A healthy 60-year-old African-American woman regularly receives health care at her neighborhood cliniShe is due for a mammogram. At her first visit, her health care provider is concerned about the 3-week wait at the neighborhood clinic and made an appointment for her to have a mammogram at a teaching hospital across town. She did not keep her appointment and returned to the clinic today to have the nurse check her blood pressure. What is the most appropriate statement for the nurse to make to this client?

Correct Answer: D

Rationale: The most appropriate statement for the nurse to make to the client, "Would you like me to make an appointment for you to have your mammogram here?" is the correct choice for several reasons. Firstly, it demonstrates patient-centered care by acknowledging the client's initial choice of seeking care at the neighborhood clinic. By offering to schedule the mammogram at the current clinic, the nurse addresses potential barriers such as transportation issues that may have led to the missed appointment at the teaching hospital. This approach promotes continuity of care and ensures the client's healthcare needs are met in a familiar setting. Option A is incorrect because it assumes the client has transportation to the teaching hospital, which may not be the case and overlooks the client's preference for care at the neighborhood clinic. Option B focuses on the missed appointment rather than addressing the client's current needs. Option C uses fear tactics and does not engage the client in a collaborative decision-making process. In an educational context, this scenario highlights the importance of patient-centered care, understanding social determinants of health, and effective communication in nursing practice. Nurses must consider individual preferences, barriers to care, and engage in shared decision-making to promote positive health outcomes for clients.

Correct Answer: A

Rationale: The correct answer is A) Weight gain, hot flashes, and blood clots. Tamoxifen is a commonly prescribed adjuvant therapy for breast cancer. Weight gain is a known side effect of tamoxifen due to its impact on metabolism and hormonal changes. Hot flashes are also common because tamoxifen can disrupt the body's hormonal balance, leading to sudden feelings of heat and sweating. Additionally, tamoxifen increases the risk of blood clots, which is an important side effect to monitor in patients taking this medication. Option B) Vomiting, weight loss, and hair loss are not commonly associated with tamoxifen therapy. Nausea, vomiting, and diarrhea in option C) are more commonly seen with other types of chemotherapy drugs rather than tamoxifen. Option D) Hot flashes, weight gain, and headaches includes two correct side effects but not blood clots, which are specifically associated with tamoxifen. In the context of maternal newborn nursing, understanding the side effects of medications like tamoxifen is crucial for providing safe and effective care to mothers who may be battling breast cancer. Nurses need to be knowledgeable about the potential side effects of adjuvant therapies to educate and support their patients through treatment while monitoring for any adverse reactions.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Small dimple located in the upper outer quadrant of the right breast. This finding is concerning as it could indicate an underlying issue such as a breast mass or tumor pulling on the skin, causing the dimpling. Any new, unexplained breast changes should be evaluated promptly to rule out malignancy. Option A, a slight difference in breast size, is a common and usually benign finding. Option B, nipple elevation, is also a common variant and not typically a cause for concern. Option C, faintly visible bilateral venous symmetry, is a normal finding as breast vasculature can vary among individuals. From an educational standpoint, it is crucial for nurses to recognize abnormal breast changes and understand the significance of each finding. Prompt referral for further testing in cases of suspicious changes is vital for early detection and intervention in breast health. Nurses play a key role in educating patients about breast self-examinations and the importance of regular screenings for early detection of breast abnormalities.

Correct Answer: A

Rationale: The correct answer is A) Removal of the breast, nipple, and areola, leaving only the skin. In a skin-sparing mastectomy, the breast tissue is removed while preserving the skin envelope, which can lead to improved cosmetic outcomes for the client. By leaving the skin intact, reconstruction options are more aesthetically pleasing and natural-looking. Option B) Removal of the breast, nipple, areola, and axillary node dissection is incorrect because it describes a more extensive procedure that includes lymph node removal, which is not specific to a skin-sparing mastectomy. Option C) Incision on the outside of the breast, leaving the nipple intact is incorrect as it does not accurately describe the preservation of the nipple-areola complex in a skin-sparing mastectomy. Option D) Removal of both breasts in their entirety is incorrect as it describes a bilateral mastectomy, which is not the same as a skin-sparing mastectomy that only removes breast tissue but preserves the skin envelope. Educationally, understanding different types of mastectomies is crucial for nurses caring for clients undergoing breast cancer surgeries. Providing accurate information and explanations can help alleviate fears and empower clients to make informed decisions about their care and treatment options.

Correct Answer: B

Rationale: Stating that she will miss having sexual intercourse with her husband indicates that further teaching is needed for this client regarding sexual activities after a hysterectomy. Although intercourse may be initially uncomfortable, the use of water-soluble lubricants, relaxation exercises, and changes in position may be helpful.