The nurse who is demonstrating breast self-examination to a patient points out that the most common area in the breast for tumors to occur is:
1. under the nipple.
2. the upper outer quadrant.
3. the six o'clock position.
4. the axillary lymph nodes.
2
Nearly half of all malignant breast tumors are located in the upper outer quadrant.
PTS: 1 DIF: Cognitive Level: Knowledge REF: 1062
OBJ: 5 TOP: Breast Self-Examination
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
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The nurse is considering delegating a task to an unlicensed assistive personnel. In deciding whether the task can be delegated, the nurse would choose to do the task if which of the following was determined?
1. The unlicensed assistive personnel is qualified to perform the task. 2. A reasonable and prudent nurse would delegate the task. 3. The act is specified in the state's nurse practice act as an LPN/LVN function. 4. The agency policy specifies that the task may be delegated.
A nurse is preparing an anxious patient for major surgery and remarks, "Everyone feels some anxiety, but you will be asleep during the whole thing." Which communication style does this exemplify?
a. Empathy b. Summarizing c. False reassurance d. Premature advice
The client's IV therapy for 10 hours stopped at 1030 PM. What is the correct military time that the nurse should document in the chart that the IV therapy was started?
A) 1030 PM B) 130 PM C) 1030 D) 1230
The nurse is performing passive range-of-motion exercises on a semiconscious client and meets resistance while attempting to extend the right elbow more than 45 degrees. What action by the nurse is best?
a. Splint the joint and continue passive range of motion to the shoulder only. b. Progressively increase joint motion 5 de-grees beyond resistance each day. c. Apply weights to the right distal extremity before initiating any joint exercise. d. Continue to move the joint only to the point at which resistance is met.