The Client with Reproductive Health Problems
TEST
■
■
■
■
■
■
■
■
■
■
■
■
The Client with Uterine Fibroids
The Client with Breast Disease
The Client with Benign Prostatic Hypertrophy
The Client with a Sexually Transmitted Disease
The Client with Cancer of the Cervix
The Client with Cancer of the Ovaries
The Client Having Gynecological Surgery
The Client with Testicular Disease
The Client with Cancer of the Prostate
The Client with Erectile Dysfunction
Managing Care Quality and Safety
Answers, Rationales, and Test Taking Strategies
The Client with Breast Disease
23. A postmenopausal woman is worried about
pain in the upper outer quadrant of her left breast.
The nurse’s fi rst course of action is to:
■ 1. Do a breast examination and report the results
to the physician.
■ 2. Explain that pain is caused by hormonal fl uctuations.
■ 3. Reassure the client that pain is not a symptom
of breast cancer.
■ 4. Teach the client the correct procedure for
breast self-examination (BSE).
24. The nurse teaches a female client that the
best time in the menstrual cycle to examine the
breasts is during the:
■ 1. Week that ovulation occurs.
■ 2. Week that menstruation occurs.
■ 3. First week after menstruation.
■ 4. Week before menstruation occurs.
The Client with Breast Disease
23. A postmenopausal woman is worried about
pain in the upper outer quadrant of her left breast.
The nurse’s fi rst course of action is to:
■ 1. Do a breast examination and report the results
to the physician.
■ 2. Explain that pain is caused by hormonal fl uctuations.
■ 3. Reassure the client that pain is not a symptom
of breast cancer.
■ 4. Teach the client the correct procedure for
breast self-examination (BSE).
24. The nurse teaches a female client that the
best time in the menstrual cycle to examine the
breasts is during the:
■ 1. Week that ovulation occurs.
■ 2. Week that menstruation occurs.
■ 3. First week after menstruation.
■ 4. Week before menstruation occurs.
29. During the admission workup for a modifi ed
radical mastectomy, the client is extremely anxious
and asks many questions. Which of the following
approaches would offer the best guide for the nurse
to answer questions raised by this apprehensive
preoperative client?
■ 1. Tell the client as much as she wants to know
and is able to understand.
■ 2. Delay discussing the client’s questions with
her until she is convalescing.
■ 3. Delay discussing the client’s questions with
her until her apprehension subsides.
■ 4. Explain to the client that she should discuss
her questions fi rst with the physician.
30. A client asks the nurse, “Where is cancer
usually found in the breast?” When responding to
the client, the nurse uses a diagram of a left breast
and indicates that most malignant tumors occur in
which quadrant of the breast?
■ 1. Upper outer quadrant.
■ 2. Upper inner quadrant.
■ 3. Lower outer quadrant.
■ 4. Lower inner quadrant.
31. Atropine sulfate is included in the preoperative
orders for a client undergoing a modifi ed radical
mastectomy. The expected outcome is to:
■ 1. promote general muscular relaxation.
■ 2. decrease pulse and respiratory rates.
■ 3. decrease nausea.
■ 4. inhibit oral and respiratory secretions.
32. During the postoperative period after a modifi
ed radical mastectomy, the client confi des in the
nurse that she thinks she got breast cancer because
she had an abortion and she did not tell her husband.
The best response by the nurse is which of the
following?
■ 1. “Cancer is not a punishment; it is a disease.”
■ 2. “You might feel better if you confi ded in your
husband.”
■ 3. “Tell me more about your feelings on this.”
■ 4. “I can have the social worker talk to you if
you would like.”
33. Postoperatively after a modifi ed radical
mastectomy, a client has an incisional drainage tube
attached to Hemovac suction. The nurse determines
the suction is effective when:
■ 1. The intrathoracic pressure is decreased and
the client breathes easier.
■ 2. There is an increased collateral lymphatic
fl ow toward the operative area.
■ 3. Accumulated serum and blood in the operative
area are removed.
■ 4. No adhesions are formed between the skin
and chest wall in the operative area.
34. Which of the following positions would be
best for a client’s right arm when she returns to her
room after a right modifi ed radical mastectomy with
multiple lymph node excisions?
■ 1. Across her chest wall.
■ 2. At her side at the same level as her body.
■ 3. In the position that affords her the greatest comfort
without placing pressure on the incision.
■ 4. On pillows, with her hand higher than her
elbow and her elbow higher than her shoulder.
35. The client with breast cancer is prescribed
tamoxifen (Nolvadex) 20 mg daily. The client states
she does not like taking medicine and asks the nurse
if the tamoxifen is really worth taking. The nurse’s
best response is which of the following?
■ 1. “This drug is part of your chemotherapy program.”
■ 2. “This drug has been found to decrease metastatic
breast cancer.”
■ 3. “This drug will act as an estrogen in your
breast tissue.”
■ 4. “This drug will prevent hot fl ashes since you
cannot take hormone replacement.”
36. A client undergoing chemotherapy after a
modifi ed radical mastectomy asks the nurse questions
about a breast prosthesis and wigs. After answering
the questions directly, the nurse should also:
■ 1. Provide a list of resources, including the local
breast cancer support group.
■ 2. Offer a referral to the social worker.
■ 3. Call the home health care agency.
■ 4. Contact the plastic surgeon.
37. A client is to have radiation therapy after
a modifi ed radical mastectomy. The nurse should
teach the client to care for the skin at the site of
therapy by:
■ 1. Washing the area with water.
■ 2. Exposing the area to dry heat.
■ 3. Applying an ointment to the area.
■ 4. Using talcum powder on the area.
38. The nurse should teach a client that a normal
local tissue response to radiation is:
■ 1. Atrophy of the skin.
■ 2. Scattered pustule formation.
■ 3. Redness of the surface tissue.
■ 4. Sloughing of two layers of skin.
39. The nurse refers a client who had a mastectomy
to “Reach to Recovery.” The primary purpose
of the American Cancer Society’s Reach to Recovery
program is to:
■ 1. Foster rehabilitation in women who have had
mastectomies.
■ 2. Raise funds to support early breast cancer
detection programs.
■ 3. Provide free dressings for women who have
had radical mastectomies.
■ 4. Collect statistics for research from women
who have had mastectomies.
The Client with Benign Prostatic
Hypertrophy
40. A 72-year-old male is in the emergency
department because he has been unable to void for
the past 12 hours. The best method for the nurse to
use when assessing for bladder distention in a male
client is to check for:
■ 1. A rounded swelling above the pubis.
■ 2. Dullness in the lower left quadrant.
■ 3. Rebound tenderness below the symphysis.
■ 4. Urine discharge from the urethral meatus.
41. During a client’s urinary bladder catheterization,
the nurse ensures that the bladder is emptied
gradually. The best rationale for the nurse’s action is
that completely emptying an overdistended bladder
at one time tends to cause:
■ 1. Renal failure.
■ 2. Abdominal cramping.
■ 3. Possible shock.
■ 4. Atrophy of bladder musculature.
42. The primary reason for lubricating the urinary
catheter generously before inserting it into a
male client is that this technique helps reduce:
■ 1. Spasms at the orifi ce of the bladder.
■ 2. Friction along the urethra when the catheter
is being inserted.
■ 3. The number of organisms gaining entrance to
the bladder.
■ 4. The formation of encrustations that may
occur at the end of the catheter.
43. The primary reason for taping an indwelling
catheter laterally to the thigh of a male client
is to:
■ 1. Eliminate pressure at the penoscrotal angle.
■ 2. Prevent the catheter from kinking in the urethra.
■ 3. Prevent accidental catheter removal.
■ 4. Allow the client to turn without kinking the
catheter.
44. Many older men with prostatic hypertrophy
do not seek medical attention until urinary obstruction
is almost complete. One reason for this delay in
seeking attention is that these men may:
■ 1. Feel too self-conscious to seek help when
reproductive organs are involved.
■ 2. Expect that it is normal to have to live
with some urinary problems as they grow
older.
■ 3. Fear that sexual indiscretions in earlier life
may be the cause of their problem.
■ 4. Have little discomfort in relation to the
amount of pathology because responses to
pain stimuli fade with age.
45. When caring for a client with a history of
benign prostatic hypertrophy (BPH), the nurse
should do which of the following? Select all that
apply.
■ 1. Provide privacy and time for the client to void.
■ 2. Monitor intake and output.
■ 3. Catheterize the client for post void residual
urine.
■ 4. Ask the client if he has urinary retention.
■ 5. Test the urine for hematuria.
46. The nurse should specifi cally assess a client
with prostatic hypertrophy for which of the following ?
■ 1. Voiding at less frequent intervals.
■ 2. Diffi culty starting the fl ow of urine.
■ 3. Painful urination.
■ 4. Increased force of the urine stream.
47. The nurse is reviewing the medication history
of a client with benign prostatic hypertrophy
(BPH). Which medication will likely aggravate BPH?
■ 1. Metformin (Glucophage).
■ 2. Buspirone (BuSpar).
■ 3. Inhaled ipratropium (Atrovent).
■ 4. Ophthalmic timolol (Timoptic).
48. A client is scheduled to undergo transurethral
resection of the prostate. The procedure is to
be done under spinal anesthesia. Postoperatively,
the nurse should assess the client for:
■ 1. Seizures.
■ 2. Cardiac arrest.
■ 3. Renal shutdown.
■ 4. Respiratory paralysis.
49. A client with benign prostatic hypertrophy
(BPH) is being treated with terazosin (Hytrin) 2 mg
at bedtime. The nurse should monitor the client’s:
■ 1. Urine nitrites.
■ 2. White blood cell count.
■ 3. Blood pressure.
■ 4. Pulse.
50. A client underwent transurethral resection of
the prostate (TURP), and a large three-way indwelling
urinary catheter was inserted in the bladder
with continuous bladder irrigation. In which of the
following circumstances should the nurse increase
the fl ow rate of the continuous bladder irrigation?
■ 1. When drainage is continuous but slow.
■ 2. When drainage appears cloudy and dark yellow.
■ 3. When drainage becomes bright red.
■ 4. When there is no drainage of urine and irrigating
solution.
51. A client is to receive belladonna and opium
suppositories, as needed, postoperatively after
transurethral resection of the prostate (TURP). The
nurse should give the client these drugs when he
demonstrates signs of:
■ 1. A urinary tract infection.
■ 2. Urine retention.
■ 3. Frequent urination.
■ 4. Pain from bladder spasms.
52. A nursing assistant tells the nurse, “I think
the client is confused. He keeps telling me he has to
void, but that isn’t possible because he has a catheter
in place that is draining well.” Which of the
following responses would be most appropriate for
the nurse to make?
■ 1. “His catheter is probably plugged. I’ll irrigate
it in a few minutes.”
■ 2. “That’s a common complaint after prostate
surgery. The client only imagines the urge to
void.”
■ 3. “The urge to void is usually created by the
large catheter, and he may be having some
bladder spasms.”
■ 4. “I think he may be somewhat confused.”
53. A physician has ordered amoxicillin 100
P.O. BID (Ampicillin). The nurse should teach the
client to: Select all that apply.
■ 1. Drink 2,500 mL of fl uids daily.
■ 2. Void frequently, at least every 2 to 3 hours.
■ 3. Take time to empty the bladder completely.
■ 4. Take the last dose of the antibiotic for the day
at bedtime.
■ 5. Take the antibiotic with food.
54. In discussing home care with a client after
transurethral resection of the prostate (TURP), the
nurse should teach the male client that dribbling of
urine:
■ 1. Can be a chronic problem.
■ 2. Can persist for several months.
■ 3. Is an abnormal sign that requires intervention.
■ 4. Is a sign of healing within the prostate.
55. A priority nursing diagnosis for the client
who is being discharged to home 3 days after transurethral
resection of the prostate (TURP) is:
■ 1. Defi cient fl uid volume.
■ 2. Imbalanced nutrition: Less than body requirements.
■ 3. Impaired tissue integrity.
■ 4. Ineffective airway clearance.
56. A client with benign prostatic hypertrophy
(BPH) has an elevated prostate-specifi c antigen
(PSA) level. The nurse should?
■ 1. Instruct the client to have a colonoscopy
before coming to conclusions about the PSA
results.
■ 2. Instruct the client that a urologist will monitor
the PSA level biannually when elevated.
■ 3. Determine if the prostatic palpation was done
before or after the blood sample was drawn.
■ 4. Ask the client if he emptied his bladder
before the blood sample was obtained.
The Client with Testicular Disease
98. A 28-year-old male is diagnosed with acute
epididymitis. The nurse should assess the client for:
■ 1. Burning and pain on urination.
■ 2. Severe tenderness and swelling in the scrotum.
■ 3. Foul-smelling ejaculate.
■ 4. Foul-smelling urine.
99. A 20-year-old client is being treated for
epididymitis. Teaching for this client should include
the fact that epididymitis is commonly a result of a:
■ 1. Virus.
■ 2. Parasite.
■ 3. Sexually transmitted infection.
■ 4. Protozoon.
100. When teaching a client to perform testicular
self-examination, the nurse explains that the examination
should be performed:
■ 1. After intercourse.
■ 2. At the end of the day.
■ 3. After a warm bath or shower.
■ 4. After exercise.
101. The nurse is assessing a client’s testes. Which
of the following fi ndings indicate the testes are
normal?
■ 1. Soft.
■ 2. Egg-shaped.
■ 3. Spongy.
■ 4. Lumpy.
102. A client has a testicular nodule that is highly
suspicious for testicular cancer. A laboratory test
that supports this diagnosis is:
■ 1. Decreased alpha fetoprotein (AFP).
■ 2. Decreased beta–human chorionic gonadotropin
(hCG).
■ 3. Increased testosterone.
■ 4. Increased AFP.
103. Although the cause of testicular cancer is
unknown, it is associated with a history of:
■ 1. Undescended testes.
■ 2. Sexual relations at an early age.
■ 3. Seminal vesiculitis.
■ 4. Epididymitis.
104. Risk factors associated with testicular malignancies
include:
■ 1. African-American race.
■ 2. Residing in a rural area.
■ 3. Lower socioeconomic status.
■ 4. Age older than 40 years.
105. A client with a testicular malignancy undergoes
a radical orchiectomy. In the immediate postoperative
period the nurse should particularly
assess the client for:
■ 1. Bladder spasms.
■ 2. Urine output.
■ 3. Pain.
■ 4. Nausea.
106. A right orchiectomy is performed on a client
with a testicular malignancy. The client expresses
concerns regarding his sexuality. The nurse should
base the response on the knowledge that the client:
■ 1. Is not a candidate for sperm banking.
■ 2. Should retain normal sexual drive and function.
■ 3. Will be impotent.
■ 4. Will have a change in secondary sexual characteristics.
107. A client diagnosed with seminomatous testicular
cancer expresses fear and questions the nurse
about his prognosis. The nurse should base the
response on the knowledge that:
■ 1. Testicular cancer is almost always fatal.
■ 2. Testicular cancer has a cure rate of 90% when
diagnosed early.
■ 3. Surgery is the treatment of choice for testicular
cancer.
■ 4. Testicular cancer has a 50% cure rate when
diagnosed early.
The Client with Cancer
of the Prostate
108. The nurse is developing a program about
prostate cancer for a health fair. The nurse should
provide information about which of the following
topics?
■ 1. The Prostate-Specifi c Antigen (PSA) test is reliable
for detecting the presence of prostate cancer.
■ 2. For all men, age 50 and older, the American
Cancer Society recommends an annual rectal
examination.
■ 3. Avoid lifting more than 20 lb aids in prevention
of prostate cancer.
■ 4. Regular sexual activity promotes health of the
prostate gland to prevent cancer.
109. The nurse is caring for a client who will
have a bilateral orchiectomy. The client asks what
is involved with this procedure. The nurse’s most
appropriate response would be? “The surgery:
■ 1. Removes the entire prostate gland, prostatic
capsule, and seminal vesicles.”
■ 2. Tends to cause urinary incontinence and
impotence.”
■ 3. Freezes prostate tissue, killing cells.”
■ 4. Results in reduction of the major circulating
androgen, testosterone.”
110. The nurse is teaching a client newly diagnosed
with prostate cancer. Which of the following points
should be included in the instruction? Select all that
apply.
■ 1. Prostate cancer is usually multifocal and
slow-growing.
■ 2. Most prostate cancers are adenocarcinoma.
■ 3. The incidence of prostate cancer is higher
in African American men, and the onset is
earlier.
■ 4. A prostate specifi c antigen (PSA) lab
test greater than 4 ng/mg will need to be
monitored.
■ 5. Cancer cells are detectable in the urine.
111. When a client is receiving hormone replacement
for prostate cancer, the nurse should do which
of the following? Select all that apply.
■ 1. Inform the client that increased libido is
expected with hormone therapy.
■ 2. Reassure the client and his signifi cant other
that erectile dysfunction will not occur as a
consequence of hormone therapy.
■ 3. Provide the client the opportunity to communicate
concerns and needs.
■ 4. Utilize communication strategies that
enable the client to gain some feeling of
control.
■ 5. Suggest that an appointment be made to see a
psychiatrist.
112. A client asks the nurse why the prostate
specifi c antigen (PSA) level is determined before the
digital rectal examination. The nurse’s best response
is which of the following?
■ 1. “It is easier for the client.”
■ 2. “A prostate examination can possibly
decrease the PSA.”
■ 3. “A prostate examination can possibly
increase the PSA.”
■ 4. “If the PSA is normal, the client will not have
to undergo the rectal examination.”
113. The nurse is performing a digital rectal
examination. Which of the following fi nding is a
key sign for prostate cancer?
■ 1. A hard prostate, localized or diffuse.
■ 2. Abdominal pain.
■ 3. A boggy, tender prostate.
■ 4. A nonindurated prostate.
114. A client is undergoing a total prostatectomy
for prostate cancer. The client asks questions about
his sexual function. The best response by the nurse
is which of the following?
■ 1. “Loss of the prostate gland means that you
will be impotent.”
■ 2. “Loss of the prostate gland means that you
will be infertile and there will be no ejaculation.
You can still experience the sensations
of orgasm.”
■ 3. “Loss of the prostate gland means that you
will have no loss of sexual function and
drive.”
■ 4. “Loss of the prostate gland means that your
erectile capability will return immediately
after surgery.”
115. A 65-year-old client has been told by the physician
that his prostate cancer was graded at stage
IIB. The client inquires if this means he is going to
die soon. The best response by the nurse is which of
the following?
■ 1. “Prostate cancer at this stage is very slow
growing.”
■ 2. “Prostate cancer at this stage is very fast
growing.”
■ 3. “Prostate cancer at this stage has spread to the
bone.”
■ 4. “Prostate cancer at this stage is diffi cult to
predict.”
116. A client with prostate cancer is treated with
hormone therapy consisting of diethylstilbestrol
(DES; Stilphostrol), 2 mg daily. The nurse should
instruct the client to expect to have:
■ 1. Tenderness of the scrotum.
■ 2. Tenderness of the breasts.
■ 3. Loss of pubic hair.
■ 4. Decreased blood pressure.
Answers
The Client with Breast Disease
23. 1. This complaint warrants the nurse’s performing
an examination and reporting the results to
the physician. Hormone fl uctuations do cause breast
discomfort, but an examination must be done at
this time to assess the breast. Although pain is not
common with breast cancer, it can be a symptom.
Teaching the client to perform BSE is important, but
it is not the priority action in this case.
CN: Physiological adaptation;
CL: Synthesize
24. 3. It is generally recommended that the
breasts be examined during the fi rst week after
menstruation. During this time, the breasts are least
likely to be tender or swollen because estrogen is
at its lowest level. Therefore, the examination will
be more comfortable for the client. The examination
may also be more accurate because the client is
more likely to notice an actual change in her breast
that is not simply related to hormonal changes.
CN: Health promotion and maintenance;
CL: Apply
25. 2. The client needs to become more confi dent
and knowledgeable about the normal feel of the
implants and her breast tissue. The best technique is
for the nurse to demonstrate breast self-examination
(BSE) to the client as the nurse conducts the clinical
breast examination. Implant surgery does not
exclude the need for monthly BSE. A mammogram
is not a substitute for monthly BSE.
CN: Health promotion and maintenance;
CL: Synthesize
26. 2. The breasts may vary in size before menstruation
because of breast engorgement caused by
hormonal changes. A woman may then note that
her bra fi ts more tightly than usual. Benign cysts do
not cause variation in breast size. A change in breast
size that does not follow hormonal changes could
warrant further assessment. The breasts normally
are about the same size, although some women have
one breast slightly larger than the other.
CN: Health promotion and maintenance;
CL: Apply
27. 2. Advancing age in postmenopausal women
has been identifi ed as a risk factor for breast cancer.
A 76-year-old client needs monthly breast selfexamination
and a yearly clinical breast examination
and mammogram to comply with the screening
schedule. While mammograms are less painful as
breast tissue becomes softer, the nurse should advise
the woman to have the mammogram. Family history
is important, but only about 5% of breast cancers
are genetic.
CN: Health promotion and maintenance;
CL: Synthesize
28. 1. If a client has questions the nurse cannot
answer, it is best to delay the signing of the consent
until the questions are clarifi ed for the client. The
surgeon should be notifi ed, and the appropriate
information or collaboration should be provided
for the client before she signs the surgical consent.
Telling her she should concentrate on recovery fi rst
ignores the client’s questions and concerns. Frequently
the plastic surgeon needs to be consulted at
the beginning of the treatment because various surgical
decisions depend on the future plans for breast
reconstruction.
CN: Management of care;
CL: Synthesize
29. 1. An important nursing responsibility is
preoperative teaching, and the most frequently
recommended guide for teaching is to tell the client
as much as she wants to know and is able to understand.
Delaying discussion of issues about which the client has concerns is likely to aggravate the
situation and cause the client to feel distrust. As a
general guide, the client would not ask the question
if she were not ready to discuss her situation. The
nurse is available to answer the client’s questions
and concerns and should not delay discussing these
with the client.
CN: Psychosocial adaptation;
CL: Synthesize
30. 1. About half of malignant breast tumors
occur in the upper outer quadrant of the breast. For
no known reason, cancer appears in the left breast
more often than in the right breast. The upper outer
quadrants of the breast, and especially the axillary
area, should be covered thoroughly in the clinical
breast examination and breast self-examination.
CN: Physiological adaptation;
CL: Apply
31. 4. Atropine sulfate, a cholinergic blocking
agent, is given preoperatively to reduce secretions
in the mouth and respiratory tract, which assists in
maintaining the integrity of the respiratory system
during general anesthesia. Atropine is not used to
promote muscle relaxation, decrease nausea and
vomiting, or decrease pulse and respiratory rates. It
causes the pulse to increase.
CN: Pharmacological and parenteral
therapies; CL: Evaluate
32. 3. The nurse should respond with an openended
statement that elicits further exploration of
the client’s feelings. Women with cancer may feel
guilt or shame. Previous life decisions, sexuality,
and religious beliefs may infl uence a client’s adjustment
to a diagnosis of cancer. The nurse should
not contradict the client’s feelings of punishment
or offer advice such as confi ding in the husband.
A social worker referral may be benefi cial in the
future, but is not the fi rst response needed to elicit
exploration of the client’s feelings.
CN: Psychosocial adaptation;
CL: Synthesize
33. 3. A drainage tube is placed in the wound
after a modifi ed radical mastectomy to help remove
accumulated blood and fl uid in the area. Removal
of the drainage fl uids assists in wound healing and
is intended to decrease the incidence of hematoma,
abscess formation, and infection. Drainage tubes
placed in a wound do not decrease intrathoracic
pressure, increase collateral lymphatic fl ow, or prevent
adhesion formation.
CN: Reduction of risk potential;
CL: Evaluate
34. 4. Lymph nodes can be removed from the
axillary area when a modifi ed radical mastectomy is
done, and each of the nodes is biopsied. To facilitate
drainage from the arm on the affected side, the
client’s arm should be elevated on pillows with her
hand higher than her elbow and her elbow higher
than her shoulder. A sentinel node biopsy procedure
is associated with a decreased risk of lymphedema
because fewer nodes are excised.
CN: Physiological adaptation;
CL: Synthesize
35. 2. Tamoxifen is an antiestrogen drug that has
been found to be effective against metastatic breast
cancer and to improve the survival rate. The drug
causes hot fl ashes as an adverse effect.
CN: Pharmacological and parenteral
therapies; CL: Synthesize
36. 1. Giving the client a list of community
resources that could provide support and guidance
assists the client to maintain her self-image and
independence. The support group will include other
women who have undergone similar therapies and
can offer suggestions for breast products and wigs.
Because the client is asking about specifi c resources,
she does not need a referral to a social worker, home
health agency, or plastic surgeon.
CN: Management of care; CL: Synthesize
37. 1. A client receiving radiation therapy should
avoid lotions, ointments, and anything that may
cause irritation to the skin, such as exposure to sunlight,
heat, or talcum powder. The area may safely
be washed with water if it is done gently and if care
is taken not to injure the skin.
CN: Reduction of risk potential;
CL: Synthesize
38. 3. The most common reaction of the skin to
radiation therapy is redness of the surface tissues.
Dryness, tanning, and capillary dilation are also
common. Atrophy of the skin, pustules, and sloughing
of two layers would not be expected and should
be reported to the radiologist.
CN: Reduction of risk potential;
CL: Apply
39. 1. The American Cancer Society’s Reach to
Recovery is a rehabilitation program for women
who have had breast surgery. It is designed to meet
their physical, psychological, and emotional needs.
The Reach to Recovery program is implemented
by women who have had breast cancer themselves.
Many women benefi t from this peer information and
support.
CN: Psychosocial adaptation; CL: Apply
The Client with Benign Prostatic
Hypertrophy
40. 1. The best way to assess for a distended
bladder in either a male or female client is to check
for a rounded swelling above the pubis. This swelling
represents the distended bladder rising above
the pubis into the abdominal cavity. Dullness does
not indicate a distended bladder. The client might
experience tenderness or pressure above the symphysis.
No urine discharge is expected; the urine fl ow
is blocked by the enlarged prostate.
CN: Reduction of risk potential;
CL: Analyze
41. 3. Rapid emptying of an overdistended bladder
may cause hypotension and shock due to the
sudden change of pressure within the abdominal
viscera. Previously, removing no more than 1,000
mL at one time was the standard of practice, but this
is no longer thought to be necessary as long as the
overdistended bladder is emptied slowly.
CN: Reduction of risk potential;
CL: Apply
42. 2. Liberal lubrication of the catheter before
catheterization of a male reduces friction along the
urethra and irritation and trauma to urethral tissues.
Because the male urethra is tortuous, a liberal
amount of lubrication is advised to ease catheter
passage. The female urethra is not tortuous, and,
although the catheter should be lubricated before
insertion, less lubricant is necessary. Lubrication
of the catheter will not decrease spasms. The nurse
should use sterile technique to prevent introducing
organisms. Crusts will not form immediately. Irrigating
the catheter as needed will prevent clot and
crust formation.
CN: Reduction of risk potential;
CL: Apply
43. 1. The primary reason for taping an indwelling
catheter to a male client so that the penis is held
in a lateral position is to prevent pressure at the
penoscrotal angle. Prolonged pressure at the penoscrotal
angle can cause a ureterocutaneous fi stula.
CN: Reduction of risk potential;
CL: Apply
44. 2. Research shows that older men tend to
believe it is normal to live with some urinary problems.
As a result, these men often overlook symptoms
and simply attribute them to aging. As part
of preventive care for men older than age 40, the
yearly physical examination should include palpation
of the prostate via rectal examination. Prostatespecifi
c antigen screening also is done annually
to determine elevations or increasing trends in elevations. The nurse should teach male clients the
value of early detection and adequate follow-up for
the prostate.
CN: Reduction of risk potential;
CL: Apply
45. 1, 2, 4, 5. Because of the history of benign
prostatic hypertrophy (BPH), the nurse should
provide privacy and time for the client to void. The
nurse should also monitor intake and output, assess
the client for urinary retention, and test the urine
for hematuria. It is not necessary to catheterize the
client.
CN: Physiological adaptation;
CL: Synthesize
46. 2. Signs and symptoms of prostatic hypertrophy
include diffi culty starting the fl ow of urine, urinary
frequency and hesitancy, decreased force of the
urine stream, interruptions in the urine stream when
voiding, and nocturia. The prostate gland surrounds
the urethra, and these symptoms are all attributed
to obstruction of the urethra resulting from prostatic
hypertrophy. Nocturia from incomplete emptying
of the bladder is common. Straining and urine
retention are usually the symptoms that prompt the
client to seek care. Painful urination is generally not
a symptom of prostatic hypertrophy.
CN: Physiological adaptation;
CL: Analyze
47. 3. Ipratropium is a bronchodilator, and its
anticholinergic effects can aggravate urine retention.
Metformin and buspirone do not affect the urinary
system; timolol does not have a systemic effect.
CN: Pharmacological and parenteral
therapies; CL: Apply
48. 4. If paralysis of vasomotor nerves in the
upper spinal cord occurs when spinal anesthesia
is used, the client is likely to develop respiratory
paralysis. Artifi cial ventilation is required until the
effects of the anesthesia subside. Seizures, cardiac
arrest, and renal shutdown are not likely results of
spinal anesthesia.
CN: Physiological adaptation;
CL: Analyze
49. 3. Terazosin is an antihypertensive drug that
is also used in the treatment of BPH. Blood pressure
must be monitored to ensure that the client does
not develop hypotension, syncope, or orthostatic
hypotension. The client should be instructed to
change positions slowly. Urine nitrates, white blood
cell count, and pulse rate are not affected by terazosin.
CN: Pharmacological and parenteral
therapies; CL: Analyze
50. 3. The decision by the surgeon to insert a
catheter after TURP or prostatectomy depends on
the amount of bleeding that is expected after the
procedure. During continuous bladder irrigation
after a TURP or prostatectomy, the rate at which
the solution enters the bladder should be increased
when the drainage becomes brighter red. The color
indicates the presence of blood. Increasing the fl ow
of irrigating solution helps fl ush the catheter well so
that clots do not plug it. There would be no reason
to increase the fl ow rate when the return is continuous
or when the return appears cloudy and dark
yellow. Increasing the fl ow would be contraindicated
when there is no return of urine and irrigating
solution.
CN: Pharmacological and parenteral
therapies; CL: Synthesize
51. 4. Belladonna and opium suppositories are
prescribed and administered to reduce bladder
spasms that cause pain after TURP. Bladder spasms
frequently accompany urologic procedures. Antispasmodics
offer relief by eliminating or reducing
spasms. Antimicrobial drugs are used to treat an
infection. Belladonna and opium do not relieve
urine retention or urinary frequency.
CN: Pharmacological and parenteral
therapies; CL: Synthesize
52. 3. The indwelling urinary catheter creates the
urge to void and can also cause bladder spasms. The
nurse should ensure adequate bladder emptying by
monitoring urine output and characteristics. Urine
output should be at least 50 mL/hour. A plugged
catheter, imagining the urge to void, and confusion
are less likely reasons for the client’s complaint.
CN: Reduction of risk potential;
CL: Synthesize
53. 1, 2, 3, 4. Ampicillin may be given with or
without food, but the nurse should instruct the client
to obtain an adequate fl uid intake (2,500 mL)
to promote urinary output and to fl ush out bacteria
from the urinary tract. The nurse should also
encourage the client to void frequently (every 2 to
3 hours) and empty the bladder completely. Taking
the antibiotic at bedtime, after emptying the bladder,
helps to ensure an adequate concentration of the
drug during the overnight period.
CN: Physiological adaptation;
CL: Synthesize
54. 2. Dribbling of urine can occur for several
months after TURP. The client should be informed
that this is expected and is not an abnormal sign.
The nurse should teach the client perineal exercises
to strengthen sphincter tone. The client may need
to use pads for temporary incontinence. The client few months and will not be a chronic problem. Dribbling
is not a sign of healing, but is related to the
trauma of surgery.
CN: Basic care and comfort;
CL: Synthesize
55. 1. Defi cient fl uid volume is a priority diagnosis
because the client needs to drink a large amount
of fl uids to keep the urine clear. The urine should
be almost without color. About 2 weeks after TURP,
when desiccated tissue is sloughed out, a secondary
hemorrhage could occur. The client should be
instructed to call the surgeon or go to the emergency
department if at any time the urine turns bright red.
The client is not specifi cally at risk for nutritional
problems after TURP. The client is not specifi cally at
risk for impaired tissue integrity because there is no
external incision, and the client is not specifi cally
at risk for airway problems because the procedure is
done under spinal anesthesia.
CN: Basic care and comfort; CL: Analyze
56. 3. Rectal and prostate examinations can
increase serum PSA levels; therefore, instruct the
client that a manual rectal examination is usually
part of the test regimen to determine prostate
changes. The prostatic palpation should be done
after the blood sample is drawn. The PSA level must
be monitored more often than biannually when it is
elevated. Having a colonoscopy is not related to the
fi ndings of the PSA test. It is not necessary to void
prior to having PSA blood levels tested.
CN: Health promotion and maintenance;
CL: Synthesize
The Client with Testicular Disease
98. 2. Epididymitis causes acute tenderness and
pronounced swelling of the scrotum. Gradual onset
of unilateral scrotal pain, urethral discharge, and
fever are other key signs. Epididymitis is occasionally,
but not routinely, associated with urinary tract
infection. Burning and pain on urination and foulsmelling
ejaculate or urine are not classic symptoms
of epididymitis.
CN: Physiological adaptation;
CL: Analyze
99. 3. Among men younger than age 35,
epididymitis is most frequently caused by a sexually
transmitted infection. Causative organisms are usually
chlamydia or Neisseria gonorrhoeae. The other
major form of epididymitis is bacterial, caused by
the Escherichia coli or Pseudomonas organisms. The
nurse should always include safe sex teaching for a
client with epididymitis. The client should also be is a mode of transmission of gram-negative rods to
the epididymis.
CN: Reduction of risk potential;
CL: Apply
100. 3. After a warm bath or shower, the testes
hang lower and are both relaxed and in the ideal
position for manual evaluation and palpation.
CN: Health promotion and maintenance;
CL: Apply
101. 2. Normal testes feel smooth, egg-shaped,
and fi rm to the touch, without lumps. The surface
should feel smooth and rubbery. The testes should
not be soft or spongy to the touch. Testicular malignancies
are usually nontender, nonpainful hard
lumps. Lumps, swelling, nodules, or signs of infl ammation
should be reported to the physician.
CN: Health promotion and maintenance;
CL: Analyze
102. 4. AFP and hCG are considered markers that
indicate the presence of testicular disease. Elevated
AFP and hCG and decreased testosterone are markers
for testicular disease. Measurements of AFP,
hCG, and testosterone are also obtained throughout
the course of therapy to help measure the effectiveness
of treatment.
CN: Physiological adaptation;
CL: Apply
103. 1. Cryptorchidism (undescended testes) carries
a greatly increased risk for testicular cancer.
Undescended testes occurs in about 3% of male
infants, with an increased incidence in premature
infants. Other possible causes of malignancy include
chemical carcinogens, trauma, orchitis, and environmental
factors. Testicular cancer is not associated
with early sexual relations in men, even though cervical
cancer is associated with early sexual relations
in women. Testicular cancer is not associated with
seminal vesiculitis or epididymitis.
CN: Health promotion and maintenance;
CL: Apply
104. 2. The incidence of testicular cancer is higher
in men who live in rural rather than suburban
areas. Testicular cancer is more common in white
than black men. Men with higher socioeconomic
status seem to have a greater incidence of testicular
cancer. The exact cause of testicular cancer is
unknown. Cancer of the testes is the leading cause
of death from cancer in the 15- to 35-year-old agegroup.
CN: Health promotion and maintenance;
CL: Analyze
105. 3. Because of the location of the incision
in the high inguinal area, pain is a major problem
during the immediate postoperative period. The
incisional area and discomfort caused by movement
contribute to increased pain. Bladder spasms and
elimination problems are more commonly associated
with prostate surgery. Nausea is not a priority
problem.
CN: Physiological adaptation;
CL: Synthesize
106. 2. Unilateral orchiectomy alone does not
result in impotence if the other testis is normal. The
other testis should produce enough testosterone
to maintain normal sexual drive, functioning, and
characteristics. Sperm banking before treatment is
commonly recommended because radiation or chemotherapy
can affect fertility.
CN: Psychosocial adaptation;
CL: Synthesize
107. 2. When diagnosed early and treated aggressively,
testicular cancer has a cure rate of about
90%. Treatment of testicular cancer is based on
tumor type, and seminoma cancer has the best prognosis.
Modes of treatment include combinations of
orchiectomy, radiation therapy, and chemotherapy.
The chemotherapeutic regimen used currently is
responsible for the successful treatment of testicular
cancer.
CN: Physiological adaptation; CL: Apply
The Client with Cancer
of the Prostate
108. 2. Most prostate cancer is adenocarcinoma
and is palpable on rectal examination because
it arises from the posterior portion of the gland.
Although the PSA is not a perfect screening test, the
American Cancer Society recommends an annual
rectal examination and blood PSA level for all men
age 50 and older, or starting at age 40 if African
American or if there is family history of prostate
cancer. To help achieve optimal sexual function,
give the client the opportunity to communicate his
concerns and sexual needs. Regular sexual activity
does not prevent cancer.
CN: Health promotion and maintenance;
CL: Synthesize
109. 4. Bilateral orchiectomy (removal of testes)
results in reduction of the major circulating androgen,
testosterone, as a palliative measure to reduce
symptoms and progression of prostate cancer.
A radical prostatectomy (removal of entire prostate
gland, prostatic capsule, and seminal vesicles) may include pelvic lymphadenectomy. Complications
include urinary incontinence, impotence, and rectal
injury with the radical prostatectomy. Cryosurgery
freezes prostate tissue, killing tumor cells without
prostatectomy.
CN: Health promotion and maintenance;
CL: Apply
110. 1, 2, 3, 4. Cancer of the prostate gland is the
second-leading cause of cancer death among American
men and is the most common carcinoma in
men older than age 65. Incidence of prostate cancer
is higher in African American men, and onset is
earlier. Most prostate cancers are adenocarcinoma.
Prostate cancer is usually multifocal, slow-growing,
and can spread by local extension, by lymphatics, or
through the bloodstream. Prostate-specifi c antigen
(PSA) greater than 4 ng/mg is diagnostic; a free PSA
level can help stratify the risk of elevated PSA levels.
Metastatic workup may include skeletal x-ray,
bone scan, and CT or MRI to detect local extension,
bone, and lymph node involvement. The urine does
not have prostate cancer cells.
CN: Health promotion and maintenance;
CL: Create
111. 3, 4. Hormone manipulation deprives tumor
cells of androgens or their by-products and, thereby,
alleviates symptoms and retards disease progression.
Complications of hormonal manipulation
include: hot fl ashes, nausea and vomiting, gynecomastia,
and sexual dysfunction. As part of supportive
care, provide explanations of diagnostic tests
and treatment options and help the client gain some
feeling of control over his disease and decisions
related to it. To help achieve optimal sexual function,
give the client the opportunity to communicate
his concerns and sexual needs. Inform the client
that decreased libido is expected after hormonal
manipulation therapy, and that impotence may
result from some surgical procedures and radiation.
A psychiatrist is not needed.
CN: Psychosocial adaptation;
CL: Synthesize
112. 3. Manipulation of the prostate during the
digital rectal examination may falsely increase the
PSA levels. The PSA determination and the digital
rectal examination are both necessary as screening
tools for prostate cancer, and both are recommended
for all men older than age 50. Prostate cancer is the
most common cancer in men and the second leading
killer from cancer among men in the United
States. Incidence increases sharply with age, and
the disease is predominant in the 60- to 70-year-old
age-group.
CN: Health promotion and maintenance;
CL: Apply
113. 1. On digital rectal examination, key signs
of prostate cancer are a hard prostate, induration of
the prostate, and an irregular, hard nodule. Accompanying
symptoms of prostate cancer can include
constipation, weight loss, and lymphadenopathy.
Abdominal pain usually does not accompany prostate
cancer. A boggy, tender prostate is found with
infection (e.g., acute or chronic prostatitis).
CN: Health promotion and maintenance;
CL: Analyze
114. 2. Loss of the prostate gland interrupts the
fl ow of semen, so there will be no ejaculation fl uid.
The sensations of orgasm remain intact. The client
needs to be advised that return of erectile capability
is often disrupted after surgery, but within 1 year
95% of men have returned to normal erectile function
with sexual intercourse.
CN: Physiological adaptation;
CL: Synthesize
115. 1. Clients who have stage IA or IIB prostate
cancer have an excellent survival rate. Prostate
cancer is usually slow growing, and many men who
have prostate cancer do not die from it. A stage I or
II tumor is confi ned to the prostate gland and has
not spread to the extrapelvic region or bone.
CN: Physiological adaptation;
CL: Synthesize
116. 2. Diethylstilbestrol causes engorgement and
tenderness of the breasts (gynecomastia). Stilbestrol
is prescribed as palliative therapy for men
with androgen-dependent prostatic carcinoma. An
increase in blood pressure can occur. Tenderness
of the scrotum and dramatic changes in secondary
sexual characteristics should not occur.
CN: Pharmacological and parenteral
therapies; CL: Apply