Nokea
The 50-year-old female client complains of bloating and indigestion and tells the nurse she has gained two (2) inches in her waist recently. Which question should the nurse ask the client?
- A. What do you eat before you feel bloated?'
- B. Have you had your ovaries removed?'
- C. Are your stools darker in color lately?'
- D. Is the indigestion worse when you lie down?'
Correct Answer: C
Rationale: Bloating, indigestion, and waist expansion are concerning for ovarian cancer; dark stools may indicate GI bleeding or metastasis, warranting urgent evaluation. Diet, oophorectomy, and positional indigestion are less specific.
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If the lump has the following characteristics when the nurse palpates the breast tissue, which one is most suggestive that the lump may be a common?
- A. The lump can be easily moved about.
- B. The lump is about 1/2" (1 cm).
- C. The lump is irregularly shaped.
- D. The lump is near the areola.
Correct Answer: C
Rationale: Irregularly shaped lumps are more suggestive of malignancy, as benign lumps are typically smooth and mobile. Size, mobility, and location near the areola are less specific indicators.
The postmenopausal client reveals it has been several years since her last gynecological examination and states, 'Oh, I don’t need exams anymore. I am beyond having children.' Which statement should be the nurse’s response?
- A. As long as you are not sexually active, you don’t have to worry.'
- B. You should be taking hormone replacement therapy now.'
- C. You are beyond bearing children. How does that make you feel?'
- D. There are situations other than pregnancy that should be checked.'
Correct Answer: D
Rationale: Postmenopausal women need gynecological exams to screen for cancers (e.g., endometrial, ovarian). Sexual activity is irrelevant, HRT is not mandatory, and feelings are secondary to health education.
Which nursing actions are appropriate in this situation? Select all that apply.
- A. Notify housekeeping to come and dispose of the papers.
- B. Toss the papers in the trash.
- C. Put the papers into the shredder bin.
- D. Try to determine who left the papers unattended.
- E. State the papers neatly, placing them off to the side.
- F. Notify the office manager of the breach in confidentiality.
Correct Answer: C,F
Rationale: Unattended medical records are a breach of confidentiality under HIPAA. Shredding the papers ensures secure disposal, and notifying the office manager addresses the violation. Tossing in the trash or stacking neatly does not protect confidentiality, and housekeeping or identifying the culprit are not immediate priorities.
The nurse discusses healthy sexual behaviors with the client. Which risk factor predisposes the client to acquiring a sexually transmitted infection?
- A. Experiencing early puberty
- B. Finding sex information on the Internet
- C. Having multiple sexual partners
- D. Receiving limited sex education
Correct Answer: C
Rationale: Multiple sexual partners increase exposure to STIs, significantly raising infection risk.
The nurse is preparing the client for an insertion of a pessary. Which information should the nurse teach the client?
- A. The pessary does not need to be changed.
- B. The client should clean the pessary routinely.
- C. The pessary must be inserted in surgery.
- D. Estrogen cream is necessary for effective use of a pessary.
Correct Answer: B
Rationale: Clients should clean the pessary routinely (per HCP guidance) to prevent infection. Pessaries need periodic replacement, are inserted in an office setting, and estrogen cream is optional for some.