The Client with ReproductiveHealth Problems TEST

The Client with Uterine Fibroids

The Client with Breast Disease

The Client with Benign Prostatic Hypertrophy

The Client with a Sexually Transmitted Disease

The Client with Cancer of the Cervix

The Client with Cancer of the Ovaries

The Client Having Gynecological Surgery

The Client with Testicular Disease

The Client with Cancer of the Prostate

The Client with Erectile Dysfunction

Managing Care Quality and Safety

Answers, Rationales, and Test Taking Strategies

The Client with Breast Disease

23. A postmenopausal woman is worried about

pain in the upper outer quadrant of her left breast.

The nurse’s fi rstcourse 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).

24. 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.

The Client with Breast Disease

23. A postmenopausal woman is worried about

pain in the upper outer quadrant of her left breast.

The nurse’s fi rstcourse 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).

24. 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.

29. During the admission workup 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 questions raised by this apprehensive

preoperative client?

■1. Tell the client as much as she wants to know

and is able to understand.

■2. Delay discussing the client’s questions with

her until she is convalescing.

■3. Delay discussing the client’s questions with

her until her apprehension subsides.

■4. Explain to the client that she should discuss

her questions fi rst with the physician.

30. A client asks the nurse, “Where is cancer

usually found in the breast?” When responding to

the client, the nurse uses a diagram of a left breast

and indicates that most malignant tumors occur in

which quadrant of the breast?

■1. Upper outer quadrant.

■2. Upper inner quadrant.

■3. Lower outer quadrant.

■4. Lower inner quadrant.

31. Atropine sulfate is included in the preoperative

orders for a client undergoing a modified radical

mastectomy. The expected outcome is to:

■1. promote general muscular relaxation.

■2. decrease pulse and respiratory rates.

■3. decrease nausea.

■4. inhibit oral and respiratory secretions.

32. During the postoperative period after a modifi

ed radical mastectomy, the client confi des 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?

■1. “Cancer is not a punishment; it is a disease.”

■2. “You might feel better if you confided in your

husband.”

■3. “Tell me more about your feelings on this.”

■4. “I can have the social worker talk to you if

you would like.”

33. Postoperatively after a modified radical

mastectomy, a client has an incisional drainage tube

attached to Hemovac suction. The nurse determines

the suction is effective when:

■1. The intrathoracic pressure is decreased and

the client breathes easier.

■2. There is an increased collateral lymphatic

flow toward the operative area.

■3. Accumulated serum and blood in the operative

area are removed.

■4. No adhesions are formed between the skin

and chest wall in the operative area.

34. 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?

■1. Across her chest wall.

■2. At her side at the same level as her body.

■3. In the position that affords her the greatest comfort

without placing pressure on the incision.

■4. On pillows, with her hand higher than her

elbow and her elbow higher than her shoulder.

35. 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. The nurse’s

best response is which of the following?

■1. “This drug is part of your chemotherapy program.”

■2. “This drug has been found to decrease metastatic

breast cancer.”

■3. “This drug will act as an estrogen in your

breast tissue.”

■4. “This drug will prevent hot fl ashes since you

cannot take hormone replacement.”

36. A client undergoing chemotherapy after a

modified radical mastectomy asks the nurse questions

about a breast prosthesis and wigs. After answering

the questions directly, the nurse should also:

■1. Provide a list of resources, including the local

breast cancer support group.

■2. Offer a referral to the social worker.

■3. Call the home health care agency.

■4. Contact the plastic surgeon.

37. 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:

■1. Washing the area with water.

■2. Exposing the area to dry heat.

■3. Applying an ointment to the area.

■4. Using talcum powder on the area.

38. The nurse should teach a client that a normal

local tissue response to radiation is:

■1. Atrophy of the skin.

■2. Scattered pustule formation.

■3. Redness of the surface tissue.

■4. Sloughing of two layers of skin.

39. The nurse refers a client who had a mastectomy

to “Reach to Recovery.” The primary purpose

of the American Cancer Society’s Reach to Recovery

program is to:

■1. Foster rehabilitation in women who have had

mastectomies.

■2. Raise funds to support early breast cancer

detection programs.

■3. Provide free dressings for women who have

had radical mastectomies.

■4. Collect statistics for research from women

who have had mastectomies.

The Client with Benign Prostatic

Hypertrophy

40. A 72-year-old male is in the emergency

department because he 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.

41. During a client’s urinary bladder catheterization,

the nurse ensures that the bladder is emptied

gradually. The best rationale for the nurse’s action is

that completely emptying an overdistended bladder

at one time tends to cause:

■1. Renal failure.

■2. Abdominal cramping.

■3. Possible shock.

■4. Atrophy of bladder musculature.

42. The primary reason for lubricating the urinary

catheter generously before inserting it into a

male client is that this technique helps reduce:

■1. Spasms at the orifice of the bladder.

■2. Friction along the urethra when the catheter

is being inserted.

■3. The number of organisms gaining entrance to

the bladder.

■4. The formation of encrustations that may

occur at the end of the catheter.

43. The primary reason for taping an indwelling

catheter laterally to the thigh of a male client

is to:

■1. Eliminate pressure at the penoscrotal angle.

■2. Prevent the catheter from kinking in the urethra.

■3. Prevent accidental catheter removal.

■4. Allow the client to turn without kinking the

catheter.

44. 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:

■1. Feel too self-conscious to seek help when

reproductive organs are involved.

■2. Expect that it is normal to have to live

with some urinary problems as they grow

older.

■3. Fear that sexual indiscretions in earlier life

may be the cause of their problem.

■4. Have little discomfort in relation to the

amount of pathology because responses to

pain stimuli fade with age.

45. 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.

■1. Provide privacy and time for the client to void.

■2. Monitor intake and output.

■3. Catheterize the client for post void residual

urine.

■4. Ask the client if he has urinary retention.

■5. Test the urine for hematuria.

46. The nurse should specifically assess a client

with prostatic hypertrophy for which of the following ?

■1. Voiding at less frequent intervals.

■2. Difficulty starting the flow of urine.

■3. Painful urination.

■4. Increased force of the urine stream.

47. The nurse is reviewing the medication history

of a client with benign prostatic hypertrophy

(BPH). Which medication will likely aggravate BPH?

■1. Metformin (Glucophage).

■2. Buspirone (BuSpar).

■3. Inhaled ipratropium (Atrovent).

■4. Ophthalmic timolol (Timoptic).

48. 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:

■1. Seizures.

■2. Cardiac arrest.

■3. Renal shutdown.

■4. Respiratory paralysis.

49. A client with benign prostatic hypertrophy

(BPH) is being treated with terazosin (Hytrin) 2 mg

at bedtime. The nurse should monitor the client’s:

■1. Urine nitrites.

■2. White blood cell count.

■3. Blood pressure.

■4. Pulse.

50. A client underwent transurethral resection of

the prostate (TURP), and a large three-way indwelling

urinary catheter was inserted in the bladder

with continuous bladder irrigation. In which of the

following circumstances should the nurse increase

the flow rate of the continuous bladder irrigation?

■1. When drainage is continuous but slow.

■2. When drainage appears cloudy and dark yellow.

■3. When drainage becomes bright red.

■4. When there is no drainage of urine and irrigating

solution.

51. 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:

■1. A urinary tract infection.

■2. Urine retention.

■3. Frequent urination.

■4. Pain from bladder spasms.

52. 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?

■1. “His catheter is probably plugged. I’ll irrigate

it in a few minutes.”

■2. “That’s a common complaint 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.”

■4. “I think he may be somewhat confused.”

53. A physician has ordered amoxicillin 100

P.O. BID (Ampicillin). The nurse should teach the

client to: Select all that apply.

■1. Drink 2,500 mL of fluids daily.

■2. Void frequently, at least every 2 to 3 hours.

■3. Take time to empty the bladder completely.

■4. Take the last dose of the antibiotic for the day

at bedtime.

■5. Take the antibiotic with food.

54. 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:

■1. Can be a chronic problem.

■2. Can persist for several months.

■3. Is an abnormal sign that requires intervention.

■4. Is a sign of healing within the prostate.

55. A priority nursing diagnosis for the client

who is being discharged to home 3 days after transurethral

resection of the prostate (TURP) is:

■1. Deficientfluid volume.

■2. Imbalanced nutrition: Less than body requirements.

■3. Impaired tissue integrity.

■4. Ineffective airway clearance.

56. A client with benign prostatic hypertrophy

(BPH) has an elevated prostate-specifi c antigen

(PSA) level. The nurse should?

■1. Instruct the client to have a colonoscopy

before coming to conclusions about the PSA

results.

■2. Instruct the client that a urologist will monitor

the PSA level biannually when elevated.

■3. Determine if the prostatic palpation was done

before or after the blood sample was drawn.

■4. Ask the client if he emptied his bladder

before the blood sample was obtained.

The Client with Testicular Disease

98. 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.

99. A 20-year-old client is being treated for

epididymitis. Teaching for this client should include

the fact that epididymitis is commonly a result of a:

■1. Virus.

■2. Parasite.

■3. Sexually transmitted infection.

■4. Protozoon.

100. 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.

101. The nurse is assessing a client’s testes. Which

of the following fi ndings indicate the testes are

normal?

■1. Soft.

■2. Egg-shaped.

■3. Spongy.

■4. Lumpy.

102. A client has a testicular nodule that is highly

suspicious for testicular cancer. A laboratory test

that supports this diagnosis is:

■1. Decreased alpha fetoprotein (AFP).

■2. Decreased beta–human chorionic gonadotropin

(hCG).

■3. Increased testosterone.

■4. Increased AFP.

103. Although the cause of testicular cancer is

unknown, it is associated with a history of:

■1. Undescended testes.

■2. Sexual relations at an early age.

■3. Seminal vesiculitis.

■4. Epididymitis.

104. Risk factors associated with testicular malignancies

include:

■1. African-American race.

■2. Residing in a rural area.

■3. Lower socioeconomic status.

■4. Age older than 40 years.

105. A client with a testicular malignancy undergoes

a radical orchiectomy. In the immediate postoperative

period the nurse should particularly

assess the client for:

■1. Bladder spasms.

■2. Urine output.

■3. Pain.

■4. Nausea.

106. 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:

■1. Is not a candidate for sperm banking.

■2. Should retain normal sexual drive and function.

■3. Will be impotent.

■4. Will have a change in secondary sexual characteristics.

107. 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:

■1. Testicular cancer is almost always fatal.

■2. Testicular cancer has a cure rate of 90% when

diagnosed early.

■3. Surgery is the treatment of choice for testicular

cancer.

■4. Testicular cancer has a 50% cure rate when

diagnosed early.

The Client with Cancer

of the Prostate

108. The nurse is developing a program about

prostate cancer for a health fair. The nurse should

provide information about which of the following

topics?

■1. The Prostate-Specifi c Antigen (PSA) test is reliable

for detecting the presence of prostate cancer.

■2. For all men, age 50 and older, the American

Cancer Society recommends an annual rectal

examination.

■3. Avoid lifting more than 20 lb aids in prevention

of prostate cancer.

■4. Regular sexual activity promotes health of the

prostate gland to prevent cancer.

109. 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:

■1. Removes the entire prostate gland, prostatic

capsule, and seminal vesicles.”

■2. Tends to cause urinary incontinence and

impotence.”

■3. Freezes prostate tissue, killing cells.”

■4. Results in reduction of the major circulating

androgen, testosterone.”

110. The nurse is teaching a client newly diagnosed

with prostate cancer. Which of the following points

should be included in the instruction? Select all that

apply.

■1. Prostate cancer is usually multifocal and

slow-growing.

■2. Most prostate cancers are adenocarcinoma.

■3. The incidence of prostate cancer is higher

in African American men, and the onset is

earlier.

■4. A prostate specifi c antigen (PSA) lab

test greater than 4 ng/mg will need to be

monitored.

■5. Cancer cells are detectable in the urine.

111. When a client is receiving hormone replacement

for prostate cancer, the nurse should do which

of the following? Select all that apply.

■1. Inform the client that increased libido is

expected with hormone therapy.

■2. Reassure the client and his significant other

that erectile dysfunction will not occur as a

consequence of hormone therapy.

■3. Provide the client the opportunity to communicate

concerns and needs.

■4. Utilize communication strategies that

enable the client to gain some feeling of

control.

■5. Suggest that an appointment be made to see a

psychiatrist.

112. A client asks the nurse why the prostate

specifi c antigen (PSA) level is determined before the

digital rectal examination. The nurse’s best response

is which of the following?

■1. “It is easier for the client.”

■2. “A prostate examination can possibly

decrease the PSA.”

■3. “A prostate examination can possibly

increase the PSA.”

■4. “If the PSA is normal, the client will not have

to undergo the rectal examination.”

113. The nurse is performing a digital rectal

examination. Which of the following fi nding is a

key sign for prostate cancer?

■1. A hard prostate, localized or diffuse.

■2. Abdominal pain.