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. A nurse is caring for an older adult client who has rheumatoid arthritis (RA) and is taking aspirin 650 mg every 4 hours. Which of the following diagnostic tests should the nurse monitor to evaluate the effectiveness of this medication? a. White blood cell count (WBC) b. Rheumatoid factor c. Antinuclear antibody (ANA) d. Erythrocyte sedimentation rate (ESR) Rheumatoid arthritis is a chronic inflammatory disease. ESR is useful in detecting and monitoring tissue inflammation in clients with RA. As the disease improves the ESR decreases.

d. Erythrocyte sedimentation rate (ESR) Rheumatoid arthritis is a chronic inflammatory disease. ESR is useful in detecting and monitoring tissue inflammation in clients with RA. As the disease improves the ESR decreases.

intussuception Dx

diarrhea abd pain jellly stools not black stools or distention

DM 2 ---eating and exercise considerations

exercise after meals note: strenuous activity can release counterregulatory hormones which raises blood sugar--- so no more that 15 carbs before strenuous activity

radiation pneumonitis

fever, cough , dspnea

TUMT TURP

get a off anticoagulants before surgery and put them on antibiotic catheter balloon filled with 30 CC the flush comes in the bladder and comes right back out

why is osteosarcoma more common in adolescence

growth spruts increases the childs chances the bone is rapidly growing

masectomy on the left side. what action should the nurse initiate

insert IV on the right side

A concerned mother brings in her child because the left eye has red coloration and the right eye has a white reflection in pictures. The mother asks if this is normal. what would be the best response to the mother. it is good you brought this to our attention because this is not a normal response. after further examination we can discuss what it might suggest

it is good you brought this to our attention because this is not a normal response. after further examination we can discuss what it might suggest why?----this could be a sign of retinoblastoma

wilms tumor-- which should the nurse not do 1 tell pt not to drink water before procedure 2 palpate the abdomen 3 provide child with dolls

palpating the abdomen can cause spread of the cancer

A nurse is assessing a 6 yr old who was just diagnosed w/ acute lymphocytic leukemia. what is her symptoms SATA 1)alopecia 2)petechiae 3)anorexia 4)insomnia 5)bleeding gums 6)pallor

petechiae anorexia bleeding gums pallor these are not symptoms because... alopecia--caused by chemo not leukemia. a child just diagnosed would not have alopecia insomnia---ALL causes fatigue and increased sleeping

BPH (benign prostatic hyperplasia)

psa raised

a pt taking allopurinol (zyloprim) for leukemia ---what is the action of this drug

reduce the formation of uric acid to protect the kidneys why? --rapid cell destruction by by chemotherapy results in high levels of uric acid formation

hypovolemic shock ---early signs

tachycardia, increased RR, greater cap refill time, cold extremities, normal pressure, decreased urine output

prostate cancer teaching

the ncl reports cancer in 1/2 of men 70+ only 3% of men older that 70 die from Prostate cancer

should a pt have their insulin before surgery

with surgery the pt must be npo before surgery so taking insulin with out food could cause hypoglycemia ----ask physician if they should have their insulin

client with insulin is enrolling in a tennis class---which answer shows she understands the effects of exercise on insulin demand

"i will eat a 15 gram snack before playing tennis"

appropriate talk with cancer pt

----can use the word cancer ----careful about the amount of information u give to the pt---only provide what they want---it can be overwhelming ----professional detachment can offend pts

radiation skin reactions prevention

---do not use straightedged razors use electric ----do not swim in chlorinated water ---do not apply products before radiation and wait 4 hrs after

. You're providing education to a patient with severe ulcerative colitis about Adalimumab. Which statement by the patient is CORRECT? A. "This medication is used as first-line treatment for ulcerative colitis." B. "My physician will order a TB skin test before I start taking this medication." C. "This medication works by increasing the tumor necrosis factor protein which helps decrease inflammation." D. "This medication is a corticosteroid. Therefore, I need to monitor my blood glucose levels regularly."

. "My physician will order a TB skin test before I start taking this medication."

A nurse is providing discharge instructions to a client who has rheumatoid arthritis and a prescription for oral betamethasone. Which of the following statements should the nurse make about how to take this medication? a. "Take the medication between meals." b. "Take the medication with orange juice. c. "Take the medication with milk." d. "Take the medication on an empty stomach." Steroids must be taken with food

. "Take the medication with milk."

hepatocellular carcinoma what signs should the nurse find 1 erthrocytosis and hypercalcemia 2 hyperkalemia and hyberalbuminemia 3 Hypernatremia and hypomagnesemia 4 hypocalcemia and hyperleukocytosis

1 Erythrocytosis (excess RBCs) and hypercalcemia ---think what does the liver do. like the kidneys if also produces Erythropoietin which casues more RBCs

what is the peak of humulin R

2-4 hrs ------if pt experiences diaphoresis or tachy take blood Glucose my be hypoglycemic

What is watchful waiting?

70+ usually, wait it out because they are unlikely to survive surgery or be cured

what is b symptoms 1 bleeding and low platelets 2 b lymphocyte malignancy 3 symptoms from exposure from Epsein Barr Virus 4 fever, night sweats, weight-loss

Answer 4 B symptoms refer to systemic symptoms of fever, night sweats, and weight loss which can be associated with both Hodgkin's lymphoma and non-Hodgkin's lymphoma.

10. You're providing teaching to a patient who has been newly diagnosed with Crohn's Disease. Which statement by the patient's spouse requires re-education? A. "Crohn's Disease can be scattered throughout the GI tract in patches with some areas appearing healthy while others are diseased." B. "There is no cure for Crohn's Disease." C. "Strictures are a common complication with Crohn's Disease." D. "Crohn's Disease can cause the large intestine to lose its form."

D. "Crohn's Disease can cause the large intestine to lose its form."

which vaccine helps prevent liver cancer hepatitis b or A Vaccine

Hepatitis B Vaccine

2. A nurse in an urgent care center is caring for a client who experienced an ankle injury. Prior to examination by the provider, which of the following nursing actions should the nurse perform? (Select all that apply.) a. Apply ice to the affected area. b. Encourage range of motion of the foot c. Provide the client with a light snack d. Apply a compression bandange e. Elevate the foot

a. Apply ice to the affected area. .D Apply a compression bandange e. Elevate the foot

. A nurse in a medical clinic is providing teaching to an older adult client who has rheumatoid arthritis that is affecting her hands. Which of the following client statements indicates an understanding of the teaching? a. I can use either heat or ice to help relieve the discomfort." b. "Ibuprofen is the first step in medication therapy for rheumatoid arthritis"---we don't want addiction c. "I should limit physical activity to prevent physical injury. d. "I will elevate my legs by placing two pillows under my knees when I go to bed."

a. I can use either heat or ice to help relieve the discomfort." Answer Rationale: The nurse should instruct the client to avoid the use of pillows under the knees as this contributes to the development of flexion contractures.

8. A nurse is caring for a client who is being admitted for an acute exacerbation of ulcerative colitis. Which of the following actions should the nurse take first? a. Review the client's electrolyte values b. Check the client's perianal skin integrity c. Investigate the client's emotional concerns d. Obtain a dietary history from the client

a. Review the client's electrolyte values

A pt with AML, acute myeloid leukemia what should the nurse plan intervention first for. 1 pain from mucositis 2 weakness 3 temp 99 p 100 r 20 bp 123/64 4 ecchymosis

answer 1 pain control is priority temp is a little high and should be monitored ecchymosis indicates low platelets check chart and maybe have labs done

red smooth tongue and ulcers at corner of mouth (angular cheilosis)--- expected lab finding 1) low hemoglobin 2) elevated RBCs 3)Prolonged Prothrombin time 4) Low white blood cells

answer 1 hint ---cheilosis is a symptom of iron deficiency

how is peripheral blood stem cell transplantation done? 1 marrow is harvested from donor 2 stem cells are collected from the donors blood which goes through a machine, removes the stem cells and then returns the blood to the donor 3 through a process called aphaeresis which removes stem cells from the blood. takes about 15 minutes 4 stem cells are obtained through blood donations at blood banks

answer 2 the process is called aphaeresis but takes 4 hrs

a child with cancer wont eat. what is the best intervention 1 provide food the child likes 2 offer sweets 3 turn on the television during mealtime 4 ask parents to be there during mealtime

answer 4 mealtime is usually at home and a time to socialize this will calm the child and make sure the child get the nutrition they need

best coping answer 1 my wig matches my hair color. i miss my own hair tho 2 i think the chemo wont cause me hair loss 3 im glad im taking chemo drug combination to avoid immune suppression and mucositis 4 i have faith in my doctor he will cure me

answer is 1 ---the others are denial or mis-informed

a doctor is over booked. who should the nurse schedule first. ---all four pts have a lump/swelling 1) child with downs syndrome 2)child who lives close to power lines 3) child with an ear infection 4) a child whose sibling was treated for osteosarcoma

answer: 1 1) child with downs syndrome --- a child with downs is at greater risk of having childhood cancer. 4) a child whose sibling was treated for osteosarcoma ----in general there is no genetic link between CHILDHOOD cancer

hodgkin lymphoma diagnosis findings SATA 1 firm lymph node enlargement in axillary area 2 night sweats 3 fever- longer that 2 days 4 weightloss 5 diet of saturated fats 6 brother had hodgkin lymphoma

answer: 1 2 3 4 6 note--- (usually in the cervical area but can be seen in the axillary area) there is not a link between diet and hodgkin lyphoma

home care for a child with neutropenic due to chemo should include SATA 1 prohibit visitors with that have just been vaccinated 2 keep child away from plants 3 provide goldfish, television and sanitized toys to occupy the child 4 have the child sleep alone 5 have the child shower daily 6 take your childs vitals 4 times a day

answer: 1, 2,4,5 1 prohibit visitors with that have just been vaccinated ---child is immune compromised 2 keep child away from plants----contains mold spores keep child away 3 provide goldfish, television and sanitized toys to occupy the child---goldfish have mold spores 4 have the child sleep alone--helps prevent catching illness from others 5 have the child shower daily--removes bacteria from skin 6 take your childs vitals 4 times a day---unnecessary

symptoms of chronic lymphocytic leukemia SATA 1 a malignancy of activated b lymphocytes 2 most common malignancy in older adults 3 unresponsive to chemo therapy 4 often not treated in early stages but the client is monitored 5 an excessive accumulation of immature lymphocytes in bone marrow 6 often asymptomatic and diagnosed during a physical examine

answer: 1,2,4,6 3 unresponsive to chemo therapy---CLL is treated with the chemo drug fludarbine 5 an excessive accumulation of Immature lymphocytes in bone marrow-------CLL is cancer of Mature inactive lymphocytes in the bone marrow Be Older And Mature Be-----B cells Older----older adult And ------Asymptomatic Mature---Mature/ inactive cells

5. A nurse is assessing a client following the application of a heating pad. Which of the following is the first indication to the nurse that the client is experiencing a superficial burn injury to the application site? a. Blistering b. Erythema c. Eschar d. Absence of pain

b. Erythema

6. A nurse in a provider's office is assessing a client who has rheumatoid arthritis (RA). Which of the following findings is a late manifestation of this condition? a. Anorexia b. Ulnar drift c. Low-grade fever d. Weight loss

b. Ulnar drift

Hypovolemic shock---later signs

bradycardia, absent pulses

Prostate cancer

can affect any part of the prostate, but it is usually the lateral lobes, the sides of the prostate and has nodules and masses psa raised

Alpha Adrenergic Blockers

can cause hypotension---rise slowly

pt is on lantus and the nurse forgets the pts evening snack and the pt is sleeping what should the nurse do

check the clients glucose when the pt is awake why----glargine (lantus) lasts for 24 hr with no peak so a bed time snack is not necessary

proper 24 hour collection

collect urine in a preservative free container and keep on ice discard 1st void and save the next ones until 24 encourage adequate amounts of fluid

symptoms of superior vena cava syndrome

cyanosis , chest pain, distended neck veins

4. A nurse is providing teaching to a client who has a prescription for heat therapy for treatment of cellulitis of the right lower leg. Which of the following client statements indicates an understanding of the teaching? a. "I will sit on the side of the tub and soak my right leg two times every day." b. "I'll keep a heating pad on the calf of my right leg when I am lying down."c c. "I'll place my leg under a heat lamp every 3 hours." d. "I'll wrap a warm, wet towel around my right calf every 4 hours." ----we want wasrm moist heat for cellulitits

d. "I'll wrap a warm, wet towel around my right calf every 4 hours." ----we want wasrm moist heat for cellulitits Answer Rationale: Moist heat is more effective than dry heat in treating cellulitis. Moist heat relieves the manifestations of inflammation by increasing blood flow to the affected area. The nurse should instruct the client to elevate the right leg 8 to 15 cm (3 to 6 in) above the level of the heart and apply warm, moist heat to the site every 2 to 4 hr.