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A healthy 60-year-old African-American woman regularly receives health care at her neighborhood cliniShe is due for a mammogram. At her first visit, her health care provider is concerned about the 3-week wait at the neighborhood clinic and made an appointment for her to have a mammogram at a teaching hospital across town. She did not keep her appointment and returned to the clinic today to have the nurse check her blood pressure. What is the most appropriate statement for the nurse to make to this client?
- A. Do you have transportation to the teaching hospital so that you can get your mammogram?
- B. I'm concerned that you missed your appointment; let me make another one for you.
- C. It's very dangerous to skip your mammograms; your breasts need to be checked.
- D. Would you like me to make an appointment for you to have your mammogram here?
Correct Answer: D
Rationale: Offering to make an appointment for the client at the neighborhood location is nonjudgmental and gives her options. This approach helps avoid embarrassment and opens a conversation about the reasons for missing her initial appointment.
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What type of mastectomy removes the entire breast but leaves the chest wall intact?
- A. total simple mastectomy
- B. modified radical mastectomy
- C. skin-sparing mastectomy
- D. nipple-sparing mastectomy
Correct Answer: A
Rationale: A total simple mastectomy is a type of mastectomy that removes the entire breast, including the breast tissue, nipple, and areola, but it leaves the chest wall muscles intact. In this procedure, the lymph nodes under the arm (axillary lymph nodes) are not typically removed. The total simple mastectomy is usually performed when the breast cancer is small and localized, and there is no evidence of spread to the surrounding lymph nodes or chest wall. This surgery is considered less extensive than other types of mastectomies, such as modified radical mastectomy, skin-sparing mastectomy, or nipple-sparing mastectomy, which involve different levels of tissue removal.
During the childbearing experience, which behavior might the nurse expect from an African-American client?
- A. Seeking prenatal care early in her pregnancy
- B. Avoiding self-treatment of pregnancy-related discomfort
- C. Requesting liver in the postpartum period to prevent anemia
- D. Arriving at the hospital in advanced labor
Correct Answer: D
Rationale: African-American women often arrive at the hospital in far-advanced labor due to viewing pregnancy as a state of wellness, which contributes to delayed prenatal care. Many practice self-treatment for discomfort and may request liver postpartum for anemia prevention.
Which situation is most representative of an extended family?
- A. It includes adoptive children.
- B. It is headed by a single-parent.
- C. It contains children from previous marriages.
- D. It is composed of children, parents, and grandparents living in the same house.
Correct Answer: D
Rationale: An extended family is a type of family unit that includes not only the nuclear family (parents and children) but also other relatives such as grandparents, aunts, uncles, cousins, etc., all living together or in close proximity. Option D, which states that the family is composed of children, parents, and grandparents living in the same house, is most representative of an extended family structure. This situation reflects the multi-generational aspect of an extended family where multiple generations live together and contribute to the household dynamics.
Which statement is true regarding the shortage of nurses in the United States?
- A. There are a larger proportion of younger nurses in the workforce as compared with older nurses.
- B. As a result of decreased RN-to-patient ratios, there is a decrease in patient mortality in the clinical setting.
- C. Nursing programs are turning away qualified applicants.
- D. There are adequate classroom and clinical facilities for training RNs.
Correct Answer: C
Rationale: The statement that nursing programs are turning away qualified applicants is true regarding the shortage of nurses in the United States. Despite the growing demand for healthcare services and the critical need for more nurses, nursing schools across the country face challenges in accepting all qualified applicants due to a shortage of nursing faculty, limited clinical space, and budget constraints. This bottleneck in nursing education and training contributes to the shortage of nurses in the workforce. As a result, many potential nursing students who are qualified and interested in pursuing a career in nursing are being turned away from programs, exacerbating the shortage.
Clients treated for syphilis with penicillin may experience a Jarisch-Herxheimer reaction. Which clinical presentation would be unlikely if a client is experiencing this reaction?
- A. Vomiting and diarrhea
- B. Headache, myalgias, and arthralgia
- C. Preterm labor
- D. Jarisch-Herxheimer in the first 24 hours after treatment
Correct Answer: A
Rationale: The Jarisch-Herxheimer reaction is characterized by fever, headache, and muscle pain, not vomiting and diarrhea.