Nurs 236 chap 38-39, question and answer

Nurs 236 chap 38-39, question and answer A female patient complains of irritability, fatigue, mood swings, and fear of losing control days before menstruation. The initial assessment suggests a nursing problem of altered coping due to cyclic hormonal changes. Which of the following instructions given by the nurse would likely promote patient coping? 1. "Avoid calcium-containing foods." 2. "Exercise regularly." 3. "Have occasional alcohol." 4. "Consider a sodium-rich diet." 1, 3, 4, 5 Which of the following nursing interventions would help relieve symptoms of dysmenorrhea? (Select all that apply.) 1. Pelvic rocking exercises 2. Cold compresses 3. Effleurage 4. Low-fat diet 5. NSAIDs 2 A 44-year-old patient complains of irregular menses with hot flashes. She is informed that she is approaching the climacteric period. Her nurse finds her withdrawn and crying. An appropriate statement by the nurse would be: 1. "It is not the end of the world." 2. "You seem upset. I am here to listen." 3. "Everything will be all right." 4. "Aging is not for the faint of heart." 4 Metrorrhagia is associated with which of the following? 1. Uterine polyps and leiomyomas 2. Trauma and foreign body in the vagina 3. Cervical cancer 4. All of these 1, 2, 4 A 65-year-old patient complains of vaginal bleeding. She has been menopausal for 11 years. Which of the following are possible causes? (Select all that apply.) 1. Postcoital bleeding from atrophic vaginitis 2. Endometrial cancer 3. Endometriosis 4. Cervical polyp 2, 3, 4 A nurse is discussing healthy lifestyle activities with a woman. Which of the following statements by the woman indicates a need for follow-up teaching? (Select all that apply.) 1. "I can use herbals such as Angelica or evening primrose oil during menstruation to decrease breast tenderness." 2. "I will focus on drinking caffeine-free colas to keep my fluid intake adequate." 3. "I will douche regularly with an alkaline solution to maintain vaginal health." 4. "I will wear form-fitting, nylon clothing and underwear for warmth and to prevent infections." 5. "As I approach menopause, I can eat wild yams, cherries, and alfalfa sprouts as a source of phytoestrogens." 4 A nurse is discussing various methods of contraception with a woman. When discussing mechanical methods of contraception that do not provide any protection from STIs, the nurse would specifically include: 1. The symptothermal method 2. The Billings method 3. The use of water-soluble spermicidal lubricants during sexual activity 4. The use of IUDs 5. OCs 2 A nurse empowers a patient who had a right radical mastectomy by providing specific instructions regarding postoperative care of the surgical site and surgical complications. Which of the following statements by the patient would indicate a need for more teaching? 1. "Blood pressure cannot be taken on the right arm." 2. "I can resume intense weight training immediately after discharge." 3. "No injections must be given in the right arm." 4. "When gardening, I need to wear gloves." 2 A 44-year-old patient who had a right radical mastectomy expresses concerns regarding her physical appearance. Further assessment indicates a nursing problem of altered body image. An important goal for this patient would be to: 1. participate in activities of daily living. 2. demonstrate acceptance of change in appearance. 3. perform aseptic wound care. 4. state signs and symptoms of infection. 2, 4, 5 A nurse is taking the gynecologic history of a postmenopausal Mexican American patient. Which strategies would help develop rapport with the patient? (Select all that apply.) 1. Establish direct eye contact. 2. Involve family members. 3. Touch the patient. 4. Use a polite tone of voice. 5. Respect privacy. 2 A patient is discharged after having a vasectomy. Which statement by the patient would indicate a need for further teaching? 1. "I don't want any more children." 2. "Now I can go home and have sex without fear of impregnating my wife." 3. "There is a possibility that this procedure can be reversed in the future." 4. "I should use ice packs to the scrotum after surgery to reduce swelling." 2 A 22-year-old man complains of sudden acute scrotal pain. Initial examination reveals absence of the cremasteric reflex. Doppler ultrasound reveals a diminished blood flow. This condition would most likely be: 1. varicocele. 2. testicular torsion. 3. hydrocele. 4. priapism. 2 A 25-year-old African American man was hospitalized for a prolonged penile erection unrelated to sexual desire or activity. A likely cause would be: 1. diabetes mellitus. 2. sickle cell disease. 3. hemophilia. 4. urinary infection. 2 A post-prostatectomy patient expresses concerns regarding his ability to have intimate relations with his wife. The nurse identifies a possible sexual dysfunction. Priority nursing interventions would be geared toward which of the following nursing goals? 1. Identify signs and symptoms of infection. 2. Facilitate verbalization of personal concerns with his partner. 3. Demonstrate good aseptic wound care. 4. Facilitate development of alternative coping strategies. 1, 2, 5 A 65-year-old man complains of difficulty urinating, described as decreased caliber of the urine stream. He also has accompanying hesitancy, dribbling, and urgency. A digital rectal examination reveals an enlarged prostate. Which nursing intervention(s) would be appropriate? (Select all that apply.) 1. Teach to decrease caffeine and artificial sweeteners. 2. Teach to limit spicy foods and alcohol intake. 3. Apply a condom catheter. 4. Restrict fluid intake. 5. Plan a timed voiding schedule. 3 A 30-year-old white male presents to the clinic for an annual examination. While there he states, "I have a hard lump on my testicle. I just noticed it recently and I think it's because I took up bike riding. I will have the doctor check it the next time I come in if it's still there." What should the nurse tell him? 1. "That's probably a good plan. Most testicular lumps are not cancer and you can always come back sooner if it does not go away." 2. "The doctor should look at it now. Most testicular lumps are cancerous and we can begin treatment right away." 3. "The doctor should check that lump today. Most testicular lumps are benign, but we do not want to take a risk." 4. "Yes. I think the doctor is running late anyway, and you should make an appointment with the doctor because that is an add-on problem, and this is a prevention visit." 2 A nurse is taking care of a 40-year-old Hispanic man who had a bilateral orchiectomy. Clinical interviews with the patient confirm mounting concerns regarding his "manhood." The nurse would effectively approach the patient's disturbance in body image by: 1. establishing eye contact. 2. demonstrating sensitivity to nonverbal cues. 3. asking specific questions. 4. involving nonessential members of the family. 1 A 40-year-old man comes into the clinic and asks for a prostate examination and a PSA test. He states, "I know that prostate cancer is the most common cancer in men. I want to start getting screened now and then annually. Screening is the best prevention." What should the nurse tell him? 1. "Screening for prostate cancer can begin at age 45 years; depending on the results, a screening prevention plan is devised based on risk." 2. "Oh you do not need to worry now. Prostate screening begins at age 50 years and then continues annually." 3. "Prostate screening is done at the same time as your colon cancer screening and begins by age 50 years." 4. "We only check PSA levels now. Examinations have been found to be unreliable." 2 A patient who had TURP complains of increasing bladder spasms. Which is an appropriate initial nursing action? 1. Medicate with a B&O suppository. 2. Check the urinary catheter tubing for kinks and obstruction. 3. Teach relaxation exercises. 4. Encourage use of patient-controlled analgesia. 1, 2, 4 A patient states, "The doctor says I have a hydrocele." How should the nurse explain a hydrocele? (Select all that apply.) 1. "A fluid collection within the scrotum that can be drained." 2. "Sometimes caused by an infection of the testis that causes inflammation." 3. "An inflammation of the testes and scrotum from an illness such as mumps." 4. "Possibly from an injury with inflammation." radical mastectomy Surgery for removal of breast, axillary lymph nodes, and chest wall muscles under the breast. It was once very common, but high success rates with a reduction in disfigurement are now made possible by using appropriate staging of the disease when making treatment decisions. modified radical mastectomy Surgery for removal of breast, axillary lymph nodes, and lining over the chest wall muscles. lumpectomy Procedure for removal of tumor only in breast. Partial or segmental mastectomy Procedure where removal of tumor and a portion of the surrounding breast tissue and axillary lymph nodes is performed. Two, the follicular phase and the luteal phase. How many phases does the ovarian cycle have and what are they? Four How many phases does the menstrual cycle have? Menstrual Stage (Dismantling Stage) 1. Endometrium sloughs away as menstrual flow begins. 2. Progesterone and estrogen are no longer secreted. 3. New follicle starts to mature. What is phase/stage I of the menstrual cycle? 1. Ovulation occurs 14 days before menses, regardless of length of menstrual cycle. It takes place when the follicle ruptures and releases egg. If pregnancy does not occur, the corpus luteum deteriorates, estrogen and progesterone decline, and the thickened tissue on the endometrium of the uterus is sloughed off and is discharged via the vagina as a menstrual "period." What is phase/stage III of the menstrual cycle? Secretory Stage (Postovulatory or Progesterone Stage) 1. Corpus luteum secretes progesterone. 2. Endometrium continues to thicken in response to estrogen and progesterone. Uterus prepares to receive fertilized ovum. What is phase/stage IV of the menstrual cycle? Toward the end of the childbearing years, women enter the phase known as the climacteric period, Where the menses become irregular in both pattern and flow and eventually cease altogether. What is a climacteric period? The amount of actual blood loss is 40 to 80 mL How much blood is lost during menstruation? Menstrual bleeding occurs about 14 days after ovulation and lasts between 2 and 8 days. When does menstrual bleeding occur after ovulation? Growth and Repair (Estrogen or Proliferative Stage) 1. Follicle grows, and egg matures. 2. Endometrium returns to normal state and then begins to thicken in response to estrogen. What is phase/stage II of the menstrual cycle? When the menses has completely ceased for at least 12 months. When does menopause occur? Some atrophy of the female organs, loss of elasticity, dryness of the vaginal membranes, and reduction of bone mass. After menopause, what occurs because of the decrease in estrogen levels. The length of the cycle can be influenced by stress, drugs, nutrition, and illness. What factors influence the length of a female's cycle? Mittelschmerz is a sharp pain in the right or left lower quadrant, sometimes felt at midcycle around the time of ovulation, and may last a few hours. Mittelschmerz is what? Birth control pills, hormone replacement therapy, and pregnancy may cause the breasts to increase in size. What factors may increase the breast size? It prevents fertilization What does the morning after pill do? When she starts having sex When should a female start having pelvic exams? At 21 years and then every 3 years. When should a female start getting Pap smears? Starting at 29 until 65 When should females have Pap smears and HPV tests concurrently performed? Females who start their periods early and late menopause, have first child late in life, history of breast cancer, and abnormal biopsies. What factors increase the chances of breast cancer? Post menopausal, diet, alcohol, and smoking What increases risk for osteoporosis? Long term estrogen use. What places women at an increased risk for breast and endometrial cancer? Cervical or uterine cancer. If a female is postmenopausal and starts bleeding what would you suspect? Vitamin E and decreasing caffeine What can help decrease fibrocystic breast changes? Any difficulty in voiding within 6 hours after prostate removal because a distended bladder may cause bleeding. When must the surgeon be called following prostate surgery? plant extracts What should not be taken if the patient is receiving hormone replacement therapy. Urinating immediately when the urge occurs and going to the bathroom. What can relieve minor symptoms of benign prostate hyperplasia (BPH)? Persistent bleeding turning the urine darker than cherry red or bright red, or viscous drainage with many clots, should be reported immediately to the surgeon. Following prostate surgery, what should be immediately reported to the surgeon? Patients who experience incontinence are taught perineal muscle strengthening (Kegel) exercises and are given instruction in bladder training What is taught to patients experiencing incontinence? Orchitis is inflammation of the testicle and may affect one or both testes. Bilateral orchitis is serious and often causes sterility. What is Orchitis? Treatment includes bed rest, analgesia, bladder sedatives, sitz baths, and stool softeners to prevent straining. Antibiotics may be prescribed according to culture and sensitivity laboratory findings. Antibiotics diffuse poorly into the prostatic fluid, so chronic prostatitis is commonly treated with alpha-adrenergic blockers What is the treatment for prostatitis? Cancer of the penis is rare, occurring mostly in men with human papillomavirus infections or who were not circumcised. What are causes for penis cancer? Inhibits the production of prostoglandins. What do NSAIDS do in the treatment for dysmenorrhea? The pelvic rock relieves discomfort by releasing endorphins, suppressing prostaglandins, and shunting the blood flow away from the pelvic organs, which results in less pelvic congestion. How does the pelvic rock help with dysmenorrhea? To promote an attitude of positive sexuality and self-worth. What is the most important management of a young adolescent or adult with dysmenorrhea? The main line of defense against infection is lactic acid, which causes an acidic pH. What is the main defense system in the vagina? Occurs between ovulation and menstruation and includes abdominal bloating, breast tenderness, irritability, appetite changes, fatigue, mood swings, and a fear of losing control. When does PMS occur and what does it