The nurse is discussing Breast Self Examination (BSE) with a postmenopausal client. What instructions should the nurse give to the client about the correct time to perform BSE?
Daily, during the shower or bath
One week after the menstrual period
On the same day every month
Weekly, at the client's convenience
The Correct Answer is C
A) Daily, during the shower or bath:
This is incorrect. Performing a breast self-examination (BSE) daily is not necessary. The goal of BSE is to check for any changes over time, not to examine the breasts every day. It's more effective to perform the exam regularly at a consistent time each month.
B) One week after the menstrual period:
This is incorrect. This instruction is relevant for pre-menopausal women, where the hormonal changes associated with the menstrual cycle can cause breast tissue to feel lumpy or swollen. The best time for them to perform a BSE is one week after the menstrual period ends when the breasts are least likely to be swollen or tender. However, for postmenopausal women, this is not necessary, as their hormonal levels are stable throughout the month.
C) On the same day every month:
This is the correct answer. For postmenopausal women, who no longer have menstrual cycles, the best time to perform a breast self-exam is on the same day every month. This ensures consistency and makes it easier for the client to notice any changes in the breast tissue over time. The day chosen should be one that is convenient and easy to remember, and it does not matter whether it is during the shower or bath, as long as the examination is done regularly.
D) Weekly, at the client's convenience:
This is incorrect. While performing a BSE weekly is not necessary, the key is consistency rather than frequency. Performing the exam monthly is sufficient, and it should be on a specific day each month, rather than at the client’s convenience on an irregular basis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D","E"]
Explanation
A) High cholesterol: Elevated cholesterol levels, particularly low-density lipoprotein (LDL) cholesterol, are a significant risk factor for cardiovascular disease. High cholesterol can lead to the buildup of plaques in the arteries, which increases the risk of heart attacks and strokes. Managing cholesterol through diet, exercise, and medication can reduce cardiovascular risk.
B) Diabetes: Diabetes, especially poorly controlled blood sugar levels, significantly increases the risk of cardiovascular disease. High blood glucose can damage blood vessels and nerves, leading to complications such as coronary artery disease and stroke. Effective management of diabetes through lifestyle changes and medication can help mitigate these risks.
C) Age: While age is a risk factor for cardiovascular disease, it is a non-modifiable factor. As people age, the risk of developing cardiovascular issues naturally increases due to changes in the cardiovascular system. Since age cannot be altered, it is not included in the list of modifiable risk factors.
D) Weight: Excess body weight, particularly obesity, is associated with an increased risk of cardiovascular disease. Obesity contributes to conditions like hypertension, diabetes, and dyslipidemia, all of which elevate cardiovascular risk. Weight management through diet, exercise, and healthy lifestyle choices is crucial for reducing this risk.
E) Smoking: Smoking is a major modifiable risk factor for cardiovascular disease. It damages the blood vessels, increases blood pressure, and reduces oxygen supply to the heart, contributing to the development of atherosclerosis and other cardiovascular conditions. Quitting smoking is one of the most effective ways to lower cardiovascular risk
Correct Answer is B
Explanation
A) Fifth intercostal space, midaxillary line:
This is incorrect. The fifth intercostal space at the midaxillary line is a location that can be assessed for tactile fremitus, but it is not typically where fremitus is felt most intensely. Fremitus tends to be stronger near the midline structures, such as over the trachea, rather than at this lateral position, which is more peripheral.
B) Between the scapulae:
This is the correct answer. Tactile fremitus is usually most intense over the area between the scapulae and near the sternum. This is because the bronchi and trachea are located close to the chest wall in these regions, creating more intense vibrations that can be palpated during assessment. The fremitus is transmitted through the airways and is easiest to feel when the lung tissue is close to the chest wall, as in the area between the scapulae.
C) Third intercostal space, midaxillary line:
This is incorrect. The third intercostal space at the midaxillary line is not typically the site where tactile fremitus is most prominent. This area is more peripheral, and fremitus tends to be weaker here compared to regions closer to the sternum or between the scapulae where the lungs are nearer to the chest wall.
D) Over the lobes, posterior side:
This is incorrect. While tactile fremitus can be assessed over the posterior lobes of the lungs, it is not generally felt most intensely here. Fremitus is usually stronger near the midline of the chest (sternum) or between the scapulae, and tends to be weaker as you move laterally or toward the lower lobes of the lungs.
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