The Client with Reproductive Health Problems 535
123. A nurse is reviewing the physician’s admitting discharge with a fishy odor is evidence for bacterial
orders on a 52-year-old client scheduled for a dilata-
tion and curettage. The nurse is unable to decipher
the handwriting and determines the medication
order reads either metoprolol succinate (Toprol) or
topiramate (Topamax). What should the nurse do
next?
■ 1. Ask the client if she has hypertension.
■ 2. Ask the client if she has migraines.
■ 3. Call the physician to clarify the order.
■ 4. Ask the pharmacist to interpret the order.
124. The unlicensed assistive personnel (UAP)
reports to the nurse that the client with an abdomi-
nal hysterectomy who returned from the recovery
room 1 hour earlier has saturated the blue pad with
bright red blood. The nurse should:
■ 1. Call the surgeon to report the bleeding.
■ 2. Ask the UAP to obtain vital signs while the
nurse calls the surgeon.
■ 3. Ask the UAP to increase the flow of I.V. fluids
to prevent shock.
■ 4. Assess the client again in 15 minutes before
the nurse takes any further action.
125. A nurse on the gynecologic surgery unit
observes a respiratory therapist (RT) take a medica-
tion cup with pills that was sitting in the medication
room. What course of action should the nurse take?
■ 1. Report the situation to the supervisor of respi-
ratory therapy.
■ 2. Tell the RT that you saw her take the pills
from the medication room.
■ 3. Report the situation to the nursing supervisor.
■ 4. Tell the nurse who was administering medi-
cations not to leave pills out.
Answers, Rationales, and Test
Taking Strategies
The answers and rationales for each question follow
below, along with keys ( ) to the client need
(CN) and cognitive level (CL) for each question. Use
these keys to further develop your test-taking skills.
For additional information about test-taking skills
and strategies for answering questions, refer to pages
10–21, and pages 25–26 in Part 1 of this book.
The Client with a Vaginal Infection
1. 1, 2, 4. Bacterial vaginosis is a clinical syn-
drome resulting from the replacement of the normal
vaginal Lactobacillus species with overgrowth of
anaerobic bacteria that cause a cluster of symp-
toms. Presence of a thick, white, adherent vaginal
Billings_Part 2_Chap 3_Test 10.indd 535
vaginosis, and the client should seek treatment.
The client should not douche unless under medi-
cal orders because douching can cause bacteria to
ascend into the uterus. Bacterial vaginosis is not
sexually transmitted, and it does not require treat-
ment of the partner. Vaginal infections commonly
require an examination and diagnostic assessment.
CN: Reduction of risk potential;
CL: Synthesize
2. 3. Douching may disrupt the normal flora of
the vaginal lactobacilli and change the pH, which
could result in overgrowth of other bacteria. Coffee,
intercourse during menses, and tampons are not
related to changes in vaginal pH or the incidence of
bacterial vaginosis.
CN: Health promotion and maintenance;
CL: Apply
3. 4. Metronidazole (Flagyl) interacts with alco-
hol and can cause a serious disulfiram (Antabuse)-
type reaction, with severe, prolonged vomiting. The
client should not douche unless following a medical
order, but douching does not interact with Flagyl.
Sexual intercourse and hot tub baths are not known
to affect the incidence or treatment of bacterial vagi-
nosis.
CN: Pharmacological and parenteral
therapies; CL: Synthesize
4. 3. Bacterial vaginosis is the most common
vaginal infection in reproductive-age women, and
up to 50% of women may be asymptomatic. Bac-
terial vaginosis is not associated with menarche,
menopause, or aging. Bacterial vaginosis is not usu-
ally transmitted sexually, and treatment of the male
sex partner has not been beneficial in preventing
recurrence of bacterial vaginosis.
CN: Health promotion and maintenance;
CL: Analyze
5. 1, 2, 4. According to the Centers for Disease
Control and Prevention, the three most common
diseases associated with vaginal discharge are
candidiasis, bacterial vaginosis, and trichomoniasis.
Candidiasis causes a white discharge that results
in redness and itching. Bacterial vaginosis causes
a thick, white, adherent discharge. Trichomonia-
sis causes a diffuse, yellow-green discharge and is
a sexually transmitted infection. Gonorrhea and
syphilis usually do not change vaginal discharge.
CN: Reduction of risk potential;
CL: Apply
6. 1, 2, 3. Candidiasis is classified by the Cen-
ters for Disease Control and Prevention as compli-
cated or uncomplicated. Women with underlying
medical conditions, such as uncontrolled diabetes
8/7/2010 10:18:33 AM
 536 The Nursing Care of Adults with Medical and Surgical Health Problems
and HIV infection or cancer-causing immunosup-
pression, correlate with an increasing severity
of candidiasis. Hypertension and asthma are not
related to immunosuppression or complicated can-
didiasis.
CN: Health promotion and maintenance;
CL: Analyze
7. 1. Antibiotics may decrease the effective-
ness of oral contraceptives. The client should be
instructed to continue the contraceptives and use a
barrier method as a back-up method of birth control
until the next menstrual cycle. The client should
not stop taking her oral contraceptives and there is
no indication for or benefit to taking the antibiotic 2
hours after the contraceptive. There is no incidence
of the adverse effects of increased hunger and fluid
retention with the interaction of antibiotic therapy
and oral contraceptives.
CN: Pharmacological and parenteral
therapies; CL: Create
8. 4. Due to the increased risk of pelvic inflam-
matory disease, candidates for the IUD should be in
a monogamous relationship. Smoking and hyper-
tension are not contraindications for an IUD. The
frequency of sexual relations will not affect IUD use.
CN: Pharmacological and parenteral
therapies; CL: Analyze
9. 1. Fluid losses can occur from vomiting, diar-
rhea, and fever and can lead to hypovolemic shock.
The first nursing action is to treat the hypovolemic
shock that accompanies toxic shock, so the I.V.
fluids must be administered immediately. The fluid
replacement is critical to avoid circulatory collapse.
Pain medication and teaching can be implemented
later. Antibiotics will be given because TSS is
caused by a staphylococcal infection; however, fluid
replacement is initiated first to treat life-threatening
hypovolemic shock.
CN: Reduction of risk potential;
CL: Synthesize
The Client with Uterine Fibroids
10. 2. The best approach for a client who is fear-
ful about having surgery is to allow the client oppor-
tunities to express her fears. Open-ended questions
should elicit the client’s individual and specific
fears. This then gives the nurse the opportunity to
provide clarification, information, and support and
possibly to offer other resources. The other actions
are not supportive and deny the client the opportu-
nity to express her feelings.
CN: Psychosocial adaptation;
CL: Synthesize
Billings_Part 2_Chap 3_Test 10.indd 536
11. 1, 2. A woman with uterine fibroids and
dysmenorrhea is at risk for iron deficiency anemia.
The hemoglobin and hematocrit indicate the likeli-
hood that the fibroids causing heavy menstrual blood
loss have resulted in anemia. A hemoglobin of less than
12 g/dL in women is considered low. The white blood
cell count and potassium levels are within normal
parameters, and normocytic red blood cells are normal.
CN: Management of care; CL: Synthesize
12. 2. It is a priority that the client knows she will
not be able to eat or drink for 8 hours before admis-
sion. A client who consumes food and fluid before
receiving a general anesthetic is at risk for aspiration,
which can lead to aspiration pneumonia, respiratory
arrest, and even death. The clothing she should wear
to the hospital and the type of medication she will
receive are important, but not the priority. Informa-
tion on exercise and resumption of normal activities
can be included in the discharge teaching.
CN: Basic care and comfort;
CL: Synthesize
13. 2. The client needs to understand that with
removal of the uterus she will no longer be able to
bear children or have menstrual periods. The surgi-
cal procedure should not change her libido or sexual
functioning. Research does not support the idea that
hysterectomy contributes to depression or weight
gain. Research demonstrates that women who have
managed health problems for some time before the
hysterectomy may actually have a more positive
effect, with less worry about their health condition,
contraception, or pregnancy.
CN: Management of care; CL: Apply
14.
4. Prepare a sterile field.
1. Lubricate the catheter adequately with a water-
soluble lubricant.
3. Insert the catheter far enough into the bladder
to prevent trauma to the urethral tissue.
2. Ensure free flow of urine.
After gathering appropriate supplies, the nurse
should prepare a sterile field. After lubricating the
catheter adequately with a water-soluble lubricant
to minimize trauma to the urethra, the nurse should
insert the catheter far enough into the bladder so
the retention balloon does not traumatize urethral
tissues. Ensuring a free flow of urine prevents
infection; improper drainage occurs when tubing is
kinked or twisted.
CN: Safety and infection control; CL: Apply
8/7/2010 10:18:33 AM

15. 2. Hyperventilation occurs when the client
breathes so rapidly and deeply that she exhales
excessive amounts of carbon dioxide. A character-
istic symptom of hyperventilation is dizziness. To
avoid hyperventilation, the nurse should assist the
client in the practice of slow, deep breathing in a
regular breathing pattern. Dyspnea, blurred vision,
and mental confusion are not associated with hyper-
ventilation.
CN: Physiological adaptation; CL: Apply
16. 4. The discomfort associated with gas pains
is likely to be relieved when the client ambulates.
The gas will be more easily expelled with exercise.
The anesthesia, analgesics, and immobility have
altered normal peristalsis. Peristalsis will be stimu-
lated by exercise. Offering a hot beverage, providing
extra warmth, and applying an abdominal binder are
not recommended and could aggravate the discom-
fort of postoperative gas pains.
CN: Physiological adaptation;
CL: Synthesize
17. 3. Elevated temperature on the second
postoperative day is suggestive of a respiratory tract
infection. Respiratory infections most often occur
during the first 48 hours after surgery. The client’s
vital signs should be monitored closely, and abnor-
malities should be reported to the surgeon. Signs of
infection, if present in the wound or urinary tract,
are likely to occur later in the postoperative period.
There is no indication that the I.V. catheter is the
source of infection.
CN: Physiological adaptation;
CL: Synthesize
18. 1. The client with a possible transient isch-
emic attack is the only client who has not had
surgery and is not immunocompromised. The cli-
ent with a recent surgery and incision should not
be exposed to a client with infection. Clients with
cancer or alcoholic cirrhosis are very susceptible to
infection, and it would not be safe to expose them to
a client with a respiratory infection.
CN: Management of care; CL: Synthesize
19. 3. When a dressing sticks to a wound, it is
best to moisten the dressing with sterile normal
saline solution and then remove it carefully. Trying
to remove a dry dressing is likely to irritate the skin
and wound. This may contribute to tension or tear-
ing along the suture line.
CN: Management of care; CL: Apply
20. 2. The social worker will be able to coordi-
nate respite care for the son and other community
resources for this family. Home health care would
provide care for the client herself, but respite care
for the son is the priority need for this family.
Billings_Part 2_Chap 3_Test 10.indd 537
The Client with Reproductive Health Problems 537
Pastoral care provides spiritual care. The volunteer
department would not be responsible for coordina-
tion of care at the client’s home.
CN: Management of care; CL: Apply
21. 2. Assessment is the first step in planning cli-
ent education. Assessing social support resources is
a key aspect of discharge planning that begins when
the client is admitted to the hospital. It is impera-
tive to know what assistance and support the client
has at home. Assessment includes obtaining data
about any family or home responsibilities the client
is concerned with during the recovery period. It is
within the scope of nursing practice to provide dis-
charge instructions. A social worker is not needed at
this time. The nurse should assess the client’s needs
before determining whether using a video or reading
instructions to the client is appropriate.
CN: Health promotion and maintenance;
CL: Create
22. 1, 2, 4. The average age of menopause is 50
to 52 years, although some variation exists. With
menopause, FSH and LH levels increase dramati-
cally. Hot flashes occur in about 80% of women;
they can range from mild to very debilitating with
disruption of sleep patterns. Depression is not usual
during menopause; if symptoms of depression do
occur, the nurse should refer the woman to her
health care provider. Contraception should be used
until menses has ceased for a full year.
CN: Physiological adaptation; CL: Create
The Client with Breast Disease
23. 1. This complaint warrants the nurse’s per-
forming an examination and reporting the results to
the physician. Hormone fluctuations 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 first 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 examina-
tion 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
8/7/2010 10:18:34 AM
 538 The Nursing Care of Adults with Medical and Surgical Health Problems
25. 2. The client needs to become more confident
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 clini-
cal 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 men-
struation because of breast engorgement caused by
hormonal changes. A woman may then note that
her bra fits 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 identified as a risk factor for breast cancer.
A 76-year-old client needs monthly breast self-
examination and a yearly clinical breast examina-
tion 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 clarified for the client. The
surgeon should be notified, 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 first
ignores the client’s questions and concerns. Fre-
quently the plastic surgeon needs to be consulted at
the beginning of the treatment because various sur-
gical 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 under-
stand. Delaying discussion of issues about which
Billings_Part 2_Chap 3_Test 10.indd 538
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 open-
ended 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 influence a client’s adjust-
ment to a diagnosis of cancer. The nurse should
not contradict the client’s feelings of punishment
or offer advice such as confiding in the husband.
A social worker referral may be beneficial in the
future, but is not the first 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 modified radical mastectomy to help remove
accumulated blood and fluid in the area. Removal
of the drainage fluids 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 flow, or pre-
vent adhesion formation.
CN: Reduction of risk potential;
CL: Evaluate
8/7/2010 10:18:35 AM

34. 4. Lymph nodes can be removed from the
axillary area when a modified radical mastectomy is
done, and each of the nodes is biopsied. To facili-
tate 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 flashes 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 specific 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 sun-
light, 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 slough-
ing 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 benefit from this peer information and
support.
CN: Psychosocial adaptation; CL: Apply
Billings_Part 2_Chap 3_Test 10.indd 539
The Client with Reproductive Health Problems 539
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 swell-
ing 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 symph-
ysis. No urine discharge is expected; the urine flow
is blocked by the enlarged prostate.
CN: Reduction of risk potential;
CL: Analyze
41. 3. Rapid emptying of an overdistended blad-
der 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 tis-
sues. 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. Irrigat-
ing 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 indwell-
ing 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 penos-
crotal angle can cause a ureterocutaneous fistula.
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 prob-
lems. As a result, these men often overlook symp-
toms and simply attribute them to aging. As part
of preventive care for men older than age 40, the
yearly physical examination should include palpa-
tion of the prostate via rectal examination. Prostate-
specific antigen screening also is done annually
to determine elevations or increasing trends in
8/7/2010 10:18:36 AM
 540 The Nursing Care of Adults with Medical and Surgical Health Problems
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 hypertro-
phy include difficulty starting the flow of urine, uri-
nary 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 empty-
ing 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. Artificial 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 tera-
zosin.
CN: Pharmacological and parenteral
therapies; CL: Analyze
Billings_Part 2_Chap 3_Test 10.indd 540
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 flow
of irrigating solution helps flush the catheter well so
that clots do not plug it. There would be no reason
to increase the flow rate when the return is continu-
ous or when the return appears cloudy and dark
yellow. Increasing the flow would be contraindi-
cated 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. Anti-
spasmodics 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 cli-
ent to obtain an adequate fluid intake (2,500 mL)
to promote urinary output and to flush out bacte-
ria 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
8/7/2010 10:18:37 AM

should be reassured that continence will return in a
few months and will not be a chronic problem. Drib-
bling is not a sign of healing, but is related to the
trauma of surgery.
CN: Basic care and comfort;
CL: Synthesize
55. 1. Deficient fluid volume is a priority diagno-
sis because the client needs to drink a large amount
of fluids to keep the urine clear. The urine should
be almost without color. About 2 weeks after TURP,
when desiccated tissue is sloughed out, a second-
ary 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 specifically at risk for nutritional
problems after TURP. The client is not specifically at
risk for impaired tissue integrity because there is no
external incision, and the client is not specifically
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 usu-
ally 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
findings 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 a Sexually
Transmitted Disease
57. 1. The client should be taught to abstain from
sexual intercourse while lesions are present. Con-
doms should be used at all times as the virus can
be shed without lesions present. Multiple partners
would promote the spread of genital herpes. There
is not a vaccine available to prevent genital herpes.
Although periodic examinations should be advised,
a urologist does not necessarily need to be seen
when lesions occur.
CN: Physiological adaptation;
CL: Synthesize
58. 4. HIV infection is transmitted through blood
and body fluids, particularly vaginal and seminal
fluids. A blood transfusion is one way the disease
can be contracted. Other modes of transmission
are sexual intercourse with an infected partner and
sharing I.V. needles with an infected person. Women
Billings_Part 2_Chap 3_Test 10.indd 541
The Client with Reproductive Health Problems 541
now have the highest rate of newly diagnosed HIV
infection. Many of these women have contracted
HIV from unprotected sex with male partners. HIV
cannot be transmitted by hugging, inhaling cocaine,
or sharing utensils.
CN: Safety and infection control;
CL: Apply
59. 3. Zidovudine (AZT) interferes with replica-
tion of HIV and thereby slows progression of HIV
infection to acquired immunodeficiency syndrome
(AIDS). There is no known cure for HIV infection.
Today, clients are not treated with monotherapy
but are usually on triple therapy due to a much-
improved clinical response. Decreased viral loads
with the drug combinations have improved the lon-
gevity and quality of life in clients with HIV/AIDS.
AZT does not destroy the virus, enhance the body’s
antibody production, or neutralize toxins produced
by the virus.
CN: Pharmacological and parenteral
therapies; CL: Evaluate
60. 2. Women who have HPV are much more
likely to develop cervical cancer than women who
have never had the disease. Cervical cancer is now
considered a sexually transmitted disease. Regular
examinations, including Papanicolaou tests, are
recommended to detect and treat cervical cancer at
an early stage. HPV does not cause sterility, uterine
fibroid tumors, or irregular menses.
CN: Health promotion and maintenance;
CL: Analyze
61. 1. HSV infection is one of a group of disor-
ders that, when diagnosed in the presence of HIV
infection, are considered to be diagnostic for AIDS.
Other AIDS-defining illnesses include Kaposi’s sar-
coma; cytomegalovirus of the liver, spleen, or lymph
nodes; and Pneumocystis carinii pneumonia. HSV
infection is not curable and does not cause severe
electrolyte imbalances. Human papillomavirus can
lead to cervical cancer.
CN: Physiological adaptation; CL: Apply
62. 4. Education to prevent behaviors that cause
HIV transmission is the primary method of control-
ling HIV infection. Behaviors that place people at
risk for HIV infection include unprotected sexual
intercourse and sharing of needles for I.V. drug
injection. Educating clients about using condoms
during sexual relations is a priority in controlling
HIV transmission.
CN: Safety and infection control;
CL: Apply
63. 4. The nurse should respond with a state-
ment that allows the client to express his thoughts
and feelings. After sharing feelings about their
8/7/2010 10:18:37 AM
 542 The Nursing Care of Adults with Medical and Surgical Health Problems
diagnosis, clients will need information, support,
and community resources. Statements of encourage-
ment or agreement do not provide an opportunity
for the client to express himself.
CN: Psychosocial adaptation;
CL: Synthesize
64. 3. The chancre of syphilis is characteristi-
cally a painless, moist ulcer. The serous discharge is
very infectious. Because the chancre is usually pain-
less and disappears, the client may not be aware of
it or may not seek care. The chancre does not appear
as pimples or warts, and does not itch, thus making
diagnosis difficult.
CN: Physiological adaptation;
CL: Analyze
65. 2. An important aspect of controlling the
spread of sexually transmitted diseases (STDs) is
obtaining a list of the sexual contacts of an infected
client. These contacts, in turn, should be encour-
aged to obtain immediate care. Many people with
STDs are reluctant to reveal their sexual contacts,
which makes controlling STDs difficult. Increasing
clients’ knowledge of the disease and reassuring cli-
ents that their records are confidential can motivate
them to seek treatment, which does help to control
the spread of the disease, but it is not as critical as
information about the client’s sexual contacts.
CN: Physiological adaptation;
CL: Synthesize
66. 2. Because of the large dose, the upper outer
quadrant of the buttocks is the recommended site.
The Centers for Disease Control and Prevention
recommends benzathine penicillin G 2.4 million
units I.M. in a single dose for adults with primary or
secondary syphilis who are not allergic to penicillin.
The deltoid and the quadriceps lateralis of the thigh
are not large enough for the recommended dose. In
infants and small children, the midlateral aspect of
the thigh may be preferred.
CN: Pharmacological and parenteral
therapies; CL: Apply
67. 1. A client with primary syphilis is at risk
for transmitting the disease to sexual partners if he
or she is not knowledgeable about how the disease
is spread. Cutaneous lesions on the palms and soles
and alopecia are signs of secondary syphilis. Chan-
cres do not bleed sufficiently to alter tissue perfu-
sion. Chancres often disappear even without treat-
ment.
CN: Physiological adaptation;
CL: Analyze
68. 1. Asking the client to describe her nervous-
ness gives her the opportunity to express her con-
cerns. It also allows the nurse to understand her
Billings_Part 2_Chap 3_Test 10.indd 542
better and gives the nurse a base to respond to the
client’s stated fears, questions, or need for further
information. Responses that make assumptions
about the source of the concern or offer reinforce-
ment are not supportive and block successful com-
munication.
CN: Psychosocial adaptation;
CL: Synthesize
69. 4. Many women do not seek treatment
because they are unaware that they have gonorrhea.
They may be symptom-free or have only very mild
symptoms until the disease progresses to pelvic
inflammatory disease. Dysuria and vaginal bleeding
are not present in gonorrhea. Gonorrhea can lead to
very serious complications. It can be cured with the
proper treatment.
CN: Physiological adaptation;
CL: Synthesize
70. 1. Statistics reveal that the incidence of STDs
is rising more rapidly among teenagers than among
any other age-group. Many reasons have been given
for this trend, including a change in societal mores
and increasing sexual activity among teenagers. Dur-
ing this developmental stage, teenagers may engage
in high-risk sexual behaviors because they often are
living in the present and feel that it won’t happen to
them.
CN: Health promotion and maintenance;
CL: Apply
71. 1, 2, 3, 4, 6. The client is suspected of hav-
ing a sexually transmitted infection. Therefore, the
client’s sexual history, assessment, and examination
must be documented, including symptoms (such as
fever, chills, and enlarged glands) and their onset
and duration. Allergies are critical to document
for every client, but are especially noteworthy in
this case because antibiotics will be ordered. If a
sexually transmitted infection is confirmed, sexual
contacts need to be treated. To protect privacy, the
names and phone numbers should never be placed
in the chart. The public health department will also
assist in obtaining information and treating known
sexual contacts.
CN: Safety and infection control;
CL: Analyze
72. 4 tablets
First, convert 1 g to milligrams:
1 g = 1,000 mg.
Next, divide the desired dose by the dose on hand:
1,000 mg/250 mg = 4 tablets.
CN: Pharmacological and parenteral
therapies; CL: Apply
8/7/2010 10:18:38 AM

73. 4. Dysuria and a mucopurulent urethral dis-
charge characterize gonorrhea in men. Gonococcal
symptoms are so painful and bothersome for men
that they usually seek treatment with the onset of
symptoms. Impotence, scrotal swelling, and urine
retention are not associated with gonorrhea.
CN: Physiological adaptation;
CL: Apply
74. 2. The most common opportunistic infection
in HIV infection initially presents as oral candidi-
asis, or thrush. The client with HIV should always
have an oral assessment. HSV and CMV are oppor-
tunistic infections that present later in acquired
immunodeficiency syndrome. Aphthous stomatitis,
or recurrent canker sores, is not an opportunistic
infection, although the sores are thought to occur
more often when the client is under stress.
CN: Health promotion and maintenance;
CL: Apply
75. 3, 4, 5. The nurse should withhold the
medication and notify the physician immediately
if the client develops manifestations of pancreati-
tis or hepatic failure including nausea and vomit-
ing, severe abdominal pain, elevated bilirubin, or
elevated serum enzymes (e.g., amylase, AST, ALT).
If both BUN and creatinine are elevated, the client
may have kidney disease.
CN: Pharmacological and parenteral
therapies; CL: Synthesize
76. 3. Interpreters are essential in enabling the
nurses’ communications to be understood accu-
rately. The chaplain may not know the client’s lan-
guage. The Joint United Nations Programme on HIV/
AIDS has the number of reported cases of AIDS. It
is not necessary for the family member to obtain
informed consent.
CN: Psychosocial adaptation;
CL: Synthesize
The Client with Cancer of the Cervix
77. 2. Although other positions may be used,
the preferred position for a vaginal examination is
the lithotomy position. This position offers the best
visualization. If the client is elderly and frail, staff
members may need to support the client’s flexed
legs while the examiner conducts the examination
and obtains the Papanicolaou smear. Positioning the
client in the other positions will make visualization
more difficult and may not be as comfortable for the
client.
CN: Health promotion and maintenance;
CL: Apply
Billings_Part 2_Chap 3_Test 10.indd 543
The Client with Reproductive Health Problems 543
78. 4. The Pap smear identifies atypical cervical
cells that may be present for various reasons. Cancer
is the most common possible cause, but not the only
one. The Pap smear does not show abnormal viral
cells unless specific gene typing is done for human
papillomavirus. An adequate smear provides accu-
rate diagnostic data; the false-positive rate is only
about 5%.
CN: Health promotion and maintenance;
CL: Apply
79. 4. Young age at first pregnancy is a risk fac-
tor for cervical cancer. Other risk factors include
a family history of the disease, sexual experience
with multiple partners, and a history of sexually
transmitted disease (e.g., syphilis, human papil-
lomavirus infection, gonorrhea). Cigarette smoking,
promiscuous male partner, human immunodefi-
ciency virus infection or other immunosuppression,
and low socioeconomic status are other risk factors.
Sexual relations with one partner, sedentary life-
style, and obesity are not risk factors for cervical
cancer.
CN: Health promotion and maintenance;
CL: Apply
80. 4. In its early stages, cancer of the cervix
is usually asymptomatic, which underscores the
importance of regular Pap smears. A light bleeding
or serosanguineous discharge may be apparent as
the first noticeable symptom. Pain, leg edema, uri-
nary and rectal symptoms, and weight loss are late
signs of cervical cancer.
CN: Physiological adaptation;
CL: Apply
81. 4. The vagina naturally cleans itself, and
douching is not recommended unless it is pre-
scribed by a health care provider for a medical
condition. Daily douching could destroy normal
flora. Perfumed douches could trigger allergenic
responses. Douching should be avoided during
menses.
CN: Reduction of risk potential;
CL: Synthesize
82. 1, 2, 3, 4. The social worker is part of the
comprehensive, holistic health care team. Because
the client does not have insurance and is a single
parent, appropriate government and charity pro-
grams and potential resources need to be explained
to the client. The needs of the client and the family
members are included in the treatment plan. The
client will have choices about whether or not she
elects to participate in any of the assistance pro-
grams.
CN: Management of care; CL: Apply
8/7/2010 10:18:39 AM
 544 The Nursing Care of Adults with Medical and Surgical Health Problems
83. 1. When cervical cancer is detected early and
treated aggressively, the cure rate approaches 100%.
The incidence of cervical cancer has increased
among African Americans, Native Americans,
and Latinas, and these women often have a poorer
prognosis because the cancer is not identified early.
Papanicolaou smears and colposcopy have the
potential to decrease mortality from invasive carci-
noma when these screening and treatment programs
are utilized by women.
CN: Physiological adaptation;
CL: Synthesize
84. 2. The client should be informed that her
next two or three periods could be heavy and pro-
longed. The client is instructed to report any exces-
sive bleeding. The nurse should reinforce the neces-
sity for the follow-up check and the review of the
biopsy results with the client. The client’s periods
will not be normal for 2 to 3 months.
CN: Reduction of risk potential;
CL: Synthesize
85. 2. Dislodged radioactive materials should
not be touched with bare or gloved hands. Forceps
are used to place the material in the lead-lined
container, which shields the radiation. Exposure
to radiation can occur only by direct exposure to
the encased radioactive substance; it cannot result
from contact with emesis or urine or from touching
the client. Disposal of eating utensils cannot lead to
radiation exposure. Radioactive dose materials are
kept only in the radiation department.
CN: Safety and infection control;
CL: Apply
86. 3. The three factors related to radiation safety
are time, distance, and shielding. Nurses on radia-
tion oncology units work with radiation frequently
and so must limit their contact. Nurses are physi-
cally closer to clients than are visitors, who are often
asked to sit 6 feet away from the client. Touching
the client does not increase the amount of radiation
exposure. Aseptic technique and isolation pre-
vent the spread of infection. Age is a risk factor for
people in their reproductive years.
CN: Safety and infection control; CL: Apply
87. 2. A client can experience anxiety because
she is immobilized on strict bed rest and cannot
care for herself while the implant is in place. During
an intracavity implant, the woman is kept flat in bed
to prevent dislodgment of the radioactive substance.
The implant may be left in place for 24 to 72 hours.
Usually, the tumor is removed before implant inser-
tion. Ineffective health maintenance and Insomnia
are not priority nursing diagnoses.
CN: Psychosocial adaptation;
CL: Analyze
Billings_Part 2_Chap 3_Test 10.indd 544
88. 2. HPV infection, or genital warts, can lead
to dysplastic changes of the cervix, referred to as
cervical intraepithelial neoplasia. The development
of cervical cancer remains the largest threat of all
condyloma-associated neoplasias. Infertility, pelvic
inflammatory disease, and rectal cancer are not com-
plications of genital warts.
CN: Health promotion and maintenance;
CL: Apply
89. 4. Bowel movements can be difficult with
the radium applicator in place. The purpose of the
low-residue diet is to decrease bowel movements.
The bowel is cleaned before therapy, and the woman
is maintained on a low-residue diet during treat-
ment to prevent bowel distention and defecation.
To prevent dislodgment of the applicator, the client
is maintained on strict bed rest and allowed only to
turn from side to side. Perineal care is omitted dur-
ing radium implant therapy, although any vaginal
discharge should be reported to the physician. It is
rare for the applicator to extrude, so this does not
need to be checked every hour.
CN: Basic care and comfort;
CL: Synthesize
90. 4. Nausea, vomiting, and a foul vaginal dis-
charge are common adverse effects of internal radia-
tion therapy for cervical cancer. A foul-smelling
discharge may develop from the destruction and
sloughing of cells. Vaginal discharge may persist for
some time. General signs and symptoms of radiation
syndrome include nausea, vomiting, anorexia, and
malaise. Vaginal itching, confusion, and high fever
are not typical adverse effects of radiation therapy
for cervical cancer.
CN: Safety and infection control;
CL: Apply
The Client With Cancer
of the Ovaries
91. 2, 4. Client teaching emphasizes the impor-
tance of regular gynecologic examinations. If a
pelvic mass is found, completely explain the
procedures for diagnosis. Explain pre-surgical and
post-surgical instructions, and explain the termi-
nology particular to staging and grading of cancer,
when appropriate. Refer all questions about the
prognosis to the physician. Routine colonoscopies
are typically begun at age 50 unless family history
warrants otherwise. Ovarian tumors are commonly
occult until symptoms of advanced disease are
present.
CN: Health promotion and maintenance;
CL: Create
8/7/2010 10:18:40 AM

92. 2, 4. Ovarian cancer is a malignant tumor of
the ovary. Ovarian cancer is the fourth most com-
mon gynecologic cancer, but the most lethal. It
is usually found in advanced stages because it is
asymptomatic in early stages. Interdisciplinary man-
agement may involve chemotherapy, radiation ther-
apy, surgery and supportive services. Chemotherapy
may be used to achieve remission of the disease; it
is not, however, curative. Surgery is the treatment
of choice, usually involving total hysterectomy with
bilateral salpingo-oophorectomy and removal of the
omentum. Radiation therapy may be performed for
palliative purposes only. The nurse should provide
referral to home health services, financial assistance,
psychological counseling, clergy, and other social
services, as appropriate. Nutrition therapy for par-
enteral lipids is not part of management of ovarian
cancer.
CN: Health promotion and maintenance;
CL: Create
93. 4. A definitive cause of carcinoma of the
ovary is unknown and the disease is multi-factorial.
The risk of developing ovarian cancer is related
to environmental, endocrine, and genetic factors.
The highest incidence is in industrialized Western
countries. Endocrine risk factors for ovarian cancer
include women who are nulliparous. Use of oral
contraceptives does not increase the risk for develop-
ing ovarian cancer, but may actually be protective.
CN: Health promotion and maintenance;
CL: Apply
94. 1. Ovarian cancer is rarely diagnosed early.
Methods for mass screening and early detection
have not been successful. Signs and symptoms are
often vague until late in development. Ovarian
cancer should be considered in any woman older
than 40 years of age who has complaints of vague
abdominal and/or pelvic discomfort or enlargement,
a sense of bloating, or flatulence. Enlargement of
the abdomen due to the accumulation of fluid is the
most common sign.
CN: Health promotion and maintenance;
CL: Synthesize
The Client Having Gynecological
Surgery
95. 3. The client should be prepared for what
to expect after surgery. The client should not drive
until she can use the brake pedal without abdomi-
nal pain. The nurse should teach the client to avoid
activities that may increase pelvic congestion, such
as dancing or brisk walking, for several months,
whereas activities, such as swimming and leisurely
Billings_Part 2_Chap 3_Test 10.indd 545
The Client with Reproductive Health Problems 545
walking, may be both physically and mentally
helpful. Heavy lifting should be avoided for two
months, but the client can lift up to 10 lb as long as
there is not tension on the abdomen or abdominal
pain.
CN: Physiological adaptation;
CL: Synthesize
96. 1. The nurse must first assess the intensity of
the client’s pain before selecting the correct analge-
sia. A high score would necessitate administering
the meperidine (Demerol). If the intensity rating
is low, an oral analgesic would be appropriate. If
acetaminophen (Tylenol #3) is given without assess-
ing the intensity of the client’s pain, the nurse must
then wait 4 hours before administering another
analgesic.
CN: Pharmacological and parenteral
therapies; CL: Synthesize
97. 3. The nurse should withhold administer-
ing docusate sodium (Colace), a stool softener, and
document the rationale on the medical record. The
nurse must assess the need for a medication even
though it is ordered. Documentation of why the
medication was withheld should be written in the
medical record. The nurse is responsible for assess-
ing contraindications and adverse effects of medica-
tions, and administering the medication when the
client already has loose stools is unsafe. The assess-
ment should also include auscultation of bowel
sounds and inquiry about gas pains, but the stool
softener should still be withheld.
CN: Pharmacological and parenteral
therapies; 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 occasion-
ally, but not routinely, associated with urinary tract
infection. Burning and pain on urination and foul-
smelling 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 usu-
ally 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
8/7/2010 10:18:40 AM
 546 The Nursing Care of Adults with Medical and Surgical Health Problems
advised against anogenital intercourse because this
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 firm to the touch, without lumps. The surface
should feel smooth and rubbery. The testes should
not be soft or spongy to the touch. Testicular malig-
nancies are usually nontender, nonpainful hard
lumps. Lumps, swelling, nodules, or signs of inflam-
mation 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 mark-
ers for testicular disease. Measurements of AFP,
hCG, and testosterone are also obtained throughout
the course of therapy to help measure the effective-
ness of treatment.
CN: Physiological adaptation;
CL: Apply
103. 1. Cryptorchidism (undescended testes) car-
ries 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 environ-
mental factors. Testicular cancer is not associated
with early sexual relations in men, even though cer-
vical 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 testicu-
lar 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 age-
group.
CN: Health promotion and maintenance;
CL: Analyze
Billings_Part 2_Chap 3_Test 10.indd 546
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 associ-
ated 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 che-
motherapy can affect fertility.
CN: Psychosocial adaptation;
CL: Synthesize
107. 2. When diagnosed early and treated aggres-
sively, testicular cancer has a cure rate of about
90%. Treatment of testicular cancer is based on
tumor type, and seminoma cancer has the best prog-
nosis. 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 andro-
gen, 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
8/7/2010 10:18:41 AM

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 Ameri-
can 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-specific antigen
(PSA) greater than 4 ng/mg is diagnostic; a free PSA
level can help stratify the risk of elevated PSA lev-
els. 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 progres-
sion. Complications of hormonal manipulation
include: hot flashes, nausea and vomiting, gyneco-
mastia, and sexual dysfunction. As part of support-
ive 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 func-
tion, 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 lead-
ing 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
Billings_Part 2_Chap 3_Test 10.indd 547
The Client with Reproductive Health Problems 547
113. 1. On digital rectal examination, key signs
of prostate cancer are a hard prostate, induration of
the prostate, and an irregular, hard nodule. Accom-
panying symptoms of prostate cancer can include
constipation, weight loss, and lymphadenopathy.
Abdominal pain usually does not accompany pros-
tate 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
flow of semen, so there will be no ejaculation fluid.
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 func-
tion 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 confined 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). Stilbe-
strol 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
The Client with Erectile Dysfunction
117. 2. Sildenafil (Viagra) should not be taken
more than once per day. Viagra offers no protection
against sexually transmitted diseases. Viagra has no
effect in the absence of sexual stimulation. The cli-
ent should notify his health care provider promptly
if he experiences sudden or decreased vision loss in
one or both eyes.
CN: Pharmacological and parenteral
therapies; CL: Synthesize
118. 2. Antihypertensives, especially beta block-
ers such as propranolol (Inderal), can cause impo-
tence. When a male client complains of impotence,
the nurse should always examine his medication
regimen as a potential contributing factor. Aspirin,
8/7/2010 10:18:42 AM
 548 The Nursing Care of Adults with Medical and Surgical Health Problems
nonsteroidal anti-inflammatory drugs, and antico-
agulants do not cause erectile dysfunction.
CN: Pharmacological and parenteral
therapies; CL: Synthesize
119. 2. ED is multifactorial in origin, and more
than 50% of the cases can be attributed to organic
causes, which include alteration in vascular sup-
ply, hormonal changes, neurologic dysfunction,
medications, and associated systemic diseases, such
as diabetes mellitus or alcoholism. The presence of
nocturnal erections is the first evaluation to differ-
entiate between organic and psychogenic causes. ED
is a common problem among men older than age 65.
CN: Psychosocial adaptation; CL: Apply
120. 1. Avoidance of alcohol can improve the out-
come of therapy. Alcohol and smoking can affect a
man’s ability to have and maintain an erection. The
client should be encouraged to follow a healthy diet,
but no specific diet is associated with improvement
of sexual function. The client should cease smok-
ing, not just decrease smoking. Increasing attempts
at intercourse without treatment will not facilitate
improvement. The client should be reassured that
ED is a common problem and that help is available.
CN: Reduction of risk potential;
CL: Synthesize
Managing Care Quality and Safety
121. 4. The registered nurse is responsible for
monitoring the surgical site for condition of the
dressing, status of the incision, and signs and symp-
toms of complications. Unlicensed assistive person-
nel who have been trained to report abnormalities
to the registered nurse supervising the care may
take vital signs, record intake and output, and give
perineal care.
CN: Management of care; CL: Synthesize
122. 4. To determine the cause of this problem, a
quality improvement study should be conducted.
Before implementing solutions to a complaint,
the precise issues in the hospital system must be
observed and documented. Consulting with the
Billings_Part 2_Chap 3_Test 10.indd 548
evening nurses may result in biased observations
because the evening nurses are not conducting care
under the same environment as the night nurses.
Including a medication nurse is not the first step in
understanding the problem and may be an unreal-
istic or expensive solution. The supervisor is not
directly involved with the problem and should only
be consulted if the problem cannot be solved by
those involved.
CN: Management of care; CL: Synthesize
123. 3. The nurse must clarify this order with the
admitting physician to ensure medication accuracy
and client safety. In health care settings without
computerized medical records or computer pre-
scribing, misinterpretation of handwriting remains
a leading cause of medication errors. It is not safe
practice to question the client regarding a diagnosis
and assume the medication is correctly prescribed.
The pharmacist will need clarification of the order
as well. It is not the role of the pharmacist to inter-
pret the order.
CN: Pharmacological and parenteral
therapies; CL: Synthesize
124. 2. The surgeon should be notified when a
client who has had an abdominal hysterectomy
develops vaginal bleeding that saturates a blue pad
in 1 hour, and care should be managed so that other
personnel can obtain vital signs while the nurse
contacts the surgeon. The client may need to have
I.V. fluids increased, but the surgeon needs to be
notified first. Waiting 15 minutes while the client
is having bright-red bleeding is an unsafe nursing
action; the client may lose a large amount of blood.
CN: Management of care; CL: Synthesize
125. 3. The nurse should follow the line of author-
ity or chain of command by reporting the observa-
tion immediately to the nursing supervisor. The
nurse should not confront the person or the medica-
tion nurse because the line of authority for reporting
incidents should be followed. The RT supervisor
may subsequently be involved in the incident, but
the nursing supervisor should initiate and follow
the policy and procedure.
CN: Management of care; CL: Synthesize
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