TEST 10: The Client with Reproductive Health Problems

Question 1

The Client with a Vaginal Infection
1. A nurse is reviewing a client’s chart and notes the Papanicolaou smear laboratory report
indicates visualization of clue cells and a vaginal pH of 3.8. What should the nurse teach this client?
Select all that apply.
1. Seek care if the vaginal discharge has a fishy odor.
2. Seek care if experiencing thick, white, adherent vaginal discharge.
3. All vaginal infections are sexually transmitted infections.
4. Do not douche unless instructed by a health care provider.
5. Usually vaginal infections can be treated with over-the-counter preparations.

Answer 1

The Client with a Vaginal Infection
1. 1, 2, 4. Bacterial vaginosis is a clinical syndrome resulting from the replacement of the normal
vaginal Lactobacillus species with overgrowth of anaerobic bacteria that cause a cluster of
symptoms. Presence of a thick, white, adherent vaginal discharge with a fishy odor is evidence for
bacterial vaginosis, and the client should seek treatment. The client should not douche unless under
medical prescriptions because douching can cause bacteria to ascend into the uterus. Bacterial
vaginosis is not sexually transmitted, and it does not require treatment of the partner. Vaginal
infections commonly require an examination and diagnostic assessment.
CN: Reduction of risk potential; CL: Synthesize

Question 2

2. A nurse is discussing daily activities with a client. Which of the following activities puts the
   client at risk for altering the normal pH of her vagina?
3. Consuming over four cups of coffee per day.
4. Having sexual intercourse during the menstrual cycle.
5. Douching unless instructed to do so by the health care provider.
6. Using tampons during the menstrual cycle.

Answer 2

2. 3. Douching may disrupt the normal flora of the vaginal lactobacilli and change the pH, which
      could result in overgrowth of other bacteria. Coffee, intercourse during menses, and tampons are not
      related to changes in vaginal pH or the incidence of bacterial vaginosis.
      CN: Health promotion and maintenance; CL: Apply

Question 3

3. A client is prescribed oral metronidazole (Flagyl) for treatment of bacterial vaginosis. What
   should the nurse instruct the client to avoid during treatment and for 24 hours thereafter?
4. Douching.
5. Sexual intercourse.
6. Hot tub baths.
7. Alcohol consumption.

Answer 3

3. 4. Metronidazole (Flagyl) interacts with alcohol and can cause a serious disulfiram
      (Antabuse)-type reaction, with severe, prolonged vomiting. The client should not douche unless
      following a medical prescription, but douching does not interact with Flagyl. Sexual intercourse and
      hot tub baths are not known to affect the incidence or treatment of bacterial vaginosis.
      CN: Pharmacological and parenteral therapies; CL: Synthesize

Question 4

4. A nurse is assessing a client with vaginal discharge. Which of the following diseases are
   commonly associated with vaginal discharge? Select all that apply.
5. Candidiasis.
6. Bacterial vaginosis.
7. Gonorrhea.
8. Trichomoniasis.
9. Syphilis.

Answer 4

4. 1, 2, 4. Candidiasis causes a white discharge that results in redness and itching. Bacterial
   vaginosis causes a thick, white, adherent discharge. Trichomoniasis causes a diffuse, yellow-green
   discharge and is a sexually transmitted infection. Gonorrhea and syphilis usually do not change
   vaginal discharge.
   CN: Reduction of risk potential; CL: Apply

Question 5

5. A female client with which condition would be at increased risk for vulvovaginal candidiasis?
   Select all that apply.
6. Uncontrolled diabetes.
7. Immunosuppression due to cancer.
8. Human immunodeficiency virus (HIV) infection.
9. Hypertension.
10. Asthma.

Answer 5

5. 1, 2, 3. Women with underlying medical conditions, such as uncontrolled diabetes and HIV
   infection or cancer-causing immunosuppression, correlate with an increasing severity of candidiasis.
   Hypertension and asthma are not related to immunosuppression or complicated candidiasis.
   CN: Health promotion and maintenance; CL: Analyze

Question 6

6. A client taking oral contraceptives is placed on a 10-day course of antibiotics for an infection.
   Which of the following instructions should the nurse include in the teaching plan?
7. “Use a barrier method of birth control for the rest of your cycle.”
8. “You should stop taking the oral contraceptives while taking the antibiotic.”
9. “Call your health care provider for increased hunger or fluid retention.”
10. “Take the antibiotics 2 hours after the oral contraceptive.”

Answer 6

6. 1. Antibiotics may decrease the effectiveness of oral contraceptives. The client should be
      instructed to continue the contraceptives and use a barrier method as a backup method of birth control
      until the next menstrual cycle. The client should not stop taking her oral contraceptives and there is no
      indication for or benefit to taking the antibiotic 2 hours after the contraceptive. There is no incidenceof the adverse effects of increased hunger and fluid retention with the interaction of antibiotic therapy
      and oral contraceptives.
      CN: Pharmacological and parenteral therapies; CL: Create

Question 7

7. A client is asking for information about using an intrauterine device (IUD). Which of the
   following questions asked by the nurse would provide pertinent information on whether or not a client
   is a candidate for an IUD?
8. “Do you smoke?”
9. “Do you have hypertension?”
10. “How often do you have sex?”
11. “Are you in a monogamous relationship?”

Answer 7

7. 4. Due to the increased risk of pelvic inflammatory disease, candidates for the IUD should be
      in a monogamous relationship. Smoking and hypertension are not contraindications for an IUD. The
      frequency of sexual relations will not affect IUD use.
      CN: Pharmacological and parenteral therapies; CL: Analyze

Question 8

8. A nurse is caring for a hospitalized 22-year-old female client with type 1 diabetes mellitus and
   toxic shock syndrome (TSS). Which of the following should the nurse perform first?
9. Administer 5% dextrose in half-normal saline solution at 150 mL/h IV.
10. Administer 50 mg of meperidine (Demerol) IM every 4 hours as needed for pain.
11. Teach the client to use pads at night instead of tampons during her menstrual period.
12. Administer 400 mg of ciprofloxacin (Cipro) IV every 12 hours infused over 1 hour.

Answer 8

8. 1. Fluid losses can occur from vomiting, diarrhea, and fever and can lead to hypovolemic
      shock. The first nursing action is to treat the hypovolemic shock that accompanies toxic shock, so the
      IV fluids must be administered immediately. The fluid replacement is critical to avoid circulatory
      collapse. Pain medication and teaching can be implemented later. Antibiotics will be given because
      TSS is caused by a staphylococcal infection; however, fluid replacement is initiated first to treat life-
      threatening hypovolemic shock.
      CN: Reduction of risk potential; CL: Synthesize

Question 9

The Client with Uterine Fibroids

9. A 39-year-old female client has been experiencing intermittent vaginal bleeding for several
   months. Her physician tells her that she has uterine fibroids and recommends an abdominal
   hysterectomy. When the client expresses fear about the surgery, the nurse should:
10. Reassure the client of her physician’s competence.
11. Give the client opportunities to express her fears.
12. Teach the client that fear impedes recovery.
13. Change the topic of conversation.

Answer 9

The Client with Uterine Fibroids
9. 2. The best approach for a client who is fearful about having surgery is to allow the client
opportunities to express her fears. Open-ended questions should elicit the client’s individual and
specific fears. This then gives the nurse the opportunity to provide clarification, information, and
support and possibly to offer other resources. The other actions are not supportive and deny the client
the opportunity to express her feelings.
CN: Psychosocial adaptation; CL: Synthesize

Question 10

10. A female with uterine fibroids has dysmenorrhea and menorrhagia. After reviewing the
    laboratory reports, the nurse should report which results to the health care provider? Select all that
    apply.
11. Hemoglobin, 9.0 g/dL (90 g/L).
12. Hematocrit, 27.1% (0.27).
13. White blood cell count, 10,000 cells/mm 3 (10 × 10 9 /L).
14. Potassium, 4.0 mEq/L (4.0 mmol/L).
15. Normocytic red blood cells.

Answer 10

10. 1, 2. A woman with uterine fibroids and dysmenorrhea is at risk for iron deficiency anemia.
    The hemoglobin and hematocrit indicate the likelihood that the fibroids causing heavy menstrual
    blood loss have resulted in anemia. A hemoglobin of less than 12 g/dL (120 g/L) in women is
    considered low. The white blood cell count and potassium levels are within normal parameters, and
    normocytic red blood cells are normal.
    CN: Management of care; CL: Synthesize

Question 11

11. The client will have an abdominal hysterectomy tomorrow. Which of the following
    information will be most important for the nurse to give to the client prior to admission to the
    hospital?
12. What to wear to the hospital.
13. What she can eat and drink before admission.
14. The type of pain medication that will be prescribed postoperatively.
15. The amount of activity she can have after surgery.

Answer 11

11. 2. It is a priority that the client knows she will not be able to eat or drink for 8 hours before
       admission. A client who consumes food and fluid before receiving a general anesthetic is at risk for
       aspiration, which can lead to aspiration pneumonia, respiratory arrest, and even death. The clothing
       she should wear to the hospital and the type of medication she will receive are important, but not the
       priority. Information on exercise and resumption of normal activities can be included in the discharge
       teaching.
       CN: Basic care and comfort; CL: Synthesize

Question 12

12. The nurse is witnessing the client’s signature on the informed surgical consent for an
    abdominal hysterectomy. It is important to ascertain that the client understands that with this surgical
    procedure she will have:
13. Decreased libido.
14. Infertility.
15. Depression.
16. Weight gain.

Answer 12

12. 2. The client needs to understand that with removal of the uterus she will no longer be able to
       bear children or have menstrual periods. The surgical procedure should not change her libido or
       sexual functioning. Research does not support the idea that hysterectomy contributes to depression or
       weight gain. Research demonstrates that women who have managed health problems for some time
       before the hysterectomy may actually have a more positive effect, with less worry about their health
       condition, contraception, or pregnancy.CN: Management of care; CL: Apply

Question 13

13. Which is the correct order, from first to last, for proper placement of a urinary catheter?
14. Lubricate the catheter adequately with a water-soluble lubricant.
15. Ensure free flow of urine.
16. Insert the catheter far enough into the bladder to prevent trauma to the urethral tissue.
17. Prepare a sterile field.

Answer 13

13.
4. Prepare a sterile field.
1. Lubricate the catheter adequately with a water-soluble lubricant.
3. Insert the catheter far enough into the bladder to prevent trauma to the urethral tissue.
2. Ensure free flow of urine.
After gathering appropriate supplies, the nurse should prepare a sterile field. After lubricating the
catheter adequately with a water-soluble lubricant to minimize trauma to the urethra, the nurse should
insert the catheter far enough into the bladder so the retention balloon does not traumatize urethral
tissues. Ensuring a free flow of urine prevents infection; improper drainage occurs when tubing is
kinked or twisted.
CN: Safety and infection control; CL: Apply

Question 14

14. Which of the following physical sensations will the client who has had an abdominal
    hysterectomy most likely experience if she hyperventilates while performing deep-breathing
    exercises?
15. Dyspnea.
16. Dizziness.
17. Blurred vision.
18. Mental confusion

Answer 14

14. 2. Hyperventilation occurs when the client breathes so rapidly and deeply that she exhales
       excessive amounts of carbon dioxide. A characteristic symptom of hyperventilation is dizziness. To
       avoid hyperventilation, the nurse should assist the client in the practice of slow, deep breathing in a
       regular breathing pattern. Dyspnea, blurred vision, and mental confusion are not associated with
       hyperventilation.
       CN: Physiological adaptation; CL: Apply

Question 15

ysterectomy?

1. Offering the client a hot beverage.
2. Providing extra warmth.
3. Applying a snugly fitting abdominal binder.
4. Helping the client walk.

Answer 15

15. 4. The discomfort associated with gas pains is likely to be relieved when the client ambulates.
       The gas will be more easily expelled with exercise. The anesthesia, analgesics, and immobility have
       altered normal peristalsis. Peristalsis will be stimulated by exercise. Offering a hot beverage,
       providing extra warmth, and applying an abdominal binder are not recommended and could aggravate
       the discomfort of postoperative gas pains.
       CN: Physiological adaptation; CL: Synthesize

Question 16

16. On the second postoperative day after an abdominal hysterectomy, the client develops a
    temperature of 100.4°F (38°C). The nurse’s first action should be to:
17. Increase the number of wound changes to minimize infection.
18. Obtain a culture and sensitivity study of the urine to determine the source of infection.
19. Ensure that the client takes at least 10 deep breaths every hour.
20. Change the site of the client’s IV fluid catheter to reduce the risk of infection.

Answer 16

16. 3. Elevated temperature on the second postoperative day is suggestive of a respiratory tract
       infection. Respiratory infections most often occur during the first 48 hours after surgery. The client’s
       vital signs should be monitored closely, and abnormalities should be reported to the surgeon. Signs of
       infection, if present in the wound or urinary tract, are likely to occur later in the postoperative period.
       There is no indication that the IV catheter is the source of infection.
       CN: Physiological adaptation; CL: Synthesize

Question 17

17. The nurse is changing the dressing of a client after an abdominal hysterectomy. Which of the
    following nursing measures would be most appropriate if the dressing adheres to the client’s
    incisional area?
18. Pull off the dressing quickly and then apply slight pressure over the area.
19. Lift an easily moved portion of the dressing and then remove it slowly.
20. Moisten the dressing with sterile normal saline solution and then remove it.
21. Remove part of the dressing and then remove the remainder gradually over a period of several
    minutes.

Answer 17

17. 3. When a dressing sticks to a wound, it is best to moisten the dressing with sterile normal
       saline solution and then remove it carefully. Trying to remove a dry dressing is likely to irritate the
       skin and wound. This may contribute to tension or tearing along the suture line.
       CN: Management of care; CL: Apply

Question 18

18. The client with an abdominal hysterectomy is being prepared for discharge in the morning.
    The client has a mentally retarded adult son whom she cares for at home. The nurse should discuss
    with the physician the need for referral to which of the following departments?
19. Home health care.
20. Social work.
21. Pastoral care.
22. Volunteer services

Answer 18

18. 2. The social worker will be able to coordinate respite care for the son and other community
       resources for this family. Home health care would provide care for the client herself, but respite care
       for the son is the priority need for this family. Pastoral care provides spiritual care. The volunteer
       department would not be responsible for coordination of care at the client’s home.
       CN: Management of care; CL: Apply

Question 19

19. When preparing discharge instructions for a client after an abdominal hysterectomy, the nurse
    should first:1. Have the client watch an educational video.
20. Assess the client’s available social supports.
21. Call the social worker to evaluate the client.
22. Read the discharge instructions to the client.

Answer 19

19. 2. Assessment is the first step in planning client education. Assessing social support resources
       is a key aspect of discharge planning that begins when the client is admitted to the hospital. It is
       imperative to know what assistance and support the client has at home. Assessment includes obtaining
       data about any family or home responsibilities the client is concerned with during the recovery
       period. It is within the scope of nursing practice to provide discharge instructions. A social worker is
       not needed at this time. The nurse should assess the client’s needs before determining whether using a
       video or reading instructions to the client is appropriate.
       CN: Health promotion and maintenance; CL: Create

Question 20

20. Which should the nurse include when teaching a 55-year-old woman in the beginning of
    menopause? Select all that apply.
21. The average age of onset for menopause is 50 to 52 years.
22. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels elevate.
23. Depression is very common as a result of menopause.
24. Hot flashes, especially at night, can occur in about 80% of women.
25. When periods become irregular, contraception is unnecessary.

Answer 20

20. 1, 2, 4. The average age of menopause is 50 to 52 years, although some variation exists. With
    menopause, FSH and LH levels increase dramatically. Hot flashes occur in about 80% of women;
    they can range from mild to very debilitating with disruption of sleep patterns. Depression is not
    usual during menopause; if symptoms of depression do occur, the nurse should refer the woman to her
    health care provider. Contraception should be used until menses has ceased for a full year.
    CN: Physiological adaptation; CL: Create

Question 21

The Client with Breast Cancer
21. A postmenopausal woman is worried about pain in the upper outer quadrant of her left breast.
The nurse’s first course of action is to:
1. Do a breast examination and report the results to the physician.
2. Explain that pain is caused by hormonal fluctuations.
3. Reassure the client that pain is not a symptom of breast cancer.
4. Teach the client the correct procedure for breast self-examination (BSE).

Answer 21

The Client with Breast Cancer
21. 1. This information warrants the nurse’s performing an examination and reporting the results to
the physician. Hormone fluctuations do cause breast discomfort, but an examination must be done at
this time to assess the breast. Although pain is not common with breast cancer, it can be a symptom.
Teaching the client to perform a breast exam is important, but it is not the priority action in this case.
CN: Physiological adaptation; CL: Synthesize

Question 22

22. The nurse teaches a female client that the best time in the menstrual cycle to examine the
breasts is during the:
1. Week that ovulation occurs.
2. Week that menstruation occurs.
3. First week after menstruation.
4. Week before menstruation occurs.

Answer 22

22. 3. It is generally recommended that the breasts be examined during the first week after
       menstruation. During this time, the breasts are least likely to be tender or swollen because estrogen is
       at its lowest level. Therefore, the examination will be more comfortable for the client. The
       examination may also be more accurate because the client is more likely to notice an actual change in
       her breast that is not simply related to hormonal changes.
       CN: Health promotion and maintenance; CL: Apply

Question 23

23. A female with bilateral breast implants asks if she still needs to do breast examinations
    because she does not know what to feel for. Which of the following is the nurse’s best response?
24. “Have your partner assess your breasts on a regular basis.”
25. “I will show you the correct technique as I do the breast examination.”
26. “A breast examination is very difficult when you have had implant surgery.”
27. “You need to have a mammogram instead.”

Answer 23

23. 2. The client needs to become more confident and knowledgeable about the normal feel of the
       implants and her breast tissue. The best technique is for the nurse to demonstrate breast self-
       examination (BSE) to the client as the nurse conducts the clinical breast examination. Implant surgery
       does not exclude the need for monthly BSE. A mammogram is not a substitute for monthly BSE.
       CN: Health promotion and maintenance; CL: Synthesize

Question 24

24. The client states that she has noticed that her bra fits more snugly at certain times of the
    month. She asks the nurse if this is a sign of breast disease. The nurse should base the reply to this
    client on the knowledge that:
25. Benign cysts tend to cause the breasts to vary in size.
26. It is normal for the breasts to increase in size before menstruation begins.
27. A change in breast size warrants further investigation.
28. Differences in breast size are related to normal growth and development.

Answer 24

24. 2. The breasts may vary in size before menstruation because of breast engorgement caused by
       hormonal changes. A woman may then note that her bra fits more tightly than usual. Benign cysts do
       not cause variation in breast size. A change in breast size that does not follow hormonal changes
       could warrant further assessment. The breasts normally are about the same size, although somewomen have one breast slightly larger than the other.
       CN: Health promotion and maintenance; CL: Apply

Question 25

25. A 76-year-old client tells the nurse that she has lived long and does not need mammograms.
    Which is the nurse’s best response?
26. “Having a mammogram when you are older is less painful.”
27. “The incidence of breast cancer increases with age.”
28. “We need to consider your family history of breast cancer first.”
29. “It will be sufficient if you perform breast examinations monthly.”

Answer 25

25. 2. Advancing age in postmenopausal women has been identified as a risk factor for breast
       cancer. A 76-year-old client needs monthly breast self-examination and a yearly clinical breast
       examination and mammogram to comply with the screening schedule. While mammograms are less
       painful as breast tissue becomes softer, the nurse should advise the woman to have the mammogram.
       Family history is important, but only about 5% of breast cancers are genetic.
       CN: Health promotion and maintenance; CL: Synthesize

Question 26

26. After the surgeon met with a client to obtain the client’s informed consent for a modified
    radical mastectomy, the client asks the nurse many questions about breast reconstruction that the nurse
    cannot to answer. The nurse should:
27. Inform the surgeon that the client has questions about reconstruction before she signs the
    consent.
28. Inform the client that she should concentrate on recovering from the mastectomy first.
29. Inform the client that she can have a consultation with the plastic surgeon in a few weeks.
30. Inform the client she can ask the surgeon these questions later when the surgeon makes rounds

Answer 26

26. 1. If a client has questions the nurse cannot answer, it is best to delay the signing of the
       consent until the questions are clarified for the client. The surgeon should be notified, and the
       appropriate information or collaboration should be provided for the client before she signs the
       surgical consent. Telling her she should concentrate on recovery first ignores the client’s questions
       and concerns. Frequently the plastic surgeon needs to be consulted at the beginning of the treatment
       because various surgical decisions depend on the future plans for breast reconstruction.
       CN: Management of care; CL: Synthesize

Question 27

27. Prior to surgery for a modified radical mastectomy, the client is extremely anxious and asks
    many questions. Which of the following approaches would offer the best guide for the nurse to
    answer these questions.
28. Tell the client as much as she wants to know and is able to understand.
29. Delay discussing the client’s questions with her until she is convalescing.
30. Delay discussing the client’s questions with her until her apprehension subsides.
31. Explain to the client that she should discuss her questions first with the physician.

Answer 27

27. 1. An important nursing responsibility is preoperative teaching, and the most frequently
       recommended guide for teaching is to tell the client as much as she wants to know and is able to
       understand. Delaying discussion of issues about which the client has concerns is likely to aggravate
       the situation and cause the client to feel distrust. As a general guide, the client would not ask the
       question if she were not ready to discuss her situation. The nurse is available to answer the client’s
       questions and concerns and should not delay discussing these with the client.
       CN: Psychosocial adaptation; CL: Synthesize

Question 28

28. Atropine sulfate is included in the preoperative prescriptions for a client undergoing a
    modified radical mastectomy. The expected outcome is to:
29. promote general muscular relaxation.
30. decrease pulse and respiratory rates.
31. decrease nausea.
32. inhibit oral and respiratory secretions.

Answer 28

28. 4. Atropine sulfate, a cholinergic blocking agent, is given preoperatively to reduce secretions
       in the mouth and respiratory tract, which assists in maintaining the integrity of the respiratory system
       during general anesthesia. Atropine is not used to promote muscle relaxation, decrease nausea and
       vomiting, or decrease pulse and respiratory rates. It causes the pulse to increase.
       CN: Pharmacological and parenteral therapies; CL: Evaluate

Question 29

29. During the postoperative period after a modified radical mastectomy, the client confides in
    the nurse that she thinks she got breast cancer because she had an abortion and she did not tell her
    husband. The best response by the nurse is which of the following?
30. “Cancer is not a punishment; it is a disease.”
31. “You might feel better if you confided in your husband.”
32. “Tell me more about your feelings about this.”
33. “I can have the social worker talk to you if you would like.”

Answer 29

29. 3. The nurse should respond with an open-ended statement that elicits further exploration of
       the client’s feelings. Women with cancer may feel guilt or shame. Previous life decisions, sexuality,
       and religious beliefs may influence a client’s adjustment to a diagnosis of cancer. The nurse should
       not contradict the client’s feelings of punishment or offer advice such as confiding in the husband. A
       social worker referral may be beneficial in the future, but is not the first response needed to elicit
       exploration of the client’s feelings.
       CN: Psychosocial adaptation; CL: Synthesize

Question 30

30. Following a modified radical mastectomy, a client has an incisional drainage tube attached to
    Hemovac suction. The nurse determines the suction is effective when:
31. The intrathoracic pressure is decreased, and the client breathes easier.
32. There is an increased collateral lymphatic flow toward the operative area.
33. Accumulated serum and blood in the operative area are removed.
34. No adhesions are formed between the skin and chest wall in the operative area.

Answer 30

30. 3. A drainage tube is placed in the wound after a modified radical mastectomy to help remove
       accumulated blood and fluid in the area. Removal of the drainage fluids assists in wound healing and
       is intended to decrease the incidence of hematoma, abscess formation, and infection. Drainage tubes
       placed in a wound do not decrease intrathoracic pressure, increase collateral lymphatic flow, or
       prevent adhesion formation.
       CN: Reduction of risk potential; CL: Evaluate

Question 31

31. Which of the following positions would be best for a client’s right arm when she returns to
    her room after a right modified radical mastectomy with multiple lymph node excisions?
32. Across her chest wall.
33. At her side at the same level as her body.
34. In the position that affords her the greatest comfort without placing pressure on the incision.
35. On pillows, with her hand higher than her elbow and her elbow higher than her shoulder.

Answer 31

31. 4. Lymph nodes can be removed from the axillary area when a modified radical mastectomy is
       done, and each of the nodes is biopsied. To facilitate drainage from the arm on the affected side, the
       client’s arm should be elevated on pillows with her hand higher than her elbow and her elbow higher
       than her shoulder. A sentinel node biopsy procedure is associated with a decreased risk of
       lymphedema because fewer nodes are excised.
       CN: Physiological adaptation; CL: Synthesize

Question 32

32. A client develops lymphedema after a left mastectomy with lymph node dissection. Which of
    the following should be included in the discharge teaching plan? Select all that apply.
33. Do not allow blood pressures or blood draws in the affected arm.
34. Avoid application of sunscreen on the left arm.
35. Use an electric razor for shaving.
36. Immobilize the left arm.
37. Elevate the left arm.
38. Perform hand pump exercises.

Answer 32

32. 1, 3, 5, 6. Blood pressures or blood draws in the affected arm, sun exposure, trauma with a
    sharp razor, and immobilization increase the risk of lymphedema. Elevation of the arm and hand pump
    exercises promote lymph flow and reduce edema.
    CN: Health promotion and maintenance; CL: Create

Question 33

33. The client with breast cancer is prescribed tamoxifen (Nolvadex) 20 mg daily. The client
    states she does not like taking medicine and asks the nurse if the tamoxifen is really worth taking. Thenurse’s best response is which of the following?
34. “This drug is part of your chemotherapy program.”
35. “This drug has been found to decrease metastatic breast cancer.”
36. “This drug will act as an estrogen in your breast tissue.”
37. “This drug will prevent hot flashes since you cannot take hormone replacement.”

Answer 33

33. 2. Tamoxifen is an antiestrogen drug that has been found to be effective against metastatic
       breast cancer and to improve the survival rate. The drug causes hot flashes as an adverse effect.
       CN: Pharmacological and parenteral therapies; CL: Synthesize

Question 34

34. A client undergoing chemotherapy after a modified radical mastectomy asks the nurse
    questions about breast prosthesis and wigs. After answering the questions directly, the nurse should
    also:
35. Provide a list of resources, including the local breast cancer support group.
36. Offer a referral to the social worker.
37. Call the home health care agency.
38. Contact the plastic surgeon.

Answer 34

34. 1. Giving the client a list of community resources that could provide support and guidance
       assists the client to maintain her self-image and independence. The support group will include other
       women who have undergone similar therapies and can offer suggestions for breast products and wigs.
       Because the client is asking about specific resources, she does not need a referral to a social worker,
       home health agency, or plastic surgeon.
       CN: Management of care; CL: Synthesize

Question 35

35. A client is to have radiation therapy after a modified radical mastectomy. The nurse should
    teach the client to care for the skin at the site of therapy by:
36. Washing the area with water.
37. Exposing the area to dry heat.
38. Applying an ointment to the area.
39. Using talcum powder on the area.

Answer 35

35. 1. A client receiving radiation therapy should avoid lotions, ointments, and anything that may
       cause irritation to the skin, such as exposure to sunlight, heat, or talcum powder. The area may safely
       be washed with water if it is done gently and if care is taken not to injure the skin.
       CN: Reduction of risk potential; CL: Synthesize

Question 36

36. The nurse should teach a client that a normal local tissue response to radiation following
surgery for breast cancer is:
1. Atrophy of the skin.
2. Scattered pustule formation.
3. Redness of the surface tissue.
4. Sloughing of two layers of skin.

Answer 36

36. 3. The most common reaction of the skin to radiation therapy is redness of the surface tissues.
       Dryness, tanning, and capillary dilation are also common. Atrophy of the skin, pustules, and sloughing
       of two layers would not be expected and should be reported to the radiologist.
       CN: Reduction of risk potential; CL: Apply

Question 37

37. The nurse is providing discharge instructions about preventing infection to a client who had a
    modified radical mastectomy. Which of the following will be most effective in preventing infection?
38. Wear protective gloves when gardening.
39. Avoid crowded areas.
40. Keep cuticles cut.
41. Remove underarm hair with a sharp razor.

Answer 37

37. 1. This client is at risk for lymphedema and infection. Precautions to avoid creating an entry
       site for infection in the affected arm include wearing protective gloves, using cuticle cream, not
       cutting cuticles, using an electric razor, using a thimble when sewing, and avoiding having injections
       or blood drawn from that arm. She does not need to avoid crowds; she is not at high risk for
       respiratory infection.
       CN: Reduction of risk potential; CL: Synthesize

Question 38

The Client with Benign Prostatic Hypertrophy
38. An adult male client has been unable to void for the past 12 hours. The best method for the
nurse to use when assessing for bladder distention in a male client is to check for:
1. A rounded swelling above the pubis.
2. Dullness in the lower left quadrant.
3. Rebound tenderness below the symphysis.
4. Urine discharge from the urethral meatus.

Answer 38

The Client with Benign Prostatic Hypertrophy
38. 1. The best way to assess for a distended bladder in either a male or female client is to check
for a rounded swelling above the pubis. This swelling represents the distended bladder rising above
the pubis into the abdominal cavity. Dullness does not indicate a distended bladder. The client might
experience tenderness or pressure above the symphysis. No urine discharge is expected; the urine
flow is blocked by the enlarged prostate.CN: Reduction of risk potential; CL: Analyze

Question 39

39. When emptying the client’s bladder during a urinary catheterization, the nurse should allow
    the urine to drain from the bladder slowly to prevent:
40. Renal failure.
41. Abdominal cramping.
42. Possible shock.
43. Atrophy of bladder musculature.

Answer 39

39. 3. Rapid emptying of an overdistended bladder may cause hypotension and shock due to the
       sudden change of pressure within the abdominal viscera. The nurse should empty the bladder slowly.
       Removal of urine from the bladder does not cause renal failure. The client may experience cramping,
       but the primary concern is the potential for shock. Bladder muscles will not atrophy because of a
       catheterization.
       CN: Reduction of risk potential; CL: Apply

Question 40

40. The primary reason for lubricating the urinary catheter generously before inserting the
    catheter into a male client is that this technique helps reduce:
41. Spasms at the orifice of the bladder.
42. Friction along the urethra when the catheter is being inserted.
43. The number of organisms gaining entrance to the bladder.
44. The formation of encrustations that may occur at the end of the catheter.

Answer 40

40. 2. Liberal lubrication of the catheter before catheterization of a male reduces friction along
       the urethra and irritation and trauma to urethral tissues. Because the male urethra is tortuous, a liberal
       amount of lubrication is advised to ease catheter passage. The female urethra is not tortuous, and,
       although the catheter should be lubricated before insertion, less lubricant is necessary. Lubrication of
       the catheter will not decrease spasms. The nurse should use sterile technique to prevent introducing
       organisms. Crusts will not form immediately. Irrigating the catheter as needed will prevent clot and
       crust formation.
       CN: Reduction of risk potential; CL: Apply

Question 41

41. The primary reason for taping an indwelling catheter laterally to the thigh of a male client is
    to:
42. Eliminate pressure at the penoscrotal angle.
43. Prevent the catheter from kinking in the urethra.
44. Prevent accidental catheter removal.
45. Allow the client to turn without kinking the catheter.

Answer 41

41. 1. The primary reason for taping an indwelling catheter to a male client so that the penis is
       held in a lateral position is to prevent pressure at the penoscrotal angle. Prolonged pressure at the
       penoscrotal angle can cause a ureterocutaneous fistula.
       CN: Reduction of risk potential; CL: Apply

Question 42

42. Many older men with prostatic hypertrophy do not seek medical attention until urinary
    obstruction is almost complete. One reason for this delay in seeking attention is that these men may:
43. Feel too self-conscious to seek help when reproductive organs are involved.
44. Expect that it is normal to have to live with some urinary problems as they grow older.
45. Fear that sexual indiscretions in earlier life may be the cause of their problem.
46. Have little discomfort in relation to the amount of pathology because responses to pain stimuli
    fade with age.

Answer 42

42. 2. Some older men tend to believe it is normal to live with urinary problems. As a result,
       these men often overlook symptoms and simply attribute them to aging. As part of preventive care for
       men older than age 40, the yearly physical examination should include palpation of the prostate via
       rectal examination. Prostate-specific antigen screening also is done annually to determine elevations
       or increasing trends in elevations. The nurse should teach male clients the value of early detection
       and adequate follow-up for the prostate.
       CN: Reduction of risk potential; CL: Apply

Question 43

43. When caring for a client with a history of benign prostatic hypertrophy (BPH), the nurse
    should do which of the following? Select all that apply.
44. Provide privacy and time for the client to void.
45. Monitor intake and output.
46. Catheterize the client for postvoid residual urine.
47. Ask the client if he has urinary retention.
48. Test the urine for hematuria.

Answer 43

43. 1, 2, 4, 5. Because of the history of BPH, the nurse should provide privacy and time for the
    client to void. The nurse should also monitor intake and output, assess the client for urinary retention,
    and test the urine for hematuria. It is not necessary to catheterize the client.
    CN: Physiological adaptation; CL: Synthesize

Question 44

44. The nurse should specifically assess a client with prostatic hypertrophy for which of thefollowing?
45. Voiding at less frequent intervals.
46. Difficulty starting the flow of urine.
47. Painful urination.
48. Increased force of the urine stream.

Answer 44

44. 2. Signs and symptoms of prostatic hypertrophy include difficulty starting the flow of urine,
       urinary frequency and hesitancy, decreased force of the urine stream, interruptions in the urine stream
       when voiding, and nocturia. The prostate gland surrounds the urethra, and these symptoms are all
       attributed to obstruction of the urethra resulting from prostatic hypertrophy. Nocturia from incomplete
       emptying of the bladder is common. Straining and urine retention are usually the symptoms that
       prompt the client to seek care. Painful urination is generally not a symptom of prostatic hypertrophy.
       CN: Physiological adaptation; CL: Analyze

Question 45

45. The nurse is reviewing the medication history of a client with benign prostatic hypertrophy
    (BPH). Which medication will likely aggravate BPH?
46. Metformin (Glucophage).
47. Buspirone (BuSpar).
48. Inhaled ipratropium (Atrovent).
49. Ophthalmic timolol (Timoptic).

Answer 45

45. 3. Ipratropium is a bronchodilator, and its anticholinergic effects can aggravate urine
       retention. Metformin and buspirone do not affect the urinary system; timolol does not have a systemic
       effect. CN: Pharmacological and parenteral therapies; CL: Appl

Question 46

46. A client is scheduled to undergo transurethral resection of the prostate. The procedure is to
    be done under spinal anesthesia. Postoperatively, the nurse should assess the client for:
47. Seizures.
48. Cardiac arrest.
49. Renal shutdown.
50. Respiratory paralysis.

Answer 46

46. 4. If paralysis of vasomotor nerves in the upper spinal cord occurs when spinal anesthesia is
       used, the client is likely to develop respiratory paralysis. Artificial ventilation is required until the
       effects of the anesthesia subside. Seizures, cardiac arrest, and renal shutdown are not likely results of
       spinal anesthesia.
       CN: Physiological adaptation; CL: Analyze

Question 47

47. A client with benign prostatic hypertrophy (BPH) is being treated with terazosin (Hytrin) 2
    mg at bedtime. The nurse should monitor the client’s:
48. Urine nitrites.
49. White blood cell count.
50. Blood pressure.
51. Pulse

Answer 47

47. 3. Terazosin is an antihypertensive drug that is also used in the treatment of BPH. Blood
       pressure must be monitored to ensure that the client does not develop hypotension, syncope, or
       orthostatic hypotension. The client should be instructed to change positions slowly. Urine nitrates,
       white blood cell count, and pulse rate are not affected by terazosin.
       CN: Pharmacological and parenteral therapies; CL: Analyze

Question 48

48. A client, who had a transurethral resection of the prostate (TURP), has a three-way
    indwelling urinary catheter with continuous bladder irrigation. In which of the following
    circumstances should the nurse increase the flow rate of the continuous bladder irrigation?
49. When drainage is continuous but slow.
50. When drainage appears cloudy and dark yellow.
51. When drainage becomes bright red.
52. When there is no drainage of urine and irrigating solution.

Answer 48

48. 3. The decision by the surgeon to insert a catheter after TURP or prostatectomy depends on the
       amount of bleeding that is expected after the procedure. During continuous bladder irrigation after a
       TURP or prostatectomy, the rate at which the solution enters the bladder should be increased when the
       drainage becomes brighter red. The color indicates the presence of blood. Increasing the flow of
       irrigating solution helps flush the catheter well so that clots do not plug it. There would be no reason
       to increase the flow rate when the return is continuous or when the return appears cloudy and dark
       yellow. Increasing the flow would be contraindicated when there is no return of urine and irrigating
       solution.
       CN: Pharmacological and parenteral therapies; CL: Synthesize

Question 49

49. A client is to receive belladonna and opium suppositories, as needed, postoperatively after
    transurethral resection of the prostate (TURP). The nurse should give the client these drugs when he
    demonstrates signs of:
50. A urinary tract infection.
51. Urine retention.
52. Frequent urination.
53. Pain from bladder spasms.

Answer 49

49. 4. Belladonna and opium suppositories are prescribed and administered to reduce bladder
       spasms that cause pain after TURP. Bladder spasms frequently accompany urologic procedures.
       Antispasmodics offer relief by eliminating or reducing spasms. Antimicrobial drugs are used to treat
       an infection. Belladonna and opium do not relieve urine retention or urinary frequency.
       CN: Pharmacological and parenteral therapies; CL: Synthesize

Question 50

50. A nursing assistant tells the nurse, “I think the client is confused. He keeps telling me he has
    to void, but that isn’t possible because he has a catheter in place that is draining well.” Which of the
    following responses would be most appropriate for the nurse to make?
51. “His catheter is probably plugged. I’ll irrigate it.”
52. “That’s a common problem after prostate surgery. The client only imagines the urge to void.”3. “The urge to void is usually created by the large catheter, and he may be having some bladder
    spasms.”
53. “I think he may be somewhat confused.”

Answer 50

50. 3. The indwelling urinary catheter creates the urge to void and can also cause bladder spasms.
       The nurse should ensure adequate bladder emptying by monitoring urine output and characteristics.
       Urine output should be at least 50 mL/h. A plugged catheter, imagining the urge to void, and confusion
       are less likely reasons for the client’s problem.
       CN: Reduction of risk potential; CL: Synthesize

Question 51

51. A physician has prescribed amoxicillin (Ampicillin) 100 PO b.i.d. The nurse should teach the
    client to do which of the following? Select all that apply.
52. Drink 300 to 500 mL of fluids daily.
53. Void frequently, at least every 2 to 3 hours.
54. Take time to empty the bladder completely.
55. Take the last dose of the antibiotic for the day at bedtime.
56. Take the antibiotic with or without food.

Answer 51

51. 2, 3, 4, 5. Ampicillin may be given with or without food, but the nurse should instruct the
    client to obtain an adequate fluid intake (2,500 to 3,000 mL) to promote urinary output and to flush out
    bacteria from the urinary tract. The nurse should also encourage the client to void frequently (every 2
    to 3 hours) and empty the bladder completely. Taking the antibiotic at bedtime, after emptying the
    bladder, helps to ensure an adequate concentration of the drug during the overnight period.
    CN: Physiological adaptation; CL: Synthesize

Question 52

52. In discussing home care with a client after transurethral resection of the prostate (TURP), the
    nurse should teach the male client that dribbling of urine:
53. Can be a chronic problem.
54. Can persist for several months.
55. Is an abnormal sign that requires intervention.
56. Is a sign of healing within the prostate.

Answer 52

52. 2. Dribbling of urine can occur for several months after TURP. The client should be informed
       that this is expected and is not an abnormal sign. The nurse should teach the client perineal exercises
       to strengthen sphincter tone. The client may need to use pads for temporary incontinence. The client
       should be reassured that continence will return in a few months and will not be a chronic problem.Dribbling is not a sign of healing, but is related to the trauma of surgery.
       CN: Basic care and comfort; CL: Synthesize

Question 53

53. The nurse should instruct the client who is being discharged to home 3 days after
    transurethral resection of the prostate (TURP) to do which of the following? Select all that apply.
54. Drink at least 3,000 mL water per day.
55. Increase calorie intake by eating six small meals a day.
56. Report bright red bleeding to the health care provider.
57. Take deep breaths and cough every 2 hours.
58. Report a temperature over 99°F (37.2°C).

Answer 53

53. 1, 3, 5. The nurse should instruct the client to drink a large amount of fluids (about 3,000
    mL/day) to keep the urine clear. The urine should be almost without color. About 2 weeks after
    TURP, when desiccated tissue is sloughed out, a secondary hemorrhage could occur. The client
    should be instructed to call the surgeon or go to the emergency department if at any time the urine
    turns bright red. The nurse should also instruct the client to report signs of infection such as a
    temperature over 99°F (37.2°C). The client is not specifically at risk for nutritional problems after
    TURP and can resume a diet as tolerated. The client is not specifically at risk for airway problems
    because the procedure is done under spinal anesthesia and the client does not need to take deep
    breaths and cough.
    CN: Physiological integrity; CL: Synthesize

Question 54

54. A client with benign prostatic hypertrophy (BPH) has an elevated prostate-specific antigen
    (PSA) level. The nurse should:
55. Instruct the client to request having a colonoscopy before coming to conclusions about the PSA
    results.
56. Instruct the client that a urologist will monitor the PSA level biannually when elevated.
57. Determine if the prostatic palpation was done before or after the blood sample was drawn.
58. Ask the client if he emptied his bladder before the blood sample was obtained.

Answer 54

54. 3. Rectal and prostate examinations can increase serum PSA levels; therefore, instruct the
       client that a manual rectal examination is usually part of the test regimen to determine prostate
       changes. The prostatic palpation should be done after the blood sample is drawn. The PSA level must
       be monitored more often than biannually when it is elevated. Having a colonoscopy is not related to
       the findings of the PSA test. It is not necessary to void prior to having PSA blood levels tested.
       CN: Health promotion and maintenance; CL: Synthesize

Question 55

The Client with a Sexually Transmitted Disease

55. What is most important for the nurse to teach a client newly diagnosed with genital herpes?
56. Use condoms at all times during sexual intercourse.
57. A urologist should be seen only when lesions occur.
58. Oral sex is permissible without a barrier.
59. Determine if your partner has received a vaccine against herpes.

Answer 55

The Client with a Sexually Transmitted Disease
55. 1. The client should be taught to abstain from sexual intercourse while lesions are present.
Condoms should be used at all times as the virus can be shed without lesions present. Multiple
partners would promote the spread of genital herpes. There is no vaccine available to prevent genital
herpes. Although periodic examinations should be advised, a urologist does not necessarily need to
be seen when lesions occur.
CN: Physiological adaptation; CL: Synthesize

Question 56

56. A nurse is planning care for a 25-year-old female client who has just been diagnosed with
    human immunodeficiency virus (HIV) infection. The client asks the nurse, “How could this have
    happened?” The nurse responds to the question based on the most frequent mode of HIV transmission,
    which is:
57. Hugging an HIV-positive sexual partner without using barrier precautions.
58. Inhaling cocaine.
59. Sharing food utensils with an HIV-positive person without proper cleaning of the utensils.
60. Having sexual intercourse with an HIV-positive person without using a condom.

Answer 56

56. 4. HIV infection is transmitted through blood and body fluids, particularly vaginal and seminal
       fluids. A blood transfusion is one way the disease can be contracted. Other modes of transmission are
       sexual intercourse with an infected partner and sharing IV needles with an infected person. Women
       now have the highest rate of newly diagnosed HIV infection. Many of these women have contracted
       HIV from unprotected sex with male partners. HIV cannot be transmitted by hugging, inhaling cocaine,
       or sharing utensils.
       CN: Safety and infection control; CL: Apply

Question 57

57. A client with human immunodeficiency virus (HIV) infection is taking zidovudine (AZT). The
    expected outcome of AZT is to:
58. Destroy the virus.
59. Enhance the body’s antibody production.
60. Slow replication of the virus.
61. Neutralize toxins produced by the virus.

Answer 57

57. 3. Zidovudine (AZT) interferes with replication of HIV and thereby slows progression of HIV
       infection to acquired immunodeficiency syndrome (AIDS). There is no known cure for HIV infection.
       Today, clients are not treated with monotherapy but are usually on triple therapy due to a much-
       improved clinical response. Decreased viral loads with the drug combinations have improved the
       longevity and quality of life in clients with HIV/AIDS. AZT does not destroy the virus, enhance the
       body’s antibody production, or neutralize toxins produced by the virus.
       CN: Pharmacological and parenteral therapies; CL: Evaluate

Question 58

58. Women who have human papillomavirus (HPV) are at risk for development of:
59. Sterility.
60. Cervical cancer.
61. Uterine fibroid tumors.
62. Irregular menses.

Answer 58

58. 2. Women who have HPV are much more likely to develop cervical cancer than women whohave never had the disease. Cervical cancer is now considered a sexually transmitted disease.
       Regular examinations, including Papanicolaou tests, are recommended to detect and treat cervical
       cancer at an early stage. Girls and women as well as boys and men (around ages 9 to 26 depending on
       the vaccine) should receive a vaccine to prevent HPV. HPV does not cause sterility, uterine fibroid
       tumors, or irregular menses.
       CN: Health promotion and maintenance; CL: Analyze

Question 59

59. The primary reason that a herpes simplex virus (HSV) infection is a serious concern to a
    client with human immunodeficiency virus (HIV) infection is that it:
60. Is an acquired immunodeficiency virus (AIDS)–defining illness.
61. Is curable only after 1 year of antiviral therapy.
62. Leads to cervical cancer.
63. Causes severe electrolyte imbalances.

Answer 59

59. 1. HSV infection is one of a group of disorders that, when diagnosed in the presence of HIV
       infection, are considered to be diagnostic for AIDS. Other AIDS-defining illnesses include Kaposi’s
       sarcoma; cytomegalovirus of the liver, spleen, or lymph nodes; and Pneumocystis carinii pneumonia.
       HSV infection is not curable and does not cause severe electrolyte imbalances. Human
       papillomavirus can lead to cervical cancer.
       CN: Physiological adaptation; CL: Apply

Question 60

60. In educating a client about human immunodeficiency virus (HIV), the nurse should take into
    account the fact that the most effective method known to control the spread of HIV infection is:
61. Premarital serologic screening.
62. Prophylactic treatment of exposed people.
63. Laboratory screening of pregnant women.
64. Ongoing sex education about preventive behaviors.

Answer 60

60. 4. Education to prevent behaviors that cause HIV transmission is the primary method of
       controlling HIV infection. Behaviors that place people at risk for HIV infection include unprotected
       sexual intercourse and sharing of needles for IV drug injection. Educating clients about using
       condoms during sexual relations is a priority in controlling HIV transmission.
       CN: Safety and infection control; CL: Apply

Question 61

to have HIV.”

4. “Tell me more about how you are feeling about being HIV positive.”

Answer 61

61. 4. The nurse should respond with a statement that allows the client to express his thoughts and
       feelings. After sharing feelings about their diagnosis, clients will need information, support, and
       community resources. Statements of encouragement or agreement do not provide an opportunity for
       the client to express himself.
       CN: Psychosocial adaptation; CL: Synthesize

Question 62

62. The typical chancre of syphilis appears as:
63. A grouping of small, tender pimples.
64. An elevated wart.
65. A painless, moist ulcer.
66. An itching, crusted area

Answer 62

62. 3. The chancre of syphilis is characteristically a painless, moist ulcer. The serous discharge is
       very infectious. Because the chancre is usually painless and disappears, the client may not be aware
       of it or may not seek care. The chancre does not appear as pimples or warts, and does not itch, thus
       making diagnosis difficult.
       CN: Physiological adaptation; CL: Analyze

Question 63

63. The nurse is interviewing a client with newly diagnosed syphilis. In order to prevent the
    spread of the disease, the nurse should focus the interview by:
64. Motivating the client to undergo treatment.
65. Obtaining a list of the client’s sexual contacts.
66. Increasing the client’s knowledge of the disease.
67. Reassuring the client that records are confidential

Answer 63

63. 2. An important aspect of controlling the spread of sexually transmitted diseases (STDs) is
       obtaining a list of the sexual contacts of an infected client. These contacts, in turn, should be
       encouraged to obtain immediate care. Many people with STDs are reluctant to reveal their sexual
       contacts, which makes controlling STDs difficult. Increasing clients’ knowledge of the disease and
       reassuring clients that their records are confidential can motivate them to seek treatment, which does
       help to control the spread of the disease, but it is not as critical as information about the client’s
       sexual contacts.
       CN: Physiological adaptation; CL: Synthesize

Question 64

64. Benzathine penicillin G, 2.4 million units IM, is prescribed as treatment for an adult client
    with primary syphilis. The nurse should administer the injection in the:
65. Deltoid.
66. Upper outer quadrant of the buttock.
67. Quadriceps lateralis of the thigh.
68. Midlateral aspect of the thigh.

Answer 64

64. 2. Because of the large dose, the upper outer quadrant of the buttocks is the recommended site.
       The deltoid and the quadriceps lateralis of the thigh are not large enough for the recommended dose.
       In infants and small children, the midlateral aspect of the thigh may be preferred.
       CN: Pharmacological and parenteral therapies; CL: Apply

Question 65

65. An 18-year-old female is to have a pelvic exam. Which of the following responses by the
    nurse would be best when the client says that she is nervous about the upcoming pelvic examination?
66. “Can you tell me more about how you’re feeling?”
67. “You’re not alone. Most women feel uncomfortable about this examination.”
68. “Do not worry about Dr. Smith. He’s a specialist in female problems.”
69. “We’ll do everything we can to avoid embarrassing you.”

Answer 65

65. 1. Asking the client to describe her nervousness gives her the opportunity to express herconcerns. It also allows the nurse to understand her better and gives the nurse a base to respond to the
       client’s stated fears, questions, or need for further information. Responses that make assumptions
       about the source of the concern or offer reinforcement are not supportive and block successful
       communication.
       CN: Psychosocial adaptation; CL: Synthesize

Question 66

66. When educating a female client with gonorrhea, the nurse should emphasize that for women
    gonorrhea:
67. Is often marked by symptoms of dysuria or vaginal bleeding.
68. Does not lead to serious complications.
69. Can be treated but not cured.
70. May not cause symptoms until serious complications occur.

Answer 66

66. 4. Many women do not seek treatment because they are unaware that they have gonorrhea.
       They may be symptom-free or have only very mild symptoms until the disease progresses to pelvic
       inflammatory disease. Dysuria and vaginal bleeding are not present in gonorrhea. Gonorrhea can lead
       to very serious complications. It can be cured with the proper treatment.
       CN: Physiological adaptation; CL: Synthesize

Question 67

67. Which of the following groups has experienced the greatest rise in the incidence of sexually
    transmitted diseases (STDs) over the past two decades?
68. Teenagers.
69. Divorced people.
70. Young married couples.
71. Older adults.

Answer 67

67. 1. Statistics reveal that the incidence of STDs is rising more rapidly among teenagers than
       among any other age group. Many reasons have been given for this trend, including a change in
       societal mores and increasing sexual activity among teenagers. During this developmental stage,
       teenagers may engage in high-risk sexual behaviors because they often are living in the present and
       feel that it won’t happen to them.
       CN: Health promotion and maintenance; CL: Apply

Question 68

68. A sexually active male client has burning on urination and a milky discharge from the urethral
    meatus. Documentation on the client’s chart should include which of the following information? Select
    all that apply.
69. History of unprotected sex (sex without a condom).
70. Length of time since symptoms presented.
71. History of fever or chills.
72. Presence of any enlarged lymph nodes on examination.
73. Names and phone numbers of all sexual contacts.
74. Allergies to any medications.

Answer 68

68. 1, 2, 3, 4, 6. The client is suspected of having a sexually transmitted infection. Therefore, the
    client’s sexual history, assessment, and examination must be documented, including symptoms (such as
    fever, chills, and enlarged glands) and their onset and duration. Allergies are critical to document for
    every client, but are especially noteworthy in this case because antibiotics will be prescribed. If a
    sexually transmitted infection is confirmed, sexual contacts need to be treated. To protect privacy, the
    names and phone numbers should never be placed in the chart. The public health department will also
    assist in obtaining information and treating known sexual contacts.
    CN: Safety and infection control; CL: Analyze

Question 69

A male client is diagnosed with a chlamydial infection. Azithromycin (Zithromax) 1 g is prescribed.
The supply of azithromycin is in 250-mg tablets. How many tablets should the nurse administer?
______________________ tablets.

Answer 69

69. 4 tablets
    Next, divide the desired dose by the dose on hand:
    CN: Pharmacological and parenteral therapies; CL: Apply

Question 70

70. A female client with gonorrhea informs the nurse that she has had sexual intercourse with her
    boyfriend and asks the nurse, “Would he have any symptoms?” The nurse responds that in men the
    symptoms of gonorrhea include:
71. Impotence.
72. Scrotal swelling.
73. Urine retention.
74. Dysuria.

Answer 70

70. 4. Dysuria and a mucopurulent urethral discharge characterize gonorrhea in men. Gonococcal
       symptoms are so painful and bothersome for men that they usually seek treatment with the onset of
       symptoms. Impotence, scrotal swelling, and urine retention are not associated with gonorrhea.
       CN: Physiological adaptation; CL: Apply

Question 71

71. The nurse assesses the mouth and oral cavity of a client with human immunodeficiency virus
    (HIV) infection because the most common opportunistic infection initially presents as:
72. Herpes simplex virus (HSV) lesions on the lips.
73. Oral candidiasis.
74. Cytomegalovirus (CMV) infection.
75. Aphthae on the gingiva.

Answer 71

71. 2. The most common opportunistic infection in HIV infection initially presents as oral
       candidiasis, or thrush. The client with HIV should always have an oral assessment. HSV and CMV
       are opportunistic infections that present later in acquired immunodeficiency syndrome. Aphthous
       stomatitis, or recurrent canker sores, is not an opportunistic infection, although the sores are thought
       to occur more often when the client is under stress.
       CN: Health promotion and maintenance; CL: Apply

Question 72

72. The nurse is administering Didanosine (Videx) to a client with HIV. Before administering this
    medication, the nurse should check which lab test results? Select all that apply.
73. Elevated serum creatinine.
74. Elevated blood urea nitrogen (BUN).
75. Elevated aspartate aminotransferase (AST).
76. Elevated alanine aminotransferase (ALT).
77. Elevated serum amylase.

Answer 72

72. 3, 4, 5. The nurse should withhold the medication and notify the physician immediately if the
    client develops manifestations of pancreatitis or hepatic failure including nausea and vomiting, severeabdominal pain, elevated bilirubin, or elevated serum enzymes (eg, amylase, AST, ALT). If both BUN
    and creatinine are elevated, the client may have kidney disease.
    CN: Pharmacological and parenteral therapies; CL: Synthesize

Question 73

73. The nurse is caring for a client from Southeast Asia who has HIV-AIDS. The client does not
    speak or comprehend the English language. The nurse should?
74. Contact the hospital’s chaplain.
75. Do an Internet search for the Joint United Nations Programme on HIV/AIDS.
76. Utilize language-appropriate interpreters.
77. Ask a family member to obtain informed consent.

Answer 73

73. 3. Interpreters are essential in enabling the nurses’ communications to be understood
       accurately. The chaplain may not know the client’s language. The Joint United Nations Programme on
       HIV/AIDS has the number of reported cases of AIDS. It is not necessary for the family member to
       obtain informed consent.
       CN: Psychosocial adaptation; CL: Synthesize

Question 74

The Client with Cancer of the Cervix
74. The nurse is preparing a 45-year-old female for a vaginal examination. The nurse should
place the client in which position?
1. Sims' position.
2. Lithotomy position.
3. Genupectoral position.
4. Dorsal recumbent position.

Answer 74

The Client with Cancer of the Cervix
74. 2. Although other positions may be used, the preferred position for a vaginal examination is
the lithotomy position. This position offers the best visualization. If the client is elderly and frail, staff
members may need to support the client’s flexed legs while the examiner conducts the examination
and obtains the Papanicolaou smear. Positioning the client in the other positions will make
visualization more difficult and may not be as comfortable for the client.
CN: Health promotion and maintenance; CL: Apply

Question 75

75. A client asks the nurse to explain the meaning of her abnormal Papanicolaou (Pap) smear
    result of atypical squamous cells. Which of the following concepts should the nurse include in the
    response? An atypical Pap smear means that
76. Abnormal viral cells were found in the smear.
77. Cancer cells were found in the smear.
78. The Pap smear alone is not very important diagnostically because there are many false-
    positive results.
79. The cells could cause various conditions and help identify a problem early.

Answer 75

75. 4. The Pap smear identifies atypical cervical cells that may be present for various reasons.
       Cancer is the most common possible cause, but not the only one. The Pap smear does not show
       abnormal viral cells unless specific gene typing is done for human papillomavirus. An adequate
       smear provides accurate diagnostic data; the false-positive rate is only about 5%.
       CN: Health promotion and maintenance; CL: Apply

Question 76

76. Which of the following is a risk factor for cervical cancer?
77. Sexual experiences with one partner.
78. Sedentary lifestyle.
79. Obesity.
80. Adolescent pregnancy.

Answer 76

76. 4. Young age at first pregnancy is a risk factor for cervical cancer. Other risk factors include a
       family history of the disease, sexual experience with multiple partners, and a history of sexually
       transmitted disease (eg, syphilis, human papillomavirus infection, gonorrhea). Cigarette smoking,
       promiscuous male partner, human immunodeficiency virus infection or other immunosuppression, and
       low socioeconomic status are other risk factors. Sexual relations with one partner, sedentary lifestyle,
       and obesity are not risk factors for cervical cancer.
       CN: Health promotion and maintenance; CL: Apply

Question 77

77. A woman tells the nurse that “there’s been a lot of cancer in my family.” The nurse should
    instruct the client to report which possible sign of cervical cancer?
78. Pain.
79. Leg edema.
80. Urinary and rectal symptoms.
81. Light bleeding or watery vaginal discharge.

Answer 77

77. 4. In its early stages, cancer of the cervix is usually asymptomatic, which underscores the
       importance of regular Pap smears. A light bleeding or serosanguineous discharge may be apparent as
       the first noticeable symptom. Pain, leg edema, urinary and rectal symptoms, and weight loss are late
       signs of cervical cancer.
       CN: Physiological adaptation; CL: Apply

Question 78

78. A 30-year-old female client asks the nurse about douching. What information should the nurse
    include in the teaching plan?
79. Douching during menstruation is safe.
80. Daily douching will decrease vaginal odor.
81. Perfumed douches are recommended to decrease odors.
82. Douching removes natural mucus and changes the balance of normal vaginal flora.

Answer 78

78. 4. The vagina naturally cleans itself, and douching is not recommended unless it is prescribed
       by a health care provider for a medical condition. Daily douching could destroy normal flora.
       Perfumed douches could trigger allergenic responses. Douching should be avoided during menses.
       CN: Reduction of risk potential; CL: Synthesize

Question 79

79. A young woman will receive 6 months of chemotherapy for cervical cancer. She is a single
    parent of two young children and can no longer work. The nurse contacts a social worker to help plan
    continuing care. The client states, “I feel overwhelmed. How can the social worker help me?” Which
    responses by the nurse about the role of the social worker are appropriate? Select all that apply.
80. “The social worker is a part of a multidisciplinary team that provides care for clients with
    cancer.”
81. “The social worker can assist in locating resources and programs to assist you during your
    treatment.”
82. “Based on your financial situation and need to care for your children, the social worker canhelp you identify needed resources at this time.”
83. “Your entire family will be included in the treatment plan. Your needs and those of your
    children will be assessed and determined so that referrals can be made to appropriate
    resources.”
84. “The social worker can authorize temporary funds to help you with child care and to pay your
    bills while you are sick.”

Answer 79

79. 1, 2, 3, 4. The social worker is part of the comprehensive, holistic health care team. Because
    the client is now unemployed and is a single parent, the social worker can provide information about
    sources of financial support. The needs of the client and the family members are included in thetreatment plan. The social worker cannot authorize temporary funds.
    CN: Management of care; CL: Apply

Question 80

80. The husband of a client with cervical cancer says to the nurse, “The doctor told my wife that
    her cancer is curable. Is he just trying to make us feel better?” Which would be the nurse’s most
    accurate response?
81. “When cervical cancer is detected early and treated aggressively, the cure rate is almost
    100%.”
82. “The 5-year survival rate is about 75%, which makes the odds pretty good.”
83. “Saying a cancer is curable means that 50% of all women with the cancer survive at least 5
    years.”
84. “Cancers of the female reproductive tract tend to be slow growing and respond well to
    treatment.”

Answer 80

80. 1. When cervical cancer is detected early and treated aggressively, the cure rate approaches
       100%. The incidence of cervical cancer has increased among women of African descent, Native
       American and Aboriginal people, and Latinas, and these women often have a poorer prognosis
       because the cancer is not identified early. Papanicolaou smears and colposcopy have the potential to
       decrease mortality from invasive carcinoma when these screening and treatment programs are utilized
       by women.
       CN: Physiological adaptation; CL: Synthesize

Question 81

81. A client with suspected cervical cancer is undergoing a colposcopy with conization. The
    nurse gives instructions to the client about her menstrual periods, emphasizing that:
82. Her periods will return to normal after 6 months.
83. Her next two or three periods may be heavier and more prolonged than usual.
84. Her next two or three periods will be lighter than normal.
85. She may skip her next two periods.

Answer 81

81. 2. The client should be informed that her next two or three periods could be heavy and
       prolonged. The client is instructed to report any excessive bleeding. The nurse should reinforce the
       necessity for the follow-up check and the review of the biopsy results with the client. The client’s
       periods will not be normal for 2 to 3 months.
       CN: Reduction of risk potential; CL: Synthesize

Question 82

82. A client with cervical cancer is undergoing internal radium implant therapy. A lead-lined
    container and a pair of long forceps are kept in the client’s hospital room for:
83. Disposal of emesis or other bodily secretions.
84. Handling of a dislodged radiation source.
85. Disposal of the client’s eating utensils.
86. Storage of the radiation dose

Answer 82

82. 2. Dislodged radioactive materials should not be touched with bare or gloved hands. Forceps
       are used to place the material in the lead-lined container, which shields the radiation. Exposure to
       radiation can occur only by direct exposure to the encased radioactive substance; it cannot result from
       contact with emesis or urine or from touching the client. Disposal of eating utensils cannot lead to
       radiation exposure. Radioactive dose materials are kept only in the radiation department.
       CN: Safety and infection control; CL: Apply

Question 83

83. The mother of a client who has a radium implant asks why so many nurses are involved in her
    daughter’s care. She states, “The doctor said I can be in the room for up to 2 hours each day, but the
    nurses say they’re restricted to 30 minutes.” The nurse explains that this variation is based on the fact
    that nurses:
84. Touch the client, which increases their exposure to radiation.
85. Work with many clients and could carry infection to a client receiving radiation therapy, if
    exposure is prolonged.
86. Work with radiation on an ongoing basis, while visitors have infrequent exposure to radiation.
87. Are at greater risk from the radiation because they are younger than the mother.

Answer 83

83. 3. The three factors related to radiation safety are time, distance, and shielding. Nurses on
       radiation oncology units work with radiation frequently and so must limit their contact. Nurses are
       physically closer to clients than are visitors, who are often asked to sit 6 feet (182.9 cm) away from
       the client. Touching the client does not increase the amount of radiation exposure. Aseptic technique
       and isolation prevent the spread of infection. Age is a risk factor for people in their reproductive
       years.
       CN: Safety and infection control; CL: Apply

Question 84

84. A client with human papillomavirus (HPV) infection is being treated by a colposcopy. The
    client asks the nurse if this procedure is really necessary. The nurse explains that the procedure to
    treat the warts is important because HPV can lead to:
85. Infertility.
86. Cervical cancer.
87. Pelvic inflammatory disease.4. Rectal cancer.

Answer 84

84. 2. HPV infection, or genital warts, can lead to dysplastic changes of the cervix, referred to as
       cervical intraepithelial neoplasia. The development of cervical cancer remains the largest threat of
       all condyloma-associated neoplasias. Infertility, pelvic inflammatory disease, and rectal cancer are
       not complications of genital warts.
       CN: Health promotion and maintenance; CL: Apply

Question 85

85. Which of the following should be included in the nursing care for a client with cervical
    cancer who has an internal radium implant in place?
86. Offer the bedpan every 2 hours.
87. Provide perineal care twice daily.
88. Check the position of the applicator hourly.
89. Offer a low-residue diet.

Answer 85

85. 4. Bowel movements can be difficult with the radium applicator in place. The purpose of the
       low-residue diet is to decrease bowel movements. The bowel is cleaned before therapy, and the
       woman is maintained on a low-residue diet during treatment to prevent bowel distention and
       defecation. To prevent dislodgment of the applicator, the client is maintained on strict bed rest and
       allowed only to turn from side to side. Perineal care is omitted during radium implant therapy,
       although any vaginal discharge should be reported to the physician. It is rare for the applicator to
       extrude, so this does not need to be checked every hour.
       CN: Basic care and comfort; CL: Synthesize

Question 86

86. The nurse should carefully observe a client with internal radium implants for typical adverse
    effects associated with radiation therapy to the cervix. These effects include:
87. Severe vaginal itching.
88. Confusion.
89. High fever in the afternoon or evening.
90. Nausea and a foul vaginal discharge.

Answer 86

86. 4. Nausea, vomiting, and a foul vaginal discharge are common adverse effects of internal
       radiation therapy for cervical cancer. A foul-smelling discharge may develop from the destruction and
       sloughing of cells. Vaginal discharge may persist for some time. General signs and symptoms of
       radiation syndrome include nausea, vomiting, anorexia, and malaise. Vaginal itching, confusion, and
       high fever are not typical adverse effects of radiation therapy for cervical cancer.
       CN: Safety and infection control; CL: Apply

Question 87

The Client With Cancer of the Ovaries
87. When teaching a client about ovarian cancer, the nurse should include information about
which of the following? Select all that apply.
1. Details about the prognosis.
2. Staging and grading of ovarian cancer.
3. Need for routine colonoscopy beginning at age 30.
4. Procedures for diagnosis if there is a pelvic mass.
5. Symptoms occurring early in the disease process.

Answer 87

The Client With Cancer of the Ovaries
87. 2, 4. Client teaching emphasizes the importance of regular gynecologic examinations. If a
pelvic mass is found, completely explain the procedures for diagnosis. Explain presurgical and
postsurgical instructions, and explain the terminology particular to staging and grading of cancer,
when appropriate. Refer all questions about the prognosis to the physician. Routine colonoscopies
are typically begun at age 50 unless family history warrants otherwise. Ovarian tumors are commonly
occult until symptoms of advanced disease are present.
CN: Health promotion and maintenance; CL: Create

Question 88

88. Interdisciplinary management of ovarian cancer includes which of the following? Select all
    that apply.
89. Combination chemotherapy to cure the cancer.
90. Bilateral salpingo-oophorectomy to remove diseased organs.
91. Radiation therapy to eliminate all cancer cells.
92. Referral to social services for supportive care.
93. Nutrition therapy for parenteral lipids.

Answer 88

88. 2, 4. Ovarian cancer is a malignant tumor of the ovary. Ovarian cancer is the fourth most
    common gynecologic cancer, but the most lethal. It is usually found in advanced stages because it is
    asymptomatic in early stages. Interdisciplinary management may involve chemotherapy, radiation
    therapy, surgery and supportive services. Chemotherapy may be used to achieve remission of the
    disease; it is not, however, curative. Surgery is the treatment of choice, usually involving total
    hysterectomy with bilateral salpingo-oophorectomy and removal of the omentum. Radiation therapy
    may be performed for palliative purposes only. The nurse should provide referral to home health
    services, financial assistance, psychological counseling, clergy, and other social services, as
    appropriate. Nutrition therapy for parenteral lipids is not part of management of ovarian cancer.
    CN: Health promotion and maintenance; CL: Create

Question 89

89. A client with ovarian cancer asks the nurse, “What is the cause of this cancer?” The most
    accurate response by the nurse is:
90. Use of oral contraceptives increases the risk of ovarian cancer.
91. Women who have had at least two live births are protected from ovarian cancer.
92. There is less chance of developing ovarian cancer when one lives in an industrialized country.
93. The risk of developing ovarian cancer is related to environmental, endocrine, and genetic
    factors.

Answer 89

89. 4. A definitive cause of carcinoma of the ovary is unknown, and the disease is multifactorial.
       The risk of developing ovarian cancer is related to environmental, endocrine, and genetic factors. The
       highest incidence is in industrialized Western countries. Endocrine risk factors for ovarian cancer
       include women who are nulliparous. Use of oral contraceptives does not increase the risk for
       developing ovarian cancer, but may actually be protective.
       CN: Health promotion and maintenance; CL: Apply

Question 90

90. The nurse is providing a community presentation about ovarian cancer. Which topic should
    receive priority attention in the lesson plan?
91. Ovarian cancer signs and symptoms are often vague until late in development.
92. Ovarian cancer should be considered in any woman older than 30 years of age.
93. A rigid board-like abdomen is the most common sign.
94. Methods for early detection have made a dramatic reduction in the mortality rate due to
    ovarian cancer.

Answer 90

90. 1. Ovarian cancer is rarely diagnosed early. Methods for mass screening and early detection
       have not been successful. Signs and symptoms are often vague until late in development. Ovarian
       cancer should be considered in any woman older than 40 years of age who has vague abdominal
       and/or pelvic discomfort or enlargement, a sense of bloating, or flatulence. Enlargement of the
       abdomen due to the accumulation of fluid is the most common sign.
       CN: Health promotion and maintenance; CL: Synthesize

Question 91

The Client Having Gynecological Surgery
91. When preparing a client for discharge 2 days after an abdominal hysterectomy, the nurse
should instruct the client to avoid which activities until recovery is complete?
1. Swimming in a pool treated with chlorine for 6 weeks after surgery.
2. Walking at a leisurely pace for 30 minutes at least once a day.
3. Driving until the client can push the brake pedal without pain.
4. Lifting greater than 2 lb (0.9 kg) until the abdominal incision has healed.

Answer 91

The Client Having Gynecological Surgery
91. 3. The client should be prepared for what to expect after surgery. The client should not drive
until she can use the brake pedal without abdominal pain. The nurse should teach the client to avoid
activities that may increase pelvic congestion, such as dancing or brisk walking, for several months,whereas activities, such as swimming and leisurely walking, may be both physically and mentally
helpful. Heavy lifting should be avoided for 2 months, but the client can lift up to 10 lb (4.5 kg) as
long as there is no tension on the abdomen or abdominal pain.
CN: Physiological adaptation; CL: Synthesize

Question 92

92. A client returned to the recovery room after a dilatation and curettage has the postoperative
    medication prescriptions shown in the chart. What should the nurse do next?
93. Ask the client to rate the intensity of her pain on a scale of 1 to 10 and administer the analgesia
    according to the intensity of the pain.
94. Administer the Demerol first because the client had surgery today.
95. Administer the Tylenol first, and if it does not relieve the pain in 2 hours, administer the
    Demerol.
96. Administer the Motrin first and if it does not relieve the pain, administer the Demerol.

Answer 92

92. 1. The nurse must first assess the intensity of the client’s pain before selecting the correct
       analgesia. A high score would necessitate administering the meperidine (Demerol). If the intensity
       rating is low, an oral analgesic would be appropriate. If acetaminophen (Tylenol) is given without
       assessing the intensity of the client’s pain, the nurse must then wait 4 hours before administering
       another analgesic.
       CN: Pharmacological and parenteral therapies; CL: Synthesize

Question 93

93. On the second day following an abdominal hysterectomy, a client reports she has had three
    brown, loose stools in moderate amount. The morning medications include a prescription for 100 mg
    of docusate sodium (Colace) daily or as needed. What should the nurse do next?
94. Administer the Colace according to the physician’s prescription.
95. Ask the client if she is having gas pains or hunger.
96. Withhold the medication and document the client’s report of loose stools.
97. Administer the Colace and instruct the client to avoid high-fiber foods.

Answer 93

93. 3. The nurse should withhold administering docusate sodium (Colace), a stool softener, and
       document that the woman has had loose stools. The nurse is responsible for assessing
       contraindications and adverse effects of medications, and administering the medication when the
       client already has loose stools is unsafe. The assessment should also include auscultation of bowel
       sounds and inquiry about gas pains, but the stool softener should still be withheld.
       CN: Pharmacological and parenteral therapies; CL: Synthesize

Question 94

The Client with Testicular Disease
94. A 28-year-old male is diagnosed with acute epididymitis. The nurse should assess the client
for:
1. Burning and pain on urination.
2. Severe tenderness and swelling in the scrotum.
3. Foul-smelling ejaculate.
4. Foul-smelling urine.

Answer 94

The Client with Testicular Disease
94. 2. Epididymitis causes acute tenderness and pronounced swelling of the scrotum. Gradual
onset of unilateral scrotal pain, urethral discharge, and fever are other key signs. Epididymitis is
occasionally, but not routinely, associated with urinary tract infection. Burning and pain on urination
and foul-smelling ejaculate or urine are not classic symptoms of epididymitis.
CN: Physiological adaptation; CL: Analyze

Question 95

95. A 30-year-old client is being treated for epididymitis. Teaching for this client should include
    the fact that epididymitis is commonly a result of a:
96. Virus.
97. Parasite.
98. Sexually transmitted infection.
99. Protozoon.

Answer 95

95. 3. Among men younger than age 35, epididymitis is most frequently caused by a sexually
       transmitted infection. Causative organisms are usually chlamydia or Neisseria gonorrhoeae. The
       other major form of epididymitis is bacterial, caused by the Escherichia coli or Pseudomonas
       organisms. The nurse should always include safe sex teaching for a client with epididymitis. The
       client should also be advised against anogenital intercourse because this is a mode of transmission of
       gram-negative rods to the epididymis.
       CN: Reduction of risk potential; CL: Apply

Question 96

96. When teaching a client to perform testicular self-examination, the nurse explains that the
examination should be performed:
1. After intercourse.
2. At the end of the day.
3. After a warm bath or shower.
4. After exercise.

Answer 96

96. 3. After a warm bath or shower, the testes hang lower and are both relaxed and in the ideal
       position for manual evaluation and palpation.
       CN: Health promotion and maintenance; CL: Apply

Question 97

97. The nurse is assessing a client's testes. Which of the following findings indicate the testes are
normal?
1. Soft.
2. Egg-shaped.
3. Spongy.
4. Lumpy.

Answer 97

97. 2. Normal testes feel smooth, egg-shaped, and firm to the touch, without lumps. The surface
       should feel smooth and rubbery. The testes should not be soft or spongy to the touch. Testicular
       malignancies are usually nontender, nonpainful hard lumps. Lumps, swelling, nodules, or signs of
       inflammation should be reported to the physician.
       CN: Health promotion and maintenance; CL: Analyze

Question 98

98. A client has a testicular nodule that is highly suspicious for testicular cancer. A laboratory
    test that supports this diagnosis is:
99. Decreased alpha fetoprotein (AFP).
100. Decreased beta–human chorionic gonadotropin (hCG).
101. Increased testosterone.
102. Increased AFP.

Answer 98

98. 4. AFP and hCG are considered markers that indicate the presence of testicular disease.
       Elevated AFP and hCG and decreased testosterone are markers for testicular disease. Measurementsof AFP, hCG, and testosterone are also obtained throughout the course of therapy to help measure the
       effectiveness of treatment.
       CN: Physiological adaptation; CL: Apply

Question 99

99. Although the cause of testicular cancer is unknown, it is associated with a history of:
100. Undescended testes.
101. Sexual relations at an early age.
102. Seminal vesiculitis.
103. Epididymitis.

Answer 99

99. 1. Cryptorchidism (undescended testes) carries a greatly increased risk for testicular cancer.
       Undescended testes occurs in about 3% of male infants, with an increased incidence in premature
       infants. Other possible causes of malignancy include chemical carcinogens, trauma, orchitis, and
       environmental factors. Testicular cancer is not associated with early sexual relations in men, even
       though cervical cancer is associated with early sexual relations in women. Testicular cancer is not
       associated with seminal vesiculitis or epididymitis.
       CN: Health promotion and maintenance; CL: Apply

Question 100

100. Risk factors associated with testicular malignancies include:
101. African race.
102. Residing in a rural area.
103. Lower socioeconomic status.
104. Age older than 40 years.

Answer 100

100. 2. The incidence of testicular cancer is higher in men who live in rural rather than suburban
        areas. Testicular cancer is more common in white than black men. Men with higher socioeconomic
        status seem to have a greater incidence of testicular cancer. The exact cause of testicular cancer is
        unknown. Cancer of the testes is the leading cause of death from cancer in the 15- to 35-year-old age
        group.
        CN: Health promotion and maintenance; CL: Analyze

Question 101

101. A client with a testicular malignancy undergoes a radical orchiectomy. In the immediate
     postoperative period, the nurse should particularly assess the client for:
102. Bladder spasms.
103. Urine output.
104. Pain.
105. Nausea.

Answer 101

101. 3. Because of the location of the incision in the high inguinal area, pain is a major problem
        during the immediate postoperative period. The incisional area and discomfort caused by movement
        contribute to increased pain. Bladder spasms and elimination problems are more commonly
        associated with prostate surgery. Nausea is not a priority problem.
        CN: Physiological adaptation; CL: Synthesize

Question 102

102. A right orchiectomy is performed on a client with a testicular malignancy. The client
     expresses concerns regarding his sexuality. The nurse should base the response on the knowledge that
     the client:
103. Is not a candidate for sperm banking.
104. Should retain normal sexual drive and function.
105. Will be impotent.
106. Will have a change in secondary sexual characteristics.

Answer 102

102. 2. Unilateral orchiectomy alone does not result in impotence if the other testis is normal. The
        other testis should produce enough testosterone to maintain normal sexual drive, functioning, and
        characteristics. Sperm banking before treatment is commonly recommended because radiation or
        chemotherapy can affect fertility.
        CN: Psychosocial adaptation; CL: Synthesize

Question 103

103. A client diagnosed with seminomatous testicular cancer expresses fear and questions the
     nurse about his prognosis. The nurse should base the response on the knowledge that:
104. Testicular cancer is almost always fatal.
105. Testicular cancer has a cure rate of 90% when diagnosed early.
106. Surgery is the treatment of choice for testicular cancer.
107. Testicular cancer has a 50% cure rate when diagnosed early.

Answer 103

103. 2. When diagnosed early and treated aggressively, testicular cancer has a cure rate of about
        90%. Treatment of testicular cancer is based on tumor type, and seminoma cancer has the best
        prognosis. Modes of treatment include combinations of orchiectomy, radiation therapy, and
        chemotherapy. The chemotherapeutic regimen used currently is responsible for the successful
        treatment of testicular cancer.
        CN: Physiological adaptation; CL: Apply

Question 104

The Client with Cancer of the Prostate
104. The nurse is developing an educational program about prostate cancer. The nurse should
provide information about which of the following topics:
1. The Prostate-Specific Antigen (PSA) test is reliable for detecting the presence of prostate
cancer.
2. For all men, age 50 and older, the American and Canadian Cancer Societies recommend an
annual rectal examination.
3. Not lifting more than 20 pounds (9.1 kg) aids in prevention of prostate cancer.
4. Regular sexual activity promotes health of the prostate gland to prevent cancer.

Answer 104

The Client with Cancer of the Prostate
104. 2. Most cases of prostate cancer are adenocarcinomas. An adenocarcinoma is palpable on
rectal examination because it arises from the posterior portion of the gland. Although the prostate-
specific antigen (PSA) is not a perfect screening test, the American Cancer Society and the Canadian
Cancer Society recommend an annual rectal examination and blood PSA level for all men age 50
years and older, or starting at age 40 years if the client is of African descent, or if there is family
history of prostate cancer.
To help achieve optimal sexual function, give the client the opportunity to communicate hisconcerns and sexual needs. Regular sexual activity does not prevent cancer.
CN: Health promotion and maintenance; CL: Synthesize

Question 105

105. The nurse is caring for a client who will have a bilateral orchiectomy. The client asks what
     is involved with this procedure. The nurse’s most appropriate response would be? “The surgery:
106. Removes the entire prostate gland, prostatic capsule, and seminal vesicles.”
107. Tends to cause urinary incontinence and impotence.”
108. Freezes prostate tissue, killing cells.”
109. Results in reduction of the major circulating androgen, testosterone.”

Answer 105

105. 4. Bilateral orchiectomy (removal of testes) results in reduction of the major circulating
        androgen, testosterone, as a palliative measure to reduce symptoms and progression of prostate
        cancer. A radical prostatectomy (removal of entire prostate gland, prostatic capsule, and seminal
        vesicles) may include pelvic lymphadenectomy. Complications include urinary incontinence,
        impotence, and rectal injury with the radical prostatectomy. Cryosurgery freezes prostate tissue,
        killing tumor cells without prostatectomy.
        CN: Health promotion and maintenance; CL: Apply

Question 106

106. The nurse is teaching a group of men about prostate cancer. Which of the following points
     should be included in the instruction? Select all that apply.
107. Prostate cancer is usually multifocal and slow growing.
108. Most prostate cancers are adenocarcinoma.
109. The incidence of prostate cancer is higher in men of African descent, and the onset is earlier.
110. A prostate specific antigen (PSA) lab test greater than 4 ng/mg will need to be monitored.
111. Cancer cells are detectable in the urine.

Answer 106

106. 1, 2, 3, Cancer of the prostate gland is the second-leading cause of cancer death among
     American and Canadian men and is the most common carcinoma in men older than age 65. Incidence
     of prostate cancer is higher in men of African descent, and onset is earlier. Most prostate cancers are
     adenocarcinoma. Prostate cancer is usually multifocal, slow growing, and can spread by local
     extension, by lymphatics, or through the bloodstream. Prostate-specific antigen (PSA) greater than 4
     ng/mg is diagnostic; a free PSA level can help stratify the risk of elevated PSA levels. Metastatic
     workup may include skeletal x-ray, bone scan, and computed tomography or magnetic resonance
     imaging to detect local extension, bone, and lymph node involvement. The urine does not have
     prostate cancer cells.
     CN: Health promotion and maintenance; CL: Create

Question 107

107. When a client is receiving hormone replacement for prostate cancer, the nurse should do
     which of the following? Select all that apply.
108. Inform the client that increased libido is expected with hormone therapy.
109. Reassure the client that erectile dysfunction will not occur as a consequence of hormone
     therapy.
110. Provide the client the opportunity to communicate concerns and needs.
111. Utilize communication strategies that enable the client to gain some feeling of control.
112. Suggest that an appointment be made to see a psychiatrist

Answer 107

107. 3, 4. Hormone manipulation deprives tumor cells of androgens or their byproducts and,
     thereby, alleviates symptoms and retards disease progression. Complications of hormonal
     manipulation include hot flashes, nausea and vomiting, gynecomastia, and sexual dysfunction. As part
     of supportive care, provide explanations of diagnostic tests and treatment options and help the client
     gain some feeling of control over his disease and decisions related to it. To help achieve optimal
     sexual function, give the client the opportunity to communicate his concerns and sexual needs. Inform
     the client that decreased libido is expected after hormonal manipulation therapy, and that impotence
     may result from some surgical procedures and radiation. A psychiatrist is not needed.
     CN: Psychosocial adaptation; CL: Synthesize

Question 108

108. A client asks the nurse why the prostate-specific antigen (PSA) level is determined before
     the digital rectal examination. The nurse’s best response is which of the following?
109. “It is easier for the client.”
110. “A prostate examination can possibly decrease the PSA.”
111. “A prostate examination can possibly increase the PSA.”
112. “If the PSA is normal, the client will not have to undergo the rectal examination.”

Answer 108

108. 3. Manipulation of the prostate during the digital rectal examination may falsely increase the
        PSA levels. The PSA determination and the digital rectal examination are no longer recommended as
        screening tools for prostate cancer. Prostate cancer is the most common cancer in men and the second
        leading killer from cancer among men in the United States and Canada. Incidence increases sharply
        with age, and the disease is predominant in the 60- to 70-year-old age group.
        CN: Health promotion and maintenance; CL: Apply

Question 109

109. The nurse is performing a digital rectal examination. Which of the following findings is a
     key sign for prostate cancer?
110. A hard prostate, localized or diffuse.
111. Abdominal pain.
112. A boggy, tender prostate.4. A nonindurated prostate.

Answer 109

109. 1. On digital rectal examination, key signs of prostate cancer are a hard prostate, induration
        of the prostate, and an irregular, hard nodule. Accompanying symptoms of prostate cancer can include
        constipation, weight loss, and lymphadenopathy. Abdominal pain usually does not accompany
        prostate cancer. A boggy, tender prostate is found with infection (eg, acute or chronic prostatitis).
        CN: Health promotion and maintenance; CL: Analyze

Question 110

110. A client is undergoing a total prostatectomy for prostate cancer. The client asks questions
     about his sexual function. The best response by the nurse is which of the following? “Loss of the
     prostate gland means that:
111. You will be impotent.”
112. You will be infertile and there will be no ejaculation. You can still experience the sensations
     of orgasm.”
113. You will have no loss of sexual function and drive.”
114. Your erectile capability will return immediately after surgery.”

Answer 110

110. 2. Loss of the prostate gland interrupts the flow of semen, so there will be no ejaculation
        fluid. The sensations of orgasm remain intact. The client needs to be advised that return of erectilecapability is often disrupted after surgery, but within 1 year 95% of men have returned to normal
        erectile function with sexual intercourse.
        CN: Physiological adaptation; CL: Synthesize

Question 111

111. A 65-year-old client has been told by the physician that his prostate cancer was graded at
     stage IIB. The client inquires if this means he is going to die soon. The best response by the nurse is
     which of the following?
112. “Prostate cancer at this stage is very slow growing.”
113. “Prostate cancer at this stage is very fast growing.”
114. “Prostate cancer at this stage has spread to the bone.”
115. “Prostate cancer at this stage is difficult to predict.”

Answer 111

111. 1. Clients who have stage IA or IIB prostate cancer have an excellent survival rate. Prostate
        cancer is usually slow growing, and many men who have prostate cancer do not die from it. A stage I
        or II tumor is confined to the prostate gland and has not spread to the extrapelvic region or bone.
        CN: Physiological adaptation; CL: Synthesize

Question 112

112. A client with prostate cancer is treated with a luteinizing hormone-releasing hormone
     agonist and antagonist goserelin. The nurse should instruct the client to expect to have:
113. Tenderness of the scrotum.
114. Flushing.
115. Loss of pubic hair.
116. Decreased blood pressure.

Answer 112

112. 2. Goserelin is used to decrease testosterone production in men to slow or stop the
        production of cancer cells. A common side effect is flushing or hot flashes. Changes in blood
        pressure, tenderness of the scrotum, and dramatic changes in secondary sexual characteristics should
        not occur.
        CN: Pharmacological and parenteral therapies; CL: Apply

Question 113

The Client with Erectile Dysfunction
113. The client is taking sildenafil (Viagra) PO for erectile dysfunction. The nurse should instruct
the client about which of the following?
1. Sildenafil (Viagra) may be taken more than one time per day.
2. The health care provider should be notified promptly if the client experiences sudden or
diminished vision.
3. Sildenafil (Viagra) offers protection against some sexually transmitted diseases (STDs).
4. Sildenafil (Viagra) does not require sexual stimulation to work.

Answer 113

The Client with Erectile Dysfunction
113. 2. The client should notify his health care provider promptly if he experiences sudden or
decreased vision loss in one or both eyes. Sildenafil (Viagra) should not be taken more than once per
day. Viagra offers no protection against sexually transmitted diseases. Viagra has no effect in the
absence of sexual stimulation.
CN: Pharmacological and parenteral therapies; CL: Synthesize

Question 114

114. A male client reports having impotence. The nurse examines the client’s medication regimen
     and is aware that a contributing factor to impotence could be:
115. Aspirin.
116. Antihypertensives.
117. Nonsteroidal anti-inflammatory drugs.
118. Anticoagulants.

Answer 114

114. 2. Antihypertensives, especially beta-blockers such as propranolol (Inderal), can cause
        impotence. When a male client has impotence, the nurse should always examine his medication
        regimen as a potential contributing factor. Aspirin, nonsteroidal anti-inflammatory drugs, and
        anticoagulants do not cause erectile dysfunction.
        CN: Pharmacological and parenteral therapies; CL: Synthesize

Question 115

115. A 65-year-old male client with erectile dysfunction (ED) asks the nurse, “Is all this just in
     my head? Am I crazy?” The best response by the nurse is based on the knowledge that:
116. ED is believed to be psychogenic in most cases.
117. More than 50% of the cases are attributed to organic causes.
118. Evaluation of nocturnal erections does not help differentiate psychogenic or organic causes.
119. ED is an uncommon problem among men older than age 65

Answer 115

115. 2. ED is multifactorial in origin, and more than 50% of the cases can be attributed to organic
        causes, which include alteration in vascular supply, hormonal changes, neurologic dysfunction,
        medications, and associated systemic diseases, such as diabetes mellitus or alcoholism. The presence
        of nocturnal erections is the first evaluation to differentiate between organic and psychogenic causes.
        ED is a common problem among men older than age 65.
        CN: Psychosocial adaptation; CL: Apply

Question 116

116. The nurse should teach the client with erectile dysfunction (ED) to alter his lifestyle to:
117. Avoid alcohol.
118. Follow a low-salt diet.
119. Decrease smoking.
120. Increase attempts at sexual intercourse.

Answer 116

116. 1. Avoidance of alcohol can improve the outcome of therapy. Alcohol and smoking can affect
        a man’s ability to have and maintain an erection. The client should be encouraged to follow a healthy
        diet, but no specific diet is associated with improvement of sexual function. The client should cease
        smoking, not just decrease smoking. Increasing attempts at intercourse without treatment will not
        facilitate improvement. The client should be reassured that ED is a common problem and that help is
        available.
        CN: Reduction of risk potential; CL: Synthesize

Question 117

Managing Care Quality and Safety
117. The nurse is assigning tasks to the unlicensed assistive personnel (UAP) for a client with an
abdominal hysterectomy on the first postoperative day. Which of the following can not be delegated
to the UAP?
1. Taking vital signs.
2. Recording intake and output.
3. Giving perineal care.
4. Assessing the incision site.

Answer 117

Managing Care Quality and Safety
117. 4. The registered nurse is responsible for monitoring the surgical site for condition of the
dressing, status of the incision, and signs and symptoms of complications. Unlicensed assistivepersonnel who have been trained to report abnormalities to the registered nurse supervising the care
may take vital signs, record intake and output, and give perineal care.
CN: Management of care; CL: Synthesize

Question 118

118. The nurse-manager on a gynecologic surgical unit is addressing reports from clients that they
     have to wait too long on the night shift for their pain medication. Which course of action should the
     nurse-manager take first?
119. Change the staffing schedule on nights to include a medication nurse.
120. Consult the nursing supervisor.
121. Consult the nurses on the evening shift about their evaluation of the night nurses regarding these
     reports from the clients.
122. Complete a quality improvement study with the night nurses to document the waiting times for
     pain medication and other data, including staffing and client acuity.

Answer 118

118. 4. To determine the cause of this problem, a quality improvement study should be conducted.
        Before implementing solutions to a problem, the precise issues in the hospital system must be
        observed and documented. Consulting with the evening nurses may result in biased observations
        because the evening nurses are not conducting care under the same environment as the night nurses.
        Including a medication nurse is not the first step in understanding the problem and may be an
        unrealistic or expensive solution. The supervisor is not directly involved with the problem and
        should only be consulted if the problem cannot be solved by those involved.
        CN: Management of care; CL: Synthesize

Question 119

119. A nurse is reviewing the physician’s admitting prescriptions for a 52-year-old client
     scheduled for a dilatation and curettage. The nurse is unable to decipher the handwriting but thinks the
     medication prescription reads either metoprolol or topiramate. What should the nurse do next?
120. Ask the client if she has hypertension.
121. Ask the client if she has migraines.
122. Call the physician to clarify the prescription.
123. Ask the pharmacist to interpret the prescription.

Answer 119

119. 3. The nurse must clarify this prescription with the admitting physician to ensure medication
        accuracy and client safety. In health care settings without computerized medical records or computer
        prescribing, misinterpretation of handwriting remains a leading cause of medication errors. It is not
        safe practice to question the client regarding a diagnosis and assume the medication is correctly
        prescribed. The pharmacist will need clarification of the prescription as well. It is not the role of the
        pharmacist to interpret the prescription.
        CN: Pharmacological and parenteral therapies; CL: Synthesize

Question 120

120. The unlicensed assistive personnel (UAP) reports to the nurse that the client with an
     abdominal hysterectomy who returned from the recovery room 1 hour earlier has saturated the blue
     pad with bright red blood. The nurse should:
121. Call the surgeon to report the bleeding.
122. Ask the UAP to obtain vital signs while the nurse calls the surgeon.
123. Ask the UAP to increase the flow of IV fluids to prevent shock.
124. Assess the client again in 15 minutes before the nurse takes any further action.

Answer 120

120. 2. The surgeon should be notified when a client who has had an abdominal hysterectomy
        develops vaginal bleeding that saturates a blue pad in 1 hour, and care should be managed so that
        other personnel can obtain vital signs while the nurse contacts the surgeon. The client may need to
        have IV fluids increased, but the surgeon needs to be notified first. Waiting 15 minutes while the
        client is having bright-red bleeding is an unsafe nursing action; the client may lose a large amount of
        blood.
        CN: Management of care; CL: Synthesize

Question 121

121. A nurse on the gynecologic surgery unit observes a respiratory therapist (RT) take a
     medication cup with pills that was sitting in the medication room. What course of action should the
     nurse take?
122. Report the situation to the supervisor of respiratory therapy.
123. Tell the RT that you saw her take the pills from the medication room.
124. Report the situation to the nursing supervisor.
125. Tell the nurse who was administering medications not to leave pills out.

Answer 121

121. 3. The nurse should follow the line of authority or chain of command by reporting the
        observation immediately to the nursing supervisor. The nurse should not confront the person or the
        medication nurse because the line of authority for reporting incidents should be followed. The RT
        supervisor may subsequently be involved in the incident, but the nursing supervisor should initiate
        and follow the policy and procedure.
        CN: Management of care; CL: Synthesize