A nurse is providing breast self-examination teaching to a client who is menopausal. Which of the following statements should the nurse identify as an indication that the teaching was effective? (Select all that apply.)
"I will make sure to feel for changes in my underarm area."
"It is important to press firmly when feeling my breasts to detect changes."
"I don't have to lie down to check my breasts. I can stand in the shower."
"If I feel a firm ridge in the lower curve of my breasts, I should report this immediately."
"Since I no longer have periods, I can perform an examination at any time of the month."
Correct Answer : A,B,C,E
The correct answer is: a, b, c, and e.
Choice A: “I will make sure to feel for changes in my underarm area.”
Reason: This statement is correct because the underarm area (axilla) contains lymph nodes that can be affected by breast cancer. Including the underarm area in a breast self-exam helps in detecting any unusual lumps or changes that could indicate a problem.
Choice B: “It is important to press firmly when feeling my breasts to detect changes.”
Reason: This statement is correct because using firm pressure during a breast self-exam helps to feel the deeper tissues of the breast, which is essential for detecting any abnormalities or lumps that might be present.
Choice C: “I don’t have to lie down to check my breasts. I can stand in the shower.”
Reason: This statement is correct because performing a breast self-exam in the shower is a common and effective method. The wet and slippery skin makes it easier to feel for any changes or lumps in the breast tissue.
Choice D: “If I feel a firm ridge in the lower curve of my breasts, I should report this immediately.”
Reason: This statement is incorrect because it is normal to feel a firm ridge in the lower curve of the breast. This ridge is part of the normal breast anatomy and does not necessarily indicate a problem.
Choice E: “Since I no longer have periods, I can perform an examination at any time of the month.”
Reason: This statement is correct because menopausal women do not have menstrual cycles to guide the timing of their breast self-exams. Therefore, they can choose any consistent day each month to perform the exam.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","D"]
Explanation
Choice A reason:
Raisins are dried grapes and are known to have a higher concentration of nutrients, including potassium. For individuals with chronic kidney disease (CKD), consuming foods like raisins that are high in potassium can lead to hyperkalemia, a condition where potassium levels in the blood are higher than normal. This can be dangerous as it may cause heart rhythm problems.
Choice B reason:
Asparagus is considered a lower-potassium food, making it a safer choice for people with CKD. It's important for individuals with CKD to manage their potassium intake, but asparagus can be included in their diet in appropriate portions.
Choice C reason:
Bananas are well-known for being rich in potassium. For someone with CKD, eating bananas can contribute to an excessive intake of potassium, which their kidneys may not be able to eliminate efficiently, potentially leading to hyperkalemia.
Choice D reason:
Tomatoes, including tomato products like sauces, juices, and purees, are high in potassium. Therefore, they should be limited or avoided in the diet of a person with CKD to prevent complications associated with high potassium levels.
Choice E reason:
Green beans are considered to be a lower-potassium vegetable. They can be included in a kidney-friendly diet, provided they are consumed in moderation and balanced with other dietary needs.
Correct Answer is B
Explanation
Choice A reason:
Decreased hemoglobin (Hgb) levels can be indicative of anemia or blood loss, but they are not typically associated with fluid volume deficit. In cases of fluid volume deficit, the Hgb concentration may actually appear elevated due to hemoconcentration as the plasma volume decreases.
Choice B reason:
Increased blood urea nitrogen (BUN) levels are expected in a fluid volume deficit because as the blood volume decreases, the concentration of solutes like urea can increase. This is often due to decreased renal perfusion and subsequent reduced renal function, leading to less urea being excreted through the kidneys.
Choice C reason:
Increased urine ketones are typically associated with diabetic ketoacidosis or starvation, not directly with fluid volume deficit. Ketones are produced when the body breaks down fats for energy, which is not a process directly related to fluid volume status.
Choice D reason:
Decreased urine specific gravity would not be expected in fluid volume deficit; in fact, one would expect the opposite. Specific gravity measures the kidney's ability to concentrate urine. In fluid volume deficit, the urine specific gravity would likely be increased as the body attempts to conserve water.
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