Nokea
For which reason will the nurse encourage the patient who is recovering from a modified radical mastectomy to exercise the affected arm?
- A. To reduce pain.
- B. To stimulate appetite.
- C. To reduce lymphedema.
- D. To increase muscle tension.
Correct Answer: C
Rationale: An exercise regimen, built up gradually, can help reduce lymphedema following a modified radical mastectomy.
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A Gram stain smear of the patient's discharge reveals the presence of Neisseria gonorrhoeae. He tells the nurse that he had sexual contact with a new girlfriend but does not think he was exposed to gonorrhea because she did not appear to have any disease. Which information will the nurse include in response to his comment?
- A. Women do not develop gonorrhea infections but can serve as carriers to spread the disease to males.'
- B. When gonorrhea infections occur in women, the disease affects only the ovaries and not the other genital organs.'
- C. Many women are not aware that they have gonorrhea because they often do not have symptoms of infection.'
- D. Women develop subclinical cases of gonorrhea that do not cause tissue damage or symptoms.'
Correct Answer: C
Rationale: Most women remain asymptomatic but may show a greenish-yellow discharge from the cervix.
The young woman comes to the free clinic for the complaint of stomach cramps. During the examination, the nurse recommends that she be tested for chlamydia. The woman says 'I don't need any test...I don't have any symptoms for a sexual infection...I just came for irregular bleeding.' Which response is most informative?
- A. Well, if you get more symptoms come back for testing.'
- B. The health care provider may have to order medicine for syphilis and chlamydia. You probably have that too. You need to be tested today!'
- C. Testing is not mandatory...I probably wouldn't bother either since you have no symptoms.'
- D. The irregular bleeding may be part of a chlamydia infection.'
Correct Answer: D
Rationale: Chlamydia frequently displays no signs or symptoms in women. Some patients do have symptoms of vaginal pruritis, burning, dull pelvic pain, low-grade fever, vaginal discharge or irregular bleeding.
A patient, age 46, is recovering from an abdominal hysterectomy. Postoperative nursing assessment findings include a urinary output of $100 \mathrm{~mL}$ in 4 hours. Which action will the nurse take?
- A. Force fluids.
- B. Report urinary retention to the charge nurse.
- C. Milk' the urinary catheter.
- D. Turn the patient onto her right side.
Correct Answer: B
Rationale: Postoperative nursing interventions for patients with abdominal hysterectomy focus on monitoring vital signs and preventing urinary retention. The patient should have an output of at least 30 mL/hr. Anything less than that should be reported.
A patient, age 41, has had a total abdominal hysterectomy and bilateral salpingo-oophorectomy for endometriosis. She asks the nurse if she will have 'hot flashes.' Knowledge of which fact will guide the nurse's response?
- A. Only the uterus was removed, and the ovaries are still producing estrogen and she will not have hot flashes.
- B. The patient is too young to have hot flashes associated with menopause.
- C. The uterus, ovaries, and fallopian tubes were removed, and she will have surgically induced menopause and may have hot flashes.
- D. The uterus and fallopian tubes were removed, and she will not experience 'hot flashes.'
Correct Answer: C
Rationale: A total abdominal hysterectomy with bilateral salpingo-oophorectomy is the removal of the uterus, fallopian tubes, and ovaries. If the ovaries are removed in these surgeries, the surgery will induce menopause and hot flashes may occur.
___ are the most benign tumors of the uterus and arise from the uterine muscle tissue.
Correct Answer: Fibroids
Rationale: Fibroids are benign tumors arising from the muscle tissue of the uterus.