Question 1

In which areas of the united states is the incidence of tuberculosis highest: a. rural farming areas b. inner city areas c. areas where clean water standards are low d. suburban areas with significant industrial pollution

Accepted Answer

inner city areas

Question 2

An obese 36-year-old multigravid client at 12 weeks\' gestation has a history of chronic hypertension. She was treated with methyldopa (Aldomet) before becoming pregnant. When counseling the client about diet during pregnancy, the nurse realizes that the client needs additional instruction when she states which of the following? A. \"I need to reduce my caloric intake to 1,200 calories a day.\" B. \"A regular diet is recommended during pregnancy.\" C. \"I should eat more frequent meals if I get heartburn.\" D. \"I need to consume more fluids and fiber each day.\"

Accepted Answer

ANSWER A. Pregnancy is not the time for clients to begin a diet. Clients with chronic hypertension need to consume adequate calories to support fetal growth and development. They also need an adequate protein intake. Meat and beans are good sources of protein. Most pregnant women report that eating more frequent, smaller meals decreases heartburn resulting from the reflux of acidic secretions into the lower esophagus. Pregnant women need adequate hydration (fluids) and fiber to prevent constipation.

Question 3

The physician has ordered a chemotherapy drug to be administered to a client every day for the next week. The client is on an adult medical-surgical floor but the nurse assigned to the client has not been trained to handle chemotherapy agents. What is the nurse\'s most appropriate response? A. Send the client to the oncology floor for administration of the medication. B. Ask a nurse from the oncology floor to come to the client and administer the medication. C. Ask another nurse to help mix the chemotherapy agent. D. Ask the pharmacy to mix the chemotherapy agent and administer it.

Accepted Answer

ANSWER A. The nurse should call the oncology unit to institute a transfer. The nurse handling chemotherapy agents should be specifically trained. It is an unwise use of nursing resources to send a nurse from one unit to administer medications to a client on another unit. It is better to centralize and send the clients who need chemotherapy to one unit. Even if the pharmacy mixes the agent, the drug must be administered by a nurse who is trained to do so.

Question 4

Which of the following nursing diagnoses would the nurse identify as a priority after surgical repair of a cleft lip? A. Pain. B. Risk for Infection. C. Impaired Physical Mobility. D. Impaired Parenting.

Accepted Answer

ANSWER B. After surgery, the most important nursing diagnosis should be Risk for Infection. Surgery involves an incision, which is at risk for infection. The infant with this type of procedure does have discomfort, which can be relieved with acetaminophen. Pain would be an important nursing diagnosis but not the priority. The infant may be in arm restraints or have the cuff of the sleeve pinned to the diaper or pants. It is important that the infant not touch the incision line or disrupt the sutures. There is no indication of Impaired Parenting. The parents would be reacting normally with a first reaction of shock.

Question 5

Which of the following would be an appropriate outcome for a client with rheumatoid arthritis? The client will A. manage joint pain and fatigue to perform activities of daily living. B. maintain full range-of-motion (ROM) in joints. C. prevent the development of further pain and joint deformity D. take anti-inflammatory medications as indicated by the presence of disease symptoms.

Accepted Answer

ANSWER A. An appropriate outcome for clients with rheumatoid arthritis is that they will adopt self-care behaviors to manage their joint pain, stiffness, and fatigue and be able to perform their activities of daily living. ROM exercises can help maintain mobility, but it may not be realistic to expect to be able to maintain full ROM. Depending on the disease progression, there may be further development of pain and joint deformity, even with appropriate therapy. It is important for clients to understand the importance of taking their prescribed drug therapy even if their symptoms have abated.

Question 6

A client\'s burn wounds are being cleaned twice a day in a hydrotherapy tub. Which of the following interventions should be included in the plan of care before a hydrotherapy treatment is initiated? A. Limit food and fluids 45 minutes before therapy to prevent nausea and vomiting. B. Increase the intravenous flow rate to offset fluids lost through the therapy. C. Apply a topical antibiotic cream to burns to prevent infection. D. Administer pain medication 30 minutes before therapy to help manage pain.

Accepted Answer

ANSWER D. Hydrotherapy wound cleaning is very painful for the client. The client should be medicated for pain about 30 minutes before the treatment in anticipation of the increased pain the client will experience. Wounds are debrided but excessive fluids are not lost during the hydrotherapy session. However, electrolyte loss can occur from open wounds during immersion, so the sessions should be limited to 20 to 30 minutes. There is no need to limit food or fluids 45 minutes before hydrotherapy, unless it is an individualized need for a given client. Topical antibiotics are applied after the therapy, not before submersion in the water.

Question 7

A health care provider has been exposed to hepatitis B through a needlestick. Which of the following drugs would the nurse anticipate administering as postexposure prophylaxis? A. Hepatitis B immune globulin. B. Interferon. C. Hepatitis B surface antigen. D. Amphotericin B.

Accepted Answer

ANSWER A. Hepatitis B immune globulin is given as prophylactic therapy to individuals who have been exposed to hepatitis B. Interferon has been approved to treat hepatitis B. Hepatitis B surface antigen is a diagnostic test used to detect current infection. Amphotericin B is an antifungal.

Question 8

When performing an otoscopic examination of the tympanic membrane of a 2-year-old child, the nurse would pull the pinna in which of the following directions? A. Down and back. B. Down and slightly forward. C. Up and back. D. Up and forward.

Accepted Answer

ANSWER A. When examining the tympanic membrane of a child younger than 3 years of age, the nurse should pull the pinna down and back. For an older child, the nurse should pull the pinna up and back to view the tympanic membrane

Question 9

Which of the following findings would the nurse most likely note in the client who is in the compensatory stage of shock? A. Decreased urinary output. B. Significant hypotension. C. Tachycardia. D. Mental confusion.

Accepted Answer

ANSWER C. In the compensatory stage of shock, the client will exhibit moderate tachycardia. If the shock continues to the progressive stage, decreased urinary output, hypotension, and mental confusion will develop as a result of failure to perfuse and ineffective compensatory mechanisms. These findings are indications that the body\'s compensatory mechanisms are failing

Question 10

A client has been prescribed hydrochlorothiazide (HydroDIURIL) for treatment of heart failure. For which of the following symptoms should the nurse monitor the client? A. Urinary retention. B. Muscle weakness. C. Confusion. D. Diaphoresis.

Accepted Answer

ANSWER B. Hydrochlorothiazide is a thiazide diuretic. Muscle weakness can be an indication of hypokalemia. Polyuria is associated with this diuretic, not urinary retention. Confusion and diaphoresis are not side effects of hydrochlorothiazide

Question 11

The son of a client with Alzheimer\'s disease excitedly tells the nurse, \"Mom was singing one of her favorite old songs. I think she\'s getting her memory back!\" Which of the following responses by the nurse is most appropriate? A. \"She still has long-term memory, but her short-term memory will not return.\" B. \"I\'m so happy to hear that. Maybe she is getting better.\" C. \"Don\'t get your hopes up. This is only a temporary improvement.\" D. \"I\'m glad she can sing even if she can\'t talk to you.\"

Accepted Answer

ANSWER A. The ability to remember an old song is related to long-term memory, which persists after short-term memory is lost. Therefore, the nurse would respond by providing the son with this information. Stating that the nurse is happy to hear about the change and that the client is getting better is inappropriate and inaccurate. This statement ignores the issue of long-term versus short-term memory. Telling the client not to get his hopes up because the improvement is only temporary is inappropriate. The information provided does not indicate that the client has expressive aphasia, which would be suggested by the statement that the client can\'t talk to the son.

Question 12

The nurse collects a urine specimen from a client for a culture and sensitivity analysis. Which of the following is the correct care of the specimen? A. Promptly send the specimen to the laboratory. B. Send the specimen with the next pickup. C. Send the specimen the next time a nursing assistant is available. D. Store the specimen in the refrigerator until it can be sent to the laboratory.

Accepted Answer

ANSWER A. A specimen for culture and sensitivity should be sent to the laboratory promptly so that a smear can be taken before organisms start to grow in the specimen

Question 13

A 16-year-old client is in the emergency department for treatment of minor injuries from a car accident. A crisis nurse is with her because she became hysterical and was saying, \"It\'s my fault. My Mom is going to kill me. I don\'t even have a way home.\" Which of the following would be the nurse\'s initial intervention? A. \"Hold her hands and say, \"Slow down. Take a deep breath.\" B. \"Calm down. The police can take you home.\" C. \"Put a hand on her shoulder and say, \'It wasn\'t your fault.\"\' D. \"Your mother is not going to kill you. Stop worrying.\"

Accepted Answer

ANSWER A. The client is in a crisis and has a high anxiety level. Holding the client\'s hands and encouraging the client to slow down and take a deep breath conveys caring and helps decrease anxiety. Telling the client to calm down or stop worrying offers no concrete directions for accomplishing this task. It is unknown from the data who was at fault in the accident. Therefore, it would be inappropriate for the nurse to state that it wasn\'t the client\'s fault

Question 14

The nurse is developing a community health education program about STDs. Which information about women who acquire gonorrhea should be included? A. Women are more reluctant than men to seek medical treatment. B. Gonorrhea is not easily transmitted to women who are menopausal. C. Women with gonorrhea are usually asymptomatic. D. Gonorrhea is usually a mild disease for women.

Accepted Answer

ANSWER C. Many women who acquire gonorrhea are asymptomatic or experience mildsymptoms that are easily ignored. They are not necessarily more reluctant than men to seek medical treatment, but they are more likely not to realize they have been affected with a disease. Gonorrhea is easily transmitted to all women and can result in serious consequences such as pelvic inflammatory disease and infertility

Question 15

A client has his leg immobilized in a long leg cast. Which of the following assessments would indicate the early beginning of circulatory impairment? A. Inability to move toes. B. Cyanosis of toes. C. Complaints of cast tightness. D. Tingling of toes.

Accepted Answer

ANSWER D. Tingling and numbness of the toes would be the earliest indication of circulatory impairment. Inability to move the toes and cyanosis are later indicators. Complaints of cast tightness should be investigated, because cast tightness can lead to circulatory impairment; it is not, however, an indicator of impairment

Question 16

While feeding a term neonate at 2 hours of age, the nurse observes that the neonate has a drooping appearance on the left side of the face. The nurse notifies the physician based on the understanding that this is associated with which of the following? A. Craniotabes. B. Meningitis. C. Facial nerve damage. D. Skull fracture.

Accepted Answer

ANSWER C. The nurse notifies the physician because a drooping of one side of the face or a \"one-side cry\" is associated with facial nerve damage. Additionally, the mother\'s delivery record and history need to be reviewed for a possible cause. Craniotabes is a softening of the skull bones. The bones are so soft that indentation from the pressure of an examining finger can occur. Meningitis, or inflammation of the meninges, is associated with a rigid neck. Other symptoms may include lethargy, poor sucking reflexes, weak cry, seizures, and apnea. Skull fracture is not associated with a drooping facial appearance. Rather, it would be evidenced by a crack in the skull bone, possibly accompanied by leaking cerebrospinal fluid

Question 17

A client tells the nurse that she has had sexual contact with someone whom she suspects has genital herpes. Which of the following instructions should the nurse give the client in response to this information? A. Anticipate lesions within 25 to 30 days. B. Continue sexual activity unless lesions are present. C. Report any difficulty urinating. D. Force fluids to prevent lesions from forming.

Accepted Answer

ANSWER C. The client should be encouraged to report any painful urination or urinary retention. Lesions are usually present for 17 to 20 days. The client is capable of transmitting the infection even when asymptomatic, so a barrier contraceptive should be used. Forcing fluids will not stop the lesions from forming

Question 18

The nurse is assigned to a client with irreversible shock. The nurse realizes that the negative outcomes of irreversible shock include severe hypoperfusion to all vital organs and failure of vital functions. Therefore, the nurse will monitor the client for A. increased alertness. B. circulatory collapse. C. hypertension. D. diuresis.

Accepted Answer

ANSWER B. Severe hypoperfusion to all vital organs results in failure of the vital functions and then circulatory collapse. Hypotension, anuria, respiratory distress, and acidosis are other symptoms associated with irreversible shock. The client in irreversible shock will not be alert

Question 19

The nurse is caring for a client who has been diagnosed with deep vein thrombosis. When assessing the client\'s vital signs, the nurse notes an apical pulse of 150 bpm, a respiration rate of 46 breaths/minute and a blood pressure of 100/60 mm Hg. The client appears anxious and restless. What should be the nurse\'s first course of action? A. Notify the physician. B. Administer a sedative. C. Try to elicit a positive Homan\'s sign. D. Increase the flow rate of intravenous fluids.

Accepted Answer

ANSWER A. Pulmonary embolism is a potentially life-threatening complication of deep vein thrombosis. The client\'s change in mental status, tachypnea, and tachycardia are all indicative of a possible pulmonary embolism. The nurse should promptly notify the doctor of the client\'s condition. Administering a sedative without further evaluation of the client\'s condition is not appropriate. There is no need to elicit a positive Homan\'s sign; the client is already diagnosed with a deep vein thrombosis. Increasing the intravenous flow rate may be an appropriate action, but not without first notifying the physician

Question 20

The charge nurse should give a new graduate nurse who made an insulin medication error the following advice: A. \"Trust your judgment; don\'t listen to your client.\" B. \"Compare the insulin doses that other clients are receiving.\" C. \"Large doses must always be double-checked.\" D. \"Use \'U\' as an abbreviation for \'Unit.\"\'

Accepted Answer

ANSWER C. The nurse should always double-check a large dose of insulin before administering it. A nurse should always listen to the client; if a client who has been taking insulin for a long time suggests that the insulin dose is not right, the nurse should recheck the physician\'s order. Comparing insulin doses of other clients has no bearing on a particular client\'s dose. The nurse should not use \"U\" or \"u\"; the nurse should specify \"unit\" to avoid errors

Question 21

A client who has MÃ©niÃ¨re\'s disease is trying to cope with the chronic tinnitus that she is experiencing. Which of the following interventions would be most appropriate for the nurse to suggest for coping with the tinnitus? A. Maintain a quiet environment. B. Play background music. C. Avoid caffeine and nicotine. D. Take a mild sedative.

Accepted Answer

ANSWER B. Coping with the chronic tinnitus of MÃ©niÃ¨re\'s disease can be very frustrating. Providing background sound, such as music, can help camouflage the low-pitched, roaring sound of tinnitus. Maintaining a quiet environment can make the sounds of tinnitus more pronounced. Avoiding caffeine and nicotine is recommended, because this can decrease the occurrence of the tinnitus. However, avoiding these substances does not help the client with coping with tinnitus when it occurs. Taking a sedative does not affect the sounds of the tinnitus

Question 22

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).

Accepted Answer

1. This complaint 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 BSE is important, but it is not the priority action in this case.

Question 23

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.

Accepted Answer

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.

Question 24

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 first with the physician.

Accepted Answer

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.

Question 25

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.

Accepted Answer

1. About half of malignant breast tumors occur in the upper outer quadrant of the breast. For no known reason, cancer appears in the left breast more often than in the right breast. The upper outer quadrants of the breast, and especially the axillary area, should be covered thoroughly in the clinical breast examination and breast self-examination.

Question 26

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.

Accepted Answer

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.

Question 27

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? 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.\"

Accepted Answer

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.

Question 28

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.

Accepted Answer

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.

Question 29

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.

Accepted Answer

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.

Question 30

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.\"

Accepted Answer

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.

Question 31

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.

Accepted Answer

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.

Question 32

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.

Accepted Answer

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.

Question 33

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

Accepted Answer

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.

Question 34

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.

Accepted Answer

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.

Question 35

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 over-distended bladder at one time tends to cause: 1. Renal failure. 2. Abdominal cramping. 3. Possible shock. 4. Atrophy of bladder musculature.

Accepted Answer

3. Rapid emptying of an over-distended bladder may cause hypotension and shock due to the sudden change of pressure within the abdominal viscera. Previously, removing no more than 1,000mL at one time was the standard of practice, but this is no longer thought to be necessary as long as the over-distended bladder is emptied slowly.

Question 36

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.

Accepted Answer

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.

Question 37

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.

Accepted Answer

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.

Question 38

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.

Accepted Answer

2. Research shows that older men tend to believe it is normal to live with some 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.

Question 39

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.

Accepted Answer

1, 2, 4, 5. Because of the history of benign prostatic hypertrophy (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.

Question 40

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.

Accepted Answer

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.

Question 41

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).

Accepted Answer

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.

Question 42

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.

Accepted Answer

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.

Question 43

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.

Accepted Answer

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.

Question 44

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.

Accepted Answer

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.

Question 45

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.

Accepted Answer

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.

Question 46

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. \"xI think he may be somewhat confused.\"

Accepted Answer

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/hour. A plugged catheter, imagining the urge to void, and confusion are less likely reasons for the client\'s complaint.

Question 47

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.

Accepted Answer

1, 2, 3, 4. Ampicillin may be given with or without food, but the nurse should instruct the client to obtain an adequate fluid intake (2,500 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.

Question 48

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.

Accepted Answer

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 few months and will not be a chronic problem. Dribbling is not a sign of healing, but is related to the trauma of surgery.

Question 49

A priority nursing diagnosis for the client who is being discharged to home 3 days after transurethral resection of the prostate (TURP) is: 1. Deficient fluid volume. 2. Imbalanced nutrition: Less than body requirements. 3. Impaired tissue integrity. 4. Ineffective airway clearance.

Accepted Answer

1. Deficient fluid volume is a priority diagnosis because the client needs to drink a large amount of fluids 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 client is not specifically at risk for nutritional problems after TURP. The client is not specifically at risk for impaired tissue integrity because there is no external incision, and the client is not specifically at risk for airway problems because the procedure is done under spinal anesthesia.

Question 50

A client with benign prostatic hypertrophy (BPH) has an elevated prostate-specific 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.

Accepted Answer

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.

Question 51

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.

Accepted Answer

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.

Question 52

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.

Accepted Answer

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 is a mode of transmission of gram-negative rods to the epididymis.

Question 53

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.

Accepted Answer

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.

Question 54

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.

Accepted Answer

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.

Question 55

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.

Accepted Answer

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. Measurements of AFP, hCG, and testosterone are also obtained throughout the course of therapy to help measure the effectiveness of treatment.

Question 56

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.

Accepted Answer

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.

Question 57

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.

Accepted Answer

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.

Question 58

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.

Accepted Answer

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.

Question 59

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.

Accepted Answer

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.

Question 60

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.

Accepted Answer

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.

Question 61

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-Specific 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.

Accepted Answer

2. Most prostate cancer is adenocarcinoma and is palpable on rectal examination because it arises from the posterior portion of the gland. Although the PSA is not a perfect screening test, the American Cancer Society recommends an annual rectal examination and blood PSA level for all men age 50 and older, or starting at age 40 if African American or if there is family history of prostate cancer. To help achieve optimal sexual function, give the client the opportunity to communicate his concerns and sexual needs. Regular sexual activity does not prevent cancer.

Question 62

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.\"

Accepted Answer

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.

Question 63

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 specific antigen (PSA) lab test greater than 4 ng/mg will need to be monitored. 5. Cancer cells are detectable in the urine.

Accepted Answer

1, 2, 3, 4. Cancer of the prostate gland is the second-leading cause of cancer death among American men and is the most common carcinoma in men older than age 65. Incidence of prostate cancer is higher in African American men, 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 CT or MRI to detect local extension, bone, and lymph node involvement. The urine does not have prostate cancer cells.

Question 64

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.

Accepted Answer

3, 4. Hormone manipulation deprives tumor cells of androgens or their by-products 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.

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