The nurse examines a client who is concerned about the amount of menstrual flow she is having. Which finding indicates an abnormality related to the client's current menstruation?

An odorless, red menstrual blood flow.

Cramping associated with the amount of flow.

Blood clots sized at 0.5 cm (0.2 in) with menstrual flow.

Blood saturation of one pad an hour.

Answer and Explanation

The Correct Answer is D

A. An odorless, red menstrual blood flow: This is considered a normal characteristic of menstruation. Menstrual blood may have a slight metallic scent due to the mixing with vaginal secretions, but an odorless red flow is not a concern and does not suggest abnormality.

B. Cramping associated with the amount of flow: Mild to moderate cramping (dysmenorrhea) is a common and expected part of menstruation related to the release of prostaglandins that cause uterine contractions especially during heavier flow days. While it can be uncomfortable, it is not typically considered abnormal unless severe or disabling.

C. Blood clots sized at 0.5 cm (0.2 in) with menstrual flow: Small blood clots can occur during menstruation, especially during heavier flow, and clots under 1 inch (2.5 cm) in diameter are generally not worrisome. This size is within normal limits and not an indication of a menstrual disorder.

D. Blood saturation of one pad an hour: This finding suggests menorrhagia, or abnormally heavy menstrual bleeding. Saturating a pad or tampon every hour for several consecutive hours is clinically significant and warrants further investigation, as it can lead to anemia and may signal an underlying gynecological issue such as fibroids or a bleeding disorder.

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Correct Answer is D

Explanation

A. Ask if the client often feels weak or hungry: While important in overall diabetes assessment, weakness or hunger are more related to poor glucose control and they do not specifically indicate peripheral vascular changes such as shiny skin and hair loss.

B. Compare the range of motion of both legs: Assessing range of motion can be useful in evaluating joint or muscular issues but does not provide specific information about vascular status or circulation, which is the primary concern here.

C. Measure the client's capillary glucose: Blood glucose levels are essential in managing diabetes but do not assess the presence or severity of peripheral vascular disease, which can lead to changes in skin and hair growth on the lower legs.

D. Palpate the client's dorsalis pedis pulses: Shiny skin and hair loss on the legs suggest poor peripheral circulation, often related to peripheral arterial disease, a common complication of diabetes mellitus. High blood sugar levels can damage blood vessels over time, leading to narrowing and reduced blood flow, particularly in the lower extremities. Palpating dorsalis pedis pulses helps assess arterial blood flow and supports evaluation of vascular insufficiency.

A. Encourage the client to keep checking the mole with a magnifying mirror. B. Advise the client to see his healthcare provider (HCP) for immediate evaluation. C. Offer to teach a family member how to monitor the skin around the mole. D. Ask the client if he often spends time outside in the sun without a shirt.

Correct Answer is B

Explanation

A. Encourage the client to keep checking the mole with a magnifying mirror: While regular self-monitoring of skin lesions is helpful for early detection, it is not an appropriate response when significant changes in a mole have already occurred. This approach delays necessary evaluation and possible diagnosis of skin cancer.

B. Advise the client to see his healthcare provider (HCP) for immediate evaluation: A mole that has darkened and increased in size could indicate malignant melanoma, a serious form of skin cancer. These changes align with the "ABCDE" criteria often used to identify suspicious moles: Asymmetry, Border irregularity, Color change, Diameter, Evolving. Prompt evaluation by a healthcare provider is crucial for early diagnosis and potential life-saving treatment.

C. Offer to teach a family member how to monitor the skin around the mole: Although involving family members in health monitoring can be supportive, it does not replace the need for immediate professional assessment when concerning changes in a mole are reported.

D. Ask the client if he often spends time outside in the sun without a shirt: Exploring sun exposure is relevant in skin cancer risk assessment, but it is not the priority action in this situation. The immediate concern is the suspicious change in the mole, which requires urgent medical attention.

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The nurse examines a client who is concerned about the amount of menstrual flow she is having. Which finding indicates an abnormality related to the client's current menstruation?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse observes that the lower legs of a client with diabetes mellitus are shiny, and with no hair growth. To obtain additional data to support these findings, which assessment should the nurse perform?

Correct Answer is D

Explanation

A client asks the nurse to look at a mole located on the back. The client tells the nurse that the mole has changed from brown to black and enlarged in size. Which is the priority nursing action?

Correct Answer is B

Explanation

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