such as cancer or infection, the nurse would not imply that this is normal. The length of time since the last menstrual period is not relevant to the patient's symptoms. Although endometrial cancer may cause spotting, this information is not appropriate as an initial response. 30. An 18-year-old visits the health clinic for a routine check-up. To determine whether a Pap test is needed, which question should the nurse ask? a. "Do you use any illegal substances?" b. "Have you ever had sexual intercourse?" c. "How old were you when your menstrual periods started?" d. "Do you have any cramping with your menstrual periods?" ANS: B The current American Cancer Society recommendation is that a Pap test be done every 3 years, starting 3 years after the first sexual intercourse and no later than age 21. The information about menstrual periods and substance abuse will not help to determine whether the patient requires a Pap test. 31. Which information will the nurse include when developing a patient teaching plan for a 48-year-old patient with uterine bleeding caused by a leiomyoma? 41 | P a g e a. Aspirin or nonsteroidal antiinflammatory drugs (NSAIDs) may be used to control mild to moderate pain. b. The tumor size is likely to increase throughout the patient's lifetime. c. The symptoms may decrease after the patient undergoes menopause. d. The patient will need frequent monitoring to detect any malignant changes. ANS: C Leiomyomas appear to depend on ovarian hormones and will atrophy after menopause, leading to a decrease in symptoms. Aspirin use is discouraged because the antiplatelet effects may lead to heavier uterine bleeding. The size of the tumor will shrink after menopause. Leiomyomas are benign tumors that do not undergo malignant changes. 32. A female patient who is seen in the health clinic is diagnosed with genital warts. The nurse will plan to teach the patient about a. the need for regular Pap tests. b. increased risk for endometrial cancer. c. appropriate use of oral contraceptives. d. symptoms of pelvic inflammatory disease. ANS: A Genital warts are caused by the human papilloma virus (HPV) and increase the risk for cervical cancer. There is no indication that the patient needs teaching about PID, oral contraceptives, or endometrial cancer. 33. Which statement by a patient who has just been instructed in the treatment for a Chlamydia trachomatis vaginal infection indicates that the nurse's teaching has been effective? a. "I can purchase an over-the-counter medication to treat this infection." b. "The symptoms are due to the overgrowth of normal vaginal bacteria." c. "The medication will need to be inserted once daily with an applicator." d. "Both my partner and I will need to take the medication for a full week." ANS: D Chlamydia is a sexually transmitted bacterial infection that requires treatment of both partners with antibiotics for 7 days. The other statements are true for the treatment of Candida albicans infection. 34. Which action by the nurse will be most important in maintaining the medicolegal chain of evidence for a patient who has been sexually assaulted? a. Label all specimens and materials obtained from the patient. b. Educate the patient about the reason for baseline sexually transmitted disease (STD) testing. c. Assist the patient in filling out the application for financial compensation. d. Discuss the availability of the "morning-after pill" for pregnancy prevention. ANS: A All of the interventions are appropriate, but only the careful labeling of specimens and materials will assist in maintaining the chain of evidence. 35. A 32-year-old patient has minor changes on her Pap test. Which action should the nurse take? a. Teach the patient about colposcopy. 42 | P a g e b. Teach the patient about punch biopsy. c. Schedule another Pap test in 4 months. d. Administer the human papilloma virus (HPV) vaccine. ANS: C Patients with minor changes on the Pap test can be followed with Pap tests every 4 to 6 months because these changes may revert to normal. Punch biopsy or colposcopy may be used if the Pap test shows more prominent changes. The HPV vaccine may reduce the risk for cervical cancer, but it is recommended only for ages 9 through 26. 36. A 19-year-old requests a prescription for birth control pills to decrease abdominal cramping and headaches during her menstrual periods. Which of these actions should the nurse take first? a. Determine whether the patient is sexually active. b. Suggest that the patient use nonsteroidal antiinflammatory drugs (NSAIDs) for symptom relief. c. Take a personal and family health history from the patient. d. Teach the patient about the side effects of oral contraceptives. ANS: C Oral contraceptives may be appropriate to control this patient's symptoms, but the patient's health history may indicate contraindications to oral contraceptive use. Because the patient is requesting contraceptives for management of dysmenorrhea, whether she is sexually active is irrelevant. Since the patient is asking for birth control pills, responding that she should try NSAIDs is nontherapeutic. The patient does not need teaching about oral contraceptive side effects at this time. 37. Which assessment finding in a woman who recently started taking hormone replacement therapy (HRT) is most important for the nurse to report to the health care provider? a. Breast tenderness b. Weight gain of 3 lb c. Intermittent spotting d. Unilateral calf swelling ANS: D Unilateral calf swelling may indicate deep vein thrombosis caused by the changes in coagulation associated with HRT and would indicate that the HRT should be discontinued. Breast tenderness, weight gain, and intermittent spotting are common side effects of HRT and do not indicate a need for a change in therapy. 38. After being sexually assaulted, a woman is brought to the emergency department by a friend. The patient is confused and has a large laceration above the left eye. Which action should the nurse take first? a. Assess the patient's neurologic status. b. Assist the patient in removing her clothing. c. Contact the sexual assault nurse examiner (SANE). d. Ask the patient to describe what occurred during the assault. 45 | P a g e with the patient. Erectile function is not usually affected by a TURP, so the patient will not need information about penile implants or reassurance that other forms of sexual expression may be used. Because the patient has not asked about fertility, reassurance about sperm production does not address his concerns. 3. The health care provider prescribes finasteride (Proscar) for a 56-year-old patient who has benign prostatic hyperplasia (BPH). When teaching the patient about the drug, the nurse informs him that a. he should change position from lying to standing slowly to avoid dizziness. b. his interest in sexual activity may decrease while he is taking the medication. c. improvement in the obstructive symptoms should occur within about 2 weeks. d. he will need to monitor his blood pressure frequently to assess for hypertension. ANS: B A decrease in libido is a side effect of finasteride because of the androgen suppression that occurs with the drug. Although orthostatic hypotension may occur if the patient also is taking a medication for erectile dysfunction (ED), it should not occur with finasteride alone. Improvement in symptoms of obstruction takes about 6 months. The medication does not cause hypertension. 4. A patient has an enlarged prostate detected by digital rectal examination (DRE) and an elevated prostate specific antigen (PSA) level. The nurse will anticipate that the patient will need teaching about a. cystourethroscopy. b. uroflowmetry studies. c. magnetic resonance imaging (MRI). d. transrectal ultrasonography (TRUS). ANS: D In a patient with an abnormal DRE and elevated PSA, transrectal ultrasound is used to visualize the prostate for biopsy. Uroflowmetry studies help determine the extent of urine blockage and treatment, but there is no indication that this is a problem for this patient. Cystoscopy may be used before prostatectomy but will not be done until after the TRUS and biopsy. MRI is used to determine whether prostatic cancer has metastasized but would not be ordered at this stage of the diagnostic process. 5. When teaching a patient who is scheduled for a transurethral resection of the prostate (TURP) about continuous bladder irrigation, which information will the nurse include? a. Bladder irrigation decreases the risk of postoperative bleeding. b. Hydration and urine output are maintained by bladder irrigation. c. Bladder irrigation prevents obstruction of the catheter after surgery. d. Antibiotics are infused on a continuous basis with bladder irrigation. ANS: C The purpose of bladder irrigation is to remove clots from the bladder and to prevent obstruction of the catheter by clots. The irrigation does not decrease bleeding or improve hydration. Antibiotics are given by the IV route, not through the bladder irrigation. 46 | P a g e 6. A patient with symptomatic benign prostatic hyperplasia (BPH) is scheduled for photovaporization of the prostate (PVP) at an outpatient surgical center. The nurse will plan to teach the patient a. how to care for an indwelling urinary catheter. b. that the urine will appear bloody for several days. c. about complications associated with urethral stenting. d. that symptom improvement will occur in 2 to 3 weeks. ANS: A The patient will have an indwelling catheter for 24 to 48 hours and will need teaching about catheter care. There is minimal bleeding with this procedure. Symptom improvement is almost immediate after PVP. Stent placement is not included in the procedure. 7. A 51-year-old man is scheduled for an annual physical exam at the outpatient clinic. The nurse will plan to teach the patient about the purpose of a. urinalysis collection. b. uroflowmetry studies. c. prostate specific antigen (PSA) testing. d. transrectal ultrasound scanning (TRUS). ANS: C An annual digital rectal exam (DRE) and PSA are recommended starting at age 50 for men who have an average risk for prostate cancer. Urinalysis and uroflowmetry studies are done if patients have symptoms of urinary tract infection or changes in the urinary stream. TRUS may be ordered if the DRE or PSA are abnormal 8. A 64-year-old has a perineal radical prostatectomy for prostatic cancer. In the immediate postoperative period, the nurse establishes the nursing diagnosis of risk for infection related to a. urinary stasis. b. urinary incontinence. c. possible fecal contamination of the surgical wound. d. placement of a suprapubic catheter into the bladder. ANS: C The perineal approach increases the risk for infection because the incision is located close to the anus and contamination with feces is possible. Urinary stasis and incontinence do not occur because the patient has a retention catheter in place for 1 to 2 weeks. A urethral catheter is used after the surgery. 9. Following a radical retropubic prostatectomy for prostate cancer, the patient is incontinent of urine. The nurse will plan to teach the patient a. to restrict oral fluid intake. b. pelvic floor muscle exercises. c. the use of belladonna and opium suppositories. d. how to perform intermittent self-catheterization. ANS: B Pelvic floor muscle training (Kegel) exercises are recommended to strengthen the pelvic floor muscles and improve urinary control. Belladonna and opium suppositories are used to reduce bladder spasms 47 | P a g e after surgery. Intermittent self-catheterization may be taught before surgery if the patient has urinary retention, but it will not be useful in reducing incontinence after surgery. The patient should have a daily oral intake of 2 to 3 L. 10. Following discharge teaching for a patient who has had a transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH), the nurse determines that additional instruction is needed when the patient says, a. "I will avoid driving until I get approval from my doctor." b. "I should call the doctor if I have any incontinence at home." c. "I will increase fiber and fluids in my diet to prevent constipation." d. "I should continue to schedule yearly appointments for prostate exams." ANS: B Since incontinence is common for several weeks after a TURP, the patient does not need to call the health care provider if this occurs. The other patient statements indicate that the patient has a good understanding of post-TURP instructions. 11. Leuprolide (Lupron) is prescribed for a patient with cancer of the prostate. In teaching the patient about this drug, the nurse informs the patient that side effects may include a. dizziness. b. hot flashes. c. urinary incontinence. d. increased infection risk. ANS: B Hot flashes may occur with decreased testosterone production. Dizziness may occur with the -blockers used for benign prostatic hyperplasia (BPH). Urinary incontinence may occur after prostate surgery, but it is not an expected medication side effect. Risk for infection is increased in patients receiving chemotherapy. 12. Which information will the nurse include when teaching a patient who has a diagnosis of chronic prostatitis? a. Ibuprofen (Motrin) should provide good pain control. b. Prescribed antibiotics should be taken for 7 to 10 days. c. Sexual intercourse and masturbation will help relieve symptoms. d. Cold packs should be used every 4 hours to reduce inflammation. ANS: C Ejaculation helps drain the prostate and relieve pain. Warm baths are recommended to reduce pain. Nonsteroidal antiinflammatory drugs (NSAIDs) are frequently prescribed but usually do not offer adequate pain relief. Antibiotics for chronic prostatitis are taken for 4 to 12 weeks 13. A couple is seen at the infertility clinic because they have not been able to conceive. When performing a focused examination to determine any possible causes for infertility, the nurse will check the man for the presence of a. hydrocele. b. varicocele. 50 | P a g e 20. When caring for a patient who has been diagnosed with orchitis, the nurse will plan to provide teaching about a. pain management. b. emergency surgical repair. c. aspiration of fluid from the scrotal sac. d. application of warm packs to the scrotum. ANS: A Orchitis is very painful and effective pain management will be needed. The other therapies will not be used to treat orchitis. 21. A patient with benign prostatic hyperplasia (BPH) is admitted to the hospital with urinary retention and new onset elevations in the blood urea nitrogen (BUN) and creatinine. Which of these prescribed therapies should the nurse implement first? a. Schedule an abdominal computed tomography (CT) scan. b. Insert a urinary retention catheter. c. Draw blood for a complete blood count. d. Infuse normal saline at 50 mL/hr. ANS: B The patient data indicate that the patient may have acute renal failure caused by the BPH. The initial therapy will be to insert a catheter. The other actions also are appropriate, but they can be implemented after the acute urinary retention is resolved. 22. When reviewing patient laboratory results, the nurse in the clinic notes elevated prostate specific antigen (PSA) levels in the following four patients. Which patient's PSA result is most important to report to the health care provider? a. A 75-year-old who uses saw palmetto to treat benign prostatic hyperplasia (BPH) b. A 38-year-old who is being treated for acute prostatitis c. A 48-year-old whose father died of metastatic prostate cancer d. A 52-year-old who goes on long bicycle rides every weekend ANS: C The family history and elevation of PSA in the 48-year-old indicate that further evaluation of the patient for prostate cancer is needed. The elevations in PSA for the other patients are not unusual. 23. After a transurethral resection of the prostate (TURP), a patient with continuous bladder irrigation complains of painful bladder spasms. The nurse observes a decrease in urine output and clots in the urine. Which action should the nurse take first? a. Increase the flow rate of the bladder irrigation. b. Administer the prescribed IV morphine sulfate. c. Give the patient the prescribed belladonna and opium suppository. d. Manually instill and then withdraw 50 mL of saline into the catheter. 51 | P a g e ANS: D The assessment suggests that obstruction by a clot is causing the bladder spasms, and the nurse's first action should be to irrigate the catheter manually and to try to remove the clots. IV morphine will not decrease the spasm, although pain may be reduced. Increasing the flow rate of the irrigation will further distend the bladder and may increase spasms. The belladonna and opium suppository will decrease bladder spasms but will not remove the obstructing blood clot. 24. A 22-year-old man tells the nurse at the health clinic that he has recently had some problems with erectile dysfunction. When assessing for possible etiologic factors, which question should the nurse ask first? a. "Are you using any recreational drugs or drinking a lot of alcohol?" b. "Have you been experiencing an unusual amount of anxiety or stress?" c. "Do you have any history of an erection that lasted for 6 hours or more?" d. "Do you have any chronic cardiovascular or peripheral vascular disease?" ANS: A A common etiologic factor for erectile dysfunction (ED) in younger men is use of recreational drugs or alcohol. Stress, priapism, and cardiovascular illness also contribute to ED, but they are not common etiologic factors in younger men. 25. A 53-year-old man tells the nurse he has been having increasing problems with erectile dysfunction (ED) for several years but is now interested in using Viagra (sildenafil). Which action should the nurse take first? a. Ask the patient about any prescription drugs he is taking. b. Tell the patient that Viagra does not always work for ED. c. Discuss the common adverse effects of erectogenic drugs. d. Assure the patient that ED is commonly associated with aging. ANS: A Because some medications can cause ED and patients using nitrates should not take Viagra, the nurse should first assess for prescription drug use. The nurse may want to teach the patient about realistic expectations and adverse effects of Viagra therapy, but this should not be the first action. Although ED does increase with aging, it may be secondary to medication use or cardiovascular disease in a 53-year- old. 26. The nurse working in a health clinic receives calls from all these patients. Which patient should be seen by the health care provider first? a. A 44-year-old man who has perineal pain and a temperature of 100.4° F b. A 66-year-old man who has a painful erection that has lasted over 7 hours c. A 62-year-old man who has light pink urine after having a transurethral resection of the prostate (TURP) 3 days ago d. A 23-year-old man who states he had difficulty maintaining an erection last night ANS: B Priapism can cause complications such as necrosis or hydronephrosis, and this patient should be treated immediately. The other patients do not require immediate action to prevent serious complications 52 | P a g e 27. Which assessment information about a 62-year-old man is most important for the nurse to report to the health care provider when the patient is asking for a prescription for testosterone replacement therapy? a. The patient's symptoms have increased steadily over the last few years. b. The patient has been using sildenafil (Viagra) several times every week. c. The patient has had a gradual decrease in the force of his urinary stream. d. The patient states that he has noticed a decrease in energy level for a few years. ANS: C The decrease in urinary stream may indicate benign prostatic hyperplasia (BPH) or prostate cancer, which are contraindications to the use of testosterone replacement therapy (TRT). The other patient data indicate that TRT may be a helpful therapy for the patient. 21. 22. 23. 24. 25. 26. 21.