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The nurse is assessing a client who has a suspected cystocele. Which signs and symptoms should the nurse expect? Select all that apply.
- A. Frequent bladder infections
- B. Sense of fullness in the vaginal area
- C. Leaking of urine
- D. Irregular vaginal bleeding
Correct Answer: D
Rationale: The correct answer is D: Irregular vaginal bleeding. A cystocele is a condition where the bladder protrudes into the vagina. This can cause pressure on surrounding tissues and lead to irregular vaginal bleeding. A, B, and C are incorrect as they are more commonly associated with other conditions such as urinary tract infections (A), pelvic organ prolapse (B), and urinary incontinence (C). Irregular vaginal bleeding is a key sign specific to cystocele due to the physical displacement of organs.
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During the physical assessment of a female client with HPV, which should the nurse expect to find?
- A. Purulent vaginal discharge
- B. Condylomata
- C. Malodorous vaginal discharge
- D. No clinical manifestation
Correct Answer: B
Rationale: The correct answer is B: Condylomata. HPV can manifest as genital warts or condylomata acuminata. These are flesh-colored growths that appear on the genital area. The presence of condylomata indicates an active HPV infection. Choices A and C are incorrect as purulent or malodorous discharge is not typically associated with HPV. Choice D is incorrect as HPV often presents with visible symptoms like condylomata.
A woman has been diagnosed with single intraductal papilloma and has nipple discharge. Which diagnostic tests will most likely be required?
- A. MRI
- B. Mammogram
- C. Core needle biopsy
- D. Ductogram
Correct Answer: D
Rationale: The correct answer is D: Ductogram. In a patient with single intraductal papilloma and nipple discharge, a ductogram is the most appropriate diagnostic test to visualize the ductal system for any abnormalities. A ductogram involves injecting contrast dye into the affected duct to identify any blockages or abnormalities. This test helps in determining the extent of the papilloma and planning appropriate treatment.
Rationale for incorrect choices:
A: MRI - While MRI can provide detailed images, it is not the primary test for evaluating intraductal papilloma and nipple discharge.
B: Mammogram - Mammogram is used for breast imaging but may not provide detailed visualization of the ductal system.
C: Core needle biopsy - While a biopsy may be needed to confirm the papilloma, it does not directly assess the ductal system for other abnormalities.
List in order of priority the immediate postoperative mastectomy nursing actions.
- A. Elevate the affected arm with pillows above the level of the right atrium to promote comfort and lymphatic channel return.
- B. Assess vital signs, being careful not to use the affected arm for blood pressure measurement, and monitor parenteral fluids.
- C. Monitor for hemorrhage by assessing drainage from dressing and drainage tubes.
- D. Teach and reinforce the use of relaxation techniques to help reduce anxiety and provide distraction.
Correct Answer: B
Rationale: The correct answer is B because assessing vital signs and monitoring parenteral fluids are essential postoperative nursing actions to detect any signs of complications such as hemorrhage or fluid imbalance. This prioritizes the patient's physiological stability and safety. Elevating the affected arm (A) is important for comfort but not as immediate as monitoring vital signs. Monitoring for hemorrhage (C) is crucial but comes after ensuring the patient's physiological stability. Teaching relaxation techniques (D) is important for holistic care but is not as immediate as monitoring vital signs and fluid balance.
Which should the nurse recommend to the client to relieve premenstrual syndrome (PMS) symptoms? Select all that apply.
- A. NSAIDs to decrease pain
- B. Exercise 5 to 6 times a week
- C. Decrease caffeine
- D. Decrease fiber
Correct Answer: D
Rationale: The correct answer is D, decrease fiber intake. High-fiber foods can worsen bloating and digestive issues associated with PMS. By reducing fiber intake, gas and bloating can be minimized, alleviating these symptoms. NSAIDs (A) can help with pain but do not address other PMS symptoms. Exercise (B) can be beneficial, but it may not directly target PMS symptoms. Decreasing caffeine (C) can help with mood swings, but it is not as effective for physical symptoms compared to reducing fiber intake.
The nurse is meeting with a client who was newly diagnosed with polycystic ovary syndrome. She knows that the client has the potential for which diagnoses? Select all that apply.
- A. Knowledge deficit
- B. Disturbed body image
- C. Risk for type 2 diabetes
- D. Impaired mobility
Correct Answer: D
Rationale: The correct answer is D: Impaired mobility. This is because polycystic ovary syndrome (PCOS) can lead to obesity and insulin resistance, which in turn can increase the risk of impaired mobility due to joint pain, reduced muscle strength, and overall decreased physical activity. The other choices are incorrect because A (Knowledge deficit) can be addressed through education, B (Disturbed body image) is more related to self-esteem and body perception issues, and C (Risk for type 2 diabetes) is a potential consequence of PCOS but not directly related to impaired mobility.