Nokea
The nurse is conducting a health history. When a middle-aged client reports last having a menstrual period 6 months ago. Upon further questioning, the client also states symptoms of hot flashes and mood fluctuations. Which question should the nurse ask next?
- A. Do you feel like hurting yourself?
- B. Are you finished having children?
- C. When was your first menstrual period?
- D. Are you taking any hormone replacement therapy?
Correct Answer: D
Rationale: To ensure a thorough health history, a client who exhibits symptoms of perimenopause should be assessed for the use of hormone replacement therapy to alleviate the symptoms. This information adds to the data reported by the client. Asking if the client is having thoughts of self-harm may be extreme with the report of mood fluctuations. Asking if the client is finished having children produces little additional data. Asking the first menstrual period is part of the health history but not the best question to ask after the client's statement.
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A parent of an adolescent female is asking the nurse for guidelines of when the daughter should have her first Papanicolaou test (Pap test) and then the subsequent frequency. The nurse is most correct to state which?
- A. The first Pap test should be at age 16 years and then annually thereafter.
- B. The first Pap test should be no later than 18 years of age and then every other year afterward.
- C. The first Pap test should be between 25 and 29 years and then every 3 years afterward.
- D. The first Pap test should be within the first year of menstruation and annually afterward.
Correct Answer: C
Rationale: The American Cancer Society (ACS) recommends no testing/screenings for women aged 21 to 24 years. Women between the ages of 25 and 29 years have the recommendation for HPV testing to be every 5 years (preferred), the HPV/Pap co-test every 5 years (acceptable), or the Pap test every 3 years (acceptable).
The nurse is preparing the female client for a pelvic examination. Into which position will the nurse assist the client?
- A. Lithotomy position
- B. Supine position
- C. Trendelenburg position
- D. Lateral recumbent
Correct Answer: A
Rationale: For a pelvic examination, the nurse is most correct to assist the client to the lithotomy position. In this position, the client lies on the back with the legs bent and spread. Many times, the feet are in lithotomy stirrups. The supine position is flat on the back. The Trendelenburg position provides the feet higher than the head at a 15?° to 30?° angle. The lateral recumbent position is a side-lying position.
The client is asking the nurse to explain the typical treatment expected when a class 4 Papanicolaou test is reported. The nurse is most correct to state which of the following?
- A. No further treatment is considered.
- B. The test will need to be repeated in 3 months.
- C. Further evaluation is needed for potential malignancy.
- D. Chemotherapy is needed and radiation is suggested.
Correct Answer: C
Rationale: A class 4 Papanicolaou test (Pap test) is strongly suggestive of malignancy. Further testing is needed to confirm the type and extent of cancer. The nurse would not suggest that no treatment is needed or to wait for 3 months. The nurse would also not suggest a typical treatment without further diagnostic testing.
What information would the nurse give the client when the client inquires what makes breast milk production?
- A. Estrogen
- B. Progesterone
- C. Prolactin
- D. Testosterone
Correct Answer: C
Rationale: Prolactin promotes the production of breast milk. Estrogen secreted by the ovaries at the onset of puberty causes the development of the mammary system. Progesterone, secreted by the placenta, stimulates the development of alveoli, which secrete the milk. Testosterone does not impact milk production.
A nurse is caring for a client who is being evaluated for a lump found on the lateral aspect of the right breast. The client is anxious and asks the nurse if the next step is to have a mastectomy. Which is the nurse's best response?
- A. Yes, breast lumps are abnormal and will need to be removed.
- B. The doctor will need a biopsy first to see if the lump is cancerous.
- C. The doctor will answer your questions when he or she arrives.
- D. Many times, an ultrasound is done to distinguish between a tumor and cyst.
Correct Answer: D
Rationale: Ultrasonography is often used with a mammogram after a breast lump is found to provide additional data on the breast lump. An ultrasound can differentiate if the lump is a fluid-filled cyst or other types of breast lesions. This step may be used before a mastectomy is performed or even a biopsy is completed. The nurse is able to provide factual information on common treatment paths, understanding that it is the physician who prescribes the medical care.