A nurse is examining a male client within normal weight range who is questioning about the cause of his enlarged breasts. Which course of action best describes how the nurse should address the client's bilateral gynecomastia?

Inform the client that his breast enlargement is benign, and normal for an adult male

Recommend that he alter his diet to include fewer fats and more lean proteins

Explain that this condition may be the result of hormonal changes, and recommend that he see his physician

Explain that gynecomastia in men usually associated with prostate enlargement and recommend that he be screened

Answer and Explanation

The Correct Answer is C

A) Inform the client that his breast enlargement is benign, and normal for an adult male:
Although gynecomastia is common and often benign, it is not always normal for adult males to experience breast enlargement. The condition can be related to various factors such as hormonal imbalances, medications, or underlying health issues. It is important not to reassure the client without further assessment, as gynecomastia may need to be evaluated by a healthcare provider to rule out any medical conditions.

B) Recommend that he alter his diet to include fewer fats and more lean proteins:
While diet can have an impact on overall health, the enlargement of the breasts in males (gynecomastia) is typically not related to fat intake. This recommendation is not appropriate for addressing the root cause of gynecomastia, which often involves hormonal changes rather than diet alone. A dietary change may not resolve the underlying condition, and medical evaluation is warranted.

C) Explain that this condition may be the result of hormonal changes, and recommend that he see his physician:
This is the most appropriate response. Gynecomastia is often caused by hormonal imbalances, particularly an imbalance between estrogen and testosterone. It can occur during puberty, in older age, or as a result of certain medications or medical conditions. The nurse should advise the client to consult a physician for further evaluation and diagnosis, as appropriate treatment depends on the underlying cause.

D) Explain that gynecomastia in men is usually associated with prostate enlargement and recommend that he be screened:
This is not accurate. While prostate issues can affect male hormones, gynecomastia is typically not directly associated with prostate enlargement. The condition is more often linked to hormonal changes involving estrogen or testosterone, not necessarily prostate problems. Recommending prostate screening would not address the underlying cause of gynecomastia and is not the most relevant next step in care.

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Correct Answer is D

Explanation

A) Tactile fremitus:
Tactile fremitus refers to the vibrations felt on the chest wall when a patient speaks. It is assessed by placing the hands on the chest while the patient says "ninety-nine" or a similar phrase. Tactile fremitus is used to detect changes in lung density, such as consolidation or fluid. It does not describe a crackling sensation on the skin surface. A coarse, crackling sensation is more indicative of a different condition.

B) Adventitious sounds:
Adventitious sounds are abnormal lung sounds, such as crackles, wheezes, or rhonchi, heard during auscultation. These sounds are typically related to lung conditions, such as pneumonia, asthma, or fluid accumulation in the lungs. While adventitious sounds are significant findings during auscultation, they do not describe the physical sensation of crackling felt on the skin surface. Therefore, adventitious sounds are not the correct diagnosis for a tactile sensation over the chest.

C) Friction rub:
A friction rub is a harsh, grating sound heard during auscultation and is caused by inflammation of the pleura (the lining around the lungs). It occurs when the inflamed pleural surfaces rub together during breathing. While it is a distinct sound, a friction rub is not a tactile or palpable sensation. The crackling sensation described in the question is not related to the sounds produced by a pleural friction rub.

D) Crepitus:
Crepitus is the correct answer. It refers to a coarse, crackling sensation felt on the skin surface when air or gas is trapped under the skin, often due to conditions such as subcutaneous emphysema. This can occur when there is air leaking from the lungs or other parts of the respiratory system, often following trauma (e.g., rib fractures or surgery) or infection (e.g., gas gangrene). The crackling sensation felt during palpation of the chest wall is characteristic of crepitus, making this the most appropriate finding in this scenario.

A. The atria contract toward the end of diastole and push the remaining blood into the ventricles B. Contraction the atria at the beginning of diastole can be felt as a click C. The ventricles contract during systole and attempt to push against closed atria D. Atrial kick is the pressure exerted against the atria as the ventricles contract during systole

Correct Answer is A

Explanation

A) The atria contract toward the end of diastole and push the remaining blood into the ventricles:
This is the correct definition of the atrial kick. The atrial kick refers to the contraction of the atria just before the ventricles contract, which occurs late in diastole. During this phase, the atria contract to push the remaining blood into the ventricles, ensuring that the ventricles are as filled as possible before the next ventricular contraction. This action contributes to about 20–30% of the ventricular filling, especially important in situations where the heart rate is fast, as there may be less time for passive filling during diastole.

B) Contraction of the atria at the beginning of diastole can be felt as a click:
This statement is incorrect. Atria contract at the end of diastole, not the beginning. The atrial contraction is not typically felt as a "click." If there is a "click" sound, it could indicate an abnormal heart valve sound, such as from a mitral valve prolapse, rather than the normal atrial contraction. The atrial kick itself is not associated with any audible click but may be heard as part of the S4 heart sound, especially in conditions with stiff ventricles (such as hypertension or heart failure).

C) The ventricles contract during systole and attempt to push against closed atria:
This is not an accurate description of the atrial kick. During systole, the ventricles contract and push blood into the aorta and pulmonary artery through the open semilunar valves, not against the atria. The atrial kick is a part of diastole, not systole, and involves the atria pushing blood into the ventricles, not the ventricles pushing against the atria.

D) Atrial kick is the pressure exerted against the atria as the ventricles contract during systole:
This description is incorrect. The atrial kick occurs when the atria contract near the end of diastole, not during systole. During systole, the ventricles contract and pump blood out of the heart, but this is not related to the atrial kick. Instead, the atrial kick is the contribution of atrial contraction to the final phase of ventricular filling, just before the ventricles contract.

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A nurse is examining a male client within normal weight range who is questioning about the cause of his enlarged breasts. Which course of action best describes how the nurse should address the client's bilateral gynecomastia?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is palpating a client's anterior chest wall and notices a course, crackling sensation over the skin surface. Which of the following should the nurse suspect from these findings?

Correct Answer is D

Explanation

A nurse reviewing the anatomy and physiologic functioning of the heart. The nurse should recognize that which statement best describes the atrial kick?

Correct Answer is A

Explanation

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