Nokea
While working on the hospital surgical unit, you are assigned to care for a client who has had a right breast lumpectomy and axillary lymph node dissection. Which task included in this client's care can you delegate to a nursing assistant?
- A. Teach the client why blood pressure measurements are taken on the left arm.
- B. Elevate the client's arm on two pillows to promote lymphatic drainage.
- C. Assess the client's right arm for lymphedema.
- D. Wrap the client's right arm with elastic bandages.
Correct Answer: B
Rationale: Elevating the arm is a simple task that can be safely delegated to a nursing assistant.
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The evening after surgery, she complains of a 'tightness' at her incision. The most appropriate nursing action would be to
- A. notify the doctor
- B. reassure Mrs. Smith that this is a normal sensation
- C. redress the wound
- D. check removal drainage
Correct Answer: B
Rationale: Reassuring the patient that tightness is normal post-surgery helps alleviate anxiety.
When do progesterone levels rise to their highest point during the female hormonal cycle?
- A. Between ovulation and the beginning of menstruation
- B. Immediately before ovulation
- C. When the blood concentration of luteinizing hormone is at its highest point
- D. When 12 primary follicles are developing to the antral stage
Correct Answer: A
Rationale: Progesterone levels rise to their highest point between ovulation and the beginning of menstruation because this is the luteal phase of the menstrual cycle when the corpus luteum (formed from the ruptured follicle after ovulation) secretes progesterone. This hormone prepares the endometrium for implantation and maintains a potential pregnancy.
Explanation for other choices:
- B: Immediately before ovulation, estrogen levels are high, not progesterone.
- C: Luteinizing hormone surge triggers ovulation, not directly related to progesterone rise.
- D: The development of primary follicles is associated with estrogen, not progesterone.
Why should a nurse educate women to have regular gynecologic examinations and Pap tests?
- A. It helps decide the mode of surgical treatment.
- B. It is the best cure for most infections.
- C. It increases the potential for an early diagnosis.
- D. It is an inexpensive test.
Correct Answer: C
Rationale: Regular screenings increase the likelihood of early detection and treatment of conditions like cervical cancer.
The child's sex is determined by:
- A. the type of the spermatozoon that fecundates the ovule;
- B. the type of the fecundated ovule;
- C. the sex chromosome of the ovule;
- D. the sex chromosome of the spermatozoon
Correct Answer: D
Rationale: The correct answer is D because the sex of the child is determined by the sex chromosome carried by the spermatozoon that fertilizes the ovule. Sperm carries either an X or a Y chromosome, determining if the child will be male (XY) or female (XX). Choices A and B are incorrect because the type of spermatozoon or ovule does not solely determine the child's sex. Choice C is incorrect as well because the sex chromosome of the ovule alone does not determine the child's sex.
Which of the following nursing interventions are required for a client undergoing antibiotic treatment for epididymitis and orchitis?
- A. Use an alcohol rub to keep the scrotum dry.
- B. Apply a skin cream.
- C. Elevate the scrotum to relieve the pain.
- D. Limit alcohol intake to 2 drinks per week.
Correct Answer: C
Rationale: Elevating the scrotum helps alleviate pain and swelling.