Nursing Elites

1. A male client is learning about testicular self-examination (TSE) from a nurse. Which statement should the nurse make to the client?

• A. 'A good time to examine the testicles is during or after you take a shower.'
• B. 'If you notice an enlarged testicle or a lump, you need to notify the physician.'
• C. 'The testicle is round and smooth. It feels firm and without lumps.'
• D. 'Perform a testicular exam monthly to detect early signs of testicular cancer.'

Correct answer: B

Rationale: The correct statement for the nurse to make to the client is 'If you notice an enlarged testicle or a lump, you need to notify the physician.' During a shower or bath is the best time to examine the testes because warm temperatures make the testes hang lower in the scrotum. The testes should feel round and smooth, without lumps. Self-examination should be performed monthly to detect any abnormalities early. The physician needs to be notified immediately if any abnormal findings are noticed. Choice A is incorrect because the best time for TSE is during or after a warm shower or bath, not just before. Choice C is incorrect as the testicle should feel round, smooth, and without lumps, not egg-shaped and lumpy. Choice D is incorrect as monthly self-examinations are recommended, not every 2 months.

2. What are the basic reasons American families are having difficulty adequately performing their vital health care function?

• A. structure of the health care system and family structure
• B. psychological factors affecting men and women seeking health care
• C. conditions labeled as disabilities and considered too time-consuming
• D. health care organizations (HMOs) and disconnected families

Correct answer: A

Rationale: The correct answer is the 'structure of the health care system and family structure'. Scholars suggest that the reasons families are having difficulty providing health care for their members lie with both the structure of the health care system and the family structure. Major factors explaining differences in utilization patterns of medical services include the lack of healthcare insurance coverage, lack of services for special populations (such as teenage males), perception by families of the health care system and the health care provider, and lack of partnership between health care providers and families in mutually addressing health care issues. Choices B, C, and D are incorrect as they do not address the fundamental reasons related to the health care system and family structure as discussed in the provided extract.

3. The client is assessing a client who has recently found out she is pregnant. Which of the following statements would be a priority for the nurse to follow up on?

• A. "I am nervous about how painful labor will be."?
• B. "I need to review my finances and make sure I am prepared to care for a child."?
• C. "I hate this nausea that I've been having for a week."?
• D. "I am preparing myself to do this on my own because I do not have any family nearby. But I have always been very independent."?

Correct answer: D

Rationale: The nurse should follow up on the client's lack of a support system. Even if there is no family in the area, there are supportive resources in the community that may help the client through the pregnancy and into motherhood. It is normal for the client to worry about labor, address financial concerns, and express displeasure from early pregnancy symptoms such as nausea. However, the priority is to address the client's statement about preparing to handle the pregnancy on her own due to the absence of nearby family support. This could have significant implications for the client's emotional well-being and ability to cope effectively throughout the pregnancy journey.

4. A nurse reviewing the physical assessment findings in a client's health care record notes documentation that the Phalen test caused numbness and burning. Which disorder does the nurse, on the basis of this finding, conclude that the client has?

• A. Scoliosis
• B. Bone deformity
• C. Heberden nodules
• D. Carpal tunnel syndrome

Correct answer: D

Rationale: The Phalen test is specifically used to assess for carpal tunnel syndrome. In this test, the client is asked to hold their hands back to back while flexing the wrists 90 degrees, which can reproduce the numbness and burning sensation experienced by individuals with carpal tunnel syndrome. Scoliosis is a condition characterized by abnormal lateral curvature of the spine, not related to the Phalen test. Bone deformity is a general term that does not specifically relate to the symptoms described. Heberden nodules are bony swellings that occur in osteoarthritis and are not assessed through the Phalen test.

5. You are caring for a 78-year-old woman who is wondering why she was diagnosed with glaucoma. Although she has several risk factors, which of these is not one of them?

• A. age
• B. blood pressure reading of 143/89
• C. Mexican-American heritage
• D. 20/80 vision

Correct answer: D

Rationale: Age over 60 and Mexican-American heritage are recognized as risk factors for glaucoma. Elevated blood pressure is also a risk factor due to its potential to cause optic nerve damage. While 20/80 vision indicates poor eyesight, it is not a direct causal factor for glaucoma. Glaucoma is mainly associated with factors like age, ethnicity, and certain medical conditions, rather than a specific visual acuity measurement. Therefore, 20/80 vision is not a risk factor for glaucoma, making it the correct answer. The other choices, such as age, Mexican-American heritage, and elevated blood pressure, are established risk factors for developing glaucoma, as they are associated with an increased likelihood of the condition.

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