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Medical Surgical Nursing 3rd Edition LeMone Burke Test Bank

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Medical Surgical Nursing 3rd Edition LeMone Burke Test Bank

ISBN-13: 978-0130990754

ISBN-10: 0130990752

 

 

Description

Medical Surgical Nursing 3rd Edition LeMone Burke Test Bank

ISBN-13: 978-0130990754

ISBN-10: 0130990752

 

 

 

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Burke: Medical–Surgical Nursing Care, 3e

Chapter 32

Caring for Female Clients With Reproductive System Disorders

 

 

 

Learning Outcome 1 Describe the pathophysiology of commonly occurring disorders and changes of the breast and female reproductive system.

 

1.The nurse is caring for a 35-year-old woman who complains of symptoms relating to premenstrual syndrome (PMS). The nurse teaches the client that one cause of symptoms is:

 

  1. Decreased levels of testosterone.
  2. Sodium retention due to increased aldosterone.
  3. Decreased prolactin levels.
  4. Decreased fluid levels.

 

Answer: 2

Rationale: 1. Testosterone is a male hormone.

  1. It is thought that the increased production of aldosterone causes sodium and water retention, which is a factor in many of the symptoms of PMS.
  2. Prolactin increases during the menstrual cycle.
  3. Fluid levels increase prior to menses.

 

Cognitive Level: Comprehension

Client Need: Physiological Integrity

Nursing Process: Implementation

 Learning Outcome: 32-1

 

 

  1. A client with dysfunctional uterine bleeding (DUB) is in the clinic for diagnosis. During the nursing history, the nurse inquires whether the client with amenorrhea has a history of:

 

  1. High-fat diet.
  2. Weight gain.
  3. Athletic training.

 

Answer: 4

Rationale: 1. High-fat diets do not contribute to amenorrhea.

  1. The client with weight loss is more apt to experience amenorrhea.
  2. Anorexia nervosa clients frequently experience amenorrhea.
  3. Clients who are vigorous athletes and train for competition can experience amenorrhea. The nurse inquires about athletic training and a history of anorexia nervosa.

 

Cognitive Level: Comprehension

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome: 32-1

 

  1. The nurse is teaching a female client about breast self-examination. How does the nurse describe the lesion that might be malignant?

 

  1. The breast swells and is painful.
  2. There is a sense of fullness prior to menses.
  3. A small, hard lump that is painless is felt.
  4. Most are found near the nipple.

 

Answer: 3

Rationale: 1. The breast swells and is painful with mastitis.

  1. Fibrocystic breast produces a sense of fullness prior to menses.
  2. Malignant cancer is usually found by the client, and is a small, hard lump that is painless.
  3. Most malignant lesions are found in the upper, outer quadrant of the breast.

 

Cognitive Level: Comprehension

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 32-1

 

 

Learning Outcome 2 Compare and contrast the manifestations of benign and malignant disorders of the breast and female reproductive system.

 

 

  1. A client is complaining of burning and itching of the nipple of the left breast. The nurse asks the client whether there is any crusting on the breast, and inspects the breast and surrounding area for:

 

  1. A lump under the arm.
  2. Ulceration near the nipple.
  3. Edema of the breast.
  4. Pathological fractures.

 

Answer: 2

Rationale: 1. The client with early Paget’s disease, which the nurse suspects, will not have metastasis to the lymph system.

  1. Along with burning and itching, the nurse inspects for ulceration or erosion of the nipple.
  2. Edema of the breast is more characteristic of inflammatory carcinoma of the breast.
  3. Pathological fractures occur when carcinoma has metastasized to the bone.

 

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome: 32-2

 

  1. A client is in the gynecologist’s office for an annual assessment. The client tells the nurse that she has found a white macular lesion on the labia minora. The client tells the nurse that she is afraid she has endometrial cancer. The best response by the nurse is:

 

  1. “Cancer of the vulva presents with a thick discharge.”
  2. “The drainage from cervical cancer is noxious.”
  3. “Endometrial cancer is characterized by a bloody discharge.”
  4. “Yes, you probably do have endometrial cancer.”

 

Answer: 3

Rationale: 1. Cancer of the vulva appears as white macular patches, a lump, an ulceration, or a red painless sore.

  1. There is not drainage from cervical cancer.
  2. Endometrial cancer is usually found when the woman visits the doctor with complaints of unusual bleeding.
  3. The nurse does not inform the client of the diagnosis, and in this case, the information would be erroneous.

 

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome: 32-2

 

 

Learning Outcome 3 Provide appropriate preoperative and postoperative nursing care for the client having gynecological surgery.

 

 

  1. A client who is experiencing excess bleeding during menses is scheduled for a dilation and curettage in a few days. The nurse instructs the client to:

 

  1. Drink extra fluids for several days prior to surgery.
  2. Avoid using tampons for 2 weeks.
  3. Come in the day before surgery for insertion of a laminaria.
  4. Avoid intercourse until after the follow-up visit.

 

Answer: 3

Rationale: 1. It is not necessary to drink extra fluids prior to surgery.

  1. The client is instructed to avoid tampons after surgery.
  2. A laminaria is inserted the day before surgery to absorb cervical secretions and to dilate the cervix.
  3. The client is instructed to avoid intercourse after surgery.

 

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 32-3

 

  1. A client is about to undergo an abdominal hysterectomy. When planning care for the client, the nurse initiates which intervention?

 

  1. Leg exercises and early ambulation
  2. Increasing fluid volume
  3. Teaching the client to resume normal activities on discharge
  4. Explaining that hormone replacement is unnecessary

 

Answer: 1

Rationale: 1. The client who has an abdominal hysterectomy is at greater risk for developing deep vein thrombosis and pulmonary embolism. The nurse seeks to decrease the risk by having the client ambulate early and perform leg exercises to increase venous return.

  1. The client will be on IV fluids immediately postoperative at a rate ordered by the physician.
  2. The client is taught to refrain from strenuous activity for 4–6 weeks after surgery.
  3. If the client’s ovaries were removed as well as the uterus, the client will be placed on hormone therapy.

 

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 32-3

 

 

Learning Outcome 4 Use the nursing process when providing nursing care for female clients with perimenopausal changes and disorders of the breast and reproductive system.

 

 

  1. A client is being evaluated for infertility. When teaching this client, the nurse advises the client to:

 

  1. Gain weight.
  2. Limit caffeine.
  3. Change jobs to a more challenging one.
  4. Refrain from intercourse during evaluation.

 

Answer: 2

Rationale: 1. Significant overweight or underweight reduces fertility.

  1. Drinking more than six cups of coffee per day can decrease fertility.
  2. The client is advised to reduce stress, not increase it.
  3. There is no restraint on intercourse.

 

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 32-4

 

9.The nurse is caring for a woman who is experiencing symptoms related to menopause and is about to begin hormone replacement therapy (HRT). The nurse plans to teach the client:

 

  1. HRT stops the manifestations of menopause.
  2. Have mammograms every 5 years.
  3. Do not operate a car when taking hormones.
  4. The importance of not smoking while on HRT.

 

Answer: 4

Rationale: 1. HRT can reduce the effects of menopause but not stop them.

  1. Mammograms are recommended every year.
  2. Hormones do not impair the client.
  3. Smoking increases the risk of deep vein thrombosis and pulmonary embolism.

 

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Planning

Learning Outcome: 32-4

 

  1. The nurse is talking with a client who is experiencing atrophic vaginitis. The client states that intercourse is very painful, and appears distraught. The nurse suggests:

 

  1. Refraining from sexual intercourse for 2 weeks.
  2. Drinking extra fluids before intercourse.
  3. Using water-soluble gel to lubricate the vagina during intercourse.
  4. That estrogen replacement has caused the problem.

 

Answer: 3

Rationale: 1. The client needs to use a lubricant rather than refraining from intercourse.

  1. Extra fluids will not lubricate the vagina.
  2. Atrophic vaginitis is caused by decrease secretion production in the vagina during the aging process. The nurse instructs the client to use a water-soluble lubricant during intercourse.
  3. Estrogen does not aggravate the condition. It is an option to take hormone replacement therapy to help alleviate dryness in the vagina.

 

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 32-4

 

  1. The nurse instructs the lactating mother with mastitis about preventing future episodes by:

 

  1. Thoroughly emptying both breasts to prevent engorgement.
  2. Not breastfeeding the infant at night.
  3. Alternating breasts every 2 minutes during each feeding.
  4. Feeding the infant from only one breast during each feeding.

Answer: 1

Explanation: 1. Thorough emptying of breasts keeps milk from lying in the ducts and providing a medium for growth of organisms, which are usually spread from the infant’s nose and throat.

Application

Implementation

Physiological Integrity: Reduction of Risk Potential

  1. Thorough emptying of breasts keeps milk from lying in the ducts and providing a medium for growth of organisms, which are usually spread from the infant’s nose and throat.

Application

Implementation

Physiological Integrity: Reduction of Risk Potential

  1. Thorough emptying of breasts keeps milk from lying in the ducts and providing a medium for growth of organisms, which are usually spread from the infant’s nose and throat.

Application

Implementation

Physiological Integrity: Reduction of Risk Potential

  1. Thorough emptying of breasts keeps milk from lying in the ducts and providing a medium for growth of organisms, which are usually spread from the infant’s nose and throat.

Application

Implementation

Physiological Integrity: Reduction of Risk Potential

Learning Outcome: 3E CH 32 LO 2

 

  1. The young woman asks the nurse about breast augmentation surgery. An appropriate response by the nurse would be:

 

  1. “It is a very common surgery, and the technique has been perfected.”
  2. “There is no evidence of implants causing cancer, but the implants do make detection of cancer more difficult.”
  3. “It has been proven that women who have breast augmentation are at greater risk for breast cancer.”
  4. “You might want to think about it, because the scar tissue distorts the breasts.”

Answer: 2

Explanation: 1. Option 2 provides honest and accurate information to the client. Scar tissue can cause excessive firmness and distortion of the breast.

Application

Implementation

Health Promotion: Prevention and Early Detection of Health Problems

  1. This provides honest and accurate information to the client. Scar tissue can cause excessive firmness and distortion of the breast.

Application

Implementation

Health Promotion: Prevention and Early Detection of Health Problems

  1. Option 2 provides honest and accurate information to the client. Scar tissue can cause excessive firmness and distortion of the breast.

Application

Implementation

Health Promotion: Prevention and Early Detection of Health Problems

  1. Option 2 provides honest and accurate information to the client. Scar tissue can cause excessive firmness and distortion of the breast.

Application

Implementation

Health Promotion: Prevention and Early Detection of Health Problems

Learning Outcome: 3E CH 32 LO 3

 

  1. A female client who has had a recurrence of breast cancer is prescribed tamoxifen (Nolvadex) therapy. What would the nurse include in the instructions for taking this medication?

 

  1. Stop smoking while taking this medication.
  2. This medication will cause chills; dress warmly.
  3. Take before meals with orange juice.
  4. Maintain a 1500-calorie diet; this medication causes weight loss.

Answer: 1

Explanation: 1. Smoking can increase the risk of thromboembolic events, which are sometimes increased with tamoxifen. The medication can cause weight gain and fluid retention. It is not necessary to take it with orange juice, and it does not cause chills.

Application

Implementation

Physiological Integrity: Pharmacological and Parenteral Therapies

  1. Smoking can increase the risk of thromboembolic events, which are sometimes increased with tamoxifen. The medication can cause weight gain and fluid retention. It is not necessary to take it with orange juice, and it does not cause chills.

Application

Implementation

Physiological Integrity: Pharmacological and Parenteral Therapies

  1. Smoking can increase the risk of thromboembolic events, which are sometimes increased with tamoxifen. The medication can cause weight gain and fluid retention. It is not necessary to take it with orange juice, and it does not cause chills.

Application

Implementation

Physiological Integrity: Pharmacological and Parenteral Therapies

  1. Smoking can increase the risk of thromboembolic events, which are sometimes increased with tamoxifen. The medication can cause weight gain and fluid retention. It is not necessary to take it with orange juice, and it does not cause chills.

Application

Implementation

Physiological Integrity: Pharmacological and Parenteral Therapies

Learning Outcome: 3E CH 32 LO 2

 

  1. The newly diagnosed client with breast cancer asks the nurse if they diagnosed the cancer too late, since the surgeon recommended surgery and radiation therapy. The appropriate response by the nurse is:

 

  1. “Chemotherapy is only used in the first stage.”
  2. “Surgery and radiation are recommended in the later stages of breast cancer.”
  3. “Surgery and radiation are recommended in cancer that has not metastasized.”
  4. “You need to discuss that with your doctor.”

Answer: 3

Explanation: 1. Radiation is typically used following surgery to destroy any remaining cancer cells that could reoccur or metastasize.

Application

Implementation

Health Promotion: Prevention and/or Early Detection of Health Problems

  1. Radiation is typically used following surgery to destroy any remaining cancer cells that could reoccur or metastasize.

Application

Implementation

Health Promotion: Prevention and/or Early Detection of Health Problems

  1. Radiation is typically used following surgery to destroy any remaining cancer cells that could reoccur or metastasize.

Application

Implementation

Health Promotion: Prevention and/or Early Detection of Health Problems

  1. Radiation is typically used following surgery to destroy any remaining cancer cells that could reoccur or metastasize.

Application

Implementation

Health Promotion: Prevention and/or Early Detection of Health Problems

Learning Outcome: 3e CH 32 LO 2

 

  1. A client with premenstrual syndrome (PMS) has been on diet therapy, diuretics, and medications such as danazol (Danocrine) and fluoxetine (Prozac), and still finds no relief from the symptoms. The nurse recognizes that the client might benefit from:

 

  1. Alternative therapies such as acupuncture and relaxation exercises.
  2. Belonging to a PMS support group.
  3. oophorectomy, to relieve the hormonal imbalance.
  4. A vigorous daily exercise regimen.

Answer: 1

Explanation: 1. Since diet and medication have not been helpful, alternative therapies provide options that have been helpful to other women with PMS. An oophorectomy would not be indicated. Exercise should be balanced with rest.

Analysis

Planning

Physiological Integrity: Basic Care and Comfort

  1. Since diet and medication have not been helpful, alternative therapies provide options that have been helpful to other women with PMS. An oophorectomy would not be indicated. Exercise should be balanced with rest.

Analysis

Planning

Physiological Integrity: Basic Care and Comfort

  1. Since diet and medication have not been helpful, alternative therapies provide options that have been helpful to other women with PMS. An oophorectomy would not be indicated. Exercise should be balanced with rest.

Analysis

Planning

Physiological Integrity: Basic Care and Comfort

  1. Since diet and medication have not been helpful, alternative therapies provide options that have been helpful to other women with PMS. An oophorectomy would not be indicated. Exercise should be balanced with rest.

Analysis

Planning

Physiological Integrity: Basic Care and Comfort

Learning Outcome: 3E CH 32 LO 4

 

  1. A client with ongoing metrorrhagia asks the nurse what she should do about the problem. Which of the following responses by the nurse is most appropriate?

 

  1. “It might help to cut back on your physical exercise.”
  2. “When was the last time you had a pelvic examination?”
  3. “If it is a small amount of bleeding, you shouldn’t worry.”
  4. “Wearing a tampon and a perineal pad will help with absorption of the drainage.”

Answer: 2

Explanation: 1. Metrorrhagia can be a sign of cervical or uterine cancer, and should be evaluated promptly.

Application

Implementation

Physiological Integrity: Reduction of Risk Potential

  1. Metrorrhagia can be a sign of cervical or uterine cancer, and should be evaluated promptly.

Application

Implementation

Physiological Integrity: Reduction of Risk Potential

  1. Metrorrhagia can be a sign of cervical or uterine cancer, and should be evaluated promptly.

Application

Implementation

Physiological Integrity: Reduction of Risk Potential

  1. Metrorrhagia can be a sign of cervical or uterine cancer, and should be evaluated promptly.

Application

Implementation

Physiological Integrity: Reduction of Risk Potential

Learning Outcome: 3E CH 32 LO 4

 

  1. When caring for the client with uterine prolapse, nursing interventions should include:

 

  1. Having the client lie in knee–chest position for an hour, twice daily.
  2. Recommending laxatives to prevent constipation.
  3. Teaching the client Kegel exercises.
  4. Having the client lie in a high Fowler’s position when experiencing low back pain.

Answer: 3

Explanation: 1. Kegel exercises help to strengthen pelvic floor muscles, helping to minimize urinary leakage and descent of the bladder and rectum into the vagina. Although prolapse can cause constipation, option 3 provides a specific intervention that can be done to help the prolapse and prevent other complications.

Application

Implementation

Physiological Integrity: Reduction of Risk Potential

  1. Kegel exercises help to strengthen pelvic floor muscles, helping to minimize urinary leakage and descent of the bladder and rectum into the vagina. Although prolapse can cause constipation, option 3 provides a specific intervention that can be done to help the prolapse and prevent other complications.

Application

Implementation

Physiological Integrity: Reduction of Risk Potential

  1. Kegel exercises help to strengthen pelvic floor muscles, helping to minimize urinary leakage and descent of the bladder and rectum into the vagina. Although prolapse can cause constipation, this option provides a specific intervention that can be done to help the prolapse and prevent other complications.

Application

Implementation

Physiological Integrity: Reduction of Risk Potential

  1. Kegel exercises help to strengthen pelvic floor muscles, helping to minimize urinary leakage and descent of the bladder and rectum into the vagina. Although prolapse can cause constipation, option 3 provides a specific intervention that can be done to help the prolapse and prevent other complications.

Application

Implementation

Physiological Integrity: Reduction of Risk Potential

Learning Outcome: 3E CH 32 LO 4

 

  1. The client diagnosed with endometriosis asks the nurse to explain what it is. The nurse provides which of the following explanations?

 

  1. “It is a condition in which the tissue found inside the uterus grows outside the uterus.”
  2. “It is an infection of the tissue that connects your intestines.”
  3. “It is inflammation of the outside lining of your uterus.”
  4. “It is inflammation of the inside of your uterus.”

Answer: 1

Explanation: 1. Endometrial tissue is found outside the uterus, often on the ovary or other pelvic organs and tissues.

Comprehension

Implementation

Physiological Integrity: Physiological Adaptation

  1. Endometrial tissue is found outside the uterus, often on the ovary or other pelvic organs and tissues.

Comprehension

Implementation

Physiological Integrity: Physiological Adaptation

  1. Endometrial tissue is found outside the uterus, often on the ovary or other pelvic organs and tissues.

Comprehension

Implementation

Physiological Integrity: Physiological Adaptation

  1. Endometrial tissue is found outside the uterus, often on the ovary or other pelvic organs and tissues.

Comprehension

Implementation

Physiological Integrity: Physiological Adaptation

Learning Outcome: 3E CH 32 LO 4

 

  1. When assisting in a community education program, the nurse knows that early cancer of the uterus or cervix causes no symptoms, and focuses interventions on:

 

  1. Promoting annual physical examinations for all females.
  2. Distribution of pamphlets describing risk factors for cervical cancer.
  3. Providing sex education programs for high school students.
  4. Promoting screening and early detection with Papanicolaou (Pap) tests.

Answer: 4

Explanation: 1. The Pap test is used to screen for cervical cancer, and when it is performed, manual palpation of the uterus is also done to assess for uterine abnormalities.

Application

Implementation

Health Promotion: Prevention and/or Early Detection of Health Problems

  1. The Pap test is used to screen for cervical cancer, and when it is performed, manual palpation of the uterus is also done to assess for uterine abnormalities.

Application

Implementation

Health Promotion: Prevention and/or Early Detection of Health Problems

  1. The Pap test is used to screen for cervical cancer, and when it is performed, manual palpation of the uterus is also done to assess for uterine abnormalities.

Application

Implementation

Health Promotion: Prevention and/or Early Detection of Health Problems

  1. The Pap test is used to screen for cervical cancer, and when it is performed, manual palpation of the uterus is also done to assess for uterine abnormalities.

Application

Implementation

Health Promotion: Prevention and/or Early Detection of Health Problems

Learning Outcome: 3E CH 32 LO 1

 

  1. When caring for a client with pelvic inflammatory disease (PID), nursing interventions will include:

 

  1. Ambulating the client frequently.
  2. Having the client take sitz baths b.i.d.
  3. Instructing the client to use tampons.
  4. Keeping the client on bedrest in a semi-Fowler’s position.

Answer: 4

Explanation: 1. PID can have severe life-threatening complications. Semi-Fowler’s position promotes drainage and localizes infection to the pelvic cavity. Tampons would interfere with flow of drainage. Antibiotics and rest are also part of the treatment.

Application

Implementation

Physiological Integrity: Reduction of Risk Potential

  1. PID can have severe life-threatening complications. Semi-Fowler’s position promotes drainage and localizes infection to the pelvic cavity. Tampons would interfere with flow of drainage. Antibiotics and rest are also part of the treatment.

Application

Implementation

Physiological Integrity: Reduction of Risk Potential

  1. PID can have severe life-threatening complications. Semi-Fowler’s position promotes drainage and localizes infection to the pelvic cavity. Tampons would interfere with flow of drainage. Antibiotics and rest are also part of the treatment.

Application

Implementation

Physiological Integrity: Reduction of Risk Potential

  1. PID can have severe life-threatening complications. This position promotes drainage and localizes infection to the pelvic cavity. Tampons would interfere with flow of drainage. Antibiotics and rest are also part of the treatment.

Application

Implementation

Physiological Integrity: Reduction of Risk Potential

Learning Outcome: 3E CH 32 LO 4