NR-304 Health Assessment II - Set 5 - Part 3

Correct Answer: "Knowing your breasts helps you find lumps between your scheduled mammograms."

Self-examination, clinical examination and mammography are complementary. Mammography detects cancers too small to feel, but interval lumps become palpable between screenings, so knowing her own breasts and reporting change promptly still matters. Option a is incorrect because imaging and self-awareness cover different gaps rather than substituting for one another. A cancer that surfaces in the months after a normal mammogram is found by the woman herself. Option b is incorrect because the American Cancer Society withdrew its endorsement of a structured monthly breast self-examination. Formal programs did not lower mortality and produced more benign biopsies, so self-awareness replaced the schedule. Option c is incorrect because clinical breast examination is not recommended as a screening test for average-risk women at any age. Relying on a yearly provider check leaves the same interval gap unaddressed.

Correct Answer: Applying the prescribed cold pack and scrotal support

Care of orchitis is supportive, and applying an ordered cold pack with scrotal elevation and support is a standardized comfort measure within the scope of assistive personnel. Assessment and teaching remain nursing responsibilities. Option b is incorrect because transillumination is an examination technique whose result must be interpreted. Deciding that a solid mass fails to glow, and what that means, requires the judgment of a licensed nurse. Option c is incorrect because patient teaching cannot be handed to unlicensed staff. Explaining how immunization prevents orchitis, testicular atrophy and reduced fertility calls for clinical knowledge and evaluation of what the family understood. Option d is incorrect because serial testicular assessment detects worsening swelling or a new hard area. Physical assessment sits squarely within the registered nurse role and is never transferred to unlicensed personnel.

Correct Answer: The external sphincter is under voluntary control.

The external anal sphincter is skeletal muscle supplied by the pudendal nerve and is under voluntary control. The internal sphincter is smooth muscle under autonomic control, maintaining resting tone that keeps the canal closed. Option a is incorrect because the internal sphincter is smooth muscle governed by the autonomic nervous system, so the client cannot consciously contract or release it. Voluntary control belongs to the skeletal external sphincter. Option c is incorrect because the arrangement is reversed: the external sphincter surrounds the internal one and a small section of it overrides the tip of the internal sphincter at the anal opening. Option d is incorrect because both muscles hold the canal tightly closed except during the passage of faeces and gas. A gaping or patulous anus at rest is abnormal and suggests neurologic injury.

Correct Answer: Notify the provider immediately for urologic consultation

The findings describe testicular torsion, and salvage falls sharply with every hour of ischemia. Immediate urologic consultation is the first nursing action; the patient is kept nothing by mouth while surgery is arranged. Option a is incorrect because heat does nothing for a mechanically twisted cord and may accelerate tissue injury. Hourly reassessment also consumes the narrow window during which the testis can still be saved. Option b is incorrect because urinalysis is typically normal in torsion, and pyuria would not exclude it either. Collecting a specimen first delays the consultation that determines whether this testis survives. Option d is incorrect because imaging follows the referral rather than preceding it. Doppler study is imperfect, and a normal or equivocal result never overrides an examination that already points to a twisted cord.

Correct Answer: That change is the normal mucus produced around ovulation

Estrogen peaks at ovulation and thins cervical mucus into a clear, copious, stretchy secretion. Discharge that does not itch, burn, smell or irritate is physiologic, so education and reassurance are the appropriate nursing response here. Option a is incorrect because candidiasis produces a thick white curdy discharge with intense vulvar itching, soreness and external dysuria. None of those symptoms is present, and clear stretchy mucus is not a yeast finding. Option b is incorrect because bacterial vaginosis gives a thin homogeneous gray discharge with a fishy odor and an elevated vaginal pH. The client specifically denies odor, so that diagnosis does not fit. Option c is incorrect because volume alone is a poor discriminator, and discharge normally rises and falls across the menstrual cycle. Telling a client to report every increase generates needless anxiety and unnecessary visits.

Correct Answer: Refer him promptly for urologic evaluation

A firm, painless, non-transilluminating nodule inside the testis is cancer until imaging proves otherwise, and this man carries the added risk of prior cryptorchidism. Testicular cancer peaks between fifteen and thirty-five years of age. Option b is incorrect because painlessness is the dangerous feature rather than a comforting one. Nothing hurts, so men delay presenting for months, and the tumor grows and spreads during that silent interval. Option c is incorrect because a year of watchful waiting allows spread to the retroperitoneal nodes and beyond. An intratesticular mass demands imaging within days, not at the next scheduled appointment. Option d is incorrect because charting this as normal is inaccurate. A hard area inside the testis is exactly what self-examination is meant to detect, and teaching cannot substitute for referring the lesion already found.

Correct Answer: Compress the glans and collect drainage for culture

Compressing the glans anteroposteriorly between thumb and forefinger opens the meatus and expresses drainage onto a swab for microscopy and culture. Identifying gonorrhea or chlamydia guides treatment and determines which partners need evaluation. Option a is incorrect because passing an applicator inside the urethra is painful and unnecessary when discharge is already visible at the opening. Instrumentation also risks pushing organisms deeper along the tract. Option b is incorrect because semen has no role in diagnosing urethritis, and requesting it is intrusive and embarrassing. The specimen needed is the purulent material at the meatus, which is immediately available. Option d is incorrect because inspecting voided urine in a cup neither identifies the organism nor preserves the exudate. A first-void urine sample can be sent for amplification testing, but it is not examined visually.

Correct Answer: Grade three, prolapsing and requiring manual reduction.

Internal hemorrhoids are graded by prolapse. Tissue that descends with defecation and must be pushed back by hand is grade three, which often requires a procedure such as rubber band ligation. Option a is incorrect because grade one hemorrhoids bulge into the anal canal but never appear outside it. This client has visible tissue emerging with every bowel movement, which places him beyond that stage. Option c is incorrect because grade two tissue slips back on its own once straining stops. Needing to replace it manually is precisely what separates the second grade from the third. Option d is incorrect because grade four hemorrhoids cannot be replaced at all and stay outside the anus permanently. Such tissue risks strangulation and necrosis, which is a surgical emergency with severe pain.

Correct Answer: Notify the provider so treatment begins today

Cervical motion tenderness with adnexal tenderness in a sexually active woman with pelvic pain meets the minimum criteria for pelvic inflammatory disease. Treatment starts presumptively, because tubal scarring and infertility follow delay and are irreversible. Option a is incorrect because deferring care until laboratory results arrive wastes the window in which tubal damage can still be prevented. Clinicians deliberately keep a low threshold for this diagnosis for that reason. Option b is incorrect because roughly half of acute cases test negative for gonorrhea and chlamydia, so a negative result would not exclude the disease. Waiting for an organism leaves many women untreated. Option c is incorrect because hygiene teaching addresses nothing in an ascending upper genital tract infection with fever. A week of observation risks tubo-ovarian abscess, ectopic pregnancy and chronic pelvic pain later.

Correct Answer: Lay her flat with knees bent and arms down

A flat plane is needed to judge contour, and hip flexion slackens the rectus abdominis so voluntary guarding does not mimic a finding. Arms above the head tense the abdominal wall and are brought down. Option b is incorrect because an upright abdomen falls forward and hides both contour and symmetry. The sequence calls for the client to lie flat at this point, which is the only planned position change before gait. Option c is incorrect because side lying is reserved for the pregnant client whose enlarged uterus compresses the vena cava, or for a woman who cannot tolerate lithotomy. It obscures abdominal contour and quadrant landmarks. Option d is incorrect because elevating the head further keeps the abdominal muscles taut and prevents an accurate reading of contour. Head elevation is a comfort measure for the pelvic examination, not for abdominal assessment.