, Question 1
A 48-year-old client with endometrial cancer is being discharged after a total hysterectomy and
bilateral salpingo-oophorectomy. Which client statement indicates that further teaching is
needed?
"Well, I don't have to worry about getting pregnant anymore."
"I can't wait to go on the cruise that I have planned for this summer."
"I know I will miss having sexual intercourse with my husband."
"I have asked my daughter to stay with me next week after I am discharged."
Correct Answer: "I know I will miss having sexual intercourse with my husband."
Rationale: Sexual intercourse is still possible after hysterectomy. This shows a misconception
requiring further teaching.
Question 2
A client who is receiving the sixth unit of packed red blood cell transfusion is demonstrating
signs and symptoms of a febrile, nonhemolytic reaction. What assessment finding is most
important for the nurse to identify?
Increased anxiety since the transfusion began.
Drowsiness after receiving diphenhydramine (Benadryl).
Complaints of feeling cold.
Flushed skin and headache.
Correct Answer: Flushed skin and headache.
Rationale: Flushed skin and headache are classic signs of a febrile nonhemolytic transfusion
reaction.
Question 3
The nurse is caring for a male client who had an inguinal herniorrhaphy 3 hours ago. The nurse
determines the client's lower abdomen is distended and assesses dullness to percussion. What is
the priority nursing action?
Assessment of the client's vital signs.
Document the finding as the only action.
A 48-year-old client with endometrial cancer is being discharged after a total hysterectomy and
bilateral salpingo-oophorectomy. Which client statement indicates that further teaching is
needed?
"Well, I don't have to worry about getting pregnant anymore."
"I can't wait to go on the cruise that I have planned for this summer."
"I know I will miss having sexual intercourse with my husband."
"I have asked my daughter to stay with me next week after I am discharged."
Correct Answer: "I know I will miss having sexual intercourse with my husband."
Rationale: Sexual intercourse is still possible after hysterectomy. This shows a misconception
requiring further teaching.
Question 2
A client who is receiving the sixth unit of packed red blood cell transfusion is demonstrating
signs and symptoms of a febrile, nonhemolytic reaction. What assessment finding is most
important for the nurse to identify?
Increased anxiety since the transfusion began.
Drowsiness after receiving diphenhydramine (Benadryl).
Complaints of feeling cold.
Flushed skin and headache.
Correct Answer: Flushed skin and headache.
Rationale: Flushed skin and headache are classic signs of a febrile nonhemolytic transfusion
reaction.
Question 3
The nurse is caring for a male client who had an inguinal herniorrhaphy 3 hours ago. The nurse
determines the client's lower abdomen is distended and assesses dullness to percussion. What is
the priority nursing action?
Assessment of the client's vital signs.
Document the finding as the only action.
