Nokea
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.
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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.
An instructor is preparing a teaching plan for a group of students about reproductive structures and sexual arousal. Which female reproductive structure would the instructor include?
- A. The mons pubis
- B. The clitoris
- C. Labia minora
- D. Labia majora
Correct Answer: B
Rationale: At the superior function of the labia, there is a fleshy protrusion of tissue called the clitoris. The clitoris is an erectile tissue that enlarges and becomes sensitive when stimulated by the penis or touching that accompanies sexual foreplay. The mons pubis, labia minora, and labia majora are female reproductive structures but do not play as prominent a role in sexual arousal.
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 states to the nurse that he is very anxious about having prostate cancer ever since his prostate-specific antigen (PSA) test came back elevated. The client asks, 'Which diagnostic test produces definitive results if cancer is present?' The nurse is most correct to state which of the following?
- A. Transrectal ultrasonography
- B. Tissue biopsy
- C. Tumor marker studies
- D. Digital rectal exam
Correct Answer: B
Rationale: Obtaining an actual piece of the tissue and analyzing it for cancer is a definitive test when cancer is found. A transrectal ultrasonography is a test to view the prostate gland from different angles. This test provides additional data on the status of the prostate gland. The tumor marker studies include the prostate-specific antigen (PSA) level. This antigen indicates a potential problem but is not definitive. PSA elevations have been noted for reasons other than cancer. A digital rectal exam provides data on the shape, size, and texture of the prostate gland.
The expert nurse is assisting a novice nurse insert a Foley catheter. The novice nurse has tried unsuccessfully to insert the catheter, and the expert nurse is providing verbal guidance while spreading which area to reveal the urethral opening?
- A. Labia majora and minora
- B. Meatus
- C. Clitoris
- D. Fourchette
Correct Answer: A
Rationale: The labia majora and minora are a portion of the external genitalia and when parted reveals the urethral opening. The meatus refers to an opening or passage. The clitoris is sensitive erectile tissue considered the site of sexual pleasure. The fourchette is the area beneath the vaginal opening at the base of the labia majora.