A patient who is attending a family planning clinic is instructed in breast self-examination by a nurse.
Which statement by the patient would indicate that she understands the instructions?

“I will perform breast self-examination on the first day of my period.”.

“I will palpate my breasts to assure that any lumps that are present are present in both breasts.”.

“I will palpate my breasts using the padded sections of my fingers.”.

“I will look at my breasts while standing sideways in front of the mirror.”.

Answer and Explanation

The Correct Answer is C

The correct answer is choice C. The patient should palpate her breasts using the padded sections of her fingers. This is the recommended technique for breast self-examination, as it allows the patient to feel any changes or lumps in the breast tissue.

Choice A is wrong because the patient should perform breast self-examination at the same time each month, preferably a few days after the menstrual period ends when the breasts are less likely to be swollen or tender.

Choice B is wrong because the patient should not assume that any lumps that are present in both breasts are normal. Some breast cancers can affect both breasts, and any new or unusual lumps should be reported to a doctor.

Choice D is wrong because the patient should look at her breasts while standing in front of the mirror with her arms at her sides, raised overhead, and pressed firmly on her hips. She should also look for any changes in the shape, size, color, or texture of her breasts and nipples.

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Correct Answer is B

Explanation

he correct answer is choice B. Sufficient perfusion and circulation of the fetus.This is because the fetal heart rate is within the normal range of 110 to 160 beats per minute, and there is moderate beat-to-beat variability, which indicates a healthy nervous system.

Choice A is wrong because insufficient perfusion of the placenta would cause fetal distress and abnormal fetal heart rate patterns, such as late decelerations or minimal variability.

Choice C is wrong because maternal hypoxia would not directly affect the fetal heart rate, unless it leads to placental insufficiency or uterine hyperstimulation.

Choice D is wrong because fetal hypoxia would cause signs of fetal distress, such as tachycardia, bradycardia, or absent variability.

A. Check the specific gravity of the amniotic fluid. B. Provide dry linens for the patient. C. Auscultate the fetal heart sounds. D. Notify the health care provider.

Correct Answer is C

Explanation

The correct answer is choice C. Auscultate the fetal heart sounds.This is because spontaneous rupture of membranes (SROM) may be associated with fetal distress or cord prolapse, and the nurse should assess the fetal well-being as soon as possible.Fetal heart sounds can indicate the presence of fetal bradycardia, tachycardia, or decelerations, which may require immediate intervention.

Choice A is wrong because checking the specific gravity of the amniotic fluid is not a priority action after SROM.The specific gravity can help differentiate amniotic fluid from urine, but it is not as reliable as other methods such as nitrazine paper test or visual inspection.

Choice B is wrong because providing dry linens for the patient is a comfort measure, but not a priority action after SROM.The nurse should first ensure the safety of the fetus and the mother before attending to their comfort needs.

Choice D is wrong because notifying the health care provider is an important action after SROM, but not the first one.The nurse should gather relevant data such as fetal heart rate, maternal vital signs, and characteristics of the fluid before contacting the provider.

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A patient who is attending a family planning clinic is instructed in breast self-examination by a nurse. Which statement by the patient would indicate that she understands the instructions?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is observing the internal fetal monitor readings of a laboring client.The fetal heart rate is between 130 and 138 beats per minute, with moderate beat-to-beat variability. How should the nurse interpret this finding?

Correct Answer is B

Explanation

A patient states, “My water just broke.” The nurse verifies that her membranes have ruptured spontaneously. Which action should the nurse take next?

Correct Answer is C

Explanation

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A patient who is attending a family planning clinic is instructed in breast self-examination by a nurse.
Which statement by the patient would indicate that she understands the instructions?