NURSING 204 : Multidimensional Care 3 Exam Questions & Answers 2024 update

NURSING 204 : Multidimensional Care 3 Exam Questions & Answers 2024 update • A nurse cares for a patient with urinary incontinence. The patient states, “I am so embarrassed. My bladder leaks like a young child’s bladder.” How would the nurse respond? Selected Answer: d. “I can teach you strategies to help control your incontinence.” Answers: a. “I understand how you feel. I would be mortified.” b. “More people experience incontinence than you might think.” c. “Incontinence pads will minimize leaks in public.” Response Feedback: • Question 2 d. “I can teach you strategies to help control your incontinence.” The nurse should accept and acknowledge the patient’s concerns, and assist the patient to learn techniques that will allow control of urinary incontinence. The nurse should not diminish the patient’s concerns with the use of pads or stating statistics about the occurrence of incontinence. 0 out of 1 points A nurse provides phone triage to a pregnant patient. The patient states, “I am experiencing a burning pain when I urinate.” How would the nurse respond? Selected Answer: c. “This means labor will start soon. Prepare to go to the hospital.” Answers: a. “You probably have a urinary tract infection. Drink more cranberry juice.” b. “Your pelvic wall is weakening. Pelvic muscle exercises should help.” c. “This means labor will start soon. Prepare to go to the hospital.” Response Feedback: • Question 3 d. “Make an appointment with your provider to have your infection treated.” Pregnant patients with a urinary tract infection require prompt and aggressive treatment because cystitis can lead to acute pyelonephritis during pregnancy. The nurse should encourage the patient to make an appointment and have the infection treated. Burning pain when urinating does not indicate the start of labor or weakening of pelvic muscles. 0 out of 1 points A nurse cares for a patient who has pyelonephritis. The patient states, “I am embarrassed to talk about my symptoms.” How would the nurse respond? Selected Answer: c. “You seem anxious. Would you like a nurse of the same gender to care for you?” Answers: a. “Take your time. It is okay to use words that are familiar to you.” b. “I understand. Elimination is a private topic and shouldn’t be discussed.” c. “You seem anxious. Would you like a nurse of the same gender to care for you?” d. “I am a professional. Your symptoms will be kept in confidence.” Response Feedback: • Question 4 Patients may be uncomfortable discussing issues related to elimination and the genitourinary area. The nurse would encourage the patient to use language that is familiar to the patient. The nurse would not make promises that cannot be kept, like keeping the patient’s symptoms confidential. The nurse must assess the patient and cannot take the time to stop the discussion or find another nurse to complete the assessment. 1 out of 1 points A nurse assesses a patient who has had two episodes of bacterial cystitis in the last 6 months. Which questions would the nurse ask? (Select all that apply.) Selected Answers: a. “Are you on steroids or other immune-suppressing drugs?” c. “Does anyone in your family have a history of cystitis?” e. “Do you take estrogen replacement therapy?” Answers: a. “Are you on steroids or other immune-suppressing drugs?” b. “How much water do you drink every day?” c. “Does anyone in your family have a history of cystitis?” d. “Do you drink grapefruit juice or orange juice daily?” e. “Do you take estrogen replacement therapy?” Response Feedback: • Question 5 Fluid intake, estrogen levels, and immune suppression all can increase the chance of recurrent cystitis. Family history is usually insignificant, and cranberry juice, not grapefruit or orange juice, has been found to increase the acidic pH and reduce the risk for bacterial cystitis. 2 out of 1 points A nurse teaches patients about the difference between urge incontinence and stress incontinence. Which statements would the nurse include in this education? (Select all that apply.) Selected Answers: b. “Urge incontinence occurs due to abnormal bladder contractions.” e. “Stress incontinence occurs due to weak pelvic floor muscles.” Answers: a. “Urge incontinence involves a post-void residual volume less than 50 mL.” b. “Urge incontinence occurs due to abnormal bladder contractions.” Response Feedback: • Question 6 c. “Stress incontinence usually occurs in people with dementia.” d. “Urge incontinence can be managed by increasing fluid intake.” e. “Stress incontinence occurs due to weak pelvic floor muscles.” Patients who suffer from stress incontinence have weak pelvic floor muscles or urethral sphincter and cannot tighten their urethra sufficiently to overcome the increased detrusor pressure. Stress incontinence is common after childbirth, when the pelvic muscles are stretched and weakened from pregnancy and delivery. Urge incontinence occurs in people who cannot suppress the contraction signal from the detrusor muscle. Abnormal detrusor contractions may be a result of neurologic abnormalities including dementia, or may occur with no known abnormality. Postvoid residual is associated with reflex incontinence, not with urge incontinence or stress incontinence. Management of urge incontinence includes decreasing fluid intake, especially in the evening hours. 0 out of 1 points A nurse assesses a patient with a fungal urinary tract infection (UTI). Which assessments would the nurse complete? (Select all that apply.) Selected Answers: b. Palpate the kidneys and bladder. c. Assess the medical history and current medical problems. d. Obtain a current list of medications. Answers: a. Inquire about recent travel to foreign countries. b. Palpate the kidneys and bladder. c. Assess the medical history and current medical problems. d. Obtain a current list of medications. e. Perform a bladder scan to assess postvoid residual. Response Feedback: • Question 7 Patients who are severely immunocompromised or who have diabetes mellitus are more prone to fungal UTIs. The nurse should assess for these factors by asking about medical history, current medical problems, and current medication list. A physical examination and a postvoid residual may be needed, but not until further information is obtained indicating that these examinations are necessary. Travel to foreign countries probably would not be important because, even if exposed, the patient needs some degree of compromised immunity to develop a fungal UTI. 1 out of 1 points A nurse cares for patients with urinary incontinence. Which types of incontinence are correctly paired with their clinical manifestation? (Select all that apply.) Selected Answers: a. Urge incontinence—loss of urine upon feeling the need to void b. Overflow incontinence—constant dribbling of urine d. Stress incontinence—urine loss with physical exertion Answers: a. Urge incontinence—loss of urine upon feeling the need to void b. Overflow incontinence—constant dribbling of urine c. Functional incontinence—urine loss results from abnormal detrusor contractions d. Stress incontinence—urine loss with physical exertion e. Reflex incontinence—leakage of urine without lower urinary tract disorder Response Feedback: Stress incontinence is a loss of urine with physical exertion, coughing, sneezing, or exercising. Urge incontinence presents with an abrupt and strong urge to void and usually has a large amount of urine released with each occurrence. Overflow incontinence occurs with bladder distention and results in a constant dribbling of urine. Functional incontinence is the leakage of urine caused by factors other than a disorder of the lower urinary tract. Reflex • Question 8 incontinence results from abnormal detrusor contractions from a neurologic abnormality. 0 out of 1 points A nurse teaches a patient about self-care after experiencing a urinary calculus treated by lithotripsy. Which statements would the nurse include in this patient’s discharge teaching? (Select all that apply.) Selected Answers: b. “It is normal to experience pain and difficulty urinating.” c. “Finish the prescribed antibiotic even if you are feeling better.” d. “Drink at least 3 L of fluid each day.” e. “Report any blood present in your urine.” Answers: a. “The bruising on your back may take several weeks to resolve.” b. “It is normal to experience pain and difficulty urinating.” c. “Finish the prescribed antibiotic even if you are feeling better.” d. “Drink at least 3 L of fluid each day.” e. “Report any blood present in your urine.” Response Feedback: • Question 9 The patient should be taught to finish the prescribed antibiotic to ensure that he or she does not get a urinary tract infection. The patient should drink at least 3 L of fluid daily to dilute potential stone-forming crystals, prevent dehydration, and promote urine flow. After lithotripsy, the patient should expect bruising that may take several weeks to resolve. The patient should also experience blood in the urine for several days. The patient should report any pain, fever, chills, or difficulty with urination to the provider as these may signal the beginning of an infection or the formation of another stone. 0 out of 1 points A nurse teaches a female patient who has stress incontinence. Which statements would the nurse include about pelvic muscle exercises? (Select all that apply.) Selected Answers: c. “Tighten your pelvic muscles for a slow count of 10 and then relax for a slow count of 10.” e. “Like any other muscle in your body, you can make your pelvic muscles stronger by contracting them.” Answers: a. “After you have been doing these exercises for a couple days, your control of urine will improve.” b. “Pelvic muscle exercises should only be performed sitting upright with your feet on the floor.” c. “Tighten your pelvic muscles for a slow count of 10 and then relax for a slow count of 10.” d. “When you start and stop your urine stream, you are using your pelvic muscles.” e. “Like any other muscle in your body, you can make your pelvic muscles stronger by contracting them.” Response Feedback: • Question 10 The patient should be taught that the muscles used to start and stop urination are pelvic muscles, and that pelvic muscles can be strengthened by contracting and relaxing them. The patient should tighten pelvic muscles for a slow count of 10 and then relax the muscles for a slow count of 10, and perform this exercise 15 times while in lying-down, sitting-up, and standing positions. The patient should begin to notice improvement in control of urine after several weeks of exercising the pelvic muscles. 0 out of 1 points A nurse is teaching patients about different medications used to treat urinary incontinence. Which medications are paired with correct information? (Select all that apply.) Selected Answers: a. Anticholinergics: Assess the patient for a history of cataracts b. Antidepressants: Warn patient to inform all providers about taking this drug Answers: a. Anticholinergics: Assess the patient for a history of cataracts b. Antidepressants: Warn patient to inform all providers about taking this drug c. Beta-blockers: Instruct the patient to obtain an annual flu vaccine d. Estrogen cream: Apply a thin layer only e. Alpha-adrenergics: Instruct the patient to monitor the blood pressure Response Feedback: • Question 11 Estrogen cream is applied in a thin layer only to avoid excessive absorption. Alpha adrenergics can increase blood pressure. Antidepressants have many drug–drug interactions, and the patient needs to inform all his or her providers about taking this drug. Anticholinergics should not be used in patients with glaucoma. Beta-blockers can affect both blood pressure and pulse. The flu vaccine is important but not related. 0 out of 1 points After treating several young women for UTIs, the college nurse plans an educational offering on reducing the risk of getting a UTI. What information does the nurse include? (Select all that apply.) Selected Answers: a. Wipe or clean the perineum from front to back b. Do not douche or use scented feminine products c. Wear loose-fitting nylon panties d. Void before and after each act of intercourse Answers: a. Wipe or clean the perineum from front to back b. Do not douche or use scented feminine products Response Feedback: • Question 12 c. Wear loose-fitting nylon panties d. Void before and after each act of intercourse e. Consider changing to spermicide from birth control pills Woman can reduce their risk of contracting UTIs by voiding before and after intercourse, not douching or using scented feminine products, and wiping from front to back. If spermicides are currently used, the woman should consider another form of birth control. Loose-fitting cotton panties are best. 0 out of 1 points A nurse assesses a patient who has a family history of polycystic kidney disease (PKD). For which clinical manifestations would the nurse assess? (Select all that apply.) Selected Answers: a. Dysuria b. Flank pain Answers: a. Dysuria b. Flank pain c. Increased abdominal girth d. Hematuria e. Nocturia f. Diarrhea Response Feedback: • Question 13 Patients with PKD experience abdominal distention that manifests as flank pain and increased abdominal girth. Bloody urine is also present with tissue damage secondary to PKD. Patients with PKD often experience constipation, but would not report nocturia or dysuria. 0 out of 1 points A nurse assesses a patient with nephrotic syndrome. For which clinical manifestations would the nurse assess? (Select all that apply.) Selected Answers: f. Costovertebral angle (CVA) tenderness Answers: a. Hypoalbuminemia b. Lipiduria c. Dysuria d. Proteinuria e. Dehydration f. Costovertebral angle (CVA) tenderness Response Feedback: • Question 14 Nephrotic syndrome is caused by glomerular damage and is characterized by proteinuria (protein level higher than 3.5 g/24 hr), hypoalbuminemia, edema, and lipiduria. Fluid overload leading to edema and hypertension is common with nephrotic syndrome; dehydration does not occur. Dysuria is present with cystitis. CVA tenderness is present with inflammatory changes in the kidney. 0 out of 1 points A nurse reviews laboratory results for a patient with glomerulonephritis. The patient’s glomerular filtration rate (GFR) is 40 mL/min as measured by a 24- hour creatinine clearance. How would the nurse interpret this finding? (Select all that apply.) Selected Answers: [None Given] Answers: a. Potential for fluid overload b. Potential for dehydration c. Reduced GFR d. Normal GFR e. Response Feedback: • Question 15 Excessive GFR The GFR refers to the initial amount of urine that the kidneys filter from the blood. In the healthy adult, the normal GFR ranges between 100 and 120 mL/min, most of which is reabsorbed in the kidney tubules. A GFR of 40 mL/min is drastically reduced, with the patient experiencing fluid retention and risks for hypertension and pulmonary edema as a result of excess vascular fluid. 0 out of 1 points A nurse assesses a patient who is recovering from a nephrostomy. Which assessment findings would alert the nurse to urgently contact the healthcare provider? (Select all that apply.) Selected Answers: [None Given] Answers: a. Bloody drainage at site b. Foul-smelling drainage c. Urine draining from site d. Clear drainage e. Patient reports headache Response Feedback: • Question 16 After a nephrostomy, the nurse would assess the patient for complications and urgently notify the provider if drainage decreases or stops, drainage is cloudy or foul smelling, the nephrostomy site leaks blood or urine, or the patient has back pain. Clear drainage is normal. A headache would be an unrelated finding. A nurse teaches a patient with polycystic kidney disease (PKD). Which 0 out of 1 points statements would the nurse include in this patient’s discharge teaching? (Select all that apply.) Selected Answers: [None Given] Answers: a. “Weigh yourself at the same time each day.” b. “Assess your urine for renal stones.” Response Feedback: • Question 17 c. “Take your blood pressure every morning.” d. “Contact your provider if you have visual disturbances.” e. “Adjust your diet to prevent diarrhea.” A patient who has PKD would measure and record his or her blood pressure and weight daily, limit salt intake, and adjust dietary selections to prevent constipation. The patient should notify the provider if urine smells foul or has blood in it, as these are signs of a urinary tract infection or glomerular injury. The patient should also notify the provider if visual disturbances are experienced, as this is a sign of a possible berry aneurysm, which is a complication of PKD. Diarrhea and renal stones are not manifestations or complications of PKD; therefore, teaching related to these concepts would be inappropriate. 0 out of 1 points The nurse is caring for five patients on the medical-surgical unit. Which patients would the nurse consider to be at risk for postrenal acute kidney injury (AKI)? (Select all that apply.) Selected Answers: [None Given] Answers: a. Firefighter with severe burns b. Patient with ureterolithiasis c. Man with prostate cancer d. Woman with blood clots in the urinary tract e. Young woman with lupus Response Feedback: • Question 18 Urine flow obstruction, such as prostate cancer, blood clots in the urinary tract, and kidney stones (ureterolithiasis), causes postrenal AKI. Severe burns would be a prerenal cause. Lupus would be an intrarenal cause for AKI. 0 out of 1 points A nurse is caring for a postoperative 70-kg patient who had major blood loss during surgery. Which findings by the nurse would prompt immediate action to prevent acute kidney injury? (Select all that apply.) Selected Answers: [None Given] Answers: a. Blood pressure of 90/60 mm Hg b. Large amount of sediment in the urine c. Urine output of 100 mL in 4 hours d. Amber, odorless urine e. Urine output of 500 mL in 12 hours Response Feedback: • Question 19 The low urine output, sediment, and blood pressure would be reported to the provider. Postoperatively, the nurse would measure intake and output, check the characteristics of the urine, and report sediment, hematuria, and urine output of less than 0.5 mL/kg/hour for 3 to 4 hours. A urine output of 100 mL is low, but a urine output of 500 mL in 12 hours would be within normal limits. Perfusion to the kidneys is compromised with low blood pressure. The amber odorless urine is normal. 0 out of 1 points A patient is hospitalized in the oliguric phase of acute kidney injury (AKI) and is receiving tube feedings. The nurse is teaching the patient’s spouse about the kidney-specific formulation for the enteral solution compared to standard formulas. What components would be discussed in the teaching plan? (Select all that apply.) Selected Answers: [None Given] Answers: a. Higher phosphorus b. Higher calories c. Lower sodium d. Lower potassium e. Response Feedback: • Question 20 Higher calcium Many patients with AKI are too ill to meet caloric goals and require tube feedings with kidney-specific formulas that are lower in sodium, potassium, and phosphorus, and higher in calories than are standard formulas. 0 out of 1 points The nurse is teaching a patient with diabetes mellitus how to prevent or delay chronic kidney disease (CKD). Which patient statements indicate a lack of understanding of the teaching? (Select all that apply.) Selected Answers: Answers: a. [None Given] Response Feedback: • Question 21 “Smoking should be stopped as soon as I possibly can.” b. “I can continue to take an aspirin every 4 to 8 hours for my pain.” c. “I really only need to drink a couple of glasses of water each day.” d. “I need to decrease sodium, cholesterol, and protein in my diet.” e. “My weight should be maintained at a body mass index of 30.” Weight should be maintained at a body mass index (BMI) of 22 to 25. A BMI of 30 indicates obesity. The use of nonsteroidal anti- inflammatory drugs such as aspirin would be limited to the lowest time at the lowest dose due to interference with kidney blood flow. The patient should drink at least 2 L of water daily. Diet adjustments should be made by restricting sodium, cholesterol, and protein. Smoking causes constriction of blood vessels and decreases kidney perfusion, so the patient should stop smoking. 0 out of 1 points A nurse is giving discharge instructions to a patient recently diagnosed with chronic kidney disease (CKD). Which statements made by the patient indicate a correct understanding of the teaching? (Select all that apply.) Selected Answers: [None Given] Answers: a. Response Feedback: • Question 22 “I need to ask for an antibiotic when scheduling a dental appointment.” b. “I’ll need to check my blood sugar often to prevent hypoglycemia.” c. “I can continue to take antacids to relieve heartburn.” d. “The dose of my pain medication may have to be adjusted.” e. “I should watch for bleeding when taking my anticoagulants.” In discharge teaching, the nurse must emphasize that the patient needs to have an antibiotic prophylactically before dental procedures to prevent infection. There may be a need for dose reduction in medications if the kidney is not excreting them properly (antacids with magnesium, antibiotics, antidiabetic drugs, insulin, opioids, and anticoagulants). 0 out of 1 points A patient is undergoing hemodialysis. The patient’s blood pressure at the beginning of the procedure was 136/88 mm Hg, and now it is 110/54 mm Hg. What actions would the nurse perform to maintain blood pressure? (Select all that apply.) Selected Answers: [None Given] Answers: a. Stop the hemodialysis treatment. b. Contact the healthcare provider for orders. c. Administer a 250-mL bolus of normal saline. d. Place the patient in the Trendelenburg position. e. Adjust the rate of extracorporeal blood flow. Response Feedback: Hypotension occurs often during hemodialysis treatments as a result of vasodilation from the warmed dialysate. Modest decreases in blood pressure, as is the case with this patient, can be maintained with rate adjustment, Trendelenburg positioning, and a fluid bolus. If the blood pressure drops considerably after two • Question 23 boluses and cooling dialysate, the hemodialysis can be stopped and the healthcare provider contacted. 0 out of 1 points A patient is unsure of the decision to undergo peritoneal dialysis (PD) and wishes to discuss the advantages of this treatment with the nurse. Which statements by the nurse are accurate regarding PD? (Select all that apply.) Selected Answers: [None Given] Answers: a. “There is less restriction of protein and fluids.” b. “It takes less time than hemodialysis treatments.” c. “You will have no risk for infection with PD.” d. “You have flexible scheduling for the exchanges.” e. “You will not need vascular access to perform PD.” Response Feedback: • Question 24 PD is based on exchanges of waste, fluid, and electrolytes in the peritoneal cavity. There is no need for vascular access. Protein is lost in the exchange, which allows for more protein and fluid in the diet. There is flexibility in the time for exchanges, but the treatment takes a longer period of time compared to hemodialysis. There still is risk for infection with PD, especially peritonitis. 0 out of 1 points The nurse is taking a history of a 68-year-old woman. What assessment findings would indicate a high risk for the development of breast cancer? (Select all that apply.) Selected Answers: [None Given] Answers: a. Osteoporosis b. Multiparity c. Age greater than 65 years d. Response Feedback: • Question 25 Genetic factors e. Increased breast density The high-risk factors for breast cancer are age greater than 65 with the risk increasing until age 80; an increase in breast density because of more glandular and connective tissue; and inherited mutations of BRCA1 and/or BRCA2 genes. Osteoporosis and multiparity are not risk factors for breast cancer. A high postmenopausal bone density and nulliparity are moderate and low increased risk factors, respectively. 0 out of 1 points The nurse is formulating a teaching plan according to evidence-based breast cancer screening guidelines for a 50-year-old woman with low-risk factors. Which diagnostic methods would be included in the plan? (Select all that apply.) Selected Answers: [None Given] Answers: a. Breast self-awareness b. Clinical breast examination c. Breast ultrasound d. Magnetic resonance imaging (MRI) e. Annual mammogram Response Feedback: • Question 26 Guidelines recommend a screening annual mammogram for women aged 40 years and older, breast self-awareness, and a clinical breast examination. An MRI is recommended if there are known high-risk factors. A breast ultrasound is used if there are problems discovered with the initial screening or dense breast tissue. 0 out of 1 points After a breast examination, the nurse is documenting assessment findings that indicate possible breast cancer. Which abnormal findings need to be included as part of the patient’s electronic medical record? (Select all that apply.) Selected Answers: [None Given] Answers: a. Nontender axillary nodes b. Nipple retraction c. Mobile mass at two o’clock d. Peau d’orange e. Dense breast tissue Response Feedback: • Question 27 In the documentation of a breast mass, skin changes such as dimpling (peau d’orange), nipple retraction, and whether the mass is fixed or movable are charted. The location of the mass should be stated by the “face of a clock.” Dense breast tissue and nontender axillary nodes are not abnormal assessment findings that may indicate breast cancer. 0 out of 1 points A woman has been using acupuncture to treat the nausea and vomiting caused by the side effects of chemotherapy for breast cancer. Which conditions would cause the nurse to recommend against further use of acupuncture? (Select all that apply.) Selected Answers: [None Given] Answers: a. Lymphedema b. High platelet count c. Bleeding tendencies d. Low white blood cell count e. Elevated serum calcium Response Feedback: Acupuncture could be unsafe for the patient if there is poor drainage of the extremity with lymphedema or if there was a bleeding tendency and low white blood cell count. Coagulation would be compromised with a bleeding disorder, and the risk of infection would be high with the use of needles. An elevated • Question 28 serum calcium and high platelet count would not have any contraindication for acupuncture. 0 out of 1 points A 28-year-old patient is diagnosed with uterine leiomyoma and is experiencing severe symptoms. Which actions by the nurse are the most appropriate at this time? (Select all that apply.) Selected Answers: Answers: a. [None Given] Response Feedback: • Question 29 Reduce the pain by low-level heat. b. Discuss in detail the side effects of laparoscopic surgery. c. Relieve anxiety by relaxation techniques and education. d. Review complete blood count for possible iron-deficiency anemia e. Discuss the high risk of infertility with this diagnosis. With uterine leiomyoma’s or fibroids, heavy bleeding is the predominant symptom, with anxiety occurring because of fears of cancer or infertility. Interventions would be directed to the heavy bleeding and anxiety relief, such as relaxation techniques and education about the pathophysiology and possible treatment of the fibroids. The nurse could suggest resources to give more information about the diagnosis. Typically patients with uterine fibroids do not have pain. Discussion of the possibility of infertility and side effects of laparoscopic surgery is premature and may increase the anxiety. The nurse is giving discharge instructions to a patient who had a total 0 out of 1 points abdominal hysterectomy. Which statements by the patient indicate a need for further teaching? (Select all that apply.) Selected Answers: Answers: a. [None Given] “I will have to limit the times that I climb our stairs at home to morning and night.” b. Response Feedback: • Question 30 “My granddaughter weighs 23 lbs (10.5 kg) so I need to refrain from picking her up.” c. “Now that I have time off from work, I can return to my exercise routine next week.” d. “I should not have any problems driving to see my mother, who lives 3 hours away.” e. “For 1 month, I will need to refrain from sexual intercourse.” Driving and sitting for extended periods of time should be avoided until the surgeon gives permission. For 2 to 6 weeks, exercise participation should also be avoided. All of the other responses demonstrate adequate knowledge for discharge. The patient should not lift anything heavier than 10 lbs (4.5 kg), should limit stair climbing, and should refrain from sexual intercourse. 0 out of 1 points The nurse is taking the history of a 24-year-old patient diagnosed with cervical cancer. What possible risk factors would the nurse assess? (Select all that apply.) Selected Answers: [None Given] Answers: a. Poor diet b. Multiple sexual partners c. Younger than 18 at first intercourse d. Smoking e. Nulliparity Response Feedback: • Question 31 Smoking, multiple sexual partners, poor diet, and age less than 18 for first intercourse are all risk factors for cervical cancer. Nulliparity is a risk factor for endometrial cancer. 0 out of 1 points A patient is scheduled to start external beam radiation therapy (EBRT) for her endometrial cancer. Which teaching by the nurse is accurate? (Select all that apply.) Selected Answers: [None Given] Answers: a. “It is not wise to stay out in the sun for long periods of time.” b. “The technician applies new site markings before each treatment.” c. “Your skin needs to be inspected daily for any breakdown.” d. “The perineal area may become damaged with the radiation.” e. “You will need to be hospitalized during this therapy.” Response Feedback: • Question 32 EBRT is usually performed in ambulatory care and does not require hospitalization. The patient needs to know to evaluate the skin, especially in the perineal area, for any breakdown, and avoid sunbathing. The technician does not apply new site markings, so the patient needs to avoid washing off the markings that indicate the treatment site. 0 out of 1 points The nurse is teaching a patient who is undergoing brachytherapy about what to immediately report to her healthcare provider. Which signs and symptoms would be included in this teaching? (Select all that apply.) Selected Answers: [None Given] Answers: a. Abdominal pain b. Visible blood in the urine c. Temperature of 99 F (37.2 C) d. Heavy vaginal bleeding e. Constipation for 3 days Response Feedback: • Question 33 Health teaching for a patient having brachytherapy would emphasize reporting abdominal pain, visible blood in the urine, and heavy vaginal bleeding. Severe diarrhea (not constipation), urethral burning, extreme fatigue, and a fever over 100 F (37.7 C) would also be reported. 0 out of 1 points A postmenopausal patient is experiencing low back and pelvic pain, fatigue, and bloody vaginal discharge. What laboratory tests would the nurse expect to see ordered for this patient if endometrial cancer is suspected? (Select all that apply.) Selected Answers: [None Given] Answers: a. Hemoglobin and hematocrit (H&H) b. International normalized ratio (INR) c. Cancer antigen-125 (CA-125) d. White blood cell (WBC) count e. Prothrombin time (PT) Response Feedback: • Question 34 Serum tumor markers such as CA-125 assess for metastasis, especially if elevated. H&H would evaluate the possibility of anemia, a common finding with postmenopausal bleeding with endometrial cancer. WBC count is not indicated since there are no signs of infection. The INR and PT are coagulation tests to measure the time it takes for a fibrin clot to form. They are used to evaluate the extrinsic pathway of coagulation in patients receiving oral warfarin. 0 out of 1 points A patient has recurrent vulvovaginitis. Which statements by the patient indicate a need for further teaching? (Select all that apply.) Selected Answers: [None Given] Answers: a. “I should not douche or use feminine hygiene sprays.” b. “I can take a long, hot bath to relieve itching.” Response Feedback: • Question 35 c. “I should use antibacterial soap to clean the area.” d. “I need to take all of my antibiotics as prescribed.” e. “I should avoid having sex until my infection is gone.” Patients should avoid hot water baths as they may increase the itching and infection. They may take warm or tepid sitz baths for 30 minutes several times a day to relieve itching. Patients should cleanse the inner labia mucosa with water, not soap, during a bath or shower. All of the other options are correct. 0 out of 1 points The nurse is doing home care teaching for a patient who has undergone cryotherapy. Which statements by the patient indicate a correct understanding of the instructions? (Select all that apply.) Selected Answers: [None Given] Answers: a. “I should shower rather than take a tub bath.” b. “There may be a lot of bleeding for a few days.” c. “I can resume my weight-lifting exercise class tomorrow.” d. “I should not use tampons, douche, or have sexual activity.” e. “There should be little or no discomfort.” Response Feedback: • Question 36 Cryotherapy involves freezing of cervical cancer cells and is often painless. Patients are restricted from heavy lifting. They may have a heavy watery discharge for several weeks, but should report any heavy bleeding, foul-smelling drainage, or a fever. The other options are correct. 0 out of 1 points The nurse is administering finasteride (Proscar) and doxazosin (Cardura) to a 67-year-old patient with benign prostatic hyperplasia. What precautions are related to the side effects of these medications? (Select all that apply.) Selected Answers: [None Given] Answers: a. Assessing for blood pressure changes when lying, sitting, and arising from the bed b. Immediately reporting any change in the alanine aminotransferase laboratory test c. Asking the patient to report any weakness, light-headedness, or dizziness d. Teaching the patient about the possibility of increased libido with these medications e. Taking the patient’s pulse rate for a minute in anticipation of bradycardia Response Feedback: • Question 37 Both the 5-alpha-reductase inhibitor (5-ARI) and the alpha1- selective blocking agents can cause orthostatic (postural) hypotension and liver dysfunction. The 5-ARI agent (Proscar) can cause a decreased libido rather than an increased sexual drive. The alpha-blocking drug (Cardura) can cause tachycardia rather than bradycardia. 0 out of 1 points A patient is interested in learning about the risk factors for prostate cancer. Which factors does the nurse include in the teaching? (Select all that apply.) Selected Answers: [None Given] Answers: a. Obesity b. Advanced age c. Eating too much red meat d. Family history of prostate cancer e. Smoking f. Race Response Feedback: • Question 38 Advanced family history of prostate cancer, age, a diet high in animal fat, and race are all risk factors for prostate cancer. Smoking and obesity are not known risk factors. 0 out of 1 points A patient came to the clinic with erectile dysfunction. What are some possible causes of this condition that the nurse could discuss with the patient during history taking? (Select all that apply.) Selected Answers: [None Given] Answers: a. Long-term hypertension b. Hour-long exercise sessions c. Recent prostatectomy d. Diabetes mellitus e. Consumption of beer each night Response Feedback: • Question 39 Organic erectile dysfunction can be caused by surgical procedures, hypertension and its treatment, diabetes mellitus, and alcohol consumption. There is no evidence that exercise is related to this problem. 0 out of 1 points The nurse is reviewing possible complications from a phalloplasty. What factors does the nurse include? (Select all that apply.) Selected Answers: [None Given] Answers: a. Infection of donor site b. Rectal perforation c. Necrosis of the neopenis d. Urinary tract stenosis e. Vaginal infections Response Feedback: • Question 40 Complications from phalloplasty include infection or scarring of the donor site, necrosis, and stenosis of the urinary tract. Rectal perforation can occur with vaginoplasty, as can infections. 0 out of 1 points A student nurse is learning about the healthcare needs of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) patients. Which terms are correctly defined? (Select all that apply.) Selected Answers: [None Given] Answers: a. Gender dysphoria—distress caused by incongruence between natal sex and gender identity b. Gender queer—a label used when gender identity does not conform to male or female c. Transition—the time between questioning and establishing a sexual identity d. Transgender—a person who dresses in the clothing of the opposite sex e. Natal sex—the sex one is born with or is assigned to at birth Response Feedback: • Question 41 Gender dysphoria is emotional distress caused by the incongruence between natal sex (sex assigned at birth) and gender identity. Gender queer is a label sometimes used by people whose gender identity does not fit the established categories of male or female. Natal sex describes the gender a person is born with or is assigned to at birth. Transgender is an adjective to describe a person who crosses or transcends culturally defined categories of gender. Transition is the period of time when transgender individuals change from the gender role associated with their sex to a different gender role. 0 out of 1 points A nurse works with many transgender patients. What routine monitoring is important for the nurse to facilitate in this population? (Select all that apply.) Selected Answers: [None Given] Answers: a. Response Feedback: • Question 42 Liver function tests b. Renal profile c. Mammograms if breast tissue is present d. Lipid profile e. Prostate-specific antigen (PSA) for natal males Common routine monitoring for this population includes lipid and liver panels, mammograms if any breast tissue is present, and PSA for natal males as the prostate is not removed during a vaginoplasty/penectomy. Renal profiles are not required based on treatment options for this population. 0 out of 1 points A primary care clinic sees some clients with sexually transmitted diseases. Which clients would the nurse be required to report to the local authority in every state, according to the Centers for Disease Control and Prevention? (Select all that apply.) Selected Answers: [None Given] Answers: a. Client with human immune deficiency virus b. Female with pelvic inflammatory disease c. Client with Chlamydia d. Man with syphilis e. Woman with gonorrhea Response Feedback: • Question 43 Chlamydia, gonorrhea, syphilis, chancroid, human immune deficiency virus (HIV), and acquired immune deficiency syndrome (AIDS) are all reportable to local authorities in every state. Pelvic inflammatory disease does not need to be reported. 0 out of 1 points A nurse wants to reduce the risk potential for transmission of chlamydia and gonorrhea with a female client diagnosed with both diseases. Which items should be included in the client’s teaching plan? (Select all that apply.) Selected Answers: [None Given] Answers: a. Expedited partner therapy b. Rescreening for infection c. Proper use of condoms d. Abstinence until therapy is completed e. Use of internal uterine devices f. Use of oral contraception Response Feedback: • Question 44 As part of client/partner education, the nurse should explain the expedited partner therapy (practice of treating both sexual partners by providing medication to the client for the partner). The nurse should also emphasize the need for abstinence from sexual intercourse until treatment is finished, proper use of condoms, and screening for reinfection 3 to 12 months after treatment. The use of an intrauterine device and oral contraception is not part of the plan. 0 out of 1 points A client being treated for syphilis visits the office with a possible allergic reaction to benzathine penicillin G. Which abnormal findings would the nurse expect to document? (Select all that apply.) Selected Answers: [None Given] Answers: a. Red rash b. Heart irregularity c. Anxiety d. Chest tightness Response Feedback: • Question 45 e. Shortness of breath The nurse should keep all clients at the office for at least 30 minutes after the administration of benzathine penicillin G. Allergic manifestations consist of rash, shortness of breath, chest tightness, and anxiety, depicting anaphylaxis and serum sickness. Heart irregularity is not seen as an allergic manifestation. 0 out of 1 points Which risk factors would the nurse teach a client about to prevent pelvic inflammatory disease (PID)? (Select all that apply.) Selected Answers: [None Given] Answers: a. Having a history of sexually transmitted diseases (STDs) b. Smoking c. Drinking two alcoholic beverages per day d. Having multiple sexual partners e. Using an intrauterine device (IUD) Response Feedback: • Question 46 Some of the same factors that place women at risk for STDs also place women at risk for PID: sexually active women of age younger than 26 years, multiple sexual partners, use of an IUD, smoking, and a history of STDs. Alcohol consumption does not impact a woman’s risk for PID. 0 out of 1 points The nurse is teaching a client who is taking an oral antibiotic for treatment of a sexually transmitted disease (STD). Which statements by the client indicate a correct understanding of the treatment? (Select all that apply.) Selected Answers: Answers: a. [None Given] “It should not matter if I skip a couple of doses of the antibiotic.” b. “Antacids should not interfere with the effectiveness of the antibiotic.” Response Feedback: • Question 47 c. “I need to wait 7 days after the last dose of the antibiotic to engage in intercourse.” d. “I need to drink at least eight glasses of fluid each day with my antibiotic.” e. “I should read the instructions to see if I can take the medication with food.” When a client is being treated with an oral antibiotic for an STD, 8 to 10 glasses of fluid should be routine, medication instructions should be reviewed, and at least a week break should occur between the last dose of the antibiotic and sexual intercourse to allow for the medication’s full effects. Use of antacids and missing doses could decrease the effectiveness of the antibiotic. 0 out of 1 points An emergency department nurse cares for a patient who is severely dehydrated and is prescribed 3 L of intravenous fluid over 6 hours. At what rate (mL/hr) would the nurse set the intravenous pump to infuse the fluids? (Record your answer using a whole number.) mL/hr Selected Answer: [None Given] Correct Answer: Evaluation Method Correct Answer C Exact Match 500 Exact Match 500 mL/hr Because IV pumps deliver in units of milliliters per hour, the pump would Exact Match • Question 48 have to be set at 500 mL/hr to deliver 3 L (3000 mL) over 6 hours. 0 out of 1 points A 23-year-old female was admitted to the hospital for intravenous antibiotic treatment of pelvic inflammatory disease. The provider has ordered cefazolin (Ancef) to be administered every 8 hours. At what rate should the nurse infuse the medication if the pharmacy provides 1 g of the medication in 50 mL of 0.9% NaCl to infuse in 30 minutes? (Record your answer using a whole number.) mL/hr Selected Answer: [None Given] Correct Answer: Evaluation Method Correct Answer Case Sensitivi Exact Match 100 Exact Match 100 mL/hr To calculate using the dimensional Exact Match analysis method: (50 mL/30 min) (60 min/1 hr) = 100 mL/hr.