A nurse is caring for a middle adult client who has just received the diagnosis of endometrial cancer. In taking a nursing history, which of the following manifestations is likely to be reported by this client?

Unilateral swelling on the posterior of the vulva

Extreme abdominal pain with intercourse

Postmenopausal bleeding

Green, malodorous vaginal discharge

Answer and Explanation

The Correct Answer is C

Unilateral swelling on the posterior of the vulva is not a typical symptom of endometrial cancer. While swelling can occur in the genital area due to various conditions, it is not specifically associated with endometrial cancer.

Choice B reason:
Extreme abdominal pain with intercourse, also known as dyspareunia, can be a symptom of many different conditions, including endometriosis and pelvic inflammatory disease, but it is not commonly associated with endometrial cancer. Endometrial cancer symptoms are more related to abnormal uterine bleeding rather than pain during intercourse.

Choice C reason:
Postmenopausal bleeding is a hallmark symptom of endometrial cancer. Any vaginal bleeding that occurs after menopause should be evaluated by a healthcare provider, as it can be an early sign of endometrial cancer.

Choice D reason:
Green, malodorous vaginal discharge can be a sign of an infection, such as bacterial vaginosis, but is not typically a symptom of endometrial cancer. While abnormal discharge can occur with endometrial cancer, it is usually bloody or watery, not green and malodorous.

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Correct Answer is B

Explanation

Choice A reason:
This choice suggests a pH of 7.50, which is indicative of alkalosis, and not typically expected in a client with chronic kidney disease (CKD). CKD often leads to metabolic acidosis due to the accumulation of acids in the body as the kidneys fail to excrete them. The HCO₃⁻ level of 20 mEq/L is slightly lower than the normal range (22-26 mEq/L), and the PaCO₂ of 32 mm Hg is within the normal range (35-45 mm Hg), but these values do not align with the expected acidosis associated with CKD.

Choice B reason:
This set of values is consistent with metabolic acidosis, which is commonly seen in clients with CKD. A pH of 7.25 indicates acidemia, and an HCO₃⁻ level of 19 mEq/L is below the normal range, suggesting a primary metabolic acidosis. The PaCO₂ of 30 mm Hg is at the lower end of the normal range, which may indicate a compensatory respiratory response to the metabolic acidosis.

Choice C reason:
A pH of 7.30, while on the lower side, is not as acidic as one would expect in a client with CKD. The HCO₃⁻ level of 26 mEq/L is within the normal range, and a PaCO₂ of 50 mm Hg suggests respiratory acidosis, which is not the primary disorder in CKD.

Choice D reason:
This choice indicates a pH of 7.55, which is too alkaline and not characteristic of CKD, where metabolic acidosis is the expected finding. An HCO₃⁻ level of 30 mEq/L is higher than the normal range, suggesting metabolic alkalosis. The PaCO₂ of 31 mm Hg is slightly below the normal range, possibly indicating a compensatory response, but it does not align with the metabolic acidosis typically seen in CKD.

A. Dosage of the medication will be reduced during pregnancy. B. Dietary modifications occur during pregnancy when taking this medication. C. The client can breastfeed when taking this medication. D. The medication should be discontinued 3 months prior to a planned pregnancy.

Correct Answer is D

Explanation

Choice A reason:
Reducing the dosage of methotrexate during pregnancy is not a safe option because methotrexate is contraindicated during pregnancy due to its potential to cause birth defects and other adverse pregnancy outcomes.

Choice B reason:
While dietary modifications may be necessary during pregnancy, this is not specifically related to the use of methotrexate. The primary concern with methotrexate and pregnancy is the risk it poses to the developing fetus, not dietary interactions.

Choice C reason:
Breastfeeding while taking methotrexate is not recommended. Methotrexate can be excreted in breast milk and may harm a nursing infant.

Choice D reason:
Methotrexate should indeed be discontinued at least 3 months prior to a planned pregnancy. This is to ensure that the drug is completely cleared from the body, as it can cause serious birth defects and other pregnancy-related complications.

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A nurse is caring for a middle adult client who has just received the diagnosis of endometrial cancer. In taking a nursing history, which of the following manifestations is likely to be reported by this client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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