NR WOMEN’S HEALTH EXAM QUESTIONS WITH ANSWERS 2023/2024 UPDATE GRADED A+ SUCCESS ASSURED, Exams of Nursing

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Medical Surgical 7 th^ Edition IGGY Chapter 72: Assessment of the Reproductive System

1. The nurse is counseling a postmenopausal woman about her new stress incontinence. Which statement by the nurse is most important? a. “You can try a variety of briefs and undergarments.” b. “It will be important to keep that area clean and dry.” c. “I can refer you to a good incontinence clinic.” d. “Unfortunately, incontinence is common in women your age.” ANS: B After menopause, the vagina becomes dry, thinner, and smoother. This atrophy places the vagina at risk for infection. The combination of this fact with the presence of urine places the woman at higher risk for infection. The nurse should teach the client good hygienic practices to reduce the likelihood of infection. Education about briefs/undergarments may be needed, and a referral to an incontinence clinic would be very helpful, but neither takes priority over preventing infection. Stating that incontinence is common is not a helpful strategy.
2. An older woman is asking the nurse about her husband’s sexual functioning. Which statement by the nurse is most accurate? a. “Men his age tend to have a rapid decline in sexual abilities.” b. “His testosterone levels will decrease only slightly until he is quite old.” c. “Changes in testosterone levels do not affect sexual performance.” d. “You are lucky your husband is healthy enough for sexual activity.” ANS: B

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Men experience a gradual but slight decrease in testosterone until they are in their 80s. Low testosterone levels do affect sexual performance. Stating that the woman is lucky does not give accurate information about sexual functioning.

3. The nurse is preparing a teaching plan for a client who is scheduled to undergo mammography for the first time. What instruction by the nurse is accurate? a. “The test should be carried out even if you are pregnant.” b. “Do not use deodorant on breasts or underarms before the test.” c. “You will not experience any discomfort because this is just an x-ray.” d. “The entire test should not take longer than 1 hour.” ANS: B The client should be reminded not to use creams, powders, or deodorant on breast or underarm areas before mammography because these products can show on the x-ray. The test should be rescheduled if any possibility exists that the client is pregnant. Women can experience discomfort as the breasts are compressed. The test is generally much less than an hour in duration.
4. The nurse is conducting a reproductive assessment of a postmenopausal woman. Which assessment finding reported by the client requires immediate intervention by the nurse? a. Urinary incontinence b. Vaginal dryness c. Painful intercourse d. Returning periods

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ANS: D

All client reports require some action by the nurse, but the priority would be to further investigate and report the “returning periods.” In a postmenopausal woman, this can signal cancer.

5. The nurse is working with a client who is recovering after a cervical biopsy. Which statement by the client indicates a need for further instruction? a. “I can resume vaginal intercourse after 6 weeks.” b. “I should report heavy bleeding to the health care provider.” c. “I must not lift heavy objects for about 2 weeks.” d. “I will use the antiseptic rinse on a regular basis.” ANS: A The client should be instructed to keep the perineum clean and dry by using antiseptic solution rinses (as directed by her health care provider) and changing pads frequently. In addition, the client is instructed not to lift heavy objects for 2 weeks and to report excessive bleeding (more than like a normal period). She can resume intercourse in about 2 weeks, when the site has healed; she does not need to wait 6 weeks.
6. The nurse is working with a client who is recovering after a laparoscopy. Which assessment finding is considered a priority by the nurse? a. Slight drainage from the incision site b. Grogginess after the anesthesia c. Discomfort from the catheter d. Reports of shoulder pain

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ANS: D

Clients should expect mild drainage or blood from the incision site. Grogginess from the anesthesia and discomfort from a catheter are also expected minor occurrences post-laparoscopy. The nurse would not be concerned about these but should intervene and treat the client with shoulder pain. Shoulder pain is referred pain from phrenic nerve irritation and can be expected.

7. A postmenopausal client says that she is experiencing difficulty with vaginal dryness during intercourse and wonders what might be causing this. Which is the nurse’s best response? a. “The less frequently you have intercourse, the drier the vaginal tissues become.” b. “Estrogen deficiency causes the vaginal tissues to become drier and thinner.” c. “Drinking at least 3 liters of water each day will make all your tissues less dry.” d. “Try using a water-soluble lubricant during intercourse.” ANS: B Estrogen deprivation, which occurs as a result of menopause, decreases the moisture-secreting capacity of vaginal cells, thereby making the area drier. The vaginal tissues also become thinner and the rugae become smoother. Reduced frequency of intercourse will not dry out the vaginal tissues. Drinking excess water will not make the tissues less dry. A water-soluble lubricant may make intercourse less difficult. However, the client is asking what causes the problem.
8. The nurse is assessing a client with a history of irregular periods. Which condition does the nurse possibly correlate with this problem? a. Childhood mumps b. Past valve replacement surgery c. Diabetes mellitus d. Mild intermittent asthma

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ANS: C

Endocrine disorders can affect the hypothalamic-pituitary-gonadal function of both men and women. Mumps would be important to know if the client were male. Past valve replacement surgery would not be contributory. Mild intermittent asthma also would not contribute to this problem. However, a client with more severe asthma who takes steroids on a long-term basis may develop secondary diabetes.

9. A client tells the nurse she is happy that she never had children because she has less risk of developing cancer. Which response by the nurse is best? a. “Actually, your risk of breast cancer is slightly higher.” b. “You’re right; your risk of all reproductive cancer is quite low.” c. “In reality, smoking is the leading risk factor for all types of cancer.” d. “Your risk of uterine cancer is higher because you had no children.” ANS: A Women who have never had children have a slightly higher risk of breast cancer than the general population. Smoking is a major risk factor for many, but not all, cancers. Uterine cancer is not influenced by pregnancy.
10. A client who has had numerous children is having her annual examination. The nurse wishes to discuss contraception, but the client is not interested. Which action by the nurse is most appropriate? a. Provide education on the value of spacing children. b. Explain the many alternatives from which to choose.

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c. Ask the client how her husband feels about so many children. d. Assess the client’s religious and cultural background. ANS: D Cultural and religious backgrounds can have a great deal of influence on clients’ attitudes toward sexuality and reproduction. Because the client does not seem interested in the topic, the nurse should gently assess for these background influences and respect them. Providing education that the client does not want is not helpful and is disrespectful. Asking about the husband’s preferences diminishes the nurse-client relationship, which should be focused on the client.

11. The nurse is teaching a postmenopausal woman about nutrition. Which statement by the nurse is most appropriate? a. “Be sure to eat cereal fortified with folic acid and B vitamins.” b. “Make sure you take a calcium supplement every day.” c. “Vitamin C is important for the postmenopausal woman.” d. “You can get all the iron you need in two daily meat servings.” ANS: B Calcium is important throughout life, but for the postmenopausal woman, it is vital to help prevent osteoporosis. Folic acid and B and C vitamins are very important for the woman taking oral contraceptives. Iron might be important for this client for other reasons but is especially important for women with heavy menstrual bleeding.
12. When performing an assessment of the external genitalia of an older man, the nurse observes the scrotum to have smooth skin and to be very pendulous. Which action by the nurse is most appropriate? a. Suggest to the client that he should wear an athletic supporter while awake. b. Ask the client if he has been treated for a sexually transmitted disease.

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c. Document the observation and continue the assessment. d. Notify the health care provider and facilitate a scrotal ultrasound. ANS: C As the male client ages, the scrotum loses rugae and becomes increasingly pendulous. This is a normal assessment finding. No further action is needed.

13. The nurse is counseling a mother who wants her teenage daughter to have a Pap smear and pelvic examination. Which statement by the nurse is most accurate? a. “If your daughter is over 18, she needs a pelvic examination and Pap smear.” b. “A teenager does not need this examination unless she is sexually active.” c. “Teach her to have her first examination by the age of 21 at the latest.” d. “It is not needed unless you are worried about sexually transmitted diseases.” ANS: C A woman needs to have her first pelvic examination with Pap smear by the age of 21, or within 3 years of becoming sexually active. The other statements are not accurate.
14. A young woman is not pregnant but has not had a menstrual period for 5 months. Which factors does the nurse explore as a possible cause of the amenorrhea? a. The client’s mother having type 2 diabetes mellitus

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b. Running 10 to 15 miles/day c. Taking aspirin daily d. Having a diet high in protein ANS: B Excessive exercise, with corresponding loss of body fat, is associated with insufficient estrogen levels for the maintenance of normal ovulatory and menstrual cycles. The other factors are noncontributory.

15. When scheduling an annual pelvic examination and Pap test, the client asks if she should abstain from intercourse before the test. Which is the nurse’s best response? a. “Yes. Avoid having intercourse for 24 hours before the test.” b. “Yes. Avoid having intercourse for 2 hours before the test.” c. “No. Intercourse does not interfere with this test.” d. “No. Intercourse can actually enhance the test results.” ANS: A The woman should not douche, use vaginal medications or deodorants, or have sexual intercourse for at least 24 hours before the test. Such activities may prevent the accurate evaluation of smears, cultures, and cytologic data.
16. During examination of the male client’s external genitalia, the nurse observes a discharge from the urethra when compressing the glans. Which is the nurse’s next action? a. Document the observation.

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b. Ask the client to turn his head and cough. c. Obtain a specimen for culture. d. Test the cremasteric reflex. ANS: C Urethral discharge is not considered normal in a continent client and should be cultured. The other options would not help provide information about the nature of the discharge.

17. A client is in the clinic for an annual examination and questions the need for a pelvic examination and Pap smear because she had a hysterectomy many years ago. Which response by the nurse is most appropriate? a. “Do you still have your cervix?” b. “Are you sexually active?” c. “We can skip it if you like.” d. “Let’s see what the doctor says.” ANS: A Women who still have their cervix after hysterectomy still need a Pap smear according to the guidelines established for other women. Sexual activity is not relevant. Simply stating that it can be skipped does not help the woman protect her health. Asking the provider does not help the nurse further assess the client.
18. A client is scheduled for an ultrasound to evaluate for possible uterine fibroids. Which instruction by the nurse is most appropriate? a. “Do not eat or drink anything after midnight.”

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b. “Take these laxatives the morning of the test.” c. “Do not urinate an hour before the test; a full bladder will give best results.” d. “Have a designated driver because you will be sleepy from the anesthesia.” ANS: C The scan is noninvasive and painless. The abdominal and pelvic organs are better visualized with the bladder full during the scan. The other statements are inaccurate.

19. An African-American client has a prostate-specific antigen (PSA) of 12 ng/mL. Which action by the nurse is best? a. Remind the client to repeat the test in 1 year. b. Prepare the client for further diagnostic testing. c. Ask if the client ejaculated within 48 hours of the test. d. Assess the client for alcohol and tobacco use. ANS: B A normal PSA level is less than 4 ng/mL. Elevated PSA levels, particularly those over 10 ng/mL, are associated with cancer. African Americans tend to have higher PSA levels as they age, but this level is so high that the nurse must suspect cancer and prepare the client for further diagnostic testing. The client should not wait a year to repeat the test. The client should not ejaculate for 24 hours before having blood drawn. Alcohol and tobacco use does not cause an elevation in PSA. MULTIPLE RESPONSE 1. The nurse is teaching high school girls about the female reproductive tract. Which statements by the nurse are accurate? (Select all that apply.)

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a. The vagina has an acidic environment. b. The cervix is where the Pap smear is taken from. c. The ovum is fertilized in the uterus. d. Ovaries produce sex steroid hormones. e. The breasts contain fat tissue. ANS: A, B, D, E The acidic environment of the vagina helps protect against infection. The cervix is the site for Pap testing. The ovaries produce sex steroid hormones. The breasts contain fat, glandular, fibrous, and ductal tissue. Ova are fertilized in the fallopian tubes.

2. A young adult client is in the clinic for evaluation of amenorrhea lasting 3 months. She takes birth control pills but is on no other medications. Which actions by the nurse are most appropriate? (Select all that apply.) a. Instruct the client on collecting a urinalysis for a pregnancy test. b. Assess the client’s urinary and bowel habits. c. Perform a physical assessment on the client’s abdomen. d. Weigh the client and calculate the body mass index. e. Reassure the client that amenorrhea can occur with oral contraception. ANS: A, D

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Amenorrhea can be caused by several things, but not by urinary or bowel problems. Pregnancy should always be considered, even if the woman is on birth control of any type. Too little body fat can lead to menstrual irregularities. Simply reassuring the client is not as helpful as conducting further assessment. Chapter 73: Care of Patients with Breast Disorders

1. A client recently had a mammogram. Which statement by the client indicates a need for clarification regarding the importance or purpose of this procedure? a. “Now that I have had a mammogram, my risk for getting breast cancer is reduced.” b. “I will still do a breast self-examination monthly even after the mammogram.” c. “Yearly mammograms can reduce my risk of dying from breast cancer.” d. “The amount of radiation exposure from a mammogram is very low.” ANS: A Regular or yearly mammography does not decrease the incidence of breast cancer. It only assists in early detection and diagnosis and decreases the mortality rate from breast cancer. The client should be instructed that the mammogram uses a very small amount of radiation in the test, and that consistent scheduling of a mammogram, along with a breast self- examination performed at least monthly, can reduce the client’s risk of dying from breast cancer.
2. When performing a clinical breast examination on a client, the nurse palpates a thickened area where the skin folds under the breast. Which is the nurse’s best action? a. Proceed with the examination. b. Determine whether the thickness is bilateral. c. Ask how long the thickness has been present.

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d. Change the client’s position and re-assess. ANS: A A thickened area where the skin folds under the breast is the inframammary ridge, a normal anatomic finding. Clients should be taught to identify this ridge and not confuse it with the presence of a lump or abnormal tissue thickening. Because this is a normal finding, no concern is necessary about whether it is present bilaterally or occurs in a different position, or how long the finding has been notable.

3. A client who has discovered a lump in her breast becomes tearful when scheduling a mammogram. Which is the nurse’s best response? a. “All lumps are considered cancerous until proven otherwise.” b. “Unless you have a relative with breast cancer, this lump is probably benign.” c. “Diagnosing cancer at this early stage is most likely to result in a cure.” d. “Many women have breast lumps, and most of the lumps are benign.” ANS: D The finding of a breast lump or mass is a frightening experience. Clients should be reassured, until they can be seen or testing is done, that 90% of all breast lumps or masses are benign. It is inaccurate for the nurse to state that all lumps are considered cancerous until proven benign, or that the lump is probably benign unless the client has a relative with breast cancer. Diagnosing cancer at an early stage results in cure more often than when the cancer is in later stages, but such a comment before diagnosis will only scare the client more.
4. A client has just been diagnosed with fibrocystic breast disease. She asks what this means in terms of her health. Which is the nurse’s best response? a. “This increases your risk for breast cancer, so schedule yearly mammograms.”

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b. “This will increase as you age, especially if you have never been pregnant.” c. “This will diminish with menopause if you don’t take replacement hormones.” d. “This is genetic and you should teach your daughters about it.” ANS: C Although the cause of fibrocystic breast changes is unknown, the condition seems to be related to normal fluctuations in estrogen levels during the menstrual cycle. Symptoms usually resolve after menopause in the absence of estrogen supplementation. The presence of fibrocystic breast changes does not necessarily increase the client’s risk for breast cancer, will not necessarily increase with age, and does not routinely have a genetic component.

5. Which client does the nurse encourage to seek genetic counseling regarding her risk for BRCA1 or BCRA2 gene mutation–related breast cancer? a. Woman whose father had lung cancer and mother had leukemia b. Woman whose sister has breast cancer and mother has ovarian cancer c. Woman whose fraternal twin sister has breast cancer d. Older woman who has bilateral benign breast disease ANS: B The best-defined increased genetic risk for breast cancer is related to mutations in the BRCA1 or BRCA2 gene. Families in which either of these genes is mutated have higher rates of breast and ovarian cancer in first-degree relatives. Being older is the primary risk factor for developing breast cancer but is not related to the genetic component; neither is benign breast disease. Lung cancer and leukemia are not genetically related to breast cancer. Having a twin with breast cancer does increase the genetic risk, but not as much as having two first-degree relatives with related cancers.

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6. Which statement made by a client about breast cancer indicates correct understanding of the disease? a. “Breast cancer is the leading cause of cancer deaths among women in the United States.” b. “Breast cancer is the leading type of cancer among women in North America.” c. “Late onset of menses and early menopause increase the risk for breast cancer.” d. “Breast cancer decreases with age, and very old women have virtually no risk.” ANS: B Breast cancer is the second most common form of cancer diagnosed in women (after skin cancer) and is the second leading cause of cancer deaths in women in the United States (after lung cancer). The incidence of breast cancer increases with age. Early onset of menses and late menopause increase the risk for breast cancer.
7. Which comment made by a client with breast cancer indicates correct understanding regarding cancer causes and prevention? a. “I will prevent recurrence of my cancer by eating a low-fat diet from now on.” b. “If I had breast-fed my children, this would not have happened to me.” c. “I hope this doesn’t increase my risk for bone cancer or lung cancer.” d. “I will have regular mammograms on my other breast to detect cancer early.” ANS: D Regular mammography can help detect breast cancer at an early stage. Women who have had breast cancer have a greater risk of developing cancer in the other breast. The other statements are inaccurate.
8. A client has advanced breast cancer and bone metastasis. Which problem does the nurse consider the priority?

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a. Pain b. Mobility problems c. Risk for infection d. Malnutrition ANS: A Bone metastasis can cause intense continuous pain that disrupts the client’s activities and sleep and reduces the client’s quality of life. This problem should be managed ahead of all other problems. Although the client may also be experiencing impaired mobility and risks for infection and malnutrition, none of these problems will be as disruptive as acute pain. The pain must become manageable before the other problems can be addressed.

9. A client had a mastectomy nearly a year ago and is distressed over continued tingling and burning in the ipsilateral arm. What orders does the nurse prepare to implement? a. Teach the client about gabapentin (Neurontin). b. Demonstrate the use of heat therapy to the axilla. c. Discuss ways to prevent constipation with pain meds. d. Reassure the client that this will disappear shortly. ANS: A Injury to nerves causes paresthesias such as burning, tingling, “pins and needles,” and numbness after a mastectomy. These sensations are usually gone by the end of a year. Because this client’s symptoms are distressing and have lasted so long, the nurse should anticipate an order for Neurontin. Narcotic pain medications will not be helpful or needed. Heat therapy may or may not be helpful, and reassuring the client at this point will sound unbelievable.

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10. A client had a mastectomy and axillary node dissection. The nurse empties sanguineous drainage from the client’s incisional Jackson-Pratt drain on the first postoperative day. Which other action regarding the drain is of high priority for the nurse? a. Flushing the tubing with urokinase to ensure patency b. Compressing and closing the drain to ensure suction Advancing the tubing inch from the insertion site c. d. Clamping the drain for 2 hours and releasing it for 2 hours ANS: B The Jackson-Pratt drain removes fluid from the wound through closed suction. The drain must be compressed and closed to create suction as it slowly re-expands. The drain should never be flushed with urokinase, tubing should not be advanced, and the drain should not be clamped and released for 2 hours.
11. A client is postoperative from a left-sided mastectomy. She says that the incision and the inner side of her arm from the armpit to the elbow are numb. Which is the nurse’s best action? a. Teach the client to avoid lifting heavy objects. b. Measure the circumference of the client’s left arm. c. Reassure the client that this is an expected finding. d. Notify the surgeon as soon as possible. ANS: C

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The nerves supplying the skin in the area were injured during surgery, decreasing sensation to the area. These problems frequently resolve over time. Teaching the client to avoid lifting heavy objects or measuring the circumference of the arm will not improve sensation to the client’s arm. The surgeon does not need to be notified about normal findings.

12. A client receiving tamoxifen (Tamofen) asks how this therapy helps fight breast cancer. Which is the nurse’s best response? a. “This agent decreases estrogen levels. so the cancer stops growing.” b. “The drug causes you to secrete testosterone, which limits cancer growth.” c. “Tamoxifen kills estrogen-secreting cells and growth of blood vessels to cancer cells.” d. “It blocks estrogen receptors, and this limits cancer cell growth.” ANS: D Tamoxifen is an estrogen antagonist-agonist. Its use in breast cancer is limited to cancers that express the estrogen receptor. Tamoxifen binds to estrogen receptors, inhibiting the binding of estrogen to receptors, thereby “starving” the cancer cells of an essential growth factor. The drug does not decrease circulating levels of estrogen, does not cause testosterone to be secreted instead of estrogen, and does not kill off estrogen-secreting cells.
13. A client asks how soon after a mastectomy she can engage in sexual activity. Which is the nurse’s best response? a. “When do you want to resume sexual activity?” b. “Most surgeons say to wait several weeks after the operation.” c. “As soon as the incision has healed completely.” d. “You shouldn’t worry about sexuality right now.” ANS: B

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Most surgeons prefer that the client wait 4 to 6 weeks postoperatively before resuming sexual activity, although this very personal advice should be individualized. Asking the client when she wants to resume sexual activity places the burden on her to make a tentative decision. Until the incision is healed, clients should be taught how to protect the incision and avoid contact with the surgical site during intercourse. Telling the client not to worry about sexuality is dismissing and disrespectful.

14. Which exercise plan or activity does the nurse teach the client for the first postoperative day after a modified radical mastectomy? “Perform no movement or exercise today. Keep the arm supported and the elbow flexed, and as close to your a. body as possible.” “Without moving your shoulder, straighten your elbow three times hourly and squeeze a rubber ball with your b. fingers.” “Face the wall and extend your arm straight out to the wall. Walk your fingers as far above your head as your c. arm will reach, and then walk them back down.” “Hold your operative arm straight out from the shoulder to the side. Use your nonoperative arm to pull the d. operative arm completely straight above your head.” ANS: B Mild exercise begins on the first postoperative day. Exercises should not put stress on the incision and do not involve the shoulder at this point. Full extension of the elbow, with support, is important, as is using grip maneuvers for the hand on the affected side. Total immobility is not recommended. The other two exercises can be performed a few days after the operation.
15. A client is experiencing lymphedema in the arm on the operative side after a modified radical mastectomy. Which statement indicates correct understanding of managing this problem? a. “I will reduce my intake of salt and water.” b. “I will elevate my arm on a pillow at night.” c. “I will try to drink at least 3 liters of water each day.”

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d. “I will wear long sleeves to prevent sun exposure.” ANS: B The formation of edema is aggravated by having the arm in a position dependent to the heart. Elevating the arm as much as possible assists gravity to promote better venous and lymph return. This will be a more effective intervention than salt reduction or drinking large amounts of water. Preventing sun exposure will have no effect on the lymphedema.

16. A woman is asking about monthly breast self-examination (BSE). What information does the nurse provide to the client? a. “It is a valuable tool for finding breast lumps early.” b. “After menopause, it is no longer useful.” c. “BSE should be combined with other assessments.” d. “Women in their 30s should begin monthly BSE.” ANS: C BSE can be presented as an option for breast self-awareness. However, BSE is no better than awareness of normal breast findings. It is best when combined with clinical breast examinations and mammography. Women of all ages can practice BSE.
17. A client with a family history of breast cancer tells the nurse that she has made several recent lifestyle changes. Which question by the nurse about these practices is most important? a. “Are you a vegetarian?” b. “Do you drink green tea?” c. “What supplements do you use?”

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d. “Do you smoke cigarettes?” ANS: C Soy supplements in high amounts should be avoided by women who have breast cancer or who are at high risk for breast cancer. Dietary soy, eaten in normal amounts, does not appear to present the same risk. The other activities do not have the same risk as taking large quantities of soy supplements.

18. A client has large breasts. Which health problem is she most likely to develop? a. Breast tenderness b. Breast cancer c. Chest pain d. Back pain ANS: D The added weight of large breasts and the altered center of gravity increase spinal pull and contribute to back pain. She is not at risk for developing increased breast tenderness, cancer, or chest pain.
19. A client is undergoing treatment for breast cancer and asks the nurse about “natural” treatments for her chemotherapy-induced nausea. Which is the most appropriate response by the nurse? a. “Anything you can take will interfere with your chemotherapy.” b. “I don’t know of any recommended complementary treatments for nausea.” c. “Black cohosh and flaxseed are good for combating nausea.”

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d. “Ginger has been used for nausea; would you consider taking it?” ANS: D Up to 80% of women with breast cancer have used complementary therapies. Ginger, along with acupuncture, aromatherapy, hypnosis, progressive muscle relaxation, and shiatsu, has been used for nausea. Black cohosh and flaxseed are used for hot flashes. The client should check with her provider and other credible sources regarding any desired therapies to ensure that they won’t interfere with the chemotherapy. Even if the nurse doesn’t know of specific therapies, it is never appropriate to just say, “I don’t know.” The nurse should investigate for the client.

20. A client had a mastectomy with reconstruction, and several axillary nodes were dissected. Which statement by the client indicates good understanding of discharge instructions? a. “I must be careful not to injure the arm or hand on the side of my surgery.” b. “I’m glad that lymphedema is no longer a problem, as it was in my mother’s day.” c. “I will have a hard time waiting for a whole year to see how my breast will look.” “I need to pull my drains out by inch each day until they are totally out.” d. ANS: A Lymphedema is a complication following mastectomy, especially if lymph nodes have been removed. The client must use measures to prevent this from occurring for the rest of her life. Preventing injury is one way of preventing lymphedema. Breast reconstruction should look optimal in 3 to 6 months. The health care provider will remove drains at a postoperative appointment.
21. A client is being treated with anastrozole (Arimidex) for breast cancer. The nurse is developing a plan of care for the client. Which intervention is the highest priority? a. Teach the client to weigh herself each day at the same time. b. Instruct the client to keep a symptom journal for menopausal symptoms.

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c. Monitor the client closely for evidence of osteoporosis. d. Review the client’s dietary habits to prevent weight gain. ANS: C Arimidex is an aromatase inhibitor. A major side effect of the aromatase inhibitors is loss of bone density. Fluid retention, menopausal symptoms, and weight gain are not primary side effects of Arimidex or other aromatase inhibitors.

22. A client with a history of breast cancer is admitted through the emergency department with shortness of breath, weakness, fatigue, and new lower extremity edema. The client’s oxygen saturation is 88%. After stabilizing the client, which action by the nurse is most important? a. Obtain a list of the client’s medications. b. Orient her to her room and surroundings. c. Place the client on intake and output. d. Assess the client’s family cardiac history. ANS: A Some chemotherapeutic drugs, such as doxorubicin (Adriamycin) and trastuzumab (Herceptin), are known to be cardiotoxic. Although all other actions are appropriate, the nurse (and the provider) must know the medications the client is on, with specific emphasis on assessing for causative agents.
23. The clinic nurse is preparing a client for a physical and breast examination. The nurse notes the client’s breast appears as shown in the photograph below. Which action by the nurse takes priority?

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a. Continue preparations and note the finding in the client’s chart. b. Ask the client how long this problem has been present. c. Alert the health care provider and prepare to order a mammogram. d. Question the client about routine drug and alcohol intake. ANS: C This finding (dimpling of the skin) is suspicious for infiltrating ductal carcinoma. The nurse should alert the provider and prepare to order a mammogram for the client. In addition, the nurse should be prepared to refer the client to a breast specialist. The nurse does need to continue preparing the client and document the finding, but this is not as important as the mammogram and referral. Assessment can continue before, during, or after the examination, but is also not as vital as facilitating further diagnostic testing. MULTIPLE RESPONSE

1. The nurse is assessing a client with a history of ductal ectasia. Which signs and symptoms supporting this diagnosis does the nurse correlate with this condition? (Select all that apply.) a. A soft mass on palpation

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b. Greenish-brown nipple discharge c. Enlarged axillary nodes d. A mass with regular borders e. Redness and edema over the site of the mass f. Mass tenderness on palpation ANS: B, C, E, F The benign condition, ductal ectasia, is caused by dilation and thickening of collecting ducts in the subareolar area. It results in activation of the inflammatory response when the ducts fill with cellular debris. Clinical manifestations of this condition include development of a hard mass with irregular borders that is tender on palpation. A greenish-brown nipple discharge, enlarged axillary nodes, and redness and edema over the site of the mass are also noted. Palpation of a soft mass or a mass with regular borders is not applicable to ductal ectasia.

2. Which factors are considered to be indicative of a moderately increased risk of a client’s developing breast cancer? (Select all that apply.) a. High postmenopausal bone density b. Ionizing radiation c. Family history of one first-degree relative d. Genetic factors e. First child born after age 30