Nursing Elites

1. At a health screening clinic, a nurse is educating a young woman about breast self-examination (BSE). The nurse determines that the client demonstrates understanding when she makes which statement?

• A. BSE should be performed monthly after the menstrual period.
• B. BSE is performed after the menstrual period.
• C. Monthly BSE is a recommended method for early detection of breast cancer.
• D. Monthly BSE includes inspection before a mirror and palpation both in the shower and while lying down.

Correct answer: D

Rationale: The correct answer is 'Monthly BSE includes inspection before a mirror and palpation both in the shower and while lying down.' BSE should be performed monthly after the menstrual period, not every other month or on the day menstruation begins. Performing BSE on the seventh day of the menstrual cycle when the breasts are smallest and least congested is recommended. While BSE is a useful tool for early detection, it is not the only method. Regular physical examinations and mammograms are also important. The correct technique for BSE includes inspecting the breasts in front of a mirror, palpating in the shower for easier detection, and conducting palpation while lying down for thorough examination.

2. A nurse is reviewing the medical record of an older client with presbycusis. Which finding would the nurse expect to note in the client's record?

• A. Difficulty hearing whispered words in the voice test
• B. Improved hearing ability during conversational speech
• C. Unilateral conductive hearing loss
• D. Difficulty hearing low-pitched tones

Correct answer: A

Rationale: Presbycusis, a sensorineural hearing loss, is the most common form of hearing loss in older adults. Typically, the loss is bilateral, resulting in difficulty hearing high-pitched tones. The condition is revealed when the client has difficulty hearing whispered words in the voice test and consonants during conversational speech. Choice A is correct because it reflects the expected finding in presbycusis. Choices B, C, and D are incorrect because presbycusis does not result in improved hearing ability during conversational speech, unilateral conductive hearing loss, or difficulty hearing low-pitched tones.

3. When teaching a woman about possible side effects of hormone replacement therapy, the nurse should include information about all of the following except:

• A. Hypoglycemia in diabetic women.
• B. The possible return of monthly menses when taking combination hormones.
• C. Increased risk of gallbladder disease.
• D. Increased risk of breast, cervical, and ovarian cancer with long-term use.

Correct answer: A

Rationale: The correct answer is 'Hypoglycemia in diabetic women.' When educating a woman about hormone replacement therapy, it is important to discuss the possible side effects. It is true that monthly menses might return when taking combination hormones, as the progestin can cause this. Additionally, there is an increased risk of gallbladder disease associated with hormone replacement therapy. Furthermore, long-term use of hormone replacement therapy is linked to an increased risk of breast, cervical, and ovarian cancer. However, hypoglycemia is not a common side effect of hormone replacement therapy, especially in diabetic women. In fact, estrogen can have a positive impact on glucose control in some cases, so hypoglycemia would not be a typical concern.

4. A nurse observes a nursing assistant communicating with a hearing-impaired client in later adulthood. The nurse should intervene if the nursing assistant performs which action?

• A. Uses short sentences
• B. Speaks at a normal rate and volume
• C. Uses facial expressions or gestures
• D. Overarticulates words

Correct answer: D

Rationale: The correct answer is 'Overarticulates words.' When communicating with a hearing-impaired client who may rely on lip-reading, it is essential to speak clearly at a normal rate and volume. Overarticulating words can distort lip movements, making it harder for the client to understand. Using short sentences helps in conveying information effectively, allowing the client time to process. While facial expressions and gestures provide additional visual cues that aid in communication, overarticulating words can be counterproductive in this scenario. Therefore, the nursing assistant should avoid overarticulating words to ensure clear and concise communication for the client.

5. A pregnant client asks how she can prevent getting Group B Strep. What is the LPN's best response?

• A. You cannot prevent getting Group B Strep; you can only treat it.
• B. You should have your partner wear a condom every time you have intercourse.
• C. You should be extra vigilant about hand-washing, especially in the third trimester.
• D. The Group B Strep vaccine is the only proven way to prevent the disease.

Correct answer: A

Rationale: The best response for the LPN to provide to a pregnant client concerned about preventing Group B Strep is that it cannot be prevented, only treated. Group B Strep is a normal flora found in the vagina, rectum, and intestines of about 25% of women and is not a sexually transmitted disease. Testing for Group B Strep is done in each pregnancy, usually around 35-37 weeks. If a woman tests positive, antibiotics are administered during labor to reduce the risk of complications for both the mother and the baby. Choice A is the correct answer as Group B Strep cannot be prevented but only treated. Choice B is incorrect; condom use does not prevent Group B Strep. Choice C is not the best response as hand-washing is important for general hygiene but does not specifically prevent Group B Strep. Choice D is incorrect as there is no vaccine available to prevent Group B Strep.

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