In examining a 70-year-old male patient, the nurse notices that he has bilateral gynecomastia.
Which of the following describes the nurse's best course of action?
Explain that gynecomastia in men is usually associated with prostate enlargement and recommend that he be thoroughly screened.
Acknowledge it as benign breast enlargement, which is not unusual in men.
Recommend that he make an appointment with his physician for a mammogram.
Explain that this condition may be the result of hormonal changes and recommend that he see his physician.
The Correct Answer is D
Choice A rationale
While prostate enlargement is common in older men, it is not typically directly associated with bilateral gynecomastia. Gynecomastia primarily involves breast tissue enlargement due to hormonal imbalances, not glandular changes related to the prostate. Recommending prostate screening solely based on gynecomastia is not the most direct or scientifically sound approach.
Choice B rationale
Acknowledging gynecomastia as benign breast enlargement without further investigation might be premature. While some cases in older men are benign and related to aging, it can also be a symptom of underlying medical conditions or medication side effects that require evaluation. Dismissing it without investigation could miss a treatable cause.
Choice C rationale
A mammogram is a screening tool for breast cancer, which is rare in men but possible. However, gynecomastia is characterized by benign glandular tissue proliferation, distinct from the tissue changes typically associated with male breast cancer. While a physician might order one to rule out malignancy, it's not the initial recommended action based solely on the finding of bilateral gynecomastia.
Choice D rationale
Gynecomastia in men can result from various hormonal changes, including a decrease in testosterone levels relative to estrogen, or an increase in estrogen production. Certain medical conditions and medications can also disrupt hormonal balance. Recommending a physician visit to investigate potential underlying causes of hormonal changes is the most appropriate initial action to determine the etiology of the gynecomastia and guide further management.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
A BMI of 30 or higher is classified as obese. Class 1 obesity is defined as a BMI between 30 and 34.9. Chelsea's BMI of 17 is significantly lower than this range.
Choice B rationale
Class 2 obesity is defined as a BMI between 35 and 39.9. Chelsea's BMI of 17 is considerably below this classification.
Choice C rationale
A BMI below 18.5 is classified as underweight. Chelsea's BMI of 17 falls within this range, indicating that her weight is lower than what is considered healthy for her height.
Choice D rationale
A normal weight range is typically defined as a BMI between 18.5 and 24.9. Chelsea's BMI of 17 is below this healthy range.
Correct Answer is D
Explanation
Choice A rationale
Securing the tube and retesting the pH in one hour is insufficient to confirm correct placement. While a pH of 3 suggests gastric placement (normal gastric pH is typically 1.5 to 3.5), it doesn't definitively rule out placement in the respiratory tract or intestines, as these can occasionally have acidic pH levels. Delaying definitive confirmation could lead to serious complications if the tube is misplaced.
Choice B rationale
Inserting the tube an additional 1-2 inches and retesting the pH is not a reliable method for confirming placement. Advancing the tube further without radiographic confirmation could increase the risk of trauma to the gastrointestinal tract or even pulmonary aspiration if the initial placement was incorrect. pH testing alone is not conclusive.
Choice C rationale
Auscultating for the "swoosh" of air while injecting air into the NG tube is an outdated and unreliable method for confirming placement. The sound can be misleading and may be heard even if the tube is incorrectly positioned in the esophagus or lungs. This method does not provide definitive proof of gastric placement and poses a risk of aspiration.
Choice D rationale
Obtaining an x-ray is the gold standard for confirming nasogastric tube placement. Radiographic imaging allows for direct visualization of the tube's trajectory and ensures that the distal tip is correctly positioned in the stomach or duodenum. This method provides the most accurate and reliable confirmation, minimizing the risk of complications such as aspiration or misadministration of feedings and medications.
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