The nurse is preparing to teach a class on breast self-examination. In describing the "at-risk" individual, the nurse should describe which woman as having the highest risk of developing breast cancer?

A 40-year-old African-American woman who started her menstrual period at age 14.

A 35-year-old woman who had both her children before age 20.

A 50-year-old Caucasian woman who has never had a mammogram.

A 32-year-old woman whose mother had breast cancer.

Answer and Explanation

The Correct Answer is D

A. A 40-year-old African-American woman who started her menstrual period at age 14: Starting menstruation at a young age is a risk factor for breast cancer, but other factors, such as family history, tend to have a greater impact on overall risk.

B. A 35-year-old woman who had both her children before age 20: Having children early in life can actually reduce the risk of breast cancer, as it reduces the number of menstrual cycles a woman experiences, thus lowering exposure to estrogen.

C. A 50-year-old Caucasian woman who has never had a mammogram: Not having a mammogram is a concern for detecting breast cancer early, but this alone is not a higher risk of developing breast cancer. Screening is important, but it is not a primary risk factor.

D. A 32-year-old woman whose mother had breast cancer: A family history of breast cancer, especially in a first-degree relative like a mother, significantly increases the risk of developing breast cancer. This genetic risk factor makes this woman the highest-risk individual.

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Correct Answer is D

Explanation

A. Inform the couple that this is not an inherited disorder: Cleft lip and palate can have a genetic component, so telling the couple it is not inherited would be misleading. While environmental factors can also contribute, the genetic link should not be dismissed.
B. Tell the couple to discuss this issue with the obstetrician: While the obstetrician can provide guidance, a genetic counselor or geneticist is more specialized in addressing hereditary concerns and can offer more precise advice on the potential risks and genetic implications.
C. Encourage the couple to consider adopting a baby: While adoption is a valid option for many, it is not the most appropriate response to the couple's concern about the potential genetic risk of cleft lip and palate. This decision should be informed by genetic counseling.
D. Refer the couple to a genetic counselor or geneticist: A genetic counselor can assess the family history and provide the couple with accurate information on the risks of having a child with a cleft lip and palate, helping them make an informed decision based on genetic factors.

A. client who is gravida 5, para 5 B. delivery of a 9 lb 1 oz (4.1 kg) female C. She was in labor for 25 hours and forceps were used to assist with the delivery D. She was given an epidural for anesthesia that was effective E. The labor and delivery nurse reported that the client had a 4th degree laceration F. Her vital signs were stable G. Estimated blood loss was 600 mL after delivery

Correct Answer is ["A","B","C","E","G"]

Explanation

Rationale for Correct Choices:

36-year-old client who is gravida 5, para 5 (G5P5): The client is a multipara, which increases the risk of uterine atony due to difficulty with uterine contractions or postpartum hemorrhage as a result of overstretched uterine muscles.
Transferred to the postpartum unit 1 hour after delivery of a 9 lb. 1 oz (4.1 kg) female: Macrosomia increases the likelihood of trauma during delivery, including lacerations and uterine atony increasing the risk for postpartum hemorrhage.
In labor for 25 hours: Prolonged labor increases the risk of uterine atony, where the uterus struggles to contract after delivery. This can lead to an increased risk of postpartum hemorrhage as the uterus fails to close off blood vessels effectively.
Forceps were used to assist with the delivery: Forceps-assisted deliveries can cause trauma to the birth canal, cervix, or perineum, leading to increased bleeding. This traumatic delivery can also contribute to uterine atony, raising the risk of postpartum hemorrhage.
4th degree laceration: A 4th degree laceration involves extensive damage to the perineum and anal sphincter, increasing bleeding risk. This severe injury requires surgical repair and is a known risk factor for postpartum hemorrhage due to the size and depth of the tear.
Estimated blood loss was 600 mL after delivery: Blood loss of 600 mL after delivery, although within the normal range for some vaginal deliveries, is considered a moderate risk factor. It may indicate ongoing bleeding or inadequate uterine contraction, both contributing to postpartum hemorrhage risk.
Macrosomic baby (9 lb 1 oz): A larger-than-normal baby (macrosomia) increases the likelihood of a difficult delivery, trauma to the birth canal, and uterine atony. These factors, combined with a prolonged labor, raise the risk of postpartum hemorrhage.

Rationale for Incorrect Choices:

Epidural anesthesia: The use of epidural anesthesia provides pain relief but does not directly increase the risk of postpartum hemorrhage. While epidurals may delay mobilization, they do not interfere with uterine tone or bleeding.
Vital signs were stable: Stable vital signs, including normal blood pressure, respiratory rate, and heart rate, indicate that the client is not in acute distress or hemorrhaging severely at this time.

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The nurse is preparing to teach a class on breast self-examination. In describing the "at-risk" individual, the nurse should describe which woman as having the highest risk of developing breast cancer?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A young married couple asks the nurse at a community outreach clinic for guidance about having children because the wife was born with a cleft lip and palate, and the husband has an uncle with a cleft lip. Which action should the nurse take?

Correct Answer is D

Explanation

Correct Answer is ["A","B","C","E","G"]

Explanation

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