A nurse is reinforcing teaching with a client about how to perform a breast self exam (BSE). The nurse should identify which of the following findings as an indication of breast cancer?
Lumps that are mobile and tender upon palpation prior to a menstrual period.
Multiple round masses that are tender and found in both breasts
Bilaterally darkened areolas
A nontender hard lump that is palpated in one breast
The Correct Answer is D
Choice A reason: This is a normal finding, not an indication of breast cancer. Lumps that are mobile and tender upon palpation prior to a menstrual period are usually benign and related to hormonal changes.
Choice B reason: This is a normal finding, not an indication of breast cancer. Multiple round masses that are tender and found in both breasts are usually benign and related to fibrocystic breast changes.
Choice C reason: This is a normal finding, not an indication of breast cancer. Bilaterally darkened areolas are usually benign and related to genetic factors, pregnancy, or aging.
Choice D reason: This is an abnormal finding, and an indication of breast cancer. A nontender hard lump that is palpated in one breast is usually malignant and related to abnormal cell growth.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: This is an incorrect statement, because the client should avoid any body piercings, tattoos, or other procedures that can cause skin or mucosal trauma and increase the risk of bacterial infection and endocarditis. The client should also seek medical attention if they have a fever or other signs of infection.
Choice B reason: This is a correct statement, because the client should notify their doctor before they have dental procedures, such as cleaning, filling, or extraction, that can cause bleeding and introduce bacteria into the bloodstream. The client may need prophylactic antibiotics to prevent endocarditis.
Choice C reason: This is a partially correct statement, because the client should floss their teeth twice a day as a part of their oral care, but this is not enough to prevent recurrence of endocarditis. The client should also brush their teeth with a soft toothbrush after each meal, use an antiseptic mouthwash, and visit their dentist regularly.
Choice D reason: This is an unnecessary statement, because the client does not need to wear a mask when they go out in public, unless they have a respiratory infection or are exposed to someone who has one. Endocarditis is not transmitted by airborne or droplet routes, but by direct contact with the infected heart valves or blood.
Correct Answer is ["A","B"]
Explanation
Choice A reason: Wearing a gown is a correct action, because it protects the nurse's clothing and skin from exposure to the client's body fluids.
Choice B reason: Wearing gloves is a correct action, because it protects the nurse's hands from contact with the client's body fluids and reduces the risk of transmission of HIV.
Choice C reason: Not needed unless there's risk of respiratory exposure, which is not indicated here. AIDS is not spread via airborne particles.
Choice D reason: Wearing a hair cover is an incorrect action, because it is not necessary for standard precautions or contact precautions, which are the types of isolation required for a client who has AIDS and is incontinent of stool.
Choice E reason: Only needed if splashing of body fluids into the eyes is likely (not typical when simply changing linens).
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