54. A 20-year-old woman tells the nurse that she performs breast self-examination (BSE) on a regular basis. The nurse evaluates the woman's understanding
... [Show More] of BSE and ability to perform the technique correctly. Which actions by the woman indicate that she needs further instruction regarding BSE? (Circle all that apply.)
A. Performs BSE every month on the first day of her menstrual cycle.
B. Observes the size of her breasts, direction of her nipples, and appearance of her skin, including the presence of dimpling, when looking at her breasts in the mirror.
C. Lies down on a bed and puts a pillow under the shoulder of the breast she is going to palpate. Then she places the arm on that side under her head.
D. Uses the tips of two fingers to palpate her breast.
E. Palpates her breast, using an overlapping circular pattern around her entire breast.
F. Palpates her breasts again, including up into her axillae, while taking a shower. CORRECT ANSWER Choices A and D are correct; a woman should perform BSE every month at the end of menstruation when the breasts are the least tender; she should use the finger- pads of her three middle fingers for palpation.
55. When palpating the small breasts of a young, slender woman the nurse should:
A. Wear clean gloves
B. Lift the hands when moving from one segment of the breast to another
C. Use both hands
D. Follow a systematic, overlapping pattern CORRECT ANSWER Choice D is correct; clean gloves are required only if open lesions are present and when compressing the nipple if discharge is anticipated; fingers should not be lifted; two hands are used for women with large, pendulous breasts.
56. A nurse instructed a female client regarding vulvar self-examination (VSE). Which statement made by the client indicates that further instruction is needed?
A. "I will perform this examination at least once a month, especially if I change sexual partners or am sexually active."
B. "I will become familiar with how my genitalia look and feel so that I will be able to detect changes."
C. "I will use the examination to determine when I should get medications at the pharmacy for infections."
D. "I will wash my hands thoroughly before and after I examine myself." CORRECT ANSWER 56. Choice C is correct; self-examination should [Show Less]