A 52-year old female tells the nurse that she has found a painless lump in her right breast during her monthly self- examination. Which assessment finding would strongly suggest that this client's lump is cancerous?
- A. Eversion of the right nipple and mobile mass
- B. Mobile mass that is soft and easily
- C. Non-mobile mass with irregular edges delineated
- D. Non palpable right axillary lymph nodes
Correct Answer: C
Rationale: The assessment finding that strongly suggests that the client's lump is cancerous is a non-mobile mass with irregular edges delineated. Generally, cancerous breast lumps tend to have irregular shapes/edges and lack mobility. This finding is concerning for malignancy because it indicates that the lump is fixed in place and possibly invading nearby tissues, which are characteristics often associated with cancerous tumors. It's essential for the client to undergo further diagnostic tests, such as a biopsy, to confirm the presence of cancer and establish a proper treatment plan.
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A patient with a new diagnosis of lung cancer decides to have radiation therapy. Which of the ff. expectations of this treatment is most appropriate?
- A. Complete cure of the cancer
- B. Prevention of the need for oxygen
- C. Increased comfort
- D. Prevention of cancer spread
Correct Answer: C
Rationale: Radiation therapy for lung cancer is typically used with the goal of increasing comfort for the patient by reducing symptoms such as pain, shortness of breath, and coughing. While it may help to shrink tumors and slow the progression of the disease, it is usually not considered a curative treatment for advanced lung cancer. It is important for the patient to have realistic expectations and understand that the goal of radiation therapy is primarily to improve their quality of life and manage symptoms.
Which of the ff. would the nurse explain to a patient is the main purpose of a hearing aid?
- A. Amplify background noise
- B. Amplify musical sounds
- C. Occlude the ear
- D. Improve ability to hear
Correct Answer: D
Rationale: The main purpose of a hearing aid is to improve the patient's ability to hear. Hearing aids are devices designed to amplify sound for individuals with hearing loss or difficulty hearing. They do not amplify background noise or musical sounds specifically; instead, they are meant to enhance the overall perception of sounds to help individuals better understand speech and communicate effectively. Moreover, hearing aids do not occlude the ear, but rather are used to transmit sound into the ear canal to make sounds louder and clearer for the wearer.
Rehabilitation plans for Mr. Gabatan;
- A. Should be left up to Mr. Gabatan and his family
- B. Should be considered and planned for early in his care
- C. Are not necessary, because he will return to former activities
- D. Are not necessary, because he will probably not able to work again Ms. J.K. is a 24-year old woman admitted to the neurosurgery floor 2 days following a hypophysectomy for a pituitary tumor. She is alert, oriented, and eager to return to her job as an executive to the hospital director. She is alert, oriented and eager to return to her job as an executive assistant to the hospital director. She calls the nurse to her room to express her concern about the frequency of urination she is experiencing, as well as the feeling of weakness that began this morning.
Correct Answer: B
Rationale: Rehabilitation plans for Mr. Gabatan should be considered and planned for early in his care. Planning for rehabilitation early on can help maximize his recovery potential, improve outcomes, and assist in a smoother transition back to his daily activities. It is important to involve Mr. Gabatan and his family in the decision-making process to ensure that the rehabilitation plan is tailored to his specific needs and goals. By addressing rehabilitation early, healthcare providers can provide the necessary support and interventions to help Mr. Gabatan achieve the best possible outcomes and quality of life following his illness or injury.
Vitamin A supplementation may be recommended for the young child who has which disease?
- A. Mumps
- B. Rubella
- C. Measles (rubeola)
- D. Erythema infectiosum
Correct Answer: C
Rationale: Vitamin A supplementation may be recommended for children with measles (rubeola) due to the disease's association with vitamin A deficiency. Measles can lead to reduced levels of vitamin A in the body, which can result in increased severity of symptoms, complications, and even death. Supplementing with vitamin A during and after a measles infection helps reduce the risk of complications and mortality, particularly in young children under the age of 5 in areas where vitamin A deficiency is common. Therefore, providing vitamin A supplementation to children with measles is an important intervention to support their recovery and improve outcomes.
The nurse is caring for a 5-year-old child with impetigo contagiosa. The parents ask the nurse what will happen to their child's skin after the infection has subsided and healed. Which answer should the nurse give?
- A. There will be no scarring.
- B. There may be some pigmented spots.
- C. It is likely there will be some slightly depressed scars.
- D. There will be some atrophic white scars.
Correct Answer: A
Rationale: Impetigo contagiosa typically does not leave scarring once it has subsided and healed. This skin infection primarily affects the superficial layers of the skin and does not cause damage deep enough to result in scarring. While there may be some temporary pigmented spots or mild changes in skin color after the infection resolves, scarring is not a common outcome of impetigo contagiosa in most cases. Thus, the nurse should reassure the parents that their child's skin is not likely to have any scarring after the infection has healed.