A 42 year-old patient tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. She says that she is afraid that she has cancer. Which assessment finding would most strongly suggest that this patients lump is cancerous?

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Question 1 of 9

A 42 year-old patient tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. She says that she is afraid that she has cancer. Which assessment finding would most strongly suggest that this patients lump is cancerous?

Correct Answer: B

Rationale: A nonmobile mass with irregular edges would most strongly suggest that the patient's lump is cancerous. Breast cancer lumps typically do not move easily and have irregular, poorly defined edges. These characteristics are concerning because they can indicate an invasive and aggressive growth pattern. Additionally, the fact that the lump is painless is another feature that raises suspicion for malignancy. It is important for the patient to undergo further evaluation, possibly including a mammogram, ultrasound, and biopsy, to determine the nature of the lump and provide appropriate treatment.

Question 2 of 9

A nurse is providing care to a group of patients.Which situation will require the nurse to obtain a telephone order?

Correct Answer: B

Rationale: In this situation, the nurse needs to obtain a telephone order because the patient's condition has changed significantly. The drop in blood pressure from 120/80 to 90/50 along with the saturated incision dressing indicates a potential complication or need for immediate intervention. The nurse must act quickly to address the situation and may require additional orders from the primary care provider over the phone to manage the patient's condition effectively. The urgency and critical nature of the situation necessitate obtaining a telephone order promptly to ensure the best outcome for the patient.

Question 3 of 9

The patient hasH. pylori. Which action shouldthe nurse take?

Correct Answer: C

Rationale: The most appropriate action for a patient with H. pylori is to encourage completion of antibiotic therapy. H. pylori is a bacterium that causes peptic ulcers, and treatment involves a combination of antibiotics to eradicate the infection. Antibiotic therapy is crucial in eliminating the bacteria and preventing complications such as recurrent ulcers or stomach cancer. Therefore, the nurse should prioritize ensuring that the patient completes the prescribed course of antibiotics to effectively treat the H. pylori infection.

Question 4 of 9

A child has been experiencing recurrent episodes of acute otitis media (AOM). The nurse should anticipate that what intervention is likely to be ordered?

Correct Answer: D

Rationale: Recurrent episodes of acute otitis media (AOM) can cause fluid accumulation in the middle ear, leading to hearing loss and increased risk of further infections. Insertion of a ventilation tube, also known as a tympanostomy tube, is a common intervention for children with recurrent AOM. This procedure involves placing a tiny tube through the eardrum to allow ventilation and drainage of fluid from the middle ear. Ventilation tubes help equalize pressure, prevent fluid buildup, and reduce the frequency of ear infections. It can improve hearing and decrease the likelihood of future episodes of AOM. Ossiculoplasty, insertion of a cochlear implant, and stapedectomy are not indicated for recurrent AOM.

Question 5 of 9

A nurse is explaining to the nursing students working on the antepartum unit how to assess for edema. Which edema assessment score indicates edema of the lower extremities, face, hands, and sacral area? N R I G B.C M U S N T O

Correct Answer: C

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Question 6 of 9

The patient asks the nurse what these numbers specifically mean. What is a correct response by the nurse?

Correct Answer: A

Rationale: A person whose vision is measured at 20/40 can see an object from 40 feet away that a person with 20/20 vision can see from 20 feet away. In this measurement system, the first number represents how far away the person is from the eye chart (the testing distance), and the second number indicates how far away a person with normal vision can be from the chart to see the same line of letters or objects. Therefore, if someone has 20/40 vision, it means they need to be at 20 feet to see what a person with 20/20 vision can see at 40 feet.

Question 7 of 9

The nurse is planning discharge education for a patient with trigeminal neuralgia. The nurse knows to include information about factors that precipitate an attack. What would the nurse be correct in teaching the patient to avoid?

Correct Answer: A

Rationale: Trigeminal neuralgia is a condition characterized by severe facial pain due to irritation or damage to the trigeminal nerve. Factors such as touching or lightly brushing the face, chewing, speaking, or even encountering a breeze can trigger an attack. Therefore, activities like washing the face that involve touching or stimulating the trigeminal nerve can precipitate an attack in patients with trigeminal neuralgia. It is important for patients to be aware of these triggers to help manage and prevent episodes of pain.

Question 8 of 9

A patients daughter has asked the nurse about helping him end his terrible suffering. The nurse is aware of the ANA Position Statement on Assisted Suicide, which clearly states that nursing participation in assisted suicide is a violation of the Code for Nurses. What does the Position Statement further stress?

Correct Answer: B

Rationale: The ANA Position Statement on Assisted Suicide stresses the importance of identifying patient and family concerns and fears. This reflects the nurse's responsibility to provide holistic care and support to patients and their families who may be struggling with end-of-life decisions. By identifying concerns and fears, the nurse can address these issues through compassionate communication, education, and appropriate interventions. This proactive approach aligns with the ethical principles of beneficence and nonmaleficence in nursing practice.

Question 9 of 9

A patient with no prenatal care delivers a healthy male infant via the vaginal route, with minimal blood loss. During the labor period, vital signs were normal. At birth, significant maternal hypertension is noted. When the patient is questioned, she relates that there is history of heart disease in her family; but, that she has never been treated for hypertension. Blood pressure is treated in the hospital setting and the patient is discharged. The patient returns at her scheduled 6-week checkup and is found to be hypertensive. Which type of hypertension is the patient is exhibiting?

Correct Answer: D

Rationale: The patient in this scenario exhibits signs of chronic hypertension, particularly due to the history of heart disease in her family, the postpartum persistence of elevated blood pressure, and the diagnosis of hypertension at the 6-week checkup. While pregnancy-induced hypertension (PIH), gestational hypertension, and preeclampsia can occur during pregnancy, they typically resolve within a few weeks after delivery. The fact that the patient's hypertension persists beyond the postpartum period suggests that she likely had preexisting, undiagnosed chronic hypertension. Therefore, option D is the most appropriate choice in this case.

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