Nokea
The nurse is caring for a client who is one (1) day postoperative hysterectomy for cancer of the ovary. Which nursing interventions should the nurse implement? Select all that apply.
- A. Assess for calf enlargement and tenderness.
- B. Turn, cough, and deep breathe every six (6) hours.
- C. Assess pain on a 1-to-10 pain scale.
- D. Apply sequential compression devices to legs.
- E. Assess bowel sounds every four (4) hours.
Correct Answer: A,C,D,E
Rationale: Assess for DVT (calf tenderness), manage pain, use SCDs for DVT prevention, and monitor bowel sounds (ileus risk) are critical post-hysterectomy. Turning every 6 hours is too infrequent; every 2 hours is standard.
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Which nursing instruction is best to provide to the client with chlamydia to prevent a recurrence of the infection?
- A. Shower or bathe after intercourse.
- B. Wash your hands well using an antiseptic soap.
- C. Encourage your sexual partners to be tested and treated.
- D. Make sure you receive adequate nutrition and fluid intake.
Correct Answer: C
Rationale: Partner testing and treatment prevent reinfection, addressing the primary source of chlamydia transmission.
If the client asks about long-term consequences that are associated with this disorder, the nurse accurately identifies which consequence?
- A. Cancer of the cervix
- B. Premature labors
- C. Spontaneous abortions
- D. Difficulty getting pregnant
Correct Answer: D
Rationale: Pelvic inflammatory disease can cause scarring of the fallopian tubes, leading to infertility or difficulty conceiving.
The client diagnosed with cancer of the prostate has been placed on luteinizing hormone-releasing hormone (LHRH) agonist therapy. Which statement indicates the client understands the treatment?
- A. I will be able to function sexually as always.'
- B. I may have hot flashes while taking this drug.'
- C. This medication will cure the prostate cancer.'
- D. There are no side effects with this medication.'
Correct Answer: B
Rationale: LHRH agonists cause hot flashes due to hormonal suppression. Sexual dysfunction is common, cure is not guaranteed, and side effects are expected.
The client has had a total abdominal hysterectomy for cancer of the uterus. Which discharge instruction should the nurse teach?
- A. The client should take HRT every day to prevent bone loss.
- B. The client should practice pelvic rest until seen by the HCP.
- C. The client can drive a car as soon as she is discharged from the hospital.
- D. The client should expect some bleeding after this procedure.
Correct Answer: B
Rationale: Pelvic rest (no intercourse, tampons) prevents complications post-hysterectomy until HCP clearance. HRT is individualized, driving is restricted initially, and bleeding is abnormal.
The nurse is caring for a client diagnosed with uterine cancer who has been receiving systemic therapy for six (6) months. Which intervention should the nurse implement first?
- A. Determine which antineoplastic medication the client has received.
- B. Ask the client if she has had any problems with mouth ulcers at home.
- C. Administer the biologic response modifier filgrastim (Neupogen).
- D. Encourage the client to discuss feelings about having cancer.
Correct Answer: B
Rationale: Mouth ulcers are a common chemotherapy side effect, requiring immediate assessment to manage pain and infection risk. Medication history, filgrastim administration, and emotional support are secondary.